Even while working on a healthier diet for better kidney function, I get that sometimes it’s impossible to avoid a quick stop for a bite. With chronic kidney disease, you probably have a half-dozen doctor’s appointments, pharmacy pick-up, and oh yeah, work if you’re still able.
I will not encourage my clients or anyone with chronic kidney disease to routinely go out for fast food as it does not help kidney disease. So this article is literally about fast food that is okay for kidney disease – but not great.
Moderation and portion control will always be the name of the game here. But as I said – sometimes it’s unavoidable. And I’d rather you make a smarter choice than to drive up and throw everything about your kidney health goals out the window.
Want a free guide and workbook to help you with your best fast food options?
First, the problems with fast food for kidney disease.
It’s not uncommon knowledge that fast food and restaurants have higher sodium content than if we were to make the same food at home. However, we generally underestimate how much is in that fast food.
In fact, according to a study done in 2014 revealed that 90% of the adults that guessed the sodium content of their meal were underestimating by an average of 1,000 milligrams. (1)
Since then, restaurants are becoming more transparent in their nutrition information with tools like nutrition calculators and PDF documents of full nutrition information available to the public.
But it doesn’t mean sodium is not still a big problem. And with kidney disease, it especially is of concern. One of the top causes of kidney disease is hypertension, or high blood pressure. (2)
Arguably one of the most challenging parts of a renal diet and fast food is determining the amount of phosphorus. Finding low phosphorus fast food is difficult; nearly impossible. (3)
If your phosphorus levels are already trending even just above 3.5 mg/dL, you are at a higher risk of further damaging your kidneys and increasing risk of death. (4)
Phosphorus is not a required nutrient to be listed on the nutrition label, although evidence suggests that it may be beneficial to the public for manufacturers to include phosphate information on their nutrition facts. (5, 6)
If you are curious about finding phosphate additives in foods at a restaurant, here are the steps you will need to take:
Look up the official restaurant website and search for nutrition ingredients. Ideally they will have a PDF that you will be able to pull up. A good example is Subway listed under “Our Ingredients.”
Once you have the PDF up, do a “find” search of the document and type in the letters phos.
Make note of the foods you pass that do not have a “phos” highlighted within the nutrition information. You may need to scan those a little closer as some may say “refer to x product ingredients,” which may or may not have phosphorus listed.
Once you comb the ingredients of the food items, you will have your own menu of no added phosphate foods!
Warning: companies can change their ingredients at any time without notice. The list you create will not be set in stone.
Luckily, potassium may be a bit easier to find. This should especially be the case more so since 2016, when the FDA required potassium content to be listed. (7)
However, potassium additives are now becoming a more prevalent issue with kidney disease, and of course are just as difficult to find obviously labeled.
You can use the steps noted above for finding phosphate additives to also find potassium additives. Just search for “potassium” instead of “phos.”
But I will add that potassium is likely not an issue for many with CKD, in fact, you may or may not need to limit your potassium.
If you are already struggling with these issues, I don’t recommend you look even for foods “okay” for kidney disease. Because ultimately, they’re not if your labs and health conditions are not well-managed.
Medications to take with fast food for kidney disease.
You may have been prescribed what is called a phosphate or phosphorus binder. This is a medication that is intended to prevent the absorption of phosphates into your bloodstream.
Too much phosphorus is very harmful to the body over long periods of time and can lead to issues such as vascular calcification (hardening of the arteries), skin breakdown, joint pain and damage, bone damage, and higher risks of heart attack, stroke and death. (8)
If your doctor has prescribed binders to you, be sure to take them as prescribed. They are most effective when taken at the beginning of your meal. If you struggle with phosphorus control, you may need to discuss a dose adjustment with your nephrologist or dietitian, especially when it comes to eating fast food.
Always discuss medication changes with your prescribing physician.
How much is fast food okay for kidney disease?
As stated, moderation will always be the name of the game. If you are able to keep it to about one meal per week, and keep to healthier choices, you are more likely to not experience significant changes in your renal function.
