High-Protein Cereals

HOW MANY TIMES in your career have you said to your patients, “You need to eat more protein because your albumin level is low”? And how many times have your patients replied, “I can’t eat another bite of meat”? As renal dietitians, we strive to help our patients maintain or improve serum albumin levels. Hypoalbuminemia is highly predictive of future mortality risk when present at the time of initiation of chronic dialysis, as well as during the course of maintenance dialysis.1

Many barriers limit the amount of protein that chronic kidney-disease patients may consume. Time spent commuting to dialysis, and then several hours dialyzing, may cause patients to miss a meal on dialysis days, thus decreasing protein intake. Anecdotal evidence in one dialysis unit showed that hemodialysis patients, either referred for checkup or after surgery, overall received only 80% of their scheduled meals, resulting in a weekly deficit of about 2800 kcal per patient. The reasons for those missed meals were, for example, fasting states before diagnostic procedures or surgery, modified schedule of dialysis sessions, postdialysis fatigue, and inadequacy between meals and patient’s preferences.2 An aversion to or inability to prepare meats presents another barrier to adequate protein intake. Phosphorus restrictions limit the variety of high-protein foods from which to choose.

High-protein cereals, which for present purposes are defined as containing >6 g protein per serving, may be beneficial in the chronic kidney-disease patient population. Cereal is easy to prepare, economic, and quick. Dry cereal is a portable and convenient snack item. One starch exchange, such as ¾ cup ready-to-eat, unsweetened cereal, provides 3 g of protein.3 The high-protein cereals listed in Table 1 contain 2 to 4 times more protein than regular breakfast cereals. Potassium and phosphorus content must be considered when choosing any breakfast cereal. Go Lean Dry Cereal by Kashi has the highest protein content, but also the highest potassium and phosphorus content. Weight Watchers Cinnamon Cluster Crunch has the lowest phosphorus burden per gram of protein. Because of the significant potassium and phosphorus content of high-protein cereals, it would be wise to consider using a milk alternative such as nondairy creamer or rice milk. Individual patient needs must be considered before recommending high-protein cereals.

Table 1. Protein Content of Selected Cereals

	Cereal	Manufacturer, City, State	Serving Size	Protein (g)	Calories	K+ (mg)	P (mg)	Ca+ (mg)	P Burden/g Protein
	Go Lean Crunch	Kashi Sales LLC, LaJolla, CA	1cup	9	200	270	N/A	0	N/A
	Go Lean Dry	Kashi Sales LLC, LaJolla, CA	1cup	13	140	480	200	48	15
	Go Lean Hearty	Kashi Sales LLC, LaJolla, CA	1packet	8	150	210	N/A	0	19
	Special K Protein Plus	Kelloggs, Battlecreek, MI	¾cup	10	100	320	150	32	15
	Weight Control Instant Oatmeal Maple/Brown Sugar	Quaker, Chicago, IL	1packet	7	160	150	150	80	21
	Weight Watchers Cinnamon Cluster Crunch	Organic Milling Corp, San Dimas, CA	¾cup	8	150	N/A	100	16	12.5
	Weight Watchers Flakes ’N Fiber with Oats	Organic Milling Corp, San Dimas, CA	½cup	9	90	150	N/A	16	N/A

P, phosphorus; N/A, not applicable.