Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved

A Nutrition Education Tool for South Asians with Renal Disease

Kalpana Balasubramanian, M.S., Ashwini Wagle, M.S., R.D., Assistant Professor & Kathryn Sucher, Sc.D., R.D., Professor

Department of Nutrition and Food Science

San Jose State University

Diet and Renal Disease

When you have renal disease, diet is an important part of your treatment plan. Your recommended diet may change over time, depending on how your condition progresses. Few things that are important to your diet include

1. Getting the right amount of calories and protein 2. Appropriate levels of phosphorus, potassium, sodium and fluids in your diet 3. Staying at a healthy body weight

Calories: Calories are important to your overall health and well being. Calories are found in all the foods you eat.

Why is getting the right amount of calories important? Getting the right amount of calories is important because they  Give your body energy  Help you stay at a healthy weight  Help your body use protein for building muscles and tissues Because your recommended diet may limit protein, you may also be cutting down on an important source of calories. As a result, you may need to get extra calories from other foods.

Proteins: Protein is found in bones, muscles, skin, organs, blood, hormones and enzymes

Why is getting the right amount of protein important? Getting the right amount of protein is important to your overall health and how well you feel. Your body needs protein for  Building muscles  Repairing tissue  Fighting infections You will need to limit the amount of protein in your diet. This will help decrease wastes in your blood, helping your kidneys to work better.

Phosphorus: Phosphorus is a mineral found in your bones. It is essential for  Building strong bones  Keeping other parts of your body healthy

Why is phosphorus important for you? Your kidneys may not be able to remove enough phosphorus from your blood. This causes the level of phosphorus in your blood to become too high. A high blood phosphorus level may cause a loss of calcium from bones. Your bones may become weak and break easily.

Phosphate Binders: Medicines called phosphate binders absorb the excess phosphate in your GI tract and help maintain serum phosphate levels. Taking a phosphate binder before every meal helps to maintain serum phosphorus levels if your levels are high.

Potassium:

Potassium is a mineral that controls nerve and muscle function.

Why is Potassium important for you? Potassium is an important mineral in the blood that

 Helps your muscles and heart work properly  Maintains fluid and electrolyte balance

The amount of potassium in the blood is controlled by the kidneys. When the kidneys are not working, high levels of potassium build up in the blood. This can cause muscle weakness. Since your heart is a muscle, high potassium levels could cause it to beat abnormally or stop.

Sodium:

Sodium is a mineral found naturally in foods. It is found in large amounts in table salt and in foods that have added table salt such as seasonings, most canned foods and some frozen foods.

Why is Sodium important for you? Sodium is essential for

 Fluid balance  Nerve activity  Muscle contraction

You will need to limit the amount of sodium in your diet, especially if you have high blood pressure and extra fluid in your body. Everyone needs some sodium. However, sodium is found naturally in foods and most people eat more sodium than they need. When kidneys fail, the extra sodium is not removed. With extra sodium in your body, you

will feel thirsty and may drink more fluids which could be dangerous for you. The best way to control thirst is to limit sodium in the diet.

Fluids:

In kidney disease, fluid restriction is essential. Fluid allowance is highly individualized.

Why is Fluid important for you? Going over your recommended fluid allowance can lead to too much fluid building up in your body between dialysis treatments. This excess fluid causes

 Swelling  High Blood pressure  Fatigue and shortness of breath  Fluid in Lungs  Congestive heart failure

Sources:

National Kidney Foundation: http://www.kidney.org/atoz/pdf/nutri_chronic.pdf

Chronic Kidney Failure- A guide to better living: Mid Atlantic Renal Coalition

Renal Exchange List

Grains/Cereals/Bread 6-11 servings each day

Milk/Yogurt/Cheese ½ cup milk or ½ cup yogurt or 1 ounce cheese each day

Meat/Protein 8-10 ounces of high protein foods each day

Fruits/Fruit Juices 2-3 servings of low potassium fruits. One serving = ½ cup or 1 small fruit or ½ cup of juice

Vegetables 2-3 servings of low potassium vegetables each day. One serving = ½ cup cooked or 1 cup raw

Salt/Sodium Use less salt and eat fewer salty foods. Use herbs, spices and low salt flavor enhancers in place of salt. Avoid salt substitutes made with potassium

Desserts Depending on your caloric needs, your Dietitian may recommend high-calorie desserts. If you are a diabetic, discuss low carbohydrate dessert choices with your Dietitian

