Our Dietitian's blog

June Martin is a Registered Dietitian who has been working with PD, Hemodialysis and CKD patients for over 10 years at Grand River Hospital in Kitchener, On. She is currently the Chair of the Canadian Association of Nephrology Dietitians and was part of the team behind "Spice It Up!", a series of cookbooks for CKD patients. June has two small children and regularly volunteers at their school.

You can contact June at blogs@kidney.ca.

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Planning for a Happy and Healthy Holiday Season!

The holidays are right around the corner and whether you’ve already started planning, shopping and wrapping or you leave it all to the end, we wanted to give you some strategies to manage your kidney diet over the holidays. Holidays

Somehow holidays and celebrations always seem to centre around food and holiday meals are an important time of sharing with family and friends. So when it comes to getting through the holidays without any medical problems, the key is to plan ahead!

  1. Start by making lists of all of your favourite holiday foods and circle all the ones you know are kidney-friendly. Highlighting all the things that you CAN have is a great way to get started (turkey and cranberries always top my list!) The ones that you’re not too sure about are great to discuss with your renal dietitian. She may have recipes or tips on how to adapt your recipes or how to make those foods safe for you.

  2. If you’re hosting a family meal, plan ahead to ensure that you have a selection of kidney-friendly foods available to you. It’s easier to stick to your diet when you have kidney-friendly, delicious foods at hand! Put out bowls of low sodium crackers or corn chips instead of potato chips or salted nuts. Make sure that a cookie tray or plate of desserts includes low potassium and low sodium options like lemon squares, shortbread, and festive sugar cookies. Bowls of fresh fruit like red and green grapes or apples are festive-looking and healthy options for everyone, especially those with diabetes. You might be surprised to find that others are looking for healthy options. Check out www.kidneycommunitykitchen.ca and www.myspiceitup.ca for wonderful, kidney-friendly recipes.

  3. When you’re the guest at a holiday function it can be a bit trickier to follow your kidney diet. If you can, bring along a dish or two that you know you’ll enjoy and choose only small portions of the items you’re not too sure about.

And if you are hosting someone with kidney disease don’t be afraid to ask in advance about diet restrictions. Another great option is to make little recipe cards to put out on a buffet table – your guests will know what’s in the food they’re eating (and they may want to steal your recipe too!)

Here’s a fabulous and festive dish to take to a holiday event – it’s as pretty as it is fresh and tasty! 

Christmas Cabbage Salad (12 portions)

2 cups cauliflower florets
1 carrot, shredded
1 cup green onions
12 cups red and green cabbage, shredded or chopped ½ cup fresh parsley, chopped

For the dressing:
¾ cup apple cider vinegar
⅓ cup canola oil
2 tsp dried basil
1 tsp fresh ground pepper (or to taste)

In a pot of boiling water, cook the cauliflower for 2-3 minutes until tender-crisp. Drain and cool right away under cold water. Toss with the rest of the vegetables. Combine dressing ingredients in a small saucepan and bring to a boil. Pour over the salad and toss well. Cover and marinate in your refrigerator for at least 2 hours or overnight.

Spotlight on phosphorus: the nutrition facts table’s missing mineral

By Emily Robins, Dietetic Intern, Grand River Hospital – Kitchener, ON

Over the past four weeks I have had the opportunity to intern under the supervision of June Martin, Registered Dietitian for the Grand River Regional Renal Program. I have spent most of my time here working with patients in the hemodialysis unit, assessing their nutritional status and providing nutrition intervention and counselling as needed.

As a student I learned that one of the functions of the kidneys is to remove extra phosphorus (an essential mineral that occurs naturally in our food, water, and bodies) from our blood and excrete it in our urine. Some phosphorus is required for growth, maintenance, and repair of all body tissues, as well as healthy bone formation and growth. But for someone with chronic kidney disease, having too much phosphorus in their blood for a long time, can make their bones weak, and cause minerals to build up in places they shouldn’t, like the heart, blood vessels, lungs, skin, and joints. Large amounts of phosphorus in the blood are also strongly linked with cardiovascular diseases and events, and death, in persons with or without chronic kidney disease1

Although normally our kidneys do a good job of removing extra phosphorus from our blood, sick or damaged kidneys aren’t so great at it. This can mean that for someone with chronic kidney disease the total amount of phosphorus in his or her blood may rise above what is normal. One of the best ways to prevent this from happening is by following a low phosphorus diet, as prescribed by your Registered Dietitian.

As a student, the idea of a low phosphorus diet didn’t seem like such a big deal. As an intern, where I tell real people to follow real diet advice, I have learned this can be quite tricky.

There are two main sources of phosphorous in our food: organic and inorganic. Organic phosphorus is found mainly in animal and plant-based protein foods like chicken, egg yolk, milk, lentils, and nuts, while inorganic phosphorus refers to phosphorus contained in food additives2. Phosphorus additives are used in a variety of food products including breads, cereals, dairy products, pasta, meats, seafood, and canned fruits and vegetables3 to improve the appearance, texture, and shelf life of the food product4.

Although animal and plant-based protein foods are abundant in organic phosphorus, our bodies only absorb about sixty-percent of naturally occurring phosphorus from animal sources, and less than forty-percent from plant sources2,5. When it comes to inorganic phosphorus from food additives however, we absorb almost one hundred percent of what we take in2,5.

The need for phosphorus on food labels
One of the real challenges of following a low phosphorous diet is that neither naturally occurring nor added phosphorus is reported on the Nutrition Facts Table. This creates several problems. First, because it is not commonly known that some food additives contain phosphorus, patients with chronic kidney disease may be eating large amounts of phosphorus without even knowing it! Second, if patients don’t know that they are eating foods with added phosphorus, it’s less likely that these foods will be identified as problematic during a diet recall or interview, which may result in a less accurate nutrition assessment and missed teaching opportunities.

Lastly, while checking the ingredients list for phosphorus additives is a good place to start, it can be a discouraging task. Ingredients lists are long, the print is small, and they still don’t tell us how much phosphorus is in a food product. From an educational perspective, knowing the amount of phosphorus in a food product − both organic and inorganic − would make it easier for patients to choose which phosphorous-containing foods are better food choices than others, and paint a clearer picture of how certain foods fit into their total intake for one day.

Life for dialysis patients is difficult for many reasons including tight diet restrictions, poor appetite, and lack of energy to cook. Having this information available at point-of-purchase would make it that much easier for patients to stick with their renal diet. Complete avoidance of processed or convenience foods is difficult for anyone, but especially for the dialysis population. Having the amount of phosphorus on the nutrition facts table would empower patients to make better food choices within their means.

Take home messages
International and national authorities should devote more attention to including the amount of natural or added phosphorus in a food product on the nutrition facts table.

For now, here’s what you can do to limit your phosphorus intake:

  1. Check the ingredients list: look for ingredients with the word “phosphorus” or “phos” in them. Limit or avoid these food products.
  2. Limit your intake of processed foods: not only do processed foods contain phosphorus additives, but they are often quite high in salt, and provide less nutritional value than a diet built around whole foods. Limiting processed foods is a good rule for anyone!

Looking for new recipes?  Ask your dietitian about the newest recipes on Spice It Up! or check out www.renalrd.ca for information about a new, patient friendly cookbook.

1. Leon, J., Sullivan, C., & Sehgal, A. (2013). The prevalence of phosphorus containing food additives in top selling foods in grocery stores. Journal of Renal Nutrition. 23(4), 265-270. doi: 10.1053/j.jrn.2012.12.003
2. Noori, N., Sims, J., Kopple, J., Shah, A., Colman, S., Shinaberger, C., Bross, R., Mehrotra, S., Kovesdy, C., & Kalantar-Zadeh, K. (2010). Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iranian Journal of Kidney Diseases. 4(2), 89-100. 
3. International Food Additives Council. (2015). Phosphates. Retrieved from: http://www.foodadditives.org/phosphates/phosphates_used_in_food.html
4. Benini, O., D’Alessandro, C., Gianfaldoni, D., & Cupisti, A. (2011). Extra phosphate load from food additives in commonly eaten foods: a real and insidious danger for renal patients. Journal of Renal Nutrition. 21(4), 303-308. doi:10.1053/j.jrn.2010.06.021 
5. D’Alessandro, C., Piccoli, G., & Cupisti, A. (2015). The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients. BMC Nephrology. 16(9), 1-6. doi:10.1186/1471-2369-16-9

A happy and healthy holiday season!

As the holidays draw ever nearer (and my list of things to do seems to get longer) food is constantly on my mind!  What to cook, when to cook, how much to cook and of course trying to make everyone happy.   And I don't even have to worry about a renal diet! So to make life seem more manageable I try to make lists and do some of the food prep in advance.  While it's never quite as smooth as I would like, I am always very happy when I am able to pull a quick meal out of the freezer or have all of my ingredients at hand!

The holidays can be challenging on a renal diet, especially when you're eating at someone else's home and aren't always certain what's in the food you're being served. Here are a few strategies you can use to make the holidays a bit more smooth.

  • make a list (check it twice) of the meals you'll be cooking and the ingredients you will need; this can save time and money
  • offer to bring something and plan on a dish that is kidney-friendly that you know you enjoy 
  • ask about the menu in advance; if there's something you aren't sure about you can ask your dietitian before you go
  • make it a "recipe potluck"; suggest everyone brings enough copies of the recipes for the items they bring to share. Everyone gets to take home new recipes (a great memento of a holiday get-together) and you get to scan all the recipes to make sure you know what you're eating!
  • watch your portions; keep servings small and avoid going back for seconds - eat slowly and join in the conversation!
  • don't be too polite; don't feel you need to clean your plate or try some of everything, especially if the food doesn't fit well into your kidney diet
  • avoid the "extras"; condiments and sauces such as, gravies, pickles, olives, cheese, nuts etc - all of these "extras" can be sources of salt, phosphorus, or potassium
  • avoid skipping meals; if you're starving you will be much more likely to overeat!

Turkey breasts with apple chutney

Condiments, gravies and sauces are often a source of potassium and sodium.  Check out this recipe from Spice It Up! for a fabulous apple and onion chutney.  You can make this ahead and serve it alongside your turkey and it's terrific on sandwiches. And your house will smell amazing while it's cooking.

Apple and onion chutney: www.myspiceitup.ca/recipes/recipe39.pdf

Wishing you a happy and healthy holiday and a wonderful 2015!

Respect the renal diet!

Every once in a while I hear something that really sticks with me. Today I met with a lovely patient who has been following some sort of renal diet for the last seven years. She expressed to me how frustrating it is when people give her “healthy” diet advice while critiquing her food choices.  Limiting dairy and choosing white bread might seem strange to others but for this patient, they were an important strategy for keeping healthy.  She told me that one day she finally said: “Respect the renal diet and I’ll respect your healthy diet!”  I have never heard anyone put it this way before but I loved it!

It’s easy to get caught up in the latest diet craze or be swept away by the latest nutrition study that seems to negate all studies before it!  In truth, many studies are not strong enough to warrant many of the headlines. And somehow, with nutrition, everyone feels qualified to give advice.  I have been confidently told that a mushroom has more protein than a piece of steak (it doesn’t) but the person sounded so certain that I couldn’t feel comfortable until I looked it up. To make things even more confusing, we are all overwhelmed by advertising with “healthy” claims or healthy sounding names. “Low in sodium” is easily confused with “lower in sodium”.  No wonder people are confused when it comes to nutrition.What it really comes down to is that everyone’s needs are a bit different so it’s okay if they eat differently! Of course you need to find something that you enjoy.  Try these curried shrimp salad rolls as an interesting lunch option or make extras, slice in half and serve as appetizers with the vinaigrette. They are a fantastic, light alternative to traditional spring rolls.

Speaking of spring rolls, check out this great new resource for Chinese renal patients and for those who love Chinese foods! The cookbook "Eating Healthy for Life" features renal friendly versions of classic Chinese recipes.  You can access it on our Brochures page under Nutrition at http://www.kidney.ca/brochures

Curried Shrimp Salad Rolls
(Per roll)
4 shrimp
1tsp curry paste (or 1 tsp oil + 1 tsp curry powder)
2 peach slices
Basil, cilantro (to taste)
Rice Paper

Spicy Garlic-Ginger Vinaigrette
1 ½ cloves garlic
1 tbsp fresh ginger
¼ tsp crushed red chilis
½ cup rice vinegar
¼ cup olive oil

Sauté shrimp in curry paste.  Set aside to cool.  Soak rice paper in warm water.  Place rice paper on towel to absorb some of the moisture.  Line rice paper with shrimp, thai basil, cilantro, peach slices, and a chiffonade of lettuce.  Roll securely. Process all vinaigrette ingredients in a blender and serve with the rolls.

Developed by Chef Leslie Cairns

Is there a banana hiding in your sandwich?

There aren’t too many “nutrition emergencies” in the hospital setting. But when a patient has a critically high potassium level they shoot to the top of our must-see list.  Potassium, which is an important nutrient for most people, can become dangerously high in kidney patients and can lead to serious and immediate complications, including a heart attack if high enough. 

Last week, one of my patients developed a high potassium level which was pretty unusual for her, since she is very well informed about her kidney diet. Her doctor ordered a repeat test and sure enough it came back critically high again.  This individual lives in a retirement home and assured me that there were absolutely no changes to her diet.  We went through all the foods she’d been eating and the only difference was that she mentioned she was getting more sandwiches than usual and wasn’t crazy about the low sodium deli-meat.  This was truly an “aha” moment for me and I immediately contacted the manager at her retirement home.  Sure enough – all of their new, low sodium deli meats were treated with potassium lactate and potassium chloride!

I’ve written about potassium additives before and talked about the potential dangers in using meats and meat products with potassium lactate but this is the first time I’ve seen a critical event that is clearly caused by consuming these meats.  Just three slices of this deli meat provides more potassium than a banana!

It’s hard to predict how prevalent these additives will become but my patient’s story is an important lesson:  If you aren’t preparing your own meals or shopping for the ingredients make sure to ask questions!  As for us?  When our patients move to any care facilities we’ll be sure to address this!

Check out these guidelines for cooking a roast beef to make your own sandwich meat:

And then try out this fantastic recipe from the Kidney Community Kitchen:

Grilled Beef Steak Sandwich with Melted Onions
3 tbsp (45 mL) olive oil
2 tbsp (30 mL) red wine vinegar
4 cloves garlic, minced
½ tsp (2 mL) hot pepper flakes
1 lb (500 g) Beef inside round or Sirloin tip marinating steak/medallions
1 sweet onion, sliced
1 baguette, white, quartered and halved lengthwise
½ bunch arugula, trimmed

1.  Combine 2 tbsp oil, vinegar, garlic and hot pepper flakes in sealable freezer bag. Set aside 2 tbsp of marinade. Using fork, pierce meat all over; add to marinade in bag. Refrigerate for 8 to 12 hours.

2.  Remove steak from bag. Discard used marinade. Grill steak over medium-high heat, about 3 to 4 minutes per side for medium-rare. Let steak rest on carving board for 10 minutes.

3.  Meanwhile, pan-fry onion in remaining oil over medium heat in non-stick skillet for 10 minutes or until softened and golden. Toss with reserved marinade.

4.  Slice steak thinly on the diagonal. Drape slices of steak on each baguette bottom piece. Top each with warm onions and arugula.

For nutrition information:


Savour Summer with New Recipes!

After a long, cold winter it is time to enjoy the warm weather and the wonderful, fresh foods that come along with that. Whether it’s blueberries, raspberries or fresh lettuce right out of your garden, the summer seems to make everything taste better! 

I’m excited to announce that there are ten beautiful and delicious new recipes available at www.myspiceitup.ca to celebrate the 10th issue of the Spice It Up! series of cookbooks. Next time you’re having a barbeque check out the Salmon Sliders with Balsamic Onions! My personal favourite is the Turkey Lasagna (make 2 and freeze 1). This was a big hit at my house! Check out the website for articles and recipes from all 10 of the cookbooks. 

In my last blog post I encouraged everyone to give feedback on food labels for a public consultation that was done by Health Canada. The new food label that is being proposed will include potassium (great news for those on a low or high potassium diet) but not phosphorus (bad news for people with kidney disease).

More consultation is underway and you can give feedback on the new proposed food label at:


Happy Summer!

Have your say!

As if the kidney diet isn’t already complicated enough, there is a new food additive to watch for and avoid (for those on a restricted potassium diet).  I’ve written a fair amount about phosphate food additives which should be avoided by everyone who has or is at risk for chronic kidney disease.  But there’s a new additive that has been approved by Health Canada for use in meat and meat products.  It’s called potassium lactate and it is a serious concern for kidney patients.  And there is currently no requirement for food companies to disclose how much potassium is in a product.

Historically, meat hasn’t been on our radar when looking at a potassium restriction but that is about to change. This new preservative can triple the potassium content of deli meat!  Three slices of oven roasted turkey breast (which should only contain about 200mg of potassium naturally) now rings in at 730mg!!!  This is especially challenging for patients who are trying to follow a high protein diet!

In fact, Health Canada estimates that “the additional dietary intake of potassium per person on a daily basis would be up to 2471mg potassium per day”. This could exceed the daily potassium requirements for many individuals on a potassium restriction.

The Kidney Foundation is advocating for mandatory labelling of key nutrients, potassium and phosphorus, to allow those with kidney disease to make informed choices about their food, nutrition and health.

Visit this page on our website and follow the link to have your say about which nutrients should be on a food label!

Looking for a great low potassium, low phosphorus, low sodium recipe? Check this one out, compliments of Alisha Groot-Nibbelink, a nutrition student from London Ontario:

Turkey Bowtie Pasta (4 portions)
For the pasta:
4 cups cooked bowtie pasta
1 lb ground turkey
1 cup cubed zucchini
1 cup raw mushrooms
1 red pepper sliced
Black pepper to taste

For the sauce:
5 tbsp margarine
1 tsp garlic powder
4 tbsp white flour
2 cups hot water
4 tbsp sour cream
1 tsp lemon juice
¼ tsp ground red pepper flakes
1 tsp Mrs. Dash

Direction for the sauce:  Melt the margarine in a small saucepan on medium heat. Add the flour while continuously stirring. Immediately add some hot water, and then slowly add the rest of the hot water as the mixture thickens. Add the sour cream and stir well to mix. Add the lemon juice, ground red pepper flakes, Mrs. Dash, and garlic powder and stir continually for 1-3 minutes. Remove from heat and continue to stir as the sauce cools (2 minutes).

