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  1. #1
    Join Date
    11-20-10
    Posts
    142

    Default It's counterintuitive

    I've been on my stupid renal diet for 6 years and do pretty well. I've seen a registered renal dietician about the pre-renal diet. I am not on D yet.

    I have two questions/concerns. I had always eaten whole grain products but now, with the pre-renal diet, understand that whole grains are high in phosphorus. For six years now, I've eaten white bread, white rice (basmati rice) and white pasta, and I am concerned that this is not really good for me. I could of course drop these items altogether from my diet, but further restricting an already prohibitively restricted diet is too dismal a prospect. Any suggestions? Is whole wheat bread really that awful? Is rye bread a reasonable alternative? How about some other sort of pasta (I have a husband who'd eat pasta every day if I let him)?

    My second question concerns the difference in phosphorus from legumes/vegetable sources from that from animal sources. I do not eat processed meats because of the phosphates (although I have found really good bacon that has no phosphates), but I know that meats you cook yourself still have phosphorus. I would love to go on a vegetarian diet as beans of all kinds are my favourite food, but there is the phosphorus issue again. I have been reading a few studies recently and hearing some discussion (on the Davita site from their Indian dietician) that say that phosphorus from lentils is processed differently than that from meat and is "safer."

    Can you guide me, please? Thank you!

  2. #2
    Join Date
    02-14-10
    Location
    LA area in California and Northern Idaho
    Posts
    125

    Default

    Dear MooseMom, it in part depends on what your Ca+, PO4 and PTH run at as far as how much phosphorus you can take in your diet. In general as you already know, less is better for many reasons.

    You are asking a good question about the whole wheat bread which is what I eat. Fortunately, I have a normal ranging PO4 even on dialysis and have never taken any binders ever. There are nutrients that the whole grains have.

    You are also correct that the type of phosphorus affects how much is taken up. Animal sources are more readily absorbed than plant PO4. Certainly a discussion worthy of your medical team.

    I believe that there is connection between PO4 and exercise and muscle mass. I have seen one article that lays the groundwork for that connection, but they didn't connect the dots. I wish I could give you more than my own personal theory on that, but I believe it is a factor in the equation. Hopefully someone someday will look at that issue, but in the mean time, I am going to keep up with my exercise, once I get some iron back in my system. Just made the appointment for iron infusion next week, I really need a load of iron right now.

    So great question and don't slow down. You are really learning a lot. We are going to have to put you to work writing your own articles soon.

    God bless,

    Peter
    Last edited by PeterLairdMD; January 6, 2011 at 08:29 PM.

  3. #3
    Join Date
    02-14-10
    Location
    LA area in California and Northern Idaho
    Posts
    125

    Default

    I reread your post and forgot to mention about pasta. I LOVE pasta with Marinara sauce. Before I started dialysis, if my wife asked, the answer was always spaghetti, always.

    When I started on the NxStage and had to increase my potassium because of the 1K bath, guess what I asked for almost every day. My wife loves it since she can whip up a batch that lasts almosts a week at a time, well 5 days anyway, and feeding the bum as she calls it becomes quite easy. I do appreciate my wife.

    After eating pasta almost every day, my cholesterol and triglycerides shot through the moon. So, now my staple is beef stew with tomato sauce instead of just plain broth. It is unique to the Philippines but wow, is it good. I get my vegetables and my protein in one big pot. Once again, once made, my wife just heats up the left overs that get better every day.

    So pasta, is a big no no for all of us and you should tread softly unless you use the whole grain pastas which just ruins the taste of my marinara sauce in my opinion. So, I get an occassional slice of pizza which has too much salt, so I don't do that very often, lazagna was a very common meal over the holidays at my wife's friends which isn't really good for me, but all things in moderation.

    The take home message is be very careful with K+ which can kill quickly and PO4/Ca which kills slowly. Na is always to be limited period. The good news is once you start dialysis daily, you can eat a whole lot more than you are right now. Sounds strange to have a reason to look forward to dialysis, but with daily dialysis, that is a bonus that we all enjoy who are at home.

    Take care and keep up the study, I am going to have to go back to school to stay ahead of you, Dori, what do you recommend?
    Last edited by PeterLairdMD; January 6, 2011 at 08:31 PM.

  4. #4
    Join Date
    08-17-04
    Posts
    2,147

    Default

    Interesting that you noted the increase in your cholesterol and triglycerides with so much pasta, Peter. Recent studies have been finding that it's starches that cause these increases--not fat, as was believed previously. Think about it, though. When they want to fatten up cattle to "finish" them for market, what do they feed them? Corn. Not fat. (If fat would make cattle fat, they would use it. It doesn't.)

    Grains and legumes have antinutrients that can deplete the body of other essential nutrients. (http://en.wikipedia.org/wiki/Antinutrient). I don't eat either one. :-) I know everyone thinks these are "healthy." But that's not necessarily the case. OTOH, I should warn you that I have ZERO training in nutrition. Strictly an amateur who reads a lot & is trying not to get type 2 diabetes like my dad has.

  5. #5
    Join Date
    02-14-10
    Location
    LA area in California and Northern Idaho
    Posts
    125

    Default

    Quote Originally Posted by Dori Schatell View Post
    Interesting that you noted the increase in your cholesterol and triglycerides with so much pasta, Peter. Recent studies have been finding that it's starches that cause these increases--not fat, as was believed previously. Think about it, though. When they want to fatten up cattle to "finish" them for market, what do they feed them? Corn. Not fat. (If fat would make cattle fat, they would use it. It doesn't.)