Source: National Kidney Foundation

Nutrient Recommendations for varying levels of kidney failure

Nutritional Normal Stages 1-4 Stage 5 Stage 5 Parameter kidney chronic Hemodialysis Peritoneal function kidney disease Dialysis Calories 30-37 30-35 30-35 30-35 (Kcal/kg/d) Protein 0.8 0.6-0.75 1.2 1.2 (gm/kg/d) Sodium Unrestricted 1000-3000 2000-3000 Highly (mg/d) individualized, can range from 2000-4000 Potassium Unrestricted Unrestricted 2000-3000 Generally not (mg/d) unless serum restricted, level is high approximately 3000-4000 Phosphorus Unrestricted 10 mg/kg/day 800-1000 800-1000 (mg/d) Fluid (mL/d) Unrestricted Unrestricted 1L/day + daily Individualized. urine output Can range from 2-3 L/day + daily urine output

Sources: Beto, J. A., Bansal,V.K. Medical nutrition therapy in chronic kidney failure: Integrating clinical practice guidelines. Journal of American Dietetic Association. 2004; 104:404- 409. Nelms, M., Sucher, K., & Long, S. Nutrition Therapy & Pathophysiology Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved

Some Suggestions and Tips :

Keep a diary of what you eat each day. Show this to your Dietitian on a regular basis.

Ask your Dietitian which nutrients you need to limit in your diet. Do get help from your Dietitian in planning your meals.

Be aware of portion size. Always choose small portions.

Learn to read food labels, so you can make healthier food choices.

Watch out for foods that have added table salt such as seasonings, canned foods, most frozen foods, salty snack foods like chips, restaurant and take out foods.

Herbs, spices, table wine and special vinegar can be used instead of salt to make your foods flavorful. Try fresh or dried herbs and spices to enhance the flavor of foods.

Limit high salt foods so you will have less thirst.

Drink from small glasses and cups. Drink only when you are thirsty. Reach for cold beverages. Beverages that are less sweet will quench your thirst. Use sour candy or sugar free gum to moisten your mouth.

Remember that some foods should be counted as liquids. These include soups, popsicles, sherbet, ice cream, yogurt, custard and gelatin.

Non-dairy creamers can be used in place of milk in cereals, coffee and many sauces to lower the amount of phosphorus in your diet.

Choose dry dishes instead of curries and sauces. If you would like to have a dish with sauce, choose smaller portions.

If you would like to have soups, instead of cream soups and dhal soups, try mulligatawny soup.

Rice is an excellent choice. Choose plain boiled rather than fried. Plain rotis and naans are good choices. Avoid rotis and naans with stuffing. Steer away from dishes which are based on chickpeas.

Many desserts contain milk, milk powder, nuts and dried fruit, so may not be suitable. Avoid dishes which contain coconut milk and shredded coconut.

Source:

National Kidney Foundation

List of Foods

Low Potassium Foods (< 200 mg/serving)

Breads Cereals / Grains / Pasta 1 Chapathi, 6”diameter ½ C Sabudhana Kichidi 1 Pulka, 6” diameter ½ C plain Poha 1 Makki ki Roti, 6”diameter ½ C Pongal 1 Roomali Roti, 6”diameter ½ C Rava Upma ¼ plain Naan ½ C plain Rice Upma ½ plain Paratha ½ C Bulgur Upma 2 plain Puris, 5”diameter ½ C Barley, pearled (cooked) 2 Methi Puris, 5”diameter ½ C Couscous (cooked) 1 Bhatura, 6”diameter ½ C White Rice (cooked) ¼ plain Kulcha ½ C Brown Rice (cooked) 2 Kakhara ½ C Tamarind Rice 1 plain Dosa, 6”diameter ½ C Lemon Rice 1 Green Gram Dhal Dosa, 6”diameter ½ C Egg Fried Rice 1 Rava Dosa, 6”diameter ½ C Vegetable Pulao 1 plain Utthapam, 6”diameter ½ C Saffron Rice 2 Rava Idlis ½ C Rice Pulao 2 Rice Idlis ½ C Shrimp Fried Rice 1 Adai, 6”diameter ½ C Rice Vermicelli 1 Pessaratu, 6”diameter ½ C Sesame Vermicelli 4 Pakodas ½ C regular Dalia 1 slice White Bread ½ C Sprouted Wheat 1 slice Wheat Bread ½ C Oatmeal 1 slice Raisin Bread ½ C Corn flakes 1 slice Rye Bread ½ C Cereal (cooked) 1 small Pau (Dinner Roll) ½ C Cream of Wheat (cooked) 1 Sweet Bun 1 C Puffed Rice Cereal ½ plain Bagel 1 square Semolina Dhokla ½ Egg Bagel ½ C Idiyappam 1 medium Pancake ½ C Lemon Pasta 2 Breadsticks, 2” ½ C plain Noodles 1 Corn Bread, 2” 1 oz Granola Bar ½ English Muffin ½ C Macaroni and Cheese 1 small Croissant ¼ white Pita, 6”diameter 1 medium Sugared Doughnut