Direction for the pasta:  Boil water without salt, then add bowtie pasta and cook according to package directions. Thoroughly cook the ground turkey in a pan (internal temperature of 74 C). In a large pan, sauté the zucchini and mushrooms until soft. Add the sliced pepper to warm, but not soften them. Add the sauce, ground turkey and pasta to the vegetables and stir well. Add black pepper to taste and serve.

What you see may not be what you get!

Vitamins, minerals and herbal supplements are a big business in Canada. Many people take vitamin supplements as a bit of an “insurance policy” just in case their diet isn’t quite as good as it should be.  Or sometimes just because they think it might do some good and probably won’t do any harm.  Others use herbals and supplements to cure or prevent disease.  But there is little science to support the routine use of supplements and now a recent study from the University of Guelph shows some pretty shocking data about supplements.

Researchers looked at 44 different herbal products and used DNA barcoding to authenticate these products.  What they found? Over half of the products contained DNA barcodes from plants that weren’t listed on the labels. Many products contained contaminants or substitutions. The authors identified that some of these contaminants could be harmful or dangerous to consumers. And 30 of the 44 products had product substitution (that means that the main herbal ingredient was substituted with a different product). See the article here: http://www.biomedcentral.com/1741-7015/11/222

Kidney patients have even more reason than most to be cautious when considering herbal supplements. There are very few studies looking at herbal products in CKD patients. What might be harmless for someone with healthy kidneys can lead to a build-up of waste products in a CKD patient and some herbs may be toxic to the kidneys. Unfortunately, herbal products in Canada are not regulated so (as shown in the study above) the safety, purity and effectiveness of these products is highly questionable. A big concern with supplements is that they may interact with prescription medications. This is especially dangerous for transplant recipients. And even if you are taking an herbal product that is known to be safe in kidney disease, you have no way of knowing if your product actually contains what it’s supposed to!

Based on this, I generally recommend avoiding herbal products in CKD. If you decide to take an herbal supplement anyway, make sure to talk it over with your kidney health care team – your doctor, dietitian and pharmacist. For vitamins – read carefully!  Often, products contain potassium, phosphorus that can really add up! 

The National Kidney Foundation in the US has a great kidney-specific resource on herbal products: http://www.kidney.org/atoz/content/herbalsupp.cfm

Here’s a great recipe to help you warm up this winter!

Cauliflower Apple Soup with Roasted Garlic Crostini (12 portions*)
1 head cauliflower, chopped into small florets
1 cup yellow onion, diced
1 cup apple, diced
2 cloves garlic, minced
1 teaspoon sage
1 teaspoon thyme
1 teaspoon rosemary
1/2 teaspoon ground black pepper
6 cups chicken stock
1 head of garlic
1 teaspoon olive oil
12 baguette slices

To make the roasted garlic crostini, preheat the oven to 350F.  Slice the tips off the whole garlic head and drizzle with olive oil.  Wrap the garlic in aluminum foil and roast in oven for 30 minutes.  While the garlic is roasting, place baguette slices on a baking sheet.  Toast in oven for approximately 10 minutes.  Once the garlic has finished roasting and has cooled slightly, squeeze out the softened    garlic cloves and spread onto the toasted baguette slices.

To make the soup, add the vegetables, dry spices, and chicken stock into a large sauce pan.  Bring soup to a boil.  Reduce heat and simmer for approximately 30 minutes or until the vegetables have softened and the flavours have developed.  With a hand blender, puree the soup until smooth.  Garnish the soup with a roasted garlic crostini and enjoy.

* Renal exchange:  1 Veg, 1 Starch
Diabetic exchange: 1 Carb choice

Nutrient Analysis per Serving
Calories 82Kcal       Total Fat 1g
Proteins 3g   Sodium 124mg
Carbohydrates 15g   Potassium 231mg
Fibre 2g   Phosphorus 64mg





'Tis the season...

… for getting together with family and friends and celebrating the holiday. Christmas get-togethers always end up being about the food and as I plan for my own Christmas celebrations I always start with the menu! I’ve been told by my patients that following the renal diet over the holidays is extra difficult, whether it is because you’re eating out and can’t control the food or because Christmas just isn’t Christmas without nuts and chocolate! 

It’s funny how our holiday traditions often center around food and when I think of Christmas from my childhood it is the smell of turkey I think of most of all. For renal-friendly holiday dinner ideas take a look at last year’s Holiday Suggestions and Sample Menu:

Holiday Suggestions
Sample Menu

For many, Christmas day begins with a big brunch! Unfortunately many traditional brunch items (ham, sausage, bacon) are not great choices for a kidney patient so here are some quick and delicious recipes for a festive holiday brunch. The mini Yorkshire puddings with roast beef are so easy and tasty – if you’re tired of sandwiches these are for you (and you won’t miss the processed meats)! The Apple Cranberry Cake is a simple recipe that can be sliced into wedges and served alongside the more traditional shortbread and sugar cookies.

I wish all of you a happy and healthy holiday season!

Mushroom and Egg Pie (8 servings)
9" pre-made pastry shell
8-10 eggs (depending on depth of shell)
½ cup sautéed mushrooms
½ cup sautéed leeks
1 tbsp olive oil
2 tbsp grated parmesan cheese
black pepper
fresh thyme

Preheat oven to 350°F. Rinse leeks well to remove sand. Chop. Sauté mushrooms and leeks in 1 tbsp olive oil. Season with fresh thyme and black pepper. Sprinkle mushrooms and onions in bottom of pastry shell. Whisk together eggs and cheese and pour over mushroom mixture. Bake for approximately 30 minutes until set.

1 serving = 1 protein, ½ starch, 2 fat


  • Use peppers in place of mushrooms
  • Make in tart shells for a snack or appetizer

Mini Yorkshire Puddings with Roast Beef
Choose whichever beef roast appeals to you. An “oven roast” works best. If you want a truly spectacular result try tenderloin. Rub roast with your favourite fresh herbs and coarsely ground black peppercorns.  Roast beef at 350°F for approximately 20 minutes per pound for a medium doneness. The roast will continue to cook slightly after it has been removed from the oven. Tent with aluminum foil until ready to slice and serve.

Yorkshire Pudding (24 mini puddings or 12 regular)
1 cup all purpose flour
1 cup milk
2 eggs
vegetable oil

Mix the first three ingredients with hand blender until smooth. Refrigerate mixture for 30 minutes. Preheat oven to 425°F. Fill bottom of muffin tins with vegetable oil (just enough to cover the bottom). Heat in oven for approximately 10 minutes or until oil is starts smoking. Fill muffin tins 3/4 full with yorkie mixture. Bake until golden..... approximately 15 minutes. Serve hot topped with a slice of beef and a dollop of mustard or horseradish.

2 yorkies = 1 protein, 1 starch
1 ounce beef = 1 protein

Serving Suggestion:
Thinly sliced roast beef plus a dollop of Dijon mustard on top of the yorkie makes a great sandwich! Makes a great low potassium alternative to potatoes

Apple-Cranberry Cake (serves 12)
1/3 cup butter
3/4 cup sugar
2 eggs
1 1/2 cup all purpose flour    
1 1/2 tsp baking soda
zest of 1 lemon
2/3 cup yogurt (plain)
1 cup cranberries (fresh or frozen)
2 apples (peeled and sliced)
1/2 cup brown sugar
1 1/2 tsp cinnamon

Preheat oven to 350°F. Line a 10" cake pan with parchment. Beat butter and sugar together. Add eggs one at a time. Alternate adding sifted dry ingredients and yogurt. Spread half of batter in cake pan. Arrange cranberries on top and sprinkle with brown sugar and cinnamon. Spread remaining batter over top. Arrange apple slices and sprinkle with brown sugar and cinnamon. Bake for 50-60 minutes.

Recipe developed by Chef Leslie Cairns


My September Resolutions

September always feels more like New Year to me than January!  With the kids going back to school and a new group of dietetic interns starting at our hospital, I always find this is the time of year I make resolutions about food!  Last year, I decided to get my kids more involved in making meals (very messy). This year, I’ve decided to do a better job with packing lunches – my own!

Packing a lunch or healthy snack can feel like a chore. But the alternative can leave you with no option except for eating out. This can be especially tricky for kidney patients who are on restrictive diets. And unfortunately the option in most hospitals looks a lot like fast food and is often expensive! While I wish that every health care centre and hospital would offer inexpensive, low sodium, healthy menu options that could easily fit into a kidney diet that just isn’t our current reality.

So what to do?

  1. Plan ahead – make a list of snacks and meals that are portable and easy to eat. Do your grocery shopping with this in mind. If you go to dialysis 3 times per week, make sure you have what you need on hand for each treatment.
  2. Use your freezer – try making muffins and loaves that can be frozen individually. When running out the door you can easily grab something to go.
  3. When going to the hospital for appointments always bring a snack – you never know when an appointment will get delayed or extra tests will get ordered. Planning ahead can help you to avoid grabbing a bag of chips or a chocolate bar.
  4. Cook with leftovers in mind.
  5. Practice safe food.  Make sure the food you bring is kept cold. This is especially important for meat, eggs and fish. Invest in an ice pack and insulated lunch bag.  Remember the golden rule when it comes to food handling – when in doubt – throw it out!
  6. Talk to your dietitian for suggestions and ideas. Check out www.kidneycommunitykitchen.ca or www.myspiceitup.ca for more recipe ideas.

I tire easily of sandwiches so a change is always good!  Here is a lovely barley salad that goes just as well with any grilled meat (or on its own) and is even tastier the next day. 

Southwestern Beef and Barley Salad (6 servings*)
1 cup barley, dry
3 cups “no salt added” beef stock or water
1 cup corn
1/2 cup red pepper, diced
1/2 cup cilantro, chopped
1/2 cup green onions, chopped
1/3 cup red onion, diced
454 grams (1pound) strip loin steak

Steak Marinade
2 cloves garlic
3 chipotle peppers
1/2 cup extra virgin olive oil

1/2 teaspoon chili powder
1/4 teaspoon ground coriander
1/2 teaspoon garlic powder
1/2 teaspoon ground cumin
1/4 teaspoon black pepper
2 tablespoons lime juice
1 tablespoon extra virgin olive oil

Bring water/stock and barley to boil in a large sauce pan. Simmer uncovered until barley becomes tender (approximately 30 minutes). Set aside in a large mixing bowl to cool. Prepare the steak marinade by blending the garlic, chipotle peppers, and extra virgin olive oil together. Pour marinade over steak and let marinate in refrigerator for at least 30 minutes. Steak can be marinated up to 24 hours in    advance. To make the vinaigrette, whisk together the spices, lime juice, and extra virgin olive oil. Preheat BBQ or grill pan over medium/high heat. Cook steak to desired doneness. To assemble the salad, pour vinaigrette over the cooked barley. Add corn, red pepper, cilantro, green onion, and red onion. Mix together with a spoon. Fan sliced steak on top of the salad and serve.

* Renal exchange: 3 Protein, 2 Starch, 1 Veg
If you have diabetes: 1 serving = 2 Carb Choices


Calories 291Kcal       Total Fat 8g
Proteins 24g   Sodium 142mg
Carbohydrates 32g   Potassium 500mg
Fibre 7g   Phosphorus 281mg






Updated nutrition info on kidney.ca!

The nutrition fact sheets on kidney.ca have been updated and are better than ever! Working collaboratively with the Ontario Renal Network, a team of dietitians has been working on these for several months.  I’d like to thank my dietitian colleagues who devoted their time and considerable talents to making sure that these are the most accurate set of materials we’ve ever had:  Christine Nash, Shannon Chesterfield, Melissa Atcheson and Darlene Broad.  I have been most excited to use the new potassium in multicultural foods factsheet! The world of food is indeed an international one and it is a challenge to keep up!  

So what can you do when you’re eating something that your dietitian has never heard of? Try taking a picture of it!  A picture is truly worth a thousand words and can be of huge help in identifying uncommon or unfamiliar foods.  In fact, sometimes the problem isn’t that we don’t know the food that our patient is eating but we just use different words for it. A quick picture can solve that problem.  I had a very creative patient who took pictures of a number of foods and emailed them to me! 

So check out the new factsheets and let us know what you think!  Keep in mind that there is no standard kidney diet and that not all factsheets apply to all patients.  Generally most people with early CKD (and even some with late stage or end stage CKD) do not need a potassium restriction. If you aren’t sure – check with your doctor or dietitian before restricting your diet unnecessarily. 

I promised more recipes from our chef day in June – so here is a fantastic summer barbeque recipe.  Enjoy!

Turkey Sliders with Peach Tarragon Aioli (3 servings*)
450 g ground turkey
1/2 tablespoon dijon mustard
1 teaspoon garlic powder
1 teaspoon poultry seasoning
1/3 cup parsley, chopped
1/4 cup red onion, diced
1/2 cup arugula
6 slider buns**

For the aioli:
2 tablespoons mayonnaise
2 tablespoons peaches, pureed
1 teaspoon tarragon, chopped

Preheat BBQ or grill pan on medium/high heat. In a mixing bowl, combine turkey, dijon, garlic powder, poultry season, parsley, and red onion. Shape mixture into 6 patties. Cook turkey sliders approximately 5-6 minutes per side or until the internal temperature reads 165F. Make peach tarragon aioli. To assemble turkey sliders, spread aioli on top and bottom of the slider buns. Place turkey patty on top of the bottom bun. Garnish with arugula and top with bun.

Recipes developed by Chef Leslie Cairns

* Renal exchange: 2 Protein, 2 Starch, 1/2 Veg
** If you have diabetes: Make sure to check the label on your slider buns to determine the Carb choices.


Calories 257Kcal       Total Fat 11g
Proteins 16g   Sodium 257mg
Carbohydrates 33g   Potassium 330mg
Fibre 4g   Phosphorus 240mg





Sometimes seeing (and tasting) is believing!

This week, the dietitians here at Grand River Hospital were excited to welcome Chef Leslie Cairns to a cooking demonstration of wonderful kidney-friendly foods. Leslie is the chef behind the recipes in the last two Spice It Up! cookbooks (www.myspiceitup.ca) and in addition to being a fantastic chef, she has a degree in nutrition.  I don’t know about you, but I am always drawn to recipes that have pictures – that way I know that I’m on the right track! Fortunately, we have a renal pharmacist, Vivian Ng, who is a gifted photographer so we have some pretty pictures to go along with the recipes.

Do you ever look at a recipe and feel sceptical that the final product will come together the way it claims? I’m not sure I would have tried the recipe below but I was blown away by how easy and good it was. This tortilla pizza below was the favourite recipe from this week’s cooking demonstration and it was so good that I’ve already made it at home (I didn’t have tortillas but used a regular thin pizza crust and it was perfect).  The pesto on the pizza makes a phenomenal pasta sauce that is an easy, no-cook, low potassium alternative to tomato sauce. If you’re using pre-made roasted red peppers (which I did) look for the lowest sodium brand you can find at your grocery store. Stay tuned for more recipes from this cooking demo coming up!

Tortilla Pizza with roasted red pepper pesto, shrimp, and basis (2 servings*)
8 large shrimp (31/40 count), peeled, deveined, and tail removed
1/4 cup vidalia onion, sliced
6 basil leaves, roughly chopped or torn
1/2 cup mozzarella cheese, grated
2 flour tortillas

For the pesto:
1 roasted red pepper
1 garlic clove
1 tablespoons lemon juice
1 tablespoon extra virgin olive oil
1/8 teaspoon ground black pepper
1 teaspoon grated parmesan cheese

Preheat oven to 425F (conventional oven).  Place all pesto ingredients in a food processor or blender and puree.  Place flour tortillas on a cookie sheet. Divide the roasted red pepper pesto between the 2 tortillas
and spread to cover the surface. Add the onions and basil.Sprinkle with mozzarella cheese. Slice shrimp in half lengthwise and place on top of the pizzas. Bake for approximately 10 minutes or until tortillas crisp and turn golden brown and the shrimp turn pink in colour.

* Renal exchange: 2 Protein, 2 Starch, 1 Veg
If you have diabetes: 1 serving = 2 Carb Choices

Calories 246Kcal       Total Fat 11g
Proteins 19g   Sodium 314mg
Carbohydrates 26g   Potassium 305mg
Fibre 2g   Phosphorus 238mg


Getting back to summer!

Ah summer!  We are, finally, having some truly hot weather in Southwestern Ontario and I have been happily ignoring my stove in favour of the barbeque. Somehow, cooking outdoors seems to make everything that much more relaxed and casual. But barbeque season has it’s dietary dangers – many BBQ favourites such as hotdogs, prepared burgers, and even the barbeque sauce are loaded with salt.  So it’s important to read your labels, and as much as possible choose fresh and unprocessed ingredients. Making your own burgers is relatively quick and easy and these have a fraction of the sodium of prepared burgers.  Another bonus? If you are on a high protein diet, you can make the burgers big and if you are on a lower protein diet you can make your portion exactly right for you!

I often hear people say that giving up these processed foods is a huge burden or challenge for them.  We become so accustomed to the taste and feel of these foods that it can be extremely hard to give them up.  But within weeks you can adjust your taste buds back – getting used to less salt takes less time than you’d think! Try a gradual reduction in your salt intake and substitute fresh ingredients such as slices of red onion and crunchy lettuce to top your burger.  Instead of that processed cheese slice on your burger – try slices of bocconcini or grated natural cheddar.

Recently I attended a dinner party where we were served a huge selection of mini-burgers (sliders) with everything from quinoa to beef as the base.  Classic hamburgers are wonderful and here is a great and easy recipe:

Classic Hamburgers (4 servings)
1lb lean ground beef
1 egg
1 small onion, minced or 2 tbsp dried minced onion
¼ cup dry bread crumbs
1 tsp no salt added steak spice (or ground pepper)
1 tsp Dijon mustard

In bowl, mix egg with onion, bread crumbs, spices and mustard. Add beef, combining gently. Shape into patties (makes 4 regular sized burgers – about 3 protein choices each). Place on greased grill over medium heat. Grill, turning once, until no longer pink inside and internal temperature reads 160°F (71°C). 

March: Kidney Health Month and Nutrition Month!

March is a busy month for renal dietitians!  Not only is it Kidney Health Month but it is also Nutrition Month!  I was fortunate to attend a conference on renal nutrition in Vancouver earlier this month and came away with a lot of wonderful ideas and information.  From kidney carbohydrate counting guides to ethnic diets to cooking demonstrations, there are a huge range of initiatives happening in dialysis units.

