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Dining Out With Confidence

Dining out can be enjoyable even when you must follow a special diet. You simply
need to choose your foods more carefully. Before eating out, it is important to
understand your diet. If you have any questions, discuss them with your dietiti
Before Eating Out
Always try to follow your diet as closely as possible. Plan ahead. Ask your diet
itian for advice before you attend a special social function where food will be
When dining out, choosing the restaurant is critical. You may want to phone ahea
d to ask some questions about the menu. Restaurants that serve a wide variety of
foods make eating out easier.
Making Wise Menu Selections
When you arrive, study the menu while waiting to be seated. Before ordering, ask
your waitress/waiter questions to get more specific information about menu item
s. In this health and nutrition conscious age, restaurant personnel are accustom
ed to special requests for food items or preparation.
Suggestions for Eating in Specific Types of Restaurants
If you find yourself at a restaurant where few food choices are available, order
as carefully as possible. The following guidelines will help you with your deci
The key to successful dining out in an American restaurant is watching portion s
ize and limiting your selection of certain items. See sections on "Protein Contr
ol When Dining Out" and "A Menu Guide. "
Mexican foods frequently contain low quality protein and are high in sodium, pot
assium and phosphorus. It might be helpful to order from the a la carte menu. A
good food choice would be a taco with meat and lettuce and plain rice.
Typically, Italian sauces should be used in small quantities because they can be
high in sodium, phosphorus and potassium. Order the sauce on the side, if possi
ble, but be advised that many Italian restaurants already have their sauce and p
astas mixed. A good choice would be salad, bread and a very plain pasta, such as
garlic and butter. Pizza is usually salty and high in potassium and phosphorus.
If you eat pizza, eat one slice and supplement with a small salad. A pizza with
hamburger, green pepper and/or onions would be preferable to a pizza with peppe
roni, sausage, olives, anchovies and/or extra cheese.
Asian dishes usually consist of meat, fish or poultry combined with fresh vegeta
bles. This can make them high in potassium. Ask for your food to be cooked to or
der so that it may be prepared without soy sauce, fish sauce or monosodium gluta
mate (MSG), all of which contain a lot of sodium. Order plain rice; it is lower
in sodium than fried rice. Do not add soy sauce to prepared Chinese or Japanese
Fast Foods
Eating at fast-food restaurants is not totally out of the question. It does, how
ever, take some thought. While many fast-food items are presalted, you can ask t
hat yours have the salt and/or extra condiments left off. This may take a few ex
tra minutes of waiting time. French fries are high in potassium. You must know h
ow much potassium you are allowed if you choose this item. Unsalted onion rings
would be a better choice. Choose a small noncola soda rather than a milk shake o
r large soda. Many fast-food restaurants now have salad bars as an alternative.
See section on Salads/Salad Bars.
Protein Control When Dining Out
Protein control is a key factor when trying to stay within dietary protein limit
s. Become familiar with different meat portions by practicing weighing them at h
ome. You may want to request half portions of meat dishes, share a part of your
large portion with a dining companion, order a child's portion or ask for a 'dog

