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 ©2010 DaVita Inc. All rights reserved. 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 ©2010 DaVita Inc. All rights reserved. 4

Audience Question #2

Have you ever had to make changes in the way you eat due to your health?

A.

B.

C.

Yes, I made changes for health reasons No, I never needed to make changes I should but haven’t made changes yet ©2010 DaVita Inc. All rights reserved. 5

Audience Question #3

Which one are you most interested in knowing about nutrition and kidney disease?

A.

B.

C.

D.

How much protein to eat Healthy foods for a kidney diet Phosphorus and potassium guidelines Sodium and fluid guidelines ©2010 DaVita Inc. All rights reserved. 6

(*BMI



30, or about 30 lbs. overweight for 5’4” person) 1990 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 1999 2008 No Data <10% 10%–14%

Source: CDC Behavioral Risk Factor Surveillance System ©2010 DaVita Inc. All rights reserved.

15%–19% 20%–24% 25%–29% ≥30%

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Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m 2 ) 1994 2000 2008

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

Diabetes 1994 2000 2008

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at ©2010 DaVita Inc. All rights reserved. http://www.cdc.gov/diabetes/statistics 8

Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008 7 20 6 5 4 3 2 1 Percent with Diabetes Number with Diabetes 18 16 14 12 4 2 0 10 8 6 0

1958 61 64 67 70 73 76 79 82

Year

85 88 91 94 97 00 03 06 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics ©2010 DaVita Inc. All rights reserved. 9

Nutrition and chronic disease link

Nutrition Weight Heart ©2010 DaVita Inc. All rights reserved. Diabetes Kidneys Blood Pressure 10

Maria

©2010 DaVita Inc. All rights reserved. • • • Married with four children ages 7, 9, 12, 15 High blood pressure At risk for kidney and heart disease 11

Prevention: DASH* Diet

Dietary Approaches to Stop Hypertension

High in…

• • • • Fiber Potassium Calcium Magnesium

Low in…

• • 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 ©2010 DaVita Inc. All rights reserved. 12

Dash Diet:

Dietary Approaches to Stop Hypertension Fruit

4-5 servings

Grains

6-8 servings

Vegetables

4-5 servings

Limit fats, oils, sweets and added sugars Nuts & Seeds

4-5 servings

Fat-free/ Low-fat Dairy Products

2-3 servings 6 oz or less -lean meat -poultry -fish

©2010 DaVita Inc. All rights reserved. 13

Portion Distortion

Most peopl e don’t recog nize a porti on Clean plate vs satisfied Is more really better?

©2010 DaVita Inc. All rights reserved. 14

Common Portion - References

©2010 DaVita Inc. All rights reserved. 15

Laverne

©2010 DaVita Inc. All rights reserved. • • • • Retired widow, two grown daughters, 5 grandchildren Type 2 diabetes High blood pressure Stage 3 CKD 16

Diet in Early Kidney Disease

Focus on… Important Nutrients Individual Differences Diet Goals ©2010 DaVita Inc. All rights reserved. • • • • • • • • • • • Sodium Protein Phosphorus (stage 3) Calories Size Stage of CKD Nutrition Lab results Weight Good nutrition Management of • • 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 Eat out less (especially Fast Food) Read labels 1000-3000 mg sodium/day for ALL kidney diets ©2010 DaVita Inc. All rights reserved. 18

Common Sodium Sources

The following has..

This much sodium 1 slice of bread 110 – 175 mg 1 cup ready-to eat cereal ½ cup canned vegetables 1 cup tomato or V-8 1 tsp salt 2 oz natural cheese 2 oz processed cheese 1/3 cup salted nuts 3 oz canned tuna 0 – 360 mg 140 – 460 mg 330 mg 2100 mg 110 – 450 mg 600 mg 120 – 200 mg 230 – 350 mg 3 oz ham ©2010 DaVita Inc. All rights reserved. 1020 mg 19

Protein Intake

Stages 1 - 3 DRI*:

• Eat protein for good health

Example:

