CHAPTER PART 5 OF 9
The second half of the Indian plate: where the protein comes from, the salt substitute trap, the additive phosphate on Indian labels, and how to leach properly.
The second half of the Indian plate: where the protein comes from, the salt substitute trap, the additive phosphate on Indian labels, and how to leach properly.
| Food | Protein g | K mg | P mg | P : protein | Verdict |
|---|---|---|---|---|---|
| Egg white, 1 raw (33 g) | 3.6 | 50 | 5 | 1.4 | Best available. Low in both. |
| Chicken breast, 75 g raw | 16.4 | 221 | 134 | 8.2 | Best meat on both metrics. |
| Mutton, goat shoulder, 75 g | 15.3 | 249 | 142 | 9.3 | Acceptable. Avoid liver at 16.5. |
| Rohu, 75 g | 14.8 | 227 | 150 | 10.1 | Fine. |
| Egg, whole boiled | 6.7 | 64 | 104 | 15.6 | The yolk is what spoils it. |
| Paneer, 50 g | 9.4 | 32 | 165 | 17.5 | Superb for potassium, poor for phosphate. |
| Milk, 200 ml cow | 6.5 | 230 | 193 | 29.6 | Restrict the milk, not the tea. |
| Curd, 1 katori (200 g) | 7.4 | 218 | 174 | 23.6 | As above. |
| Khoa, per 100 g | 16.3 | 536 | 476 | 29.1 | Avoid. Festival sweets are this. |
| Processed cheese slice, 20 g | 3.6 | n/a | 128 | 35.4 | Worst item in the shop. Additive phosphate, near fully absorbed. |
Two rows are not IFCT. There is no IFCT entry for curd, so the curd row is derived from Indian buffalo milk on the reasoning that fermentation removes no minerals; USDA yogurt would give a higher 310 mg potassium, which overstates Indian dahi. The processed cheese row is USDA, with potassium not reported.
50 g of paneer gives 9.4 g of protein with only 32 mg of potassium but 165 mg of phosphorus with no phytate. 75 g of chicken breast gives 16.4 g of protein with 221 mg of potassium and 134 mg of phosphorus. If the problem is hyperkalaemia, paneer wins. If the problem is hyperphosphataemia, chicken breast or egg white wins. There is no single "renal protein". Pick for the abnormality in front of you.
Any salt sold as lite, low sodium, heart salt or sodium-reduced has had sodium chloride replaced with potassium chloride.
"For your kidneys, low-sodium salt is swapping one poison for another. Use ordinary salt, and use less of it."
FSSAI does not require phosphorus in the nutrition panel. It appears only in the ingredient list, as an INS number. Teach five numbers, not a chemistry list.
Phosphoric acid, sodium, potassium and calcium phosphates, di-, tri- and polyphosphates. Note 340 is a potassium phosphate: double hazard.
The standard Indian euphemism on cheese and processed meat labels.
Any number following raising agent, stabiliser, emulsifying salt, acidity regulator or thickener needs checking.
Categories to screen in India: colas and dark fizzy drinks (INS 338), processed cheese and cheese spread (INS 452), instant noodles (339, 450, 452 plus about 1,000 mg sodium per 100 g), biscuits, bread, pav, rusk and khari (341, 450), packaged and frozen meat, chicken and prawns (451, sodium tripolyphosphate, added to hold water), non-dairy creamers and 3-in-1 coffee and tea premixes (340, 452), and instant idli, dosa, upma, soup and gravy mixes (phosphated starches 1412 to 1442).
Keep two packets in the counselling room. Britannia 50-50 lists raising agents including INS 341, a calcium phosphate. Britannia NutriChoice Digestive lists only carbonates, INS 500 and 503. Same brand, same shelf, one has phosphate and one does not. This single demonstration teaches three things at once: that reading works, that substitution is possible, and that the patient's serum phosphate responds to the packet and not to the roti.
Only for patients who are actually hyperkalaemic. The method differs by food, and the step patients skip is the one that does all the work.
| Food | Best method | K removed |
|---|---|---|
| Potato, yam | Peel, cube to 1 to 2 cm, then pressure cook 2 to 3 min in 1:5 water and discard the water. A prior 4 to 8 h soak, discarded, is a reasonable extra step but was not tested in combination. | 75% |
| Potato, yam | Double cook: boil, discard, boil again in fresh water, discard | 66–67% |
| Amaranth, thotakura | Chop, soak 8 h in 1:5 warm water, discard, cook briefly | 87% |
| Spinach, palak | Soak as above | 64% |
| Toor dal | Soak 4 h or overnight 1:5, discard the soaking water, cook in fresh water | 84% |
| Urad dal | As above | 76% |
| Moong dal | As above | 64% |
| Banana | Nothing works | 11% |
One. For tubers, soaking alone does almost nothing. The heat step is what removes potassium, and cutting small is the dominant variable. For leafy greens it is the reverse: soaking beats boiling, and microwaving is the worst method of all because no water is discarded.
Two. Indian households cook dal in its soaking water and eat the liquid. Pappu, sambar, dalcha and haleem are dishes where the cooking liquid is the food. If the patient soaks the dal and then cooks it in the same water, the potassium benefit is exactly zero. Say the words "throw the water away" out loud, and confirm the patient repeats them back.
What else goes into the water: thiamine, riboflavin, niacin, folate and vitamin C. This is an accepted trade, since hyperkalaemia kills and subclinical thiamine deficiency does not, but a patient leaching heavily long-term should be on a water-soluble vitamin supplement. Tell them about the vitamin loss yourself, so they do not find it on the internet and abandon leaching altogether.