7-Day Meal Plan for Kidney Disease and Diabetes

1. Introduction to Kidney Disease and Diabetes

Kidney disease and diabetes are two chronic health conditions that can affect an individual simultaneously. According to The Korean Diabetes Research Report 2012, one out of ten adults has diabetes, two out of ten have impaired fasting glucose, and three out of ten adults are threatened by high blood glucose 1.

The number of diabetes patients is predicted to reach about six million in 2050. Diabetic nephropathy occurs more frequently among patients with long-term diabetes, significantly affecting individual quality of life. Treatment of complications associated with diabetes requires large medical and economic burdens.

According to the Korean National Health Insurance Service Statistics, the number of cases undergoing renal dialysis treatment after developing diabetic nephropathy increased from 16,511 in 2001 to 28,955 in 2010. A balanced diet is recommended for diabetes patients; however, for those with diabetic nephropathy, food intake increases the burden on kidney function. Therefore, nutrition education is crucial for managing the disease and improving quality of life.

The analysis of a balanced diet containing the daily recommended intake of nutrients will be helpful. Diabetes mellitus is one of the chronic diseases whose prevalence is rising annually along with various complications. The prevalence is predicted to be 6.0% in 2030 and 7.3% in 2045.

Diabetic nephropathy, a chronic complication of diabetes, develops after about ten years of diabetes onset, with a high incidence among patients with long-term diabetes 2. However, there are few reports regarding dietary pattern and diabetic nephropathy. The dietary pattern score is calculated by summing scores for individual foods or food groups based on an individual’s consumption frequency. Nutritional intervention at the onset of diabetic nephropathy is crucial for delaying its progression.

1.1. Overview of Kidney Disease and Diabetes

Kidney disease, also referred to as renal disease, encompasses conditions that harm kidney function, preventing the organ from filtering blood properly. This causes build-up of excess fluids, electrolytes, and waste in the body. Such accumulation can adversely affect heart function, blood vessels, and metabolic processes. Kidneys may be affected by a variety of diseases, with diabetes being one of them 1.

Chronic Kidney Disease (CKD) is a progressive disease with irreversible damage. An estimated 9-13% of the global population suffers from CKD. Diabetes is a growing health burden impacting millions of people worldwide, contributing to increased CKD cases. About 40% of patients with diabetes develop diabetic kidney disease, accounting for more than 50% of new CKD cases.

Both CKD and diabetes adversely affect patients’ morbidity and mortality, raising health care costs. Thus, effort should be taken to limit or delay CKD progression, particularly in diabetic patients. Besides pharmacological treatment, dietary management is a crucial approach in preventing kidney disease development.

2. Nutritional Guidelines for Managing Kidney Disease and Diabetes

To help people manage their kidney disease with diabetes, these nutritional guidelines promote the best diet choice. On a renal diet, people can still have a variety of food while complying with dietary restrictions regarding kidney disease and diabetes. It is essential to fully understand dietary restrictions to help support health and overall well-being.

It is certainly not easy, but it is worth the effort and can be accomplished. This section discusses nutritional guidelines in managing kidney disease and diabetes, dietary restriction being the focus. Kidneys are responsible for filtering electrolytes, toxins, urea, and glucose to be transported to urine. If damaged, the filtration of some components is impaired.

Diabetes can develop complications and affect other organs. According to 1, diabetic nephropathy occurs more frequently among patients suffering from diabetes for a long time and has a large impact on patient’s quality of life. Diabetes can develop complications in other organs, including kidney disease.

Additionally, long-term diabetes can damage the kidney, which manages the elimination of glucose. By avoiding or limiting food and beverage intake with added preservatives or high glucose levels, blood glucose levels can be maintained. High potassium causes hyperkalemia, resulting in muscle weakness and the heart slowing down, potentially resulting in a heart attack. Foods high in potassium should be limited on a renal diet.

According to current guidelines, it has been recommended that potassium be kept less than or around 3,500 mg/day for patients with kidney disease with potassium restrictions. Sodium is also limited on a renal diet. High sodium causes hypertension and fluid build-up, which can cause heart disease or hard work for the heart, potentially resulting in heart failure 3.

2.1. Understanding Dietary Restrictions

Diabetes and chronic kidney disease (CKD), including end-stage renal disease (ESRD) on dialysis, impose dietary and lifestyle restrictions. Unfortunately, the public often harbors misconceptions about dietary restrictions. Some commonly held beliefs are that rice, fruits, and meat must be excluded from the diet.

