From My Kidney Garden to My Kidney Kitchen: FALLING IN LOVE WITH ARUGULA

by Robin Rose MD -September 10, 2025

Arugula is a Perfect Kidney-Friendly Superfood

I didn’t really love arugula until I learned about nitric oxide and CKD. Now it’s a sweetheart. We grow it in our garden - it’s very easy to grow in the ground and in pots - and there’s an array of varieties to choose from.

For those with chronic kidney disease (CKD), seeking kidney success celebrates nutrition - which does not only have to be a series of restrictions [watch your potassium, cut phosphorus, limit protein]. It can be a joyful process of discovery.

Some foods don’t simply “fit” a kidney diet — they offer us active support for kidney and heart health.

And one of the best examples is arugula (also known as rocket): a peppery green that is both safe for CKD and incredibly powerful for blood vessel and kidney protection.

Why is Arugula Special for CKD?

Arugula (Eruca sativa) is a rare vegetable that is both low in potassium, phosphorus, and oxalate - while being one of the richest dietary sources of nitrate, making it uniquely suitable for CKD patients.

• Low in potassium → Unlike spinach or beet greens, arugula won’t push potassium and oxalates too high.

  
  

• Low in phosphorus

  
  

• Exceptionally high in natural nitrates → Arugula is one of the richest vegetable sources of nitrates, which fuel the nitric oxide (NO) pathway.

How Arugula Boosts Nitric Oxide

The Nitric Oxide Pathway

• Nitrate (NO₃⁻) from arugula is absorbed when eaten, chewed, swallowed - then concentrated in saliva, and reduced to nitrite (NO₂⁻) by the friendly oral commensal bacteria on the tongue.

  
  

• Nitrite is further reduced to nitric oxide (NO) in acidic gastric environments and in hypoxic tissues.

  
  

• CKD is characterized by reduced NO bioavailability due to uremic toxins, oxidative stress, and impaired endothelial function (Baylis 2008).

This powerful little molecule, nitric oxide, is one of the body’s most important “signals” for blood vessel health.

Nitric Oxide Matters in CKD

The Many Benefits of NO in CKD

• Renal microcirculation: NO enhances cortical blood flow, stabilizes GFR, and counteracts ischemic injury. Improved blood flow to the nephrons protects filtration.

• Anti-fibrotic/anti-inflammatory: Downregulates NF-κB signaling and improves redox balance. Reduced oxidative stress and chronic inflammation prevents or slows down the dread accelerated kidney scarring that heralds failure.

• Cardiovascular protection: Improved endothelial function, arterial compliance, and blood pressure reduction. (Carlström 2018). Since NO helps blood vessels relax and open wider, it lowers blood pressure naturally.

We know that statistically the majority of CKD patients die from heart disease, and don’t ever progress to kidney failure — NO directly improves arterial elasticity and reduces this vascular risk.

In CKD, nitric oxide levels are often low due to uremia, oxidative stress, and endothelial dysfunction. This makes nitrate-rich foods like arugula very enticing and valuable.

Why Not Spinach or Beets?

Spinach and beet greens contain high (beneficial) nitrate levels, but their potassium (>500 mg/100 g) and oxalate load (see below) make them unsafe in advancing CKD - and unreasonable for frequentl inclusion in kidney success diets.

Arugula delivers ~250–500 mg nitrate/100 g, but with very low potassium (~150 mg/100 g) and negligible phosphorus.

Since arugula gives us the nitrate benefit without the potassium and oxalate risk, it is a uniquely beneficial choice for CKD.

Oxalate in Arugula (is low)

• Arugula (Eruca sativa) is considered a low-oxalate leafy green. The USDA and university extension data place raw arugula at ~7–15 mg oxalate per 100 g (varies with growing conditions).

  
  

• Compare:

  • Spinach: 600–750 mg/100 g (very high).

  • Beet greens: 500+ mg/100 g (very high).

  • Kale: ~20 mg/100 g (low).

  • Romaine lettuce: ~2–5 mg/100 g (very low).