gie bag. " Watch starch and vegetable portions - they have some protein too!
Another good way to control protein is by ordering a la carte. You may choose to
make your meal from several appetizers instead of the typical "complete" dinner
menu offerings.
Avoid "hidden" proteins such as cheese or cream sauces, au gratin dishes, dishes
prepared with milk, nuts, dried beans or eggs.
A Menu Guide
Breakfast may be one of the easiest meals to eat out. Most restaurants offer a l
a carte style breakfast items.
* Choose: Eggs cooked to order; Omelets with low-potassium vegetables; toast, bi
scuits, bagels, English muffins, croissants with margarine, jelly, honey, cinnam
on and sugar; low-potassium fruit or juice; pancakes, waffles, French toast with
syrup; hot or cold cereals with nondairy creamer; donuts, Danish pastry, sweet
rolls, coffeecake without nuts.
* Avoid: Cured or salted meats or fish, ham, sausage, bacon, lox, Canadian bacon
; omelets with cheese or above meats; fast-food breakfast sandwiches; hash brown
ed potatoes; gravy; high-potassium fruits and juices; bran cereals, whole grain
cereals and muffins.
Cocktails and Beverages
When dining away from home, it is important to limit fluids. Many beverages you
choose when eating out may have high potassium and/or phosphorus content. This i
s especially important since the meal itself probably has a higher content of th
ese minerals than the meals you have at home. Request lemon wedges or crushed ic
e if you remain thirsty and ask the waiter not to refill your water glass. After
the meal, chew gum or suck on hard candies to avoid drinking too much fluid. Ha
ve the waiter remove your water glass to avoid the temptation.
* Choose: Cocktails mixed with low-sodium club soda, ginger ale or other noncola
soft drink; beer, wine in moderation; iced tea, coffee with no refills; lemonad
e; water.
* Avoid: Cocktails mixed with fruit juice, milk, cream or ice cream; cola soft d
rinks; high potassium juices such as prune, orange, grapefruit and tomato; cocoa
, milk, milk shakes; any fluid exceeding fluid restriction.
It is probably best to skip this course unless you are going to use it as a subs
titute for an entree item. Evaluate the protein content of the remainder of the
meal before you select high-protein appetizers like cottage cheese or seafood co
* Choose: Fruit cup (canned); fresh low potassium vegetables; clams, shrimp, cra
bmeat; lower potassium juices such as cranberry, grape, apple.
* Avoid: Soups; high potassium juices such as orange, grapefruit, prune; vegetab
le juices; potato skins; salted chips and crackers.
Salads/Salad Bars
Eating salads and selecting from salad bars IS possible once you understand your
diet. In fact, salads can be an excellent way to obtain sources of vitamins and
fiber as well as adding color and variety to your meal. Small tossed salads are
generally a good choice. Ask for the dressing on the side and use it sparingly.
Remember you can bring your own low-sodium dressing. You may want to mix your o
wn dressing at the restaurant by combining vinegar and oil (usual ratio 3:1) or
mix lemon with black pepper.
* Choose: Lettuce; carrots; radishes; cauliflower; green peppers; celery; onions
; cucumbers; green peas; beets; alfalfa sprouts; Chinese noodles; grated cheese
in moderation; coleslaw; macaroni salad; gelatin salads; cottage cheese; canned
peaches or pears; canned fruit cocktail; fresh grapes; fresh or canned pineapple
; small fresh peach.
* Avoid: Raw spinach; olives; pickles or bacon bits; tomatoes or mushrooms; broc
coli; kidney beans; chickpeas; seeds or nuts; croutons; potato salad; three bean
salad; olive salads; relishes and pickles; soups; dried fruit; fresh fruit sala
d; kiwi; melons; bananas; oranges.

Most entrees are prepared with salt. Ask that yours be prepared without salt or
other salted seasonings. Ask that sauces and gravies be served on the side inste
ad of over foods so that you can use them sparingly. Remove skin or crust from b
readed items to reduce sodium intake.
* Choose: Broiled or grilled steaks, burgers, chops, chicken, fish or seafood (s
easoned with fresh lemon); inner cut of prime rib or roast; omelets with vegetab
les; sandwiches with meat filling.
* Avoid: Casseroles and mixed dishes; sauces, gravies; heavily breaded or batter
ed items; cured or salted meats; omelets with cheese, ham, sausage or bacon.
Side Dishes
The kind of side dish you order depends on the amount of potassium you should ea
t each day. Fried, baked and hash-browned potatoes are higher in potassium than
mashed or boiled potatoes. You might also consider asking for a lower potassium
substitute like rice or noodles. If the cooked vegetable is not a good choice fo
r you, order a salad or ask for a substitute vegetable.
* Choose: Lower potassium vegetables such as green beans, corn, cabbage, asparag
us, green peas, eggplant, carrots, cauliflower, squash; plain rice, pastas, nood
* Avoid: Higher potassium vegetables such as spinach, potatoes, tomatoes, mushro
oms, winter squash; baked beans; sauerkraut; vegetables in sauces.
Since many of you are probably being advised to add calories to your diet, the d
essert course is a good time to treat yourself to something special. Remember, s
ome desserts, such as fruit ice, gelatin and sherbet must be counted as fluids.
If you have diabetes, check with your dietitians about which desserts you should
* Choose: Canned or allowed fresh fruit; sherbet, sorbet; plain cookies; plain c
akes; fruit pies with allowed fruits; gelatin; strawberry shortcake.
* Avoid: Desserts containing chocolate, nuts, coconut or dried fruit; cheesecake
; custard, puddings; high potassium fresh fruits; pies such as cream, minced, pu
mpkin, rhubarb and pecan; ice cream.
Your Phosphate Binder
Eating out is a great way to take a break from cooking. It should not be used as
an excuse for skipping your phosphate binders, however. To achieve good control
of your phosphorus level, which is so important for maintaining healthy bones,
you need to take your phosphate binder each time you eat. With a little planning
, this doesn't have to be a problem.
Plan to take your medication with you. For women carrying a large purse, this ma
y be as easy as dropping the bottle into your purse. However, more than likely,
you will prefer to take along a small container with just the pills you need. A
variety of pill boxes are available that slip easily into a pocket or small purs
e. If you are taking a liquid phosphate binder that might be difficult to carry,
ask your doctor about prescribing a 'pill' form to take with you when going out
to eat.
When you are away from home or are not following your usual routine, it is easie
r to forget to take your phosphate binder even if you bring it with you. This pr
oblem can also be overcome with a little planning. It may be helpful to make a h
abit of putting your pills at your place when you sit down for a meal. You may a
lso want to ask a companion to help you remember. A pill box with an alarm is an
other solution. Simply set the alarm for the time you plan to eat. Place your me
dication in your wallet - you will see it when you pay for your meal.
Updated: 11/03/05
Back to top
See also in this A-Z guide:
* Nutrition and Hemodialysis
* Nutrition and Chronic Kidney Disease
* Nutrition and Peritoneal Dialysis
* Nutrition and Transplantation
All health information in this A-Z Guide has been approved for medical accuracy
by the Scientific Advisory Board of the National Kidney Foundation. This informa