Serving sizes of the foods are essential in this situation. By selecting a smaller, or even “junior” meal, you are better limiting the problematic items listed above.
Fluids can also play an important role in kidney disease and kidney health. Choose the smallest size available, which is oftentimes a 10-12 ounce cup already, to prevent excessive bloating, swelling, and fluid overload.
Luckily, the larger a restaurant chain is, the more scrutiny and expectations will be had to their nutrition transparency (even if it’s not the best).
Each of these top 5 companies include their nutrition information and access to ingredients listings for you to find the best kidney-friendly foods for your top concerns.
Let’s dive into a few of the top categories.
Kidney Friendly Burgers
First off… no super-sizing! As mentioned above, the larger sizes come with larger amounts of sodium and phosphate additives in burgers. Potassium is also a consideration of meat but doesn’t beat out these other concerns.
Stick to a 4-ounce burger (about the size of a deck of cards) to keep the kidneys safe. Even on dialysis, you don’t need more than that.
Condiments on the side. Instead of having them decide how much ketchup, mustard, mayo, and relish to top on, skip it all. Ask for a packet of each ketchup and mustard, mayo if they have it, and add it yourself. The difference will shock you, but that goes to show the heavy-handed dollops they put on are likely high in sodium and fat.
Load up with lettuce (an onion, even a slice of tomato). This is where I say you should bulk up! More veggies, yes please! Ask for extra lettuce and onions if you like.
Skip the cheese. Although if you did your research on phosphates and potassium additives, you’ll probably already know this. By the way, a slice of cheese can add over 200 milligrams of sodium!
Kidney friendly options at McDonald’s
If this is a must, stick with McDonald’s classic hamburger. Add the lettuce and skip the pickles if you need to avoid potassium additives or extra salt.
The fish will give you 450 milligrams sodium (without the cheese but with the tartar sauce) and no phosphate/potassium additives. The McChicken comes at 500 milligrams sodium (no mayo), but the chicken DOES have phosphate additives.
As far as sides go, the side salad with any dressing is a decent option (they all have NO phosphate/potassium additives!)
Apple slices are a low-potassium fruit that will add sweetness and crunch to your meal. Get two packs if you like!
If you must, a small order of fries may be okay if you do not need to restrict potassium (it has 15% daily value, about 700 milligrams of potassium). And know that it will also add at least 200 milligrams of salt to your meal.
Iced Tea (unsweetened), Sprite, apple juice, or black coffee are your best options here. No added phosphates or potassium. Ask for extra ice and stick to an extra small if you need to limit your fluids.
Is the Impossible Burger kidney friendly?
Many of my clients have asked me if the Impossible Burger can fit into a renal diet. And many have tried.
Even though this is deemed as a “plant-based” alternative, it is definitely not something I would recommend in an ongoing rotation in your diet. Or mine, for that matter.
The Impossible Whopper clocks in with 630 calories compared to the original Whopper with 660 calories.
Both are incredibly high in sodium, with the original Whopper at 980 milligrams. And the Impossible? It has 1,080 milligrams of sodium.
To be fair, the bun itself has 420 milligrams of sodium. But the Impossible burger meat alone has 330 milligrams of sodium and 7 grams of saturated fat. That’s more than half your day’s worth of saturated fat from just a burger patty.
If you have later stages of CKD and need to limit your protein intake, the Impossible Whopper won’t do you any good. It has 25 grams of protein compared to the regular Whopper’s 28 grams.
Kidney Friendly Chinese Food
Sodium is by far the top concern when it comes to Chinese food. But by focusing on a plant-heavy dish and requesting steamed varieties, you will significantly lower the sodium (and fat) content of your dish.
Serving sizes can often be family style, even when marketed as an individual plate. If concerned with the amount, request a side plate and serve yourself a meal on that. After you finish, taking about 20 minutes to enjoy your food, decide if you are in fact hungry enough to eat more.
Kidney Friendly Options at Panda Express
I have known a lot of people to ask about kidney friendly chinese food, which of course brings to mind one of the most common restaurants, Panda Express.
