NUTRITION: A RESOURCE GUIDE FOR ESRD PATIENTS
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Working Towards Good Nutrition
- Good nutrition is key to living a healthy lifestyle.
- Good nutrition is just good food sense.
- Good nutrition means learning to compare, select and manage what you eat as an important part of your overall health care.
- Good nutrition for a kidney patient means managing the foods you eat to avoid some of the symptoms of chronic renal failure.
The primary function of the kidneys is removing water and waste from the body.
When your kidneys fail, you must learn to do for your body what your kidneys did for you automatically.
As a renal patient, you now depend on dialysis to remove water and waste from your body.
By following a good renal diet, you reduce the amount of water and waste products produced and stored in your body between sessions.
Specifically the renal diet works to reduce the amount of fluids, urea, protein and metabolism waste products, and the mineral waste products of sodium, potassium and phosphorous.
By keeping the renal diet, you also help to control some of the more common complications of renal failure like fluid overload, itching and high blood potassium levels.
As a result, the renal diet is an important part of your treatment. For some renal patients practicing good renal nutrition means avoiding all "forbidden" foods while for others it means learning to take only moderate amounts of certain foods and counting exchanges.
Although the renal diet has some general basic principles that apply to all patients, the specifics of any individual renal diet will depend on your overall health and the type of treatment being given. Either way there will still be many tasty and familiar foods to choose from.
You will have to explore, along with your doctor, dietitian and other health professionals, what will work best for you.
As far as possible, make an effort to include foods that conform to your individual taste and cultural preference. This will help you to keep to your diet.
In some instances, you may have to do without the foods you like. For example, bananas will not work for the majority of renal patients no matter how you dress them up. On the other hand, using egg whites or Eggbeaters® in a sugar-free pudding mix may allow you to enjoy a favorite dessert.
You may have to apply special nutritional plans if you have diabetes, high blood pressure or any other condition that further limits your food choices. The key to good dietary management is planning.
For more information see Nutrition and Kidney Disease and download your Na-K Phos Counter (also available in Spanish, Sodio y Potasio y Fosforo)
Overall, your goal should be to set up a healthy approach to eating - a nutritional plan which you will maintain over a lifetime.
Setting up your nutritional plan will take time and require adjustments to your eating habits. Learn what works for you and set up your food choices accordingly.
You may want to take some of the following steps to reach your goal:
- Take inventory of your eating habits and food choices (keep a food diary which includes what you eat, how much you eat, where and with whom you eat)
- Evaluate what you need to change (e.g. food choices, portions)
- Consult your dietitian and set goals based on your specific needs
- Learn the effects of too much sodium or fluids, for example, thirst, fluid gain, high blood pressure, muscle cramps during dialysis
- Set up a daily eating schedule (e.g. 3 meals and 2 snacks or 6 small meals)
- Watch your food portions (how much and how many)
- Set up a way to check your progress
- AND, remember to allow for other special needs (like diabetes) in planning your diet and making food choices
Initially it's important just to learn what's on your plate. Keeping a food diary for a month is a good way to what, when and how much you are eating.
You can make important changes right away like eliminating that morning glass of OJ or banana on your cereal. Spotting other areas that need control may take a little time and some examination, such as learning how to manage your fluid intake.
Just keeping track of sauces, stock and custards as sources of fluid will take some getting used to at first.Take time to cook creatively. Before you stop making your favorite recipes check to see if they can be adapted to meet your renal diet. Changing a recipe so that it fits the renal diet can be as simple as using egg whites instead of whole eggs or it may mean using one of a number of special renal nutritional products available today.
Menu plans set up by the week or month can be a big help. Nothing will sabotage an eating plan more quickly than cooking pre-packaged meals or eating on the run.
In addition, have sample meal plans ready to guide your food selections when dining out. When eating at the home of family or friends, let them know ahead of time what your needs are. If necessary bring your own. Learn to speak up about your nutritional needs.
Whether at home, work, with friends, or when eating out, you will need the support of those around you to help you maintain your dietary goals. Learn to ask for help. Also explain to others how they can assist you.
Support and reward yourself as you maintain your goals - on a daily, weekly or monthly basis. You set the goals and you determine the incentives. Some rewards could be a night out at the movies or a new pair of shoes. Try to stay away from using snacks or treats as rewards.
