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Kidney Disease Nutrition
Dr. Mirza Baig, a nephrologist with Hendricks Regional Health explains kidney-friendly nutrition and the many benefits modifications can have for patients.
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Learn more about Mirza Baig, MD
Mirza Baig, MD
Mirza Baig, MD is a Staff Nephrologist at Hendricks Nephrology and Hypertension Associates.Learn more about Mirza Baig, MD
Transcription:
Kidney Disease Nutrition
Melanie Cole (Host): It’s imperative that people with chronic kidney disease carefully watch what they eat and drink because their kidneys are unable to remove waste products from the body like they should. So, here to tell us about good nutrition if you’re someone with chronic kidney disease is my guest Dr. Mirza Baig. He’s a nephrologist with Hendricks Regional Health. Dr. Baig, I’m so glad to have you here. Please explain for the listeners why is good nutrition important for people with kidney disease? What do the kidneys really do?
Mirza Baig, MD (Guest): Thank you very much for having me on the show Melanie. So, once you are diagnosed with CKD, you need to be on a special diet. As the kidney dysfunction progresses through stage four and five; your blood might have certain derangements that might necessitate restricting your proteins, potassium and phosphorus etc. So, depending on the stage of the chronic kidney disease, early, late or pre-dialysis; there are certain nutrition modifications which are appropriate.
Because if we don’t do that; they just accentuate the worsening of the chronic kidney disease. And mostly for pre-dialysis patients we follow the National Kidney Foundation guidelines. So, once the patients actually reach the stage three or four, protein restriction is actually indicated. With this principle in mind; we want to provide adequate energy to prevent malnutrition and also protein adequate for helping with reducing the swelling and trying to put more fluid back in circulation. But once dialysis is started; you have to eat more protein especially with protein peritoneal dialysis.
So, there are not only protein restrictions but there are salt restrictions as well as potassium and phosphorus restrictions that patients have to abide. But in no means – in now way this means that there is restrictions; you can always add flavor to the diet and work with your dietician to come up with a plan.
Host: So, as we talk about those different stages and the different nutritional needs for those stages; let’s start with sodium. Because it’s everywhere. It’s something we really have to read labels Dr. Baig to make sure of how much sodium that we are using. So, how much sodium are they supposed to be taking in and are all sodium products considered equal. Should they be looking for low sodium in everything whether it’s soup or nuts or any processed kinds of foods?
Dr. Baig: Sure. It’s important to actually look at labels and any patients with chronic kidney disease get proficient in this once they have been diagnosed with this condition. A key to the treatment is avoiding processed foods like deli meats, canned food and convenience and fast foods, so to speak. And also like salty seasoning. And it’s also important to pay attention to like hidden salt. By that I mean like reading labels and if you have like 2 grams of sodium allotted for the day; you know if you have already taken an item with 500 milligrams of sodium in your breakfast, you know you have 1500 more milligrams of sodium to go. So, it’s important to keep a tab all along the day.
And make sure that you’re avoiding mostly like the processed food which have got loads of salt.
Host: That’s really great information. Now you mentioned phosphorus and potassium which are so important for so many functions in our body but walking that thin line between too much and not enough and as you mentioned, malnutrition; what about phosphorus, calcium, potassium. Where do we find these and how are they restricted? What should patients be looking to?
Dr. Baig: Yeah, so, a normal amount of potassium in a typical diet of a healthy American is about 3500 to 4500 milligrams per day. A potassium restricted diet which we typically advise for CKD patients is about 2000 milligrams per day. So, remember that some foods that have been frequently considered as wholesome may have been a popular choice for centuries for people because of their advantage in terms of weightloss or low glycemic index; they might in fact, have high potassium content. Some examples of these are like avocadoes, coconut juice, apricot, banana, green leafy vegetables.
If you want to include some high potassium vegetable in your diet, leaf them before using. That’s a very good method that we always advise patients with advanced CKD. So, leafing is a process by which some potassium can be pulled out of the vegetable and a very good example that I always discuss with my dietician is double cooking the potato and that has been for people who are like potato fans is really helpful. So, if they know this technique.
And if you are on dialysis, you be sure to get all your treatment and exchanges because that’s your only modality of getting the potassium out. And coming to the phosphorus. High phosphorus and calcium leads to dangerous calcium deposits in the blood vessels and heart. Phosphorus can be divided loosely into two types; the organic phosphorus and the inorganic phosphorus. Organic phosphorus is what you find naturally in protein rich foods like meats, poultry, fish, nuts, beans and dairy products. And as a general rule of thumb, the phosphorus found in animal foods is absorbed more readily than the phosphorus found in the plant foods. So, it is – it will be wise actually to kind of try to derive most of your phosphorus from the plant foods if possible.