Here in Kitchener we’re getting ready to do a presentation to our patients on the importance of protein for dialysis patients. Did you know that malnutrition is incredibly common in for both hemodialysis and peritoneal dialysis patients? Often, dialysis patients are dealing with many different medical conditions, diets, constant travel to and from dialysis and on top of all that need to replace the protein that is lost during dialysis.  Malnutrition can lead to poor wound healing, increased risk of hospitalization and higher mortality risk.

A recent Canadian study has shown that patients who are admitted to hospital tend to leave more malnourished than they came in.  All jokes about hospital food aside, that leaves those of us working in healthcare very concerned about keeping our patients well nourished.  For more information on this study, check out the Canadian Malnutrition Task Force website: nutritioncareincanada.ca.

Getting enough protein can definitely be a challenge for dialysis patients (in and out of hospital). Here are some suggestions for how to get enough:

  • Choose a source of protein at each meal (eggs, chicken, fish, pork, beef, cheese)
  • Eat the protein part of your meal first
  • Make your snacks count with protein (try low sodium cottage cheese and fruit)
  • Increase your serving size of protein foods
  • Get creative – have French toast or add a hard-boiled egg to your salad.
  • Add chopped chicken or cooked shrimp to your pasta or rice
  • Try adding pasteurized egg whites (safe to eat without cooking and found where eggs are in the grocery store) to cranberry juice, soup, or mashed potatoes.

There are protein supplements on the market but it is important to talk to your dietitian about which supplements are safe for you. Some are high in potassium or phosphorus and not all of them are a great source of protein.

So what about when you don’t feel like eating meat?  Here is a recipe for a quick and delicious smoothie that is light and refreshing:

Blueberry Smoothie (3 servings*)
1 ¼ c pineapple juice
2c frozen blueberries (slightly thawed)
3/4c pasteurized egg whites
2 tsp sugar or Splenda
1/2c water (can use more or less as desired depending on how thick you like your smoothie)

Put all ingredients in a blender and puree. Enjoy!

* 1 serving = 1 protein + 1 fruit choice

Portions matter!

Doing recipe analysis for the renal diet is a far more complicated endeavor than I realized when I started out in renal nutrition.  The renal diet is a complex system and each “food group category” has a maximum allowable amount for potassium, sodium, and phosphorus and a minimum amount of protein. You can’t ignore carbohydrates, fibre or fat either since many kidney patients also have to deal with diabetes and cardiac disease.

So every once in a while a recipe comes along that looks great and has a lot of renal-friendly ingredients but when I do the analysis the potassium, sodium or phosphorus is just too high.  Recently I was asked to look at a recipe for a honey-mustard sauce. Both honey and mustard are usually okay for kidney patients but the amount of prepared mustard was just too much to have a low sodium recipe. Sometimes even the amount of spices can push a recipe over the edge!  I have learned that cinnamon is a pretty decent source of fibre (not a surprise when you consider it is the bark of a tree!). I have also learned that a “serving size” to a chef is at least 4 times bigger than a “serving size” is to a dietitian!

Which brings me to portion size.  I spend a lot of time talking about portion size especially when it comes to potassium but it is important for all aspects of your nutrition.  Whether you are trying to lose weight, gain weight, restrict sodium, potassium, phosphorus, fat or increase your fibre – portions matter. It is extremely easy to eat on the go without paying attention to your portions.  Eating while cooking (or testing the meal as I like to call it) can add up when you really calculate it out.  We call this “mindless eating”.

The key to getting your portions right is to pay attention!  Every once in a while, measure out your portions or check how much your soup bowl really holds. Or keep a food record for a few days (sometimes that is an eye-opening experience). Try not to eat while you’re doing something else (reading, watching TV, driving).  Eat the food you serve yourself on your plate, take your time and enjoy it.

Use the online nutrition information at restaurants before you eat out. Thinking of the Superbowl weekend, a patient of mine asked just how bad a pound of wings could really be.  The answer: really bad.  At that particular chain restaurant he went to – 1300kcal and 1300mg of sodium!
Sometimes it’s nice to find a recipe that takes care of the portions for you!  Try this easy stuffed pepper recipe that my neighbour makes:

Stuffed Peppers
4 red, green or yellow bell peppers
1 cup cooked white rice or couscous
2 cup cooked ground beef (or try using leftover chopped roast beef, roast pork or chicken)
1 teaspoon dried basil
1 tablespoon fresh chopped parsley (or 1 tsp dried)
1/2 cup no salt added chicken stock
1/2 small red onion, chopped
(If you don’t require a potassium restriction, add a peeled, diced tomato to the mix).
Fresh ground pepper
1 tbsp parmesan cheese

Slice off tops of bell peppers, remove seeds and discard. Chop up the bell pepper tops and place into a large bowl. Add rice or couscous, chopped meat, dried basil, parsley, chicken stock and red onions. Toss to combine and season with fresh pepper. Stuff each pepper with filling, sprinkle with parmesan and place in a square baking dish. Bake at 325 degrees for 45 minutes or until tender.

Navigating the Food Bank on a Kidney Diet

This is the season of giving and receiving and seems to bring out the best in everyone! I walk into work each day past bins of food and toys that our renal unit is collecting for a local family and my children’s school is hosting food drives, mitten drives and toy drives all month. It's nice to see all of this generosity everywhere you go!

One of my colleagues recently gave an interview to our local paper on what sort of healthy foods one could donate to the food bank because this year there is more demand than ever.  This of course makes one realize that there is a large need for all of these things and never more than as the holiday season approaches and the weather gets cold.

Take a look at this new resource on Navigating the Food Bank on a Kidney Diet:

If you're looking to make a donation to the foodbank consider donating some of the "Kidney-friendly" items discussed in the resource.

Christmas (for me) always evokes memories and thoughts of food. And it doesn't really seem like the holidays until I've baked my first batch of Christmas cookies with my children. Here's an easy and delicious recipe that takes almost no time to put together. 

Here is a recipe for Almond Meringue Cookies to help you satisfy your nut craving without the nuts! Flavour extracts such as almond extract or maple extract are a great way to get the flavour without the potassium or phosphorus.

Almond Meringue Cookies
2 egg whites or 4 tbsp pasteurized egg whites (allow to come to room temperature)
1tsp cream of tartar
½ tsp almond extract
½ tsp vanilla extract
½ cup white sugar

Beat egg whites with cream of tartar until doubled in volume. Add remaining ingredients and beat until firm peaks are formed. Using two teaspoons, push one teaspoon full of meringue onto a parchment lined cookie sheet with the back of the other spoon. Back at 300F for approximately 25 minutes or until meringues are crisp. Store in an airtight container.

A Wealth of Information

This fall, I had the opportunity to travel to Winnipeg for the Manitoba Renal Program conference. It’s always a pleasure to learn about practices and resources that are available across the country.  I was very impressed by the resources available on their website (www.kidneyhealth.ca) including a kidney-friendly cookbook!  Take a look at their website, the recipes and resources.  Congratulations to the Manitoba dietitians for putting together such a fantastic resource.

There is a wealth of information these days on the Internet. Unfortunately, there seems to be an almost equal amount of misinformation.  I rarely see someone these days who hasn’t at least googled “kidney diet” before coming to a dietitian appointment. Most of the time this is a great thing since it generates good questions and discussion, but occasionally the information found on line doesn’t apply, is wrong, or actually dangerous.  A few things to watch for while you surf online:

  • Beware of websites or people that are selling you something.  The information on the site is designed to get you to purchase a product, NOT to educate you.  Herbals or vitamin supplements are not necessarily safe and are often very expensive. These are businesses whose primary goal is to stay in business.  If it sounds too good to be true, it probably is. 

  • Be sceptical of websites that claim to know a “secret” that your doctor doesn’t want you to know or that talks about “ancient” cures.  If people knew how to cure kidney disease hundreds of years ago that knowledge would not have been lost! 

  • Watch out for websites that are based purely on anecdotal information.  One person’s story is not necessarily going to hold true for all people.  Diet and nutrition are way too complex to come down to a single “superfood”.

So who do you trust?  

Well a good rule of thumb is to choose websites that are associated with a national organization (like The Kidney Foundation of Canada of course), or a provincial entity (like the Manitoba Renal Program above).  Hospitals and universities are also safe and reputable sources of information.  But, no matter where or from whom you get your information, ask questions and make sure that the advice you receive is tailored to your particular needs because, as I may have mentioned before, there is no standard renal diet!

Check out the recipes on kidneyhealth.ca and enjoy!

Back to routine!

As sad as I am to see the end of summer, it is always nice to get back into a routine. This has been a hectic but fun summer.  Here in Kitchener, the dietitians at our hospital and Candice Coghlin from the local Kidney Foundation branch hosted a “Sizzlin’ Summer Cooking Demo” with Chef Mike Brennan.  Mike has spent a lot of time cooking and travelling in Thailand and he prepared a fabulous menu with an Asian flair. And without any salt!  The flavours were amazing – incredibly fresh!  Best of all (for me anyway) the recipes were all very quick.  The stirfry was amazing and perfect for a quick meal after working all day. The Litchi Sorbet was delightful and I froze it into popsicles for my kids. What I especially liked about these recipes was that they were unlike anything I currently make, and sometimes it’s really nice to try something different!

All of the recipes are available on the Kidney Community Kitchen website with a complete nutrient analysis and the pictures were taken the night of the cooking demo.  I hope you give them a try!

So as we head back into the fall, I start to feel a real time crunch. Work gets busier, school starts, homework starts and to make it all worse, the days get shorter!  I find that it becomes really important to plan meals ahead and if possible, make something on the weekend that will freeze for a meal on a busy weeknight.  Planning your meals for the week and making a grocery list based on that is critical for avoiding all those last minute trips to the grocery store and less than healthy “last minute” suppers. This is a widely-used successful strategy for following just about any diet – from kidney diets to weight loss. And planning your meals has also been shown to save you money!

I also want to share with you this incredible story about a patient’s journey with kidney disease. It’s an important reminder that “natural” doesn’t always mean safe. Check out: 

So get out your grocery list and jot down some of the ingredients for the fabulous recipes below!

Cucumber Salad (10 servings)
3 English cucumbers peeled or striped
1 red onion
1/2 cup rice vinegar
1/2 cup water
1/3 cup sugar
2 tbsp white sesame seeds, toasted for garnish

Slice cucumber thinly into rounds and finely dice red onion, place into a bowl. Stir together rice vinegar, water and sugar and pour over cucumber and onion. Cover and marinate for an hour. Plate and garnish with sesame seeds.

Corn Potage (8 servings)
8 cups No Salt Added Chicken Broth
2 1/4 c fresh or frozen corn kernels
2 tbsp sake
1 tsp sugar
2 tbsp corn starch (blended with 2 tbsp water)
2 egg whites lightly beaten
4 scallions thinly sliced

Bring stock to a boil, add corn and cook for 5 minutes. Strain stock over a bowl, reserve liquid, transfer corn to a blender and blend until smooth. Return stock to the pan, press corn through a China cap to remove any solids. Bring to a boil, stir in sake and sugar. Add cornstarch mixture and cook stirring constantly until thickened. Drizzle in the beaten egg white while slowly stirring in circular motion. Remove from heat, add scallions, reserve some for garnish.

Asian Noodle Stir Fry (4 servings)
200 gr chow mein noodles (par-cooked using package instructions)
1 leek shredded
1 1/3 c bean sprouts
6 shiitake mushrooms thinly sliced
12 raw tiger shrimp shelled and deveined
2 eggs beaten
2 tbsp oil for stir frying
3 tbsp mirin (rice cooking wine)
2 tbsp fresh cilantro leaves

Chilli oil
Sesame oil
2 scallions thinly sliced
2 tbsp pickled ginger (store bought)

Par-cook the noodles following instructions on package, strain and place in a bowl. Add the leek, bean sprouts, mushrooms, shrimp and eggs to the noodles and mix well to combine. Preheat a wok or large skillet over high heat, add a little oil and hear until very hot. Add the noodle mixture and stir fry until golden and the shrimp have turned pink and are cooked through. Add the mirin and cilantro and toss together. Divide the noodles between four bowls, drizzle with chilli and sesame oils, sprinkle over the scallions and ginger.

Litchi Sorbet (4 servings)
14 oz canned litchis or 1 lbs fresh litchis peeled and pitted
2 tbsp powdered sugar
1 pasteurized egg white
Thinly sliced lemon wedge

Put litchi flesh and sugar in a blender or food processor and process to a puree. Press the pure through a fine strainer to remove any remaining solids. Transfer to a freezer proof container and freeze for 3 hours. Turn the mixture into the blender or processor and process until slushy. With the motor running add the egg white. Return mixture to freezer proof container and freeze for 8 hour/overnight. Puree sorbet in blender right before serving, garnish with thinly sliced lemon.

What’s it really like to follow a kidney diet?

While I talk (and blog) about the kidney diet a lot, I am fortunate enough not to have to fit it into my life on a daily basis.  But what about those who do?  Everyone’s experience with their kidney disease is different but I was really excited when one of our dialysis patients, Lori Kraemer, offered to share her story about following the renal diet.  I think we can learn a lot from people who live with CKD every day - I know that I do.  Want to share your story?  Try out one of the discussion forums at www.kidneycommunitykitchen.ca.

Lori said she hopes to inspire others with her story – she certainly inspires me with her positive attitude and courage!  Here is Lori’s story:

People look at me like I have two heads when I tell them that I am on the renal diet. “The what diet?”  people ask. I get that kind of response a lot. I then explain that it is low-phosphorus, low-potassium and low-sodium food diet.  I also tell them why I began this special diet.

On August 15, 2010, I suffered end-stage renal failure. I almost died because I was so sick from the toxins that had built up in my bloodstream. Upon being admitted to Grand River Hospital, I started dialysis which was a process to begin the removal of the deadly toxins in my body. While I was in the hospital for about nine days, I was approached by a renal dietitian who told me that I would have to eat a low-phosphorous diet. I was shocked and devastated that I would have to watch everything that I would eat from that point onward. I felt like the world had come to the end when I was told that.  I loved a lot of dairy foods pre-renal failure and knew I’d have to drastically reduce my dairy intake. That would be so hard, I thought.

I went home feeling very overwhelmed so within a short time I called the hospital and requested to talk to a dietitian.  June Martin, one of the renal program dietitians, offered to come into my home to talk to me. June talked to me about different foods that I could eat now that I was on the renal diet.  Since I was on a low phosphorus diet she gave me some very helpful ideas on how to still eat some of the foods that I still loved, with some changes.  One of the foods I vividly recall her telling me about how to change was cheese. I love cheese and dreaded having to cut back in eating cheese.  She told me that brie cheese is lower in phosphorous. I had never eaten brie cheese before and thought I would give it a whirlwind of a try. I loved the taste of it. I started to feel like the renal diet wasn’t such a bad thing after all and that I could do it.

One thing that I have learned since renal failure is that having a good attitude helps.  I decided early on in the dietary changes that having a positive attitude towards food would help me to adjust easier to the change of lifestyle.   I also realized that a positive attitude would also make it easier to cope with the diet changes.
Exercise, not diet alone, has helped me a lot too.  I love to walk and exercise at least a half hour daily.

Over the last almost two years that I have been on dialysis, I have lost a lot of weight. I realize now a lot of my pre-dialysis weight was likely fluid gain. Before renal failure I was drinking a can of Coca-Cola and a can of Iced Tea every day. Cutting back on a lot of sugar has really helped me to lose a lot of weight and now maintain a good, healthy weight. Eating a lot of fresh fruits and vegetables and cutting back on the processed foods was very helpful for me also. Drinking only water after my kidneys failed has helped a lot too in losing weight and maintaining my weight also.

I love chicken and fish too, which are very high in protein. These meats are great to eat when you are post dialysis. I take phosphate binders, but with taking my binders regularly, taken with food at meals, I’m able to keep my phosphate levels under control.  It’s a really good feeling every month when my dietitian, Rebecca Larratt-Smith, visits me at the Freeport Satellite clinic and has a smiley face on my monthly blood work progress report card!

Now, after having been on dialysis for almost two years, I have adjusted to the renal diet. I’m not sure when I will have a transplant that I can have a more liberal diet, but for now, I’m okay following the renal diet. I am enjoying the foods that I now eat. It’s great to also eat and not feel like there is a metallic taste in my mouth nor feel nauseated when I eat.  Since I’ve been on dialysis, I’m finding that foods that I never used to like pre-renal failure, I enjoy now. One particular food is cream cheese. It’s low in sodium and is actually fairly low in phosphate that I can eat it. I enjoy eating it on occasion now.  My taste buds have changed for the better.

I also enjoy using “Spice It Up” recipe books!  My most favorite recipe is the Honey- Ginger Crackles cookies, they are so good!   They are renal-friendly, low in potassium and phosphorus. Recently I visited a grocery store called Vincenzo’s. It’s located in Waterloo.  June Martin had suggested getting a chili olive oil there that is low in sodium. It is quite good, you just drizzle it in olive oil and it is great for dipping white bread in. While shopping there, I also stumbled across a no-salt added pasta sauce so that I can enjoy one of my favorite meals, spaghetti once in awhile.

In my experience of being on the renal diet, it doesn’t always mean that you have to totally ‘give up’ some foods if you are able to find a low-sodium product. I used to hate grocery shopping. I now find it a fun experience and enjoy looking for foods that are healthier

for me! I have found that inquiring to my dietitians have helped me a lot. If you’re ever stuck for ideas or need help to find out information they are very helpful. Over the last two years I have learned to live with my kidney disease and have adjusted to the diet. Cooking and baking while on the renal diet can be a lot of fun. My hope is that I inspire others with kidney disease to think outside the box when it comes to the renal diet and explore different ideas for foods to experience with when cooking and baking is involved.

Lori Kraemer

What about potassium additives?

Last month, I blogged about the growing body of evidence that has nephrology healthcare professionals worried about the potential public health impact of phosphate additives. I talked about the risks to kidney patients and the potential for risk to all Canadians.

But what about potassium additives?

These are a concern for people who can’t eliminate potassium from the body and this includes some, but not all, kidney patients. Potassium is usually very tightly regulated in the body and levels that are too high or too low can be life threatening. Many medications (such as certain blood pressure meds or diuretics) can affect potassium levels. Most people on conventional (3 times a week) hemodialysis need to limit their potassium but some kidney patients may need to increase their dietary potassium, or even take a supplement.