Low Potassium Foods (< 200 mg/serving)

Vegetables Fruits/ Fruit Juices ½ C Radish (cooked) 1 small Apple ½ C Fenugreek leaves (cooked) 10 Cherries ½ C Zucchini (cooked) 10 Jambu ½ C Carrots (cooked) 10 Lychi or Lychees ½ C French Beans (cooked) 15 Grapes ½ C Brinjal (cooked) 1 small Pear ½ C Onions (cooked) 1 small wedge Watermelon ½ C Papdi (cooked) 1 small Tangerine ½ C Cauliflower (cooked) 1 small Plum ½ C Karela (cooked) ½ C whole Strawberry ½ C Bell Pepper (cooked) ½ C canned Mandarin Oranges, drained ½ C Turnip (cooked) ½ C canned Peaches, drained ½ C Lauki (cooked) ½ C Raspberry ½ C Cabbage (cooked) ½ C Blackberry ½ C Mixed Vegetables (cooked) ½ C Blueberry ½ C Drumstick leaves (cooked) ½ C Cranberry ½ C Okra (cooked) ½ Grapefruit ½ C Tindora (cooked) ½ C canned Fruit Cocktail, drained ½ C Snake Gourd (cooked) ½ C fresh Pineapple ½ C Ridge Gourd (cooked) ½ C canned Peaches, drained 1 small Celery stalk (raw) ½ C Apple sauce ½ C Lemon Juice ½ C Lime Juice ½ C Apple Juice ½ C Grape Juice ½ C Cranberry Juice ½ C Pineapple Juice 2 tbsp Raisins

Low Potassium Foods (< 200 mg/serving)

Meat/ Protein Nuts/ Seeds ½ C Egg Burji 1 oz Kaju (Cashewnuts) ¼ C Egg Substitute 1 oz Roasted Peanuts 1 Egg White Omelet 1 oz Akroot (Walnuts) 1 Egg White 1 oz Pine nuts ½ C Chicken Rice Pilaf 1 oz Sunflower seeds ½ C Shrimp Fried Rice 1 oz Sesame seeds 1 Soya Kebab 2 tbsp fresh grated coconut 12 Oysters, canned ½ C Tuna Fish, canned, drained 1 Meatball, regular mince

Sweets Snack Foods 1 Kaju Katli 1 Chakli / Muruku 1 Mysore Pak, 1”x1” 1 Papad 1 Son Papdi, 1”x1” 2 Bhakarwadis 1 Sandesh 10 Pani Puris 1 Milk Peda, 1”x1” ½ C Plain Chivda 1 Jalebi 1½ C Popcorn 1 Petha, 1”x1” 10 Pretzels 2 small Nankatai 10 Vanilla Wafers ½ C Sooji Halwa 4 Unsalted Crackers 1 Sooji Ladoo 4 Whole wheat crackers 1 small plain Donut 4 Graham Crackers 1 small Frosted Cupcake 1 Rice cake 1 small slice Chocolate cake, 2”x2” 1 small slice Pound cake 1 Homemade Brownie, 2”x2” 1 Cream Puff 1 Popsicle ½ C Sorbet 1 Strawberry Fruit Bar 10 Jelly Beans 4 Hard Candy 1 tbsp Honey 1 tbsp Sugar 1 tbsp Jelly 1 small slice Carrot cake, 2”x2”

Low Potassium Foods (<200 mg/serving)

Milk/ Milk Products Beverages ½ C Whole Milk, 3.25% ½ C Chai Tea ½ C Skim Milk ½ C Coffee ½ C Soymilk ½ C Ginger Ale ½ C Rice Milk unenriched ½ C Cranberry Juice Cocktail ½ C Plain Yogurt, regular ½ C Lemonade ½ C Buttermilk, plain ½ C Apple Cider 1 tbsp Non dairy creamer ½ C Soft drinks 1 tbsp Half and Half ½ C Soda 1 tbsp Sour cream ½ C Colas 1 tbsp Whipping cream ½ C Hot Cocoa 1 oz Cream cheese 1 oz Cottage cheese 1 tbsp Mozzarella cheese, grated 1 tbsp Parmesan cheese, grated