And phosphorus has been found – it can also be added to the food in the form of additive or preservative like inorganic phosphorus. And that’s abundant in fast foods and ready to eat foods, canned and bottled beverages and some cured and enhanced meats. So, mostly when you think about inorganic phosphorus like think about processed foods. This kind of phosphorus is completely absorbed. So, avoiding phosphorus additives can actually lower your intake of phosphorus and it’s important when you’re grocery shopping, it’s important to look for phosphorus. Sometimes it is just indicated by the letter P or PHOS and it’s important to kind of lay stress on that and try to avoid food that has high phosphorus content.
And that’s very important especially for advanced kidney disease for mostly bone health because as phosphorus rises, the calcium which you need is not available for the bone health. So, that’s where we develop a condition called renal osteodystrophy. So, all these things, small nutrients they matter. When you come to like pill vitamins, that’s also a very important ingredient. Sometimes you need some specific vitamins like which are important for bone, muscle and heart. Some water soluble vitamins are lost during dialysis treatment that need to be supplemented so, most of the patients on dialysis you see that they are on a special renal vitamin. And that supplies them those vitamin sources.
So, it’s important to go through with your dietician on a regular basis to make sure that you are maintaining like food diaries and beverage diaries and reviewing with your dietician because there could be some inadvertent stuff which is normally healthy but may not be so good for the patients with chronic kidney disease.
Host: Wow, Dr. Baig what a great lesson. Because as you say, some of the healthy foods we think are healthy are not necessarily great for people with chronic kidney disease. And you’ve been so specific with your answers. Thank you about that. That’s fantastic. Seriously, great advice and Dr. Baig summarize it for us. When you are dealing with patients every single day as a nephrologist and you see this all the time; what would you like patients to take away from this segment about diet, good nutrition and chronic kidney disease?
Dr. Baig: Okay. So, whenever I meet a patient with advanced kidney disease, I say to them that okay you might have gotten a lot of information from reading literature, looking at internet, but it’s important to understand that giving up those food items actually does not mean that you’re giving up flavor. You could always especially when it comes to salt, you can always season your food with herbs and spices and there are a lot of if you want to get proteins.
There are a lot of protein shakes and bars with added flavor that can definitely increase the palatability of food. It’s important to actually work with a dietician because no single eating plan is right for everyone with kidney disease. And modifications can be made according to your habits, the food that you are accustomed to eat and you can work closely with your nephrologist and dietician in improving your overall kidney health.
Host: Thank you again Dr. Baig for joining us and really answering all those questions so clearly about why it’s important that people with kidney disease really adhere to a pretty strict diet and meet with a dietician so that they can get all that great information that you’re giving us today. To make an appointment with Dr. Baig, or his colleagues, please visit www.hendricks.org. This is Health Talks with HRH, Hendricks Regional Health. I’m Melanie Cole.
Kidney Disease Nutrition
Melanie Cole (Host): It’s imperative that people with chronic kidney disease carefully watch what they eat and drink because their kidneys are unable to remove waste products from the body like they should. So, here to tell us about good nutrition if you’re someone with chronic kidney disease is my guest Dr. Mirza Baig. He’s a nephrologist with Hendricks Regional Health. Dr. Baig, I’m so glad to have you here. Please explain for the listeners why is good nutrition important for people with kidney disease? What do the kidneys really do?
Mirza Baig, MD (Guest): Thank you very much for having me on the show Melanie. So, once you are diagnosed with CKD, you need to be on a special diet. As the kidney dysfunction progresses through stage four and five; your blood might have certain derangements that might necessitate restricting your proteins, potassium and phosphorus etc. So, depending on the stage of the chronic kidney disease, early, late or pre-dialysis; there are certain nutrition modifications which are appropriate.
Because if we don’t do that; they just accentuate the worsening of the chronic kidney disease. And mostly for pre-dialysis patients we follow the National Kidney Foundation guidelines. So, once the patients actually reach the stage three or four, protein restriction is actually indicated. With this principle in mind; we want to provide adequate energy to prevent malnutrition and also protein adequate for helping with reducing the swelling and trying to put more fluid back in circulation. But once dialysis is started; you have to eat more protein especially with protein peritoneal dialysis.
So, there are not only protein restrictions but there are salt restrictions as well as potassium and phosphorus restrictions that patients have to abide. But in no means – in now way this means that there is restrictions; you can always add flavor to the diet and work with your dietician to come up with a plan.
Host: So, as we talk about those different stages and the different nutritional needs for those stages; let’s start with sodium. Because it’s everywhere. It’s something we really have to read labels Dr. Baig to make sure of how much sodium that we are using. So, how much sodium are they supposed to be taking in and are all sodium products considered equal. Should they be looking for low sodium in everything whether it’s soup or nuts or any processed kinds of foods?
