Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved
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A Nutrition Education Tool for South Asians with Renal Disease Kalpana Balasubramanian, M.S., Ashwini Wagle, M.S., R.D., Assistant Professor & Kathryn Sucher, Sc.D., R.D., Professor Department of Nutrition and Food Science San Jose State University Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Diet and Renal Disease When you have renal disease, diet is an important part of your treatment plan. Your recommended diet may change over time, depending on how your condition progresses. Few things that are important to your diet include 1. Getting the right amount of calories and protein 2. Appropriate levels of phosphorus, potassium, sodium and fluids in your diet 3. Staying at a healthy body weight Calories: Calories are important to your overall health and well being. Calories are found in all the foods you eat. Why is getting the right amount of calories important? Getting the right amount of calories is important because they Give your body energy Help you stay at a healthy weight Help your body use protein for building muscles and tissues Because your recommended diet may limit protein, you may also be cutting down on an important source of calories. As a result, you may need to get extra calories from other foods. Proteins: Protein is found in bones, muscles, skin, organs, blood, hormones and enzymes Why is getting the right amount of protein important? Getting the right amount of protein is important to your overall health and how well you feel. Your body needs protein for Building muscles Repairing tissue Fighting infections You will need to limit the amount of protein in your diet. This will help decrease wastes in your blood, helping your kidneys to work better. Phosphorus: Phosphorus is a mineral found in your bones. It is essential for Building strong bones Keeping other parts of your body healthy Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Why is phosphorus important for you? Your kidneys may not be able to remove enough phosphorus from your blood. This causes the level of phosphorus in your blood to become too high. A high blood phosphorus level may cause a loss of calcium from bones. Your bones may become weak and break easily. Phosphate Binders: Medicines called phosphate binders absorb the excess phosphate in your GI tract and help maintain serum phosphate levels. Taking a phosphate binder before every meal helps to maintain serum phosphorus levels if your levels are high. Potassium: Potassium is a mineral that controls nerve and muscle function. Why is Potassium important for you? Potassium is an important mineral in the blood that Helps your muscles and heart work properly Maintains fluid and electrolyte balance The amount of potassium in the blood is controlled by the kidneys. When the kidneys are not working, high levels of potassium build up in the blood. This can cause muscle weakness. Since your heart is a muscle, high potassium levels could cause it to beat abnormally or stop. Sodium: Sodium is a mineral found naturally in foods. It is found in large amounts in table salt and in foods that have added table salt such as seasonings, most canned foods and some frozen foods. Why is Sodium important for you? Sodium is essential for Fluid balance Nerve activity Muscle contraction You will need to limit the amount of sodium in your diet, especially if you have high blood pressure and extra fluid in your body. Everyone needs some sodium. However, sodium is found naturally in foods and most people eat more sodium than they need. When kidneys fail, the extra sodium is not removed. With extra sodium in your body, you Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved will feel thirsty and may drink more fluids which could be dangerous for you. The best way to control thirst is to limit sodium in the diet. Fluids: In kidney disease, fluid restriction is essential. Fluid allowance is highly individualized. Why is Fluid important for you? Going over your recommended fluid allowance can lead to too much fluid building up in your body between dialysis treatments. This excess fluid causes Swelling High Blood pressure Fatigue and shortness of breath Fluid in Lungs Congestive heart failure Sources: National Kidney Foundation: http://www.kidney.org/atoz/pdf/nutri_chronic.pdf Chronic Kidney Failure- A guide to better living: Mid Atlantic Renal Coalition Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Renal Exchange List Grains/Cereals/Bread 6-11 servings each day Milk/Yogurt/Cheese ½ cup milk or ½ cup yogurt or 1 ounce cheese each day Meat/Protein 8-10 ounces of high protein foods each day Fruits/Fruit Juices 2-3 servings