Managing Diabetes with Advanced Kidney Disease | Dr. Michael Dansinger

By Kym McNicholas, CEO, Global PAD Association

Managing diabetes is challenging on its own, but when you add advanced stage chronic kidney disease (CKD) to the mix, dietary choices become incredibly complex. In our latest episode of “Ask Dr. Danzinger,” Dr. Michael Danzinger from Diabetes Reversal Partners attempts to untangle this complicated web of dietary restrictions.

((Don’t miss the shopping list, meal plan, and recipes to print below))

The Triple Threat: Diabetes, High Blood Pressure, and Kidney Disease

One of the most concerning aspects of this combination is how it creates the perfect storm for vascular problems. As Dr. Danzinger explained, “Diabetes is the leading cause of kidney dialysis and high blood pressure is another leading cause of kidney dialysis, and many people who have kidney disease already have high blood pressure or diabetes.”

This dangerous trio often leads to poor circulation in the legs known as peripheral artery disease (PAD) and poor circulation in the heart known as coronary artery disease (CAD), creating a cascade of health complications that can be difficult to manage.

“The reason diabetes and high blood pressure is so damaging to the kidneys is because the kidneys are a delicate filter,” Dr. Danzinger explained. “The delicate capillaries in the kidneys are damaged by high blood sugar and high blood pressure. And so that’s why it’s so common in type 2 diabetes.”

Managing Blood Pressure for Kidney Protection

Dr. Danzinger emphasized that controlling blood pressure is crucial for protecting kidney function. “The best thing you can do for your blood pressure is to lose weight,” he noted. “And so if you have excess body fat, weight loss and exercise are the most valuable.”

Additionally, he highlighted how diet affects blood pressure:

1. Limit sodium intake: “Processed foods have a lot of salt in them and you want to take it easy with the salt shaker, but most of the sodium people are eating are in canned and packaged foods.”

2. Focus on potassium-rich foods (if kidney function allows): “High potassium foods are very good for helping to lower blood pressure. And so all these high potassium foods that we mentioned are good as a preventative until the point where you’re not able to tolerate them anymore.”

3. Home cooking: “Anytime you’re cooking for yourself, you’re in much better control.”

This approach to managing blood pressure becomes especially important for those with both diabetes and early kidney disease who want to prevent further kidney damage.

The Protein Paradox

For diabetics, protein is typically a dietary friend, helping to reduce reliance on carbohydrates that spike blood sugar. However, as Dr. Danzinger pointed out, when kidney function declines, protein becomes problematic.

“In someone without kidney disease, you might be eating twice that much protein safely, but protein can be hard on the kidneys,” Dr. Danzinger noted.

The formula he recommends for those with kidney disease: Take your body weight in pounds, divide by three, and that’s your protein limit in grams per day. For example:

• 180 pounds ÷ 3 = 60 grams of protein maximum

• 150 pounds ÷ 3 = 50 grams of protein maximum

When to Limit Protein and Other Nutrients

Dr. Danzinger explained when protein limitations become necessary: “We start to limit dietary protein in kidney disease when we see that there’s damage in the urine. If we see that there’s protein in the urine that’s leaking from the kidney… that’s a sure sign of kidney disease.”

He further noted that kidney disease is staged using the glomerular filtration rate (GFR): “Once your GFR is starting to dip below 30, that’s pretty advanced. That’s stage 4 kidney disease… you’re at 30% or less kidney function, that you certainly need to be very careful about protein.”

Potassium and Phosphorus: The Hidden Dangers

For patients with advanced kidney disease (typically when kidney function drops below 25-30%), monitoring potassium and phosphorus becomes crucial. These minerals, which healthy kidneys normally filter, can accumulate to dangerous levels and contribute to cardiovascular complications.

