The Hunk Alert

Recommended diet for chronic kidney diseases

When has chronic renal diseases, need to make changes in the diet, including:

• Limiting fluids
• Eating a low-protein diet (this may be recommended)
• Restricting salt, potassium, phosphorous, and other electrolytes
• Getting enough calories if you are losing weight

Function

The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients who are on dialysis. The special diet is important because dialysis alone does not effectively remove ALL waste products. These waste products can also build up between dialysis treatments.

Most dialysis patients urinate very little or not at all. Therefore, fluid restriction between treatments is very important. Without urination, fluid will build up in the body and lead to excess fluid in the heart, lungs, and ankles.

Recommendations

Ask for a referral to a registered dietitian for diet information about kidney disease. Some dietitians specialize in kidney diets. Your dietitians can help you create a diet to fit your specific needs.

The Kidney Foundation has chapters in most states. It is an excellent resource for programs and educational materials to help people with kidney disease and their families.

Your daily calorie intake needs to be high enough to keep you healthy and prevent the breakdown of body tissue. Ask your doctor and dietitian what your ideal weight should be, and weigh yourself every morning.

CARBOHYDRATES

If you are overweight or have diabetes, you may need to limit the amount of carbohydrates you eat. Talk with your doctor, nurse, or dietitians.

Otherwise, carbohydrates are a good source of energy for your body. If your health care provider has recommended a low-protein diet, you may replace the calories from protein with:

• Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins.
• Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas.

FATS

Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to help protect your arteries. Talk to your doctor, nurse, or dietitian about fats and cholesterol that may increase your risk for heart problems.

PROTEIN

Low-protein diets may be helpful before dialysis. Your doctor or dietitian may recommend a moderate-protein diet (1 gram of protein per kilogram of body weight per day).

Once you start dialysis, you will need more protein. In fact, a high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended. This will help you replace muscles and other tissues that you lose.

People on dialysis should eat 8 – 10 ounces of high-protein foods each day. Your doctor, dietitian, or nurse may suggest adding egg whites, egg white powder, or protein powder.

CALCIUM AND PHOSPHOROUS

Calcium and phosphorous, two other important minerals in the body, are also monitored closely. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can become too high. This can cause:

• Low calcium (this causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break)
• Itching

You will need to limit the amount of dairy foods that you eat. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including tub margarine, butter, cream cheese, heavy cream, ricotta cheese, brie cheese, sherbet, and nondairy whipped toppings.

Fruits and vegetables contain only small amounts of phosphorous.

You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body. If dietary measures to lower phosphorous are not enough, your doctor may recommend “phosphorous binders.”

FLUIDS

In the early stages of chronic kidney disease, you do not need to limit how much fluid you drink. As your kidney disease becomes worse or when you are on dialysis, you will need to watch how much you drink. In between dialysis sessions, fluid can build up in the body.

Your doctor and dialysis nurse will let you know how much you should drink every day. Do not eat too much of foods that contain a lot of water, such as soups, Jell-O, popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.

Use smaller cups or glasses and turn over your cup after you have finished it.

Tips to keep from becoming thirsty include:

• Avoid salty foods
• Freeze some juice in an ice cube tray and eat it like a popsicle (you must count these ice cubes in your daily amount of fluids)
• Stay cool on hot days

SALT OR SODIUM

Reducing sodium in your diet helps you control high BP keeps you from being thirsty, and prevents your body from holding onto extra fluid. A low-salt diet is usually needed.

Look for these words on food labels:

• Low-sodium
• No salt added
• Sodium-free
• Sodium reduced
• Unsalted

Check all labels to see how much salt or sodium foods contain per serving. Also, avoid foods that list salt near the beginning of the ingredients. Look for products with less than 100 mg of salt per serving.

Do not use salt when cooking and take the salt shaker away from the table. Most other herbs are safe, and you can use them to flavor your food instead of salt.

DO NOT use salt substitutes because they contain potassium. People with chronic kidney disease also need to limit their potassium.

POTASSIUM

Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result.

Potassium is found in many food groups, including fruits and vegetables. Choosing the right item from each food group can help control your potassium levels.

When eating fruits:

• Choose peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines, and watermelon
• Limit or avoid oranges and orange juice, nectarines, Kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines

When eating vegetables:

• Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash
• Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, avocado, and cooked spinach

IRON

Patients with advanced kidney failure usually need extra iron.

Many foods contain extra iron (liver, beef, pork, chicken, lima and kidney beans, iron-fortified cereals). Because of your kidney disease, talk this over with your doctor, nurse, or dietitian.

What To Eat If You Have Chronic Kidney Disease

The National Kidney Foundation suggests guidelines for renal dietitians who are preparing and teaching special diets for persons with kidney disease. This article will help you plan your meals and eating in order to slow or halt the progression of kidney disease. Specifically, if the amount of protein eaten is limited, it may help alleviate the symptoms of uremia, such as nausea, vomiting, bad taste and weight loss.

PROTEIN

Protein may be limited to 0.6 grams per kilogram ideal body weight per day. If the patient simply cannot adhere to this restriction, then 0.75 grams per kilogram ideal body weight per day. For your information, the Recommended Dietary Allowance (RDA) for protein in healthy persons is 0.8 grams per kilogram body weight per day. One can see there is very little difference in the normal diet for healthy individuals and the diet that is recommended to delay the progression of kidney disease. People probably eat twice the amount of protein needed to be healthy.