    Grains and legumes have antinutrients that can deplete the body of other essential nutrients. (http://en.wikipedia.org/wiki/Antinutrient). I don't eat either one. :-) I know everyone thinks these are "healthy." But that's not necessarily the case. OTOH, I should warn you that I have ZERO training in nutrition. Strictly an amateur who reads a lot & is trying not to get type 2 diabetes like my dad has.
    My wife gave up rice 6 months ago and has lost 20 pounds as of two days ago, that with a WHOLE lot of exercise that it is. She started to develop elevated blood sugars, never to the point of diabetes, but it does run in her family. I scared her enough that she has really got a handle on it now. Unfortunately, it is a lifetime battle that doesn't stop or go away. Nevertheless, we have both learned our lessons with our favorite starches. Too bad, but I still get a little bit every once in a while. I guess that there is also eggplant parmasian without much of the parmiasian it is fine.

  6. #6
    Join Date
    08-17-04
    Posts
    2,147

    Default

    Sugar in any form--including rice, corn, wheat, potatoes--is best avoided by those of us who have a genetic predisposition to type 2 diabetes. 90% of it is preventable with diet and exercise. I'm appalled when I hear from friends who have type 1 and are on insulin pumps that they are told to eat 160 grams of carbs a day. I try for 50 or less!

  7. #7
    Join Date
    11-20-10
    Posts
    142

    Default

    Re K, a couple of years ago, I was just returning home from my daily 2 mile walk feeling all virtuous when I heard the phone ringing. It was my neph's nurse calling to tell me that there had been a sudden spike in my K to 6.1; I knew how dangerous this could be. So after a lot of emergency phone calls, I was put on 10 gr sodium bicarb...that's 8 big tablets A DAY. My neph had advised me to ADD SALT to my diet to combat an upwardly creeping K level. I never thought I'd hear a doc telling me to add salt, of all things. Just goes to show how CKD can affect different people in weirdly different ways. Fortunately, my K is better controlled now, but geez...8 sod.bicarb tabs each day. blech.

    There could be a case made for how bad any particular food can be for you. My general rule is no processed food, avoid the foods really high in PO4 and K, no sugar (don't like sweets anway) and everything else in moderation. Half a glass of red wine when I get good news from my neph.

  8. #8
    Join Date
    03-15-10
    Location
    Los Angeles, CA
    Posts
    23

    Default

    This is a very interesting thread. A lot of patients talk about the counterintuitive aspect of the renal diet - white bread instead of wheat bread, white rice instead of brown rice, and a restriction on fruits and veggies. Even though these foods are considered "healthy" for the regualr population, they are not so healthy for people with kidney problems. The level of restriction, of course, depends on each patient's individual lab results. Rye bread is can be an acceptable substitute for wheat bread and is a nice alternative to white bread.

    Legumes and beans can be kind of tricky because they contain both potassium AND phosphorus. Some studies have shown that vegetarian protein sources such as beans and tofu are safer for the kidneys than animal protein. I think choosing a variety of foods that are reasonable in terms of potassium and phosphorus is a good principle to follow. Go for both meat and vegetarian meals. Follow-up with your renal dietitian to make sure you are staying on track.

    I know it is not an easy diet to follow. Your commitment and interest in learning are really important. Keep up the good work!

    LeeAnn Smith Weintraub, MPH, RD

  9. #9
    Join Date
    11-20-10
    Posts
    142

    Default

    The reason it is not an easy diet to follow is because generally speaking, it is too often taught in terms of what to avoid rather than in terms on what to eat to maintain health. Over time, instead of seeing food as fuel and as nourishment, food becomes the enemy. Food is important in human society...we use it as a conduit to celebration, comfort and even grief. Food is heritage. When you deny people food, you deny them of more than just potassium and phosphorus. So I'd really like to see more of an emphasis on what renal patients CAN eat and enjoy.

    I personally have reached the point that I simply do not enjoy foods that I know are bad for me. I was down south for Thanksgiving, and even though my family knew about my dietary restrictions, they didn't understand them, the result being that there was not one single "safe" food. Butter beans, black eyed peas, pecan pie, mashed potatoes, sweet potatoes...sheer assassination by food! This is the food of my family, my heritage, my culture. I hate being precious about food. I dislike the whole weasly mindset of "oooh, I can't eat that because of my delicate state, oooh." So, I had small spoonfuls of each, kept my mouth shut and vowed to compensate by being extra vigilant for the rest of the week. But it has taken me years to get to the point where I can live fairly happily with the diet. The real tricks are 1. watch your portions and learn to be happy with a mere occasional spoonful of the outlawed treat, 2. pay attention to your labs so that you can learn how much you can "cheat", and 3. learn to substitute and learn to like more of a variety of foods. I may not be able to eat oranges and bananas, but give me strawberries and grapes and I'm perfectly happy. I wish my renal dietician had taught me these three tips the first time I met with her.

  10. #10
    Join Date
    11-20-10
    Posts
    142

    Default

    OK, I don't mean to put anyone on the spot, but I'm going to put you on the spot! Being CKD4, I've been told to limit my protein intake. With that in mind, if I had the choice between a cup of lentils and a 3 oz portion of fish (no creamy sauce), which would be safest in terms of limiting protein and phosphorus?

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