tion was current as of the date listed at the top of the page. Our Scientific Ad
visory Board members.
If you would like to become a volunteer and find out more about what's happening
where you live, contact your local NKF Affiliate.
If you would like more information, please contact us.
2007 National Kidney Foundation. All rights reserved. This material does not cons
titute medical advice. It is intended for informational purposes only. No one as
sociated with the National Kidney Foundation will answer medical questions via e
-mail. Please consult a physician for specific treatment recommendations.

Original Article:http://www.nlm.nih.gov/medlineplus/kidneydiseases.html
Renal diet for vegetarians: Choosing the right proteins
I have end-stage kidney failure, I must follow a special renal diet. How
ever, I am a vegetarian. What are the best sources of protein for someone like m
e who also needs to limit phosphorus and potassium?
The answer depends on what type of vegetarian you are. Following a proper renal
diet is extremely important in treating chronic kidney failure. Research shows t
hat a carefully planned vegetarian diet
or even part-time vegetarian eating
is n
ot only safe but beneficial in managing chronic kidney failure.
Although a renal diet restricts protein, you still need to eat some protein ever
y day while also limiting sodium, phosphorus and potassium. The chart below list
s the best protein sources according to which type of vegetarian diet you follow
. If you're a lacto-ovo vegetarian, you can also consider the vegan protein sour
ces. If you're a pesco-vegetarian, you can consider vegan and lacto-ovo vegetari
an protein sources, and so on.
Type protein
no animal
for renal
or any food derived from a living creature, such
milk or eggs)
Eggs butter
no more
than 2milk
and eggs)a day
or frozen
or reduced-sodium
fish, suchfish
in addition
to milk and eggs)
* Shellfish, such as clams, crabs, lobster or shrimp
* FreshAvoid
fish, which
is high
in addition
in sodium.
to dairy and eggs)
* Fresh turkey
Note: Avoid smoked chicken and turkey, which are high in sodium. Also, because f
resh poultry is often injected with sodium, look for "natural" on the label, whi
ch indicates
for kidney
no added
are tailored
or consult
to the
butcher. Figuring out what to ea
t and what not to eat can be tricky. Ask your doctor to refer you to a dietitian
who specializes in nutrition for people with chronic kidney disease. A dietitia
n can help you plan meals that fit your habits and preferences but also provide
the nutrition you need and avoid or limit foods that can cause problems.