On the one hand, rice is consumed daily by most people. Fruits are generally considered healthy foods, but diabetic or kidney failure patients may think they should not eat them since it is apparent that ‘sugar/poison is not good for diabetes/kidney disease’ 1. On the other hand, the same fruit may be eaten by a diabetic patient and a kidney patient, but their selections could be entirely different. The same fruit may be consumed in an entirely different form, e.g., a diabetic may eat it pickled, while a kidney patient may choose to boil it to remove potassium.

The idea is to facilitate understanding of dietary restrictions, not to assist in the actual choices of menu or food, which would be excessively complicated. There are other concepts in dietary control that are introduced herein. Dietary and lifestyle control are mutually inclusive; a healthy lifestyle makes dietary control easier. This understanding is necessary for grasping meal plans and recipes concocted subsequently.

3. Day 1: Breakfast, Lunch and Dinner

Kidney disease is a chronic disease that tends to progress over time, causing further kidney damage. Individuals with this condition will have different dietary needs depending on how badly their kidneys are damaged. Diabetes is a chronic disease characterized by high glucose levels in the blood. People with diabetes often take precautions to eat healthily and keep their blood sugar under control. Having both kidney disease and diabetes makes matters even more complicated.

Creating meal plans can be difficult for many diabetic patients. Patients with kidney disease and diabetes are even less likely to find meal plans that suit their dietary needs. The following is a healthy weekly meal plan for patients with advanced chronic kidney disease and diabetes. In this meal plan, food options were selected to control potassium, phosphorus, sodium, protein, and glucose intake. A suggested 7-day meal plan that complies with the above dietary needs is listed out below.

Focus on portion size and foods low in potassium and phosphorus. Avoid concentrated sweets, sugar-sweetened beverages, cakes, pastries, and syrups. The patient should always check if potassium and phosphorus levels are within the allowable volume before meal prep. Cook foods from scratch with fresh ingredients, while avoiding processed or pre-packaged foods. As for drinks, water, fresh lemon juice, buttermilk, and iced tea made from steeping tea leaves with no milk or cream are suggested.

Day 1 meals include different dishes for breakfast, lunch, and dinner:

For breakfast, choose 61g (1 whole) of green bean pancake, 25g dried willows pickled, and 50g ice-cold blueberry, pairing it with 239ml water.

For lunch, make a meal containing roasted chicken drumsticks with soy sauce, 59g (1/5 cup) boiled green peas, 37g (¼ cup) corn macédoine, 174g boiled potato, and 177ml iced lemon tea.

For dinner, opt for baked grass eel with garlic chili, 36g preserved cabbage, 29g (1/3 apple) of sweet red apple, and 239ml water.

Recipes of dishes chosen are provided as well as notes on portion sizes for blood glucose control.

3.1. Recipes and Portion Sizes

Being diagnosed with kidney disease is scary enough, but when the diagnosis also states diabetes, the medications and dietary changes seem overwhelming. After a diagnosis of chronic kidney disease (CKD) stage 3 and type 2 diabetes with high blood pressure, the odds of being prescribed a pill for every ailment is very common.

While combinations of medications may treat the symptoms, a well-balanced diabetic kidney disease-friendly meal is equally important to help slow the progress of the disease. With careful planning, well-balanced meals that are suitable for the kidneys, diabetic, and heart health will help to keep A1C levels stable, blood pressure in check, and satisfy nutritional needs.

When prepping meals, it is advised to check food labels and evaluate sodium, potassium, phosphorus levels, and protein in addition to carbohydrates to control blood sugar levels. Using a portion guide will help with food exchanges, amounts to eat, and keeping track of sodium, potassium, phosphorus, and protein. Serving sizes of a meal should have a combination of starch, non-starchy vegetables, protein, and fat.

A meal should consist of 3 exchanges of grams of carbohydrate from each of the following: starch, and/or fruit, and/or milk; and 2-3 exchanges of protein; and 1 exchange of fat. In addition to the measured food exchanges, meals may include calorie-free drinks (water, diet soda, unsweetened iced tea, low sodium broth, herbal tea, etc.) and low-calorie sweeteners (aspartame, saccharin, stevia, or sucralose).

Below is a meal plan designed for diabetes with foam restrictions to also help with kidney concerns. Each meal contains a daily intake of 1500 mg of sodium, 2000 mg of potassium, and 800 mg of phosphorus. This is a weekly plan that can be used continually. It is recommended to check with a healthcare provider before making any dietary changes.

