Although most of my social media presence comes from cooking meals at home, my "day job" is actually working full time at a hospital. I work with patients with kidney disease who are trying to get or have already received kidney transplants. Many of these patients also have diabetes. Chronic kidney disease (CKD) has perhaps the most confusing dietary guidelines out of all chronic diseases. Many of the foods people think of as healthy have traditionally been discouraged for people with CKD. This is all in an attempt to keep blood levels of potassium and phosphorous within normal limits. In addition to these restrictions, people with late stage CKD are also told to limit their protein intake, since too much protein can further damage the kidney. This population has to become expert level nutrition label readers, and they soon learn that potassium and phosphorus are truly in everything. FLAVIS is a company that creates food for people with chronic kidney disease. Their products are low in potassium, phosphorus, sodium, and protein. In addition, their products are high in fiber, a nutrient that is often lacking in the traditional CKD diet. This recipe uses FLAVIS brown bread to make a vegetarian breakfast strata. Check it out below:
Kidney Friendly Vegetarian Strata
- 1 cup of asparagus, finely chopped
- 1 medium sweet red pepper, finely chopped (about 1 cup)
- 1 portobello mushroom cap, chopped
- 1 cup red onion, chopped
- 2 tablespoons olive oil
- 3 garlic cloves, minced
- 1/2 teaspoon thyme, dried
- 1/4 teaspoon pepper
- 1 small loaf Flavis bread (10 slices), cubed and hardened *see below
- 1/2 cup goat cheese, crumbled
- 1 cup grated parmesan cheese
- 8 eggs
- 2 cups unsweetened non-dairy milk, I used almond milk
- 1/4 teaspoon ground nutmeg
- 1/8 teaspoon black pepper
- Pre-heat oven to 350F.
- Heat olive oil in a large skillet over medium high. Add zucchini, red pepper, mushrooms and onion; sauté until tender. Add garlic, thyme, salt and pepper, then sauté 1 minute longer.
- In a bowl, whisk eggs, milk, nutmeg, and black pepper. Add half of the parmesan cheese and half of the goat cheese.
- Coat a 13x9-inch baking dish with cooking spray. Layer half the bread cubes, vegetables, and the rest of the parmesan cheese. Add another layer of bread cubes and vegetables. Then pour milk mixture over the top. Top with the rest of the goat cheese.
- Cover with foil and bake for 35 minutes Uncover and bake for 10-15 minutes more, until strata is brown at the edges and set in the center.
Cooking and Servings Tips: To harden bread, cut into cubes and let sit uncovered for at least 2 days to get stale. Alternatively, you can cube and bake at low heat around 250F for 20-30 minutes.
Nutrition information (makes 8 servings): 334 calories, 20g protein, 18g carbs, 5g fiber, 21g fat, 9g saturated fat, 667 mg sodium, 265 mg potassium, 259 mg phosphorus
As mentioned above, it is important for people with CKD to limit their potassium intake. Potassium is found in many foods, but especially fruits, vegetables, beans, whole grains, nuts and seeds. Limiting these foods makes it difficult to meet dietary fiber recommendations. Interestingly, fiber intake is also important in regulating serum potassium levels because people with CKD become more efficient at excreting potassium in their stool. So how are people supposed to get enough fiber without getting too much potassium? FLAVIS brown bread provides 3 grams of fiber per slice, while also providing negligent levels of potassium and phosphorus. The recipe also provides a half cup vegetables per serving. Lower potassium vegetables were chosen in order to meet dietary guidelines.
In addition to the previously mentioned plant sources of potassium, dairy also contains significant amounts of both potassium and phosphorus. This recipe uses almond milk, which has about half the potassium and phosphorus of dairy milk. Rice milk is actually the lowest potassium/phos option, but lacks the creaminess needed for this dish. Although this recipe does contain two different types of cheese, the lower potassium/phos options were chosen in order to add flavor without exceeding nutrient guidelines. Almond milk is also lower in protein than cow's milk, keeping the total protein of this recipe at 20 grams.