Have you been told you can’t have chocolate because you have chronic kidney disease (CKD)? Well, I have great news for you – you CAN enjoy chocolate if you have CKD! Let’s break down what chocolate is, it’s nutrition content and some things you would want to consider when deciding how to enjoy chocolate in a kidney friendly way.
What is chocolate?
Chocolate actually starts off as a plant-based food – it comes from a cocoa tree after all! But there are many steps involved in turning the cocoa beans into the sweet chocolate bars we enjoy so much. The cocoa beans are harvested, fermented, and dried out. Cacao nibs, which are the inside part of the cocoa bean, are ground up to make a paste, called cocoa mass, which is then melted to create chocolate liquor – the base of all chocolate bars. When put under high pressure, the chocolate liquor can separate into cocoa butter and cocoa powder.
Types of chocolate
Chocolate comes in many varieties which vary based on amounts of ingredients used. The main ingredients in chocolate bars are chocolate liquor, sugar and some varieties may contain milk and cocoa butter. Let’s look at the different types of chocolates and what they are made of.
Dark chocolate is made of chocolate liquor and sugar. The Food and Drug Administration (FDA) actually has guidelines on chocolate! In order for a product to be called “dark chocolate” it must contain at least 15% chocolate liquor, but most dark chocolates contain 50% or more. Dairy is not typically added to quality dark chocolate making it a vegan friendly choice.
Milk chocolate contains chocolate liquor, sugar and you guessed it- milk! Per FDA regulations, chocolate milk should contain at least 10% chocolate liquor and 12% dairy. Milk chocolate contains more sugar compared to dark chocolate which is why it has a sweeter flavor.
White chocolate is in-fact considered actual chocolate as it has ingredients which come from the cocoa bean. It is made of cocoa butter, sugar, milk and vanilla. It lacks the chocolate liqueur which gives chocolate its brown color. According to the FDA, white chocolate should contain at least 20% cocoa butter, 14% milk and no more than 55% sugar.
Nutrition Content of Chocolate
Nutrition content will vary slightly brand to brand – but here is the general nutrition breakdown of each type of chocolate:
Let’s get into nutrients on concern with chocolate and CKD and why chocolate may have ended up on the “no” list!
Potassium in Chocolate
Potassium is one reason chocolate was put on the “no” list for CKD. Remember how chocolate actually comes from a plant? Well, plant foods are typically a source of potassium, some plant food being higher than others in this mineral. A food is deemed “high” in potassium if it has 250 mg potassium or more.
Dark chocolate, which has the most chocolate liquor, is highest in potassium at 159 mg per ounce. However, your average chocolate bar is not just one ounce, they are typically 1.55 oz or larger. If you eat two ounces of dark chocolate you’ll be taking in 318 mg which means you’ve turned a medium potassium food to a high potassium food.
Not everyone with chronic kidney disease needs to limit potassium. In fact, limiting potassium when you don’t have to is not going to help your kidneys one bit! If you are on a low potassium diet and want to indulge in dark chocolate, just be mindful of the portion size and you’ll be golden!
Phosphorus in Chocolate
Like the vast majority of foods, chocolate does contain some phosphorus. Phosphorus is found naturally in the cocoa bean itself as well as any milk that has been added. But remember, we do need phosphorus in our diet. The recommended daily intake of phosphorus for adults in 700 mg which is very easy to achieve.
When it comes to phosphorus control for CKD, the source of phosphorus is the most important factor to consider. We do not absorb all of the phosphorus from natural food sources. Phosphorus additives, however, are 90-100% absorbed. Phosphorus additives aren’t typically used in chocolate bars, but it’s always a good idea to double check the label to be sure!
Is it possible to get too much phosphorus from chocolate? Yes… but it all comes back to portion size. If you are eating multiple servings of chocolate bars, you’ll be getting multiple servings of phosphorus which may be an issue if you deal with high phosphorus levels.
Oxalates in Chocolate
Chocolate contains a compound called oxalate which is found in many plant foods. Some people with kidney issues may need to watch their intake of oxalates, but not everyone. If you have polycystic kidney disease (PKD) or deal with high urine oxalate levels you will definitely want to monitor for intake of oxalates.
The oxalate in chocolate comes from the chocolate liquor derived from the cocoa bean – so luckily milk and white chocolate, which has less of the actual chocolate liquor, are low in oxalate. If you have PKD or high urine oxalate levels and really miss dark chocolate – there may be ways to safely sneak some in – a kidney dietitian can show you how!
Sugar in Chocolate
Chocolate bars do have varying amounts of sugar. Let’s be real – sugar isn’t a health food… but it doesn’t mean you can’t enjoy foods with sugar in moderation if you choose. The darker the chocolate, the lower the sugar (but also the more bitter the flavor).
When it comes to how much sugar one should consume with CKD, it varies. As a general rule, you should limit your intake of added sugar to less than 10% of your total calories. That means if you consume a 2,000 calorie diet, less than 200 of those calories should be coming from added sugar.
Health Benefits of Chocolate
Chocolate contains powerful antioxidants and other plant chemicals that can actually benefit those with CKD. These chemicals come from the cocoa bean itself so dark chocolate (and cocoa powder) will have the most be health benefits.
Having CKD itself can lead to inflammation in the body. Chemicals in chocolate can help to reduce inflammation and oxidative stress. Researchers found that giving patients on dialysis 40 g of 70% dark chocolate three times a week resulted in a reduction in the inflammatory marker TNF-α without having any impact on potassium or phosphorus levels.
Those with CKD have an increased risk of developing cardiovascular disease. The chemicals in chocolate have been shown to improve the function of our blood vessels which can help improve blood pressure control. Cocoa is also a prebiotic and feeds the good bacteria in our gut! A healthy gut is especially important for those with CKD.
Besides having amazing antioxidant power, dark chocolate also is a good source of other vitamins and minerals, particularly copper, magnesium and iron! No wonder cocoa is considered a super food!
Chocolate may be a source of potassium, phosphorus but if you are aware of your nutrient needs and portion size – you can enjoy without worry. Those who are watching oxalates should be aware that dark chocolate is considered high in oxalate – but a kidney dietitian can show you how to get your dark chocolate fix in. Milk and white chocolate, however, can be easily included into a low oxalate diet!
Remember how chocolate originates from a tree? Plant foods have special chemicals that have amazing health benefits! Chocolate is no exception! Dark chocolate will have the most benefit as it contains more antioxidants and special plant chemicals.
We need to stop spreading rumors that chocolate is automatically bad for kidney disease. Chocolate may play a role in improving your health! Want to learn how you can continue to enjoy your favorite foods with CKD without worry and guilt? Reach out to me and I’ll show you how!