Download DISEASE RELATED DIETS:

DISEASE RELATED
DIETS:
RENAL
Pre-End Stage Renal Disease
Pages: 487-499
Dialysis
Pages: 455-473
DESCRIPTION
A diet that is designed to
minimize the metabolic
complications associated
with renal disorders and
possibly delay the need for
dialysis. The nutrient
content of the diet is
planned to meet the
individual need, usually low
protein, sodium and
phosphorus. Potassium is
not usually restricted unless
urine output is diminished
or the patients is taking a
potassium sparing diuretic.
A diet that is used to
minimize uremic
complications and to
maintain acceptable blood
chemistries, blood pressure
and fluid status while
meeting the need of
individuals with impaired
renal function on
maintenance dialysis.
The diet is deficient in
calcium, iron, Vitamin B12,
and zinc due to low
phosphorus and protein
intake. Diets with  60
grams of protein may be
deficient in niacin, riboflavin
and thiamin. A specific renal
multivitamin (e.g.
nephrovite, nephrocaps) is
recommended.
INDICATIONS
PRINCIPLES
Patients with pre End Stage
Renal Disease or Chronic
Renal Insufficiency.
FOR ALL RENAL DIETS:
Offer high biological value
protein sources, such as
meat, poultry, fish and eggs
within the limits of the
protein restriction.
* DIABETIC RENAL*
GIVE GRAPE JUICE OR
APPLE JUICE FOR
LOW BLOOD SUGAR
Adjust phosphorus
allowance for lab values, &
reinforce the importance of
taking phosphorus binders
and limiting dairy products.
Supplement dietary calcium
intake.
Avoid salt and high
sodium foods, such as
bacon, sausage, luncheon
meats, regular soups, and
salted snack foods. Do not
use salt substitutes that
contain potassium, e.g.
NuSalt.
Avoid high potassium
foods like oranges, citrus,
prunes, melons, bananas,
yams, potatoes, tomatoes,
spinach, & winter squash.
Limit fluid intake, as
instructed. Offer hard
candies or chewing gum for
thirst.
Patients with End-Stage
Renal Disease on Dialysis,
either Hemodialysis or
Peritoneal dialysis.
LOW PROTEIN
Refer to Liver Disease,
pages: 415-419
POTASSIUM
RESTRICTED
“Low Potassium”
Refer to Potassium Modified
Diets on Pages: 761-768
SODIUM RESTRICTED
Pages: 769-777
A regular diet which
provides a specific level of
protein according to the
individual’s needs. Fluids
and electrolytes may need to
be restricted due to
coincident metabolic
complications.
Nutritionally adequate at 60
grams of protein; below that
is deficient in protein,
calcium, folic acid, iron,
phosphorus, thiamin, niacin
and riboflavin.
A regular diet which restricts
potassium rich foods in
order to achieve and
maintain fluid and
electrolyte balance when
potassium intake exceeds the
adaptive abilities of the
body. Commonly prescribed
levels are 3000mg (77mEq),
2000mg (51mEq), and
1000mg (25mEq)- however
less than 2000mg is difficult
to achieve through diet, and
will limit most vitamins &
minerals.
A modification of the
regular diet that restricts
foods high in sodium. This
diet is nutritionally adequate
and may be ordered at the
following levels:
 3-4 gram Na (130-174
mEq) = No Added Salt Diet
 2 gram Na (87 mEq)
Only at MAH & NEBH:
 1 gram Na (43 mEq)
For treatment of hepatic or
other disorders when normal
protein levels are not
tolerated. Also for lowering
serum ammonia levels and
to provide essential amino
acids.
Control amount of protein,
choose at least 75% from
high biological value
sources, such as eggs, meat,
fish, poultry and dairy
products.
Increase calories as
necessary by adding high
sugar and fat foods as
indicated.
Indicated in the treatment of
hyperkalemia, Renal Failure,
massive tissue destruction,
catabolic states, adrenal
insufficiency, Addison’s
Disease.
May be required for patients
taking potassium-sparing
drug therapy and some
immuno-suppressive
medications.
Indicated in the treatment of
Congestive Heart Failure,
Acute and Chronic Renal
Failure, impaired liver
function, edema, HTN,
CAD, and as an adjuvant to
adrenocorticol therapy.
Fluid restriction (1000-2000
ml) as needed.
Use low protein
manufactured products as
appropriate.
Limit intake of milk and
dairy products, fruits and
vegetables.
Refer to the RENAL DIET
list of high potassium foods
to avoid.