For those who need to limit potassium, additives are a major concern – especially potassium chloride. Many companies use potassium chloride in place of sodium chloride when making sodium reduced products. These can provide a huge amount of potassium. The food laws in Canada do require that if a company uses potassium chloride or KCl in place of sodium then the Nutrition Facts Table must include the total potassium content. This can be an important clue to lead you to check the ingredients list.

For example, a low sodium vegetable cocktail that has potassium chloride in place of sodium chloride provides a whopping 700mg of potassium in only 163mL of juice. That’s like eating two small bananas! Indeed, regular vegetable cocktail provides less than half this amount and is still considered a high potassium food.

Another place we see a lot of potassium chloride is in salt substitutes that are a white powder. Generally these products come with a warning that some kidney and heart patients should avoid them but the words are tiny and many people miss the warning. I recall several years ago going out to a retirement home where two of my patients had high potassium levels we just couldn’t figure out. When I arrived I noticed every table in the dining room had a bottle of salt substitutes containing potassium right in the centre!

Bottom line: If you need to follow a low potassium diet read your labels, be suspicious if something has a low sodium claim and don’t use white powder salt substitutes.


Phosphate Additives May Become a Public Health Issue

Last week, I was at a conference in Washington, DC where my fellow dietitian Melissa Atcheson and I presented a poster on the Kidney Community Kitchen (www.kidneycommunitykitchen.ca). This was a great opportunity to share the Kidney Foundation of Canada’s exciting new website with our American colleagues. I was delighted to hear that many had already heard of the site (often from their patients)!

I need to take a moment to thank a very gifted graphic designer, Robin Parsons, who took our poster and turned it into a work of art! She did this on her own time and she definitely made us look good! Thanks Robin! Check out the poster we presented:

Click on the image to expand

Attending a conference is a great opportunity to keep up to date with the hot topics in nephrology and nutrition and of course, phosphate additives were the focus of several presentations. I’ve blogged about this many times in the past but what I found very exciting at the conference was that there seems to be a push to raise these concerns as a public health issue. We’ve known for some time that phosphates are bad for kidney patients but new studies are showing that these additives may pose a risk for everyone.

What I found very interesting (and I am sure it applies to the Canadian food supply) is that presenters reported that products that were acceptable last year now have phosphate additives. One presenter reported that half of all pork products available in the US had phosphate additives. This really emphasized to me how important it is to check your labels.

Over the past two years, we have had our dietetic interns do a survey of local grocery stores to find out just how common phosphate additives are in Canada. They surveyed major grocers and looked at over a thousand products! This past fall they presented their own poster on what they found. These results are very interesting and I thought I’d include their poster too! Take a look at what Jenna Cafferty and Cherie Wan saw in 3 national grocery stores in Southern Ontario. See how your grocery stores compare!

Click on the image to expand

Spring is here!

After a winter that never really seemed to happen (in Ontario anyway) it is wonderful to see the spring!  This seems to be an exciting time in kidney nutrition with a lot of new resources for people dealing with kidney disease. 

  • The Kidney Community Kitchen website (www.kidneycommunitykitchen.ca) has new recipes, meal plans, grocery lists and lots of information for kidney patients.  Kidney patients and their families are some of the most often overlooked sources of advice for dealing with kidney diets. If you have a recipe or diet tip that helps you manage your kidney diet, consider submitting it to the Kidney Community Kitchen. Our team will analyze your recipe and post it for everyone to benefit!
  • There’s a new cookbook and a brand new website available at www.myspiceitup.ca with six new kidney friendly recipes for you to try.
  • Kara’s Kitchen – Kara Dawson is a Toronto dietitian and chef who is a regular contributor to the Kidney Community Kitchen and who runs cooking classes for kidney patients.  Check out Kara’s website: www.karaskitchen.ca.  You’ll find information about her classes and some amazing kidney-friendly recipes.  Attending Kara’s classes has the added benefit of letting you actually make and taste the recipes yourself!  I would love to hear about and share similar initiatives that are happening across the country.  If you know of cooking classes or seminars in your community please share them with us so we can help get the word out! If you are interested in starting a program like this, the above resources are a great place to find recipes.

Now that the warm weather has finally come, it’s a great time to get outside and get active. Along with a healthy diet, physical activity is important for maintaining almost all aspects of your health.  Don’t believe me?  Check out this short little video that is as educational as it is inspiring:

Now that the weather is warming up, I start to get tired of soups, stews and casseroles and start looking forward to barbecuing and eating fresh produce!  Here’s a lovely and quick marinade that’s great on chicken. I usually marinate the chicken breasts or thighs for 1-2 hours but even if you only have ½ an hour to marinate your chicken, you’ll still have lots of flavour. This is a quick go-to dinner after work that I usually serve with a salad and rice.  

Dijon Marinade
2 Tbsp lemon juice
2 Tbsp canola oil
1 Tbsp Dijon mustard
1/2 teaspoon ground pepper
1lb chicken (breasts or thighs)

Mix all ingredients together. Marinate your chicken for a minimum of 30minutes.  Grill on med-high heat for about 20 minutes (turning once) or until no trace of pink remains.  Enjoy!

Read those labels!

Sometimes being a dietitian feels a bit like being a detective. Every once in a while I will come across someone whose blood work just doesn’t seem to make any sense. Diet recalls and food records don’t show any significant sources of potassium or phosphorus so both the patient and I are completely unable to figure out the source of the problem. That is because sometimes it’s not the person who has changed her diet but the foods themselves that have changed. I have a couple examples that I thought I would share:
Recently one of our grocery stores switched meat suppliers and brought in new products with phosphate additives. Many people who’ve been shopping there for years didn’t notice the switch and all of a sudden saw a jump in their serum phosphorus levels! Their chicken breasts were suddenly a very high phosphorus (and sodium) food!

Low sodium foods can sometimes be an unsuspected source of potassium. Switching from your regular soup to the low salt version may seem like a bit of a no-brainer but for people on a potassium restriction it can be dangerous. Food manufacturers often substitute sodium chloride with potassium chloride since it has a salty flavour. This can bring potassium levels way up!  By law in Canada, if potassium chloride is used to reduce sodium then the nutrition facts table needs to include the amount of potassium in the list. This can be an excellent clue to the presence of added potassium chloride. When in doubt though – you should check your list of ingredients for potassium chloride.

And even something as innocent as a morning bowl of oatmeal can be a source of hidden salt. Switching to the packets of instant oatmeal instead of regular oatmeal can add 170mg sodium to your breakfast!

So the real message is “read your labels”! Compare plain pasta or rice at 0mg sodium/serving with some of the packaged pasta and rice “sides” that can add upwards of 700mg/serving. Try this quick pasta dish that goes together very quickly and is very low in salt.

Spaghetti with shrimp

1/2 lb spaghetti or spaghettini
1/3 cup extra virgin olive oil
1/3 cup dry white wine
2 cloves garlic, crushed
1/4 tsp crushed red chilies
1 red pepper, diced
1 lb raw shrimp
1/3 cup toasted fresh bread crumbs
Freshly ground pepper
Chopped fresh parsley (optional)

Cook pasta according to package instructions. In large skillet, heat oil over medium-low heat and add garlic and crushed red chilies. Cook, stirring, for one minute. Add peppers and cook 5 minutes longer (don’t brown). Add the shrimp and cook for one minute longer. Add the wine and turn the heat up to medium. Simmer until the shrimp turns opaque and starts to curl. If the spaghetti is not ready yet keep warm over low heat. Drain pasta, place in large serving dish. Pour sauce over pasta and toss together with breadcrumbs until the pasta is coated. Serve with freshly ground pepper and parsley. Makes 4 servings.

The Kidney Diet Challenge!

So how hard is the kidney diet?  Over the years, I have met with many other health care professionals, students, and caregivers who occasionally surprise me with their response to learning about the diet.  Most respond by saying that they are so happy they don’t have to follow a diet like this or that it must be hard to follow.  Every once in a while I hear someone say:  I could follow that diet – it’s not that bad! And I try not to respond with disbelief!  In fact, I encourage them to give it a try. I don’t know if anyone has ever actually followed through though.

Recently I heard about the team at St. Mike’s hospital in Toronto who are doing a “Walk the talk” challenge to follow the renal diet, take Tums® with their meals and blog about how it’s going. I think this is one of the best ideas I’ve ever heard – (and while wishing that I had thought of it first) – I wanted to share it with you.  It should probably be required reading (and maybe a required activity) for all nephrology health care professionals.  Check out their blog at walkthetalkchallenge.blogspot.com. I hope you enjoy it!

One of the comments made by Alison Thomas, just a few days into her kidney diet, was about this experience making her think that nocturnal home hemodialysis was more and more attractive because of the LACK of dietary restrictions.

I have to say that I agree!  For patients who are on more frequent and sustained hemodialysis, there is generally very little in the way of diet restrictions.  While it’s important to maintain adequate nutrition (there are still losses in the dialysate) nocturnal hemodialysis has been a real game changer when it comes to kidney nutrition.  But it also highlights the ever-changing challenges for kidney patients and we often see patients who have been on 3 or 4 different diets since they developed kidney disease. This in itself is a huge challenge!

Here’s a lovely, kidney friendly side dish (yes I’ve made it!) that I hope you enjoy. Cabbage is a wonderfully low potassium, high fibre vegetable. I like it served with salmon.

Roasted Cabbage Wedges
1 green cabbage (cut into 1” wedges)
2 tsp sugar
¼ tsp freshly ground pepper (or to taste)
1 tbsp balsamic vinegar
2 tbsp olive oil

Preheat oven and baking sheet to 450°F. Combine pepper and sugar in small bowl. Quarter cabbage through core and cut each quarter in to 1-inch wedges but try to leave core intact – this will prevent your cabbage wedges from falling apart. You'll have about 16 wedges. Brush wedges with oil and sprinkle with sugar and pepper. Place the seasoned wedges on hot baking sheet and roast until cabbage is tender and lightly browned around edges, about 25 minutes. Drizzle cabbage with balsamic vinegar.

Happy Holidays!

Food is an important part of any holiday or celebration.  As I was thinking about what to write about for my Christmas blog post, I was trying to think of how to articulate why food is so important to the holidays and to almost any celebration.  For me, Christmas Eve is the smell of tourtiere (and my brother complaining about having to eat it) and Christmas day could never be the same without turkey and stuffing.  And regardless of what holiday you celebrate, food plays a huge role.  Preparing food and eating together is a part of almost every culture’s rituals for celebration.

Unfortunately having kidney disease can make celebrating the holidays much more difficult! Trying to maintain family and religious traditions while balancing the sodium, potassium, phosphorus, protein and fluid in your diet takes planning and skill.  

Limiting potassium can be especially difficult over the holidays. Even over-eating low potassium foods can tip the balance! An extra serving of mashed potatoes or a bit of scalloped potatoes can throw a huge wrench in your holiday eating!  For more information on potassium check out the fact sheet Potassium and chronic kidney disease.

A few noteworthy items to watch out for over the holidays:

  • Eggnog – high in both potassium and phosphorus – try hot apple cider or mulled wine instead
  • Potatoes – even the double boiled variety can add up! If potatoes are essential to your holiday celebrations then make your servings small. Try the cranberry risotto at www.kidneycommunitykitchen.ca for a delicious alternative.
  • Nuts – often salty and always high in potassium and phosphorus – it’s difficult to eat “just one”! Choose unsalted pretzels or popcorn instead.
  • Turkey! Watch out for the “self-basting” or “frozen, seasoned” turkeys – these are loaded with salt and phosphate. Choose fresh or frozen turkeys with nothing extra added. Then save those bones to make a fantastic turkey stock!
  • Oranges are very high in potassium – ask Santa to put a clementine or mandarin in your stocking instead.
  • Chocolate – high in potassium and phosphorus – choose sugar cookies, shortbread, sorbet, apple pie, lemon tarts or pound cake.
  • Buffet tables – it’s very easy to overeat – fill your plate once!

One of my favourite holiday foods is the bright and lovely cranberry! Very low in potassium, it’s festive and pretty and incredibly versatile! If you don’t like cranberries try another low potassium favourite - raspberries.

Traditional cranberry sauce is wonderful with turkey but try these other ideas:

  • Add chopped cranberries to bread stuffing for chicken, turkey, duck or pork
  • Add a few chopped cranberries to cabbage salads or rice for colour and flavour
  • Add cranberries to apple or pear crisps and pies
  • Serve leftover cranberry sauce with pancakes, or fold into Cool Whip and top homemade waffles or pancakes
  • Press cooked cranberries through a sieve and sweeten slightly; serve under grilled chicken breast or pork chop
  • Add cranberries to muffins, biscuits, cakes and cookies
  • Mix cranberry juice with white wine or sparkling water for a colourful spritzer - toss in a few whole cranberries for garnish

Or try these yummy and decadent Cranberry Shortbread cookie bars!

Cranberry Shortbread cookie bars
1 cup butter, room temperature
3/4 cup sifted icing sugar
1 teaspoon vanilla extract
2 cups sifted all-purpose flour
1/2 cup finely chopped dried cranberries

Heat oven to 325 degrees with the rack in the center. Combine butter, confectioners' sugar, vanilla, and flour in a large mixing bowl. Beat with a wooden spoon until combined but not too creamy. Stir in dried cranberries. Pat dough evenly into an 8- or 9-inch-square baking pan. Bake until just beginning to turn golden, about 20 minutes. Place pan on cooling rack until cool enough to touch, about 20 minutes. Run knife around edges, remove shortbread, and transfer, right side up, to work surface. Use a sharp paring knife to cut into bars.

Optional:  Try using 1tbsp grated orange zest instead of the vanilla for orange cranberry bars!

The Launch of the Kidney Community Kitchen

Last week I had the good fortune to attend the launch of the new nutrition website, www.kidneycommunitykitchen.ca, at Divino Wine Studio in Ottawa.  I had the chance to meet some great people and sample some fabulous kidney friendly foods!  The Fettuccini with Pork Ragu was delicious and I made the sauce for my family who all enjoyed it too (although I wasn’t ambitious enough to make my own pasta!) I look forward to seeing the other recipes on the site.

This website has been a project I’ve been involved in from the start so I was extremely excited to get the chance to be a part of its launch. Initially, when the planning for the site began, I have to admit I had a hard time envisioning how it would come together.  Chefs and dietitians from across Canada donated time, recipes and expertise to the site.  And I have to say the final result surpassed all of my expectations!    As a renal dietitian I am often asked by patients to put together meal plans and recipes and I can really see how this new website will be a great tool for people living with kidney disease and their caregivers. I am sure that my well-meaning meal plans often missed the mark of what people actually would want to eat!  This new resource will allow a much more individualized approach.

It’s important to know and set your own nutrition goals.  Having goals can be motivating and help to give you focus.

One of the keys to sticking to your nutrition goals (for anyone) is planning ahead.  You are much less likely to end up relying on convenience or fast foods if you’ve planned your meals for the week and have all of the ingredients handy.  I love that this website can generate a grocery list for you – this is a huge timesaver.

The journaling feature is another great tool to help you track and achieve your goals. Many studies looking at nutrition goals have shown that people do better when they write down what they eat. Why? Keeping track of your food and fluids makes you much more attuned to what you eat and drink and really limits mindless eating.

I hope that you`ll enjoy and explore the new website and use it to help you achieve your goals!

New Resource for Kidney Friendly Recipes!

I'm very excited to write about the launch of a new website dedicated to nutrition for people living with kidney disease!  The Kidney Community Kitchen is an on-line nutrition resource that has been developed to help put the fun and excitement back into cooking and eating - even on a kidney diet. The recipes and content has been reviewed by a team of Canadian dietitians from across the country. 

The resource will allow you to:

  • Find exciting kidney-friendly recipes
  • Learn more about kidney nutrition
  • Use meal planning tools
  • "Ask a dietitian" and consult an FAQ for kidney diet questions
  • Submit your own recipes to share
  • Share experiences with others living with kidney disease

Check out the new website at www.kidneycommunitykitchen.ca and let us know what you think!

Coming soon...

On Monday November 28th there will be a brand new, exciting website dedicated to putting the fun back into eating and cooking on a kidney diet!  This new site will be a wonderful recipe and meal-planning resource along with a wealth of information on kidney nutrition.  With input from dietitians and chefs from across Canada, the new Kidney Community Kitchen will be a fun and interactive tool for kidney patients everywhere! 

I'm so excited to share this resource and hear what you think, so on Monday November 28th check out at www.kidneycommunitykitchen.ca.


Phosphorus in the Progression of Kidney Disease

If you’ve read many of my blog posts or heard me speak then you probably know that I think phosphate additives are a serious concern for kidney patients at all stages of chronic kidney disease. It’s been long established that high levels of phosphorus are a sign of bone and mineral disorder in CKD patients but that doesn’t tell us the whole story.

A study published online in the Journal of the American Society Nephrology (JASN) (http://www.asn-online.org/press/files/phosphate.pdf) showed that that patients with high phosphate levels developed kidney failure faster than those with low phosphate levels. They also showed that high phosphate interfered with kidney medications. This is just one of several recent studies that support the idea that phosphate plays a role in the progression of CKD and is much more than a complication of the disease.

Phosphorus in our food is a confusing subject. The phosphorus in meat and dairy is much more easily digestible than that in plant proteins, but generally about 40-60% of naturally-occurring phosphorus is absorbed. Phosphates from food additives however are estimated to be absorbed at over 90% and some studies suggest we get as much as 1000mg/d in the average diet.

So what does this mean for CKD patients or those people at risk for CKD? Well I think that even if your blood levels of phosphorus are normal, it’s a very good idea to avoid foods with phosphate additives. The phosphorus in these foods is extremely well absorbed and is generally found in products that are processed, high in salt and are of low nutritional value. Unlike sodium, phosphorus is not found on the nutrition facts table so it’s very hard to figure out exactly how much phosphorus is in a food product. And, because they are a food additive, phosphates may be listed anywhere in the ingredients list (not necessarily in order of amount).

Phosphate additives are added to foods for many reasons including as a leavening agent, a preservative, and a flavour enhancer. Baking powder is a source of phosphate that you may have in your pantry.

Unfortunately there is no easy list of foods containing phosphate additives so you have to read the labels.