High Potassium Foods to Limit:

• Tomatoes and tomato products

• Potatoes

• Cooked spinach and chard

• Mushrooms

• Winter squash

• Avocados

• Bananas, oranges, cantaloupes, honeydew

• Kiwis, mangoes

• Dried fruits and pomegranates

High Phosphorus Foods to Limit:

• Dairy products (milk, cheese, yogurt)

• Cola beverages

• Highly processed foods

• Certain shellfish (clams, mussels, crabs)

• Sardines

• Nuts and seeds

• Whole grains like quinoa and brown rice

• Kidney beans

Making Smart Carbohydrate Choices

When protein is limited and many fruits and vegetables are restricted, patients often turn back to carbohydrates, which can worsen diabetes control. This creates a challenging balancing act.

Dr. Danzinger acknowledged this dilemma: “It’s the catch-22 situation with the carbs. If you reach a point where you’re nearing kidney dialysis, you almost have no choice but to eat some starchy foods… And those are bad for blood sugar and diabetes.”

For those not yet at advanced stages of kidney disease, focusing on lower glycemic options is preferable. As kidney disease advances, even these healthier choices may need to be evaluated for their potassium and phosphorus content.

Hydration Considerations

Proper hydration is essential but can become complicated with advanced kidney disease. Dr. Danzinger emphasized that until you’re on dialysis, adequate hydration remains important—but once on dialysis, fluid restrictions become critical.

For those not on dialysis, a structured approach to hydration like using a marked water bottle can help ensure adequate intake throughout the day, primarily in the first half of the day to minimize nighttime bathroom trips.

Can Kidney Disease Be Reversed?

An important question addressed in our conversation was whether kidney disease can be reversed. Dr. Danzinger explained that while complete reversal is unlikely, improvement is possible:

“The short answer is to a partial extent, you can allow the kidneys to heal… Once you have chronic kidney disease, let’s say you’re at 40%. Sometimes I see it go back up to 50%, but not like 70% generally.”

He emphasized that the most critical time to be careful is when kidney function is severely reduced: “If I see someone with kidney function at like 20% and they’re near dialysis, that’s the most important time to be careful because you can delay the amount of time until dialysis or maybe even avoid it altogether.”

Prevention Is Key

For those with diabetes or early kidney disease who haven’t yet reached advanced stages, Dr. Danzinger’s message was clear: take action now to prevent progression.

“I urge people who have signs of kidney disease or risk of kidney disease to take this seriously,” he emphasized. “You don’t want to end up in the position where your dietary options are limited.”

Through proper diabetes management, blood pressure control, and appropriate dietary choices, it may be possible to slow or even halt the progression of kidney disease and reduce the risk of developing PAD.

In our next episode, we’ll be discussing exercise strategies for people with diabetes and vascular complications. Make sure to subscribe to our channel to be notified when it’s published!

---

Kidney & Diabetes-Friendly Shopping List

This shopping list focuses on foods that are generally lower in potassium, phosphorus, and sodium while also being lower glycemic for diabetes management. Individual needs may vary based on lab values and disease progression, so always review with your healthcare team.

Proteins (Remember: Limit based on body weight ÷ 3 = grams per day)

• [ ] Egg whites

• [ ] Tofu (regular, not firm which is higher in phosphorus)

• [ ] Chicken breast (skinless)

• [ ] Turkey breast (skinless)

• [ ] Wild-caught fish (salmon, cod, etc.)

• [ ] Small amounts of unsalted macadamia nuts

• [ ] Small amounts of unsalted almonds

Low-Potassium Vegetables

• [ ] Bell peppers (all colors)

• [ ] Cabbage (green or red)

• [ ] Cauliflower

• [ ] Cucumber

• [ ] Green beans

• [ ] Lettuce (all varieties)

• [ ] Onions

• [ ] Radishes

• [ ] Snow peas

• [ ] Yellow squash

• [ ] Zucchini

• [ ] Bok choy

• [ ] Water chestnuts

• [ ] Green onions

• [ ] Asparagus (moderate potassium - portion control)

• [ ] Artichokes (moderate potassium - portion control)

Low-Potassium Fruits

• [ ] Apples

• [ ] Blueberries

• [ ] Strawberries

• [ ] Raspberries

• [ ] Cranberries

• [ ] Peaches

• [ ] Plums

• [ ] Pineapple (small amounts)

Lower Glycemic Carbohydrates

• [ ] Sourdough bread (small portions). We prefer Cauliflower thins if possible.

