Milk Alternatives for People with Chronic Kidney Disease

[okarol]

Milk Alternatives for People with Chronic Kidney Disease
By DaVita® Dietitian Chien-Wei Kung, RD

“got milk?®” This phrase --- developed by the California Milk Processor Board --- has become one of the most recognized slogans in advertising history. The popular campaign for increasing consumption of dairy started in the 1990s and has featured numerous celebrities and cultural icons crediting milk for their strong bones and muscle health.
Yet people with chronic kidney disease (CKD) have to limit dairy product intake in their kidney diet. Eight ounces of low-fat milk contains 8 grams of protein, 230 mg of phosphorus, 366 mg of potassium and 290 mg of calcium. The high levels of these minerals are not good for someone trying to adhere to a kidney diet.
People with CKD are urged by their dietitian to limit consumption of dairy products, usually to half a cup of milk, half a cup of yogurt or one ounce of cheese per day. People considering low-fat milk as a better option may be surprised to learn that it is actually less kidney-friendly than the high-fat counterparts, because low-fat milk contains higher levels of potassium and phosphorus.
But isn’t milk good for my bones?
Bones are mostly made of calcium and phosphorus. When kidneys function well, they are able to keep these two minerals in balance in the blood and bones. However, kidney disease causes this process to become dysfunctional:
Excess phosphorus cannot be excreted by the kidneys and builds up in the blood
Kidneys no longer activate Vitamin D which affects the ability to absorb calcium from food eaten
Low blood calcium levels cause calcium (and phosphorus) to be released from the bones, weakening them over time
Increased phosphorus in the blood combines with calcium, causing calcifications elsewhere in the body and decreasing amount of blood calcium
More calcium (and phosphorus) is released from the bones and a vicious cycle is initiated
Despite milk’s calcium content, its high phosphorus content may actually weaken bones.
There is calcium in both hemodialysis and peritoneal dialysis (PD) solutions, so patients receive some of their daily calcium requirements with their dialysis treatments. In addition, some phosphate binders also contain calcium. Therefore, it is unusual for a dialysis patient to get insufficient amounts of calcium.
Are there any alternatives to milk if I have kidney disease?
Yes. In recent years, the number of alternative milk choices in the market has grown significantly. Soy milk and nondairy creamer can be found in most grocery stores, while products such as rice milk and almond milk have also gained in popularity. However, some of these products do contain significant amounts of potassium and/or phosphorus. It is important to check the label for additives containing these nutrients.
What should I consider in choosing a milk alternative?
Calcium, phosphorus, potassium and protein content should all be considered when choosing a milk alternative. Your dietitian can help you determine which milk alternative is right for your diet. Unfortunately, only calcium and protein are usually listed on food labels. The amount of phosphorus and potassium in the product are not often included in the nutrition facts. However, DaVita has developed the Food Analyzer, a database that details nutrients in many foods you eat, including potassium and phosphorus. The ingredient list often gives clues to help when selecting a milk alternative. Products with phosphate additives or fortified with calcium would not be the best choices.
It is also important to be aware that product formulas can change. One brand of soy milk that is low in phosphorus may be fortified with phosphorus the following year. Even within the same brands, different flavors can have varied amounts of phosphorus, calcium and potassium. It often helps to contact the company directly to get the most current nutritional information. Here are some milk alternatives that people with kidney disease may consider using in their diets:
Rice milk
Rice Dream® Rice Drink Original Classic
Rice Dream Rice Drink Vanilla Classic
Nondairy creamer
Nestle® Coffee-Mate®, Original Fat Free
Nestle CoffeeMate Original Low Fat
Nestle CoffeMate Original
Rich’s® Coffee Rich®, Regular and Fat Free
Mocha Mix® Original
Soy milk
Edensoy® Light Vanilla Soy Milk
Edensoy Light Original Soy Milk
PacificTM Select Soy Low Fat Plain
Pacific Select Soy  Low Fat Vanilla
Almond milk
Almond Breeze®, Unsweetened Original
Almond Breeze, Unsweetened Vanilla
Pacific Organic Almond Unsweetened Low Fat Original
Pacific Organic Almond Unsweetened Low Fat Vanilla
Pacific Organic Almond Original
Pacific Organic Almond Vanilla
What types of meals can I make with my milk alternatives?
Many recipes call for milk as a key ingredient. DaVita.com has a wealth of recipes that can help a person make kidney-friendly meals with alternative milk products. Here are some yummy choices:
Breakfast
Baked French Toast Custard
Beach Boy Omelet
Jackie’s Corn Bread Muffins
Lunch
Hearty Chicken Soup
Nevada’s Best Tangy Coleslaw
Zucchini Casserole
Dinner
Chicken and Apple Curry
Easy Shepherd’s Pie
Ranch Chicken Pasta
Dessert
Apple Crisp
Slow Cooker Mixed Fruit Pudding
Warm Bread Pudding
Beverages
Hazelnut Cinnamon Coffee
High Protein Berry Shake
Spiced Eggnog
Summary
Although regular milk contains high amounts of phosphorus, potassium and calcium, that doesn’t mean people with kidney disease can’t enjoy the various substitutes for it. Milk alternatives, such as rice milk, nondairy creamer, soy milk and others, are available so that people who have health issues don’t have to give up milk altogether.

