By: Kellsey Reed RDN, LDN, PatientsLikeMe Contributor
Sandwiches are a favorite lunch option for so many people in the world. They are easy to make, compact, and travel well in a lunch box. Turkey, ham, tuna, and cheese, the possibilities are endless! When it comes to CKD/Chronic Kidney Disease, sandwiches can sometimes be thought of as “bad” food. Why? Because they can be higher in sodium, protein, and saturated fats. Having these nutrients in excess is not ideal for those with CKD. Instead of cutting out your favorite sandwich, try keeping a few key things in mind when choosing your ingredients.
Bread is a controversial topic when it comes to chronic kidney disease. To clarify things, it can help to talk about the nutrients in bread and how they fit into a kidney-friendly diet. Bread contains carbohydrates and sodium as well as some protein, fat, and fiber usually. Bread can also sometimes contain added sources of phosphorus that are not healthy for the kidneys.
Eating a diet high in sodium and low in fiber is not beneficial for those with CKD. It is important to follow a low-sodium diet with CKD as it can help to manage your blood pressure and overall kidney health. If you are eating two slices of bread, the sodium from that bread can add up quickly. That is why it’s important to find bread that is lower in sodium for your sandwich and be mindful of your portion sizes.
Eating a diet high in phosphorus is not helpful for those with CKD. Some bread can contain phosphate additives. These inexpensive additives are added to processed foods to help preserve and stabilize them. Phosphate additives are also found in baking powder. With kidney disease, we want to make sure we are keeping phosphorus levels within the normal range for optimal kidney and bone health. Phosphate additives are highly absorbed in the body and can contribute to high phosphorus levels in the blood in someone with kidney disease. Phosphorus is not required to be listed on the food label, unfortunately. Instead, you can spot phosphate additives in the ingredient list. When you are looking for phosphate additives in bread,
When it comes to which type of bread to buy, a common question I often hear is: “Should I buy whole grain or white bread?” Whole grain bread is made with all of the elements of the grain, the bran, germ, and endosperm. This allows for the bread to contain more nutrients. White bread is made from refined flour and only includes the endosperm. This leaves out fiber and other essential nutrients. Fiber is so important for managing cholesterol, blood sugar levels, and the gut microbiome. All of these things play a role in kidney health too! Because of this, whole-grain bread is recommended over white bread for those with kidney disease.
Overall, it is recommended to buy lower sodium whole grain bread made without phosphate additives. Some bread that I recommend for my clients with chronic kidney disease are:
- Dave’s Killer Bread Powerseed Bread
- Pepperidge Farm 15-Grain Bread
- Food for Life Ezekiel Bread
- Angelic Bakehouse No Salt Added Bread
Condiments and Spreads
What is a good sandwich without the right condiments? When it comes to condiments and spreads, it can be helpful to keep a few things in mind. These items can often be high in saturated fats and sodium. It’s important to choose lower sodium options and pick items with healthier fats in them. For example, instead of a butter-based spread, try avocado slices or a mayo made with olive oil or avocado oil for more heart-healthy fats. Oils, vinegars, and lemon juice can be great ways to add flavor to sandwiches without adding excessive amounts of saturated fats and sodium.
Some condiments and spreads I suggest for those with CKD are:
- Nut butter
- Olive oil and vinegar
- Lower sodium pesto
Meats and Cheeses
Meats and cheeses can be both high in protein and sodium. For CKD, excessive intake of protein and sodium can be harmful to the kidneys. It is important to find lower sodium and lower protein meat and cheese options to help optimize your kidney health. Remember, portion size is key here. Try limiting your meats and cheeses to 1-2 slices instead of 4-5 slices. This will help you keep your sodium and protein intake within range.
Meats and cheese also can contain phosphate additives too. That is why it is so important to always read the nutrition labels and ingredient lists of your foods!
Some deli meats and cheeses that I recommend are:
- Swiss cheese
- Fresh mozzarella cheese
- Goat cheese
- Applegate Organics Oven Roasted Turkey Breast
- Hormel Natural Choice Oven Roasted Deli Turkey
It can also be helpful to add in more plant-based sources of protein as opposed to animal-based sources of protein in a kidney-friendly diet. A plant-based and lower-protein diet has been shown to help slow the progression of CKD. Instead of meat and cheese-based sandwiches, try a more plant-based sandwich like:
- Hummus and veggies
- Peanut butter and sliced strawberries
- Chickpea “tuna” salad sandwich
- Tofu “egg” salad sandwich
- Pesto and veggie panini
Toppings can be great additions to your beloved sandwiches. Instead of using higher sodium toppings like banana peppers, pickles, sauerkraut, and roasted red peppers, try using fresh veggies and herbs for a lower sodium sandwich.
Some toppings I suggest using are:
- Bell peppers
- Red onions
- Cucumber slices
- Tomato slices
- Romaine lettuce
- Italian seasoning
Can you eat sandwiches when you have CKD?
In summary, yes, you can 100% enjoy sandwiches when you have CKD. It can help to keep a few key things in mind:
- Look for lower-sodium breads, meats, cheeses, and condiments.
- Read the label and ingredients list to check for phosphate additives in breads, meats, and cheeses.
- The more veggies, the better!
- Flavor your sandwiches with vinegars, flavored oils, herbs, spices, and low sodium seasonings.
- Try more plant-based sandwich options as opposed to meat-based sandwiches.
If you are trying to juggle all the restrictions of the CKD diet has your head spinning, there are ways you can start managing your diet and keep it kidney-friendly. Check out patientslikeme.com/forum/ckd/topics to join our discussion. You can share what you are going through, ask for advice, and plan a path forward from people who understand.