Fats Spices / Condiments / Chutneys / Sauces 1 tsp Margarine 1/8 tsp Garam Masala 1 tsp Mayonnaise (Regular/Light/Fat free) 1/8 tsp Cinnamon 1 tsp Canola oil 1/8 tsp Fenugreek seeds 1 tsp Corn oil 1/8 tsp Fennel seeds 1 tsp Safflower oil 1/8 tsp Mustard seeds 1 tsp Sunflower oil 1/8 tsp Garlic 1 tsp Soybean oil 1/8 tsp Ginger 1 tsp Olive oil 1/8 tsp Cloves 1 tsp Peanut oil 1/8 tsp Ajwain 1 tsp Coconut oil 1/8 tsp Asafoetida 1 tsp Ghee 1/8 tsp Red Pepper 1 tsp Butter 1/8 tsp Black Pepper 1/8 tsp Turmeric 1/8 tsp Saffron 1/8 tsp Nutmeg 1/8 tsp Cumin seeds 1 tbsp Tomato chutney 1 tbsp Coconut chutney 1 tbsp Cilantro chutney 1 tbsp Mint chutney 1 tbsp Mango chutney 1 tbsp Salsa

1 tbsp Ketchup 1 tsp Low Sodium Pickles 1 tsp Tamarind

High Potassium Foods (>200 mg/serving)

Breads Cereals / Grains / Pasta ½ Aloo Masala Paratha 1 C Muesli ½ Masala Paratha 1 C Raggi porridge ½ Paneer Paratha ½ C Sprouted Moong Dalia ½ Onion Paratha ½ C Moong Missal 1 Mughlai Roti, 6”diameter ½ C Dhansak 1 Khasta Roti, 6”diameter ½ C plain Kichidi 1 Missi Roti, 6”diameter ½ C Moong dhal Kichidi 1 Tandoori Roti, 6”diameter ½ C Curd Rice 1 Masala Dosa, 6”diameter ½ C Tomato Rice 1 Tomato Utthappam, 6”diameter ½ C Bisebelabath 1 Chilli Cheese Utthappam, 6”diameter ½ C Mutter Paneer Pulao 1 Pepper Adai, 6”diameter ½ C Lamb Biriyani 1 Besan Cheela ½ C Vegetable Dum Biriyani ½ C Chicken Dum Biriyani ½ C Cheese Ravioli

Pulses / Dhals / Legumes Vegetables ½ C Rasam ½ C Beetroot (cooked) ½ C Sambhar ½ C Peas (cooked) ½ C Kesari Dhal (cooked) ½ C Yellow Corn (cooked) ½ C Toor Dhal (cooked) ½ C White Corn (cooked) ½ C Masoor Dhal (cooked) ½ C Broad beans (cooked) ½ C Mung Dhal (cooked) ½ C Spinach (cooked) ½ C Channa Dhal (cooked) ½ C Pumpkin (cooked) ½ C Tomato & Onion Dhal (cooked) ½ C Potato (cooked) ½ C Dhal Fry ½ C Sweet Potato (cooked) ½ C Dhal Makhani ½ C Colacasia (Taro)(cooked) ½ C Chole ½ C Yam (cooked) ½ C Pindi Chole Masala ½ C Drumsticks (cooked) ½ C Rajma ½ C Broccoli (cooked) ½ C Black Eyed Peas ½ C Brussels sprouts (cooked) ½ C Beans (Lima/Navy/Pinto) ½ C Green Plantain (cooked) ½ C Black Gram Dhal (cooked) ½ C Mashed Potato (cooked) ½ C Soybeans ½ C Palak Paneer ½ C Matki Usal ½ C Paneer Jalfrezi ½ C Moong Missal ½ C Malai Kofta 1 C Carrots (raw)

Fruits / Fruit Juices Meat / Protein 1 small Banana ½ C Butter Chicken 1 small Nectarine ½ C Chicken Tikka Masala 1 small Kiwi ½ C Chicken Korma 1 small Mango ½ C Indian Fish Curry 1 small Orange ½ C Fish Stew 1 small Chickoo ½ C Shrimp Curry 1 small Custard Apple ½ C Lamb Kofta Curry 1 small Guava ½ C Pork Curry

1 C Tomato (raw) ½ C Mushrooms (cooked)

High Potassium Foods (>200 mg/serving)

