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Transcript
Hot Nutrition Topics
Kelly L. Welsh, R.D., C.D.
Registered Dietitian
Author of “Brilliant Eats: Simple and Delicious Recipes for
Anyone Who Wants to Be KidneyWise”
March 8th, 2011
Objectives
• Learn about basic kidney nutrition concepts.
• Get familiar with the current state of knowledge
regarding kidney nutrition and various topics
affecting such.
• Learn how to critically review the options in
various food, supplement and new product items,
which will help the attendee in making educated
decisions as to what is helpful, harmful, economic
and safe.
Why is Diet Important?
• Your diet affects how you feel.
• By monitoring your diet, you can help control
your blood pressure, blood sugars, and
weight.
• Your diet keeps you healthy and wellnourished.
• Current research demonstrates that a person
with PKD can play a major role in controlling
the development of their disease with regular
health care maintenance, a good diet and
regular exercise.
Normal weight Americans
are now in the
MINORITY!?!?
USA Obesity Rates Reach Epidemic
Proportions
• 101 million Americans are
overweight or obese
• 8 out of 10 people over 25 are
overweight
• 78% of Americans do not
meet basic activity level
recommendations
• 76% increase in Type II
Diabetes in adults since 2000
• Childhood obesity has tripled
in 20 years
Obesity-Related Diseases
• 80% of type II diabetes is related to obesity; 40% of
people with type II diabetes will end up with kidney disease
• 70% of cardiovascular disease is related to obesity
• 42% of breast and colon cancer is diagnosed among obese
individuals
• 30% of gall bladder surgery is related to obesity
• 26% of obese people have high blood pressure
Managing Your Diet
• IMPORTANT! Each individual’s diet should
be personalized by your physician and/or
dietitian.
• Everyone has different needs, based
upon: lab results, weight loss/gain, age,
gender, other disease states, etc.
• Continue to learn all that you can about
your diet and changing trends.
Vitamin D
•
•
59% of the U.S. population is
deficient in Vitamin D
Importance, deficiencies and
adverse affects
–
•
Sources
–
–
•
Excessive bone loss, immune
deficiencies, MS, Diabetes, cancer,
and rheumatoid arthritis
Natural sunlight
Fortification of dietary foods, dairy
products, eggs, some cereals and
oily fish
RDA
–
–
400-600 IU
Upper safe limit is 2,000-4,000
Vitamin D Levels in Serum
25 (OH) D Level
ng/ml
(used in USA)
nMol/L
(international)
Deficient
less than 8
less than 20
Insufficient
8-20
20-50
Optimal
20-50
50-125
High
50-90
125-225
Toxic
greater than 90
greater than 225
Vitamin D Supplementation
• Children and adults with poor sunlight exposure- 600-1000
units/day
• Adults older than 70- 800-1000 units/day
• Patients with cystic fibrosis- 800-1000 units/day
• Patients with malabsorption- Up to 50,000 units/day, check levels
• Patients with liver disease- May need active metabolites
• Patients with kidney disease- Need active metabolites
• Patients with kidney stones- Be careful not to give excess,
check levels, don't exceed 30 ng/mL
Probiotics
• Science on and
immune health vs.
Prebiotics
• Good advice
• How much?
High-Protein Diets
• Promote ketosis
• Stress the kidneys
• Promote temporary weight
loss
• Low in important nutrients
and fiber
• High in fat
• Bad for the bones
Protein
• Aim for no more than .8 grams of protein per
kilogram of Ideal Body Weight (IBW) per day.
• Animal and human studies have demonstrated
that a modified-protein diet can help slow the
progression of PKD, especially if implemented
before severe symptoms appear.
– To figure out IBW:
• Women: First 5 feet = 100#; Every inch
above 5 feet, add 5 pounds
• Men: First 5 feet = 106#; Every inch above
5 feet, add 6 pounds
Soy Protein
• Add soy protein to your daily diet:
– Some studies report that soy protein slows the
progression of PKD.
– When compared to Western cultures, Asia has lower
rates of PKD, which they believe is due in part to their
higher soy intake.
– Soy contains antioxidants (isoflavones) and essential
fatty acids that help cool down inflammation in the
kidneys.
– Examples: soybeans, soy nuts, tofu, soy flour, and
soymilk.
– Soy has also been proven to help ward off other
diseases, such as cancer, osteoporosis and heart
disease.
