Breads can be a source of confusion for dialysis patients or CKD non-dialysis patients who require phosphorus restriction. Refined white bread (made from wheat flour) is generally lower in phosphorus and potassium, compared to whole wheat bread. The more bran and whole grains in bread, the greater the potassium and phosphorus content (and higher fiber content). A soft wheat bread that does not contain whole grain is acceptable for most kidney diets limited in potassium and phosphorus. Often soft wheat breads contain molasses to give the brown color. In deciding which one, consider how many slices you would consume (a whole sandwich vs. one slice) and if potassium and phosphorus levels are normal or high on monthly blood work.
Consider Whole Wheat Benefits
Whole wheat bread can be part of a kidney friendly diet. We have learned that not all naturally occurring phosphorus is absorbed by our bodies (generally 30-60% absorbed)1. This means the benefits of whole wheat bread can be enjoyed by someone with kidney disease. The benefits of nutrients (vitamins and minerals) and fiber in whole wheat, that are not the same in refined white bread, is a plus.
A fact often overlooked is all breads, regardless or being refined or whole grain, provide a significant amount of sodium, around 130 mg or more per slice. It adds up for those who eat 3 or more slices of bread a day. Compare labels and look for low sodium breads as an alternative. Checkout size of the bread slices too–thicker slices are generally provide more minerals than thin slices.
Check with the renal dietitian for guidance on including whole grain bread if you choose it over refined bread. Guidelines for how often and how much to include each day are helpful.
Here’s a comparison of wheat breads:
1 slice white bread: 36 mg potassium, 28 mg phosphorus sodium, 142 mg, fiber 0.8 grams
1 slice soft wheat bread: 40 mg potassium, 37 mg phosphorus, sodium 137 mg, fiber 1.2 grams
1 slice whole grain bread: 71 mg potassium, 59 mg phosphorus, sodium 127 mg, fiber 1.7 grams
Reference:
- Joshi S, McMacken M, Kalantar-Zadeh K. Plant-Based Diets for Kidney Disease: A Guide for Clinicians. American Journal of Kidney Disease, 2020; 77, 287-296.