Here is an example of how the protein in the diet would be figured:

A man 5’7″ tall and 150 pounds (70 kilos)

0.6  grams X 70 kilos = 42 grams protein per day 
0.75 grams X 70 kilos = 52 grams protein per day

Here are some samples of protein in foods:

1 egg                          =          7 grams protein 
1 chicken thigh          =          14 grams protein 
8 ounces skim milk   =          8 grams protein 
1 slice bread              =          2 grams protein 
1 cup cooked rice     =          4 grams protein 
1/2 cup corn               =          2 grams protein

CALORIES

According to the National Kidney Foundation Guidelines, calories in this special diet should be 35 calories per kilogram per day for those less than 60 years of age and 30 calories per kilogram per day for those over 60 years of age. Calories are found in carbohydrates, protein, fats and alcohol. As alcohol is not a necessary nutrient, it is not recommended. People with diabetes may need to eat more calories from carbohydrates to prevent weight loss. The medication to control blood sugar may need to be adjusted and/or increased.

POTASSIUM

Potassium is not usually restricted until urine output begins to decrease. Sometimes people with diabetes may need to have potassium limited. Foods high in potassium are: 
Bananas, Oranges, Orange Juice, Milk, Prunes, Prune Juice, Tomato Juice, Tomato Sauce, Nuts, Chocolate, Dried Peas and Beans

SODIUM AND BLOOD PRESSURE

High sodium foods can increase blood pressure. High blood pressure is one of the major causes of kidney disease. New research tells us strict blood pressure control is important. Ask your doctor what your target blood pressure should be. A person may require more than one high blood pressure medicine. The first line of high blood pressure medication is called an “ace inhibitor.”  This may improve a condition known as “proteinuria” or protein in the urine. This can affect diabetics and non-diabetics with high blood pressure. Some persons need a diuretic or “water pill” to help control high blood pressure. High sodium foods to avoid include: Salt, Bacon, Ham, Corned Beef, Pepperoni, Sausage, Pizza, Chinese Food, Fast Foods, Pickles, Cheese, Soy Sauce, Canned Soups, Potato Chips, Fritos, Cheetos

FLUID RESTRICTION

There is usually no restriction in the amount of fluids you can drink until severe kidney disease (Stage 4 or 5) is reached. The amount of urine your kidneys can make will usually not decrease until it is almost time to begin dialysis. It is called “kidney failure” because eventually the kidneys fail to make urine.

PHOSPHORUS

Phosphorus is a mineral found in almost all foods. Normal kidneys will balance the amount of phosphorus in our bodies. However, when the kidneys fail to eliminate this in the urine, the phosphorus will increase in the blood. High phosphorus foods will need to be limited and/or avoided. A medication called a phosphate binder (such as Oscal, Phoslo and Tums) may be ordered by your physician to be taken every time you eat. This medication will bind the phosphorus in the food and eliminate it in the stool. Control of phosphorus is very difficult for kidney disease patients. Ignoring this problem can lead to bone disease with pain in the back and joints. High phosphorus foods to eliminate are: Milk (any kind) – Start learning to use a milk substitute like Cremora (powdered) or Coffeemate (liquid) – Beans (red, black, white), Black Eyed Peas, Lima Beans, Nuts, Chocolate, Yogurt, Cheese, Liver, Sardines, Desserts made with milk

ANEMIA

Healthy kidneys make a hormone that helps make red blood cells. One of the symptoms of  kidney disease is anemia, which causes weakness, tiredness and shortness of breath. Your kidney doctor may give you an injection called “Procrit.” This may help improve your anemia. The doctor may also order iron injections because in order to make red blood cells, you will need enough iron. Unfortunately, in some people the special diet will not provide enough iron and iron pills would be taken.

VITAMINS

Diseases of the heart and blood vessels remain the number one health problem in the U.S.  Recently, a new risk factor has been identified in kidney disease patients. It is an amino acid called homocysteine. Over 75 percent of dialysis patients have increased homocysteine levels. Too much homocysteine in the blood has been found to be associated with increased risk of heart disease, stroke and blood vessel disease. Studies have shown that homocysteine levels in the blood are strongly influenced by these specific vitamins: Folic Acid, Vitamin B12 and Vitamin B6. The American Heart Association has indicated that a reasonable therapeutic goal should be less than 10 micromoles per liter. Ask your kidney doctor if you should be taking a special vitamin to help prevent high levels of homocysteine.

DIABETICS

Since about 40 percent of all kidney disease patients are diabetic, it is important to know about good control of your blood sugar. There is a special blood test called a “hemoglobin A1C.” This test tells what your blood sugars have been in the past two to three months. The normal range is 4.5 to 6.0 percent. Poor control of blood sugar contributes to the progression of your kidney disease. Be sure to ask your doctor how you are doing with blood sugar control. It may be necessary to be referred to a diabetes educator for help.