http://www.davita.com/kidney-disease/diet-and-nutrition/lifestyle/milk-alternatives-for-people-with-chronic-kidney-disease/e/6809

[MooseMom]

Almond milk?  Milk made from nuts?  I thought nuts were to be avoided.  This doesn't make sense to me.

I don't use milk other than on breakfast cereals, and I've never used much milk even in that instance.  So I've just been using regular milk, but I'm happy to try other types of milk (although I don't like soy milk as it is too sweet).  For those of you who use a milk-substitute on cereal, what do you recommend that's not too sweet or gross?

Tell me more about non-dairy creamers, please.  I use a bit of half and half in coffee, but I drink maybe 2 cups of coffee a week at most.  Not really an issue, but I am interested in cutting back milk whenever I can.  I always assumed that non-dairy creamers were chock full of chemicals I'd rather avoid.

[greg10]

Almond milk?  Milk made from nuts?  I thought nuts were to be avoided.  This doesn't make sense to me...

Tell me more about non-dairy creamers, please...

I think we had a discussion on this topic a week ago.  The conclusion was that you really need to read the product labels and understand the nutritional information of each product.  Most commercial preparation of "milk" from nuts, rice, soy or whey are actually reconstituted protein fractions from their respective starting product.  So that rice or soy milk was probably precipitated and filtered or ion-exchange columned isolates of proteins.  In that regard, a lot of the minerals and sugars have all been removed.  That is why generally the sodium, potassium, phosphorus, lactose and other sugars are minimally present and therefore the protein isolates are fairly safe for consumption for someone with ESRD, assuming the patient has some way to get rid of the digested protein waste products such as urea.  What is shown below is a picture of how whey protein isolates are made.

As to non-dairy creamers, I would personally stay away from them because they were usually made by hydrogenation of palm oil and there are not that many redeeming qualities about hydrogenated oil or palm oil.

[Zach]

In addition to what Greg10 posted, not all of the "non-dairy" creamers are still non-dairy.
http://foodallergies.about.com/od/dairy/qt/milkfreediet.htm

Rich's (the first non-dairy creamer) is most likely still non-dairy.  You'll find it in the frozen food isle.

I'd just stick to half and half, or better yet, just use a little cream.  It tastes better, too!

Even Cool Whip is no longer "non dairy." 

[MooseMom]

Yeah, Zach...sometimes it's just easier to cut out a foodstuff entirely than to faff about trying to find a suitable alternative.  Since I don't really use milk anymore, I'll just continue to use my 1/2 cup a day allowed on my cereal and be done with it.

My apologies, greg10, for bringing up a redundant topic; I had not realized this discussion had already taken place.

[tyefly]

I love the info.....