In CKD, impaired tubular clearance + gut dysbiosis can worsen oxalate accumulation. Frequent antibiotics and subsequent yeast/candida infections predispose to oxalate accumulation and harm.

Arugula’s low oxalate makes it a safe choice compared to spinach or beet greens, which are off the table for stone-formers or CKD patients with high oxalate risk.

Nutrient Info for Arugula

Including and Using Arugula

• Fresh in salads- chopped fine and mixed with lettuce and cabbage and celery and radish and cucumber etc (combined with lemon, balsamic, olive oil, garlic, dill, parsley, cilantro).

  
  

• Added to sandwiches or wraps.

  
  

• Lightly wilted as a side dish, included in stir fries, added to soups, casseroles, chopped and dropped on cooked tofu dishes - slip it into favorite recipes

  
  

• Added to smoothies for a peppery boost.

Side Effects and Allergy Concerns

Yes — arugula (Eruca sativa) is generally safe and often recommended as a kidney-friendly green, but there are a few side effects & allergy considerations worth knowing about - especially for CKD patients.

1. Allergic Reactions

• Cross-reactivity: Arugula belongs to the Brassicaceae (mustard) family, along with mustard greens, kale, cabbage, broccoli, and radish.

  
  

  People with mustard seed allergy can sometimes react to arugula (oral itching, swelling, or even more serious reactions).

  
  

• Pollen cross-reactivity: Rarely, people with grass or ragweed pollen allergy can get oral allergy syndrome (tingling/itching in the mouth after eating raw arugula).

  
  

• Skin contact: Handling arugula may cause contact dermatitis in very sensitive individuals.

2. Gastrointestinal Effects

• Peppery compounds (glucosinolates and isothiocyanates) can cause mild digestive upset in some people (bloating, gas, stomach irritation).

  
  

• Eating very large amounts raw may trigger diarrhea or nausea in sensitive individuals.

3. Interactions & Special Considerations

• Vitamin K content: Arugula is fairly high in vitamin K. Patients on warfarin or other vitamin K–sensitive anticoagulants should keep intake consistent.

  
  

• Goitrogenic potential: Like other cruciferous vegetables, raw arugula contains goitrogens, (which in extremely high amounts can interfere with thyroid hormone production). Usually not an issue in normal servings, especially if varied diet or if arugula is lightly cooked.

  
  

• Nitrate conversion: The nitrates in arugula are beneficial (blood pressure, vascular health).

  
  

  However, patients with active oral infections or using strong antiseptic mouthwashes may have impaired conversion of nitrate → nitrite (reducing benefit rather than causing harm).

4. CKD-Specific Points

• Potassium & phosphorus: Arugula is naturally low in both, so it’s generally safe — but concentrated juices, powders, or extracts may have higher levels.

  
  

• Oxalate awareness is wise for everyone with declined kidney function- their injury to kidney tubules cannot be ignored even in those without kidney stones.

  
  
  
  

Bottom Line & Clinical Integration

I often recommend arugula as a regular leafy green for most anyone requiring low-potassium, low-phosphorus, low- oxalate diets - as well as everyone else who can benefit from vascular/NO support.

• Ideal adjunct for patients with hypertension, vascular stiffness, or proteinuric CKD.

  
  

• Monitor BP response in hypotensive patients

  
  

Arugula is a perfect food for CKD:

• Low potassium ✔

• Low oxalate ✔

• Low phosphorus ✔

• High nitrate → nitric oxide ✔

• Supports kidney microcirculation, lowers blood pressure, protects the heart ✔

Sometimes the best medicine really does grow in the garden.

References

• Baylis C. Nitric oxide deficiency in chronic kidney disease. Am J Physiol Renal Physiol. 2008;294:F1–F9.

• Carlström M, et al. Dietary nitrate, nitric oxide and cardiovascular health. Nat Rev Nephrol. 2018;14:521–535.

• Lundberg JO, et al. Nitrate and nitrite in biology, nutrition and therapeutics. Nat Chem Biol. 2009;5:865–869.

• Kapil V, et al. Inorganic nitrate supplementation lowers blood pressure in humans. Hypertension. 2015;65:320–327.