Sample Menu: 40-50 grams protein
(For non diabetic man 5’7″ tall and 150 pounds (70 kilos) with CKD)

BREAKFAST

• 1/2 cup (4 ounces) orange juice • 1 English muffin or 2 slices bread 
• At least one tablespoon margarine with jelly 
• Coffee or tea with non-dairy creamer and sugar

SNACK

2 canned pear halves in heavy syrup

LUNCH

• 2 slices white bread • At least 2 tablespoons mayonnaise with lettuce and tomato 
• 1 ounce chicken (such as a small thigh) or 1 hard boiled egg 
• 2 canned peach halves in heavy syrup 
• 7-UP, lemonade or Hawaiian Punch

SNACK

• Baked apple with 1/2 cup non-dairy whipped topping

DINNER

• 3-4 ounces steak (weigh after cooking, without bone) , sauté in tablespoons olive oil
• 1 small baked potato with at least 2 tablespoons margarine 
• 1/2 cup fresh green beans, carrots or broccoli with margarine 
• Lettuce, onions, cucumbers, green pepper 
• At least 2 tablespoons olive oil with vinegar or lemon 
• 1/8 apple or cherry pie with 1/2 cup fruit sorbet (this is not sherbet) 
• Iced tea with sugar and lemon or Sprite

SNACK

• 1 small banana and 10 vanilla wafers 
• Coffee or tea with non-dairy creamer and sugar

Eating Vegetarian Foods While Living With Kidney Disease

Historically, vegetarianism has been met with skepticism in chronic kidney disease (CKD) patients. However, we now know that with careful planning vegetarianism, or even part-time vegetarian eating is not only safe, but also beneficial to CKD management.1,2 Research shows eating vegetarian proteins can actually slow down the progression of kidney disease and other complications associated with this disease.1,2

Nutrition management focuses on decreasing waste product build up from digested foods, which would normally leave the body as urine. The primary goals of planning a diet with plant-based foods are three fold: 1.) obtaining the appropriate amount of plant protein to meet protein needs while minimizing waste product build up in the blood 2.) maintaining sodium, potassium and phosphorus balance and 3.) maintaining good nutrition. The following information is meant to be an initial guide to those with early kidney disease (30-50 percent of normal kidney function) and not receiving dialysis treatments. More careful follow up is recommended, especially when kidney function decreases below 30 percent or when regular dialysis treatment is required.

Quality Protein

People with CKD should modify the amount of protein they eat.1 Since plant proteins are less demanding on kidney clearance, this restriction does not need to be as severe as with animal protein diets.8 Keeping to .8 gram (g) of protein per kilogram (kg) body weight is recommended, with approximately two-thirds of this protein coming from quality plant protein or animal/plant combination, such as the following:4

Quality Protein

Serving Size = 7 g protein

Egg

1

Meat analogues
(processed soy foods)

2 oz.

Seitan
(Wheat gluten)

1 oz.

Beans, dried cooked

1/2 cup

Tofu

1/4 – 1/2 cup

Tempeh

1/4 cup

Nut Butters

2 tablespoons

Meat, Fish, Poultry

1 oz.

EXAMPLE:

• Your weight: 70 kg
• Your total protein needs: 70 x .8 = 56 grams
• Amount needed from quality protein  sources: 56 x 2/3 = 37 grams
  (1 pound = 0.4535924 kilogram)

A mixture of these protein sources should be eaten to ensure receiving an adequate balance of all essential amino acids (meat, fish and poultry are optional sources).5-8  Soy protein has been shown to be particularly beneficial in minimizing some complications associated with kidney disease. This includes proteinuria (protein loss in the urine) and minimizing hyper filtration (excess filtering of the kidney causing more kidney damage).9-12 Try to include at least one serving of soy protein per day, such as tofu, tempeh or a milk substitute, soymilk.

Sodium, Potassium, & Phosphorus

Sodium
Though vegetarian foods are healthy in general, some can be very high in sodium. A few foods to avoid for limiting sodium in plant-based foods include:8

• Convenience foods such as frozen meals, canned soup, dried soups, miso or packaged vegetable broths
• Soy-based cheese
• Processed dairy cheese
• Meat analogues — this includes such foods as tofu hot dogs, veggie burgers or other  canned or frozen soy products
• Salt, soy sauce, tamari sauce or any spices that contain the words sodium or salt

Potassium

In general, potassium does not need to be restricted unless the function of the kidney decreases to less than 20 percent. Routine blood testing is the best way to know your potassium requirements. An estimated two-thirds of diet potassium comes from fruits,

vegetables and juices. So initially, the easiest way to limit this mineral will be to minimize fruit and vegetable selections to five servings per day.

A potassium serving size:
1/2 cup fresh fruit, canned fruit or juice 
1 cup fresh vegetables 
1/2 cup cooked vegetables

If this does not decrease your serum potassium to the normal range, limit these foods:

High Potassium
Limit 1 per day

 

Textured vegetable protein

1/4 cup

Soy flour

1/4 cup

Nuts and Seeds

1/4 cup

Dried, cooked beans or lentils

1 cup

Dried cooked soybeans

1/2 cup

Tomato products

1/4 cup

Potatoes

1/2 cup

Dried fruit

1/4 cup

Tropical fruit

1/2 cup

Melons

1/2 cup

If you use a lot of beans or textured vegetable protein, alternative protein selections may be needed in order to keep potassium levels from going too high. This will mean using more tofu, tempeh, seitan and eggs or if you prefer some meat, fish or poultry to meet protein needs.

