Kidney Disease: Dining Out with Confidence
Plan ahead and review the menu online to see your food options. Here are more dining out tips.
Dining out can be enjoyable even when you must follow a special diet. You simply need to choose your foods more carefully. Before eating out, it is important to understand your diet. If you have any questions, discuss them with your dietitian.
Before Eating Out
Always try to follow your diet as closely as possible. Plan ahead. Ask your dietitian for advice before you attend a special social function where food will be served.
When dining out, choosing the restaurant is critical. You may want to phone ahead to ask some questions about the menu. Restaurants that serve a wide variety of foods make eating out easier.
Making Wise Menu Selections
When you arrive, study the menu while waiting to be seated. Before ordering, ask your waitress/waiter questions to get more specific information about menu items. In this health and nutrition conscious age, restaurant personnel are accustomed to special requests for food items or preparation.
Suggestions for Eating in Specific Types of Restaurants
If you find yourself at a restaurant where few food choices are available, order as carefully as possible. The following guidelines will help you with your decisions.
The key to successful dining out in an American restaurant is watching portion size and limiting your selection of certain items.
Mexican foods frequently contain low quality protein and are high in sodium, potassium and phosphorus. It might be helpful to order from the a la carte menu. A good food choice would be a taco with meat and lettuce and plain rice.
Typically, Italian sauces should be used in small quantities because they can be high in sodium, phosphorus and potassium. Order the sauce on the side, if possible, but be advised that many Italian restaurants already have their sauce and pastas mixed. A good choice would be salad, bread and very plain pasta, such as garlic and butter. Pizza is usually salty and high in potassium and phosphorus. If you eat pizza, eat one slice and supplement with a small salad. A pizza with hamburger, green pepper and/or onions would be preferable to a pizza with pepperoni, sausage, olives, anchovies and/or extra cheese.
Asian dishes usually consist of meat, fish or poultry combined with fresh vegetables. This can make them high in potassium. Ask for your food to be cooked to order so that it may be prepared without soy sauce, fish sauce or monosodium glutamate (MSG), all of which contain a lot of sodium. Order plain rice; it is lower in sodium than fried rice. Do not add soy sauce to prepared Chinese or Japanese food.
Eating at fast-food restaurants is not totally out of the question. It does, however, take some thought. While many fast-food items are pre-salted, you can ask that yours have the salt and/or extra condiments left off. This may take a few extra minutes of waiting time. French fries are high in potassium. You must know how much potassium you are allowed if you choose this item. Unsalted onion rings would be a better choice. Choose a small non-cola soda rather than a milk shake or large soda. Many fast-food restaurants now have salad bars as an alternative.
Protein Control When Dining Out
Protein control is a key factor when trying to stay within dietary protein limits. Become familiar with different meat portions by practicing weighing them at home. You may want to request half portions of meat dishes, share a part of your large portion with a dining companion, order a child's portion or ask for a 'doggie bag. "Watch starch and vegetable portions - they have some protein too!
Another good way to control protein is by ordering a la carte. You may choose to make your meal from several appetizers instead of the typical "complete" dinner menu offerings.
Avoid "hidden" proteins such as cheese or cream sauces, au gratin dishes, dishes prepared with milk, nuts, dried beans or eggs.
A Menu Guide
Breakfast may be one of the easiest meals to eat out. Most restaurants offer a la carte style breakfast items.
- Choose: Eggs cooked to order; Omelets with low-potassium vegetables; toast, biscuits, bagels, English muffins, croissants with margarine, jelly, honey, cinnamon and sugar; low-potassium fruit or juice; pancakes, waffles, French toast with syrup; hot or cold cereals with nondairy creamer; donuts, Danish pastry, sweet rolls, coffeecake without nuts.
- Avoid: Cured or salted meats or fish, ham, sausage, bacon, lox, Canadian bacon; omelets with cheese or above meats; fast-food breakfast sandwiches; hash browned potatoes; gravy; high-potassium fruits and juices; bran cereals, whole grain cereals and muffins.
Cocktails and Beverages
When dining away from home, it is important to limit fluids. Many beverages you choose when eating out may have high potassium and/or phosphorus content. This is especially important since the meal itself probably has a higher content of these minerals than the meals you have at home. Request lemon wedges or crushed ice if you remain thirsty and ask the waiter not to refill your water glass. After the meal, chew gum or suck on hard candies to avoid drinking too much fluid. Have the waiter remove your water glass to avoid the temptation.
- Choose: Cocktails mixed with low-sodium club soda, ginger ale or other non-cola soft drink; beer, wine in moderation; iced tea, coffee with no refills; lemonade; water.
- Avoid: Cocktails mixed with fruit juice, milk, cream or ice cream; cola soft drinks; high potassium juices such as prune, orange, grapefruit and tomato; cocoa, milk, milk shakes; any fluid exceeding fluid restriction.
