Hd Diet Basics.v2

8/6/2019 Hd Diet Basics.v2

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RENAL DIET

BASICS


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WHAT KIDNEYS DO

! Remove wastes from the blood via urine! Balance fluid content in the body! Produce the enzyme renin that helps control blood pressure! Produce the hormone erythropoietin to help make red blood

cells

!Activate vitamin D to maintain healthy bones!Maintain the proper balance of acid and minerals, including

sodium, phosphorus, calcium, potassium and magnesium


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DIALYSIS AND DIET

DIALYSISand aGOOD MEAL PLAN can help you maintaingood health and feel good

TO MAINTAIN GOOD HEALTH, YOU WILL NEED TO CONTROL 6 THINGS:

! PROTEIN! PHOSPHORUS! CALCIUM! POTASSIUM! SODIUM! FLUID


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PROTEIN YOU NEED PROTEIN TO KEEP YOUR BODY STRONG AND HEALTHY

PROTEIN IS IMPORTANT FOR:

! Fighting infections!Growth and tissue repair! Production of hormones, antibodies and enzymes! Balance of acid-base, fluid and electrolytes

!As a dialysis patient, your protein needs are HIGHERbecause each timeyou dialyze, you lose some protein.

!Animal protein is called HIGH QUALITY PROTEIN because it has all thebuilding blocks (amino acids) that our body needs.

ALBUMIN is a type of protein found in the blood. It can be used toevaluate your nutritional status. A low albumin on your monthly lab

report can mean that you are not getting enough protein.

YOU WANT YOUR ALBUMIN IN A SAFE RANGE OF4.0 5.2 G/DL


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ESTIMATING A SERVING OF PROTEIN

!1 oz cooked = a matchbox!3 oz cooked = a deck of playing cards or an average persons palm!8 oz cooked = a paperback book

3 oz also equals to: 2 thighs = 2 drumsticks = 1 thigh + 1 drumstick = 3

slices of luncheon meats (low salt) =3/4 cup of tuna or chopped meat = 6

small spareribs = 4 medium shrimp

PROTEIN HIGH QUALITY PROTEIN SOURCES INCLUDE:

Meat Fish SeafoodPoultry Game Eggs

= 1 oz of protein

If you cant meet your protein needs with food alone, you may

require a protein supplement

Most dialysis patients need to eat about8 -10 ounces of HIGH QUALITY PROTEINdaily


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PHOSPHORUS! Phosphorus is a mineral found in many foods, like nuts, dried beans,

and dairy products.!About 85% of phosphorus in the body is in bones.!The body uses phosphorus to:

! Form strong bones and teeth!Make energy!Get oxygen to tissues!Move muscles! Produce hormones

EATINGTOO MUCH PHOSPHORUS CAN CAUSE:! Itching! Bone pain! Bone weakening, causing bones to crack or break! Hardening of soft tissue (calcification)! Nausea, vomiting, diarrhea


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PHOSPHORUS

HOW TO KEEP PHOSPHORUS UNDER CONTROL:

! Follow a low-phosphorus diet.!Take the prescribed dose of phosphate binders (PhosLo, Tums,

Fosrenol, Renagel, Renvela, calcium carbonate) with EACHmeal and snack. It is also important to take your bindersWITHIN 10 MINUTESof meals and snacks.

! Be sure to go to and complete ALL of your dialysis treatments.HIGH PHOSPHORUS FOODS

1 cup Milk (236 mg)

1 cup Frozen Yogurt (353 mg)

1 oz Chocolate (200 mg)

12 oz Cola (44 mg)

1/2 cup Brown Rice (81 mg)

L AL APOSSIBLE ALTERNATIVES1 cup Non-Dairy Creamer (132 mg)

1 cup Sorbet (19 mg)

1 oz Jelly Beans or Hard Candy (1 mg)

12 oz Ginger Ale or Root Beer (0 mg)

1/2 cup White Rice (12 mg)


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CALCIUMCALCIUM!Calcium is the most abundant mineral found in the body.!About 99% of calcium in the body is in bones and teeth.!The remaining 1% is found in blood and soft tissues.

YOUR BODY USES CALCIUM TO:

" Form and maintain strong bones and teeth" Help muscles contract and relax" Transmit nerve impulses" Aid in blood clotting

LOWcalcium can cause:

" Muscle spasms" Bone loss" Very low levels can cause

seizures

HIGHcalcium can cause:

" Calcification of soft tissue" Weakness" Very high levels can cause

confusion and vomiting

Calcium and phosphorus work together to help build bones.They do this by keeping a balance in your bloodstream.

If they are off balance, trouble begins!


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CALCIUMCALCIUM! If calcium levels are too low, calcium supplements may be necessary.! If levels are high, limiting exposure to calcium is very important.