– Use in moderation, if you have liver cysts.
Vegetarian
Diets
• Eat a (mostly) vegetarian diet high
in antioxidants:
– Diets based on plant proteins
versus animal proteins help
lower blood pressure and may
help slow the growth of kidney
cysts.
– Sources of plant proteins
include: legumes,
peanuts/peanut butter and soy
products. Other sources of
protein are vegetables and
whole grain products.
– Brightly colored fruits and
vegetables, whole grains and
legumes are rich sources of
antioxidants, which may help
protect the kidneys.
Animal vs. Vegetable
Protein
• Animal proteins are considered complete
proteins, because they contain ample amounts of
all the essential amino acids.
• Vegetable protein (grains, legumes, nuts, seeds,
and other vegetables) are incomplete proteins,
because they are missing or do not have one or
more of the essential amino acids.
Carbohydrates
• Use whole grains whenever possible:
– Chromium
• Diabetes, Heart Disease, Cholesterol, Triglycerides,
Hypertension, Stroke, Neurologic problems, and
Weight Problems.
– Magnesium
• Diabetes, Cancer, Cardiovascular Disease,
Hypertension, Osteoporosis, Migraines, Kidney
Stones, Pregnancy Problems, and PMS.
Carbohydrates
Friend or Foe?
Carbohydrates
• Fiber
– RDA recommendation for fiber is 30
grams per day.
– Look for foods that identify fiber content
of >3 grams of fiber per serving.
– Why fiber?
Food
Fiber grams
Serving size
Raspberries
8.0
1 cup
Spaghetti, whole
wheat, cooked
6.2
1 cup
Potato, baked, with
skin
15.6
1 medium
Broccoli
5.1
1 cup
Pear, medium, with
skin
5.0
1
Apple
3
1 medium
Popcorn
3.6
3 cups
Fiber: Where to get it?
The Bottom Line
•
•
•
•
•
Choose high-fiber, low-fat foods
Choose whole grain
Limit high-calorie snack foods
Monitor portion sizes
Limit use of artificial sweeteners
-What about Stevia, Truvia, etc…
Organic Foods
• What is organic?
• Is organic better?
• When is it worth
the splurge?
Omega 3’s
• Benefits
• Sources
• How much do I
need?
• Should I
supplement?
Energy Drinks
What are they?
Common Ingredients
Are these harmful?
Caffeine
– Recommended
intake
• Water
– How much?
– Types: Purified,
spring, mineral and
sparkling
•
•
•
•
Food Item
Caffeine
Monster Energy 160 mg
Drink - 16 oz.
Coffee - 8 oz.
100 mg
Red Bull - 8.2
oz.
80 mg
Mountain Dew - 56 mg
12 oz.
M&M’s Milk
Chocolate
candies - ½
cup
16 mg
Root Beer - 12
oz.
0 mg
Eat This
• Power Foods
– Red bell peppers, cabbage, cauliflower,
garlic, onions, apples, blueberries,
raspberries, strawberries, cherries, red
grapes, egg whites, salmon, and olive or
grapeseed oil.
Eat This
Power Spices
Cinnamon
Ginger
Oregano
Red Pepper
Rosemary
Thyme
Yellow Curry
Garlic
Cloves
Tumeric
Not This
• Sodium
– Processed Foods: Lunch meats, hot dogs,
sausages, etc.
– Canned soups
• High-Fructose Corn Syrup
– Soda and other sweetened drinks
– Fast Food
• Trans-Fatty Acid (partially hydrogenated
vegetable oils)
– Margarine
– High-fat baked goods
– Snack foods
Other Concerns for Kidney Disease
Patients
• Potassium
• Phosphorus
• Herbal
supplements
Potassium
• Load up on potassium-rich foods - AS
YOUR LABS DICTATE !!!
• Potassium is a mineral that helps muscles
and nerves work the right way.
• High-potassium diets may help slow the
decline in kidney function.
High-Potassium Foods
•
•
•
•
•
•
•
•
Bananas
Avocados
Oranges
Cantaloupe
Dried Fruit
Legumes
Nuts/Seeds
Chocolate
•
•
•
•
•
•
•
•
Milk
Molasses
Salt Substitute
Tea
Coffee
Granola
Bran/Bran Products
Tomato/Tomato
Products
Phosphorus and Calcium
• Phosphorus is a mineral which combines with
calcium to keep bones and teeth strong.