**Day 1**

Breakfast

1/2 cup Cream of Wheat (Low Sodium) with 2 tsp. Sugar

1/2 cup Blueberries (fresh or frozen, no sugar added)

4 oz. (1/2 cup) 1% Milk (or other allowed milk)

Lunch

2 oz. Turkey Breast (Deli, low sodium)

1 slice White Bread

1 slice American Cheese (Low Sodium)

1/2 cup Carrots (baby or sliced, cooked low sodium)

1/2 medium Apple (fresh, no sugar added)

4 oz. Water

Dinner

1/2 cup Rice (Uncle Ben’s Converted Rice)

2 cups Spinach (fresh, cooked low sodium)

1 tsp. Olive Oil (for cooking)

1/2 medium Banana (fresh)

4 oz. Low Sodium Club Soda

4. Day 2: Breakfast, Lunch and Dinner

4.1. Recipes and Portion Sizes

Breakfast: Cheesy Scrambled Egg with Tomato and Spinach

Ingredients: (1) Two large eggs (or egg substitute) cooked with one ounce of sliced American cheese (or less sodium or Velveeta), one tablespoon of low-fat milk (optional), ¼ cup of diced tomatoes (fresh or canned without salt), one cup of raw spinach (or one cup of frozen spinach cooked without salt), one teaspoon of olive oil, salt and pepper (to taste). Optional garnish: sour cream and hot sauce.

Preparation: 1. Beat eggs and milk (if using), cheese, salt, and pepper, and pour into a medium nonstick pan while preheating over low heat for two minutes. 2. Sprinkle in spinach and tomato, then increase heat to medium-low. Let the eggs cook gently without stirring for one minute. 3. With a spatula, stir egg mixture for another minute, then let it sit again. Continue this process until eggs are scrambled but still creamy. Remove from heat immediately to keep eggs soft and moist.

Lunch: Smoked Turkey Sandwich with Avocado

Ingredients: Two slices of whole grain bread with entire grain and seed crust, two ounces of smoked turkey (preferably low sodium), side salad of one cup of mixed greens tossed with two teaspoons of vinaigrette, and a fruit side: one medium fresh peach or half the can in water.

Preparation: 1. Place slices of bread toasted or untoasted on surface and top with one ounce of turkey breast. Place two slices of tomato on other slice and tear lettuce to fit. Press sides together and cut in half.

Dinner: Grilled Chicken Breast with Dilled Tzatziki Sauce

Ingredients: (1) One chicken breast (4 ounces), ¼ cup of low-fat plain yogurt (1% fat), ¼ cup shredded or diced cucumber (fresh or drained from canned), ½ teaspoon dill weed (or fresh dill), salt and pepper (to taste), lemon juice (optional), and olive oil (optional).

Preparation: 1. Season chicken breast with salt and pepper. 2. Grill chicken on medium-high heat for five to seven minutes, turning frequently, until cooked through. 3. Combine yogurt, cucumber, dill, salt and pepper, and lemon juice and olive oil in a bowl (optional). Serve sauce on the side with chicken breast.

4.1. Recipes and Portion Sizes

Following are the recipes and portion sizes for Day 2 of the 7-Day Meal Plan for Kidney Disease and Diabetes.

Breakfast: Scrambled Eggs with Spinach

• 2 large eggs • 1 cup fresh spinach • 1 tbsp olive oil • Salt and pepper to taste (preferably salt-free)

1. In a pan, heat olive oil over medium heat. Add spinach and sauté until wilted. 2. In a bowl, whisk eggs and mix with spinach. Pour into the pan. 3. Stir occasionally, cooking until eggs are set. Season with salt and pepper.

Lunch: Quinoa Salad with Cucumber

• 1 cup cooked quinoa • 1/2 cucumber, diced • 1/2 cup cherry tomatoes, halved • 1 tbsp olive oil • 1 tbsp lemon juice • Salt and pepper to taste (preferably salt-free)

1. In a bowl, combine cooked quinoa, cucumber, and tomatoes. 2. In a small bowl, whisk olive oil, lemon juice, salt, and pepper. 3. Pour dressing over quinoa mixture and toss to combine.

Dinner: Baked Chicken Breast with Asparagus

• 4 oz skinless chicken breast • 1 cup asparagus, trimmed • 1 tbsp olive oil • 1 tsp garlic powder • Salt and pepper to taste (preferably salt-free)

1. Preheat oven to 400°F (200°C). Place chicken and asparagus on a baking sheet. 2. Drizzle with olive oil, garlic powder, salt, and pepper. Toss to coat. 3. Bake for 25-30 minutes until chicken is cooked through and asparagus is tender.

5. Day 3: Breakfast, Lunch, Dinner

 5.1. Recipes and Portion Sizes

**Breakfast: Poached Eggs and Spinach** Poaching eggs is a great cooking method for kidney diets because the nutrient content remains the same while the cholesterol level is reduced. Pair it with whole-grain bread and spinach sautéed in olive oil for a healthy breakfast. The breakfast takes about ten minutes to prepare and serves two.

