American Kidney Fund reaching out giving hope improving lives Healthy Eating for People on Hemodialysis reaching out giving hope improving lives Healthy Eating for People on Hemodialysis Y ou need a “kidney-friendly” diet when you are on dialysis. Watching what you eat and drink will help you stay healthier. This brochure is for people who have kidney failure and are on hemodialysis. It will describe a kidney-friendly diet and why it is important. This brochure will teach you about: • The basics of a healthy diet • What makes the kidney-friendly diet different • Special steps for people with diabetes • Where to find more information Keep this in mind… This guide gives only general information. Diet needs vary from person to person depending on size, activity, and other health concerns. Talk to a renal dietitian, someone who specializes in the kidney-friendly diet, to find a meal plan that meets your needs. Your dialysis center will have a dietitian that you can meet with, and Medicare will cover this service. 1 Why is diet important? Healthy Diet Basics W A hat you eat affects your health. Maintaining a healthy weight and following a diet that is low in salt can help you control your blood pressure. If you have diabetes, your diet is also important in helping to control your blood sugar. This can help you prevent other health problems. A kidney-friendly diet goes a step further. It limits certain minerals in the foods you eat. This helps keep waste from building up in your blood and may help prevent some common problems caused by kidney failure. ll diets, including the kidney-friendly diet, need to take into account some of the same things, like: • Calories • Carbohydrates • Protein • Fat • Portions In this section, we’ll review each of these. We’ll also take a look at the nutrition facts label and explain how you can use this tool to help you have a healthy diet. We’ll start by reviewing the basics of a healthy diet. Then, we’ll take a look at the kidney-friendly diet and some helpful kidney-friendly diet resources. 2 3 Calories Carbohydrates Y Carbohydrates (“carbs”) are the easiest kind of energy for your body to use. Healthy sources of carbohydrates include whole grains, fruits and vegetables. Other unhealthy sources of carbohydrates include sugar, honey, hard candies, soft drinks and other sugary drinks. our body gets energy from the calories you eat and drink. Calories come from the carbohydrates, protein, and fat in your diet. How many calories you need depends on your age, sex, size and activity level. You may also need to adjust how many calories you eat based on your weight goals. Some people will need to limit the calories they eat. Others may need to have more calories. Your dietitian can help you figure out how many calories you should have each day. Work with your dietitian to make a meal plan that helps you get the right amount of calories, and keep in close contact for more advice and follow up. 4 Some carbohydrates are high in potassium and phosphorus, which you may need to limit. We’ll talk about this in more detail a little later. You may also need to watch your carbohydrates carefully if you have diabetes. Your dietitian can help you learn more about the carbohydrates in your diet and how they affect your blood sugar. 5 Protein Fat Protein is one of the building blocks of your body. Your body needs protein to grow, heal and stay healthy. Before you started dialysis, your doctor or dietitian may have told you to limit the protein in your diet. Now that you are on dialysis, you may need to eat more protein. This will help replace protein that is lost during your treatments. You need some fat in your diet to stay healthy. Fat gives you energy, keeps you warm, and helps you use some of the vitamins in your food. But too much fat can lead to weight gain and heart disease. Try to limit fat in your diet, and choose healthier fat when you can. Talk to your dietitian to find out how much protein you should have each day. Your dietitian can help you make a meal plan that helps you get the protein you need. Use the table below to learn which foods are low or high in protein. Lower-protein foods Higher-protein foods %UHDG 0HDW )UXLWV 3RXOWU\ 9HJHWDEOHV )LVK 3DVWD (JJV 5LFH Healthier fat or “good” fat is called unsaturated fat. Examples of unsaturated fat include: • Olive oil • Vegetable oils Unsaturated fat can help reduce cholesterol. If you need to gain weight, try to eat more unsaturated fat. If you need to lose weight, limit the unsaturated fat in your diet. As always, moderation is the key. Too much “good” fat can also cause problems. Saturated fat, also known as “bad” fat can raise your cholesterol