• [ ] Coconut wraps with turmeric (Available on Amazon)

• [ ] Shirataki noodles (zero carb) (LOVE THESE! Especially the fettucine version!)

• [ ] Cauliflower rice

• [ ] Zucchini noodles

• [ ] Small portions of thin rice noodles (when needed)

Dairy Alternatives

• [ ] Unsweetened cashew milk

• [ ] Unsweetened almond milk (check phosphorus additives)

• [ ] Unsweetened cashew yogurt

• [ ] Unsweetened coconut yogurt

Healthy Fats

• [ ] Extra virgin olive oil (First Harvest, Hand-picked, Cold Pressed, Extra Virgin)

• [ ] Avocado oil (small amounts)

• [ ] Almond butter (small amounts)

Seasonings & Flavor Enhancers

• [ ] Ceylon cinnamon

• [ ] Fresh herbs (basil, thyme, rosemary, parsley)

• [ ] Garlic

• [ ] Ginger

• [ ] Turmeric

• [ ] Lemon juice (small amounts)

• [ ] Mrs. Dash salt-free seasonings

• [ ] Ground chia seeds (small amounts)

• [ ] Ground flax seeds (small amounts)

• [ ] Kimchi (check sodium content)

Beverages

• [ ] Water (Ask your doctor about how much water to consume daily and don’t forget to take into account water in foods)

• [ ] Herbal teas (check ingredients) We love Hibiscus for artery health! Also Turmeric and Ginger teas are great for inflammation!

• [ ] Diluted cranberry juice (unsweetened)

Specialty Items

• [ ] Rice cakes (unsalted)

• [ ] Popcorn (air-popped, unsalted)

IMPORTANT REMINDER: Foods NOT TO BUY as you need to Avoid (High Potassium/Phosphorus AND High Glycemic)

• Bananas, oranges, mangoes, kiwi

• Potatoes, sweet potatoes, tomatoes

• Spinach, Swiss chard, collard greens

• Beans, lentils, peas

• Processed foods with phosphate additives

• White bread, white rice, regular pasta

• Dairy products (milk, cheese, yogurt)

• Nuts and seeds in large amounts

• Chocolate, cocoa

• Whole wheat products

• Brown rice, wild rice, quinoa

• Dried fruits

• Most processed or packaged foods

• Cola beverages

Budget-Friendly Shopping Tips

During our discussion, Dr. Danzinger and I acknowledged that healthy eating on a budget is possible:

1. Check dollar stores for frozen vegetables, which can be just as nutritious as fresh

2. Look for sales on fresh produce and freeze extras

3. Consider food banks and community programs

4. Cook at home rather than eating out

5. Use canned vegetables (rinsed to reduce sodium) when fresh aren’t available

   ---

Meal Plan for Managing Both Diabetes and Advanced Kidney Disease

These meal suggestions aim to balance the needs of both conditions by limiting potassium, phosphorus, and protein while keeping carbohydrates low to moderate glycemic impact. Always review with your healthcare team before implementing.

Breakfast Options:

Breakfast 1:

• 1 egg white scrambled with kimchi (low in potassium, adds flavor without salt) — Recipe below

• ¼ cup fresh blueberries

• Ceylon cinnamon sprinkled on top (helps with blood sugar control)

Breakfast 2:

• ½ cup unsweetened cashew milk yogurt

• 1 tablespoon crushed walnuts (portion controlled)

• ¼ cup strawberries

• ½ teaspoon ground chia seed powder

• Sprinkle of Ceylon cinnamon powder

Breakfast 3:

• 1 slice sourdough bread (lower glycemic impact than white bread). Another great option is a Cauliflower thin.