**Ingredients**: – 2 eggs, unpeeled – 2 slices whole-grain bread – 2 cups spinach, chopped – ½ tablespoon garlic, minced – ½ tablespoon olive oil – Salt, to taste – Pepper, to taste

**Preparation**: At first, steam or boil the spinach until wilted and set aside. Heat a pan and add oil, garlic, spinach, salt, and pepper. Stir until fragrant. While sautéing spinach, place eggs in a pot with boiling water and cook for five minutes and transfer to an ice bath. Toast the whole-grain bread and top it with sautéed spinach and poached eggs. Season with salt and pepper to taste.

**Lunch: Quinoa Salad with Chickpeas** This lunch recipe replaces rice with quinoa because of its higher nutritional value. It is high in protein, gluten-free, and significantly lower in carbohydrate content compared to rice. Quinoa salad is a great choice for diabetic and kidney disease patients and is suitable for meal prep, serving six.

**Ingredients**: – 1 cup quinoa, rinsed – 1 block tofu, cut into cubes – 1 can chickpeas, drained and rinsed – 1 cup tomato, diced – 1 cup cucumber, diced – 1 cup bell pepper, diced – ¼ cup sundried tomatoes, chopped – ½ cup parsley, chopped – 1 tablespoon olive oil – ½ tablespoon lemon juice – Salt, to taste – Pepper, to taste

**Preparation**: To prepare quinoa, add it and three to one quart of water into a pot. Bring it to boil, and then let it simmer for about 15 minutes. Once done, fluff the quinoa and set aside. While cooking quinoa, bake tofu cubes with olive oil, salt, and pepper for 20 minutes at 200°C (390°F). Once the tofu is cool, mix it with quinoa, chickpeas, tomato, cucumber, bell pepper, sundried tomatoes, parsley, oil, lemon juice, salt, and pepper. Combine well and serve with greens.

**Dinner: Grilled Vegetable Quesadillas** Grilled vegetable quesadillas with homemade hummus are a simple yet nutritious dinner option. Store-bought wraps can contain excess sodium or preservatives, which is why this recipe also includes a homemade wrap recipe. The wrap dough can be prepared in advance, and it is a great option for keto diets and meal prep. The dish serves six.

**Ingredients**: – For the homemade wrap – 2 cups whole-wheat flour – ½ tablespoon salt – ½ cup water – 1 tablespoon olive oil – For quesadillas – 2 cups zucchini, sliced – 2 cups carrot, sliced – 2 cups bell pepper, sliced – 2 cups mushroom, sliced – 2 tablespoon olive oil – 8 oz low-fat mozzarella cheese – ½ tablespoon garlic powder

For number five, prepare the wrap. In a bowl, mix flour and salt. Then, add warm water and oil to the dry ingredients. Knead well and let it rest for 15 minutes. Divide it into six portions and roll the dough to a thin round shape (8 inches in diameter). To prepare quesadillas, preheat a grill, and toss vegetables with oil, salt, and garlic powder. Grill the vegetables until tender and cut into smaller pieces. Place half of the vegetable mixture on one side of the wrap, followed by cheese and another half of the vegetable mixture. Fold the wrap and grill for about six minutes until the cheese melts.

5.1. Recipes and Portion Sizes

The provided recipes in this meal plan have been developed and adjusted to be the most health-promoting for people with chronic kidney disease and diabetes.

In general, strict portion control is not necessary. Portion sizes should be adapted according to personal satiety level and time since the last meal. One good reference for a proper serving is that half of your plate is mostly vegetables, one-quarter whole grains, and the last quarter protein. When eating snacks, generally a handful of nuts, one piece of fruit, or one cup of fresh vegetables is appropriate.

Note: A food scale is required for exact portion control.

**Recipes**

*Breakfast: Creamy Oatmeal with Pear and Cinnamon*

**Ingredients** (serves 2): 1 cup rolled oats 2 cups water or oat milk 1-2 ripe pears 1½ tsp cinnamon (Optional) 2 tbsp honey or maple syrup

**Instructions**: 1. In a pot, bring oats and water to a boil; reduce heat, simmer for 5-10 minutes, stirring occasionally. 2. Meanwhile, grate or finely chop the pears. 3. Stir pears, cinnamon, and sweetener into the oatmeal. Enjoy warm!

*Lunch: Kale Salad with Lemon Vinaigrette*

**Ingredients** (serves 2): 2 cups shredded kale ½ cup cooked brown rice 1 avocado ½ cup radishes 2 tbsp olive oil 2 tbsp lemon juice Salt and pepper to taste

**Instructions**: 1. In a large bowl, mix together kale, rice, and dressing (olive oil, lemon juice, salt, and pepper) – let sit for at least 30 minutes. 2. Top with avocado and radishes, and serve.