Avoid potassium containing
salt substitutes, such as
NuSalt and Morton’s Lite.
Omit salty foods and added
salt, including salt seasonings
such as garlic salt. Omit
cured foods and restrict
processed foods.
Refer to the RENAL DIET
list of salty foods.
CARDIAC DIET
Refer to:
“Fat and Cholesterol
Controlled”, “Step I or II”
Pages: 265-288
Refer also to Cardiac
Surgery on pages 255-258.
DIABETIC diet
“ADA”, “Calorie
Controlled”
Pages: 301-336
A diet that controls overall
dietary fat, saturated fat and
cholesterol, and based on
patient’s nutritional status,
management may include
sodium, and/or fluid
restriction.
Other co-morbid conditions
(i.e. Diabetes) should be
considered when
determining appropriate diet
therapy. Fluid restriction
(1000-2000 ml) as needed.
This diet is nutritionally
adequate.
A regular diet with balanced
carbohydrate content
designed to guide the person
with diabetes in making
appropriate food choices
and behavioral changes that
will result in optimal blood
glucose and lipid levels,
improved nutritional status
and self-management of
diabetes.
This diet is nutritionally
adequate.
To lower elevated serum
cholesterol levels and other
serum lipid levels in the
prevention and treatment of
hyperlipidemia. For
individuals who are at risk
for developing heart disease.
To control abnormal glucose
metabolism due to insulin
resistance or the lack of
insulin; as seen in Type1 & 2
Diabetes Mellitus,
Gestational Diabetes
Mellitus (GDM) and
Impaired glucose tolerance.
 6 ounces or less per day of
lean meat, skinless poultry,
fish and meat alternatives
 Skim or 1% lowfat milk
 Low-fat or fat-free dairy
products
 6 to 8 teaspoons per day of
unsaturated fats and oils
 Limit egg yolks and regular
soups
 6 or more servings/day of
breads, cereals, rice and
pasta; whole grains for more
fiber.
 3-5 servings per day of
vegetables (fresh or frozen)
 2-4 servings per day of
fruit
 Limited modified fat
desserts
 Restrict fluids as ordered.
 Caffeine may be limited.
*see FAT RESTRICTED &
SODIUM RESTRICTED
diet guidelines
Provide well-balanced
regularly scheduled meals.
The diet controls the
amount of carbohydrate
provided at each meal to
ensure adequate, but not
excessive portions.
Carbohydrates are found in
fruits, starches, milk and
milk products. Provide
appropriate calories for
individual needs. Encourage
regular exercise. Decrease
total fat, saturated fat and
cholesterol. Recommend
Dietitian Consult for
individual Carbohydrate
Counting Plan. Timing of
meals and medications (such
as insulin or an oral
hyperglycemic agent) may
need to be adjusted based on
individual’s treatment plan.
NO CONCENTRATED
SWEETS
Pages: 336A
A regular diet with the
exclusion of concentrated
sources of simple
sugars/carbohydrates. The
caloric level is not specified
but individuals should
achieve and maintain their
desirable body weight.
Non-insulin dependent
diabetes, and for patients
with medical, psychological
or socio-economic
circumstances which
interfere with compliance to
a standard meal pattern.
Achieve and maintain a
desirable body weight.
Avoid concentrated sweets,
such as regular desserts, soft
drinks, honey, jelly & sugar.
Eat well-balanced, regularly
scheduled meals. Include
high fiber foods. Control
portion size. Encourage
regular exercise. Decrease
total fat, saturated fat and
cholesterol.
For fasting or post-prandial
(reactive) hypoglycemia.
Hypoglycemia can occur
from impaired glucose
tolerance due to delayed and
excessive insulin response.
Eat small, frequent meals,
(usually 6 per day). Meals
should be appropriately
timed.
Meals should be wellbalanced, including complex
carbohydrates, protein, fat,
and fiber, which help delay
absorption of carbohydrate.
Limit alcohol and caffeine.
Refer to DIABETIC and
NO CONCENTRATED
SWEETS diets.
Not recognized by ADA.
REACTIVE
HYPOGLYCEMIA
Pages: 337-340
(refer to Chapter 20, p.301336, Diabetes Mellitus, for
more information to help
regulate carbohydrate intake)
This diet is nutritionally
adequate.
This diet minimizes rapid
elevation of blood glucose
and prevents the symptoms
of low blood glucose that
may result. Simple or refined
carbohydrates should be
avoided due to their ability
to stimulate rapid insulin
secretion. Small, frequent,
high-fiber meals should be
eaten.