Phosphorus
Some plant proteins are high in phosphorous, but because of the high phytate content (a naturally occurring compound which blocks phosphorous absorption) these foods alone usually do not increase serum phosphorous levels.8 This includes dried cooked beans and nuts. Dairy products are the main source of concentrated phosphorus.14 This will mean decreasing dairy products to one serving or less per day. For the vegan a few other high phosphorus foods are worth noting:

High Phosphorus
Limit 1 per day

 

Milk

1 cup*

Cottage Cheese

2/3 cup

Cheese

2 ounces

Pudding or custard

8 ounces

Yogurt

8 ounces

Soy cheese

4 ounces

Soy yogurt
(non fortified)

12 ounces

*Non-dairy creamer, rice milk and up to two cups of soymilk per day can be used as a replacement for milk

Good Nutrition A plant-based diet is often lower in calories and higher in fiber than an animal-based diet. As a result, you need to be careful you do not lose weight. Here are some ideas to help add healthy calories to your eating plan:

• Soy shakes: Make shakes with soymilk, tofu, rice milk and non-dairy frozen dessert.
• Adding fats: Use more oils such as olive oil, peanut oil or canola oil in cooking. Drizzle flaxseed oil on food after it is cooked, or mixed with salad dressing over lettuce.
• Snacks: Eat small frequent meals if you fill up quickly.
• Sweets: Even though a high sugar diet is not the best choice for food, on occasion these calories can be beneficial to avoid weight loss. Good choices are jellybeans, hard candy, sherbets or sorbet.

Vitamins and Minerals Supplementation of vitamins and minerals in kidney disease needs to be treated on an individual basis.  Most people will require a water-soluble vitamin without fat-soluble vitamins or minerals. Mineral levels will need to be checked individually to determine if a supplement is needed. High dosages of any vitamin and or mineral in kidney disease are discouraged since the poor clearance from you kidney can cause toxic levels in the blood.15

Foods to Avoid With Kidney Problem

The kidneys control a variety of metabolic processes, including flushing waste materials from the body and controlling blood pressure When the kidneys don’t function properly, they may begin to break down, leaving the body vulnerable to numerous problems, some being potentially very serious. Maintaining good renal function contributes to your overall good health If you know you have chronic kidney disease (CKD), or have received blood tests indicating potential renal dysfunction, you can help your kidneys function with greater efficiency by reworking your dietand avoiding specific foods.

Fruits, Vegetables and Legumes

Reducing potassium intake is only necessary if your kidney function drops to below 20 percent, according to the Association of Kidney Patients. Cut back on the amount of fruits and vegetables you consume to reduce potassium. Eat no more than a total of five servings of fruits and vegetables per day. This includes limiting the amounts of textured vegetable protein (TVP) and legumes (beans) for vegetarians.

Animal Proteins

The American Association of Kidney Patients recommends reducing animal proteins which are high in purines that convert to uric acid in the kidneys. Urine then becomes too acidic, which leads to the formation of uric acid crystals that are deposited in the kidneys as kidney stones. Uric acid crystals also deposit in joints, causing gouty arthritis. Replace poultry, red meats and fish with vegetarian sources of protein, such as soy or legumes, combined with whole grains to form complete proteins.

High Oxalate Foods

Limit foods high in oxalic acid, recommends the National Kidney Foundation, to avoid developing a variety of kidney stones. These foods include instant coffee, tea, Concord grapes, tofu, beets, berries, peanuts, oranges, sweet potatoes, beans, chocolate, dark leafy green vegetables and draft beer.

Canned, Processed, Frozen and Fast Foods

The kidneys’ role in maintaining blood pressure is closely involved with the body’s sodium balance. One of the causes of kidney disease is hypertension, and it is also one of the side effects of kidney disease. Too much sodium intake can trigger high blood pressure, with renal function going haywire, according to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Lower salt intake and all foods that are high in sodium, all canned foods (unless they are labeled “low sodium”), canned and dried soups, vegetable broths, soy-based cheeses, convenience foods, chips, fast foods, boullion, frozen meals, hot dogs, processed cheese slices, salt, soy sauce, processed meats, pickled foods, tamari, ketchup, marinades and anything that has the words “sodium added” on the label.

Chocolate, Dairy and Nuts

The body’s electrolyte balance is controlled by the kidneys. If they are not working properly due to disease or other conditions impacting their function, electrolytes must be reduced to avoid straining the kidneys. Phosphorus blocks the absorption of calcium, so reducing the following high-phosphorus foods will help retain needed calcium, recommends the American Association of Kidney Patients. Cut back on cocoa, nuts, chocolate, vegetables, carbonated drinks and dairy products. Eat only one portion of these foods per day, especially cottage cheese, yogurt, milk, soy cheese, soy yogurt and hard cheeses, which are high in phosphorus.

Nutrition for Later Chronic Kidney Disease in Adults

As kidney disease progresses, nutritional needs change as well. If you have reduced kidney function, your doctor may recommend that you change your diet to protect your kidneys.

You can prevent or delay health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in phosphorus, potassium, and sodium. Eating too much protein can also burden the kidneys and speed the progression of CKD. Protein foods like meat and dairy products break down into nitrogen and creatinine, waste products that healthy kidneys remove from the blood. But diseased kidneys can’t stop waste products from building up in the blood and causing health problems.

