Diet For Kidney Disease Patients

Is an Even Lower Protein Intake Better? 

This has been a very controversial topic in nephrology. If a low-protein diet decreases the workload of the kidneys, wouldn't eating even lower amounts be even better? There have been major studies examining both views that have found very different results. In the mid-1990s, studies were done which demonstrated that eating very low-protein diets - in the range of 0.2 mg/kg a day - supplemented with amino acids, reduced the amount of protein in the urine. For those with very advanced kidney disease, it delayed the time until dialysis was started.
 

However, in a study published in 2009, patients who were on a moderately low-protein diet - 0.5 to 0.6 g/kg of body weight - were compared to those on a very low-protein diet - 0.2 g/kg of body weight. Both groups of patients were followed closely by their doctors for years. Those on a very low-protein diet did not fare any better than those on the higher-protein diet. It was also suggested by the study that those on a very low-protein diet may have a higher mortality. The one factor that made a significant difference in preventing kidney disease from worsening was maintaining a lower blood pressure.
 
Most nephrologists are recommending a moderately lower protein intake of 0.6 to 0.8 g/kg. It also may mean that there are factors other than the amount of protein that can contribute to a worsening of kidney disease. In addition to a higher blood pressure, I submit that this also includes a sustained inflammatory response.

RESTRICTING PHOSPHORUS IN THE DIET 

Phosphorus is an important mineral found in all cells of the body. When joined with calcium, it helps maintain the integrity of our teeth and bones. As CKD progresses, the kidneys can no longer eliminate excess phosphorus to maintain body balance, and as a result, phosphorus accumulates in the blood.
 
When this happens, calcium is leached from the bones and can also build up in the blood, which can cause changes in bone health as well as heart and blood vessel damage. Blood work will again indicate if dietary changes or medication is needed. If results indicate that the phosphorus level is too high, the doctor will more than likely prescribe a medication called a phosphate binder.
 
Normal Phosphorus Levels
 
A normal phosphorus level, as reported in your blood work, is 2.5 to 4.5 meq. When the number reaches 5.5 or higher, your doctor may talk with you about using a phosphorus binder, as discussed earlier.
 
Sources of Phosphorus 

Phosphorus is found in most foods, but mainly in protein-based foods, such as meat, poultry, fish, and dairy. Therefore, restricting dietary protein will limit the amount of phosphorus consumed.
 
Phosphorus is also found in much smaller quantifies in fruits and vegetables. You should be aware of hidden sources of phosphorus, as well. For example, phosphate additives are added to commercially prepared foods and soft drinks, especially colas. As with potassium, the phosphorus content may not be listed on all food labels. You need to be aware of the phosphorus content of the food that you buy. In general, the amount of phosphorus restricted is to about 700 to 1000 mg each day.

KEEPING AN EYE ON MAGNESIUM INTAKE 

Magnesium is a mineral that is important in bone and nerve health. Normal levels as reported on blood work are approximately 1.6 to 2.0 mg. In the advanced stages of CKD, the kidneys can have trouble eliminating excess magnesium.

Pay attention to how much magnesium you are consuming. In addition to vegetables and whole grains, magnesium is also found in over-the-counter medications such as laxatives, milk of magnesia, epsom salts, many antacids, and pain relievers. Over-consumption of these products could put you at risk for magnesium toxicity. It is very important that your doctor know about all of the over-the-counter medications you are taking, including multivitamins containing potassium and magnesium. Again, blood work will dictate if restrictions are necessary. To find out more, you can check out Diet For Kidney Disease Patients.
 

Kidney Disease Diet Recipes

WATCHING YOUR POTASSIUM INTAKE 

Declining kidney function and some prescribed medications can alter potassium levels. Routine blood tests will determine if potassium needs to be increased or restricted. Some people with CKD may need to curb their intake of food and beverages that are high in potassium, because in diabetes or advanced CKD - stages four or five - the kidneys can have trouble getting rid of the extra potassium.
 

Kidney Disease Diet Recipes

High potassium levels in the blood can also affect heart function. Think of the heart as a big electrical circuit; if the potassium levels get too high, it can short circuit the heart and even lead to life-threatening arrhythmias - abnormal electrical rhythms of the heart. If your potassium levels tend to be high, your doctor will be monitoring you closely with blood work.
 
Normal Potassium Levels
 
As reported on your blood work report, a normal potassium level is between 3.5 and 5.0 milliequivalents (meq). Levels higher than 5.5 warrant close monitoring, more dietary restrictions of potassium, a change in medication, or active treatment for the potassium depending on how high the level is. Your doctor will discuss the various treatment options with you.
 