Read the ingredient list and look for variations of the word “phosphate” (all contain PHOS) such as:

  • PHOSphoric acid
  • Sodium PHOSphate
  • Monocalcium PHOSphate
  • PolyPHOSphate
  • PyroPHOSphate
  • Sodium hexametaPHOSphate

Typically you will find phosphates added to:

  • Processed cheeses, spreadable cheeses or slices
  • Colas
  • “Seasoned” meats, poultry and seafood including most processed and deli meats.  Read labels carefully since these meats may appear in your fresh meat counters at local grocery stores.
  • Frozen meats, fish, chicken breasts
  • Bakery products such as biscuits, muffins and snack cakes
  • Non-dairy creamers

When cooking at home you can easily substitute baking powder for baking soda and cream of tartar to lower the phosphorus in your homemade items:

Substitute 1 tsp baking powder for 1/4 tsp baking soda + 1/2 tsp cream of tartar


Collaboration in healthcare is a wonderful thing!  This past spring, one of my colleagues Diana Endicott attended a major nephrology conference and came back with some wonderful resources. Attending conferences is always a great way to stay on top of the latest research and practice guidelines as well as to learn about practice in other regions. Sometimes there are unique and practical sessions that inspire us!  Diana attended a session by a chef who is also a CKD patient and she got the chance to taste a few kidney friendly, vegetarian recipes. She brought me back a copy of the recipes to post on this blog since they were simply too good not to share! I contacted Chef Duane Sunwold (www.dinnerwithduane.com) and he was very pleased to give me permission to share these recipes.

Thanks to both Diana and Duane!

Questions about vegetarianism and kidney disease are very common but rarely have a simple answer. Choosing a vegetarian lifestyle with kidney disease takes careful planning. If you need to limit your potassium or increase your protein levels a vegetarian diet is best done in consultation with your dietitian who can tailor the diet to your specific needs. But even if you have no desire to be a vegetarian these recipes are a delightful way to enjoy some of the fresh vegetables available right now. Diana tells me she enjoyed all of these recipes.

Here’s what she had to say:

“I tried all three recipes and I really enjoyed all of them, especially the soups.”
“The roasting of the veggies really brings a unique and delicious flavour to the stock.”
“French onion soup is one of my favourites, and this recipe did not let me down. I think using the red onions added a lovely sweetness and I swear I could taste the cognac??!!”
“Finally, the Roasted Onion Garlic Pizza carried the same theme of flavours and was a nice accompaniment to the soup.”
“I hope your readers enjoy these recipes.”

Bon Appetit! Click here to download the recipes (pdf)

What About Kidney Stones?

I get a lot of questions from people who have had the unpleasant and painful experience of kidney stones. Kidney stones are incredibly common in Canada with approximately 10% of all Canadians experiencing at least one kidney stone in their lifetime. For more information on kidney stones in general check out the KFOC information on this website. Diet plays a huge role to prevent forming more kidney stones if you have had kidney stones before. 

So where does the diet for kidney stones fit in? Many of the recommendations fit in with general healthy eating (low salt, moderate protein portions and water, water, water) but some might surprise you.

I decided to ask my colleague and friend Melissa Atcheson to help me answer this question. Melissa is the dietitian who manages all of the nutrition consults for kidney stones in our facility. I asked her to give me the highlights of the diet:

  • Drink lots of fluids.  Not drinking enough fluids is the most common cause of kidney stones.  No matter what type of kidney stone, the most important thing to do (if your doctor says it is okay) is drink lots of water and drink often.  Try to drink 10-12 cups (2.5-3.0 litres) of fluid each day, spread out through the day.  At least half should be water; milk, calorie-free beverages and lemonade are other good choices.  Avoid drinking grapefruit juice and dark colas (with phosphoric acid).   You are drinking enough when your urine is clear or light yellow.  If it is dark yellow, you are not drinking enough fluids.  
  • Eat less salt and salty foods.  Don’t add salt when you cook or eat.  Limit convenience foods, fast foods and processed foods.  Avoid foods high in salt like processed meat, salty snacks, canned vegetables, vegetable juices, canned or dried soups, soy sauce, seasoning salts, sauerkraut, olives, pickles and condiments.  Instead, get back to the basics and cook fresh foods from scratch using garlic, lemon, herbs and spices for flavour.  Read labels and aim for no more than 2300 mg of sodium per day.
  • Include adequate calcium each day.  Stones are often made up of calcium, but that doesn’t mean that you should avoid calcium rich foods.  Follow Canada’s Food Guide and have 2-3 servings of dairy foods each day.  If you have to take a calcium supplement, take it with your meals.
  • If you had a calcium oxalate stone, limit high oxalate foods like spinach, rhubarb, Swiss chard, leeks, beets, nuts, peanut butter, chocolate, strawberries and tea (no more than 2 cups per day, add milk to decrease oxalate).  Avoid vitamin C supplements.
  • If you had a uric acid stone, avoid high protein-low carbohydrate weight loss diets, avoid high purine foods such as organ meats, anchovies, herring, sardines, meat-based broths/gravies, alcohol and glucose-fructose sweetened foods.  Do not eat too much meat, fish, chicken or pork.

If you have had a kidney stone in the past, it may also help to:

  • Eat a balanced diet that is not too high in animal protein.  Keep portions of beef, pork, chicken and fish to the size of a deck of cards.  Most people do not need more than 2 such portions per day.
  • Drink lemonade made from real lemon juice (1/2 cup lemon juice mixed with 8 cups of water).  This may lower urine citrates and help prevent stones from forming.
  • Limit sucrose or sugar.
  • Avoid vitamin C supplements and cod liver oil.  Do not take more than the recommended dose of vitamin D.  Only take calcium supplements if you are unable to eat adequate amounts of calcium or if recommended by your doctor.
  • Maintain a healthy body weight through healthy food choices and exercise.
  • Increase fruit and vegetable intake.

These diet recommendations are designed to prevent recurrence of kidney stones, not to treat stones once present, thus should be followed long term.

Here’s a great low sodium summer pasta salad recipe that can be enjoyed by all.

Lemony Orzo Salad (two 1-cup servings)
1 cup orzo pasta
1 red pepper, diced
1 green onion, diced
2 tbsp tarragon, chopped
2 tbsp parsley, chopped
2 tbsp lemon juice
1 tsp garlic, minced
1 tbsp extra virgin olive oil
1/2 tsp black pepper

Cook orzo in boiling water for 8 to 10 minutes. Drain and cool under running water. Add remaining ingredients and serve alongside your favourite grilled meat or fish.

Recipes created by Chef Leslie Cairns


Salt – making the news
Lately the media has been reporting a lot on a recent Cochrane Review and suggesting that perhaps salt reduction isn’t all it’s cracked up to be - that it may not offer any cardiovascular benefit.  Since diet advice on salt restriction is the cornerstone of many guidelines for the management of hypertension, these reports made dietitians across Canada sit up and take a closer look at the study.  What if we can suddenly change all of our advice?

Well, the Cochrane Review doesn’t actually show that reducing salt has no benefit, it demonstrates that current dietary interventions are not effective in significantly reducing salt intake (and it reinforces the notion that the media sometimes misses the point when reporting on studies). Here is what the authors actually say:

Our findings are consistent with the belief that salt reduction is beneficial in normotensive and hypertensive people. However, the methods of achieving salt reduction in the trials included in our review, and other systematic reviews, were relatively modest in their impact on sodium excretion and on blood pressure levels, generally required considerable efforts to implement and would not be expected to have major impacts on the burden of CVD.

This is not a big surprise to those of us teaching about sodium reduction. We know that reducing sodium is tough because it is in our food supply - the majority of Canadians’ sodium intake comes from processed foods.  And, to top it off, Campbell’s Soup Company recently made headlines announcing that they are putting salt back in their soups in their US market (not Canada thankfully)!  

So where does that leave us?  Well, I think it actually makes us need to sit up and look closely at how we give diet advice. And it reinforces the notion that just telling people to eat less salt is not enough – we need to reduce the sodium in our food supply to have long term change in dietary intake.  

I certainly think we can continue to focus on eating fresh, unprocessed foods more often!  

Reference:  http://www2.cochrane.org/reviews/en/ab009217.html

Happy Summer!
Summer can be a particularly hard time to be on a renal diet, especially if you need to follow a potassium restriction.  As all the fresh fruits and vegetables come into season it is so easy to indulge in the plentiful and fresh foods in your garden, at farmer’s markets and roadside stands. I vividly remember moving to Southern Ontario from Northern Alberta as a child and I think we stopped at every fruit and vegetable stand on the way!  Somehow my dad could never hear us as we shouted for him to stop at ice cream stands but he could spot a peach stand from a mile away.

The key to managing your potassium levels in the summer is: portion size, portion size, portion size.  So – while cherries are on the ``Enjoy`` list, it’s important to keep in mind that the serving size is half a cup and not a basket.  This is true for most fruits and vegetables – so when in doubt – stick to the half cup serving. Most kidney patients who are on a potassium restriction should limit their fruit and vegetable servings to 6 (half cup) servings per day.  If your dietitian has calculated something different for you then follow those guidelines.

The trickiest foods to limit seem to be: strawberries, cherries, peaches, corn and tomatoes!  One half of a cob of corn is one vegetable choice!  One good strategy for managing potassium is not to drink your fruit. One half cup of juice generally has as much potassium as one serving of the fruit but is not nearly as satisfying.  Take out one serving and put away the rest. It is much easier to stop when the food is not in front of you.  Most importantly though, take the time to savour and enjoy the foods you eat!

As we head into the hot days of summer I want to tell you about a wonderful dessert.  In the interest of “research”, my colleague and I were perusing the dairy case at one of our local stores and came across a lemon gelato that was non-dairy, had no phosphate or potassium additives and was one carb choice per half cup serving.  This looked like a great product to us so we immediately purchased a carton.  This tart lemony gelato is incredibly refreshing and a wonderful alternative to ice cream.  It is delightful served with fresh raspberries or blueberries!

Raspberry Lemon Gelato Sundae

½ cup Dorgel Lemon Gelato (sold in most grocery and specialty stores – if you can’t find it – ask!)
½ cup fresh raspberries

Top the gelato with the fresh raspberries and enjoy!

Staying Safe
As a dietitian, I have the opportunity to learn about an incredible variety of foods and ways of eating that I had never conceived of before. Some time ago I was chatting with a gentleman in the grocery store line who described to me what he was planning to make for dinner. It involved ground beef mixed with an egg and seasoned with salt and pepper. That was it – no heating at all.  As a dietitian I was horrified and despite my policy of never giving nutrition advice at the grocery store, I strongly encouraged him to rethink the no-cooking part of his dinner!  I don’t think I convinced him but I have been thinking of him more and more over the past few days as I watch the news unfolding from Europe and the deadly E. coli outbreak that is happening there.  I decided to focus this next blog on food safety.

It’s easy to think that this will never happen to you but it’s always a good idea to refresh your food handling techniques at home to make sure it doesn’t!  One of the groups of people who are most at risk of infection are those with compromised immune systems (such as many kidney patients).
Health Canada offers the following advice to prevent E. coli poisoning:
  • Cook food to a safe internal temperature using a digital thermometer. (Ground beef must be cooked to at least 160F)
  • Do not eat hamburger patties that are pink in the middle. If served an undercooked hamburger, send it back for further cooking. Ask for a new bun and a clean plate, too.
  • Avoid spreading harmful bacteria. Keep raw meat separate from ready-to-eat foods. Wash hands, counters, and utensils with hot soapy water after they have come in contact with raw meat. Never place cooked hamburgers on the unwashed plate that held raw patties. Wash thermometers in between testing patties.
  • Eat and drink only pasteurized juice, cider, milk and milk products.
  • Drink water from a safe (treated or boiled) supply.
  • Wash your hands thoroughly before preparing or eating food.
  • Wash raw fruits and vegetables thoroughly with clean, safe running water before you prepare and eat them. Use a brush to scrub produce with firm or rough surfaces, like oranges, cantaloupes, potatoes and carrots. Even if you don’t plan to eat the peels, fruits like melons and oranges should always be washed before cutting to help prevent any bacteria from being transferred from the peel during peeling or cutting.
  • Wash your hands after contact with animals (at home, farms, petting zoos and fairs).
  • Keep pets away from food storage and preparation areas.
  • If you think you are infected with E. coli bacteria or any other gastrointestinal illness, do not prepare food for other people.
  • The golden rule when it comes to leftovers:  If in doubt – throw it out!

Check out http://www.hc-sc.gc.ca/fn-an/securit/ill-intox/index-eng.php for more information of food safety and food-related illnesses.

Being concerned about food safety doesn’t mean you can’t enjoy your food – and as we are most definitely in barbeque season I’d like to share this recipe with you.  I came across this in a cookbook that we received with our new barbeque last year and as soon as I found a recipe that had no salt added I had to try it.  Happily it was a hit with my entire family and I hope you will enjoy it too!

Persian Chicken
1 large onion, chopped
½ cup fresh lemon juice
2 tbsp dried oregano
2 tsp sweet paprika
2 tsp minced garlic
1 cup olive oil
10 boneless, skinless chicken thighs

In the bowl of a food processor or blender, puree the onion, lemon juice, oregano, paprika and garlic. With the motor running, slowly add the oil. Place the chicken in a large, resealable plastic bag and pour in the marinade. Press the air out of the bag and seal tightly. Turn the bag to distribute the marinade and refrigerate for 1 hour. Remove the chicken from the marinade and discard the extra marinade. Barbeque the chicken over direct medium heat for about 10 minutes, turning once. Ensure no trace of pink remains inside and the internal temperature is 165F. Enjoy with rice and a green salad!

Recipe adapted from Weber’s Way to Grill
Can you do the DASH?
May 17th is World Hypertension Day.  The theme of this year’s day is: “know your numbers: target your blood pressure”.  This is great advice for people who have or are at risk for CKD.  For more information check out www.worldhypertensionleague.org.  According to this group high blood pressure or hypertension is the single leading risk factor for preventable stroke, heart and kidney disease.  And what you eat can play a huge role in blood pressure.

I’ve blogged many times about the need to limit salt or sodium to help lower blood pressure. Other important measures include maintaining a healthy body weight, being physically active most days and limiting alcohol or drinking in moderation. There is however another, important nutritional approach when it comes to high blood pressure. It’s known as the DASH Diet.  This stands for Dietary Approaches to Stop Hypertension. Combining the DASH diet with a reduction in your salt intake has been shown in clinical studies to have a big benefit for lowering blood pressure.

The DASH diet is quite simply a very high fruit and vegetable diet (usually 8-10 servings) with modest amounts of meat, poultry and fish. It includes low fat dairy and encourages nuts, seeds and legumes several times per week. 

But the DASH diet isn’t for everyone.  Can YOU do the DASH?

This is a very high potassium diet so if you require a potassium restriction then the DASH isn’t for you. But you can still incorporate some elements of this diet by eating as many low potassium fruits and vegetables as allowed by your meal plan (usually no more than 6 small servings per day).  And those on a phosphorus and potassium restriction will need to limit their nuts and seeds and reduce milk intake as well (usually ½-1cup per day).  Talk to your dietitian about what parts of this diet can work for you.

If you are looking to reduce your risk for CKD or for general healthy eating the DASH diet can be a great tool. For more detailed information check out this fact sheet from the Dietitians of Canada website www.dietitians.caUsing the DASH Diet to Help Lower Blood Pressure

So in keeping with the theme of fruits and vegetables here is a simple low sodium, low potassium, low phosphorus salad that is a perfect summer side dish.

Garlic Green Bean Salad (serves 4)
2 cups green beans
1 clove minced garlic
1 tbsp balsamic or red wine vinegar
1 tbsp sesame oil

Clean beans and cook in boiling water until tender. Drain and cool immediately under cold water.  Toss beans with garlic, vinegar and sesame oil.

Recipe developed by Chef Leslie Cairns
Happy Spring!

This has felt like a very long winter to me and in Southern Ontario at least, spring has been a very long time coming. So as the weather gets nicer and the birds start chirping I start to get tired of soups and stews and all of my favourite winter foods and start looking for a change!

The other day someone asked me what this blog is all about – is it about food or nutrition he asked.  This question took me a bit by surprise because generally I think it’s pretty hard to separate the two. And hopefully this blog tends to be about both.  Because (to steal someone’s line) we don’t eat nutrition, we eat food. We just need to make sure the food we eat provides the nutrition we need without a lot of stuff we don’t need!  And this is even more challenging for someone with chronic kidney disease who has a long list of nutrients to avoid! Often that means enlisting the help of a registered dietitian who can help you design a diet that fits your needs! And be prepared that the recommendations might change if your health or medications change.

I’m excited to tell you that there is a new renal-friendly Spice It Up! cookbook available in dialysis units, Kidney Foundation offices and online. If you’d like to check it out – go to www.myspiceitup.ca.  

So in the spirit of the coming spring, warm weather and barbeque season here is my favourite coleslaw recipe. Most commercial dressings are loaded with sodium – especially since most people use way more than the 1tbsp serving size listed on the bottle. This was my grandmother’s recipe and shockingly there’s no salt in it. Unlike the traditional creamy dressings this one is very light-tasting. It’s incredibly easy and hopefully I won’t upset my father when I tell you that this is one of the only things he cooks! If you don’t have the time or energy to shred or chop the cabbage, buy the pre-shredded coleslaw blend available in your supermarket.

My Favorite Coleslaw Recipe
1 head cabbage, shredded or chopped
1 carrot, grated

1/3 cup white vinegar (or try with half white vinegar and half apple cider or raspberry vinegar)
1/3 cup white sugar
1/3 cup canola oil (or less)
1 tsp celery seed

In small saucepan bring the dressing ingredients to a boil on high heat while stirring constantly. Remove from heat and pour over prepared vegetables. Toss to mix, cover and refrigerate. Salad is best if made early in day or the night before and keeps well.

So just what is a “healthy diet” anyway?
Recently I got a call from a patient who told me that her doctor told her all she needs to do is eat a “healthy diet”. So her question for me was: what exactly is a healthy diet these days?  

That’s a pretty loaded question and one that is not at all easy to answer. She went on to tell me that she has been looking at labels regularly and is very confused. Between marketing claims for nutritious and healthy foods and front of package claims that suggest that just about everything is a healthy choice, she was pretty frustrated. And I can’t blame her. I’m pretty frustrated myself. Even with a degree in nutrition and 12 years as a dietitian I find myself wanting to trust the myriad of symbols on the front of food packages and am often shocked by what I see when I look a little closer.