With reduced kidney function, you may need to start paying attention to the protein, phosphorus, sodium, and potassium content of the foods you eat. Learning about your food will help you understand what changes you need to make.

Calories

Calories are units of energy provided by food. Work with your dietitian to determine how many calories you need each day to maintain a healthy weight.

As CKD progresses, you may find that foods do not taste the same, and you may lose your appetite. Your dietitian can help you find healthy ways to add calories to your diet if you are losing too much weight.

Protein

Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. But proteins also break down into waste products that must be cleaned from the blood by the kidneys. Eating more protein than your body needs may put an extra burden on the kidneys and cause kidney function to decline faster.

Doctors have long recommended that patients with CKD eat moderate or reduced amounts of protein. Some worried, however, that restricting protein would lead to malnutrition in many patients. In the 1990s, a major clinical trial measured the benefits and dangers of protein restriction for kidney patients. The Modification of Diet in Renal Disease (MDRD) Study assigned groups of CKD patients to diets with different levels of daily protein intake. The study found that patients who succeeded in reducing their daily protein intake by 0.2 grams for each kilogram of body weight for 1 year had healthier levels of bicarbonate, phosphorus, and urea nitrogen in their blood.

For example, a man who weighs 154 pounds (70 kilograms) and who normally eats 56 grams of protein a day would have to reduce his protein intake to 42 grams a day. To cut back on protein, he might eat oatmeal at breakfast (6 grams of protein) instead of a bacon, egg, and cheese sandwich (18 grams of protein).

Medical Nutrition Therapy

Figuring out what to eat can be tricky at first. You may need to cut down on foods you’ve always considered healthy, like fruits and vegetables. First, you need to learn how certain foods affect your kidneys and how reduced kidney function changes the way your body uses food. Then learn about the nutritional content of foods so you can recognize foods that are acceptable and foods that contain the substances you need to limit or avoid, like sodium, phosphorus, and potassium.

Working with a dietitian can help you understand how foods affect your health. Ask the dietitian to review your lab reports for problems that you can address by changing your diet. For example, your lab report might show a high level of phosphorus in your blood. Your dietitian can show you how to lower your phosphorus level by avoiding high-phosphate foods like dairy products, nuts and peanut butter, beer, cola, canned iced teas and lemonade, and certain vegetables.

Together, you can plan meals that fit your habits and your preferences but also provide the nutrition you need and avoid or restrict the foods that can cause problems.

Ask your doctor to refer you to a dietitian who specializes in nutrition for people with chronic kidney disease. The dietitian’s fee may be covered by your health insurance. Check with your insurance provider. You may need a referral from your doctor. If you qualify for Medicare, you can receive a benefit for medical nutrition therapy (MNT) from a registered dietitian or nutrition professional when your doctor provides a referral indicating that you have diabetes or kidney disease. Medicare covers 80 percent of the Medicare-approved amount for MNT after you have paid the $100 deductible for Part B services.

One way to locate a qualified dietitian is to consult the American Dietetic Association website at www.eatright.org, which features a “Find a Nutrition Professional” page. Users can enter their address or ZIP code and a list of dietitians in that area will appear. Click on “Renal nutrition” in the specialty field.

The typical American diet contains more than enough protein. Most people can get the protein they need by eating two 3-ounce servings of meat or meat substitute each day. Learning about portion sizes can help you limit your protein intake.

What’s the Right Size?

A 3-ounce serving of meat is about the size of a deck of cards or the palm of your hand. You can moderate your protein intake by limiting meat in your diet to two 3-ounce servings each day.

Talk with your dietitian about the amount of protein and the sources of protein in your diet. Animal sources such as egg whites, cheese, chicken, fish, and red meats contain more of the essential amino acids your body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your dietitian can suggest ways to make small adjustments in your eating habits that can result in significant protein reduction. For example, you can make sandwiches using thinner slices of meat and filling out the sandwich with lettuce, pickles, cucumber slices, apple slices, and other garnishes.

Protein Content of Foods

High-Protein Foods

Lower Protein Alternatives

Ground beef
Halibut
Salmon
Tuna
Chicken breast
Chili con carne

Egg substitutes
Shrimp
Tofu
Imitation crab meat
Chicken drumstick
Beef stew

Fat

Fat provides energy, helps produce hormone-like substances that regulate blood pressure and other heart functions, and carries fat-soluble vitamins. You need fat in your diet, but some fats are healthier than others. Saturated fats and trans-fatty acids can raise your blood cholesterol levels and cause clogging of blood vessels.

Talk with your dietitian about healthy and unhealthy sources of fat. Saturated fats are found in animal products like red meat, poultry, whole milk, and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercial baked goods like cookies and cakes and in fried foods like doughnuts and french fries.

Your dietitian can suggest healthy ways to get fat into your diet, especially if you need more calories. Vegetable oils like corn or safflower oil are healthier than animal fats like butter or lard. Avoid hydrogenated vegetable oils because they are high in trans-fatty acids. Monounsaturated fats—olive, peanut, and canola oils—are healthy alternatives to animal fats.