SOURCES OF CALCIUM MAY INCLUDE:DIET- high calcium foods, enriched or fortified foods

DIALYSATE

CALCIUM BASED PHOSPHATE BINDERSsuch as PhosLo, Tums or calciumcarbonate (Renagel and Fosrenol do not contain calcium)

ANTACIDSsuch as Tums or Rolaids

! Reading the food label is a good way to find out if a food product is

calcium fortified and how much calcium is in a serving of food.! Do not buy foods whose labels state that they are "good or excellent"

source of calcium.

! Foods that provide 10% or more of the Daily Value (DV) for calciumshould be avoided unless recommended by your dietitian.


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POTASSIUM

! Potassium is a mineral that is needed for your nerves and muscles towork properly.

! Fruits and vegetables are the major sources of potassium in our diet.!To control your potassium level, limit your intake of combined fruit andvegetable servings to 5 per day.

!Serving size is important. One serving is usually1/2 cup or 1 small.

! piece.Eating too much potassium can cause:Muscle weakness

Irregular heart beat

Slow heart beat

Heart attack

Low potassium levelscan cause:Muscle weakness

Cramping

Fatigue

Irregular heartbeat

Excessive vomiting or diarrhea, poor food intake, and certainmedications, such as diuretics, can cause low potassium levels


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POTASSIUM

AVOID THE FOLLOWING HIGH POTASSIUM FRUITS

MELONS: honeydew, cantaloupe, watermelon

DRIED FRUITS: figs, apricots, dates, prunes, raisins

CITRUS FRUITS: orange, orange juice, tangelo

PASSION FRUITS: kiwi, mango, papaya, guava, nectarine, coconut, starfruit

MISCELLANEOUS: bananas, avocados

AVOID THE FOLLOWING HIGH POTASSIUM VEGETABLES

POTATOES: baked, mashed, sweet, white, French fries, chips

TOMATOES: juice, soup, spaghetti sauce, salsa, ketchup

SQUASH: winter, acorn, hubbard, butternut, spaghetti, pumpkin

DRIED BEANS: lima, red, garbanzo, navy, white, pinto, kidney, black

DRIED PEAS: chickpeas, black-eyed, split peas, cowpeas, lentils

MISCELLANEOUS: artichoke, baked beans, kohlrabi, spinach, parsnip, Swiss chard,

beet greens, and rutabagas


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SODIUM! Sodium is a mineral found in all foods, and your body needs it in

moderate amounts to stay healthy.

! Sodium is mainly found in table salt, processed and conveniencefoods.

! You need to control sodium intake to help control thirst andexcessive fluid gains between your treatments.

! Limiting salt also helps control blood pressure.

EATINGTOO MUCH SALT (SODIUM) CAN CAUSE:

" Swelling in legs, hands and face" Shortness of breath due to fluid build up in the lungs" High blood pressure" Heart failure" Thirst and drinking too much fluid


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SODIUM

TIPS TO KEEP YOUR SODIUM INTAKE IN A HEALTHY RANGE:

" Do not add table salt during or after cooking" Avoid highly processed or canned foods" Pick low sodium foods over regular foods when possible" Rinse canned vegetables under cold water to reduce sodium" Use regular flour, and omit baking soda and baking powder" Use herbs and spices to season, instead of salt substitutes" Do not buy items with > 300 mg of sodium per serving" Avoid foods that have sodium listed as one of the first 5

ingredients on the INGREDIENTS LIST (food label)

1 teaspoon of salt = 2300 mg of sodium


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Large shiftsin fluid can cause:

! Nausea and vomiting!Muscle cramps! Low blood pressure

during treatment

Fluidoverload can cause:

! High blood pressure! Swelling of the feet and hands! Shortness of breath! Congestive heart failure

FLUID" Since the kidneys are making much less urine or no urine at all, fluids

need to be limited.

" Even though dialysis gets rid of excess fluid and wastes in the body, it isnot as effective as healthy kidneys.

" Hemodialysis removes fluid as the blood is filtered through the dialysismachine. However, there is a limit on how much fluid can be safelyremoved during a dialysis session.

" It's recommended that you try to keep your fluid gains to less than 5% ofyour dry weight.


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FLUID

Usually fluid intake is limited to 4-6 (8 oz) cups a day

ANY LIQUID OR FOOD THAT MELTS AT ROOM TEMPERATURE COUNTS AS FLUID:" Ice Cream, Sherbet"Jell-O" Popsicles or juice bars"Sorbet or fruit juice"Wine, beer, or other alcoholic drinks" Ice cubes"Soft drinks, lemonade, fruit drinks"Sport drinks"Tea and coffee"Soup and broth"Custard and pudding"Milk and milk substitutes, shakes" Nepro, Magnacal Renal, and other enterals


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FLUID

"Plan ahead to spread allowed fluids over the course of the day andmeasure liquids BEFORE you drink them.