Most people find it hard to make even simple changes in their diet. Food is an emotionally charged subject for most of us. Food is comfort. Food is central to many family traditions. Food reflects cultural ties. Food is fun. Food is obviously more than just nourishment for your body.
So when you're having problems meeting your goals, it's good to take a moment to understand what factors are operating. You may find that you tend to stray from your diet when you are:
- out with friends
- angry or stressed
- it's a holiday
- there are potato chips in the house
- the state fair is in town.
Some situations are within your immediate control while others may take some time to bring under control. When facing special occasions like holidays, you may want to consult with your health care team about how you can make your food choices in a safe way.
Some of the changes that you will need to make may have more to do with your approach to food or eating habits.
For example, slow down as you eat and allow more time for your brain to receive the body's message that it's full. Such a strategy will help you cope with reduced portions.
Another example, avoid foods that have emotional and/or social cues attached to them and stop yourself from eating unplanned foods or beverages. For example, avoid the buffet if you can't resist the temptation to have extra portions or choose foods outside your diet.If you go off your meal plan, remember to…
- ask yourself how you got side-tracked
- don't beat yourself up, just plan to do better
- break down your goals into small steps and make priorities - don't try to do it all at one time
- don't give up
- celebrate your accomplishments
Good nutrition will require on-going management and will present long-term challenges. Understandably this means that some days you will do better
than others. The main thing is to make a commitment to yourself to use your diet and nutrition to enhance your treatment and improve your quality of life.Learning what you need to know to manage your nutrition well requires education. Your dietitian can provide you with more in-depth information on sodium, calcium etc. as they relate specifically to your individual renal dietary needs.
- A number of excellent publications are available to you through a variety of renal organizations.
- Cookbooks and special renal nutritional products are also available to help you meet your dietary goals.
- More information is available on the Internet.
Research and review the educational materials available to you.
American Kidney Fund (AKF)
6110 Executive Blvd., Suite 1010
Rockville, MD 20852
(301) 881-3052 or 1-800-638-8299
(301) 881-0898 (fax)
E-mail helpline@akfinc.org
Website: www.akfinc.orgNational Kidney Foundation (NKF)
30 East 33rd Street
New York, NY 10016
1-800-622-9010
(212) 689-9261 (fax)
Website: www.kidney.orgAmerican Association of Kidney Patients (AAKP)
100 S. Ashley Drive, Suite 280
Tampa, FL 33602
(813) 223-7099 or 1-800-749-2257
(813) 223-0001 (fax)
E-mail AAKPnat@aol.com
Website: www.aakp.orgPolycystic Kidney Research (PKR) Foundation
4901 Main Street, Suite 200
Kansas City, MO 64112-2674
(816) 931-2600 or 1-800-PKD-CURE
E-mail pdkcure@pkrfoundation.org
Website: www.pkdcure.orgCarbohydrate and Sodium Controlled Recipes (for Diabetic Hemodialysis and Peritoneal Dialysis patients)
Council on Renal Nutrition of Northern California and Nevada
Marilyn Mayfield, MS, RD
El Camino Dialysis Services
2500 Grant Road
Mountain View, CA 94039Cooking For David
Order the cookbook and/or browse their archive of renal recipes and nutrition hints of the week for dialysis patients. http://culinarykidneycooks.comCooking The Renal Way
Council on Renal Nutrition of Oregon
Lois Edelstein, RD, OCRN
Good Samaritan Hospital and Medical Center Dialysis Services
1015 NW 22nd Ave.
Portland, OR 97210Creative Cooking For Renal Diets and, Creative Cooking For Renal Diabetics Diets
The Cleveland Clinic Foundation Department of Nutrition Services
Pat Ellis, MS, RD
Senay Publishing, Inc.
PO Box 397
Chesterland, OH 44026
To order these cookbooks logon to http://patientsupport.netDietary Management Of Renal Disease
Jacquelyn S. Cort, RD
Charles B. Slack, Inc.
6900 Grove Road
Thorofare, NJ 08086The Good Eating Series - 101 Low Sodium Recipes
Corinine T. Netzer
Bantam Doubleday Publishing Group, Inc.
666 5th Ave.
