Whole food plant based/vegan diet on dialyisis?

I was vegan in my pre-d days and vegetarian throughout my dialysis cycle. Began to eat animal protein post-tx due to protein needs.

Back in the day, a lot of the renal diet literature specifically pointed out vegetarian sources of protein as too high in potassium and phosphorus. I won’t deny it, it’s true. It takes a lot of juggling, math and meal planning to have a vegan or vegetarian diet with ESRD.

Times have changed though as renal dieticians look at the protein per phosphorus or potassium values these days too. So, a large serving of beef may have your typical protein needs, but, it may be higher in phosphorus than the vegetarian options.

While I understand that you are working with a nutritionist in regard to cardiac care, I ALWAYS put the word of my renal dietician ahead of any others. Full stop. Why? Not everyone knows the requirements of a dialysis patient and what could land one in the hospital. As such, I didn’t receive the best advice from my diabetic dieticians. So, anyway, discuss this plan with the one in charge of your renal nutrition and follow your numbers.

If your numbers are in good ranges, you are allowed servings of things like seitan (lower in potassium), cottage cheese, legumes like lentils and beans (find out which ones are lower than the other; cooking them reduces their potassium), tofu, heavy yogurts (but things like skyr and Greek are too high in phosphorus for my liking) and small servings of nut butters.

Ancient grains are often promoted but again, this does not take in consideration the potassium and phosphorus elements of the renal diet. You’ll have to have a good sit down with your renal dietician or a lot of research to see which ones can be added easily to your diet.

Kefir is a little higher in the potassium department but lower in phosphorus. I drank this a lot and made smoothies, with low potassium fruits, tossed in.

I was allowed two servings a week of whole grains such as brown rice and oatmeal. Cream of wheat offers more protein but is a middle-range potassium food so, I ate that instead.

If you plan on eating some of these higher potassium foods, make sure to adjust your fruit and vegetables intake. Such as, if you’re having beans, make a low potassium salad with red pepper, onion or scallions, and pineapple. Vinegar, herbs... done. Like I said before, a lot of balancing and thinking.

Tempeh is more acceptable these days in the renal world but to me, it’s still too high in the bad stuff to be acceptable.

Non-dairy milks are okay to drink. Some are higher in potassium and phosphorus than others (think of cashew). Coconut milk (the refrigerated kind, not in the canned cooking kind) seems best.

But that brings me to another point... non dairy products. I’d stay away from the non-dairy yogurts because they are mostly made with cultured coconut. And as a result, high in potassium.

As for non-dairy non-soy cheeses like Daiya, they are nice thoughts. Very low in phosphorus but equally low in protein. Really high in sodium. They can be used in moderation if you are craving something cheesy.

If you go vegan or vegetarian, you’ll hear a lot about adding in nutritional yeast. Just don’t: it’s high in phosphorus and potassium for adding in small amounts.

Another thing that kept me going but I don’t see them as widely available in stores in North America (except ethnic grocers) are plasma biscuits. They are iron supplements in cookie form and I ate a lot of those in Russia. Um, they aren’t a medical prescription thing but found in the cookie aisle. But yeah, they helped my protein too.

I agree with your dietician in that keeping lean fish and chicken, even turkey, is a wise decision. Prepare them in low fat manners too. I only learned this post-tx (as I was rigid in my diet before) that the added protein helps.

Good luck and if you have any questions, I’m available.