and put you at risk for heart disease. Examples of foods that have saturated fat include: • Butter • Lard • Shortening • Meat Limit these in your diet. Choose healthier, unsaturated fat instead. Trimming the fat from meat and removing the skin from chicken or turkey can also help limit saturated fat. 6 7 Sodium Sodium (salt) is a mineral found in almost all foods. Too much sodium can raise your blood pressure and make your heart work harder. Too much sodium can also make you thirsty. One of the best things that you can do to stay healthy is to limit how much sodium you eat. A dialysis diet should have less than 2,000 milligrams (mg) of sodium per day. To limit sodium in your diet: • Do not add salt to your food when cooking or at the table. Try cooking with fresh herbs, lemon juice or other salt-free spices. • Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, rinse them to remove extra salt before cooking or eating them. • Avoid processed meats like ham, bacon, sausage and lunch meats. • Munch on fresh fruits and vegetables rather than crackers or other salty snacks. • Avoid canned soups and frozen dinners that are high in sodium. • Avoid pickled foods, like olives and pickles. • Limit high-sodium condiments like soy sauce, BBQ sauce and ketchup. 8 Warning! Be careful with salt substitutes and “reduced sodium” foods. Many salt substitutes are high in potassium. Too much potassium can be dangerous for someone with kidney failure. Work with your dietitian to find low-sodium foods that are also low in potassium. 9 The Nutrition Facts Label Serving Size Use nutrition facts labels to learn more about what is in the foods you eat. The nutrition facts label will tell you how much carbohydrates, protein, fat and sodium are in each serving of a food. This can help you pick foods that are high in the nutrients you need and low in the nutrients you should limit. Use the diagram on page 11 to find key areas of the nutrition facts label that will give you the information you need. Note: People with kidney disease may also need to watch the amount of potassium and phosphorus they get. These do not have to be listed on the nutrition facts label. Be careful! Even if they aren’t listed, the food may be high in these. Check the package ingredients list for other clues. • Foods high in potassium might list the ingredient potassium chloride or KCl. • Foods high in phosphorus might have the words phosphate or phosphoric somewhere in the ingredients list. See pages 14 and 15 to learn more. Your dietitian can also help you learn which foods are high in potassium and phosphorus. 10 This part of the label tells you how much of the food is equal to one serving. Many packages contain more than one serving, but the information on the label is for just one serving. Using the example below, if you have one cup of this food, you will get 50 calories. If you have two cups of this food, you will get 100 calories. If you have half a cup of this food, you will get 25 calories. This same idea applies to all of the other nutrients listed. Calories This part of the label tells you how many calories are in each serving of the food. An average adult will need about 2,000 calories per day, but this might vary based on age, sex, size, activity level and health concerns. Ask your doctor or dietitian how many calories you should have each day. Nutrients Look here to see how much fat, sodium, carbohydrate and protein are in each serving. % Daily Value (%DV) This part of the label tells you how much of your daily needs of a nutrient are met with one serving of the food. This number is not exact, as each person’s needs may be a little different. As a general rule, when the %DV is less than 5%, the food is low in that nutrient. When the %DV is more than 20%, the food is high in that nutrient. 11 Portions How is a kidney-friendly diet different? C Dialysis helps to replace the work of your kidneys, but it does not work as well as healthy kidneys. Some waste and fluid still build up in your body. Over time, the waste and extra fluid can cause heart, bone and other health problems. A kidney-friendly diet limits how much of certain minerals and fluid you take in. This can help keep the waste and fluid from building up and causing problems. hoosing healthy foods is a great start, but eating too much of even healthy foods can be a problem. The other part of a healthy diet is portion control, or watching how much you eat. To help control your portions: • Eat slowly, and stop eating when you are not hungry any more. It takes about 20 minutes for your stomach to tell your brain that you are full. If you eat too quickly, you may eat more than you need. • Check