Sources of Fats

Bad Fats

Good Fats

Saturated fats

• Red meat
• Poultry
• Whole milk
• Butter
• Lard

Monounsaturated fats

• Corn oil
• Safflower oil
• Olive oil
• Peanut oil
• Canola oil

Trans-fatty acids

• Commercial baked goods
• French fries
• Doughnuts

Hydrogenated vegetable oils

Sodium

Sodium is found in ordinary table salt and many salty seasonings like soy sauce and teriyaki sauce. Canned foods, some frozen foods, and most processed meats have large amounts of table salt. Snack foods like chips and crackers are also high in salt.

Too much sodium in your diet can be harmful because it causes your blood to hold fluid. The extra fluid raises your blood pressure and puts a strain on your heart and kidneys. Talk with your dietitian about ways to reduce the amount of sodium in your diet. Look for the sodium content on the nutrition labels of the foods you buy. Choose “sodium-free” or “low-sodium” food products. Aim to keep your daily sodium intake less than 1,500 milligrams.

Try alternative seasonings like lemon juice, salt-free seasoning mixes, or hot pepper sauce. But avoid salt substitutes that use potassium.

Sodium Content of Foods

High-Sodium Foods

Lower-Sodium Alternatives

Salt
Canned vegetables
Hot dogs
Packaged rice with sauce
Packaged noodles with sauce
Frozen vegetables with sauce
Canned soup
Tomato sauce
Snack foods

Salt-free herb seasonings
Frozen vegetables
Plain rice
Plain noodles
Unsalted pretzels
Unsalted popcorn

Potassium

Potassium is found in many fruits and vegetables, such as bananas, potatoes, avocados, and melons. Check your blood tests to make sure that your potassium level stays in the normal range. If it begins to climb, talk with your dietitian about ways to limit the amount of potassium you eat. You may need to avoid some fruits and vegetables. You can reduce the potassium content of potatoes by soaking them in water for several hours before cooking.

Potassium Content of Foods

High-Potassium Foods

Lower-Potassium Alternatives

Oranges and orange juice
Melons
Apricots
Banana
Kiwi
Potatoes
Tomatoes
Sweet potatoes
Cooked spinach
Beans (baked, kidney, lima, pinto)

Apples and apple juice
Cranberry juice
Canned fruit
Strawberries, blueberries, raspberries
Plums
Pineapple
Cabbage
Cauliflower
Mustard greens
Broccoli

Phosphorus

Phosphorus is a mineral found in many foods. Too much phosphorus in your blood pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Too much phosphorus may also make your skin itch. Foods like milk and cheese, dried beans, peas, colas, canned iced teas and lemonade, nuts, and peanut butter are high in phosphorus. Talk with your dietitian about how much phosphorus you should have in your diet.

As your kidney disease progresses, you may need to take a phosphate binder like sevelamer hydrochloride (Renagel), calcium acetate (PhosLo), or calcium carbonate (Tums) to control the phosphorus in your blood. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool.

Phosphorus Content of Foods

High-Phosphorus Foods

Lower-Phosphorus Alternatives

Dairy foods (milk, cheese, yogurt)
Beans (baked, kidney, lima, pinto)
Nuts and peanut butter
Processed meats (hot dogs, canned meat)
Cola
Canned iced teas and lemonade
Bran cereals
Egg yolks

Liquid non-dairy creamer
Sherbet
Pasta rice
Rice and corn cereals
Popcorn
Green beans
Lemon-lime soda
Root beer
Powdered iced tea and lemonade mixes

Fluids

As your kidney disease progresses, you may need to limit how much you drink because your kidneys can’t remove the extra fluid, so it builds up in your body and strains the heart. Tell your doctor if you notice you are making either less urine or more urine or if you have any swelling around your eyes or in your legs, arms, or abdomen.

Keep Track of Test Results

If you have CKD, your doctor will order regular blood tests. Many patients find that keeping track of their test results helps them see how their treatment is working. Ask your doctor for copies of your lab reports and ask to have them explained. Note any results that are out of the normal range. When you learn how to read your reports, you will see how the foods you eat affect your kidneys. Talk with your doctor or your dietitian about what you can do to make healthier food choices. Remember that you are the most important member of your health care team.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at slowing the progression of chronic kidney disease. For example, the NIDDK is sponsoring the Chronic Renal Insufficiency Cohort study to determine the risk factors for rapid decline in kidney function and development of cardiovascular disease. This study of about 3,000 patients with chronic renal insufficiency, another way of describing CKD, will reflect the racial, ethnic, and gender composition of the people in the United States who have permanent kidney failure. The data collected and specimens obtained from people in this study will serve as a national resource for investigating CKD as well as cardiovascular disease. Establishing this group of patients and following them into the future will also provide an opportunity to examine genetic, environmental, behavioral, nutritional, quality-of-life, and health resource use factors in this population. The main part of the study will consist of monitoring patients and following up at regular clinic visits with kidney function measurements, cardiovascular studies, and laboratory tests. In addition, participants will answer questionnaires to assess various demographic, nutritional, and quality-of-life factors.

Diet for Kidney Disease (Dialysis Diet)

Lifestyle

Dialysis is an artificial way of doing some of the work of the kidneys, but it cannot replace the natural function of the kidneys. If you are on dialysis you need to carefully regulate your kidney diet.