Dr. Baig: Sure. It’s important to actually look at labels and any patients with chronic kidney disease get proficient in this once they have been diagnosed with this condition. A key to the treatment is avoiding processed foods like deli meats, canned food and convenience and fast foods, so to speak. And also like salty seasoning. And it’s also important to pay attention to like hidden salt. By that I mean like reading labels and if you have like 2 grams of sodium allotted for the day; you know if you have already taken an item with 500 milligrams of sodium in your breakfast, you know you have 1500 more milligrams of sodium to go. So, it’s important to keep a tab all along the day.
And make sure that you’re avoiding mostly like the processed food which have got loads of salt.
Host: That’s really great information. Now you mentioned phosphorus and potassium which are so important for so many functions in our body but walking that thin line between too much and not enough and as you mentioned, malnutrition; what about phosphorus, calcium, potassium. Where do we find these and how are they restricted? What should patients be looking to?
Dr. Baig: Yeah, so, a normal amount of potassium in a typical diet of a healthy American is about 3500 to 4500 milligrams per day. A potassium restricted diet which we typically advise for CKD patients is about 2000 milligrams per day. So, remember that some foods that have been frequently considered as wholesome may have been a popular choice for centuries for people because of their advantage in terms of weightloss or low glycemic index; they might in fact, have high potassium content. Some examples of these are like avocadoes, coconut juice, apricot, banana, green leafy vegetables.
If you want to include some high potassium vegetable in your diet, leaf them before using. That’s a very good method that we always advise patients with advanced CKD. So, leafing is a process by which some potassium can be pulled out of the vegetable and a very good example that I always discuss with my dietician is double cooking the potato and that has been for people who are like potato fans is really helpful. So, if they know this technique.
And if you are on dialysis, you be sure to get all your treatment and exchanges because that’s your only modality of getting the potassium out. And coming to the phosphorus. High phosphorus and calcium leads to dangerous calcium deposits in the blood vessels and heart. Phosphorus can be divided loosely into two types; the organic phosphorus and the inorganic phosphorus. Organic phosphorus is what you find naturally in protein rich foods like meats, poultry, fish, nuts, beans and dairy products. And as a general rule of thumb, the phosphorus found in animal foods is absorbed more readily than the phosphorus found in the plant foods. So, it is – it will be wise actually to kind of try to derive most of your phosphorus from the plant foods if possible.
And phosphorus has been found – it can also be added to the food in the form of additive or preservative like inorganic phosphorus. And that’s abundant in fast foods and ready to eat foods, canned and bottled beverages and some cured and enhanced meats. So, mostly when you think about inorganic phosphorus like think about processed foods. This kind of phosphorus is completely absorbed. So, avoiding phosphorus additives can actually lower your intake of phosphorus and it’s important when you’re grocery shopping, it’s important to look for phosphorus. Sometimes it is just indicated by the letter P or PHOS and it’s important to kind of lay stress on that and try to avoid food that has high phosphorus content.
And that’s very important especially for advanced kidney disease for mostly bone health because as phosphorus rises, the calcium which you need is not available for the bone health. So, that’s where we develop a condition called renal osteodystrophy. So, all these things, small nutrients they matter. When you come to like pill vitamins, that’s also a very important ingredient. Sometimes you need some specific vitamins like which are important for bone, muscle and heart. Some water soluble vitamins are lost during dialysis treatment that need to be supplemented so, most of the patients on dialysis you see that they are on a special renal vitamin. And that supplies them those vitamin sources.
So, it’s important to go through with your dietician on a regular basis to make sure that you are maintaining like food diaries and beverage diaries and reviewing with your dietician because there could be some inadvertent stuff which is normally healthy but may not be so good for the patients with chronic kidney disease.
Host: Wow, Dr. Baig what a great lesson. Because as you say, some of the healthy foods we think are healthy are not necessarily great for people with chronic kidney disease. And you’ve been so specific with your answers. Thank you about that. That’s fantastic. Seriously, great advice and Dr. Baig summarize it for us. When you are dealing with patients every single day as a nephrologist and you see this all the time; what would you like patients to take away from this segment about diet, good nutrition and chronic kidney disease?
Dr. Baig: Okay. So, whenever I meet a patient with advanced kidney disease, I say to them that okay you might have gotten a lot of information from reading literature, looking at internet, but it’s important to understand that giving up those food items actually does not mean that you’re giving up flavor. You could always especially when it comes to salt, you can always season your food with herbs and spices and there are a lot of if you want to get proteins.
There are a lot of protein shakes and bars with added flavor that can definitely increase the palatability of food. It’s important to actually work with a dietician because no single eating plan is right for everyone with kidney disease. And modifications can be made according to your habits, the food that you are accustomed to eat and you can work closely with your nephrologist and dietician in improving your overall kidney health.
Host: Thank you again Dr. Baig for joining us and really answering all those questions so clearly about why it’s important that people with kidney disease really adhere to a pretty strict diet and meet with a dietician so that they can get all that great information that you’re giving us today. To make an appointment with Dr. Baig, or his colleagues, please visit www.hendricks.org. This is Health Talks with HRH, Hendricks Regional Health. I’m Melanie Cole.