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Kidney Disease
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Amount of Bread

Could someone tell me the amount of bread it is safe to eat in a day with Stage 4 CKD?

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Hi Greatest,

What an interesting question. The answer is not easy. Do you have to watch your carbs because of diabetes? Then the answer is based on your carb allotment. You have to factor in your total carb count for the day. For example, do you eat other high carb food in quantity such as cereal, rice, pasta, cake...you get the picture.

But if your only concern is CKD stage four, then eating bread is fine in moderation. And I am talking bread, not crackers, not snack foods, not muffins. Just plain bread.

But here is what I personally discovered for myself. I love bread. I love pasta. I have controlled diabetes so I have to watch closely what I eat. When I eat pasta, my sugar gets very high. When I eat bread, not so much. I also discovered that bread I make at home does not raise my sugar at all. And there is nothing like fresh bread from the oven. I also use 50% butter to save on calories, but no margarine. (Margarine is the Worse product in the world, except for fake whipped creme) I make plain yeast white bread with only five ingredients: water, yeast, tiny bit of sugar, flour and salt. I find the stuff out there in the supermarkets has a lot of hidden garbage like preservatives in it and going for the purest stuff helps. I noticed this last summer when I bought bread from a farmer's market. So if you are going to consume bread, less garbage in it, the better.

Also need to consider is phosphate. A lot of breads have phosphate products in them and that can impact your CKD health.

I asked my renal dietician about whole grains. The concern with that is phosphorous. However, ask she explained, only 50% or less of phosphorous from plant based materials is absorbed in humans, so whole grains in moderation is fine. The fiber of course is also good for you.

Long answer for a short question.

Hope that helps.

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Hi Bassetmommer -

Thanks so much for that answer - and that you took the trouble to explain it all -

No, I do not have diabetes and I have started eating only rice cakes with low fat cottage cheese and oats and honey bread - but having been a farmer's wife for many years I have a fair knowledge of making bread but am very interested in your recipe. Could you share with me the amounts of flour etc......that you use to make a loaf? It would have to be a smallish loaf so as to remain fresh. I find the oats and honey bread is extremely heavy to digest. Do you use whole wheat flour ?

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HI,

1 cups water. 1 full teaspoon of white or brown sugar. 2 1/4 teaspoons or packet active dry yeast. 3 cups unbleached All-Purpose Flour. 1 tablespoon salt.

Trick is to keep the bread warm. I find that using a digital food temp gauge helps. Make sure your bowl is not cold and where you kneed the bread is not cold. I make sure my starter, sugar water and yeast, are at 110 degrees. Let the starter sit in the glass you blend it in for about five minutes until bubbly. Using the bowl on the mixer, I add the flour in increments, a 1/2 cup at a time. I add salt to the third 1/2 cup of flour in the flour to not kill the yeast. They sometimes recommend not adding the salt until the end but I worry it doesn't blend well. I rarely use all three cups of flour so slow down when you start to add the last cup of flour. I use a Kitchen Aide mixer with a dough hook for 5 -6 mins and then finish the kneeding for three minute by hand on a ceramic tile counter with a bit of flour. Once the dough is elastic and somewhat shinny, cover your hands with a bit of oil and rub on the dough ball. Do not saturate the dough. Place in the bowl. Then I proof it in the oven with a very warm pot of water next to it covered with a wet tea towel for about an hour. Then I re-kneed it for a bit, and shape it into what ever dough size you want and let it rise again until it is at least double. Just before baking, I put an egg wash on it. Then bake at 375 for about 20 mins or so, depending on how you shape it and viola. Thumb the bottom of the loaf. If it sounds hollow, it is done. Let it sit for at least an half hour so it will cut well. Oh is is so good.

I have experimented with Rye flour. My first attempt was not so good. But neither was my first try at white bread. We still ate it even though it was pretty dense from not kneeding it enough and it was tasty. It gets easier every time.

For other recipes using different flours and ingredients, there are a ton out there. A friend of mine and I are going to have bake-offs by trying different recipes to pass the winter.

Good luck.

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Thanks so much for that answer. You are indeed an amazing source of information and I really appreciate it. I am going to go to the shops tomorrow to get that flour and make my first loaf of bread. I shall put a message on regarding the result.

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Fabulous. I like swapping food and recipe ideas for CKD. If I can figure out how to post pictures, it would make it even more fun.

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That's for sure.... I will ask my son to show me how. Keep as healthy as you can and thanks again

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Hi, Bassetmommer,

Your reply to Greatest raises a question that my dietician does not answer. (I don't call her a renal dietician because I don't think she even knows where her kidneys are.)

Would it work to subtract half of the plant-based phosphorus I eat from my daily phosphorus total?