of low potassium fruits. One serving = ½ cup or 1 small fruit or ½ cup of juice Vegetables 2-3 servings of low potassium vegetables each day. One serving = ½ cup cooked or 1 cup raw Salt/Sodium Use less salt and eat fewer salty foods. Use herbs, spices and low salt flavor enhancers in place of salt. Avoid salt substitutes made with potassium Desserts Depending on your caloric needs, your Dietitian may recommend high-calorie desserts. If you are a diabetic, discuss low carbohydrate dessert choices with your Dietitian Source: National Kidney Foundation Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Nutrient Recommendations for varying levels of kidney failure Nutritional Normal Stages 1-4 Stage 5 Stage 5 Parameter kidney chronic Hemodialysis Peritoneal function kidney disease Dialysis Calories 30-37 30-35 30-35 30-35 (Kcal/kg/d) Protein 0.8 0.6-0.75 1.2 1.2 (gm/kg/d) Sodium Unrestricted 1000-3000 2000-3000 Highly (mg/d) individualized, can range from 2000-4000 Potassium Unrestricted Unrestricted 2000-3000 Generally not (mg/d) unless serum restricted, level is high approximately 3000-4000 Phosphorus Unrestricted 10 mg/kg/day 800-1000 800-1000 (mg/d) Fluid (mL/d) Unrestricted Unrestricted 1L/day + daily Individualized. urine output Can range from 2-3 L/day + daily urine output Sources: Beto, J. A., Bansal,V.K. Medical nutrition therapy in chronic kidney failure: Integrating clinical practice guidelines. Journal of American Dietetic Association. 2004; 104:404- 409. Nelms, M., Sucher, K., & Long, S. Nutrition Therapy & Pathophysiology Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Some Suggestions and Tips : Keep a diary of what you eat each day. Show this to your Dietitian on a regular basis. Ask your Dietitian which nutrients you need to limit in your diet. Do get help from your Dietitian in planning your meals. Be aware of portion size. Always choose small portions. Learn to read food labels, so you can make healthier food choices. Watch out for foods that have added table salt such as seasonings, canned foods, most frozen foods, salty snack foods like chips, restaurant and take out foods. Herbs, spices, table wine and special vinegar can be used instead of salt to make your foods flavorful. Try fresh or dried herbs and spices to enhance the flavor of foods. Limit high salt foods so you will have less thirst. Drink from small glasses and cups. Drink only when you are thirsty. Reach for cold beverages. Beverages that are less sweet will quench your thirst. Use sour candy or sugar free gum to moisten your mouth. Remember that some foods should be counted as liquids. These include soups, popsicles, sherbet, ice cream, yogurt, custard and gelatin. Non-dairy creamers can be used in place of milk in cereals, coffee and many sauces to lower the amount of phosphorus in your diet. Choose dry dishes instead of curries and sauces. If you would like to have a dish with sauce, choose smaller portions. If you would like to have soups, instead of cream soups and dhal soups, try mulligatawny soup. Rice is an excellent choice. Choose plain boiled rather than fried. Plain rotis and naans are good choices. Avoid rotis and naans with stuffing. Steer away from dishes which are based on chickpeas. Many desserts contain milk, milk powder, nuts and dried fruit, so may not be suitable. Avoid dishes which contain coconut milk and shredded coconut. Source: Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved National Kidney Foundation List of Foods Copyright © 2011 Department of Nutrition and Food Science, SJSU All Rights Reserved Low Potassium Foods (< 200 mg/serving) Breads Cereals / Grains / Pasta 1 Chapathi, 6”diameter ½ C Sabudhana Kichidi 1 Pulka, 6” diameter ½ C plain Poha 1 Makki ki Roti, 6”diameter ½ C Pongal 1 Roomali Roti, 6”diameter ½ C Rava Upma ¼ plain Naan ½ C plain Rice Upma ½ plain Paratha ½ C Bulgur Upma 2 plain Puris, 5”diameter ½ C Barley, pearled (cooked) 2 Methi Puris, 5”diameter ½ C Couscous (cooked) 1 Bhatura, 6”diameter ½ C White Rice (cooked) ¼ plain Kulcha ½ C Brown Rice (cooked) 2 Kakhara ½ C Tamarind Rice 1 plain Dosa, 6”diameter ½ C Lemon Rice 1 Green Gram Dhal Dosa, 6”diameter ½ C Egg Fried Rice 1 Rava Dosa, 6”diameter ½ C Vegetable Pulao 1 plain Utthapam, 6”diameter ½ C Saffron Rice 2 Rava Idlis ½ C Rice Pulao 2 Rice Idlis ½ C Shrimp Fried Rice 1 Adai, 6”diameter ½ C Rice Vermicelli 1 Pessaratu, 6”diameter ½ C Sesame Vermicelli 4 Pakodas ½ C regular Dalia 1 slice White Bread ½ C Sprouted Wheat 1 slice Wheat Bread ½ C Oatmeal 1 slice Raisin Bread ½ C Corn flakes 1 slice Rye Bread ½ C Cereal (cooked) 1 small Pau (Dinner Roll) ½ C Cream of Wheat (cooked) 1 Sweet Bun 1 C Puffed Rice Cereal ½ plain Bagel 1 square Semolina Dhokla ½ Egg Bagel