Here are some examples I find especially annoying and confusing to consumers. 
  • Vegetable juices that are loaded with sodium but are marketed as being pretty much the same as fresh veggies and carry an endorsement on the front of the package that makes them seem heart healthy.

  • Serving sizes that don’t resemble what most of us would consider a serving.

  • Products that claim to be “part” of a nutritious breakfast but don’t actually contribute anything healthy to your diet. This includes sugary cereals that are pointedly aimed at kids.

  • High fat products (such as potato chips) that say “cholesterol free” on the package! Only animal based foods contain cholesterol and the evidence that dietary cholesterol is bad for us is pretty limited compared to the evidence that high fat is bad for us.

  • “Sodium-reduced” products that still provide over half of your daily sodium needs.

  • Fresh fruits, vegetables, grains and unprocessed meats that don’t carry any health claims but are truly the cornerstone of any “healthy diet”.
So the answer to the question truly seems to be: a healthy diet includes as much fresh and unprocessed food as possible. If you don’t require a potassium restriction it also includes lots of fresh fruits and vegetables (in their unprocessed state) or as many as your dietitian says you can safely include. And the bottom line is: be sceptical! Turn the product over, read the ingredients and the Nutrition Facts table.

For a great website on label reading for sodium check out www.sodium101.ca.

Here’s a great salad dressing recipe that has no added salt:

Tarragon Vinaigrette
1 tsp Dijon mustard
2 tbsp lemon juice
2 tbsp white wine vinegar
1 tbsp minced shallot
2 tbsp fresh tarragon or 1 tsp dried tarragon
1/3 cup extra virgin olive oil

Mince shallots. Add mustard, tarragon, lemon juice, and vinegar. Whisk in olive oil. Drizzle over your favourite greens. Make it a complete meal with leftover chicken and a roll.

Recipe developed by Chef Leslie Cairns.

Winter Warm Up!
When the weather is this cold, I start to think of comfort foods – soups, stews and chilli. Recently I spent some time browsing through my Mom’s handwritten recipes. I love to read the little notes she used to write on her recipes and the specific ones she left for me, often along the lines of:” June don’t try to cut out all the salt it won’t taste right.” I shudder to think of the salt in most of those old recipes. This summer I pulled out the old dill pickle recipe and thought I might try my hand at pickles. For some reason I decided to do a nutrient analysis of the recipe and was horrified to discover that each jar contained over 28000mg of sodium. I did not make the pickles.

The other day I came across a recipe that was perfect for a cold day and very low in salt. I don’t know where it came from but with a very little bit of tweaking this Chicken Chili Stew was very low in salt and loaded with flavour. Most chili recipes are loaded with salt and high potassium beans but  this is a wonderfully fresh flavoured chili stew that needs no salt. Even better – it only takes about 30minutes to get on the table!

Chicken Chili Stew
1lb chicken breasts, cut into bite sized pieces
2 ½ cups cold chicken broth (use a "No Salt Added" brand)
4 cloves garlic, finely chopped
1 jalapeno chili, seeded and diced
1 tablespoon flour
1 red pepper, diced
1 small carrot, diced
1 cup frozen corn
¼ tsp freshly ground pepper
½ tsp ground cumin
2 tablespoons cilantro, finely chopped
1 tablespoon cornstarch
12 unsalted or low salt tortilla chips (optional)

In a large saucepan, heat 1/4 cup broth to boiling. Cook chicken in broth, stirring, until white (about 4-5 minutes). Remove chicken and set aside. Cook garlic and jalapenos in broth over med-high heat stirring frequently (about 2 minutes). Stir in flour, turn heat to low and stir constantly for 2 minutes. Gradually add 2 cups of broth.  Add chicken, red pepper, carrots, corn, pepper, cumin and cilantro and heat to boiling. Reduce heat, cover and simmer approximately 20 minutes until the chicken is cooked all the way through. Mix cornstarch in remaining 1/4cup of broth and stir into stew. Continue to cook, stirring often, until heated through and thickened. Serve topped with crushed tortilla chips and extra cilantro.

Option: Double up the broth and leave out the cornstarch for a warm and satisfying soup.


Happy New Year!!!
It seems that the newspapers are chock full of health and nutrition advice these days – it’s no surprise since January seems to be everyone’s favourite time of year to take stock and get ready to be healthier.  The flyers are dominated by fitness equipment and the parking lot at the gym is full!  It’s a great time of year to be a dietitian! I’ve been thrilled to see great articles about sodium, fat and processed foods over the past week and what I see in most of the really good articles is a common theme:
  • Eat fresh, unprocessed foods more often
  • Eat regular meals
  • Prepare food at home more often; eat out less often
  • Cut back on salt and sugar
  • Be conscious about what you eat – plan ahead

While none of these ideas are all that surprising (we all know these are good things to do), it’s great that they can all be applied to a kidney diet.  I can relate especially well to the last item.  Life gets busy and too often planning meals happens on the way home from work!  Planning ahead, making a list and having the ingredients on hand are all important to a healthy lifestyle.

I love new recipes and I’ve been perusing many of the sites looking for new and healthy recipes that are easy and fast but to my dismay many are simply low calorie or low fat and still far too high in sodium to really be called healthy.  Avoid recipes that call for processed foods in the ingredients list (for example: ham, sausage, processed cheese, broth or bouillon).  You can substitute better ingredients in many cases (for example: sodium free broth or unprocessed cheeses) but your finished product may not be what you expect. 

If added salt is the problem try cutting the sodium in half or eliminating it altogether.  If you cut out the salt make sure to boost up the other flavour enhancers (herbs, spices, lemon, garlic). Beware of seasoning salts (onion salt, garlic salt) which are high in sodium and salt substitutes which contain potassium chloride (for example: NoSalt or Half Salt).

As always, read through the ingredients list and make sure that all the ingredients fit with YOUR nutrition requirements (low potassium, low phosphorus). Here’s a simple but delicious way to prepare chicken breasts...

Herb and Ricotta Stuffed Chicken Breast with Roasted Red Pepper Coulis

Stuffed Chicken with Ricotta Filling
1 clove garlic, sautéed
1 tbsp extra virgin olive oil
1 cup ricotta
1 egg
¼ cup chopped fresh herbs (eg: basil, parsley, thyme)
¼ tsp black pepper
4 chicken breasts (boneless and skinless with NO phosphate additives)

Sauté garlic in olive oil. Combine ricotta, eggs, garlic, and herbs. Cut slit in fattest side of the chicken breast. Stuff mixture into chicken breast. Heat olive oil in skillet. Brown chicken in skillet than transfer to a 350F preheated oven. Bake for approximately 20-30 minutes until no pink remains.

Roasted Red Pepper Coulis
1 cup roasted red peppers
1/4 cup extra virgin olive oil
2 tbsp lemon juice
1 garlic clove, minced

Puree all ingredients in a blender. Warm in saucepan or microwave. Serve with chicken. Can also be used as a quick pasta sauce.

1 stuffed chicken breast = 4 protein choices

Recipes developed by Chef Leslie Cairns


Phosphorus – the new “f-word”?
Recently we had a “take your children to work” day at the hospital. The daughter of my manager came in and spent time learning about some of the professionals who work in a dialysis unit, including the dietitian. Her mom came in the next day and told me how, over dinner, her daughter had told the family all about the renal diet – potassium, sodium, protein and the other one – “the f word”. I have to admit this made me laugh out loud because I spend a lot of my time talking about phosphorus and the importance of limiting it in the renal diet.

I actually think the new “f-word” should be fast food. A recent study in the US looking at patients with chronic kidney disease found that those who had the lowest income had the highest phosphorus. The authors believe this has to do with the intake of convenience and fast foods and the amount of phosphorus in them. Most fast food restaurants do not provide the phosphorus content of their products but will give you a detailed ingredients list of their products.

I thought it would be useful to use this information to be able to provide my patients with lists of foods that did NOT have phosphate additives in our local fast food restaurants however the list was so short it was almost comical! One very popular fast food restaurant even puts phosphate in their French fries. Almost every chicken product I looked up had additives. Surprisingly in most cases, a burger (without cheese) proved to be the safest bet.

The best choice is always to choose fresh and unprocessed foods but if you’re in a pinch and must eat “fast food” try to familiarize yourself with the nutrition info first! While there might not always be a good choice, there is usually a better choice!

For a fast and easy side dish try this pasta recipe. It's an excellent low potassium alternative to pasta with tomato sauce and can be served with chicken, pork or beef. Try it with grilled chicken breast!
Pasta Alio e Olio (serves 4)
1 lb spaghetti / linguini
1/2 cup extra virgin olive oil
2 cloves garlic minced
cracked black pepper
1 tsp dry chili flakes
1 green onion
1/2 cup fresh herbs (such as parsley, basil etc)

Cook pasta according to directions. In a skillet over medium heat, sauté garlic, chili flakes, and onion in olive oil for one minute. Add cooked pasta and fresh herbs. Toss together and serve immediately.

Recipe developed by Chef Leslie Cairns
Buyer Beware
Somehow the fall always seems to be such a busy time of year both at work and at home. All of those projects that were put on hold over the summer come back with a vengeance when the cooler weather hits, and this year it’s all about salt! It seems that everything I read lately is warning me about the health risks of too much sodium in the diet. From high blood pressure to kidney stones, sodium is being pointed to as a risk factor in a number of chronic diseases. More than ever before I am seeing low sodium, sodium reduced and salt free products in the stores. As I look at each product, I am reminded of the slogan: “buyer beware”. Some of these products are not all they’re cracked up to be!

When reading labels, always check the ingredients list. Often a low salt product will use potassium chloride to replace the flavour of sodium chloride. This potassium chloride (KCl) can be dangerous for people who have kidney disease. Another ingredient to watch out for is “phosphate” additives. These have many names but you’ll recognize the “PHOS” in the name (examples are: sodium phosphate, phosphoric acid). Phosphate additives are often found at the end of the ingredients list and should be avoided.

The kidney diet can be frustrating and complicated. Sometimes the best message is simply to choose fresh and unprocessed foods as much as possible.

Every autumn my family ventures out to one of our local apple orchards to pick a bushel of apples. My children love to eat apples that they picked themselves! And for several weeks we have everything from apple muffins to apple pancakes to try to use them all up. So here’s another apple recipe to enjoy!

Apple-Cranberry Cake (serves 12)
1/3 cup butter
3/4 cup sugar
2 eggs
1 1/2 cup all purpose flour                
1 1/2 tsp baking soda
zest of 1 lemon
2/3 cup yogurt (plain)
1 cup cranberries
2 apples (peeled and sliced)
1/2 cup brown sugar
1 1/2 tsp cinnamon

Preheat oven to 350°F. Line a 10" cake pan with parchment. Beat butter and sugar together.  Add eggs one at a time. Alternate adding sifted dry ingredients and yogurt. Spread half of batter in cake pan. Arrange cranberries on top and sprinkle with brown sugar and cinnamon.  Spread remaining batter over top. Arrange apple slices and sprinkle with brown sugar and cinnamon. Bake for 50-60 minutes.

Recipe developed by Chef Leslie Cairns

A Taste of Vancouver

I just returned from a lovely trip to beautiful Vancouver. Vancouver is a wonderful city with so much to see and do but I have to say the highlight of my trip wasn’t the sea safari, or the float plane, but the food. We enjoyed spectacular fish and seafood every day, often with an Asian flare. While I know that there was a lot more salt in the food that I ate than I would normally have I decided to share the soup below because it is a perfect example of a recipe that doesn’t need salt. When this soup was demonstrated at a chef day event at our hospital, it was probably the most popular soup we’d ever tried (with staff and patients alike). Don’t be afraid to be very generous with the fresh herbs and lime – they pack a punch of flavour. 

Consider that a ½ cup serving of this soup provides only 37mg sodium compared to over 500mg from a commercial chicken soup.

Thai Fish & Rice Soup (yield 12 servings)
5 cups water (boiling)
2 frozen white fish fillets
1 cup chopped green onion
1 tbsp minced fresh ginger
2 garlic cloves, chopped
1 cup diced carrot*
1 cup diced celery
2-3 tbsp chopped fresh basil
2-3 tbsp chopped fresh cilantro
2-3 tbsp chopped fresh mint
black pepper
lime juice
1 cup bean sprouts
1 cup cooked long grain rice
Dried chilies (if you like it spicy)

Sauté ginger, garlic, celery, and green onions in 1 tbsp oil. Add boiling water, fish, and carrots. Simmer until the fish is cooked. Season with black pepper and fresh herbs. Add the cooked rice and serve hot. Garnish with bean sprouts, more fresh herbs (to taste), and a generous squeeze of lime juice.

* If you require a potassium restriction bring the carrots to a boil in a separate pot prior to adding

1 portion = 1 protein choice, ½ starch choice


  • Try chopped red pepper in place of carrots for a low potassium colourful option
  • Add shrimp to boost protein & flavour

Recipe developed by Chef Leslie Cairns



What’s old is new again!
Yesterday my brother emailed me the latest “fad diet” that’s been making the rounds in his office and asked me what I thought about it. Immediately, I rolled my eyes at what was sure to be another “too good to be true” diet. Most fad diets offer something revolutionary, new or secret but generally have very little science to back them up. Some diets offer cures or the ability to replace medications and can even be dangerous for people with health conditions.

This new “diet” my brother sent started out by suggesting you have a source of fat at breakfast to promote feeling full longer (I instantly imagined a big plate of greasy bacon). It went on to encourage smaller portions at supper, staying away from saturated fats (so no bacon) and processed meats and encouraged lots of water, fruits and vegetables throughout the day. All of a sudden it struck me: this newest “fad diet” is actually just a high fiber, healthy way to eat!

So I thought I’d spend a bit of time talking about fiber and chronic kidney disease. Fiber is not a very glamorous topic but it is something that we all need to include in our diets. Fiber is not technically a nutrient since it passes through the gastrointestinal tract without being absorbed but it’s still important for health. Fiber helps promote bowel regularity, keeps your gut healthy and helps you feel satisfied after a meal. Getting enough fiber is tricky for those with kidney disease who need a low potassium, low phosphorus kidney diet.

These are some easy things you can do every day:
  • Eat whole fruits more often – fruit juice contains little fiber.
  • Try to eat the recommended number of fruits and vegetables on your meal plan each day.
  • Eat skins and peels to increase fiber intake, where possible.
  • Try adding natural wheat bran (germ removed) to your food. Start with 1 tablespoon per day and gradually increase to 2-3 tablespoons per day.
Some of the best fiber foods for someone on a kidney diet include:
Carrots (boiled)
Corn Bran cereal
Green/Yellow Beans
Green peas
Popcorn (unsalted)

Ask your doctor or dietitian to suggest a fiber supplement if you still can’t get enough fiber in your diet. Try this high fiber dessert this fall:

Warm Baked Apples
4 tart apples
1/2c sugar or Splenda
4 tbsp butter or non-hydrogenated margarine
2 tsp cinnamon

Preheat oven to 350° F (175° C). Scoop out the core from top of the apple, leaving a well. Try not to cut all the way through. Stuff each apple with 2 tablespoons sugar and 1 tablespoon butter. Place in a shallow baking dish and sprinkle with cinnamon. Bake in preheated oven for 20 minutes, until sugar begins to caramelize and apples are tender. Serve warm!

Each of these apples provides 3.2g of fibre and make a wonderful dessert or treat!
Time Flies!!
It’s hard for me to believe that it’s been a year since I started doing a blog for the Kidney Foundation of Canada! This August I’m busy getting ready for “back to school” with my children and am excited about participating in the Kidney Foundation’s Walk for Life in September.

A year later headlines and health news reports continue to be full of sodium news and reports about the food industry’s response (or lack of response) to the call to reduce sodium in packaged foods. I’m excited to see more and more companies committing to lowering the sodium in their food but I can’t help but think label reading is going to be even more challenging for kidney patients in the years to come.

Some low sodium products have additives that can be a concern for kidney patients. Potassium Chloride (KCl) is commonly used to give a “salty” flavour. For those on a potassium restriction, this can be quite dangerous. Most products don’t list potassium in their “Nutrition Facts” table so the only way to know is to read the list of ingredients. 

Phosphates or phosphorus are also used in low sodium products and are even harder to find on the label. The ingredients list may have phosphoric acid, sodium phosphate, sodium hexametaphosphate or many other types of “phos” ingredients. If you see these phosphates on your ingredients list, try a different product!

I often hear people say that they don’t worry about these things as long as they are at the end of the ingredients list. But what makes food additives different than food ingredients is that they do not have to be listed by amount and can be found in any order on the list. It’s important to scan the ingredients lists for any questionable additives.

The recipe below uses the convenience of frozen tart shells but gives you the taste of homemade. These simple tarts have two very delicious toppings to choose from and are surprisingly quick to make and impressive to serve. Enjoy!

Amaretto Berry Tart Duet (yields 12 servings)
12 mini tart shells (frozen)
2 cups berries (fresh or frozen)
2 tsp amaretto (optional)
1 tsp cornstarch

In a saucepan, cook berries over medium heat. Once berries start to break down, mix amaretto and cornstarch together, and add to warm berries to thicken. Spoon mixture into tart shells.

1 tart =  1 starch choice, 1 sugar choice
1 tart if using Splenda = 1 starch choice

Cobbler Topping
½ cup unsalted butter (cold)
1 cup all purpose flour
¼ cup brown sugar*
¼ cup white sugar
(or substitute brown and white sugar with ½ cup Splenda)

Mix all ingredients by hand until butter is evenly distributed. Spoon topping over fruit tarts and bake at 350°F for approximately 15-20 minutes.

* Brown sugar is higher in potassium and phosphorus than white sugar so using a combination of white and brown sugar will still give you the great taste while lowering the potassium.

Meringue Topping
1/4 cup pasteurized egg whites
1/2 cup white sugar
1/4 tsp cream of tartar

Whisk egg whites and cream of tartar together until frothy. Slowly whisk in sugar and continue to whisk until firm peaks are formed. Spoon meringue over baked berry tarts. Place under broiler until meringue becomes golden.

Recipes developed by Chef Leslie Cairns

Beating the Heat on a Fluid Restriction
Hot summer days are wonderful but can be torture for people who must restrict their fluids. While this generally applies only to dialysis patients or those with congestive heart failure, I thought I’d devote this blog to those who have to try to manage both their fluids and the heat. If you don’t need to follow a fluid restriction make sure you get enough fluids in the summer heat to keep your kidneys working well.