"Pour your daily fluid allowance (measured as water) into a pitcher.Whenever you drink or eat anything that counts as fluid, pour thesame amount of water out of the pitcher. Throughout the day, youwill know how much fluid you have left by seeing how much water isstill in the pitcher.

FLUID CONVERSIONS

1 cup = 8 ounces = 240 cc or ml

1 single popsicle =1/4 cup fluid

1 cup crushed ice =1/2 cup fluid

4 - 5 standard ice cubes =1/2 cup fluid1/2cup jello, ice cream or pudding =1/4 cup fluid

2 cups of fluid = 1 lb or1/2 kg


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VITAMINS

! Most people on dialysis cant get enough of some vitamins due to:" Vitamin losses during the dialysis treatment" Dietary restrictions" Poor appetite

! On the other hand, some vitamins need be limited becausethey can build up to toxic levels in your body.

!Special RENAL VITAMINSare usually recommended for dialysispatients to ensure that you get the right vitamins and minerals.

!Since dialysis removes some vitamins from your body, you need to

take your renal vitaminsAFTER YOUR DIALYSIS TREATMENT!

REMEMBER: Do not take any vitamin, mineral, or herbal supplements

without consulting your dietitian or doctor first.


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OOD LA ELFOOD LABELThe food label includes several sections: the nutrition panel, the ingredientlist, manufacturer contact information, and possibly some health claims.

!The NUTRITION PANEL part of the label identifies theserving size and how many servings are in that package.

All of the nutrition facts are given per serving.

! If the food is fortified or enriched with other nutrients,these must also be included on the nutrition panel.

!On this part of the label, nutrients may be stated as aPercent of Daily Value (DV). This includes calories,

protein, fat, carbohydrate and various vitamins

and minerals but as a percentage of a 2000 calorie

reference diet.

!Labels do not have to list phosphorus or potassium

this is voluntary. If this information is given, it may be

listed either as milligrams or percent DV.

! Remember: since phosphorus and potassiuminformation is optional, the food can still be high in

either one or both of these even though they are not

listed on the nutrition panel.


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OOD LA ELFOOD LABEL

! INGREDIENTS LIST- foods with more than one ingredient must have aningredient list on the label. This part of the label lists ingredients by weightfrom the LARGEST to the SMALLEST. So, whatever is listed first, is mainly

what this product has in it.

!Some ingredients that are used as preservatives or additives are betterabsorbed into the body than phosphates that are normally found within food.

In other words, the phosphorus from preservatives and additives more easilygets into the blood stream and raises the phosphorus level.

INGREDIENTS: SUCROSE, DEXTROSE, CITRIC ACID, SALT,

SODIUM CITRATE, NATURAL LEMON AND LIME FLAVORS,

MONOPOTASSIUM PHOSPHATE, YELLOW 5

Example of INGREDIENTS LIST

! Look for these things on the food label:"Sodium: limit to no more than 10% DV or 250 mg per serving" Potassium: limit to no more than 6% DV or 200 mg per serving" Phosphorus: limit to no more than 15% or 150 mg per serving"Calcium: limit to no more than 10% or 100 mg per serving


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OOD LA ELFOOD LABEL!Watch for things that have phosphate or potassium as part of the

ingredients listed.

! Examples are: phosphoric acid, sodium phosphate, monocalcium phosphate,dicalcium phosphate, monopotassium phosphate, or potassium chloride. It is

best to avoid or limit foods containing these in the ingredient list, particularly if

it is TOWARDS THE BEGINNING of the ingredient list.

! NUTRIENT CONTENT CLAIMSare guidelines from the FDA on what terms canbe used on labels.

! Examples of most popular claims:" REDUCED - means 25% or less of " GOOD SOURCE OF means it has 10% or more of the Daily Value of ..." HIGH IN - means it has 20% or more of the Daily Value of " LOW SODIUM less than 140 milligrams of sodium per serving" VERY LOW SODIUM - 35 milligrams or less sodium per serving


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KNOW YOUR LAB VALUES

YOU WANT TO SEE THESE VALUES ON YOUR MONTHLY NUTRITION REPORT

Albumin:

Phosphorus:

Calcium:

Potassium:

Cholesterol:

Hemoglobin:

URR:

eKt/v:

PTH:

> 4.0

3.5 - 5.5

> 70

11 - 12

100 - 200

3.5 - 5.5>1.2

8.4 - 9.5

150 - 300

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Hd Diet Basics.v2