Please read the FAQ section below. If you require further assistance please email Nicki Welch with any dietitian related questions or concerns.
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.
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.
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.
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.
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
Chocolate, though often thought of as a junk food, does have its pluses and minuses. The minuses are that chocolate does contain a lot of calories and fat. Eating too much can lead to weight gain and therefore increasing health risks that come with weight gain. However, when eaten in moderation chocolate can have some positive health benefits. The fat in chocolate is a combination of saturated and unsaturated fat. One type of unsaturated fat found in chocolate is Oleic Acid, a monounsaturated fat that is also found in olive oil. This type of fat makes up about one third of the fat in chocolate and has been found to have beneficial effects for your heart.
Chocolate , especially dark chocolate, contains antioxidants and flavonoids. The darker the chocolate the more of these are found in it. Antioxidants have been shown to aid with the prevention of cholesterol sticking to your arterial walls, therefore decreasing your risk for heart attack and stroke. The flavonoids also have disease preventing benefits just like the flavonoids in red wine and tea.
So next time you crave that chocolate go ahead and enjoy it. Just make sure you don’t over indulge.
Losing weight is not always an easy thing to do. Changing your eating behaviors is a life long commitment if you are serious about losing weight and keeping it off. It is good that you have been paying attention to your sugar and fat contents in food. Just because something is low in sugar or fat does not always mean that it is low in calories. Often times it is more beneficial to read the food label on the item that you buy rather than just the health claims.
When sugar is taken out of a food it is often still high in fat and may often contain the same amount of calories as the original version. Just because the item may not have what we refer to as table sugar it still may have some form of carbohydrate or alternate form of sugar that will have the same amount of calories.
When items are low in fat they may still be high in simple sugars which if eaten in large quantities will be stored as fat. It is great that you watch your fat and sugar, but remember to also count calories. No matter what type of calories you are eating, if you eat more than you need you will store it as fat.
The low carb diet is not a healthy diet and is not recommended due to the fact that it is generally a high fat, high protein diet. A healthy diet is actually 55-60% Carbohydrates, 20-30% fat and10-20% protein. When following a low carb diet you tend to lose more than just fat, you lose muscle and water. This is why you lose weight so rapidly on this diet. It also is why you gain weight back quickly after returning to your normal diet. You gain a lot of water weight back. The safest and most effective rate to lose weight is no more than 1-2 pounds per week. This is the rate that your body can lose fat. Anything more is usually water and muscle. To lose a pound of fat in a week you need to cut back 3500 calories. This is equal to 500 calories per day. I recommend that you keep a food record for about three days and then look at what you are eating. There are many ways to cut out calories. For example if you drink regular soda switch to diet. This will decrease your calories dramatically. Change whole or two percent milk to skim milk. You also can make sure you use only 100% fruit juice instead of fruit drinks.
Exercising to lose weight is usually recommended at least 5 times per week. Check with your doctor before starting any new exercise routine. Exercising three times per week will most likely prevent you from gaining weight, but to really lose you need to increase to about five days per week.
It is great that you have started watching his fat and cholesterol intake. Make sure to pay special attention to his saturated fat. This type of fat has the most effect on his serum cholesterol (the cholesterol in his blood). Since most foods that are high in cholesterol are also high in saturated fat you will find that you are probably already avoiding a lot of these foods.
We recommend that individuals with high cholesterol try to eat no more than 300 mg of cholesterol per day. Since egg yolks contain about 200 mg of cholesterol per egg I would recommend that he eat no more than 3 or 4 eggs per week. The cholesterol in the egg is found in the yolk of the egg so if you avoid the egg yolk you avoid the cholesterol. The fat in eggs is mostly polyunsaturated and monounsaturated. This means that he should limit his egg yolks but not the egg whites. When cooking you can substitute two egg whites for every one whole egg and you will have the same taste and texture without the cholesterol.