½ C dried Prunes ½ C Kheema (Mutton/ Lamb/ Beef) ½ C dried Apricots ½ C Mutton Korma ½ C Cantaloupe cubes ½ Tandoori Chicken ½ C Honey dew melon cubes ½ Chicken Fry ½ whole Papaya ½ Grilled Chicken ½ C Jackfruit 2 Chicken Nuggets ½ C dried Fruits 2 Chicken Egg Rolls ½ C Pomegranate 2 Vegetable Egg Rolls 5 dried Figs 1 Medium Fish Fillet 5 whole Dates 1 Medium Fish Tikka ½ C Grapefruit juice 2 Curried Lamb Chops ½ C Tomato juice ½ C Mango juice ½ C Prune juice ½ C Papaya Juice ½ C Apricot juice ½ C Carrot Juice ½ C V-8 Juice

Nuts/ Seeds Fats 1 oz Pistachio 2 tbsp Peanut butter 1 oz Pumpkin seeds 2 tbsp Almond butter 1 oz Almonds 1 C Fresh Coconut meat, raw

High Potassium Foods (>200 mg/serving)

1 Ghujia 1 Egg Puff 1 Gulab jamun 1 Samosa 1 Rasgulla 1 Bonda 1 Rasmalai 1 Dhal Kachori 2 small Appam 1 Vegetable Kachori 2 small Malpuas 1 Urad Dhal Vada 2 small Modak 1 Medhu Vada ½ C Carrot Halwa 1 Dahi Vada ½ C Badam Halwa 1 square Besan Dokhla, 2”x2” ½ C Banana Halwa 6 Khandvi ½ C Dry fruit Halwa ½ C Fried Masala Chivda ½ C Moong dhal Halwa ½ C roasted Masala Peanuts ½ C Sweet Pongal 1 oz Potato Chips ½ C Phirni 1 oz Tapioca Chips ½ C Kheer / Payasam 1 oz Masala Chips ½ C Badam Kheer 1 oz Fried Banana Chips ¾ C Rabadi 1 small French Fries ¾ C Basundi 4 All purpose Flour Biscuit ½ C Lemon Souffle ½ C Vanilla Pudding ½ C Caramel Pudding ½ C Banana bread pudding ½ C Mango pudding ½ C Date & Bread pudding ½ C Jaggery 1 tbsp Molasses

High Potassium Foods (>200 mg/serving)

Milk/ Milk Products Spices / Condiments / Chutneys / Sauces ½ C Chocolate Milk ½ C Marinara Sauce ½ C Ovaltine Milk ½ C Spaghetti Sauce ½ C Boost Milk ½ C Bournvita Milk ½ C Complan Milk ½ C Horlicks Milk ½ C Badam Milk Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved

½ C Kesar badam Milk ½ C Rose Milk ½ C Sweetened Condensed milk ½ C Fruit Milk shakes ½ C Masala Chai ½ C Thandai ½ C Kulfi ½ C Falooda ½ C Ice cream ½ C Custard ½ C Pudding ½ C Sweet Lassi ½ C Mango Lassi ½ C Chaas ½ C Fruit Yogurt ½ C Raita ½ C Shrikand ½ C Cream Soup 1 oz Khoa 1 oz Paneer 1 oz Tofu 1 oz Chenna

Low Phosphorus Foods (<110 mg/serving)

Breads Cereals / Grains / Pasta 1 Chapathi, 6”diameter ½ C Sabudhana Kichidi 1 Roomali Roti, 6’diameter ½ C plain Poha 1 Pulka, 6”diameter ½ C Rice Upma ¼ plain Naan ½ C Bulgur Upma ½ plain Paratha ½ C Barley, pearled (cooked) 2 plain Puris, 5”diameter ½ C Couscous (cooked) 1 plain Dosa, 6”diameter ½ C White Rice(cooked) Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved

1 plain Utthappam, 6”diameter ½ C Brown Rice (cooked) 2 Rava Idlis ½ C Lemon Rice 2 Rice Idlis ½ C Vegetable Pulao 4 Pakodas ½ C Saffron Rice 1 slice White Bread ½ C Rice Pulao 1 slice Wheat Bread ½ C Shrimp Fried Rice 1 small Pau (Dinner Roll) ½ C Rice Vermicelli ½ Bagel ½ C Sesame Vermicelli 1 medium Pancake ½ C Oatmeal 2 Breadsticks, 2” ½ C Corn flakes 1 Corn Bread, 2” ½ C Cereal (cooked) 1 slice Pumpkin Bread ½ C Cream of Wheat (cooked) ½ English Muffin 1 C Puffed Rice Cereal 1 small Croissant ½ C Idiyappam ¼ white Pita, 6”diameter ½ C Lemon Pasta 1 medium Sugared Doughnut ½ C Plain Noodles