Their teriyaki grilled chicken, however, does not appear to have added phosphates but comes with 530 milligrams sodium alone. Keep to 3-4 ounces (about the size of a deck of cards) for the best portion for kidney health.
All other entrees at Panda Express unfortunately have phosphate and/or potassium additives.
I would recommend choosing a bowl of half rice and greens for a lesser amount of phosphate additives. A chicken egg roll to go along with it can be acceptable. This meal provides about 620 milligrams of sodium and 12 grams of protein and 7 grams of fiber (and 64 net grams of carbohydrates for those of you following a renal diabetic diet).
Cream cheese rangoons are phosphate/potassium additive free, as is the hot and sour soup (mind your fluids and keep to the smaller serving).
Kidney Friendly Coffee Shops
When choosing a fancy coffee order, keeping to the small (“tall”) cup size is a great way to enjoy while not overdoing it. You still get 12 ounces of your beverage but won’t have to push away a cup of water at your next meal.
Of course, black coffee is best (and yes, you can have coffee if you have kidney disease).
Choose sugar-free syrups if you need a sweetened drink. Not a fan of sugar-free? Try half sugar-free, half regular. A venti sweetened black coffee will set a woman over her daily allowance of added sugars. Also, skip the whip for even less sugar and saturated fat.
Finding the phosphate additives here is much trickier as they do not feature a webpage or PDF that includes all ingredients. To identify if a menu item has additives, you need to individually select that option and then review the ingredients. You can still do “control + F” search on that web page to make it a bit quicker.
Kidney Friendly Options at Starbucks
Stick to the cow’s milk or almond milk. Oat and coconut milk options have phosphate additives, as shown in the image above. Soy is difficult to find and may vary store-to-store.
The cafe mocha has no potassium or phosphate additives (although chocolate is typically seen as higher in phosphorus naturally). Vanilla and classic syrups have potassium additives but no phosphate so could be acceptable in small quantities.
If you need breakfast to go along with it, the Spinach, Feta, and Egg White Wrap is a decent choice with no additives. Beware the sodium content, however, as it clocks in at 830 milligrams.
The Sprouted Grain Vegan Bagel will give you 12 grams of protein and 7 grams of fiber along with 490 milligrams of sodium for 330 calories. Having some cream cheese, which is lower in phosphorus and potassium is acceptable.
In fact, the majority of their hot bakery items do not have phosphates included, with the exception of their smoked bacon.
Need lunch? The Tomato and Mozzarella sandwich should do, with 580 milligrams sodium and 15 grams of protein (although that may be too much protein if you’re on a severe protein restriction).
The Prosnax Green Apples, Egg, Mild Cheddar Cheese, and Cashews Snack Box may be a better option at 250 milligrams sodium and 13 grams protein for 320 calories.
I’m not getting into the bakery sweets here as that is generally not recommended.
Kidney Friendly Sandwiches
Choose the least-processed meats (if any). Sticking to a veggie sandwich is ideal in this situation as most of the meat options in a deli will be significantly high in sodium and potentially have phosphate and/or potassium additives.
Adding creaminess with avocado (if your potassium allows for it), regular mayo, vinegar and oil are good options. Wraps are generally not recommended as the tortillas are high in sodium and are most guaranteed to include phosphate additives.
Kidney Friendly Options at Subway
A 6-inch Veggie Delite on 9-grain wheat with some avocado and mayo will surely be filling (and bonus!- it’s one of the cheaper menu items).
Don’t like wheat and need a little animal meat? Try the Turkey Breast with no added phosphates on the artisan flatbread. It’ll push you up to 720 milligrams of sodium and 18 grams of protein but still includes 5 grams of fiber.
I wouldn’t bother with the sliders consider they’re not filling enough for a meal but provide the sodium amount for one (about 500 milligrams for only 200 calories and 1 gram of fiber).
For the best side, grab the applesauce pack for an easy and portable side that is low in potassium. Add a small drink if you need it – brewed iced tea or bottled water is best here.
Kidney Friendly Taco Order
Not only do I actively participate in #TacoTuesday, but even I will swing through for a Taco Bell lunch from time to time. And I have a bit of a bias with Taco Bell because I love their nutrition calculator!!
