62-year-old woman with type 2 diabetes, hypertension, and stage 3b CKD. Takes lisinopril, metformin, and atorvastatin.
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Plant-forward (flexible): mostly plants, with room for occasional fish or lean options.
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When two of your conditions or medicines call for opposite things, here is how the plan handled it.
A plant-forward pattern is encouraged for your conditions, but potassium is being limited (kidney disease and/or medication). The plan keeps plants central and steers toward lower-potassium options rather than cutting produce.
Emphasize
Favor plant protein sources within the prescribed protein target.
Follow a DASH-style pattern rich in vegetables, fruit, whole grains, legumes, and nuts.
Emphasize nonstarchy vegetables, legumes, whole grains, nuts/seeds, and whole fruit; choose minimally processed, high-fiber carbohydrate.
Emphasize a variety of vegetables, fruit, whole grains, legumes, nuts, and liquid plant oils.
Limit
ACE inhibitors, ARBs, and potassium-sparing diuretics raise the risk of high potassium. Discuss high-potassium foods with your clinician.
Limit inorganic phosphate additives (highly absorbed) found in many ultraprocessed foods; adjust phosphorus to keep serum phosphate normal.
With moderate CKD plus an ACE inhibitor, ARB, or potassium-sparing diuretic, limit high-potassium foods to lower the risk of high blood potassium.
Limit sodium to support blood-pressure and volume control.
Reduce sodium, especially from processed and restaurant foods.
Replace sugar-sweetened beverages (including juices) with water; minimize added sugar, refined grains, and ultraprocessed foods.
Minimize added sugars, ultraprocessed foods, processed/red meat, and excess salt.
Avoid
Grapefruit blocks intestinal CYP3A4 and can raise levels of simvastatin and atorvastatin. (Pravastatin and rosuvastatin are not affected.)
Do not use potassium-containing salt substitutes without consulting your clinician. Risk of hyperkalemia is higher with kidney disease or diabetes.
Phosphorus here is managed by limiting additives and ultraprocessed foods. Total phosphorus is individualized to your labs with a renal dietitian.
Potassium intake should be adjusted to serum levels (KDOQI 6.4.1). Avoid potassium-based salt substitutes unless cleared by your clinician.
Protein targets in CKD with diabetes are individualized and need a renal dietitian; balance kidney protection with glycemic control.
Long-term metformin can lower vitamin B12. Periodic B12 testing is advised; include B12 sources or discuss supplementation with your clinician.
2,300 mg/day is the upper limit; the AHA's optimal goal is no more than 1,500 mg/day for most adults - aim lower if tolerated.
Recommended recipes
Browse all recipesA lower-potassium, low-sodium bowl that works for kidney-conscious diets.
- Features encouraged foods: cruciferous vegetables, other vegetables, whole grains, olive oil
- Low sodium (37 mg/serving)
A hearty, low-sodium soup built on lentils and aromatic vegetables.
- Features encouraged foods: legumes, other vegetables, olive oil
- Low sodium (26 mg/serving)
A high-fiber, no-added-sugar breakfast that keeps well overnight.
- Features encouraged foods: whole grains, berries, fruit, nuts and seeds
- Note: contains foods to limit (high potassium)
- Low sodium (5 mg/serving)
A high-protein vegetarian breakfast with whole grains and berries.
- Features encouraged foods: berries, fruit, whole grains, nuts and seeds
- Note: contains foods to limit (high potassium)
- Low sodium (108 mg/serving)
A fiber-rich salad - note: tahini is high in phosphorus and potassium.
- Features encouraged foods: leafy greens, cruciferous vegetables, legumes, other vegetables
- Note: contains foods to limit (high potassium)
- Low sodium (55 mg/serving)
A filling breakfast - note: salted peanut butter adds sodium.
- Features encouraged foods: whole grains, nuts and seeds, fruit
- Note: contains foods to limit (high sodium food, high potassium)
- Low sodium (80 mg/serving)
One way to put the plan together. Totals are checked against the day's targets.