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Milk
Substitut
es
Meat or
Equivale
nt
Fruit or
Fruit
Juices
Bread or
Starches
Vegetabl
es
Milk Substitutes
1 serving/day = 0.5g
protein
For the following
foods, 1 serving =
cup or 0.5g protein
cup liquid milk
substitute (Rice, Almond
Milk, Unsweetened)
Meat or Equivalent
3 ounces/day = 7g
protein
Weigh after cooking,
without bone
For the following
foods, 1 serving = 1
ounce*
Beef, lamb, veal, or pork
(lean)
Chicken, Turkey, or duck
(no skin)
cup cottage cheese
1 large egg or c egg
substitute
Fish or Seafood (no
*unless specified
otherwise
Fats (oils,
margarin
e, mayo)
No
Restrictio
n
Breads or Starches
Vegetables
2 servings/day = 2g protein
Fresh, frozen or canned
without salt are allowed
For the following foods, 1
serving = cup or 1g
protein*
Alfalfa sprouts (1 cup raw)
Bamboo shoots (1 cup canned)
Bean sprouts (1 cup cooked)
Beets
Cabbage
Corn
Cauliflower (1/2 cup cooked, 1
cup raw)
Corn
Cucumber
Eggplant (1 cup cooked)
Green beans (1/2 cup cooked)
Mushrooms (1/4 cup cooked,
cup raw)
Lettuce (1 cup)
Onions
*unless specified
otherwise
Yes
No
Dont Know
Fluid Restriction: __________ CC/day
Note: Fluids are any drink or food that is liquid at room temperature. The
sodium, potassium, and/or phosphorus content of beverages can vary
greatly. Read labels carefully. Please allow 40mg of potassium for every 8
Ice cream,
frozen
yogurt
Soup/broth
ouncesCoffee
serving of (brewed) tea and
150mg
of potassium
for
every 8Fruit Drinks
Fruit or Vegetable juice
Fruit smoothies with added
ice or liquids
Milk substitutes
Non dairy creamers
Sugar-free popsicles, Juice
bars
Diet soft drinks
Tea
Water
Sugar-free gelatin snack