Nutrition and Kidney
Disease
Sara Colman, RD, CDE
DaVita.com Nutrition Project Specialist
©2010 DaVita Inc. All rights reserved.
1
What this talk means to you
tomorrow
•
What you eat matters to your health in
chronic disease prevention and treatment
•
Diet goals change with stages of chronic
kidney disease (CKD) and dialysis
•
What you do now makes a difference
tomorrow
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2
Today’s Discussion
•
•
•
•
•
•
What to eat to prevent kidney disease
What is a kidney diet?
Making changes in eating habits
Healthy foods to include
Tools and resources
Questions and answers
©2010 DaVita Inc. All rights reserved.
3
Audience Question #1
Which one best describes the way you eat?
A.
B.
C.
D.
E.
Regular, no restrictions
Heart healthy diet
Diabetic diet
Low sodium diet
Kidney diet
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4
Audience Question #2
Have you ever had to make changes in the
way you eat due to your health?
Yes, I made changes for health reasons
B. No, I never needed to make changes
C. I should but haven’t made changes yet
A.
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5
Audience Question #3
Which one are you most interested in
knowing about nutrition and kidney
disease?
How much protein to eat
B. Healthy foods for a kidney diet
C. Phosphorus and potassium guidelines
D. Sodium and fluid guidelines
A.
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6
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1999
1990
2008
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Source: CDC Behavioral Risk Factor Surveillance System
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7
Age-adjusted Percentage of U.S. Adults Who Were
Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/m2)
1994
No Data
<14.0%
2008
2000
14.0-17.9%
18.0-21.9%
22.0-25.9%
>26.0%
Diabetes
1994
No Data
2008
2000
<4.5%
4.5-5.9%
6.0-7.4%
7.5-8.9%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at
http://www.cdc.gov/diabetes/statistics
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>9.0%
8
Number and Percentage of U.S. Population with Diagnosed Diabetes,
1958-2008
7
20
6
Percent with Diabetes
Percent with Diabetes
16
Number with Diabetes
5
14
12
4
10
3
8
6
2
4
Number with Diabetes (Millions)
18
1
2
0
0
1958
61
64
67
70
73
76
79
82
85
88
91
94
97
00
03
06
Year
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
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9
Nutrition and chronic disease link
Nutrition
Weight
Heart
Diabetes
Blood
Pressure
Kidneys
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10
Maria
Married with four
children ages 7, 9, 12,
15
• High blood pressure
• At risk for kidney and
heart disease
•
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11
Prevention: DASH* Diet
Dietary Approaches to Stop Hypertension
High in…
Low in…
Fiber
• Potassium
• Calcium
• Magnesium
Sodium
• Fat
•
•
Could lead to…
Lower systolic (upper number) blood pressure 11 points
*Free booklet available at www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
*NOTE: Not recommended for people with advanced kidney disease
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12
Dash Diet:
Dietary Approaches to Stop Hypertension
Fruit
4-5
servings
Grains
6-8
servings
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Vegetables
4-5
servings
Fat-free/
Low-fat
Dairy Products
2-3
Limit fats,
servings
oils, sweets
and added
sugars
Nuts &
Seeds
4-5
servings
6 oz or
less
-lean meat
-poultry
-fish
13
Portion Distortion
Most
peopl
e
don’t
recog
nize
a
porti
on
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Clean plate vs
satisfied
Is more really
better?
14
Common Portion - References
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15
Laverne
Retired widow, two
grown daughters, 5
grandchildren
• Type 2 diabetes
• High blood pressure
• Stage 3 CKD
•
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16
Diet in Early Kidney Disease
Focus on…
•
Important
Nutrients
•
•
•
•
Individual
Differences
•
•
•
•
Diet Goals
•
•
Sodium
Protein
Phosphorus (stage 3)
Calories
Size
Stage of CKD
Nutrition
Lab results
Weight
Good nutrition
Management of
•
•
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Blood pressure
Glucose
17
Tips to Decrease Sodium Intake
Cook at home with low-sodium
ingredients
Cut out: • Salt
• High-sodium condiments
• Processed, cured foods
Add:
• Herbs
• Spices
• Lemon
• Vinegar
1000-3000 mg
sodium/day
for ALL kidney
diets
Eat out less (especially Fast Food)
Read labels
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18
Common Sodium Sources
The following has..