• Too little calcium and too much phosphorus will
weaken your bones.
• Your physician may prescribe a phosphate binder
(Tums, Phoslo, Renagel, Fosrenol) or a calcium
supplement.
• Do not take any binders or calcium supplements
unless your physician or dietitian approves them.
High-Phosphorus Foods
Cocoa/Chocolate
Bran
Chicken/Beef Liver
Avocados
Dairy Products
Oatmeal
Legumes and Dried
Beans
• Broccoli
•
•
•
•
•
•
•
Cornbread
Mushrooms
Brussel Sprouts
Caramel
Nuts and Peanut
Butter
• Artichokes
• Asparagus
• Cola Sodas
•
•
•
•
•
Vitamin, Herbal and Over-the-Counter
Supplements and Remedies
• Do not take anything that your physician and/or
dietitian has not approved.
• PKD patients should only use Tylenol as an OTC
pain reliever.
• Do not use ibuprofen or ibuprofen-containing
products except under the supervision of a
physician.
Use of Herbal Supplements in
Chronic Kidney Disease
• Very few herbs have been studied in CKD patients. What may
be safe for healthy persons may not be safe for someone with
CKD, and, in fact, could be dangerous. Therefore, you need to
be very cautious about your use of these products.
• The government does not regulate herbal supplements, so the
exact content of these products is unknown. Without
regulation, there are no requirements for testing, so the
purity, safety and effectiveness of the products are unknown.
• Herbal preparations are subject to contamination (may
contain toxic heavy metals, such as lead or mercury).
• Products may contain minerals harmful to CKD patients. For
example: potassium.
Use of Herbal Supplements in
Chronic Kidney Disease (cont’d)
• Some herbs that may serve as diuretics may also cause
“kidney irritation” or damage. These include bucha leaves
and juniper berries. Uva Ursi and parsley capsules may have
negative side effects as well.
• Many herbs can interact with prescription drugs. A few
examples are St. John’s Wort, echinacea, ginkgo, garlic,
ginseng, ginger, and blue cohosh. Transplant patients are
especially at risk, as any interaction between herbs and
medications could potentially put them at risk for rejection or
losing the kidney.
• It is important to ask your doctor and/or pharmacist about
any herbs or medicines you want to take to avoid potential
problems.
Use of Herbal Supplements in
Chronic Kidney Disease (cont’d)
Herbs That May Be Toxic to the Kidneys
Artemisia Absinthium (Wormwood Plant)
Periwinkle
Autumn Crocus
Sassafras
Chuifong Tuokuwan (Black Pearl)
Tung Shueh
Horse Chestnut
Vandelia
Cordifolia
Use of Herbal Supplements in
Chronic Kidney Disease (cont’d)
Herbs That May Be Harmful in Chronic Kidney Disease
Alfalfa
Buckthorn
Ginger
Nettle
Aloe
Capsicum
Ginseng
Noni juice
Bayberry
Cascara
Horsetail
Panax
Blue Cohosh
Coltsfoot
Licorice
Rhubarb
Broom
Dandelion
Mate
Senna
Vervain
Use of Herbal Supplements in
Chronic Kidney Disease (cont’d)
Herbs Known to Be Unsafe for All People
Chapparal
Pennyroyal
Comfrey
Pokeroot
Ephedra (Ma Huang)
Sassafras
Lobelia
Senna
Mandrake
Yohimbe
Herbal Supplements
Before you take any herbal supplement:
• Check with your doctor, dietitian, pharmacist and/or
product manufacturer regarding safety, dosage,
duration of use, interactions with prescription drugs,
etc.
• Use only standardized herbal extracts made by
reputable companies.
• Never take more than the recommended dosage or
for longer than recommended.
• Do not use herbal remedies for serious illnesses.
Will My Diet Change Over Time?
• Your diet may change as your kidney
function changes.
• As kidney function declines, and
waste products build up, you will
probably need more dietary
restrictions.
• Initiation of dialysis will then change
diet requirements again.
Conclusion
• Moderation is still the best policy.
• Stay informed!
• Remember, each person’s diet
should be set up for him or her.
• Always consult your physician and/or
dietitian before making any changes
and/or additions to your dietary plan.
Questions