New York, NY 10103Gourmet Renal Nutrition Cookbook
Meredith C. Greene, RD
Lenox Hill Hospital Dialysis Unit
100 E. 77th St.
New York, NY 10021
http://kidney-cookbook.comKidney Patients Wellness Diet
Emma Keenan
Grunwald and Radcliff Publishers
5044 Admiral Wright Rd, Suite 344
Virginia Beach, VA 23462Living Well On Dialysis A Cook Book For Patients And Their Families
The National Kidney Foundation Council of Renal Nutrition
41 Madison Ave.
New York, NY 10010
Available on computer disk (3.5") as well as booklet form. Please contact your dietitian for a copy. Or click on the link to view a PDF file.Kidney HELPER Phosphorous and Potassium Food Guides
94 New Salem Street, Suite 104
Wakefield, MA 01880
1-800-556-7117The Mayo Clinic Renal Diet Cookbook
Joyce Daly Margie, MS
Western Publishing Company, Inc.
850 Third Ave.
New York, NY 10022Nutritional Products and Recipes Used by Renal Dietitians
The ESRD Network of Texas
14114 Dallas Pkwy, Suite 660
Dallas, TX 75240
Email: info@nw14.esrd.net
Website: www.esrdnetwork.orgThe Renal Gourmet
Emenar, Inc.
320 Charmile Ln
Wood Dale, IL 60191
Order the “The Renal Gourmet Cookbook” http://kidney-cookbook.comThe Renal Patients Guide to Good Eating
Charles C. Thomas, Publisher
2600 S. First Street
PO Box 19265
Springfield, IL 62794-9265Southwest Cookbook for People on Dialysis
El Paso Chapter Council on Renal Nutrition and
The National Kidney Foundation of Texas
Available from Amgen in a Spanish/English formats. Contact your dietitian or social worker. Or click on the link to view a PDF file copy.American Diabetes Association - diabetes.org
American Foundation for Urologic Disease - www.usrf.org
American Heart Association - www.amhrt.org
National Kidney and Urologic Disease Information Clearinghouse - www.niddk.nih.gov
Renal Specialty Products - Manufacturer's Addresses
(Taken from "Nutritional Products and Recipes Used by Renal Dietitians" and reprinted with permission from ESRD Network of Texas.)
Ballas Dried Egg Whites®
Ballas Egg Product Corp.
P.O. Box 2217
Zanesville, OH 43702-2217
(740) 453-0386
(740) 453-0491 (fax)Ross Adult Nutrition
Ross Consumer Relations
625 Cleveland Avenue
Columbus, Ohio 43215-1724
(800) 986-8510
(800) 544-7495
Home Delivery
P.O. Box 29139
Shawnee Mission, KS 66201
(800) 986-8502HMR Benefit® Bars and HMR Benefit® Powder
Health Management Resources
194 Hanse Ave.
Freeport, NY 11520
(516) 379-9500
(800) 467-6467Just Whites®
Deb El Foods
2 Papetti Plaza
Elizabeth, NY 07206
(800) 773-8822NuBasics Bars® and NuBasics VHP® and NuBasics Soup®
Nestle Clinical Nutrition
Three Parkway North, Suite 500
P.O. Box 760
Deerfield, IL 60015-0760
(708) 317-2800
Home Link (800) 776-5446The Perfect Protein®
NutriPower
1292 Old Skokie Rd.
Highland Park, IL 60035
(800) 247-8842ProPlus®
NutriSoy
P.O. Box 313
Newburgh, IN 47629
(888) 769-0769Pro-Right Protein®
I.F.P.
6300 West Gross Point
Niles, IL 60714
(800) 247-8842Re/Gen® and Egg/Pro®
Nutra/Balance Products Inc.
7155 Wadsworth way
Indianapolis, IN 46219
800-654-3691
Website: www./nutra-balance-products.comSustacal®
Mead Johnson and Company
Evansville, IN 47721
(800) 247-7893The following products are available at most local grocery stores or supermarkets:
Coffee Rich®
Egg Beaters®
Egg Scramblers®
Mocha Mix®
Poly Rich®Additional Resource
NutriGenie Renal Diet for Windows, ver 4.1
A computer based dietary management program built on the Surgeon General and National Institute of Health's guidelines for ESRD. Features analyses of food values, tracking logs and menu generators.