Vegetables Fruits / Fruit Juices ½ C Green Beans (cooked) 1 small Pear ½ C Beetroot (cooked) 1 small Apple ½ C Potato (cooked) ½ C Applesauce ½ C Suran (cooked) 1 small Grapefruit ½ C Drumstick leaves (cooked) 1 small Guava ½ C Karela (cooked) 1 small Lemon ½ C Brinjal (cooked) ½ C dried Prunes ½ C Cauliflower (cooked) 1 small wedge Watermelon ½ C Coriander leaves (cooked) ½ C Fruit Salad ½ C Chayote squash (cooked) ½ C canned Peaches, drained ½ C Tindora (cooked) ½ C dried Apricots ½ C Okra (cooked) ½ C Blackberry ½ C Snake gourd (cooked) ½ C Blueberry ½ C Spinach (cooked) ½ C canned Mandarin Oranges, drained ½ C Mushrooms (cooked)

Low Phosphorus Foods (<110 mg/serving)

Vegetables Fruits / Fruit Juices ½ C Onions (cooked) ½ C Cranberry ½ C Cabbage (cooked) ½ C Fresh Pineapple ½ C Pumpkin (cooked) ½ C Apple juice ½ C Green Plantain (cooked) ½ C Grape juice ½ C Methi leaves (cooked) ½ C Strawberry juice ½ C Capsicum (cooked) 1 small Banana

½ C Green Mango (cooked) ½ C Broccoli (cooked) ½ C Zucchini Stir fry (cooked) ½ C Stir fry Vegetables (cooked) ½ C Spicy Bell pepper medley (cooked) 1 C Tomato (raw) 1 small Celery stalk (raw) 1 C Carrot (raw) 1 C Cucumber (raw) 1 C Alfalfa sprouts (raw)

Meat / Protein Nuts / Seeds ½ C Egg Burji 1 C Fresh Coconut meat, raw ¼ C Egg Substitute 2 Tbsp Fresh Grated Coconut 1 Egg White ½ C cooked Peanuts ½ C Chicken Noodle soup 1 oz Akroot (Walnuts) ½ C Chicken and Vegetable soup ½ C Shrimp Fried Rice ½ C Chicken Rice Pilaf

Sweets Snack Foods 1 Sooji Ladoo 2 Vegetable Cutlets ½ C Sweet Vermicelli 10 Pani puris 1 slice Pound cake, 2”x2” 1 Papad 1 slice Carrot cake, 2”x2” 10 Pretzels 1 Homemade Brownie, 2”x2” 10 Vanilla Wafers ½ Fruit Ice Bar 4 Unsalted Crackers 1 medium Popsicle 4 Whole wheat crackers ½ C Sorbet 4 Graham Crackers 4 Hard Candy 1 oz Potato Chips 10 Jelly Beans ½ C plain Chivda ½ C Jaggery 1½ C Popcorn ½ C Jello 1tbsp Honey 1 tbsp Sugar

Low Phosphorus Foods (<110mg/serving)

Milk / Milk Products Beverages ½ C Chai Tea ½ C Sherbet ½ C Coffee ½ C Homemade Lemonade ½ C Soymilk ½ C Lemon Soda ½ C Hot Cocoa ½ C Sugarcane juice ½ C Rice Milk unenriched ½ C Nariyal Pani (Coconut water)

1 tbsp Non Dairy creamer ½ C Ginger Ale 1 tbsp Half and Half ½ C Soda 1 tbsp Sour cream ½ C Colas 1 tbsp Whipping cream ½ C Hot Cocoa 1 oz Cream cheese 1 oz Cottage cheese 1 tbsp Mozzarella cheese, grated 1 tbsp Parmesan cheese, grated

Fats Spices / Condiments / Chutneys / Sauces 1 tsp Margarine 1/8 tsp Garam Masala 1 tsp Mayonnaise (Regular/Light/Fat free) 1/8 tsp Cinnamon 1 tsp Canola oil 1/8 tsp Fenugreek seeds 1 tsp Corn oil 1/8 tsp Fennel seeds 1 tsp Safflower oil 1/8 tsp Mustard seeds 1 tsp Sunflower oil 1/8 tsp Garlic 1 tsp Soybean oil 1/8 tsp Ginger 1 tsp Olive oil 1/8 tsp Cloves 1 tsp Peanut oil 1/8 tsp Ajwain 1 tsp Butter 1/8 tsp Asafoetida 1 tsp Ghee 1/8 tsp Red Pepper 1 tsp Coconut oil 1/8 tsp Black Pepper 1/8 tsp Turmeric 1/8 tsp Saffron 1/8 tsp Nutmeg 1/8 tsp Cumin seeds 1 tsp Tamarind 1 tbsp Cilantro chutney 1 tbsp Mango chutney 1 tbsp Ketchup ½ C Marinara sauce ½ C Spaghetti sauce