*Dinner: Spicy Sweet Potato and Lentil Bowl*

**Ingredients** (serves 2): 8 oz sweet potato or yam 1 tbsp olive oil 1 tsp paprika ½ tsp cayenne pepper 1 cup cooked lentils 1 zucchini 2 cups spinach Salt and pepper to taste

**Instructions**: 1. Preheat the oven to 400°F (200°C). 2. Wash, peel, and cut sweet potato into 1-inch cubes. 3. In a bowl, toss sweet potato with olive oil, paprika, cayenne, and salt. 4. Spread on a baking sheet, roast for 25-30 minutes. 5. Sauté zucchini in a pan; add spinach and lentils. 6. Divide lentil mixture into bowls; top with roasted sweet potatoes. Enjoy warm!

**Snacks** **Hummus with Fresh Veggies** (2 servings) 1 cup hummus 2 cups cut fresh vegetables (e.g. carrot sticks, cucumber slices)

**Fruit Salad** (2-4 servings) 2 apples, cubed 1 pear, sliced 1 cup grapes, halved 1 cup strawberries, sliced

6. Day 4: Breakfast, Lunch, Dinner

This day’s breakfast choice is an Oatmeal Blueberry Smoothie. Start by blending together a third of a cup of quick oats, half a cup of frozen blueberries, a banana, one cup of almond milk, and a fourth of a teaspoon of cinnamon. This recipe provides two servings. Each serving includes 90 calories, with a fair amount of carbohydrates (14g), protein (3g), and fats (2g) adjusted for those on both kidney and diabetic diets.

For lunch, there is a Honey Mustard Chicken Salad. Combine two cups of mixed salad greens, a third of a cup of thinly sliced red peppers, a third of a cup of shredded carrots, and a pound of grilled boneless chicken breast. Prepare a dressing with three tablespoons of Dijon mustard, three tablespoons of honey, two tablespoons of wine vinegar, and a tablespoon of olive oil. This recipe also provides two servings, with each serving containing 350 calories, 27g carbohydrates, 29g protein, and 10g fats.

The dinner choice is Light Beef Stir-fry over Brown Rice. Prepare a sauce with a quarter of a cup of water, three tablespoons of soy sauce, and a teaspoon of cornstarch. Combine a pound of stir-fry beef and the sauce and set aside. In a skillet, heat three teaspoons of sesame oil. Add two cups of broccoli, one cup of sliced mushrooms, and one cup of pepper strips, sautéing until tender. Stir in the beef mixture and add six cups of cooked brown rice. This too provides two servings, with each containing 602 calories, 61g carbohydrates, 41g protein, and 24g fats.

6.1. Recipes and Portion Sizes

The following kidney-friendly recipes are designed with diabetic considerations in mind. The ingredients listed allow the cook to prepare either one or two servings as needed. The following nutrients are calculated per serving.

1) Breakfast: Scrambled Eggs with Spinach and Onion

Ingredients: – 1 egg – 1/4 cup egg substitute – 1/3 cup fresh spinach – 1 T onion

Preparation: 1. In a bowl, whisk egg and egg substitute together until fluffy. Set aside. 2. In a skillet coated with nonstick cooking spray, sauté onion until tender. 3. Add spinach and heat until slightly wilted. 4. Pour in egg mixture and cook, stirring gently, until scrambled.

2) Lunch: Spinach Salad with Strawberries and Walnuts

Ingredients: – 2 cups spinach – 1/4 cup strawberries – 1 T walnuts – 1 T balsamic vinaigrette dressing

Preparation: 1. In a bowl, toss spinach with strawberries and walnuts. 2. Drizzle with dressing and toss to coat.

3) Dinner: Baked Chicken with Vegetables

Ingredients: – 1/2 chicken breast – 3/4 cup vegetable mix (carrot, squash, cauliflower, broccoli) – 1 T olive oil – Oregano and black pepper (to taste)

Preparation: 1. Preheat oven to 350 F. 2. In a baking dish, combine oil, vegetables, oregano, and black pepper, adding chicken last. 3. Bake for approximately 20 minutes or until chicken is cooked through.

4) Snack: Mixed Fruit

Ingredients: – 1/2 medium orange – 1/4 cup melon, diced – 1/2 kiwi

Preparation: 1. Cut orange into wedges and section. 2. Cut kiwi into quarters. 3. In a bowl, mix all fruit together.