This much sodium
1 slice of bread
110 – 175 mg
1 cup ready-to eat cereal
0 – 360 mg
½ cup canned vegetables
140 – 460 mg
1 cup tomato or V-8
330 mg
1 tsp salt
2100 mg
2 oz natural cheese
110 – 450 mg
2 oz processed cheese
600 mg
1/3 cup salted nuts
120 – 200 mg
3 oz canned tuna
230 – 350 mg
3 oz ham
1020 mg
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19
Protein Intake
Stages 1 - 3
DRI*: • Eat protein for good health
All stages – if malnourished
•
Eat additional protein
Example: • 55 grams
A 150 lb
• 1 cup milk
(68kg)
• 1 egg or 2 egg whites
•
•
•
4 oz meat
3 – 4 vegetables
6 servings of grains
50% High Quality Protein Sources
*DRI = Dietary Reference Intake
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20
Benefits of Carbohydrate Counting
•
•
•
•
•
Has biggest effect on blood sugar (compared
to protein and fat)
Helps improve glucose control
Increases awareness of carbohydrate intake
Requires more self-monitoring and decision
making
Easier than some of the complicated diabetes
meal planning methods
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21
Carbohydrate Counting
•
•
•
•
•
Which food groups have Carbs?
How much carbohydrate to eat at each
meal or snack?
What is a serving/choice/exchange?
How much carbohydrate is in a serving?
Label reading for carbohydrates
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22
Goals for Glucose Control
American Diabetes Association
Recommends the following ranges:
Glucose
•Pre-meal:
90-130 mg/dL
•2 hours after eating:
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HbA1C: < 7%
<180 mg/dL
23
When to Monitor Glucose
Type 1
•
•
•
•
Daily before each meal
and bedtime
Hypoglycemia or
hyperglycemia
During insulin
adjustment periods
Changes in exercise,
diet, meal times
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Type 2
•
•
•
•
•
1-4 times a day, 3-4
days a week
Before breakfast
Before and 2 hour after
the largest meal
Medication changes
Changes in exercise,
diet, meal times
24
Alex
Married, high school
teacher, 2 teenage
sons
• High blood pressure
• Stage 5 kidney failure
• Training to start
dialysis
•
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25
Diet in CKD Stages 4 - 5
Focus on…
•
Important
Nutrients
•
•
•
Individual
Differences
Diet Goals
Calories
Protein
Sodium
Phosphorus
•
Size
Nutrition
Lab results
•
Management of
•
•
•
•
•
•
©2010 DaVita Inc. All rights reserved.
Blood pressure
Glucose
Minerals
Fluid
Fluid
Potassium
Calcium
•
•
•
•
•
Weight loss
prevention
Nutrition
26
Protein Intake
Stage 4 or 5 Not on dialysis
DRI*: • Eat LESS protein
Example: • 41 – 48 grams
A 150 lb
• ½ cup milk
(68kg)
• 1 egg or 2 egg
whites
• 2 oz meat
• 2 – 3 vegetables
• 5 – 6 servings of
grains
Stage 5 On dialysis
•
Eat MORE protein
•
82 grams
All stages – if
malnourished
•
Eat additional
protein
½ cup milk
2 eggs or 4 egg
whites
• 6 oz meat
• 3 vegetables
• 8 servings of
grains
•
•
50% High Quality Protein Sources
*DRI = Dietary Reference Intake
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27
Potassium and CKD
CKD Stages 1 – 3
•
Usually not restricted
CKD Stages 4 and 5
•
•
•
•
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Changes in medications that
increase potassium
Stop using salt substitute and
products that have potassium
chloride added (check labels)
Learn about highest
potassium fruits and
vegetables—have these less
frequently and in smaller
portions
Learn about other high
potassium foods to limit
28
Common Potassium Sources
The following has..
