The National Kidney and Transplant Institute, Nutrition and Dietetics Division Nutrition and Healthy Lifestyle Clinic offer diet counseling and nutrition consultation in many diets especially in renal nutrition.
Diet Instruction and counseling offered.
RENAL DIET MANAGEMENT
The use of nutrition therapy aims to retard progression of the kidney disease. It is to afford rest to the organ and to minimize uremic toxicity.
Diet and meal plan is computed based on the treatment plan for each patient. Allowances for specific food and nutrient intake varies depending on the stage of the renal disease. There are differences in the diet requirement of patients with dialysis/renal replacement therapy (Hemodialysis and Peritoneal Dialysis), without dialysis called pre-dialysis diet and for patients who underwent kidney transplantation.
Nutrients commonly modified in the renal diet are the daily intake of
- Sodium and potassium
- Calcium and Phosphorus
- Fluid and water intake
The next paragraph contains information on nutrition and its relation to the kidney disease.
NUTRITION AND RENAL DISEASE
- Eat just enough protein. Excess intake of protein would lead to the accumulation of waste products like urea, creatinine and uric acid in the blood. Consumption of white meat (chicken, fish and eggs) is better than the intake of red meat (pork and beef). Avoid concentrated foods like organ meats, kare-kare, laing and processed foods.
- Phosphorus level in the blood increases as kidney function declines, therefore, it is important to avoid foods high in this nutrient, such as:
- Excess intake of milk, cheese and other dairy products
- Legumes like beans and mongo beans
- Chocolate and cocoa
- Pinipig, peanuts and pili nuts
- High levels of phosphorus causes skin itchiness and disturbances in the bone and calcium metabolism in the body. Doctors prescribe phosphate binders to correct levels of phophorus in the blood.
- Avoid salty foods and condiments (bagoong, dried fish, salted egg, chips, soy sauce, fish sauce, vetsin, broth cubes). Excess sodium in the diet could cause high blood pressure and edema.
- Eat only the recommended amount of fruits and vegetables especially if you are on hemodialysis. High levels of potassium in the blood causes irregular heartbeat, palpitation and worse could lead to cardiac arrest.
- Drink the right amount of water or follow what is prescribed by your doctor. Avoid excess intake of fluids especially when there is edema or oliguria.
- Eat enough carbohydrates and fats for daily energy source of the body. Fat can be eaten in allowed amount, through frying and sautéing of foods. To avoid increases in the blood cholesterol levels, buy and use vegetable and plant oil sources.
- Avoid eating of simple sugars and sweets (cakes, candies, chocolate bars) if you have diabetes. These foods can increase your blood glucose level and may create another problem.
KIDNEY TRANSPLANT DIET
The diet for renal transplantation is to provide adequate calories and protein to counteract the catabolic effect of surgery during the early post transplant period and to manage the nutritional side-effect of immunosuppressive drugs.
- Nutrition after kidney transplantation is given a well-balanced diet. This means that it contains foods from all food groups-egg, meat, fish, chicken, milk, cheese, fruits, vegetables, cereals, sugars. Initially, during the first month after transplantation, the patient is advised short-term dietary management. This may expedite wound healing, muscle growth and development and prevent drug-induced diabetes commonly observed after transplantation. However diet-related complication that may lead to organ rejection. Therefore, the following nutritional guidelines are recommended.
Short-Term Management (During the first month after transplantation)
- Adequate protein intake to replace further protein breakdown due to high doses of steroid. Good protein food sources are meat, fish, poultry, egg, milk and milk products.
- Eat small amount of simple sugars: honey, jams, jelly, candy, softdrinks, cakes and sweet desserts.
- Limit intake of salt, seasonings and processed foods to prevent increase in blood pressure and fluid retention.
Long –Term Nutritional Management
- Lower protein intake as steroid dosage is reduced.
- Eat less fat and cholesterol to reduce the risk of developing heart disease and increase in body weight.
- Continue limiting intake of simple sugars and salty condiments and high-sodium containing foods.
- Mineral and vitamin supplements may be taken as allowed by the physician
Other renal diets commonly used in kidney disease management are:
Foods rich in protein are also rich in phosphorus. Thus, restricting protein also restricts phosphorus in the diet.
