Ask A Dietitian

Questions

1) Can you tell me more about a renal diet, for someone who has kidney/renal disease and is on dialysis?

2) I am a 68 year old man and my doctor told me to add protein to my diet to help me heal. I also need to lose weight, but am confused on how to add extra protein and not extra calories. What foods would help me gain protein without weight? I found a product at a nutrition store that is a protein supplement and wondered if it would be okay to use it. I am 6 foot 2 inches and weigh 240 pounds. How much protein do I need in a day?

3) I have been diagnosed with high triglyceride levels. My doctor told me to cut out the fats, watch my carbs and watch my total calorie intake to avoid gaining weight. What else is there? I feel like there isn't much left in my diet but vegetables and water. What exactly are triglycerides and how does my diet affect them?

4) I am diabetic and have been wondering if fruit is a good choice for me to eat. I know fruit is naturally high in sugar but isn't it also high in vitamins and minerals? What should I do?

5) What is GERD and what foods should I avoid?

6) Previous Questions and Answers

 

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Answers

1. Can you tell me more about a renal diet?

When your kidneys do not function as they should the waste that normally is filtered through your urine remains in the blood. Dialysis removes some of this waste, but not all so it is important to follow the diet prescribed by your physician or dietitian at your dialysis center. They will check your labs and tell you what you need to restrict. The nutrients that are restricted on a renal dialysis diet are protein, sodium, phosphorus and potassium. Fluid may also need to be restricted based on your water weight gain between each dialysis treatment.

For more information on the renal diet I would recommend the National Kidney Foundation website: www.kidney.org. There you will find a tab for patients under which is a nutrition and diet page that you can visit.

There is also a website for the American Association of Kidney Patients. Here you will find nutrition information available also.

I hope this is of some help. Since Kidney disease is different in every individual your diet should be individualized also. Speak with your physician and dietitian to work out a plan that is specific for you.


2. How much protein do I need in a day?

I understand your confusion, but hopefully I can help. You are right that it is difficult to add protein without extra calories. You need to try and add some lean meats and meat substitutes to your diet. Foods that are high in protein and low in fat would include chicken, poultry (white meat, no skin), cornish hen (no skin), fish, shellfish, wild game (no skin), low fat or non fat cheese, egg whites, and egg substitutes. When selecting Beef products choose those that are USDA Select or Choice grades of lean meat.

As for the supplement product and how much protein you need I would suggest you use caution. When determining protein needs it is very important that your kidney function is considered. Excess protein can be hard on your kidneys if you have any type of kidney failure. If you have ever had any problems with your kidneys I would suggest that you ask your doctor about the amount of protein or have him refer you to a dietitian that can evaluate your medical history. Based only on your height and weight your protein needs for a day would be about 74 grams of protein per day. You may need a little more or a little less depending on your kidney function and your muscle depletion. Where the caution comes into the picture is with the supplements. It is very easy to get too much protein from some of these supplements. Some supplements can provide almost 30% of your protein needs in one serving.

My recommendation for you would be to try and find a dietitian in your area that could sit down with you and help you determine how much protein you are taking in and whether you need supplements or not. Keeping a food journal for about three days with all the foods that you eat along with the amounts will help with assessing your actual intake.


3. What exactly are triglycerides and how does my diet affect them?

Triglycerides are the form in which most fat is stored in your body and found in food. Triglycerides can be derived from the fat that you eat as well as from other calorie sources. Any calories you consume that are in excess of what you need will be broken down and stored in your fat cells as triglycerides. The body releases stored triglycerides when it needs energy between meals.

Although watching all of these things in your diet sounds overwhelming they actually go hand in hand in a healthy diet. By watching your fat intake you will be cutting down on your calories because fat has twice the calories as carbohydrates and protein. Therefore eating less fat will lead you to eat less calories as long as you aren't doubling up on the other foods. By watching your carbohydrates that does not mean all carbohydrates. Not all carbohydrates are equal. The more simple the carbohydrate the more effect it will have on your triglyceride levels.

Limiting your alcohol intake may also have considerable effects on your triglyceride levels.

By choosing low fat foods and avoiding sweets such as sugar, candy, honey, sweetened beverages, pastries and desserts you should be able to control your calories without having to count them. Please look on our website for some low fat cooking ideas as well as ways to use sugar in moderation.


4. I am diabetic and have been wondering if fruit is a good choice for me to eat.

Fruit is a healthy choice for diabetics and non diabetics. The confusion with fruit sugar is a common concern. Diabetics are often told to avoid foods high in sugar yet if you read a food label for natural fruit products it would appear that these foods are off limits for the diabetic population.

Let me ease your worry. You can eat fruit. You just have to control your serving sizes. It is true that fruit is naturally high in sugar and vitamins and minerals. Therefore they are a great choice for small snacks or in addition to a more balanced meal. There is no one fruit that is better for you than another, but there are some fruits that you can eat more of. For example dried fruits such as raisons and prunes tend to pack a lot of sugar in a small package, therefore the serving size is considerably smaller. (2 tbsp) On the other hand food such as watermelon has a lot of water to spread those sugars around a larger volume so the serving size is considerably larger. (1 1/4 cup). Most fruits like apples, oranges, bananas, and peaches have a serving size of one medium item or one half cup of a canned item (in fruit juice).

Remember a diabetic diet is a healthy diet so no one food is a taboo. All are acceptable in moderation.


5. What is GERD and what foods should I avoid?

GERD stands for Gastroesophageal Reflux Disease. To explain it more simply...... Heartburn. The esophagus is the tube that leads from your mouth to your stomach. There is a muscle at the base of the esophagus that controls the food entering your stomach. In the natural state this muscle is contracted or closed. When you swallow the muscle relaxes thereby opening and allowing the food swallowed to enter your stomach. When an individual has GERD this muscle has a weak closure or is relaxed allowing stomach acid to reflux or back up into the esophagus. This may be a chronic condition or one that is aggravated by certain foods.

Each individual may be affected differently by certain foods, but there are some common foods that we recommend to avoid.

The first group of foods are those foods that may lead to the relaxing of this muscle. They are Coffee, (regular and decaffeinated), Caffeine containing soft drinks, Tea, Cocoa, Peppermint, Spearmint, and Alcohol. Cigarette smoking may also lead to this condition.

The second group of foods are those that if refluxed may lead to irritation. These are; Raw onion, cabbage, cucumber, Tomato juice, tomato products, and citrus fruits/juices. If you have totally eliminated citrus and tomato products from your diet you may need to take an additional source of vitamin C. (Please contact your doctor or dietitian for supplement recommendations)

The third recommendation is to avoid lying down two hours after you eat. This will help prevent the food from refluxing back up into your esophagus