How to eat and what to eat is good for kidney is the top concern of almost all kidney disease patients, and I am asked such questions every day in my expert clinics as well as in questions from readers of the public. To be realistic, eating properly and scientifically plays an important role in the efficacy of kidney disease treatment to some extent. How should I replenish energy when on a low protein diet? Many patients with chronic kidney disease need to restrict protein intake (low protein diet), but the physiological functions of the human body cannot be separated from protein, how to accurately grasp protein intake and ensure that the intake of protein into the body is fully utilized is the core of the dietary treatment of patients with chronic kidney disease. Energy and protein are closely related in the metabolic process in the body. If energy is sufficient, even if protein intake is low, the body can maintain sufficient vitality and a healthy body. What do doctors mean by adequate caloric supply? In patients with CKD1~3, energy intake is based on achieving and maintaining ideal body weight. When weight loss or other signs of malnutrition occur, energy supply should also be increased. For patients with CKD stage 4~5, energy intake needs to be maintained at 146 kJ (35kcal)/(kg-d) (age ≤ 60 years) or 126 kJ~146 kJ (30~35kcal)/(kg-d) (age > 60 years) while restricting protein intake. For example, for a patient with chronic kidney disease who has a strictly restricted protein intake [0.6 g/(kg-d)], energy intake needs to be maintained at 35 kcal/(kg-d), which means that a patient with a standard weight of 60 kg and an energy requirement of approximately 2100 kcal/day can consume 36 g of protein. In order to achieve sufficient total energy, excluding the energy value provided by protein foods, the shortage is supplemented by vegetable oils and starchy foods, so the patient can consume 125 grams of cereals and potatoes (i.e. staple foods, etc.), 250 grams of starch and 40 grams of fats and oils per day. Food choices to improve energy sources in a low-protein diet The main sources of energy in a quality low-protein diet are starch and sugar. In addition to limiting animal protein, the intake of vegetable protein in common rice (6.8% protein) and flour (9.9% protein) should not be neglected in a low-protein diet for patients with chronic kidney disease, so wheat starch (or corn starch, potato starch, etc., containing about 0.3%-0.6% protein) can be used as a staple food instead of common flour and rice. Choose more foods with low protein and high calorie content such as potato, white potato, lotus root, water chestnut, clarified flour, yam, taro, pumpkin, vermicelli, vermicelli, rhizome flour, sago, etc. instead of ordinary staple foods or as additional meals between meals. Rice and noodle foods with low phosphorus, low potassium and low protein can also be used. Patients with normal blood sugar can add a moderate amount of white sugar, rock sugar or honey during the cooking process of food to increase energy. For example, add a little sugar or honey to milk before drinking. It should be noted, however, that most commercially available snacks are high in protein, so they are generally not recommended. Oils and fats are also one of the best sources of energy supplementation for efficiency. Elderly people and patients with chronic kidney disease (CKD) with complications such as hypertension, dyslipidemia, diabetes and atherosclerosis should try to choose vegetable oil as the main cooking oil and limit the amount of oil used to less than 30 ml per day. Patients with CKD who are lean or malnourished can consume small amounts of lard, butter or fatty meats with high fat content to increase some of their energy intake. For example, fish, meat and eggs can be fried or pan-fried, a few drops of sesame oil can be added to boiled food or vegetarian soup, and sesame seeds can be sprinkled on stir-fried vegetables or cold dishes. For the elderly or patients with a reduced appetite, pour lemon, mandarin orange, grapefruit and other citrus juices over fried foods to make the diet lighter.