the nutrition facts label to learn the true serving size of a food. Many packages have more than one serving. For example, a 20-ounce bottle of soda is really two-and-a-half servings. • Do not eat directly from the package the food came in. Instead, take out one serving of food, and put the bag or box away. • Avoid eating when watching TV or driving. When you are distracted you may not realize how much you have eaten. Exactly how strict your diet should be depends on your treatment plan and other health concerns. Still, most people on dialysis will need to limit: • Potassium • Phosphorus • Fluids Good portion control is an important part of any diet. It is even more important in a kidney-friendly diet, because you may need to limit how much of certain foods you eat. Keep reading to learn more! 12 13 Potassium Phosphorus Potassium is a mineral found in almost all foods. Your body needs some potassium to make your muscles work, but too much potassium can be dangerous. When you are on dialysis, your potassium level may be too high or too low. Having too much or too little potassium can cause muscle cramps, irregular heartbeat and muscle weakness. Most people on dialysis will need to limit potassium to 2,000 to 4,000 mg per day. Ask your dietitian how much potassium you should have each day. Phosphorus is a mineral found in many foods. It works with calcium and vitamin D to keep your bones healthy. Healthy kidneys help keep the right balance of phosphorous in your body. When you are on dialysis, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily. Use the table below to learn which foods are low or high in potassium. Your dietitian can also help you work in some higher potassium foods in small amounts. Eat this… (lower-potassium foods) $SSOHVFUDQEHUULHVJUDSHV SLQHDSSOHVDQGVWUDZEHUULHV Rather than… (higher-potassium foods) $YRFDGRVEDQDQDVPHORQV RUDQJHVSUXQHVDQGUDLVLQV &DXOLÀRZHURQLRQVSHSSHUV $UWLFKRNHVNDOHSODQWDLQV UDGLVKHVVXPPHUDQG]XFFKLQL VSLQDFKSRWDWRHVDQGWRPDWRHV VTXDVKOHWWXFH 3LWDWRUWLOODVDQGZKLWHEUHDG %UDQSURGXFWVDQGJUDQROD 14 %HHIDQGFKLFNHQ %HDQVEDNHGEODFNSLQWRHWF :KLWHULFH %URZQRUZLOGULFH Most people on dialysis will need to limit phosphorus to about 1,000 mg per day. Ask your dietitian how much phosphorus you should have each day. Use the table below to learn which foods are low or high in phosphorus. Eat this… (lower-phosphorus foods) Rather than… (higher-phosphorus foods) ,WDOLDQ)UHQFKRUVRXUGRXJKEUHDG :KROHJUDLQEUHDG 5LFHFHUHDOVDQGFUHDPRIZKHDW %UDQFHUHDOVDQGRDWPHDO 8QVDOWHGSRSFRUQ 1XWVDQGVXQÀRZHUVHHGV /LJKWFRORUHGVRGDVDQGOHPRQDGH 'DUNFRORUHGFRODV :KLWHULFH %URZQRUZLOGULFH To help control your phosphorus, your doctor may also prescribe a medicine called a phosphate binder. This helps to keep phosphorus from building up in your blood. A phosphate binder can be helpful, but you will still need to watch how much phosphorus you eat. Ask your doctor if a phosphate binder is right for you. 15 Fluids Other diet concerns You need water to live, but when you are on dialysis, you may not need as much. This is because fluid may build up in your body between treatments. Too much fluid in your body can be dangerous. It can cause high blood pressure, swelling, heart failure and trouble breathing. Extra fluid can also make your dialysis treatments more difficult. Vitamins Most people on dialysis will need to limit fluids. Ask your dietitian how much fluid you should have each day. If you need to limit fluids, you will need to cut back on how much you drink. You may also need to cut back on some foods that contain a lot of water. Soups or foods that melt, like ice, ice cream and gelatin, have a lot of water. Many fruits and vegetables are high in water, too. When you limit your fluids, you may feel thirsty. To help quench your thirst, you might try to: • Chew gum • Drink from small cups • Rinse your mouth • Suck on a piece of ice, mints or hard candy (Remember to pick sugar-free candy if you have diabetes.) 16 A kidney-friendly diet may make it hard to get all of the vitamins and minerals you need. To help you get the right balance of vitamins and minerals, your dietitian may suggest a special supplement made for people with kidney failure. Your dietitian might also suggest a special kind of vitamin D, folic acid or iron pill, to help avoid some common side effects of kidney failure, like bone disease and anemia. Regular multi-vitamins may not be healthy for you if you have kidney failure. They may have too much of some vitamins and not enough of others. Talk to your dietitian to find vitamins that are right for you. Important! Tell your doctor and dietitian about any vitamins, supplements or over-the-counter medicines you are taking. Some may be harmless, but others can cause problems. 