Foods to be avoided:
- Fish, dried
- Chick peas
Low Calcium Diet
This diet is advised to patients with calcium oxalate renal stones. It is designed to minimize the concentration of the components associated in the formation of renal stones.
Examples of foods high in calcium: green leafy vegetables like “malunggay” and “saluyot,” calcium-fortified fruit juices and other beverages, too much intake of milk and dairy products, dried beans, sardines and anchovies.
Low Oxalate Diet
An oxalate-restricted diet is indicated for individuals with calcium oxalate renal stones. The dietary modification is designed to minimize its concentration in the urine associated with its formation. A regular or general diet is provided with avoidance of foods known to be high in oxalate.
Examples of foods high in oxalate: Chocolate (beverages and drinks, candies and bars), soy beans and products, strawberries, ripe tamarind, green leafy vegetables, celery, eggplant, wheat germ/bran, cassava, sweet potato, white corn, all nuts and products, tea and draft beer.
Low Potassium Diet
Potassium is an essential mineral needed by the body for normal nerve transmission and muscle contraction, including the normal beating of the heart.
A low potassium diet is prescribed for people with renal disease, hyperkalemia or Addison’s disease in which the potassium in the blood is high. Low level should be less than 2 grams per day since the usual intake from foods is 2-6 grams per day.
Foods to be avoided are the following:
- green leafy vegetables such as malunggay, spinach, talbos ng kamote and sili
- fruits such as banana, orange, buco, siniguelas, lanzones, melon and dried fruits
- wheat and wheat products such as oatmeal, misua and wheat bread
- legumes and beans
- coconut milk
- chocolates (bars, candies, beverages)
- cola drinks
This diet provides 30-40 grams protein per day only, 2/3 of the amount is derived from intake of meat, fish and eggs (high biological value protein) and the remaining 1/3 coming from rice, sugar, fats and vegetables (low biological value protein).
It aims to prevent or minimize muscle and tissue breakdown, hence sufficient calories are provided with liberal use of carbohydrates and fats.
Too little protein, the person develops malnutrition. Too much protein, the blood urea rises. For people with renal insufficiency, restricting protein may help protect the remaining nephrons.
The diet follows the regular menu selection except that intake of protein is limited. Foods restricted are internal organs, dried fish, viands cooked with coconut milk, beans and legumes, high sodium containing canned meats and milk in excess amount.
A low purine diet restricts the amount of purine to only 150 mg per day. The low purine diet diet is prescribed as an adjunct to drug therapy for gout, arthritis and other disorders affecting purine metabolism. It is also recommended for people with uric acid stone. Daily consumption of water should be increased since this helps in eliminating uric acid. A high intake of carbohydrates also favors uric acid secretion while a high fat intake favors its retention.
Food to be Avoided:
- Internal organs (Pork, Chicken, Beef)
- Small and large intestines
- Dilis (Anchovies)
- Matang Baka
- Legumes and dried beans
- Chick peas
- Lima beans
- Mungo beans
The diet for a diabetic patient is designed to maintain near-normal blood glucose and lipid levels, to provide adequate energy from foods, prevent/delay disease complications and promote good nutritional well-being.
The diet of a diabetic person should be well balanced. Foods from the different food groups (meat, poultry, milk and products, legumes, vegetables, fruits, rice and cereals) should be included in the diet. The caloric amount of food and regular eating time is emphasized in the nutritional management of the patient. The following guidelines are also recommended:
- Maintain the desirable body weight.
- Eat foods rich in fiber: rice, bread, root crops, fresh fruits and vegetables. Fiber in foods helps to control blood sugar and cholesterol levels.
- Eat less fat to avoid/delay having cardiovascular diseases.
- Avoid simple sugars in the diet.
- Use less salt/seasoning and avoid eating too much processed and salty foods to help control blood pressure.
- Refrain from drinking alcoholic beverages. If so desired, consult a dietitian on how to work it in the meal
Follow a regular meal plan.
Cardiovascular diseases remain one of the leading causes of mortality to almost all population. Efforts to fight heart diseases have led to valuable health discoveries and public education awareness. The following are recommendations for a healthy lifestyle and proper food and dietary habits:
- Follow a low fat and a low cholesterol diet.
- Eat more fruits, vegetables and rootcrops. Fiber present in these foods helps in lowering blood cholesterol and lipid levels and promoting normal bowel movement.