By Mayo Clinic Staff

Nov 6, 2006
1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights
reserved. A single copy of these materials may be reprinted for noncommercial p
ersonal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Reli
able tools for healthier lives," "Enhance your life," and the triple-shield Mayo
Clinic logo are trademarks of Mayo Foundation for Medical Education and Researc



Vitamins and Minerals in Kidney Disease

Vitamins and minerals are important for everyone's good health. Now that you are
on dialysis, you will need to know which vitamins and minerals you can use in t
he form of supplements.
What are vitamins and minerals?
Vitamins and minerals are substances needed by your body to help carry out speci
al functions. They help your body use the foods you eat. They are needed to make
energy, promote growth and repair and replace many types of body tissues. Kidne
y disease changes your body's need for certain vitamins and minerals.
Will I need to take vitamin and mineral supplements?
Almost all vitamins and minerals come from the foods you eat. Your body does not
make these substances. Healthy people who can eat foods from all the food group
s eat a variety of meats, grains, fruits, vegetables and dairy products. Your ki
dney diet limits some food groups, and therefore, you may not be getting all the
vitamins and minerals you need each day. It may be important for you to take ce
rtain amounts of some vitamins and minerals in the form of supplements.
Why do I need different amounts of vitamins and minerals?
Kidney disease changes your need for some nutrients. Some of the reasons are lis
ted below:
* The poisons that build up in your body each day can change the way your body u
ses vitamins and minerals.
* Some of the medicines you take can also change the way your body uses certain
vitamins and minerals.
* Dialysis causes some vitamins to be lost during treatment.
* Following a CKD diet can mean you miss certain vitamins and minerals from some
food groups.
* Some days you may not feel well enough to eat a healthy diet. You may not get
enough vitamins and minerals that day.
* When you have kidney disease, certain substances cannot be made by your kidney
s anymore. Your need for certain vitamins and minerals changes.
* Certain vitamins and minerals are affected by the loss of kidney function.
What supplements will I need to take?
Your doctor will probably want you to take vitamin C and a group of vitamins cal
led B complex. Sometimes, your doctor may need to write a prescription for these
You may also need to take an iron pill or have iron given during your hemodialys
is treatment if you are taking EPO. You should only take iron if your doctor ord
ers it for you.
You will also take a calcium tablet used to bind the phosphorous from your food.
This serves to give you the extra calcium your body needs.
How does my body use these vitamins and minerals?
Vitamin C is used to keep many different types of tissue healthy. It also helps
wounds and bruises heal faster and may help prevent infections.
B complex vitamins are grouped together, but each has a different job to do. One
of the important functions of vitamin B6, B12 and folic acid is to work togethe
r with EPO and iron to prevent anemia.
Additional B vitamins, called thiamine, riboflavin, panthothenic acid and niacin
, can also be given as a supplement. These vitamins help to change the foods you
eat into energy your body can use.
Calcium along with vitamin D helps to keep your bones healthy. Vitamin D can be

given in a special pill form called vitamin D3. This vitamin can also be given d
uring your hemodialysis treatment so you do not have to take it in a pill form.
Either form has to be ordered by your doctor.
Talk with your doctor or dietitian before taking any vitamins that are not order
ed for you.
Is it safe to use herbal remedies?
Very little is actually known about these remedies. Some of them may actually be
harmful to dialysis patients. Always speak to your doctor before using any herb
al remedies, over-the-counter-medicines, or supplements.
What if I have more questions?
If you have more questions, be sure to speak to your kidney doctor or dietitian.
They can help you learn about your vitamins and mineral supplements. Your socia
l worker may be able to answer questions about how to pay for your supplements.
Sometimes, your insurance or medical assistance will pay for them. You can also
order a free copy of our brochure by calling 800 622-9010.
Updated: 09/22/05
Back to top
See also in this A-Z guide:
* Nutrition and Chronic Kidney Disease
* Nutrition and Transplantation
* What You Should Know About Good Nutrition
All health information in this A-Z Guide has been approved for medical accuracy
by the Scientific Advisory Board of the National Kidney Foundation. This informa
tion was current as of the date listed at the top of the page. Our Scientific Ad
visory Board members.
If you would like to become a volunteer and find out more about what's happening
where you live, contact your local NKF Affiliate.
If you would like more information, please contact us.
2007 National Kidney Foundation. All rights reserved. This material does not cons
titute medical advice. It is intended for informational purposes only. No one as
sociated with the National Kidney Foundation will answer medical questions via e
-mail. Please consult a physician for specific treatment recommendations.