7. Day 5: Breakfast, Lunch, Dinner

Breakfast: White whole wheat English muffin with natural peanut butter and strawberries. Servings: 1. – 5.5″ whole wheat English muffin, toasted – 1 tbsp natural peanut butter – 1/2 cup sliced fresh strawberries

Lunch: Roasted turkey wrap with low-fat Tillamook cheddar cheese and greens. Servings: 1. – 1 whole wheat tortilla wrap, 8″ or larger – 3 oz. roasted turkey breast, sliced – 1 slice low-fat Tillamook extra sharp cheddar cheese, sliced – 1/4 avocado, sliced – Salt and pepper, to taste – 1 cup mixed greens (spinach, kale, arugula, etc.) – 1/4 cup salsa

Dinner: Lemon basil quinoa with grilled salmon. Servings: 1. – 1 cup cooked quinoa* – 5 oz. cooked salmon fillet, grilled – 1 tbsp lemon juice – 1 tbsp fresh basil, chopped – 1 cup steamed broccoli – Zest of one lemon – 1 handful of watermelon, cubed

Kidney-friendly beverage suggestions: – Unsweetened iced tea (regular or herbal) – No-calorie sparkling water – Homemade lemonade with lemon juice and water

*Quinoa is a great grain alternative for persons with kidney disease because it is low in phosphorus compared to rice or wheat. Cook it according to package directions and control the portion size to about 1 cup cooked per day. If you are on a pump, you may want to monitor the total carbohydrate count instead of just counting the quinoa.

7.1. Recipes and Portion Sizes

Breakfast: Spinach and Feta Omelette with Oatmeal

Ingredients: • 2 large eggs • ½ cup fresh spinach, chopped • ¼ cup feta cheese, crumbled • ½ tsp olive oil • ½ cup rolled oats • 1 cup water

Instructions: 1. Whisk the eggs in a bowl. Add spinach and feta; mix well. 2. Heat oil in a non-stick skillet over medium heat. Pour egg mixture into skillet, cooking until set. Fold and serve. 3. In a pan, bring water to a boil. Add oats and stir, cooking for 5 minutes. Serve.

Portion Size: 1 omelette (2 eggs) and ½ cup oatmeal.

Nutritional Information: Calories: 380, Carbohydrates: 35g, Protein: 25g, Fat: 18g, Sodium: 300mg

Lunch: Roasted Chicken Salad with Balsamic Dressing

Ingredients: • 4 oz roasted chicken breast, shredded • 2 cups mixed greens (arugula, spinach, romaine) • ½ cup cherry tomatoes, halved • ½ cucumber, sliced • ¼ cup balsamic vinegar • ½ cup olive oil

Instructions: 1. In a large bowl, combine chicken, greens, tomatoes, and cucumber. 2. In a jar, mix vinegar, oil, salt, and pepper; shake well. Drizzle over salad and toss.

Portion Size: 1 large bowl.

Nutritional Information: Calories: 500, Carbohydrates: 20g, Protein: 35g, Fat: 35g, Sodium: 250mg

Dinner: Quinoa and Vegetable Stir-Fry

Ingredients: • 1 cup cooked quinoa • 1 cup mixed bell peppers, chopped • 1 cup broccoli florets • 1 carrot, sliced • 2 tbsp low-sodium soy sauce • ½ tsp sesame oil • 1 tsp sesame seeds

Instructions: 1. Heat sesame oil in a wok; stir-fry veggies for 5 min. Add quinoa and soy sauce; stir-fry for 3 min. Serve topped with sesame seeds.

Portion Size: 1 cup.

Nutritional Information: Calories: 350, Carbohydrates: 50g, Protein: 12g, Fat: 12g, Sodium: 300mg

8. Day 6: Breakfast, Lunch and Dinner

Breakfast: Oatmeal with Cinnamon and Blueberries

Ingredients: • 1/2 cup rolled oats • 1 1/2 cups water • 1/2 tsp ground cinnamon • 1/4 cup fresh blueberries • 1 tbsp chopped pecans (optional)

Preparation: 1. Toss oats and water in a saucepan on medium-high heat. Bring to a boil, stirring occasionally. 2. Reduce heat to low or medium-low. Cook, stirring occasionally, for 5-7 minutes, until the oats are tender. 3. Mix in cinnamon. Top with blueberries and pecans (if using).

