Enjoy Your Own Recipes Using Less Protein

A guide for people with chronic kidney disease

If you have just learned that you have chronic kidney disease (CKD), your doctor may tell you to start limiting the protein in your diet. Changing your diet to meet your body's lower protein needs and still using the foods and recipes you are used to can be difficult. This fact sheet has ideas and tips to help you lower the protein in your favorite recipes, using the foods you normally use every day.

Why do I need to eat less protein?

Protein is needed for growth, upkeep and repair of all parts of your body. Protein is found in almost all foods. When your body breaks down and uses the food you eat, a waste product called urea is made. When your kidneys are not working well, urea is not removed as it should be. Urea then builds up inside your body. Side effects of a high urea level are fatigue (tiredness) and poor appetite. By decreasing the amount of protein you eat, you can help your kidneys have a lighter workload, with less urea to clean out.

What foods have the most protein?

There are two types of protein in the food we eat:

1. Animal protein is called high-value protein. It is easier for your body to use. Examples of high-value animal proteins are: red meat, chicken, turkey, pork, eggs and dairy products.

* It is very important for you to eat enough high-value protein to keep your body healthy.

* Dairy products are high-value protein, but are also high in phosphorus. You may need to use less dairy products in your diet to control your blood level of phosphorus.

1. Vegetable or plant proteins are low-value proteins. Examples of low-value proteins are: bread, cereals, dried beans, nuts, rice, pasta or noodles and vegetables.

A dietitian trained to work with those who have CKD can help you balance your protein.

How can I eat less protein and still feel like I am eating enough?

Here are some tips to help you stretch protein foods so that a smaller amount will still feel like enough.

Sandwiches

• Fill up sandwiches with lettuce, alfalfa sprouts, cucumber, chopped celery, apple, parsley or water chestnuts.
• Use meats that are sliced very thin; this will spread them out to look like a larger portion.
• Use bread that is more thickly sliced, and consider more flavorful breads such as sour dough or rye bread.

Soups

• Use lower-protein foods such as rice and pasta to add bulk to a soup without adding much protein.
• Use milk substitutes that are low in protein when making cream soups.

Main Dishes

• Use vegetables and grains as the main dish and meats or other high-value protein as the side dish.
• Try kebabs, using smaller pieces of meats and more vegetables or fruits.
• Prepare dishes with small pieces of meat or chicken mixed in with rice or pasta. Fried rice dishes or ground meat with pasta work well.
• Toss together a chef salad with lettuce and crisp vegetables, adding smaller strips of meat and egg.
• For casseroles, use smaller amounts of meat than the recipe calls for, increase the starch (rice or pasta). Buy low-sodium soups to use in all casserole recipes.
• Allow yourself extra portions or larger servings of bread, rolls, pasta and rice to help meet your calorie needs without increasing your protein intake by very much.
• For a stronger cheese taste with a smaller amount of cheese, buy sharp cheddar, Parmesan or Romano cheese. A little bit of these cheeses will go a long way.

What are calorie boosters?

When you are eating less protein, you may also eat fewer calories. Using fewer calories may cause you to lose weight. It is always important for you to stay at your healthiest weight for your body size. To keep from losing too much weight, you can "make up" some of the calories lost when cutting down on protein foods by using foods with higher calorie levels.

• Heart-healthy fats such as canola oil, olive oil corn oil, safflower oil, soybean oil or sunflower oil and mayonnaise-type salad dressings can be used in larger amounts to fry or season foods.
• Candies such as hard candies, gumdrops, jellybeans, chewy fruit flavored candies and marshmallows can be used as desserts or snacks. Sweeteners such as honey, jams or jellies and white sugar can be added to foods or drinks to increase calories. (Please consult your dietitian if you are diabetic.)

Modifying recipes to lower protein

Here are some examples of how you can take a typical recipe and modify it to lower the protein content:

Festive Turkey Salad
(Original Recipe)	(Modified Recipe)
3 cups chopped cooked turkey breast without skin 1/4 cup diced celery 1 cup raw red delicious apples with skin 1/4 cup coarsely chopped pecans 3 tbs. low calorie mayonnaise (Cranberry French Dressing) 1/4 cup jellied cranberry sauce 1/8 tsp. salt 1/8 tsp. paprika 1/8 tsp. dry mustard 1/8 tsp. pepper 1 tbs. vinegar 2 tbs. vegetable oil Yield: 4 one-cup servings with 2 tbs. dressing on each serving	1 1/2 cups chopped cooked turkey breast without skin 1 cup diced celery 3 cups raw red delicious apples with skin 1/4 cup coarsely chopped pecans 3 tbs. regular mayonnaise (Cranberry French Dressing) 1/2 cup jellied cranberry sauce 1/8 tsp. paprika 1/8 tsp. dry mustard 1/8 tsp. pepper 1 tbs. vinegar 2 tbs. vegetable oil Yield: 6 one-cup servings with 2 tbs. dressing on each serving
Combine first five ingredients in large bowl. Stir well. Cover and chill thoroughly. Serve with Cranberry French Dressing. Dressing: Combine first four dressing ingredients in small bowl, stirring with a wire wisk until smooth. Gradually add vinegar to cranberry mixture, alternately with oil, beginning and ending with vinegar. Stir well with each addition.

National Renal Diet Exchanges: (per serving)
Original Recipe		Modified Recipe
Meats	6	Meats	1
Vegetables	1	Vegetables	1
High Calorie	1	Fats	2
		Fruits	1
Protein	43 grams
		Protein	9 grams

Adapted from a recipe developed by the Modification of Diet in Renal Disease (MDRD) Study - University of Iowa Center.

Chicken Pasta Casserole
(Original Recipe)	(Modified Recipe)
1 12-oz package egg noodles 1-1/2 lb ground chicken or beef 1 tsp. onion salt 1 tsp. garlic salt Accent to taste 1 tsp. black pepper 1 6-oz can tomato paste 1 4-oz can mushroom stems and pieces (drained) 1 8-oz container sour cream 1/4 cup cottage cheese 1/2 lb grated cheddar cheese	1 12-oz pkg. regular or low-protein noodles 1/2 lb ground chicken or beef 1 cup diced celery 1 tsp. onion powder 1 tsp. garlic powder 1 tsp. black pepper 1 6-oz can tomato paste 1 4-oz can mushroom stems and pieces (drained and rinsed) 4 oz sour cream 3 tbs. cottage cheese 1/4 lb grated sharp cheddar cheese
Yields: 8 servings (cut 9" x 13" pan 4" x 2")
Prepare noodles according to package directions. Drain in colander, rinse with cold water and set aside. Brown chicken (and sauté celery until tender in modified recipe). Add seasonings, tomato paste, one tomato-paste can of water and mushrooms. Place noodles in large bowl; mix in sour cream and cottage cheese. Line bottom of 9" x 13" baking dish with noodle mixture. Top with ground chicken mixture. Sprinkle cheddar cheese on top. Bake at 350, until cheese melts and casserole is heated through.

National Renal Diet Exchanges: (per serving)
	Original Recipe	Modified - Reg. Pasta	Modified - Low Protein Pasta
Meats	4	2	2
Starch	2	2	0*
Vegetables	1	1	1
Fats	2	1	2
Protein	33 grams	19 grams	15 grams
			(* High Calorie - 2)

Sources of low-protein products