If you have kidney disease, you’ll know you have to be careful what you eat. Dairy is a major food for those who are not lactose intolerant, so it's worth asking whether you can drink milk if you have chronic kidney disease.
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There are a variety of kidney diseases, some of which are much more common than others. Chronic kidney disease or kidney failure related to diabetes or high blood pressure is the most common.
Rarer kidney issues can be caused by IgA nephropathy,¹ an autoimmune condition that attacks the looping blood vessels in the kidneys; IgA vasculitis,² where the immune system attacks small blood vessels, causing a red or purple rash and problems with the GI tract, joints, and kidneys; lupus; and polycystic kidney disease,³ a genetic disorder that causes cysts in the kidneys.
The other common form of kidney disease is kidney stones, which can be extremely painful until they pass. Some people may experience kidney stones more frequently than others.
The leading causes of kidney disease are uncontrolled diabetes and high blood pressure. These often go together, as poorly controlled diabetes can also cause your blood pressure to go up.
Rarer causes include cancer and genetic issues such as IgA nephropathy.
All these conditions can lead to end-stage kidney failure, in which your kidneys no longer function well enough to keep you alive, and you will need dialysis or a transplant.
The primary job of your kidneys is to filter waste products and expel them in your urine. Because of this, people with chronic kidney disease need to eat a diet that takes the strain off of their kidneys so they can function better.
You may also face dietary restrictions if you are on dialysis. Typically, you will be recommended to limit sodium, potassium, and phosphorus, as well as limit the amount of protein in your diet. Your nutritionist will be able to give you more specific advice.
One of the signs of kidney disease is elevated levels of creatinine in your blood and lower levels in your urine. This is because your kidneys are not doing their job of filtering creatinine out of your system. Creatinine is created by your muscles during normal activities and is a waste product.
Some foods can increase creatinine levels, such as cooked meat. Milk does not increase creatinine specifically, but protein consumption does, and milk is a high-protein food.
The biggest issue with milk and chronic kidney disease is that animal milk, especially cow's milk, is high in potassium and phosphorus. Consuming high levels of these minerals can put a strain on your kidneys. Some plant-based milks are also high in both of these.
As they are essential nutrients, it is not uncommon for dairy products and substitutes to have phosphorus added.
You may also have been advised to eat a low-protein diet, in which case it is also a good idea to limit your dairy intake. This does not mean you have to give up milk altogether, but you will have to restrict your consumption.
Understanding the overall impact of milk consumption on kidney disease is important. As already mentioned, cow's milk is high in nutrients that can put additional strain on your kidneys.
First of all, for people who do not have kidney disease, there are indications that consuming low-fat dairy can, in fact, be beneficial. This appears to be because increasing calcium has a protective effect, but more studies are necessary.
Also, a higher calcium intake is associated with a lower risk of developing kidney stones. Calcium is, of course, found in plenty of things other than milk, including leafy greens. Taking calcium supplements, however, increases your risk.
You should try to get your required calcium through food, not supplements. However, when you have kidney problems, the potassium, phosphorus, and calcium found in milk may not be properly filtered out of your body and can become excessive.
Excessive potassium, in particular, can cause a serious condition called hyperkalemia.⁴ At extremely high levels, this can lead to severe muscle weakness and even cardiac arrest.
In short, drinking plenty of milk or consuming other dairy products is good for your kidneys if you are healthy. But if you have been diagnosed with kidney disease, you should talk to your doctor or nutritionist about how much milk you should consume.
Milk is not the only potential problem if you have kidney disease. A renal-friendly diet requires that you avoid or limit certain foods, including:
Foods with added phosphorus, which includes any word beginning with phos
Processed meat, which often contains a lot of phosphorus
Bran cereals and oatmeal
Beans, lentils, and nuts, also have a lot of protein in them
Dark-colored soda, which typically has added phosphorus, as well as a lot of sugar or artificial sweeteners (Also check bottled or canned iced teas and fruit punch.)
Oranges and orange juice
Potatoes, tomatoes, and anything else in the nightshade family (If you do eat potatoes, peel them to lower the potassium content, then dice them into small pieces or grate and boil.)
Brown and wild rice
Whole-wheat bread and pasta
The most important thing is to take the strain off your kidneys by lowering your consumption of potassium and phosphates and keeping your protein consumption balanced. Too little protein can cause fatigue and muscle issues, so it is important to find a good medium.
