If you’ve compared one of my sample meal plans to the numbers your doctor gave you, you may have noticed they don’t line up. Maybe your handout says 1,500 mg of sodium and my day has 2,200. Maybe you were handed limits for protein, sodium, potassium, and phosphorus all at once, and my meal plans don’t seem to follow half of them.
I hear some version of this all the time, so here’s how I think about each of those numbers.
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First, a word about your doctor
Your doctor wants to protect your kidneys. But nephrologists have very little time in each appointment and a lot to get through: your labs, your medications, your symptoms, and your overall treatment plan. Detailed nutrition advice rarely fits in that window, and nutrition is what dietitians spend years training in.
So nutrition advice often comes as a quick handout, and a handout has to work for everyone who gets it. That’s how people end up with numbers that are generic, out of date, or stricter than they need to be.
You shouldn’t ignore your doctor’s advice. But it’s fair to ask where a number came from.
Calories and protein: your size makes a big difference
My meal plans land around 2,000 calories and 60 grams of protein. My main goal was making sure there were enough calories. I didn’t want to be one more source handing out 1,200-calorie kidney meal plans that leave most adults hungry.
But calorie and protein needs fall along a range. A tall, larger man needs more of both than a petite woman does. Your metabolism can shift your calorie needs, and your stage of CKD and the amount of protein in your urine can shift your protein number.
So if the number you were given is higher or lower than mine, it may simply reflect your size. Scale the portions up or down to fit. (If you have diabetes too, here’s how I think about protein when you have CKD and diabetes.)
Sodium: why yours might be lower than mine
For sodium, I go by the KDOQI guidelines, the kidney nutrition guidelines that dietitians and doctors use. They recommend less than 2,300 mg a day for adults with CKD, which is the same number as the Daily Value printed on food labels.
Some people are told 1,500 mg instead. For some, like people with congestive heart failure, a number that low may really be necessary.
But I often see sodium goals that are stricter than a person needs, and I have two guesses about why. People on dialysis often do need to cut sodium dramatically, because their kidneys can’t get rid of much of it anymore, and I suspect that mindset sometimes carries over to people who aren’t on dialysis. The other possibility is strategy: tell someone 1,500, and maybe they’ll at least get down to 2,000.
I understand the thinking, but I’ve seen it backfire. When a goal feels out of reach, people start to think, if I can’t hit 1,500, why even try? So I usually start with 2,300. Once someone is there consistently, we look again. If they’re still dealing with fluid buildup or protein in their urine, that’s when I’d consider going lower. I don’t like to be aggressive right out of the gate, because I’m not always convinced it’s necessary.
Potassium: the restriction a lot of people don’t need
I’ll be honest: a lot of people get handed a potassium restriction they don’t need. Often it comes from an old pamphlet that goes to everyone with kidney disease, whatever their labs say.
Even the kidney nutrition guidelines don’t set one potassium number for everyone. They say to adjust the potassium in your diet to keep the potassium in your blood in the normal range.
And even when someone has had a high potassium result, a restriction isn’t always the right first step. Food is only one of several things that can push potassium up, and it’s worth finding out what’s driving it before you cut out fruits and vegetables. That’s a big part of what my Potassium 101 course covers.
Especially in the earlier stages of CKD, I push back on a lot of the potassium restrictions people bring to me. If your potassium has been normal, it’s fair to ask your doctor whether you need a limit at all.
Phosphorus: a number you can’t really follow
I’ll admit, this one is a pet peeve of mine. If you were given a phosphorus limit in milligrams, you may have noticed there’s no practical way to count it. Food labels aren’t required to list phosphorus, and very few do.
The same guidelines tie phosphorus to your blood levels rather than a set number, too. That’s why my meal plans don’t list phosphorus. What I focus on instead is phosphorus additives. Your body absorbs them much more easily than the phosphorus found naturally in food, and they have to appear on the ingredient list, so you can actually spot them.
So whose number should you follow?
If your doctor set a number based on your labs, follow it, and ask about it at your next visit. A few questions worth bringing with you:
- Is this number based on my current labs, or an older result?
- Is this a daily limit? (It’s worth confirming. A daily number misread as a weekly one looks impossible to follow.)
- Which of these limits is most important for me right now?
- Could I see a kidney dietitian?
Whatever your numbers are, lower isn’t automatically better. A kidney-friendly day shouldn’t leave you hungry, and if you’re losing weight you didn’t mean to lose, bring it up at your next appointment.
Want help sorting out your numbers?
This is a big part of what I do with patients: figuring out which restrictions you actually need, and turning the rest into meals you’d want to eat.
I see patients one-on-one through telehealth, and I’m in network with Aetna, Anthem, BCBS, Cigna, Humana, Medicare, and UHC. Many people pay nothing out of pocket, depending on their plan. If you have Medicare, nutrition counseling for kidney disease is a covered benefit with a referral from your doctor. (Here’s more on how insurance works for dietitian visits.)
I can see you if you’re physically located in one of these places at the time of your appointment: Alaska, Arizona, California, Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Massachusetts, Michigan, New York, Oklahoma, Oregon, Pennsylvania, Texas, Utah, the US Virgin Islands, Virginia, Washington, and Wisconsin.
Not in one of those states? Here’s how to find a kidney dietitian near you.
Have diabetes too? Here’s why my meal plans aren’t low-carb.
New here? Get my free 5-day CKD meal plans.