Extra fluid on your body can often be seen as swelling (edema), increased blood pressure, weight gain or shortness of breath and can be quite dangerous. If in doubt see your doctor!

Check with your dietitian to see how much fluid you should aim for every day. As a general rule of thumb you should gain no more than 2-2.5 kg (4.4-5.5 lbs) of fluid between hemodialysis treatments. Remember every 500 ml (2 cups) of fluid not used by the body equals ½ kg (1 lb) in weight gain. Fluid allowance may change depending on your urine output. In general, you may drink 1 litre (4 cups) of fluid per day plus an amount equal to your urine output.

If a food is liquid at room temperature, it is considered a fluid. Fluids include coffee, tea, popsicles, sherbet, ice cream, jello, soup and ice.

To Control Fluid Intake:

  • Drink only to satisfy thirst.
  • Keep cool – stay out of the sun and try to find air conditioned spaces.
  • Choose cool, moist foods at meals.
  • If you avoid high sodium foods, you will be less thirsty.
  • Don’t drink from habit or to be social.
  • Try to get the most nutrition from your allowed liquids. Give up coffee, tea, soft drinks and alcoholic beverages before milk, soups, juices and other nutritious foods.
  • Try having allowed fruits and vegetables ice cold between meals. Frozen grapes or raspberries can be a satisfying way to quench thirst.
  • Try sliced lemon wedges to moisten a dry mouth.
  • Use sour hard candies and chewing gum to moisten mouth.
  • Rinse your mouth with water, but don’t swallow it. 
  • Weigh morning and evening and adjust your liquid intake so that you have a fluid weight gain of about 1 kg/day (2.2 lbs/day).
  • Most people find ice more satisfying than the same amount of water. Try putting lemon juice in ice cubes; you’ll use fewer. Use about half a lemon per tray of water. Remember to include ice in your daily fluid allowance.
  • Use small cups and glasses for beverages and other liquids.
  • Freeze allowed fruit juices in ice cube trays to reduce amounts taken.
  • When thirsty, try eating something like bread and margarine with jelly before taking liquids.  Often the sense of thirst is really due to having a dry mouth.
  • If you have diabetes, high blood sugars will increase your thirst. Having good control of your diabetes will help to control thirst.
  • Speak to your pharmacist about trying an oral rehydration solution (treatment for dry mouth).
  • Measure your daily fluid allowance into a jug in the morning. Each time you swallow any fluids pour out an equal amount of water from the jug. When the jug is empty, you have consumed your fluid allowance for the day.

Tired of the usual lunch fare? These cool, refreshing salad rolls are an interesting alternative to sandwiches. Look for the rice paper in the Asian section of your grocery store.

Curried Shrimp Salad Rolls
Per Roll:
4 shrimp
1 tsp mild curry paste
¼ cup bean sprouts
2 peach slices
thai basil, cilantro (to taste)
rice paper

Sauté shrimp in curry paste. set aside to cool. Soak rice paper in warm water. Place rice paper on towel to absorb some of the moisture. Line rice paper with shrimp, thai basil, cilantro, bean sprouts, peach slices, and a chiffonade of lettuce. Roll securely and serve with mint yogurt dipping sauce.

Mint Yogurt Dipping Sauce
¼ cup plain yogurt
½ bunch fresh mint, blanched
¼ tsp honey
1 tbsp milk

Process in blender and serve with salad rolls.

Recipe developed by Chef Leslie Cairns
Tips for the Barbecue Season

Summer is definitely here. The hot weather can make cooking a chore and it’s nice to be able to grill your meal outdoors. Unfortunately many “barbeque” foods like sausages, hot dogs, and prepared burgers are loaded with salt. It’s best to use fresh, unprocessed meats as the basis for your meal. Rubs or marinades without salt are great to add flavour: try freezing your meat in your favourite marinade and it will be ready to grill as soon as it thaws. 

Many condiments also come loaded with salt and should be used very sparingly. Most of us don’t pay attention to our serving sizes of condiments and the sodium can really sneak up on you. The numbers below are an average of what’s available at your grocery stores and you can find a huge variation in sodium content from product to product. Compare:  

2tbsp Ketchup    =   338mg sodium
2tbsp BBQ sauce   =   260mg sodium
2tbsp steak sauce  =   435mg sodium
2tbsp Asian Eggplant Dip = 50mg sodium

Try making a great sauce or dip, like the eggplant dip below that makes a fresh and fantastic alternative to salty barbeque sauces. It’s also great with crusty bread or as a sandwich spread.

Asian Eggplant Dip with Seared Peppercorn Steak

Steak Marinade
1 tbsp brown sugar
2 cloves garlic, minced
1 tbsp cracked black peppercorns
1 tsp olive oil
2 lb sirloin steak

In a small bowl, combine marinade ingredients. Pat steak dry, brush with oil and rub with mixture. Marinate for minimum one hour. Grill to desired doneness.

Asian Eggplant Dip (makes approximately 1.5 cups)
1 large eggplant
2 tbsp brown sugar
1 tbsp rice vinegar
1 tbsp water
1 tsp vegetable oil
4 cloves garlic, finely chopped
1 tbsp finely chopped fresh ginger root
4 green onions, chopped
1 tsp chili paste
1 tsp sesame oil
2 tbsp chopped fresh cilantro

Roast eggplant in preheated 425°F oven for approximately 45 minutes. Peel eggplant and chop finely. In a small bowl combine sugar, vinegar, and water. In a large skillet, sauté garlic, ginger, green onions and chili paste until fragrant. Add vinegar mixture. When bubbling, add eggplant. Stir to combine. Remove from heat and add sesame oil. Serve cold or at room temperature along with grilled steak.

Recipes developed by Chef Leslie Cairns

Summer's (almost) here!
While summer is not officially here yet, it certainly feels like it! I’m having a houseful of company this weekend and of course the cooking is made so much easier with plans to make a bunch of cold salads ahead and barbecue something easy. Warmer weather often means outdoor get-togethers, pot-lucks and barbecues. Navigating the buffet table while on a renal diet can be very stressful so make sure to always bring something you know you can eat. It can be especially difficult if you are on a low potassium diet.

Food Group


Vegetables and Salads

Snacks and Sweets

High Potassium
Limit or Avoid

Cantaloupe, Honey Dew, Kiwi, Mango, Nectarines, Prunes, Oranges, Bananas, Apricots

Baked Beans, Kidney Beans, Bean Salads, Baked Potatoes, Potato Salad, Spinach, Tomatoes

Potato Chips, Nuts and Seeds, Chocolate Desserts, Ice Cream
Enjoy Instead

Berries, Apples, Cherries, Grapes, Plums, Pineapple, Peaches, Canned Fruit Cocktail

Corn, Cucumbers, Green & Yellow Beans, Lettuce, Zucchini, Macaroni Salad, Coleslaw, Crab Salad, Gelatin Salad, Tuna Salad

Unsalted Popcorn or Pretzels, Strawberry Shortcake, Sherbet, Sorbet, Sugar Cookies, White Cake

 This super-fast, easy and delicious salad can be served warm or cold and becomes a complete meal when combined with leftover grilled meat, chicken, fish or shrimp. If you’ve never tried couscous before you’ll be pleasantly surprised by how easy it is and how well it keeps.  

COUSCOUS SALAD (serves 10)
3 cups boiling water
1/2 tsp cinnamon
1/2 tsp cumin
1 tbsp honey
2 tbsp lemon juice
3 cups quick cooking couscous
2 tsp olive oil
1 green onion finely chopped
1 small carrot finely chopped
1/2 red pepper finely chopped
fresh cilantro

Bring water to boil with cinnamon, cumin, honey & lemon juice. Add couscous. Cover and remove from heat. Fluff with fork and add vegetables, olive oil, and fresh herbs. Salad can be served warm or chilled.

Four Key Messages for World Hypertension Day
May 17th is World Hypertension Day and the theme for 2010 is Healthy Weight, Healthy Blood Pressure.  Hypertension is a major cause and complication of kidney disease. Most people think of cutting down on their salt intake when they have high blood pressure but achieving and maintaining a healthy body weight is also a critical part of preventing and controlling hypertension.
There are 4 key messages this year for World Hypertension Day and they are:
  • Check your waist – a healthy waist circumference for adult men is less than 94cm and it is less than 80cm for adult women

  • Eat green – increase your fruits and vegetables (if you have to follow a potassium restriction choose whole fruits and vegetables in the amount recommended by your dietitian)

  • Exercise – take it slow and gradually build up your exercise tolerance

  • Cut salt – avoid processed foods and don’t add salt to your food
It’s hard to imagine, but it’s estimated that as many as 1 billion people worldwide are overweight and we know that childhood obesity is on the rise.  Without making lifestyle changes that includes both nutrition and physical activity, this problem will only get worse.  Everyone is busy and exercise is very often the first thing we cut out of our busy schedules.  For any lifestyle change to be effective it must first be sustainable and fit in with your schedule.  My short-lived plan of going for a brisk walk at 5 A.M. before work lasted only one morning (and consisted of snoozing the alarm until my kids woke up).  Going out in the evening fits much better into my routine.  Don’t skip meals – almost everyone I see for obesity counseling skips at least one meal per day.  

For more information on hypertension check out www.hypertension.ca.

Finding fast and healthy alternatives to the usual high fat, high salt meals can be a challenge.  Many people rely on a can of soup as the base of their supper meal. Here is a low sodium, low fat, and delicious alternative to using a canned cream soup as a sauce for chicken.  This recipe was given to my by a patient many years ago and I sometimes substitute dry white wine for half of the broth.

Chicken in Mushroom Sauce
1/4 cup all-purpose flour
2 tbsp light sour cream
1 tbsp Dijon mustard
1 cup chicken broth (use a no salt added brand)
4 chicken breasts (not “seasoned”)
1/4 tsp dried thyme
1 tbsp nonhydrogenated margarine
1 1/2 cups mushrooms, quartered
3 chopped green onions
Fresh ground pepper and chopped fresh parsley to taste

Mix together 2tsp flour, sour cream, mustard and 2tbsp of chicken broth. Set aside. Sprinkle chicken with thyme and pepper then dredge in flour.  Melt margarine in large nonstick pan on medium-low heat. Cook chicken for about 5 minutes per side or until no longer pink inside.  Remove chicken and keep warm.

Add mushrooms to skillet and cook, stirring, for 3 minutes. Add remaining chicken broth, increase heat to high and boil for 3 minutes. Whisk in sour cream mixture; add green onions.  Stir until thickened (about 3 minutes).  Pour over chicken, garnish with pepper and parsley and serve.

Important Information Concerning Vitamin B Supplements
Many CKD patients and their families have questions about vitamins – should they take vitamins, which ones and how much? Often they receive different advice from different people. Over-the-counter vitamins seem like a safe “back-up” to a healthy diet and the benefits, while often vague, are touted by the media, alternative healthcare practitioners, and numerous books.  

This past week a study was published in the Journal of American Medical Association that all CKD patients with diabetes should be aware of.  Researchers were trying to determine if vitamin therapy could slow down the progression of kidney disease and prevent heart attacks and stroke. In this study, patients with diabetes and diabetic kidney disease who took high dose B-vitamin therapy had a greater decrease in kidney function and much higher rates of heart attacks and strokes compared with those who took a placebo!  

The doses of folic acid, vitamin B12, and, vitamin B6 used in the study are considered “pharmacological” which means to have a “drug-like” effect and significantly higher than the daily recommended intake. What is concerning however is that some over-the-counter vitamin preparations contain high amounts of some of these same vitamins. B complex vitamins may provide as much as four times the Vitamin B6 used in this study and a single nutrient supplement like vitamin B12 can be commonly found at the dose used. These vitamins are all “water soluble” and are filtered by your kidneys.

What does this mean for someone with chronic kidney disease and diabetes? Well I would strongly recommend talking to your kidney care team and reviewing all of your vitamins. If you’re taking any large doses of B-vitamins that weren’t prescribed by your physician, stop them. Talk to your renal team before starting any new products.

This study leaves us with many questions but it serves as an important warning that you can have too much of a good thing.  

Reference: Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy. JAMA. 2010;303(16):1603-1609


Salt – cut back when you can’t cut it out!
There are few things that bring me back to my childhood more than the smell of warm, fresh baked bread.  I remember coming home after school to a heavenly snack of fresh , warm bread and butter.  I remember we used to polish off a whole loaf before dinner, usually leaving us too full to eat.   Recently, when I was home with my sick daughter I decided to try my hand at making my own bread.  And, like the dietitian I am, I decided to try making some with no salt at all and some with about 2/3 of the salt called for.  Vague memories from food sciences class in university warned me that there was an important role for the salt in bread and sure enough my no-salt bread was not quite right.  My bread with less salt was exactly what I remember and as I watched my kids devour it, I decided that next time I’d try cutting back to about ½ of the amount called for in the recipe.  

Unfortunately I rarely have the time (or energy) to make bread from scratch and it’s a staple for my family and for most Canadians.  It’s impossible to completely remove the sodium from the bread that you eat but make sure to compare labels at the grocery store and choose the bread with the lowest sodium.  Flour tortillas can have a surprising amount of sodium in them so pitas may make a better choice for a wrap.  The recipe I am including today is for fajitas which are traditionally served in a flour or corn tortilla but, if you can’t find a low enough sodium brand, are also great in warmed pitas.  This marinade has no salt added but you won’t miss it! 

Fajita Marinade
¼ cup lime juice
2 tsp cumin
2 tsp chilli powder
2 cloves garlic, crushed

Mix all ingredients together and marinate either ½lb steak or 2 chicken breasts.  If using steak marinate overnight in the fridge or for at least 2 hours for chicken.  Grill, slice thinly and serve on warmed pitas or tortillas with slices of pepper and onion.


Helping Out In Tough Times
When someone is sick or a family crisis occurs, the first response is often to bring food! Recently when someone in my own family was ill we were so grateful to receive gifts of homemade muffins, casseroles and freezer-ready meals. Friends, neighbours, co-workers and family all helped out during a very difficult time giving us one less thing to worry about.

I’ve heard kidney patients tell me that they too have been brought gifts of food but that because of their renal diet they can’t or are afraid to use these items. And I’ve received many a call from people asking what they can bring their Mom/Dad/Neighbour who is on dialysis. So I thought today I would write about some ideas for renal-friendly gifts of food.  In fact, I can’t think of a nicer thing to give someone who is probably already exhausted when they get home from appointments or treatments and would love a break from cooking.

It helps to make a note of the ingredients in the food you’re giving (send along the recipe) or the source of the recipe (ie from a kidney friendly cookbook or the Kidney Foundation website). That helps to make sure that everyone is comfortable enjoying your gift without stressing about the salt or phosphorus content.  

Bring someone one of these lovely soups portioned in two containers (one to eat now and one to freeze). Check out www.myspiceitup.ca for more recipe ideas.

Roasted Red Pepper Soup: (yields 6-8 servings)
5 large roasted red peppers (10 oz jar)
5 cups water
2 small chopped yellow onions
5 cloves garlic
1 tbsp olive oil
1/2 cup fresh basil
1/2 tsp ground pepper
1/4 tsp hot sauce

Saute onions and garlic in olive oil until soft and aromatic. Combine peppers, onions, garlic, and seasonings in blender. Slowly add water to vegetable puree until desired consistency. Chill before serving or can be heated and served hot. (1 serving=1vegetable choice)

Puree of Corn and Fennel Soup
shrimp shells
2 tbsp vegetable oil
1 kg frozen corn
2 onions/leeks chopped
1 celery stalk chopped
6 cloves garlic
2 cups chopped fennel
black pepper to taste
tarragon to taste
2 liters cold water

Sauté shrimp shells in oil until the shells turn pink. Add onion, celery, garlic, fennel, & corn and sauté until the onions become translucent and the flavour begins to develop. Add the liquid and bring to a boil. Let simmer for at least 30 minutes. Process soup in a blender and strain to remove excess fibers. Adjust seasonings with freshly ground black pepper and tarragon. Yield : 8-10 cups, 2/3 cup serving = 1 vegetable choice.

Fennel is a higher potassium vegetable but pairing it with an acceptable potassium vegetable like corn is a great way to safely include it into your diet!

Happy World Kidney Day!
The theme of the 2010 World Kidney Day is Diabetes – the leading cause of chronic kidney disease worldwide. March also happens to be nutrition month so I want to talk a bit about nutrition and diabetes.  

I have been away from work for the past several weeks and as I returned this week I was asked if it would be inappropriate to celebrate World Kidney Day at our hospital by giving out cookies – since the theme this year is diabetes and we should be telling people to avoid sugar. While there is definitely some merit to this idea, I think it’s important that we don’t oversimplify this very complicated disease. Avoiding sugar alone is not going to prevent or control diabetes. In fact it is more important to achieve and maintain a healthy weight to prevent diabetes. For those individuals who have diabetes it is critical to focus on portion control, regular meals and carbohydrate counting. The key is really balance. Canada’s Food Guide is a very useful tool to help you get started on a balanced track to healthy eating. For people with kidney disease and diabetes check out the tools on this website and be sure to see a dietitian who can design a diet just for you.  

I am delighted to see that the new nutrition fact sheets are available on the Kidney Foundation website and hope you will take a look at these new resources.  

So in the spirit of World Kidney Day I am including some extremely healthy recipes that are also delicious!  

Warm Mushroom Salad With Watercress
4 tbsp olive oil
2 tbsp balsamic vinegar
1/2 tsp thyme
1/2 cup sliced mushrooms
1/2 c shallots
4 cups mixed greens (including watercress)

Sauté mushrooms and shallots in olive oil. Season with thyme and finish with balsamic vinegar. Serve over a bed of greens.  

Broiled Red Snapper with Herb Pesto
15 oz red snapper
Herb Pesto:
2 cups herbs (basil, parsley, cilantro mint)
2 garlic cloves
¼ cup olive oil
2 tbsp limejuice

Pulse all Pesto ingredients in a blender until smooth. If you don't have a blender, finely chop the herbs & garlic and whisk in oil and limejuice to blend. Set the oven temperature dial to broil. Generously coat snapper fillets with pesto and broil for approximately 10 minutes or until fish flakes.

Fragrant Basmati Rice
1 cup basmati rice
2 tsp olive oil
1 bay leaf
1/2 tsp turmeric
1 1/2 cup water
cinnamon stick

Heat oil in sauce pan. Add rice and spices and toast slightly. Add water. Bring to a boil. Cover and simmer for approximately 15 minutes.