Reading Food Labels
 
When grocery shopping, read the food labels. You should know the nutritional value of what you are buying. Many food labels display the sodium content but not the potassium content. This, however, does not mean that those foods are without potassium or other electrolytes and minerals. Rather, it means that you have to search for more information regarding the nutritional value. To do so, you can visit the website of that particular product, or you can visit excellent websites like www.fns.usda.gov or www.nutritiondata.com.
 
LOWERING YOUR PROTEIN INTAKE 

In the United States, most of us eat way more protein than we need. Having protein in the urine forces your kidneys to work harder, and in CKD they do not cope well with the accumulated protein overload. One of the mainstays of treatment is a diet lower in protein. If you have CKD, the general recommendation with regards to dietary protein is that you should take in no more than 0.6 to 0.8 g/kg of body weight daily. These calculations are again done using the metric system (just to make it more confusing!).

For calculations concerning body weight, the first step is to convert your body weight from pounds to kilograms. To do this, simply divide your weight in pounds by 2.2 to get your weight in kilograms (2.2 kg = 1 lb). For example, a body weight of 150 lbs, divided by 2.2, is equal to 68 kg of body weight. The amount of allowable protein, then, is 68 g x 0.8, which equals about 55 total g of protein daily.

There is a general misconception that protein can only be obtained from animal sources. Animals are good sources of protein, but they are often high in saturated fat and a main source of dietary cholesterol. Some plants, however, are equally good sources of protein and they have the added benefits of being low in saturated and high in fiber. One concern had been that by eliminating all animal sources of protein, you were not getting all of the different types of protein your body requires. By combining many plant sources, however, daily protein needs can be met.

In addition to plants, other non-animal sources of protein include soy, tofu (a soy-based food), and whole grains. If it is determined that you need additional protein in your diet, you can see that you have many supplemental sources to choose from, both soy- and vegetable-based. Always talk with your doctor before trying a new supplement.

A concern in restricting protein worth mentioning is the potential for malnutrition. Your doctor will order routine blood work to assess albumin and prealbumin levels. These tests measure the nutritional status in your body. High protein diets or body-building protein supplements are strictly off-limits unless otherwise directed by your doctor or dietitian. To find out more, you can check out Kidney Disease Diet Recipes.

 

Diet For People With Kidney Disease

LOWERING YOUR SODIUM INTAKE 

One of the first conversations you had with your doctor likely included a discussion on sodium, with the recommendation to lower your sodium intake and omit the use of the salt shaker. The reason for this is that diseased kidneys cannot deal with the increased sodium of the present-day diet. A high sodium intake increases the risk of high blood pressure, edema, and in some cases, leads to congestive heart failure.
 

Diet For People With Kidney Disease

The Difference Between Sodium and Salt 

Sodium chloride, or table salt, contains about 40 percent sodium. In general, a teaspoon of salt contains about 800 ml of sodium. With CKD, you should not add salt to your cooking or to your food at the table. You should also limit naturally salty foods. If your doctor has prescribed a fluid restriction, salt will increase your thirst, which can make it difficult to comply with her orders.
 
An additional, hidden source of sodium is found in over-the-counter medications. These include pain relievers, cough medicines, laxatives, effervescent tablets, and antacids. Research on pain relievers suggests that a high number of tablets and frequency of use can result in increased risks of high blood pressure in both men and women. Always consult with your doctor before taking any over-the" counter medications.

More on Fluid Restriction
 
In addition to restricting sodium, depending on your stage of kidney disease and other health issues, you may also be asked to watch the amount of fluids you take in. Previously, we talked a little about the reasons for restricting fluid intake. Here we will talk about how to go about it. A prescribed fluid restriction includes all fluids, including fluids taken with medications, alcohol, coffee, cream, fruit, milk, popsicles, pudding, sauces, soft drinks, soda, and yogurt, including frozen yogurt. Ice cream, ice milk, and ice cubes are also considered. One ice cube equals 10 mls of liquid.
 
Some people find it easier to visually monitor their intake throughout the day by measuring out their total fluid allowance into a pitcher or other container every morning. This helps them ration their allowances throughout the day. After taking a drink, an equal amount of fluid is removed from the container. When the container is empty, the allotted fluid has been reached for the day.
 
Remember that any food that is liquid at room temperature also needs to be included as fluid intake. Don't forget those juicy fruits such as melons and citrus fruits, and also vegetables like cucumbers. Save up your allowance if you have a scheduled social event or will be celebrating a holiday in the evening. 