- Avoid too much consumption of salty foods (bagoong, processed meats) for better control of blood pressure and prevent edema.
- Exercise regularly for good muscle tone and body weight maintenance.
- Do not smoke.
- Avoid alcohol and other liquors, since they are high in fat and cholesterol. Avoid too much intake of caffeine-containing foods that may cause heart irregularities.
- Eat a balanced meal. Stay away from too much restaurant foods that increase your sodium and cholesterol intake.
- Learn to relax. Yoga, meditation and music help fight stress that weakens the immune system.
- Consult your doctor for a regular medical check-up.
A low fat diet is an allowance of food and drink with the total amount of fat limited to 15% of the total calories. This diet is advised for weight reduction, heart disorder, gall bladder inflammation, portal cirrhosis, hepatitis, pancreatitis, and fat malabsorption. Fats from animal sources are not recommended while fats from plant sources is recommended since it does not contribute to the disease condition. Ample intake of fruits and vegetables and multi-vitamin supplements may be prescribed.
Foods commonly omitted from the diet:
- carabao’s milk
- mami, miki and canton noodles
- chocolate (bars, candy and beverages)
- doughnuts and pastries with heavy icing
- viands cooked with coconut milk-Laing
- lard/animal fat
- too much frying/sautéing in the diet
- pork crackling (chicharon), kare-kare (ox tripe), pork suckling (lechon)
Cholesterol is a waxy fat-like substance found in foods of animal origin. Cholesterol in the blood is derived from two sources-from the diet and that which is produced by the body.
The average diet provides at least 450 mg cholesterol per day, the recommended intake is 300 mg or less per day. The current interest in cholesterol is due to its role in cardiovascular diseases particularly atherosclerosis-a comditioncharacterized by the hardening of walls of the arteries.
Foods commonly omitted from the diet:
- all types of internal organs
- egg yolk
- pastries and other rich desserts
- chocolates (bars, candies, beverages)
- whole milk and products
- processed meats such as longganiza, hotdog, corned beef
- viands cooked with coconut cream or “gata”
- alcoholic beverages
- animal fat or lard
- too much intake of butter and mayonnaise
PULMONARY AND IMMUNE DISORDERS DIET:
Chronic Pulmonary Obstructive Diet
Nutrition in COPD is important because it improves respiratory muscle function, lowers excessive carbon dioxide production in the lungs and enhances oxygen needs of the body. Good COPD nutrition may facilitate withdrawal from mechanical ventilation and increase resistance against infection.
The diet contains less carbohydrates, about 40% of the total calories, while fat intake is increased to 40% of the total calories. This is because carbohydrates produces more carbon dioxide than fats and protein. Enough protein is also provided for muscle function and tissue repair. The amounts of calories, protein, calcium and potassium and sodium should be sufficient to meet the body’s needs.
Some helpful nutritional tips:
- Eat 3 small square meals with 3 snacks. Large food intake distends the stomach making a full and bloated diaphragm.
- Do not lie down after eating.
- Avoid gas forming foods and drinks: soft drinks, corn, onions and cruciferous vegetables like cauliflower, broccoli
- Eat foods that are easy to chew and digest.
- Keep the body hydrated by drinking enough fruit juices and water.
- Rest before eating.
- Eat a variety of foods to ensure the body of good nutrition Avoid sulfite-containing processed foods such as cookies, crackers, wine, beer, fruit juices, dried and glazed fruits and condiments (pickles, salad dressings mixes, wine vinegar). Some asthmatic patients are sensitive to sulfites.
Hypoallergenic Diet/Hypersensitivity Diet
This diet restricts the intake of foods known to cause allergic and hypersensitivity reactions in the different parts of the body such as skin, lungs, heart, stomach, eyes, etc.
- Common foods that are eliminated from the daily intake are the following:
- chicken and eggs
- fishes such as tambakol, tulingan, tuna, and sardines
- processed foods such as ham, salami and sausage
- fruits and vegetables such as strawberries, fresh tomatoes, citrus fruits (lemon, pomelo, grapes)
- milk and milk products (cheese, ice cream)
- nuts (peanuts, almond nuts)
- chocolate bars, candies and beverages
- wheat products (wheat bread and oatmeal)