Weight loss is a problem that causes particular concern in kidney failure. This is usually because patients are not eating enough protein and energy-providing food. Malnourished people lose weight and muscle mass. Malnutrition can develop with patients on either hemodialysis or peritoneal dialysis. Dietitians monitor renal patients for any signs of malnutrition.

Obesity can cause practical problems for people on dialysis. Overweight people with fat arms can have particular problems with access for hemodialysis. Their veins can be difficult to reach, or weak, and therefore difficult to make a fistula from. Peritoneal dialysis is less likely to work for patients who have a fat or distended tummy.

Overweight patients should refer to a dietitian for advice. Reversing obesity will not cure kidney failure, but it will bring significant health benefits.Some patients lose their appetite and you may be asked to increase your food intake to prevent malnutrition from developing.

Pay special attention to specific aspects of kidney diet and nutrition such as your intake of iron, phosphate and calcium, potassium, protein, sodium, and vitamins, all discussed in this section. Check with your dietitian if you are unsure about any aspect of your renal diet.

Iron
Many people with kidney failure suffer from anemia. One of the causes of anemia is a low level of iron in the body. If you have low iron levels you may need to take medication.

Phosphate and calcium Phosphate and calcium affect the health of the bones. When a person has kidney failure, the calcium level in their body tends to be too low and the phosphate level too high.

Treatment for kidney patients aims to raise blood calcium levels and lower blood phosphate levels. This can be achieved by moderating the phosphate content of your diet, by adequate dialysis, and by the use of a phosphate binder taken with meals.

However, it is difficult to cut down on phosphate intake without also lowering protein intake.

Potassium
If potassium levels in the blood are too high, the heart can stop beating. Low potassium levels may cause arrythmias.

The dietitian will try to find out if a patient is eating anything that might lead to a high level of potassium. Hemodialysis patients might have to avoid such high-potassium foods as chocolate, and moderate their intake of other potassium-contianing foods such as bananas.

Peritoneal dialysis patients rarely need to restrict their potassium intake.

Protein
Protein is an essential nutrient that enables the body to build muscles and repair itself. It also helps the body to fight infection. The main sources of protein in our diet are meat, fish, dairy products, eggs, and vegetables such as peas, beans, and lentils. Low levels of protein can lead to malnutrition, fluid retention and a reduction in the body’s ability to fight infections. When protein is used by the body waste products are formed and enter the blood. One of these wastes is called urea. Normal healthy kidneys are good at getting rid of urea. Failing kidneys are not good at this, but kidney patients should still eat protein.

When the time for dialysis draws closer, some patients do not feel as hungry as they used to, and some food, particularly meat products, may taste ‘funny’. Special dietary supplements may help such patients maintain adequate protein intake.

It is very important to follow your dietitian’s advice regarding your protein intake.

Sodium
Hemodialysis patients often have greater restrictions on fluid intake than peritoneal dialysis patients, and therefore need to be very careful about salt. This is because a salty diet can make a patient thirsty and may increase blood pressure.

Vitamins
Vitamins B and C are lost during dialysis. Your doctor may prescribe vitamin supplement tablets. You should not take any over-the-counter vitamin supplements unless your doctor has prescribed them.

When your kidneys fail you have to face physical and medical challenges every day and make major adjustments in your life. It’s only natural to feel confused, frustrated, sad, angry, or depressed because of what is happening to you.

Members of the renal team can help you cope with these emotions and with problems your illness may cause in your relationships.

There is no single renal diet, and advice will vary depending on things such as your weight, blood tests and if appropriate dialysis choice. On these pages we can only give some general ideas and advice. 

Detailed individual advice for patients with severe kidney disease (less than 30% function, stages 4 and 5 CKD) is best from a renal dietitian.

About protein: A typical daily intake in the UK is 60-80g, about 1g/kg of ideal body weight. If you are eating enough calories you can manage with 45-60g (0.75g/kg). The richest sources of protein are Animal protein – meat, fish, cheese, eggs, milk and yoghurts. Vegetable protein – nuts, pulses (beans, lentils etc), tofu, quorn.

Excessive intake of protein must be avoided in CKD. Historically and on rare occassions a low protein diet has been advised for patients with renal failure. We don’t usually do this.

 

How much protein does food contain?

 

Milk 500ml (a pint is 568ml)

17g

Yoghurt (1 pot)

7g

40g portion of cheese

10g

Tin of beans (small, 135g)

7g

Cooked meat 100g

26-28g

Egg (1 large)

8g

 

Sodium (salt)

About sodium (salt)

 

A typical daily intake in the UK is 150 – 200mmol (9-12g of salt, or 3-5g of sodium). We need much less than half of this.

Only around 10% of sodium is found in fresh food, the rest is added as salt in cooking and as table salt sprinkled on the food after cooking.

A large amount is also found in processed foods e.g. ready meals, processed meats and ready made sauces.

 

Common salt is sodium chloride. Modern diets contain too much salt, and sick kidneys cannot cope. A high salt intake can lead to high blood pressure and to fluid retention and overload. Many blood pressure tablets only work properly if combined with a reduced salt intake.

