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
NOTE: Olive oil, margarine and mayonnaise contain little or no protein
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