17 Other diet concerns What if I have diabetes? Diabetes is the leading cause of kidney failure. Diabetes can also damage other parts of your body, like your eyes and heart. If you have diabetes, you will need to watch your blood sugar and diet to stay healthy. Work with your dietitian to make a kidney-friendly meal plan that helps you keep your blood sugar in control. A diabetes educator can also help you learn how to control your blood sugar. Ask your doctor to refer you to a diabetes educator in your area. You can also get a list of diabetes educators from the American Association of Diabetes Educators at www.diabeteseducator.org or 1.800.338.3633. Medicare and many insurance companies may help pay for sessions with a diabetes educator. My Diet Following the kidney-friendly diet can be difficult. Your dietitian can help you learn how much of each nutrient you should have each day. Next time you meet with your dietitian, take this worksheet. Ask your dietitian to help you fill in the blanks. Nutrient Protein Sodium Potassium Phosphorus Fluid Your dietitian can also help you learn what foods to limit and other foods you might try instead. Work with your dietitian to find a meal plan that works for you. Summary Foods To Limit A well-balanced diet is important for good health. It is even more important for people with on dialysis, because it may help prevent other problems. Work with the dietitian at your dialysis center to make a meal plan that helps you get the right amount of calories, carbohydrates, protein, fat and sodium. Your dietitian can also help you limit your potassium, phosphorus and fluids. 18 How Much I Should Have Each Day Because They’re High In… What to Try Instead 19 Kidney-Friendly Cookbooks Brilliant Eats: Simple and Delicious Recipes for Anyone Who Wants to be Kidney Wise Kelly L. Welsh, RD, CD www.brillianteats.com 1.866.524.6732 Creative Cooking for Renal Diabetic Diets Creative Cooking for Renal Diets Cleveland Clinic Foundation www.patientsupport.net 1.800.247.6553 Calabash Cookbook for Kidney Health National Kidney Foundation of Hawaii www.kidneyhi.org 1.800.488.2277 The Gourmet Renal Cookbook Sharon Stall, RD 212.434.3266 Carbohydrate & Sodium Controlled Recipes CRN No. California/No. Nevada www.crn-norcal.org 415.353.7725 Chinese Renal Kitchen BC Chinese Nutrition Consultants 604.806.8141 Cooking for David: A Culinary Dialysis Cookbook Sara Colman, RD, CDE and Dorothy Gordon, BS, RN www.culinarykidneycooks.com 714.842.4684 The Kidney Helper Cookbook Bob and Natalie Lufty with Mary Pinto, RD www.consumermedhelp.com 1.877.248.2331 Kidney Kids’ Cookbook Kay Anderson, Frances Buchanan, Linda Tyler Edited by Betsy Watson 1.800.282.0190 Now You’re Cooking: A Resource for People with Kidney Disease Council on Renal Nutrition of New England www.kidneyhealth.org 1.800.542.4001 Cooking the Renal Way Oregon Council on Renal Nutrition 503.371.8047 20 21 Renal Lifestyles Manual Peggy Harum, RD, LD Available in bookstores. The Renal Patient’s Guide to Good Eating Judith Curtis www.ccthomas.com 1.800.258.8980 Southern Comforts of Mississippi National Kidney Foundation of Mississippi www.kidneyms.org 1.800.232.1592 Online Recipes DaVita www.davita.com/recipes Kidney Kitchen National Kidney Foundation www.kidney.org/patients/kidneykitchen Kidney Times Renal Support Network www.kidneytimes.com Northwest Kidney Centers www.nwkidney.org The Vegetarian Diet for Kidney Disease Treatment Joan Brookhyser, RD, CSR, CD Available in bookstores. 22 23 Helpful Kidney Disease Resources Notes: American Kidney Fund www.kidneyfund.org 1.800.638.8299 American Association of Kidney Patients www.aakp.org 1.800.749.2257 American Dietetic Association www.eatright.org 1.800.877.1600 National Institute of Diabetes and Digestive and Kidney Diseases www.niddk.nih.gov 1.800.891.5390 Acknowledgements Our sincere thanks to Rebecca Brosch, RD, LD for her continued support of the American Kidney Fund and for her input on this brochure. The American Kidney Fund is the leading national voluntary health organization serving people with and at risk for kidney disease through direct financial assistance, comprehensive education, clinical research, and community service programs. 24 25 American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, MD 20852 Phone: 301.881.3052 Fax: 301.881.0898 Toll-Free: 800.638.8299 HelpLine: 866.300.2900 [email protected] http://www.kidneyfund.org Se habla español. Combined Federal Campaign #11404 © Copyright 2010 by American Kidney Fund, Inc. All rights reserved.
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