Portion size: 1 serving ADD NOTE

Nutritional Information (per serving): • Calories: 245 • Total Fat: 5g • Saturated Fat: 0g • Sodium: 0mg • Total Carbohydrate: 46g • Dietary Fiber: 8g • Sugars: 1g • Protein: 9g • Potassium: 233mg

Lunch: Black Bean Salad

Ingredients: • 1 can (15 oz) black beans, rinsed and drained • 1 medium red bell pepper, chopped • 1 medium tomato, chopped • 1/4 cup red onion, chopped • 1/4 cup cilantro, chopped • 1 tbsp olive oil • 2 tbsp red wine vinegar • 1/4 tsp ground cumin • Salt and pepper to taste

Preparation: 1. In a bowl, combine the black beans, bell pepper, tomato, onion, and cilantro. 2. In a separate bowl, whisk together the olive oil, vinegar, cumin, salt, and pepper. 3. Pour the dressing over the salad and mix well.

Portion size: 1 serving ADD NOTE

Nutritional Information (per serving): • Calories: 231 • Total Fat: 7g • Saturated Fat: 1g • Sodium: 0mg • Total Carbohydrate: 37g • Dietary Fiber: 12g • Sugars: 1g • Protein: 10g • Potassium: 310mg

Dinner: Garlic Rice with Chicken and Broccoli

Ingredients: • 1 cup brown rice • 2 cups water • 1 1/2 tsp olive oil • 1 lb chicken breast, cut into pieces • 1 cup broccoli florets • 1/2 tsp garlic powder • Salt and pepper, to taste

Preparation: 1. In a pot, bring water to a boil. Add rice, reduce heat, cover, and simmer for 50 minutes. 2. Heat oil in a pan over medium-high heat. Add chicken, cook for about 5 minutes, until browned. 3. Add broccoli, cook for another 5 minutes, until tender. Add garlic powder, salt, and pepper. Serve with rice.

Portion size: 1 serving ADD NOTE

Nutritional Information (per serving): • Calories: 495 • Total Fat: 17g • Saturated Fat: 2g • Sodium: 0mg • Total Carbohydrate: 41g • Dietary Fiber: 6g • Sugars: 1g • Protein: 48g • Potassium: 817mg

8.1. Recipes and Portion Sizes

The recipes provided have been crafted with care to optimize flavor and nutrition while adhering to dietary restrictions. Here are the ingredient lists and preparation instructions for each recipe.

Breakfast: Avocado Toast with Scrambled Eggs

Servings: 1 Ingredients: – 1 slice whole-grain bread – 1 small avocado – 1 large egg – Salt and pepper, to taste – Cooking spray or 1 tsp olive oil – Optional: cooked tomato or spinach on top

Instructions: 1. Toast the bread to your liking. 2. While the bread is toasting, crack the egg into a bowl, add salt and pepper (optional). Using a fork or whisk, scramble the egg until it’s well mixed. 3. On the stovetop, spray a skillet with cooking spray (or add olive oil) over medium heat. Pour the scrambled eggs into the pan and gently stir the eggs until they begin to cook. 4. Stir occasionally for about 2-4 min until they are scrambled to your desired consistency. 5. To make the avocado mash, combine the avocado in a bowl with salt and a sprinkle of pepper (optional). Mash the avocado with a fork until it is creamy with a few lumps. 6. Spread the mashed avocado on top of the toast and add cooked eggs on top.

Lunch: Turkey and Hummus Wrap

Servings: 1 Ingredients: – 1 whole-wheat wrap – 1/4 cup hummus (store-bought or homemade) – 3-4 slices turkey – 1/4 cucumber, sliced – 1/4 cup shredded carrots – 1/4 cup mixed greens

Instructions: 1. Spread hummus evenly on the wrap, leaving about a half-inch border around the edges. 2. Layer turkey, cucumber, carrots, and greens in the center of the wrap. 3. Fold the sides of the wrap in over the filling. 4. Gently roll the wrap from the bottom up, keeping it tight. 5. Slice in half and serve.

Dinner: Grilled Salmon with Quinoa and Vegetables

Servings: 1 Ingredients: – 4 oz salmon fillet – 1 tbsp olive oil – Juice of 1/2 lemon – Salt and pepper, to taste – 1/2 cup cooked quinoa – 1 cup mixed vegetables (e.g. zucchini, bell peppers, broccoli) – 1 tsp minced garlic – 1/2 tsp Italian seasoning

Instructions: 1. Preheat grill to medium-high heat. In a small bowl, mix olive oil, lemon juice, salt, and pepper. Brush half the mixture on the salmon fillet. 2. Place salmon skin-side down directly on the grill. Close the lid and cook for 5-7 min until the flesh is opaque and flakes easily. 3. In a large skillet over medium heat, heat the remaining olive oil. Add mixed vegetables and cook for 5-7 min until tender. 4. Stir in cooked quinoa, garlic, Italian seasoning, salt (to taste), and pepper (to taste). Cook for 3-5 min until heated through. 5. Plate the quinoa and vegetable mixture, and top with grilled salmon. Serve with lemon wedges if desired.