In most patients with kidney disease or on dialysis we recommend keeping salt down to ‘no added salt’ levels of less than 100mmol/day (6g of salt, which is just over 2g of sodium – still a lot more than we need). This diet allows small amounts of salt to be used in cooking, but means limiting very salty foods, and not adding salt to food at the table. The less salt the better!

Salt substitutes such as ‘Lo-Salt’ are not suitable for patients with renal failure, because they contain large amounts of potassium.

Sodium can also be found in some medicines. Effervescent or soluble painkillers are a particular problem – don’t use them if you need to control your salt intake.

Potassium

About potassium

 

A typical daily intake in the UK is 50-150mmol.

A low potassuium diet should ideally be less than 65 mmol.

Potassium is present in most foods but in higher amounts in fruit & vegetables.

 

Potassium levels can be high in severe renal failure and on dialysis, but potassium intake should not be restricted routinely – only if tests show high potassium levels. This is because potassium-containing foods include many healthy foods. Very high potassium levels (e.g. 6.5 or higher) can be dangerous as they can lead to a cardiac arrest. As well as diet, some drugs can cause high potassium in patients with CKD, and there are some other causes. More detail is available from the links below.

Fluid (liquids)

About fluid

Most people drink 1-2 litres a day and don’t need to reduce fluid intake until kidney disease is very severe. However if you are a dialysis patient who doesn’t produce much urine, you have to cut down the amount you drink, otherwise you will accumulate fluid.

 

All drinks contain mostly water. Fluids refer to all drinks taken per day. If you are not on dialysis, you should not restrict fluids unless you have a particular problem with fluid overload. For most patients there is no special benefit from drinking extra water.

 

Phosphate

About phosphate

 

Phosphate is often found in high protein foods, especially in dairy foods.

Ohter protein foods such as meat and fish contain phosphate but advice can be given on choices and safe amounts of these.

Too much phosphate in the blood (hyperphosphataemia) usually becomes a significant problem in the later stages of renal failure (stages 4 and 5 CKD, usually less than 20% kidney function). The problem continues for most dialysis patients, as dialysis does not remove enough phosphate and in addition a combination of diet and medicines are usually needed to control it.

Calcium and phosphate are a major problem for kidney patients, causing serious bone disease across the years if they cannot be controlled. High calcium and phosphate also makes you itch very badly, and is damaging to arteries and joints too. People with very poor phosphate control don’t do so well on dialysis.

Diet alone is rarely enough to control phosphate in severe renal failure, and medicines called phosphate binders are also used. These are taken alongside food, and work by keeping the phosphate from your food in the gut, preventing it being absorbed into the blood when the food is digested. It is important that these are taken at the right time with food (or with it) as they won’t work otherwise. Timings can vary depending on which binder is prescribed.

In both CKD and dialysis patients, the aim is to keep phosphate levels below 1.8mmol/l. Download short information from the box above about phosphate in food and phosphate binders.

Energy: Too few calories lead to the breakdown of muscle to provide energy. If you lose muscle you become weak and debilitated. Once this has happened it takes months to recover strength. Appetite is decreased in many patients with kidney disease, and in some it is necessary to provide nutritional supplements.

Malnutrition can be a serious problem in severe kidney disease and in some dialysis patients. It tends to be a particular problem in people who have had other illnesses, or a complicated time as they have developed kidney failure. Early help from expert dietitians is very valuable if this occurs.

A controlled diet high in fat and low in carbohydrate can repair kidney damage in diabetic mice, according to US scientists. The study, published in journal PLoS ONE, showed a “ketogenic diet” could reverse damage caused to tubes in the kidneys by too much sugar in the blood. 

In the UK around a third of the 2.8m people with either type 1 or 2 diabetes go on to develop kidney damage. Diabetes UK said it was “questionable” whether humans could sustain the diet. 

Damage reversed The researchers at the Mount Sinai School of Medicine in New York used mice with both type 1 and type 2 diabetes. Once kidney damage had developed, half the mice were put onto the ketogenic diet for eight weeks. The highly controlled diet, which is 87% fat, mimics the effect of starvation and should not be used without medical advice.  After eight weeks the researchers noted that kidney damage was reversed.  Professor Charles Mobbs, who led the research at Mount Sinai School of Medicine, said: “Our study is the first to show that a dietary intervention alone is enough to reverse this serious complication of diabetes. ”I certainly think it has promise, but I can’t recommend it until we have done clinical trials.” The researchers also need to figure out the exact process that leads to repair. Dr Iain Frame, director of research at Diabetes UK, said: “This research was carried out in mice so it is difficult to see how these results would translate into any real benefits for people with diabetes at this stage. “It is too simple to say that kidney failure could be prevented by diet alone and it is also questionable whether the diet used in this model would be sustainable for humans, even in the short term.” Helen Nickerson, from the Juvenile Diabetes Research Foundation, which part funded the research, said: “Dr Mobbs’ novel observation could lead to new molecular insights in diabetic kidney disease.”

About the Author

drizharnium@gmail.com, Bangalore India

Hi Friends, I am Izhar currently pursuing MD in Unani System of Medicine from NIUM Bangalore, love all of you, and  I’d like to write about my interest, and here i am sharing about my opinion, prevention regarding to many diseases, maintaining  views for Health, Beauty & Younger looking Secrets at article base…

 

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