One thing people with chronic kidney disease can do is look at alternatives to cow's milk. However, this involves some careful thought.
When selecting a milk alternative, plant-based milk alternatives are typically better, but you should consider sodium, calcium, potassium, and phosphate content. One thing to consider is that oat, rice, macadamia, and soy milk have similar nutritional profiles to cow's milk. This means that they are unlikely to be good alternatives.
However, if you are choosing a milk alternative for other reasons, these milks provide a similar protective effect against kidney stones and should be top of your list.
You should avoid flax milk due to its high levels of sodium. Almond milk is high in oxalates, although good on the other parameters. Cashews and hazelnut also have fairly high oxalate levels, which can aggravate kidney stones and cause problems for people at high risk.
Also, be aware that both soy and nut-based milks are common allergens. You should avoid these milks if you have a known allergy, but when trying milk from a source you have not consumed before, be sure to taste a small amount and watch for potential allergy symptoms.
The best milk alternative for damaged kidneys appears to be coconut milk since it has low potassium, sodium, and oxalates. Macadamia milk is also a good choice as it’s much lower in sodium than cow's milk.
One thing to be wary of is added phosphates, which can be common in dairy alternatives aimed at people avoiding milk for ethical reasons. It's important to read the label and stick to brands that do not add phosphates to milk substitutes.
Avoid non-dairy creamers, which often have a lot of added potassium and phosphates.
If in any doubt, you should talk to your nutritionist, who will take into account the rest of your diet, any allergies you may have, and what is readily available in your area.
Plant-based milk is considered highly acceptable for patients with kidney disease, although you should be careful which one you choose. Many nutritionists also recommend a plant-based diet, in general, to help you control your protein and sodium levels.
Again, check the label on any milk substitutes you purchase to ensure they have not been fortified with potassium and phosphate to bring their nutritional profile closer to cow's milk.
Things are a little different if you are on hemodialysis.⁵ You will need to be particularly careful with certain foods.
How does what I eat and drink affect my hemodialysis?
People on hemodialysis often experience issues between sessions with fluids not being properly removed from their bodies. This can create swelling, changes in blood pressure, and breathing problems.
Because of this, nutritionists recommend limiting fluid consumption, which includes liquid foods such as milk. It also includes ice cream, which is liquid at room temperature.
You may also be asked to limit the consumption of water-rich foods such as melons, grapes, oranges, tomatoes, etc.
You should also limit potassium-rich foods such as avocados, bananas, and kiwis.
If you are on hemodialysis, you should have no more than half a cup of milk a day. You should also limit tea, poultry, fish, nuts, beans, and dark-colored soda. Choose lean, low-fat meats that are low in phosphorus.
All this will help you feel better and have a higher quality of life between your dialysis sessions.
Another issue with hemodialysis is that it can affect your appetite, resulting in weight loss. Add vegetable oils, soft margarine, honey, jams, and jellies to your diet — unless you are diabetic.
Take a supplement specifically designed for people with kidney failure, but ensure it’s safe by checking with your physician first.
You should talk to your nutritionist about how much and what kind of dairy you can consume. A nutritionist will advise most people with kidney disease to limit the amount of cow's milk they consume. You can manage this by switching to plant-based substitutes and by drinking your coffee black. Be careful with cheese too.
You can also drink things other than milk, including unsweetened green tea. Sparkling water is a good substitute for soda. Make sure to check for hidden dairy in other foods too. If you like chocolate, get dark, bitter chocolate, and check the ingredients, as even dark chocolate sometimes contains milk. Chewing gum also often contains milk products.
For healthy people, drinking low-fat cow's milk can have a protective effect on your kidneys. It can reduce your risk of chronic kidney disease and getting painful stones.
However, for those diagnosed with kidney disease, the high calcium, phosphorus, and potassium levels in cow's milk can cause issues. You should limit cow's milk consumption and consider switching to plant-based substitutes. Make sure your chosen dairy substitute is also low in phosphorus and potassium, and talk to your nutritionist about your best options.
IgA nephropathy | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
IgA vasculitis | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Polycystic kidney disease (PKD) | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Hyperkalemia (high potassium) | National Kidney Foundation
Eating & nutrition for hemodialysis | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Eating right for chronic kidney disease | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Alternative milk beverages (2009)