Recipes developed by Chef Leslie Cairns

Happy New Year!
It’s hard to believe that it’s 2010! I wish all of you a healthy and happy New Year. The last decade has brought some very welcome changes for nutrition: trans fats have been identified and are being phased out of most foods; the public, government, and industry have identified the need to reduce sodium in packaged foods; and most importantly there is a real focus on eating local and fresh foods. This makes following a low sodium diet much more realistic as well as being a healthy and environmentally friendly way to eat!

Unfortunately, Chronic Kidney Disease patients have other nutrition concerns and need to be vigilant when label reading. Watch out for phosphate and potassium additives in the ingredients lists of the foods you eat. When in doubt – double check with your dietitian.

I just returned from a trip to Disney World and was inspired to talk a little bit about fluids! Most beverages that came with our meals were a litre (32ounces) - this is the entire daily fluid requirement for many hemodialysis patients! Initially my children thought they were in heaven when they got 600mL of chocolate milk with their lunch! Even if you don’t need to restrict your fluids, many of these huge beverages are loaded with sugar. While we quickly learned to order water it was shocking to see the sizes of juice, milk and sodas being consumed. The trip was a lot of fun for all of us and my husband and I had a fantastic time watching our children “experience” everything for the first time.

Here’s a slow-cooker recipe that’s perfect for cold winter days! Too tired after dialysis to cook a big meal? Put this tasty dish together in the morning to enjoy a hot meal later in the day! Serve this pork roast with rice or over noodles.

Slow-Cooker Pineapple Pork Roast
1 pork roast (about 3 lbs)
1/2 tsp crushed red chilies (use only if you like it spicy!)
1 can crushed pineapple (8 oz)
2 tablespoons sugar
1/2 tablespoon light soy sauce
1 clove garlic, minced
1/4 teaspoon dried basil
2 tablespoons cornstarch
1/4 cup cold water
1 green or red pepper, chopped

Cut trimmed roast in half, if necessary, and place in Crock Pot. Add pepper to taste. Combine all ingredients except cornstarch, water and green pepper; pour over roast. Cover and cook on low for 8 to 10 hours or high for 4-6 hours. Remove roast and check internal temperature with a meat thermometer. Drain pineapple and reserve cooking liquid. Return meat and pineapple to cooker. Add water to liquid to make 1 3/4 cups. Pour into saucepan. Blend cornstarch and cold water together to form a smooth paste. Stir into hot reserved liquid. Add chopped green pepper. Cook and stir until thickened. Pour over roast.

Serving size: 1/6th recipe
Sodium:  83mg   3% of DV

New Recipe Resource Online and Holiday Recipes!
I have been a renal dietitian for over 10 years and many patients tell me that the diet is one of the most depressing parts of their disease.  I have heard patients say: if it tastes good it must be bad for you!  This is why the cookbook series that I worked on is one of my favourite projects ever!  These books are filled with recipes that are wonderfully tasty and flavourful for anyone to enjoy.  Because they were printed in a limited quantity and primarily for dialysis patients, many people with kidney disease haven’t been able to get a copy. Now, however these cookbooks are available online to anyone in French and English. Check out www.myspiceitup.ca for the first Canadian recipe website for kidney patients.

As the Christmas season gears up many of us start to think of entertaining, baking and eating!  For people on a renal diet this is a very daunting time of year. Many traditional foods are off limits (think ham and scalloped potatoes) and even good choices (turkey and stuffing) are sometimes prepared with ingredients that makes them a concern.  My colleague Melissa Atcheson created the following holiday resources for kidney patients and graciously allowed me to share it with you.  Thanks Melissa!

Holiday Dinner Suggestions

Sample Holiday Menu with Recipes

Happy Holidays!

What about phosphorus?
The past few weeks have been very busy ones for me.  I have been working on a new project about hidden phosphates in foods. Healthy kidneys help regulate the amount of phosphorus in your blood, and if you have impaired kidney function your healthcare team may recommend you limit your phosphate intake. High phosphorus levels in the blood can lead to bone and cardiovascular problems in kidney patients.

Almost all foods contain some phosphorus so it is impossible to eliminate it altogether but your dietitian will likely recommend you limit milk, whole grains, lentils, nuts, seeds, chocolates and foods with phosphate additives.

Phosphate additives are added to foods for many reasons including as a leavening agent, a preservative, and a flavour enhancer.  The phosphates from food additives are especially dangerous since our bodies absorb them much more efficiently than the phosphates that occur naturally in things like milk, lentils and whole grains.

Unfortunately there is no easy list of foods containing phosphate additives so you have to read the labels.  Look for words that say “phosphate” or “phosphoric” such as sodium phosphate, sodium tripolyphosphate, or phosphoric acid.

Typically you will find phosphates added to:
  • Processed cheeses, spreadable cheeses or slices
  • Colas
  • “Seasoned” meats, poultry and seafood including most processed and deli meats.  Read labels carefully since these meats may appear in your fresh meat counters at local grocery stores.
  • Bakery products such as biscuits, muffins and snack cakes
If you have or are at risk for kidney disease I recommend you avoid or cut back on these processed foods

Label reading is the key – I spend a lot of time at the grocery store reading food labels – maybe too much. Recently my 7 year old daughter Lily came home from school and told me that her teacher had brought in a treat (processed cheese spread and crackers).  Lily advised her that this was not a healthy food because it is high in sodium and phosphates.  When I asked my daughter how her teacher responded she said she just shook her head and told her to go back to her desk.  I was pretty proud of my health conscious seven year old until she announced that this kind of cheese is “wonderful”!  

Choose unprocessed or homemade foods more often! Try these low-phosphorus tea biscuits:

Buttermilk Biscuits
1 1/2 cup all purpose flour
2 tsp sugar
1 tsp baking soda
4 tbsp unsalted butter
1/2 cup buttermilk

Mix dry ingredients together.  Cut in butter until pea-sized.  Add buttermilk to bring dough together.   Roll dough out and cut into biscuits. Bake at 350F for approximately 10 minutes or golden.

Recipe Developed by Chef Leslie Cairns.

Eating out on a renal diet
Going out to eat can be a fun social outing, a break from cooking or a necessity while away from home. Eating out at a restaurant while following your diet is a serious challenge but it can be managed with some careful planning.  Don’t be afraid to check out the menu online and call ahead to ask questions. Review your renal diet before you go out or bring your food lists with you.

Plan Ahead
If you know you will be eating out, cut back on serving sizes early in the day and avoid any salty or high potassium foods.  If you are on a fluid restriction you may wish to save your fluids throughout the day to allow more when you are eating out.  If you are on phosphate binders remember to bring them with you and take them with your meal. Talk to your renal dietitian about eating out and which local restaurants are best for you.

Read the menu carefully
Ask questions about any menu items you are not sure of.  Servers are used to being asked questions about the menu. If you’re not comfortable asking in front of your dinner companions – call ahead or check out the menu online!  Many restaurants have nutritional information available.

Special Requests
Many restaurants will be only too happy to make substitutions (ie rice instead of potatoes) or serve salad dressings, sauces and gravies on the side so you can control the amount you eat.  Ask if your entrée can be cooked without extra or added salt.

Keep in mind that anything you eat in a restaurant will be saltier than what you have at home – remember moderation is the key.  

Menu Choices

Appetizers and Salads
  • Look for fresh, simple items to avoid a heavy salt or fluid load.
  • Ask which fruits and vegetables are in the salad if the menu does not specify.
Better Choices:  Chef salad, crab cakes, shrimp cocktail, garlic bread without cheese, fried zucchini or onion rings.

  • Watch your portion sizes – try to estimate how much you normally would eat at home. Ask for a container to take the extra home.
  • Avoid mixed dishes or casseroles which are often higher in salt and phosphorus
  • Remove the skin from poultry to help decrease the salt content
Better Choices:  grilled or broiled steaks, lamb chops, prime rib, hamburger without cheese, fajitas, chicken (fried, grilled or roasted), sandwiches

Side Dishes
  • Choose starches and vegetables that are lower in potassium if you are on a potassium restriction.
  • Save your fruit and vegetable choices during the day to give you more options when you are eating out
  • Ask for a substitute if necessary
Better Choices:  rice, noodles, green beans, mixed vegetables

  • Ask for a clear description of the dessert
  • Avoid desserts made with chocolate, cream cheese, ice cream or nuts which will be higher in potassium and phosphorus – or share with a friend
  • Low potassium fruits make a good dessert choice especially if you have diabetes

Better Choices:  Low potassium fruit, fruit ice, sorbet, apple, blueberry, lemon meringue pies, strawberry shortcake


Happy Thanksgiving!
While I am unable to provide personal nutrition advice to the readers who come to this blog I want to encourage those of you with questions about your own diet to contact your dietitian for a meal plan that is personalized to YOU!  There is no “one size fits all” renal diet and the best advice is always tailored to your own needs.

I thought I would devote this blog to the holiday weekend that is coming up.  I have spent most of my time talking about sodium and salt but many kidney patients have to worry about many other nutrients including: protein, phosphorus, potassium, fluid, and sugars if they are diabetic.  Planning a Thanksgiving Feast with so much to think about can be a daunting task!  Enjoy turkey, cranberries, stuffing (made with white bread), green beans, rice, salads.  If you are limiting potassium be sure to double boil your potatoes (bring the potatoes to a boil, discard the water and start anew) and avoid yams, pumpkin, squash.

Today I want to talk turkey!  

When purchasing your Thanksgiving bird remember to read the label – if the turkey is “seasoned” or prestuffed there may be salt and phosphates that have been added.  Choose a fresh or frozen turkey that has no additives. Thaw the turkey in the refrigerator and use a meat thermometer to make sure that it is fully cooked.  (Nothing spoils Thanksgiving like food poisoning!!) Cook stuffing separately from the turkey.  If you must stuff your turkey, make sure the turkey reaches 180F and the stuffing reaches 165F.  Your oven should be set no lower than 325F.  

No holiday meal is complete without a fantastic dessert and I highly recommend these Spiced Pear Cupcakes with Maple Frosting developed by Chef Leslie Cairns!  They were a huge hit with our dialysis patients last year and an even bigger hit with my children.  They are a decadent lower phosphorus, lower potassium alternative to pumpkin pie.

Pear Cupcakes (yields 24-30 cupcakes)
½ tsp dry ginger
½ tsp nutmeg
½ tsp cinnamon
2 ¾ cups all purpose flour
1 ½ tsp baking soda
1 cup butter
2 cups sugar
3 eggs
1 tsp vanilla
3 medium pears peeled & chopped
1 cup pear juice

Preheat oven to 350 F. Sift dry ingredients together.  Cream butter & sugar.  Add eggs one at a time until fully incorporated.  Add vanilla.  Alternate adding dry ingredients with pear juice.  Fold in pears.  Bake in lined muffin tins for approximately 15-20 minutes.

1 cupcake with frosting = 3 starch choices, or 2 starch choices if using Splenda

Maple Frosting
4 cups icing sugar
½ cup butter (softened)
1 tsp maple extract
¼ cup milk

Cream butter & sifted icing sugar.  Add maple essence & milk.  Spread frosting on top of cupcakes.  Lick bowl!

Happy Thanksgiving!

Label Reading for Sodium
I had an excellent question recently from someone who is struggling with label reading for a low sodium diet and I thought it very likely applies to everyone.  Here it is:

“I have a sodium question for you.  If the sodium intake for a healthy adult is between 1500mg to 2300mg per day, why is the nutritional information labels on our food based on the intake of 2400mg of sodium per day?  It drives me crazy because I am always trying to figure out what the % daily value is per serving for my meals based on 1500mg/day.”

This is a great question!  The labelling is out of date and Health Canada recommends that adults do not exceed 2300mg of sodium per day.  Check out this link for more info: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/sodium-eng.php

Unfortunately changing food labels is a huge undertaking and takes a long time.  Labelling laws must be approved by both Canadian and US regulators and once new guidelines are issued, it takes some time for the food companies to change all their labelling.

So for now I give this advice – take whatever percentage you see on a label and add 50%.  So if a product has 10% sodium – you should count it as 15%.  If a product has 8% sodium you should count it as 12%.  This is probably the quickest way to convert when reading a label.  It will give you a percentage of a 1600mg sodium per day diet – which is a whole lot better than 2400mg.

Here’s a simple chart:
Amount of Sodium in Food  
   % DV on label  

  % DV of a low sodium 1600mg diet


Here is a recipe for a low sodium salad dressing that is a fantastic alternative to commercial, high salt salad dressing:

Shallot Vinaigrette  
2/3 cup extra virgin olive oil
1 shallot minced
3 tbsp red wine vinegar
cracked black pepper
1 tsp Dijon mustard

Combine all ingredients except oil in blender.  Slowly add oil to emulsify, OR you can whisk the oil into the other ingredients and serve immediately.  This dressing is wonderful served with arugula topped with slices of crunchy pear!

Recipes developed by Chef Leslie Cairns

Shake Up your BBQ without a Salt Shaker
It’s hard to believe that September is here and summer is almost over!  I thought I’d spend a bit more time talking about salt and sodium since it is such an important issue.  When we talk about eating “renal-friendly” limiting salt is the very first thing that comes to mind!  I recently had several questions about using different rock salts for their healing properties.  Some types of salts are being advertised as “cures” for various ailments and some even claim to “detoxify” your body.  Sea salt is sometimes called a “healthier” salt than table salt.  The bottom line is that salt is sodium regardless of whether it comes from the mountains, the sea or the salt factory and all Canadians (especially those at risk of kidney disease) should not add extra salt to their food.  In fact, because sea salt and rock salt are larger crystals most people need to add more to get the same amount of flavour.

One of the big salt culprits is condiments.  Soy sauce, dips, salad dressings and barbecue sauce can provide your entire day’s worth of sodium.  Check labels closely and choose the products lowest in salt. Or – better yet try making it from scratch.  Most recipes for salad dressings can easily be made without salt.  Try a rub (see below) instead of barbecue sauce for your meat.  Unfortunately salt also comes from foods such as breads, cereals and snack foods.  Even eating a muffin at your local Tim Horton’s can provide half of your daily sodium (a raisin bran muffin contains a shocking 790mg of sodium).  Check out this link for a fun interactive tool to help you see where the salt in your diet comes from: http://www.theglobeandmail.com/special-reports/hard-to-shake/salt-o-meter/article1187915//

The last summer long weekend is often filled with barbecues and get-togethers. If you have been invited out to eat it’s always a good idea to bring something that you know you can eat and if you’re hosting serve up low sodium fare that everyone will enjoy like the recipes below.

Did you know…
“Seasoned” pork or chicken is treated with a sodium phosphate solution that is not only high in sodium but is also a hidden source of phosphorus!

Roasted Vegetable Salad with Arugula and Bocconcini (yields 24 servings)
2 large eggplant diced
2 large zucchini diced
2 red onions diced
3 red peppers diced
1/4 cup olive oil
1 cup mixed herbs
2 tbsp chopped garlic
2 cups bocconcini cheese
1/4 cup olive oil
2 tsp ground black pepper
1 cup arugula
2 tbsp balsamic vinegar

Toss vegetables in olive oil and roast at 350˚F for approximately 45 minutes.   Allow to cool.   Combine roasted vegetables with remaining ingredients and serve. This salad is lovely as a side dish or a perfect light lunch served with fresh bread!

1 serving = 1 vegetable choice, 1 protein choice

Coffee Rubbed Sirloin (yields 6 servings)
2 lb sirloin steak OR 2 unseasoned pork tenderloins
Dry Rub:
2 tsp paprika
2 tsp chili powder
2 tsp ground coffee
2 tsp cumin
2 tsp brown sugar

Massage meat with dry spice rub. (chef’s suggestion – rub all over first with olive oil.) 
For Beef: Grill or panfry on medium heat to desired doneness (a one inch steak would take about 16minutes on the grill or 12minutes to panfry to achieve medium doneness)
For pork:  Roast at 325˚F for approximately 25 minutes or until the internal temperature reads 160˚F.   The pork will be cooked to a medium doneness.

One ounce of meat = 1 protein choice

Recipes developed by Chef Leslie Cairns

Welcome to my blog!
I am very excited to be involved in the new Kidney Foundation of Canada Website!  What a wonderful resource for Canadian kidney patients and their families.  

I have been a renal dietitian for 10 years and I can honestly say that the “renal diet” is one of the most challenging diets there is.  There is no simple diet sheet that we can hand out to everyone with kidney problems – every diet must be individualized to meet the needs of the person we see.  In addition, the diet may change as bloodwork, medication or kidney function changes.  Unfortunately there is also so much nutrition information in the media and on the web that many people are confused about what they can eat.  I hope that the nutrition section of this website will help answer some of your questions but if you have kidney disease I encourage you to get a referral to a dietitian.  It is so important that nutrition information be credible – make certain that the person who is advising you on your diet is a Registered Dietitian.  Dietitians must meet national standards for education and training and are held accountable by provincial regulatory bodies.

Ultimately everyone asks “what can I eat?”  With each installment of this blog I plan to include ideas and recipes that will apply to anyone with kidney disease.  The biggest challenge is often salt or dietary sodium.  Even without using a salt shaker most Canadians eat too much salt or sodium from processed foods and fast food.   The average Canadian consumption of sodium is 3500mg which is well above the Tolerable Upper Limit of 2300mg.  A small bag of potato chips can contain as much as 500 mg sodium!  Try the following lower salt alternative to chips and dip:

Baked Pita Chips:  12 servings
3 (6") pita rounds
extra virgin olive oil
chili powder

Separate pitas into 2 rounds with kitchen scissors.   Cut each pita into 8 wedges.   Brush pita wedges with olive oil and sprinkle with chili powder.   Bake at 350F for approximately 15 minutes or until crisp.

Roasted Red Pepper Dip: (yield 1 cup)
1 cup roasted red peppers
1 tbsp olive oil
1 tsp lemon juice
1 clove garlic
1 tsp cumin
Mix all ingredients together in food processor.   Serve with baked pita chips.

Recipes developed by Chef Leslie Cairns


The Kidney Foundation of Canada is not responsible for the content displayed on external websites. Hyperlinks or references to organizations, companies or individuals does not constitute an endorsement of any information, product or service you may receive from such sources. The Kidney Foundation of Canada does not exercise any editorial control over the information you may find at these locations.

The views on this blog do not, and should not, replace personalized medical advice. The Kidney Foundation of Canada strongly recommends that you seek healthcare advice appropriate to your own situation; and that this blog be used to inform those discussions.



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