How to choose which juices to sip and which to skip!

People with chronic kidney disease (CKD) are often encouraged to hydrate, hydrate and hydrate! But, for many, drinking plain old water day in and day out can get monotonous. Some people simply don’t enjoy the taste of water which could be making it hard to meet their fluid goals. You may be wondering if bottled juice can fit into your kidney friendly diet. Good news, it can! Read on to learn how to choose a juice that fits best with your diet needs.

Fluid intake for CKD

Before we get into the “juice” of this post – let’s quickly discuss fluid considerations for CKD. Maintaining good hydration is important to keep your kidneys healthy. But how much fluid is the right amount? Just like diet, there is no one-size-fits all recommendation for fluid. Fluid needs can vary based on your stage of CKD, cause of CKD and other health conditions. 

If you have stage 5 of end-stage kidney disease, you may have been told to limit fluids. This could be due to the fact you are retaining fluid as your kidneys are unable to make urine like they are supposed to. A typical fluid restriction is one liter plus urine output. So if you measure your urine, and you urinate about 500 mL, you would be allowed 1.5 liters of fluids a day.

On the other hand, some people with CKD may need to drink extra fluid. If you have a history of kidney stones or polycystic kidney disease, you may have been told to up your fluid intake to three liters or more. Keep in mind that drinking in excess is not helpful for everyone.

If your doctor hasn’t advised you on any special precautions for fluid intake, a good starting point is drinking half your bodyweight (in pounds) in ounces. Keeping an eye on your urine color throughout the day can clue you in to your hydration status. If your urine is often dark yellow and concentrated, that could be a sign you aren’t drinking enough. Clear, light yellow urine throughout the day often means your body is well hydrated.

Tips for Choosing a Juice

Sugar Content

Juices can be a source of added sugar in the diet. Not everyone has blood sugar issues with CKD, but excess added sugars are not ideal for overall health. Added sugars can increase your risk of developing type 2 diabetes, obesity and heart disease. Watch out for juices that contain a sweetener called high fructose corn syrup which have been linked to gout flares, increased kidney stone risk and non-alcoholic fatty liver disease when consumed in excess.

There aren’t specific guidelines for added sugar in people with CKD, but the American Heart Association recommends limiting added sugars to no more than 36 grams for males and no more than 25 grams for females. Just one cup of juice could eat up your added sugar allowance. To avoid added sugars in your juice, opt for one that says “100% juice” on the label. Labels can be tricky – so make sure to read carefully! The Minute Maid drink listed below says “100% natural flavors” on the label and it does contain added sugar!

Keep in mind that 100% fruit juice, although free of added sugar, is still a good source of natural sugar and carbohydrates. If you have diabetes – it’s a good idea to keep some 100% juice around if you want to treat a hypoglycemia episode – but drinking juice throughout the day can cause high blood sugar levels.

If you are looking for a lower carbohydrate juice there are lots of “diet” and “light” options on the market. Diet juices will generally have minimal calories and carbohydrates. Diet juices use artificial sweeteners such as aspartame, sucralose or “natural” sweeteners like stevia. Artificial and “natural” non-nutritive sweeteners are generally regarded as safe for CKD when used in moderation. Light/less sugar juices will be less carbs and calories compared to regular options, but not quite as low as diet. Light juices may be watered down to reduce the carbs and sugar per serving.

Potassium Content

Not everyone with CKD needs to limit potassium, but for those who do, be aware of the potassium in your juice. If you drink multiple servings the potassium can add up quickly! When limiting potassium, aim for juices with less than 200 mg potassium per serving. 

Potassium content in various juices:

• Tomato juice: 530 mg per 1 cup
• Pomegranate juice: 530 mg per 1 cup
• 100% orange juice: 450 mg potassium per 1 cup
• 100% pineapple juice: 330 mg potassium per 1 cup
• 100% apple juice: 240 mg potassium per 1 cup
• 100% grape juice: 140 mg per 1 cup
• Cranberry juice cocktail: 45 mg potassium per 1 cup
• Fruit punch: 40 mg potassium per 1 cup
• Lemonade: 25 mg potassium per 1 cup

Another thing to think about when it comes to potassium is potassium additives. Potassium additives can be located in the ingredient list of the juice and are any ingredient containing the word “potassium”. Examples include: acesulfame potassium, potassium benzoate and potassium sorbate. Research has shown that potassium additives are readily absorbed into the body and can have more of an impact on blood levels compared to potassium found in fruits and vegetables. If you have a history of high potassium or drink juice frequently – it may be wise to avoid juice with these man-made forms of potassium. 

Phosphorus Additives

Dark sodas are not the only beverage where phosphorus is lurking, phosphorus additives can sneak their way into juice, too! Phosphorus additives are problematic as our body absorbs 100% and they can double to triple the amount of natural phosphorus in a product. Excess phosphorus in our blood combines with calcium to form crystals which deposit throughout your blood vessels and soft tissues, causing slow but serious damage over time. 

Phosphorus is not a required nutrient on the food label, so just because you don’t see phosphorus listed on the nutrition facts doesn’t mean it’s not there. Check the ingredient list and scan for any ingredient containing “phos”. (Hint: the “phos” can sometimes be hidden in the words!) Checking the ingredients can seem overwhelming at first, but with practice it gets easier.

Bottled Juices with Potential Benefits for CKD

Now that we talked about some basics for choosing a juice – what about juices that claim to have benefits for our health? Are there any juices out there that can potentially improve kidney function?

Cranberry Juice and CKD

There are no studies that show cranberry juice can help with improving kidney function. However, for those who deal with frequent urinary tract infections (UTIs), cranberry juice may help prevent them. It is thought that cranberries contain compounds that prevent certain infection causing bacteria from sticking in the bladder and urethra. 

A study conducted on women showed that drinking one cup of cranberry juice (not cranberry cocktail) did reduce the frequency of UTIs in those who were prone. So if you do struggle with recurrent UTIs, adding cranberry juice may be beneficial, otherwise it may not be worth the extra sugar.

Tart Cherry Juice and CKD

Many people with CKD also suffer from a condition called gout. Gout is caused by a buildup of uric acid, if the kidneys are unable to eliminate uric acid effectively, it can build up and form crystals in the body. These crystals can settle in joints which leads to pain and inflammation that can last up to two weeks.

If you’ve ever had a gout flare you may have read that cherry juice can be helpful at reducing flares. There are several studies that have found ingestion of tart cherry juice concentrate (or powder) is associated with reduced uric acid levels when compared to those who did not supplement with the cherry products. If you have high uric acid, tart cherry juice concentrate may have some benefit – but it is quite tart in taste and exact dosing to get benefits is unclear. 

Summary

If you aren’t a juice drinking, adding it into your diet is likely not going to provide any benefit to your kidney function. However, juice can be part of a well balanced kidney friendly diet and does count towards your fluid intake. When selecting a juice, aim for one that is 100% juice instead of ones that contain added sugars. If you struggle with high potassium, choose a low potassium juice and remember to look out for potassium additives. Light and diet juices are useful for those who want to enjoy juice but with less calories and carbohydrates. Be sure to double check the ingredients and avoid “phos” additives when selecting your juice. By following these tips, I hope you’ll be able to enjoy your juice without worry!