When it comes to tacos, choose crunchy and corn tortillas over soft shell flour tortillas. Corn tortillas are significantly lower in sodium (sometimes even with no added sodium) compared to flour tortillas that can be hundreds of milligrams of sodium – and we’re just talking about the tortilla!
Mexican restaurants will often have vegetarian and vegan options easily available. Two of the biggest veggies included in Mexican-style food are peppers and onions, which are lower in potassium.
Go easy on the salsa. It adds up quick- and I’m talking about both sodium and potassium here. See if they offer a corn-based salsa to at least lessen the potassium content.
Kidney Friendly Options at Taco Bell
After doing the research between these different restaurants, Taco Bell’s nutrition information actually allows you to sort lowest to highest sodium!
I recommend going for the crunchy tacos over soft just because of the sodium content (310 milligrams compared to 500 milligrams per taco). You can almost have two crunchy tacos for the amount of sodium you get from one soft taco!
If you can’t stay away from soft taco, I recommend the Fresco Shredded Chicken soft taco, at 430 milligrams of sodium and no added phosphates in the chicken.
Really hungry? Get the Veggie Power Bowl but skip the cheese, sour cream and avocado ranch sauce to keep the sodium better controlled at 690 milligrams. But for that you get 8 grams of protein and 10 grams of fiber, which will surely fill you up!
Kidney Friendly Pizza
Pizza is typically a no-no when it comes to the renal diet. High in sodium (from the crust, cheese, and toppings like processed meats), high in potassium (from the cheese, tomato sauce, and toppings), and low in nutritional value of fiber. But you can make changes to help influence that!
Choose a whole wheat crust when available. Thin crust can be another option but may be just as high in sodium as the regular crust, plus more saturated fats. Each company will be a little different.
Many pizza joints like Pieology are now adding cauliflower crusts to their menu. This can be a great way to get in more vegetables but is often higher in sodium.
Kidney Friendly Options at Papa John’s
Go with Papa John’s gluten-free crust for the lowest sodium at 100 milligrams. Choose Alfredo sauce over the traditional tomato-based sauces to keep potassium in check.
Good news with PJ’s ingredients is that they don’t have added phosphate or potassium preservatives in their crusts.
The bacon, philly steak and chicken meat options have added phosphates. Other meat options do not have additives but will definitely add up in sodium. I would still recommend avoiding all meat options when it comes to pizza.
A slice of the gluten-free garden fresh pizza will give you only 300 milligrams per slice.
The plain bread sticks or cheese sticks are phosphate-additive free but definitely won’t contribute much nutritional benefits and, again, raise the sodium of your meal. Each bread stick will tack on about 250-300 milligrams of sodium, about the same amount as a whole slice of pizza.
How can I find kidney-friendly restaurants near me?
If you need help in finding some places around you, check out the National Kidney Foundation’s My Food Coach app where you can search local restaurants. It will give you some insight into options available nearby but you will still have to do some of the heavy lifting yourself.
However, just like this information here, the exact phosphorus load will not be available as it is not required to be calculated by restaurants.
I hope in sharing the links and information here I have made it slightly easier on you to figure that out for yourself.
I have one more resource for you. Here is an article that shows a comparison of potassium and phosphorus content of different fast food restaurants from 2014. Keep in mind this information may change as companies change their recipes and ingredients. (10)
In general, we need to all have a better game plan when it comes to eating out and grabbing some fast food. It’s unrealistic to say we will never go out to eat, so let’s make a plan and have some quick meals that we can find are best for us.
If you are already experiencing challenges in managing your phosphorus, sodium/blood pressure, and potassium levels, now is not the time for you to be dining out with kidney disease.
To help you make that game plan for yourself, I have created a workbook to guide you and keep you on track. List your preferred restaurants, look up their information and keep track of a few menu options you know are best for you and your kidney health goals.
I highly recommend you do the work and check your restaurants. Then review the information you collect with your renal dietitian and nephrologist to be sure that it is acceptable for your kidney disease, your labs, your health.