High Phosphorus Foods (>110 mg/serving)

Breads Cereals / Grains / Pasta ½ Aloo Masala Paratha 1 C Muesli ½ Paneer Paratha 1 C Raagi porridge ½ Roghani Paratha ½ C Biriyani ½ Masala Paratha ½ C Regular Dalia

¼ Masala Kulcha ½ C Vegetable Dalia 1 Missi Roti, 6”diameter ½ C Curd Rice 1 Bajra Roti, 6”diameter ½ C Bisebelabath 1 Jowar Roti, 6”diameter ½ C Plain Kichidi 2 Urad Dhal Puris, 5”diameter ½ C Moong dhal Kichidi 1 Bhatura, 6”diameter ½ C Dhansak 2 Khakras ½ C Mutter Paneer Pulao 1 Paneer Dosa, 6”diameter ½ C Sprouted Wheat 1 Chilli Cheese Utthappam, 6”diameter ½ C Macaroni and Cheese 1 Besan Cheela ½ C Whole Wheat Ravioli 1 Onion Adai, 6”diameter ½ C Cheese Ravioli 1 Pepper Adai, 6”diameter 1 oz Granola Bar 1 medium slice Cheese Pizza 1 small Oat Bran Muffin 1 Buttermilk Waffle 2 oz Whole Wheat Atta 2 oz Besan 1 oz Soy Flour 1 Sweet Bun

Pulses / Legumes/ Dhals Vegetables ½ C Rasam ½ C Besan Kadi ½ C Sambhar ½ C Malai Kofta ½ C Kesari dhal (cooked) ½ C Coconut Stew ½ C Toor Dhal (cooked) ½ C Aviyal ½ C Mung Dhal (cooked) ½ C Patra ½ C Channa Dhal (cooked) ½ C Vegetable Kurma ½ C Tomato & Onion Dhal (cooked) ½ C Undhiyu ½ C Dhal Fry ½ C Palak Paneer ½ C Dhal Makhani ½ C Paneer Jal Frizzi ½ C Chole ½ C Colacasia leaves Curry (cooked) ½ C Rajma ½ C Colacasia (cooked) ½ C Black Eyed Peas ½ C Broad Beans (cooked) ½ C Beans (Lima/Navy/Pinto) ½ C Water Chestnuts ½ C Black Gram Dhal (cooked) 1 Yellow Corn ½ C Soybeans ½ C Matki Usal ½ C Moong Missal High Phosphorus Foods (>110 mg/serving)

Fruits / Fruit Juices Meat / Protein ½ C Dry Fruits 1 Cheese Omelet ½ Grilled Chicken 2 Chicken Nuggets

1 medium Fish Tikka 1 Soy Kebab ½ C Pork Curry ½ C Kheema (Mutton/Lamb/Beef) ½ C Chicken Curry 12 Oysters, canned ½ C Tuna Fish, canned, drained 1 Meatball, regular mince

Sweets Snack Foods 1 Besan Ladoo 2 Vegetable Cutlets 1 Boondi Ladoo 2 Alu Vadi 1 Puran Poli 4 Paneer Pakodas 1 Peanut Chikki 4 Fish Pakodas 1 Chocolate Burfi, 1”x1” 4 Muthias 1 Coconut Burfi, 1”x1” 1 Vada Pav 1 Pista Burfi, 1”x1” 1 Vegetable Puff 1 Ghujia 1 Egg Puff 1 Gulab jamun 1 Samosa 1 Rasgulla 1 Bonda 1 Rasmalai 1 Dhal Kachori 1 Jalebi 1 Vegetable Kachori 1 Kaju Katli 1 Urad Dhal Vada 1 Mohanthal, 1”x1” 1 Medhu Vada 1 Son Papdi, 1”x1” 1 Dahi Vada 2 small Appam 1 square Besan Dokhla, 2”x2” 2 small Malpuas 6 Khandvi 2 small Modak ½ C Fried Masala Chivda ½ C Carrot Halwa ½ C roasted Masala Peanuts ½ C Badam Halwa 1 oz Potato Chips ½ C Banana Halwa 1 oz Tapioca Chips ½ C Dry fruit Halwa 1 oz Masala Chips ½ C Moong dhal Halwa 1 oz Fried Banana Chips ½ C Sweet Pongal 1 small French Fries

