The renal exchange lists in Making Choices, Meal Planning for People with Diabetes and Chronic Kidney Disease (Stages 3 and 4)(1) present foods in two categories:
- "Other food choices" (<100 mg phosphorus/exchange serving) which are commonly included in the renal diabetic diet
- "Higher" phosphorus foods (>110 mg phosphorus/exchange serving) which need to be counted and limited
The following table is derived from information from:
- Making Choices, Meal Planning for People with Diabetes and Chronic Kidney Disease Stages 3 and 4(1)
- Southeast Asia Renal Exchanges(3)
- Manual of Clinical Nutrition.(4) NOTE: Krause lists only milk and milk-derived products, bran cereals, dried beans, peas and chilli as high phosphorus foods.(4)
|
Lower Phosphorus (<110 mg/exchange) |
Higher phosphorus (> 110 mg/exchange) |
|
Beef, chicken, clams, crab, egg, egg substitute, fish, imitation crab, lamb, lobster, port, scallops, shrimp, tuna (rinsed, canned or fresh), turkey, veal, wild game |
Organ meats (heart, liver, kidney, brains), oysters, sardines, bacon (pork or turkey), bratwurst, soy kebab, pork and chicken curry, canned oysters, canned tuna not rinsed |
The Southeastern Asia exchange lists show selected nuts as high phosphorus: pistachio, pinenuts, pumpkin seeds, almonds, cashew nuts, roasted peanuts, walnuts, sunflower seeds or sesame seeds in 1 oz portions.(3) However these portion sizes are much larger than traditional exchange servings. E.g. 1 oz = 24 almonds, 18 medium cashews, 35 peanuts, 15 pecan halves and 14 English walnut halves while exchanges are considerably smaller portions at ¼ cup.(1)
|
Lower Phosphorus (<110 mg/exchange) |
Higher phosphorus (> 110 mg/exchange) |
|
Cheddar, Colby, Monterey jack, mozzarella, provolone, ricotta, string, swiss cheese |
Blue, feta, soft goat, and cottage cheese |
|
Lower Phosphorus (<110 mg/exchange)
|
Higher phosphorus (> 110 mg/exchange) |
|
Buns, cornbread, dinner rolls, English muffin, muffin, corn or flour tortilla, animal crackers, graham crackers, melba toast, popcorn, pretzels, rice cake, rye krisp, saltine crackers, tortilla chips, or potato chips, Chapathi, Roomali roti, pulka, naan, plain paratha, puris, plain dosa, Sabudhana Kickidi Poha, Rice Bulgur Upma, barley, couscous, rice, croissant, pita, vermicelli, oatmeal, cornflakes, puffed rice, noodles |
Bagel, white or wheat, biscuit, whole wheat English muffin, pancake. waffle, bran cereal, granola, wheat germ, aloo masala, paneer, roghani, or masala paratha, muesli, raagi porridge, biriyani, dalia, missi, bajra and jowar roti, paneer dosa, onion and pepper adai, oat bran muffin, soy flour, sweet buns, sprouted wheat, whole wheat ravioli, granola bar |
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| Lower Phosphorus (<110 mg/exchange) |
Higher phosphorus (> 110 mg/exchange) |
|
Angel food cake, brownie, cake, cookie (chocolate chip, sandwich, shortbread, or sugar), Danish, sweet roll, doughnut, glazed, fruit pie, gingersnaps, lemon meringue pie, rice krispie treat vanilla wafers, pumpkin pie, fruit ice bars, hard candy, popsicles, sweet vermicelli |
Cake doughnut, Besan or boondi ladoo, burfi, gulab jamun, halwa, pongal, rasgulla, rasmalai, jalebi, kaju katli, mohanthal, son papdi, appan, malpuas, modak, sweets made with lentil, besan, gram or garbanzo flour, desserts make with concentrated milk (burfi), lassee (milk based dessert drinks), molasses |
Only one fruit is listed as higher phosphorus: Coconut milk, canned (1 cup), and dried fruits (if eaten in ½ cup portions)
Non-starchy Vegetables
Few of the non-starchy vegetables are identified as higher phosphorus. Only colacasia leaves, and water chestnuts. Vegetables are considered less than 110 mg per 1/2 cup. An average of 55 mg per 1/2 cup serving is used to estimate intake.
Starchy Vegetables
| Lower Phosphorus (<110 mg/exchange) |
Higher phosphorus (> 110 mg/exchange) |
|
Chickpeas/garbanzo , black, kidney, pinto lima, or butter beans, blackeyed peas, split peas, canned, frozen, or boiled can, hominy, mixed vegetables, green peas, plantain, instant, boiled or baked potatoes, parsnips, sweet potato, yams, winter squash, artichokes, cassava, sunchoke, pumpkin NOTE: |
Canned navy beans, broad beans, yard long beans, refried beans, lentils, Rasam, Sambhar, Kesari, toor, mung, channa, and tomato & onion, and black gram dhal, |
Lower Phosphorus (<110 mg/exchange) |
Higher phosphorus (> 110 mg/exchange) |
| All regular milk and products made from milk (ice cream, custards, puddings, lassi) are considered higher phosphorus (and high potassium) foods and therefore portion sizes are usually limited to smaller quantities than included in normal diabetic meal plans. Some dairy alternatives such as almond, rice and soy milks can be lower in phosphorus (check by brand). NOTE: Dairy portion size is limited in the Renal Exchanges to 1/2 cup servings. Dairy products, yogurt in particular, range up to 272 mg of phosphorus per full cup. In this case 130 mg phosphorus is used as the amount of phosphorus per 1/2 cup of yogurt. |
FATS/OILS |
Most fats are low enough in phosphorus to not be limited due to phosphorus content.
|
Lower Phosphorus (<110 mg/serving) |
Higher phosphorus (> 110 mg/exchange) |
|
1/8 tsp portions of: Garam masala, cinnamon, fenugreek seeds, fennel seeds, mustard seeds, garlic, ginger, cloves, ajwain, asafoetida, red pepper, black pepper, turmeric, saffron, nutmeg, cumin seeds Larger portions of tamarind (1 tsp) Tablespoon of cilantro (coriander) chutney, mango chutney, ketchup |
|
References
1. Ro L, Munson L, eds. Making Choices: Meal Planning for People with Diabetes and Chronic Kidney Disease Stages 3 and 4. Chicago, IL: Academy of Nutrition and Dietetics; 2015.
2. Diabetes and Chronic Kidney Disease Stages 1 through 4: Nutrition Guidelines. Nutrition Care Manual 2016; www.nutritioncaremanual.org. Accessed Feb 02, 2017.
3. Balasubramanian, K, Wagle, A, Sucher, K. A Nutrition Education Tool for South Asians with Renal Disease. Available at: www.sjsu.edu/people/ashwini.wagle/Southasians/Renal-Tool-for-South-Asians.pdf. Accessed Feb 02, 2017.
4. Mahan, K, Raymond. Krause's food and nutrition care process. 14th ed, Appendix 29. Elsevier, St Louis MO, 2017.