It is probably best to skip this course unless you are going to use it as a substitute for an entree item. Evaluate the protein content of the remainder of the meal before you select high-protein appetizers like cottage cheese or seafood cocktail.
- Choose: Fruit cup (canned); fresh low potassium vegetables; clams, shrimp, crabmeat; lower potassium juices such as cranberry, grape, apple.
- Avoid: Soups; high potassium juices such as orange, grapefruit, prune; vegetable juices; potato skins; salted chips and crackers.
Eating salads and selecting from salad bars IS possible once you understand your diet. In fact, salads can be an excellent way to obtain sources of vitamins and fiber as well as adding color and variety to your meal. Small tossed salads are generally a good choice. Ask for the dressing on the side and use it sparingly. Remember you can bring your own low-sodium dressing. You may want to mix your own dressing at the restaurant by combining vinegar and oil (usual ratio 3:1) or mix lemon with black pepper.
- Choose: Lettuce; carrots; radishes; cauliflower; green peppers; celery; onions; cucumbers; green peas; beets; alfalfa sprouts; Chinese noodles; grated cheese in moderation; coleslaw; macaroni salad; gelatin salads; cottage cheese; canned peaches or pears; canned fruit cocktail; fresh grapes; fresh or canned pineapple; small fresh peach.
- Avoid: Raw spinach; olives; pickles or bacon bits; tomatoes or mushrooms; broccoli; kidney beans; chickpeas; seeds or nuts; croutons; potato salad; three bean salad; olive salads; relishes and pickles; soups; dried fruit; fresh fruit salad; kiwi; melons; bananas; oranges.
Most entrees are prepared with salt. Ask that yours be prepared without salt or other salted seasonings. Ask that sauces and gravies be served on the side instead of over foods so that you can use them sparingly. Remove skin or crust from breaded items to reduce sodium intake.
- Choose: Broiled or grilled steaks, burgers, chops, chicken, fish or seafood (seasoned with fresh lemon); inner cut of prime rib or roast; omelets with vegetables; sandwiches with meat filling.
- Avoid: Casseroles and mixed dishes; sauces, gravies; heavily breaded or battered items; cured or salted meats; omelets with cheese, ham, sausage or bacon.
The kind of side dish you order depends on the amount of potassium you should eat each day. Fried, baked and hash-browned potatoes are higher in potassium than mashed or boiled potatoes. You might also consider asking for a lower potassium substitute like rice or noodles. If the cooked vegetable is not a good choice for you, order a salad or ask for a substitute vegetable.
- Choose: Lower potassium vegetables such as green beans, corn, cabbage, asparagus, green peas, eggplant, carrots, cauliflower, squash; plain rice, pastas, noodles.
- Avoid: Higher potassium vegetables such as spinach, potatoes, tomatoes, mushrooms, winter squash; baked beans; sauerkraut; vegetables in sauces.
Since many of you are probably being advised to add calories to your diet, the dessert course is a good time to treat yourself to something special. Remember, some desserts, such as fruit ice, gelatin and sherbet must be counted as fluids. If you have diabetes, check with your dietitians about which desserts you should choose.
- Choose: Canned or allowed fresh fruit; sherbet, sorbet; plain cookies; plain cakes; fruit pies with allowed fruits; gelatin; strawberry shortcake.
- Avoid: Desserts containing chocolate, nuts, coconut or dried fruit; cheesecake; custard, puddings; high potassium fresh fruits; pies such as cream, minced, pumpkin, rhubarb and pecan; ice cream.
Your Phosphate Binder
Eating out is a great way to take a break from cooking. It should not be used as an excuse for skipping your phosphate binders, however. To achieve good control of your phosphorus level, which is so important for maintaining healthy bones, you need to take your phosphate binder each time you eat. With a little planning, this doesn't have to be a problem.
Plan to take your medication with you. For women carrying a large purse, this may be as easy as dropping the bottle into your purse. However, more than likely, you will prefer to take along a small container with just the pills you need. A variety of pill boxes are available that slip easily into a pocket or small purse. If you are taking a liquid phosphate binder that might be difficult to carry, ask your doctor about prescribing a 'pill' form to take with you when going out to eat.
When you are away from home or are not following your usual routine, it is easier to forget to take your phosphate binder even if you bring it with you. This problem can also be overcome with a little planning. It may be helpful to make a habit of putting your pills at your place when you sit down for a meal. You may also want to ask a companion to help you remember. A pill box with an alarm is another solution. Simply set the alarm for the time you plan to eat. Place your medication in your wallet - you will see it when you pay for your meal.
Copyright by the National Kidney Foundation, Inc. All rights reserved.