• 1 tablespoon almond butter (portion controlled)

• Thin apple slices (low potassium fruit)

Lunch Options:

Lunch 1:

• 2 oz chicken in a coconut wrap with turmeric (available on Amazon)

• Lettuce, cucumber, bell peppers

• 1 teaspoon olive oil and herbs

• Side of fresh green beans

Lunch 2:

• Cabbage “bowl” filled with:

• 2 oz lean ground turkey

• Zucchini noodles (instead of rice noodles)

• Green onion and bell pepper

• Light ginger-garlic sauce (no added salt)

Lunch 3:

• Vegetable soup made with:

• Low-sodium broth

• Green beans, cabbage, onion

• Small amount of shirataki noodles (zero carb)

• 1 oz tofu cubes for protein

• Side of ½ apple

Dinner Options:

Dinner 1:

• 3 oz wild salmon

• Cauliflower “rice” seasoned with herbs

• Roasted green beans, onions, and yellow squash

Dinner 2:

• 2 oz chicken breast

• Asparagus

• Mashed radishes with herbs (loses bitterness when cooked) — Recipe below

• Light olive oil and herb dressing

Dinner 3:

• Stir-fry with:

• 2 oz tofu or tempeh

• Snow peas, bok choy, water chestnuts

• Choice of: shiratki noodles or a small portion of thin rice noodles. A large portion of riced cauliflower may be considered, too.

• Garlic and ginger seasoning

Snack Options:

Snack 1:

• ½ cup fresh berries with a small handful (about 6-8) of low-potassium nuts like macadamias

Snack 2:

• Cucumber and red bell pepper slices with a small amount of hummus

Snack 3:

• Homemade popsicle made with unsweetened cashew milk, a few strawberry pieces, and a touch of stevia if desired — Recipe below

  ---

Recipe: Mashed Radishes

Ingredients:

• 2 cups radishes, peeled and quartered

• 1 tablespoon olive oil

• 1-2 cloves garlic, minced

• Fresh herbs (thyme, rosemary, or parsley)

• Black pepper to taste

Instructions:

1. Boil radishes until tender (about 15 minutes)

2. Drain well

3. Mash with a fork or potato masher

4. Mix in olive oil, garlic, and herbs

5. The cooking process removes much of the peppery bite

Recipe: Kimchi Egg White Scramble

Ingredients:

• 2 egg whites

• 1 tablespoon well-drained kimchi, chopped

• ½ teaspoon olive oil

Instructions:

1. Heat olive oil in a non-stick pan

2. Add kimchi and sauté for 30 seconds

3. Pour in egg whites and scramble until just set

4. Serve immediately with blueberries on the side

Recipe: Cashew Milk Popsicles

Ingredients:

• 1 cup unsweetened cashew milk

• ¼ cup chopped strawberries

• ½ teaspoon vanilla extract

• Stevia to taste (optional)

Instructions:

1. Blend all ingredients until smooth

2. Pour into popsicle molds

3. Freeze for at least 4 hours

Portion Guidelines

As stated earlier, remember to calculate your protein limit using:

• Body weight in pounds ÷ 3 = maximum grams of protein per day

Example:

• 150 lbs ÷ 3 = 50 grams protein maximum daily

• 180 lbs ÷ 3 = 60 grams protein maximum daily

IMPORTANT CONSIDERATIONS:

• These meals are low to moderate in potassium and phosphorus

• Protein portions are controlled for kidney protection

• Carbohydrates are either low glycemic or portion-controlled

• Always work with a renal dietitian for personalized advice

• Lab values should guide specific restrictions

---

Disclaimer: The information provided in this blog post is for educational purposes only and should not replace medical advice. Always consult with your healthcare provider before making changes to your diet, especially if you have chronic conditions like diabetes or kidney disease. It’s important to always ask your doctor for a referral to a dietitian or nutritionist who specialists in diabetes and kidney disease to best understand what dietary options are right for your presentation of disease.

If you are in New Hampshire, Massachusetts, Virginia, Minnesota, or Florida, go to diabetesreversalpartners.com to learn more about Dr. Michael Dansinger’s Diabetes Reversal Programs for patients covered by Medicare or Medicare Advantage PPO plans.

If you have questions about how diabetes and chronic kidney disease can cause poor circulation in the legs, known as Peripheral Artery Disease, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org