Examples of Foods High in Sodium
 
Many foods contain traces of sodium, but processed foods can contain very high amounts. Most people already know that snacks such as chips, crackers, pretzels, etc, are packed with sodium. However, they are typically unaware of unexpected sources of sodium such as canned foods, processed meats and cheeses, ready-made meals, gravy mixes and sauces, stuffing, bouillon cubes, and other processed foods. This is why it is so important to read food labels and find out the amount of sodium each item has. To give you an example, certain types of canned soups can have as much as 1 g (1000 mg) of sodium in one can. If you are on a sodium restriction, then by consuming that soup you will have already met more than half of your total daily requirement.
 

Sodium Allowance 

In general, you should restrict your sodium intake to no more than 2 g (or 2000 mg) daily. If you have advanced CKD, significant edema, or congestive heart failure, then your doctor may discuss lowering it even further, to about 1500 mg daily. This amount is not set in stone and can vary if your health condition changes. For example, if you were to get a "stomach bug" and experience some diarrhea, your doctor may instruct you to eat more sodium-rich foods to replace what you are losing. In the case of diarrhea, for example, you may also be asked to drink more fluids in order to prevent dehydration. It's important to communicate with your doctor if you notice any changes in health. To find out more, you can check out Diet For People With Kidney Disease.

Best Diet For Kidney Disease

Exposures at Work
 
With regards to kidney health, exposures to certain heavy metals, such as lead, mercury, and cadmium can affect your kidney function over time. Painters, those working on old houses, machinists, and the like should be aware of the environment in which they work for exposures that affect their kidney health.
 

Best Diet For Kidney Disease

KEEPING HYDRATED
 
Once you have established that your drinking water is safe, it is important to stay hydrated. Our bodies are 60 percent water, and keeping ourselves hydrated is important not only in keeping our systems healthy, but also in keeping our systems flushed.

How much you can drink depends on your overall situation. For someone with CKD, this is a loaded question. Some people in advanced stages of CKD may be restricted by how much they take in. Examples of such restrictions commonly prescribed by doctors include one liter (one liter is about one quart) or one and a half liters total for the whole day. If you also have a heart problem such as congestive heart failure (CHF) or significant problems with edema, your doctor may also place a restriction on how much you can drink on a daily basis. Please understand that fluid restriction means the total amount of fluid; this not only includes water, but tea, juice, and other beverages, as well.
 
Additionally, you may be asked to weigh yourself daily. If there are significant weight changes on a daily basis - either too much weight or too little weight - the amount of fluid you take in each day can change. Weight that changes daily is reflective of water weight; weight that changes over longer periods of time is more reflective of changes in food intake.

If your doctor has not placed a restriction on the amount of liquid you can take in, an acceptable approach is to drink when you are thirsty. You can also take in water through other sources, including food.
 
Our water, our environment, and even some of our over-the-counter medications can have toxic effects on our kidneys and overall health. Not only as consumers, but as people with CKD, we need to know what we are being exposed to, and what we can do to avoid it. Keep vigilant, and look closely at what you are putting in your mouth, because your kidneys could be affected.

Eating right is something that all of us can and should do. This is especially true in kidney disease. Food is power. Consuming a well-balanced diet can help our bodies maintain good health and slow down - even improve - the progression of kidney disease.

Before going any further, however, it is important to clarify the term "diet." A diet is not an abstinence regimen to lose weight; rather, it is a balanced way of eating and living. If you are overweight, weight loss is important. The key is losing it while still providing your body with the nutrition it needs. Many of us eat to excess and yet we are sufficiently lacking the nutrients our bodies require. You can eat less and still feel more satisfied by eating healthy. If you are tempted to eat sweets and empty-calorie junk foods when they are in your pantry, simply don't put those items in your grocery shopping cart. Your wallet, your waistline, and your health will all thank you.

A "kidney diet" can vary from person to person according to other medical conditions and the results of blood work. Deciding what to eat often becomes a juggling act, especially if diabetes - the leading cause of CKD - and hypertension - the second leading cause of CKD - are present. Depending on your stage of CKD, further food restrictions may be required.

We will be discussing general food guidelines in the setting of CKD, emphasizing natural rather than processed foods. You will gain an understanding of how nutritious food translates to decreased inflammation and body balance maintenance. You will also begin to understand how to make better food choices while still adhering to the many "dietary restrictions" you face. Always consult with your doctor and dietitian before attempting any dietary changes. This is important, especially if your kidney disease has progressed to stages four and five. To find out more, you can check out Best Diet For Kidney Disease.