High Phosphorus Foods (>110 mg/serving)

Sweets Snack Foods ½ C Phirni ¼ C Shakarpara ½ C Kheer / Payasam 1 All purpose Flour Biscuit

½ C Badam Kheer ¾ C Rabadi ¾ C Basundi ½ C Lemon Souffle ½ C Vanilla Pudding ½ C Banana bread Pudding ½ C Mango Pudding ½ C Caramel Pudding ½ C Date & Bread Pudding 1 Cream Puff 1 slice Chocolate cake ½ C Jaggery 1 tbsp Molasses

Milk / Milk Products Nuts / Seeds ½ C Whole Milk, 3.25% 1 oz Pistachio ½ C Skim Milk 1 oz Pine nuts ½ C Chocolate Milk 1 oz Pumpkin seeds ½ C Ovaltine Milk 1 oz Almonds ½ C Boost Milk 1 oz Kaju (Cashewnuts) ½ C Bournvita Milk 1 oz Roasted Peanuts ½ C Complan Milk 1 oz Akroot (Walnuts) ½ C Horlicks Milk 1 oz Sunflower seeds ½ C Badam Milk 1 oz Sesame seeds ½ C Kesar badam Milk ½ C Rose Milk ½ C Sweetened Condensed milk ½ C Fruit Milk shakes ½ C Masala Chai ½ C Thandai ½ C Kulfi ½ C Falooda ½ C Ice cream ½ C Custard ½ C Pudding ½ C Sweet Lassi ½ C Mango Lassi ½ C Chaas

High Phosphorus Foods (>110 mg/serving)

Milk / Milk Products Fats ½ C Buttermilk, plain 1 tbsp Peanut Butter

½ C plain Yogurt, regular ½ C Fruit Yogurt ½ C Raita ½ C Shrikand ½ C Cream Soup 1 oz Khoa 1 oz Paneer 1 oz Chenna 1 oz Tofu

Resources:

1. Gopalan C, Rama Sastri BV, Balasubramanian SC. Nutritive Value of Indian foods. Hyderabad, India: National Institute of Nutrition, Indian Council of Medical Research. Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved

1971.

2. Self NutritionData: Know what you eat: http://nutritiondata.self.com. 2009.

3. Nelms, M., Sucher, K., & Long, S. Nutrition Therapy & Pathophysiology.

4. Spices Board India. Nutritive value of Indian spices: http://www.indianspices.com.2010

Meal Food Choices

Sample Meal Plans

Sample Menu (40g protein)

Breakfast ½ C Chai Tea Menu Food2 Semolina Choices Idlis Breakfast ½ C CRoffeava eU pma 1 tbsp NConoconut dairy chutney creamer 1 small Apple Mid Morning Snack 5 Pretzels 1 Sooji Ladoo Lunch ½ C Low Sodium Chicken Noodle Soup 1 Chapathi ½ C Rice ½ C Dhal Makhni 1 C plain Cucumber Salad ½ C Cauliflower Subji Afternoon Snack 2 Shortbread Cookies ½ Pear ½ C Ginger Ale Dinner ¼ plain Naan ½ C Chicken Pulao ½ C plain Dhal ½ C Okra Subji 1 Papad Snack ½ C plain Chivda 1 small Banana

Approximate Nutrition Analysis: Calories: 2021; Protein: 40.65g (8% of calories); Carbohydrate: 340g (67% of calories); Fat: 57g (25% of calories); Phosphorus: 685mg; Potassium: 2407mg; Sodium: 1683mg; Fluid: 1.2L.

1 tsp Sugar 1 Egg White Omelet 1 slice White bread with 1 tablespoon Margarine 1 small Orange Mid Morning Snack ½ C Sabudhana Kichidi 1 C whole Strawberries Lunch ½ C Mulligatawny Soup ½ plain Paratha 2 pc Dokhla ½ C Shrimp Fried Rice ½ C Chole 1 C plain Cucumber Salad Afternoon Snack 2 Vegetable Cutlets 4 Pakodas ½ C Lemonade Dinner 2 plain Pooris ½ C Chicken Tikka Masala ½ C Vegetable Biriyani ½ C Lauki Subji Snack ½ C drained Fruit Cocktail Sample Menu (80g protein)

Approximate Nutrition Analysis: Calories: 2396; Protein: 80.2g (14% of calories); Carbohydrate: 325g (54% of calories); Fat: 85g (32% of calories); Phosphorus: 968mg; Potassium: 2836mg; Sodium: 2400mg; Fluid: 1.1L.