I am supposed to limit phosphorus to under 500 mg/day. I track every single thing I eat and drink, restrict my protein, avoid high-P produce, and on and on. But no matter how careful I am, I use up my phosphorus allotment way before I have enough calories for the day. I'm hungry all the time.

I use Cronometer for tracking (I love it) and have asked them if their phosphorus totals are reduced for plant-based phosphorus. They say no, because they use govt and other data that only show total phosphorus, not available phosphorus. I don't want to change the numbers on my own without knowing if they will be accurate.

Actually I'm also searching for info on another, similar question.

Would it work to subtract the phosphorus that is bound by phosphate binders--and if so, how to do it?

I take Tums and am tempted to subtract out the 39% of phosphate they are supposed to bind. But I can't find data on what amount of my phosphate consumption they affect--e.g., do they bind 39% of all the phosphate only in the meal I take them with?

Do you have any info on those questions or where I might look for answers?

Btw, I always appreciate your posts--they are so informative and helpful.

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Oh boy. First of all, thank you for the compliment. I am not a renal dietician, but I am inquisitive, so I ask a lot of questions of mine. She is excellent and used extensively with the nephrologist and medical center we are all affiliated with.

So, going on what she said, about 40 to 50 % of the phosphorous in plant based products is absorbed in consumption. Here is what I found from Google:

"It’s important to note that plant-based phosphorus foods such as whole grains, beans, and nuts provide the nutrient in the form of “phytate,” which is not as easily absorbed as phosphorus in animal sources. We absorb about half of the phosphorus from these plant-based foods."

universityhealthnews.com/da...

So going on that assumption, the food could be calculated with that lower phosphorous, I would think. My issues is a lot of these foods are also high in potassium.

I know how hard it is to maintain a strict diet watching potassium and phosphorous as I need to do both. My issue is, I have limited my intake of animal protein, so I am not eating any meat, and very very little chicken. I was eating white fish because it was low in calories until I realized it is high in potassium. It is so hard to get a balanced and varied diet with calories, carbs, potassium and phosphorous being limited.

I told my dietician there was basically nothing I can eat.... and the issue was, that was what I was doing. And then, I was not getting enough calories and would be miserable. And I was was not losing any more weight. My body went into a starvation mode and lowered my metabolism rate to compensate.

I too also take a potassium binder, which binds me up so bad that I am not taking it as I should. The answer about binders is that they need something to bind to. So taking a binder should be done just prior to eating or while you are eating. After you eat or on an empty stomach is the wrong approach. Can you count less on the phosphorous on the foods you eat when you take a binder? Good question and I will ask my dietician. For me, I keep the counts as they are, but let myself have a higher count if I take my binder. (Its like drinking mud) I will allow a day with a higher value and then be more restrictive the next day. Since this diet is for life, I need to be a bit flexible. I also stay away completely from the known high K veggies such as potato, tomato and winter squashes and high Phosphorous foods such as nuts, nut butters, and limit my diary intake.

There is a lot of discussion on whether or not leaching vegetables takes out much potassium and or phosphorous. I do leach my broccoli by soaking it for several hours, dumping the water and then with fresh water, boiling it. I like broccoli too much to give it up.

kidney.org/atoz/content/pot...

nephroplus.com/leaching-rig...

Do you take Tums because that was what was prescribed for you? When you have kidney disease, it is always good to run everything by your nephrologist.

I am so with you on this journey.

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Many thanks for your reply. It calmed me down to read your similar experience on this impossible diet, and how you deal with it.

The main idea I got was to let myself be a tiny bit less obsessive about counts for plant-based phosphorus and for when I take a phosphorus binder. Fortunately I can still have a reasonable amount of potassium. I can't imagine what you can eat that was considered healthy in life before CKD.

To answer your question, my nephro suggested Tums but said he would prescribe a different binder if I wanted it. He did not tell me how to count the binding effect of Tums or how much of it to take, and he did not make the least effort to figure out what type of binder would be best for me.

Finding a new CKD team is on my list, after finding kidney-friendly foods that are filling.

Thanks for sharing the results of your studying and improvising on this journey.

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Good question. If you are diabetic, for instance, you may be told to avoid processed, white flour, yet the renal diet will say the opposite. It can be tricky, so your healthcare team will be able to answer this question the best for you. The one suggestion I have is to read the labels on the bread you purchase at the store. You may not see phosphorus numbers listed, but the labels should show potassium as well a the sodium added, which is often a great deal. Here is some information on the subject from Kidney Buzz. I hope this is helpful.

kidneybuzz.com/best-breads-...

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Thank you so much. I went out today to buy the flour recommended by Bassetmommer...... Did you read what he or she said? So I am going to try and bake but will definitely look at the site you have given me. Thanks

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I have just read the site you sent me. It is so informative and very interesting. There are things I would never have thought I could eat. Thanks again.

