Got milk? Americans are familiar with the milk ad campaign that shows up on television and in magazines. Celebrities sport a milk mustache that  promotes health benefits of drinking milk. For people with kidney disease on dialysis, milk restriction is advised. Milk is high in potassium, phosphorus and calcium-some of the nutrients that become out of balance when the kidneys are no longer working. Milk is often limited by chronic kidney disease patients who are on a lower protein diet. Read more…

Thursday March 11 is World Kidney Day, a time to bring attention to kidney disease awareness, treatment and prevention. I will be participating in Building Bridges to Optimum Health World Kidney Day Los Angeles, a conference at the Holman United Methodist Church—please stop by if you happen to be in the LA area.
For those of you who cannot attend, here are a few highlights from my talk on Nutrition and Kidney Disease.
Kidney disease continues to rise with a strong link to epidemic rates of obesity, diabetes and high blood pressure. Early nutrition intervention can make a difference in preventing and treating these diseases that increase risk for kidney failure.

• If you are at risk for kidney disease but do not have it yet, follow a DASH diet (Dietary Approaches to Stop Hypertension) to help lower your blood pressure and eat healthier. For more information on DASH diet: www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
• If you already have early kidney disease (stage 1-3) focus on controlling blood pressure and diabetes. A low sodium diet, carbohydrate counting, glucose monitoring and daily exercise are recommended. Reduce protein to the Dietary Reference Intake (DRI) 0.8 grams/kg body weight/day and limit high phosphorus foods and phosphate additives to help preserve kidney function. Most Americans eat much more protein in their daily diets. Work with your doctor and dietitian to be sure you eat enough high quality protein to prevent malnutrition.
•  If you are in stage 4-5 CKD, not on dialysis, you may need to restrict potassium, phosphorus and fluids in addition to sodium. A reduction in protein to help decrease waste build-up in the blood may be prescribed, but maintaining adequate calorie and protein intake to prevent malnutrition is even more important.
• After starting dialysis there is no need to restrict protein—in fact extra protein is needed to replace losses in the dialysis treatment. Low sodium and low phosphorus are still required. Potassium and fluid restriction depend on the type and frequency of dialysis selected.
• In addition to the above, focus on consuming healthy fats (omega 3’s from fish, monounsaturated fats from olive and canola oil), high quality, low phosphorus proteins (egg white, fish, lean meats).
• Eat the rainbow–for good health include colorful fruits and vegetables high in anti-oxidants with anti-inflammatory properties as well as fiber, vitamin C and vitamin E.
• For successful dietary changes focus on education, family support, variety in meals and commitment to making changes to improve your health.
  Takeaways
• What you eat matters in your health-disease  for chronic disease prevention and treatment
• Diet goals change with stages of chronic kidney disease (CKD) and dialysis
• Start making changes now; it will make a difference tomorrow.

Learn more about kidney disease at www.kidneyawarenesstime.org, www.davita.com, www.yourkidneys.com, and www.kidneytrust.org.

‘Tis the season to be jolly…and to face a new set of holiday diet challenges. For people with chronic kidney disease or dialysis patients, knowing what to eat and when to be cautious while following a low potassium diet is extremely important. High potassium levels are dangerous and could cause the heart and nerves to stop working properly.

Here are some important things to know and do Read more…

The Daily Value (DV) on food labels was established for the general public to help determine if a food is a high or low source of specific nutrients.

For people with healthy kidneys a high potassium intake is considered healthy. The daily goal is to consume enough high potassium foods to provide at least 3500 mg potassium.

Once the kidneys can no longer remove potassium (usually in later stage 4 and stage 5 CKD), and blood potassium values rise above normal (3.5-5.0 mEq/L) a lower potassium diet is usually prescribed.

Some but not all foods include potassium on the Nutrition Facts Label. An understanding of what to look for can help make grocery shopping easier. Here’s a general potassium DV guideline to help interpret the numbers when reading food labels:

• Up to 4 % DV = 0-140 mg, low potassium
• Up to 7 % DV = 141-250 mg, medium potassium
• Up to 14% DV = 251-500 mg, high potassium
• Over 20% DV = 700 mg or more, very high potassium

Each person has individual requirements for potassium depending on kidney function, lab values, appetite and type of dialysis treatment. It’s a good idea for people with chronic kidney disease to always check with their kidney care team rather than guess about their diet requirements for potassium.

Potassium restriction is not required by all people with chronic kidney disease (CKD). Usually those on hemodialysis or in late stage kidney failure, but not yet on dialysis are prescribed a lower potassium diet by their doctor or dietitian. People with early stage chronic kidney disease or daily dialysis may require a more liberal potassium intake unless their lab values are high.

This is often confusing when first diagnosed with CKD. Doctors and dietitians monitor potassium lab values to determine when their patient needs to start limiting foods high in potassium. As kidney function declines, more potassium is retained in the blood, so dietary intake must be reduced to prevent high potassium levels. Too much potassium is dangerous and can cause heart failure.

People who are unsure can check with their kidney doctor and dietitian to confirm an individual daily goal for potassium as well as other diet parameters.

Listing potassium on food labels is optional for food manufacturers. Dialysis patients be aware that just because potassium is not listed on the label, it does not mean the food is potassium free.

Potassium is plentiful in milk, meats, fruits, vegetables, beans and nuts. If these ingredients are in the food, it contains potassium.

Another potassium source to be aware of is potassium chloride, the main ingredient in salt substitute. Some manufactured low-sodium food products contain potassium chloride instead of salt. Avoid this ingredient for a low potassium diet because a single teaspoon contains 2800 mg potassium.

Currently, the FDA is studying revision of nutrients required on food labels. (Docket No. 2006N-0168, titled Food Labeling: Revision of Reference Values and Mandatory Nutrients). People with CKD will benefit if potassium and phosphorus are added to the revised nutrition label.