9. Day 7: Breakfast, Lunch, Dinner

Day 7 features simple recipes that are healthy, filling, and easy to make. It is a good way to end the week. Breakfast is Low-Sodium Cornmeal Porridge. For lunch, there are Quinoa Bowl with Edamame and Kale and Low-Sodium Pickled Carrots. Dinner features Roasted Eggplant and Chickpea Salad with Lemon-Tahini Dressing.

Low-Sodium Cornmeal Porridge

Ingredients (Serves 1)

1/4 cup cornmeal

1 1/2 cups water

1/4 tsp turmeric powder

1/4 tsp dried paprika

1 tbsp maple syrup

1 tbsp ground chia seeds (optional)

1/2 pear or apple, diced

Instructions: 1. Combine water, turmeric powder, and paprika in a pan. Bring to a gentle boil over medium heat. 2. Add cornmeal while continuously whisking. Stir for another minute while cooking on low heat. 3. Remove from heat. Mix maple syrup, dried chia seeds, and fruit. 4. Serve warm. The chia seeds will thicken the porridge and make it more filling.

Quinoa Bowl with Edamame and Kale

Ingredients (Serves 1)

1/2 cup cooked quinoa

1/2 cup cooked edamame

1 cup kale

1 clove garlic, minced

1 tbsp sesame oil

Salt, to taste

1/2 avocado, sliced (optional)

Instructions: 1. Warm sesame oil in a frying pan over medium heat. Add garlic and sauté for 1 minute. 2. Add kale and stir-fry for 2-3 minutes until water disappears. 3. Combine cooked quinoa, edamame, and sautéed kale. Add salt to taste. 4. Serve warm topped with avocado slices.

Low-Sodium Pickled Carrots

Ingredients (Makes about 1 cup)

2 large carrots, shredded

1/4 cup apple cider vinegar

1 tsp onion powder

1 tsp garlic powder

1-2 tbsp maple syrup

1/2 tsp ground ginger

Instructions: 1. Combine all ingredients in a bowl. Add more sweetener to taste. Let the mixture rest for 30 minutes. 2. Store pickles in a jar in the fridge for up to 2 weeks.

Roasted Eggplant and Chickpea Salad

Ingredients (Serves 2)

1 large eggplant, cubed

1 1/2 tbsp olive oil

1/4 tsp salt

1 (15 oz) can halloumi chickpeas, drained

2 cups arugula

1/4 cup walnuts, toasted and chopped

2 green onions, chopped

1/4 cup tahini

2 tbsp lemon juice

1 tsp garlic cloves

1/4 cup water

Instructions: 1. Preheat the oven to 425°F (220°C). Toss eggplant, olive oil, and salt on a tray and roast until soft (about 30 min), stirring halfway through cooking. 2. Combine chickpeas, arugula, walnuts, green onion, and roasted eggplant in a bowl. 3. Mix tahini, lemon juice, garlic, and water in another bowl. Combine the two bowls and serve with lemon-tahini dressing.

9.1. Recipes and Portion Sizes

Recipes and portion sizes for breakfast, lunch, and dinner are vital for maintaining a healthy balance between kidney disease and diabetes. Recipes should incorporate low potassium, low sodium, and low phosphorus foods while limiting added sugar. Care should be taken to avoid processed foods, as they usually contain high sodium, preservatives, and other additives.

Breakfast should be prepared with blueberry muffins made with white flour, light brown sugar, egg, oat milk, unsweetened almond milk, cinnamon, and blueberries, along with oatmeal cooked with rolled oats and water and served with honey. This meal is packed with dietary fibers and vitamins needed for blood sugar management. Portion sizes should be adjusted according to the dietary needs of individuals.

Lunch should consist of chickpea salad with lettuce, cucumber, tomato, carrot, bell pepper, chickpeas, onion, parsley, balsamic vinegar, vegetable oil, fresh garlic, dried basil, olive oil, salt, and pepper, served with baked potato with herbs, garlic, and olive oil, and grape and pear salad. These help improve heart and vascular health and promote kidney health by lowering potassium and phosphorus levels.

References:

1. Young Kim H. Nutritional Intervention for a Patient with Diabetic Nephropathy. 2014. ncbi.nlm.nih.gov

2. H Deeb H, K Bachour R. Comparison of Plasma Concentrations for Some Biological Markers in Patients with Type 2 Diabetes Before and After Consuming a Vegetarian Diet. 2019. [PDF]

3. D’Alessandro C, Barbara Piccoli G, Calella P, Brunori G et al. “Dietaly”: practical issues for the nutritional management of CKD patients in Italy. 2016. ncbi.nlm.nih.gov