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I'm glad you found it informative! When my husband was on dialysis (stage 5/ESRD) I had to learn to cook for that diet as well as his diabetic diet. It was quite a challenge! One of the best resources I had was the dietitian at his dialysis center. Do you have a dietitian available within your healthcare team?

Another site I found and still find very helpful is

ndb.nal.usda.gov/ndb/search...

it has non-processed items listed (e.g. fresh spinach, frozen peas, baked chicken breast, with skin without bone, etc.) as well as prepackaged foods such as Quacker Oats this, that, and the other. If you use apps, Nutrition Lookup by Sparkpeople is something I like, too.

Good luck with everything! You will get the hang of it all soon. 🙂

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Thanks so much for all the help. I am going to investigate far more than I did before. This morning I am going to bake Bassetmommer's bread. Wish me luck!!

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Homemade bread is delicious. Good luck and have fun, too! 🙂

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I have just had my first slice and what you say is true..... SO much nicer than bought bread!!!

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White bread is not a healthy choice. White bread is full of sugar. Whole wheat bread is recommended. Though I have stopped taking bread and switched to whole wheat tortillas, Indian roti & chapatis.

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Thank you. I will try what you recommended

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Just for information, white bread is not loaded with sugar. It is a carbohydrate that raises blood sugar. There are many foods out there which all have a similar glycemic level. It is a choice as to what to consume in moderation.

hsph.harvard.edu/nutritions...

BTW, tortillas are usually loaded with sodium, which can be very bad for CKD patients. Please read labels to see what is really in what you are eating.

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Tortillas that are similar to the Indian wheat roti is what I meant. I know super markets do not sell roti's in some places but they do sell "whole wheat/whole grain (no salt) tortillas" - atleast they do in my Walmarts.

I cannot consume white bread not just because of its sugar content but also because of the yeast in it which is not "natural" most of the time. White breads are now highly "processed" (also very cheap) and actually falls in the processed food category.

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Well! I never realised until I decided to change my diet drastically that there was so much to learn about bread!!! It just never came to mind but now I'm reading everything I can about it. By the way I went and got that Unbleached flour which I didn't even know existed and tomorrow is the day I am going to try. My husband has insisted in ordering a MaBaker to make the next loaf in because he says it will cut down on electricity. Will it be OK to do it in that?

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Well I had to look up Ma Baker. If you do not use a mixer and kneed by hand, the only fuel you will consume is in the oven and that only 20 minutes or so.

Let me know how your experiment comes out.

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I have never used a Ma Baker but he says it works very well. Apparently you all your ingredients in..... In a certain order..... Then you close it and a peddle inside starts slowly mixing the ingredients and so it changes speed until it is all thoroughly mixed. Then everything stops and it proofs...... When ready according to the settings you have put in it starts baking. This is all new to me so I will wait until it arrives and try it out. Tomorrow I am doing the kneeding by hand like you do. Will let you know!

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oh... it s a bread maker machine. I have one and I have never used it. This process is so easy, especially if you have a heavy duty mixer. The first time I made bread recently, I did all by hand and I did not kneed it enough. I used to make tons of bread when I was younger using only muscle power. Now, as I am lot older, I love my Kitchen Aide mixer.

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Well done and dusted and the bread was super. Thanks again for sharing your recipe. By the way I want to ask what may seem to be an idiotic question but do as many Vegans get CKD as meat eaters?

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Jeepers, what a good question. My first thoughts were that it would require and evidence based study to answer this, and I could not find one. I would think that there are so many factors causing CKD that it would be hard to answer. CKD can be caused by auto-immune diseases no matter what you eat. You can have CKD onset from reaction to medications (my situation). High blood pressure and diabetes is often the cause, and all though my reading said the a plant based diet will help with both of those things, there was no direct information on preventing CKD.

What I did find that was interesting is that a true vegan diet has other complications that can be prevalent in CKD, like anemia and low B12 and how if you have CKD, you have be careful.

So I cannot answer that question exactly. What I did find was lots of information on how a plant based diet can help maintain kidney function with CKD.

nutritionstudies.org/can-wh...

vivahealth.org.uk/veganheal...

ncbi.nlm.nih.gov/pmc/articl...

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Sorry.... Put all your ingredients etc....

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Thanks for sending those sites... I am going to read them all. I know that many things cause CKD..... Mine is for instance genetic...... But when I started to read how too much protein can affect kidneys I started to wonder if Vegans, although they may get it, progress downward at a slower rate. Living on the farm in Namibia for so many years and meat being a huge part of the diet set me to wondering. I have changed this last week to almost only fruit and veg and bread...... A little chicken and fish. Thanks for your reply.

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