This much potassium
1 medium baked potato
925 mg
1 medium sweet potato
540 mg
½ cup cooked spinach
290 mg
½ cup fresh tomato
210 mg
1 cup cantaloupe
430 mg
1 medium banana
420 mg
1 orange
240 mg
½ cup beans
360 mg
1/3 cup nuts or seeds
120-310 mg
1 cup milk or yogurt
360-490 mg
3 oz meat, poultry, fish
200-400 mg
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29
Phosphorus and CKD
CKD Stages 1 – 2
•
Usually not restricted
CKD Stages 3 – 5
•
•
•
•
•
•
•
©2010 DaVita Inc. All rights reserved.
800 to 1000 mg/day for most
patients
Lower protein diets decrease
phosphorus
Phosphate binders may be
needed
Ask your doctor to check
phosphorus level and discuss the
results
Learn about and limit highest
phosphorus foods
Processed foods and phosphate
additives—read labels
Early phosphorus control may
delay bone disease
30
High Phosphorus Foods
The following has..
This much phosphorus
1 oz meat
65 mg
2 tablespoons peanut butter
100 mg
½ cup milk
110 mg
1 cup Hawaiian Punch
115 mg
1 oz cheese
100 – 150 mg
½ cup beans (pinto, lima)
125 mg
2/3 cup bran flakes
150 mg
Fast food small cheeseburger
176 mg
3 tablespoon (1 oz) sunflower seeds
328 mg
Fast food sausage & egg biscuit
490 mg
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31
Calcium
CKD Stages 1 – 4
1200 – 1500 mg/day
based on DRI*
• May need vitamin D3
•
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CKD Stage 5
Not to exceed 2000
mg/day, including
calcium-based
binders
• Activated vitamin D
• PTH control
important
•
*DRI = Dietary Reference Intake
32
Healthy Foods to Eat
Healthy Fats
•
•
Omega 3’s
• Sardines
• Salmon
• Mackerel
• Trout
• Fish oil supplements
High Quality Proteins
Egg white
• Fish
• Lean meats & poultry
•
Fiber
•
Berries
• Apples
•
•
Olive oil
• Canola oil
• Flax seed oil
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Vegetables
Broccoli
• Green beans
• Cabbage
• Summer squash
•
Monounsaturated fats
•
Fruits
•
Bread, cereals & grains
33
Eat the Rainbow for Good Health
red, orange, yellow, green and purple
Anti-inflammatory,
high antioxidants
•
Fruits
•
•
•
•
•
•
•
•
Apples
Blueberries
Cherries
Cranberries
Raspberries
Red grapes
Strawberries
Vegetables
•
•
•
•
•
Cabbage
Cauliflower
Garlic
Onion
Red peppers
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Vitamin C
Fruits
• Grapefruit
• Lemon
• Strawberries
• Tangerine
• Vegetables
• Bell peppers
• Broccoli
• Greens
• Cabbage
• Celery
• Zucchini
•
Vitamin E
•
Oils
Canola
• Sunflower
• Wheat germ
• Vegetable
Beta-carotene
•
•
Fruits
•
•
Apricots
Vegetables
•
•
•
•
•
Carrots
Leafy greens
Broccoli
Romaine
lettuce
Green Peppers
34
Making Diet Changes
Educate
•
Learn about
foods
Best to have
• What to limit
•
•
Use existing
Kidney
Education
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Support
Educate family
and friends
• Join a support
group
• Start a
recipe/meal
exchange
•
Commit to
Change
Vary Meals
Experiment with
new herbs and
spices in familiar
foods
• Explore
unfamiliar foods
• Try new recipes
•
Start small
• Acknowledge
successes
• Keep
records/food
diary
• Focus on
benefits and
motivation
sources
•
35
Kidney Diet Tools and Resources
Possible Sources
•
Websites*
Newsletters
Books
Kidney organizations
•
DaVita Diet Helper*
•
Videos
Magazine articles
•
Kidney Friendly
Recipes
Online Meal
Planners and
Trackers
Diet and
Nutrition
Education
Kidney
Community
©2010 DaVita Inc. All rights reserved.
•
•
•
•
•
Blogs
Discussion forums*
*Available at www.davita.com
36
Takeaway: What this means to you
tomorrow morning
•
What you eat at each meal now makes a
difference in your future health
•
Diet goals change with stages of chronic
kidney disease (CKD) and dialysis
•
You can make small gradual changes that
really add up
©2010 DaVita Inc. All rights reserved.
37
Thank you!
©2010 DaVita Inc. All rights reserved.
38