A 150 lb (68kg) • 55 grams • 1 cup milk • • • • 1 egg or 2 egg whites 4 oz meat 3 – 4 vegetables 6 servings of grains

All stages – if malnourished

• Eat additional protein

50% High Quality Protein Sources

*DRI = Dietary Reference Intake ©2010 DaVita Inc. All rights reserved. 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 ©2010 DaVita Inc. All rights reserved. 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 ©2010 DaVita Inc. All rights reserved. 22

Goals for Glucose Control

American Diabetes Association Recommends the following ranges:

Glucose

• Pre-meal:

90-130 mg/dL

• 2 hours after eating:

< 180 mg/dL HbA1C: < 7%

©2010 DaVita Inc. All rights reserved. 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

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 ©2010 DaVita Inc. All rights reserved. 24

Alex

©2010 DaVita Inc. All rights reserved. • • • • Married, high school teacher, 2 teenage sons High blood pressure Stage 5 kidney failure Training to start dialysis 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 • Blood pressure • • • Glucose Minerals Fluid • • • Fluid Potassium Calcium • • Weight loss prevention Nutrition ©2010 DaVita Inc. All rights reserved. 26

Protein Intake

Stage 4 or 5 Not on dialysis DRI*:

• Eat LESS protein

Stage 5 On dialysis

• Eat MORE protein

Example:

A 150 lb (68kg) • 41 – 48 grams • • • • • ½ cup milk 1 egg or 2 egg whites 2 oz meat 2 – 3 vegetables 5 – 6 servings of grains • 82 grams • ½ cup milk • • • • 2 eggs or 4 egg whites 6 oz meat 3 vegetables 8 servings of grains

50% High Quality Protein Sources All stages – if malnourished

• Eat additional protein *DRI = Dietary Reference Intake ©2010 DaVita Inc. All rights reserved. 27

Potassium and CKD

CKD Stages 1 – 3

• Usually not restricted

CKD Stages 4 and 5

• • • • 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 ©2010 DaVita Inc. All rights reserved. 28

Common Potassium Sources

The following has..

1 medium baked potato 1 medium sweet potato ½ cup cooked spinach ½ cup fresh tomato 1 cup cantaloupe 1 medium banana 1 orange ½ cup beans 1/3 cup nuts or seeds 1 cup milk or yogurt 3 oz meat, poultry, fish This much potassium 925 mg 540 mg 290 mg 210 mg 430 mg 420 mg 240 mg 360 mg 120-310 mg 360-490 mg 200-400 mg ©2010 DaVita Inc. All rights reserved. 29

Phosphorus and CKD

CKD Stages 1 – 2

• Usually not restricted • • • • • • •

CKD Stages 3 – 5

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 ©2010 DaVita Inc. All rights reserved. 30

High Phosphorus Foods

The following has..

This much phosphorus 1 oz meat 65 mg 2 tablespoons peanut butter ½ cup milk 1 cup Hawaiian Punch 1 oz cheese ½ cup beans (pinto, lima) 2/3 cup bran flakes Fast food small cheeseburger 3 tablespoon (1 oz) sunflower seeds Fast food sausage & egg biscuit 100 mg 110 mg 115 mg 100 – 150 mg 125 mg 150 mg 176 mg 328 mg 490 mg ©2010 DaVita Inc. All rights reserved. 31

Calcium

CKD Stages 1 – 4

• • 1200 – 1500 mg/day based on DRI* May need vitamin D3

CKD Stage 5

• • • Not to exceed 2000 mg/day, including calcium-based binders Activated vitamin D PTH control important ©2010 DaVita Inc. All rights reserved. *DRI = Dietary Reference Intake 32

Healthy Foods to Eat

Healthy Fats High Quality Proteins

• • Omega 3’s • Sardines • • • • Salmon Mackerel Trout Fish oil supplements Monounsaturated fats • • • Olive oil Canola oil Flax seed oil • • • Egg white Fish Lean meats & poultry

Fiber

• • • Fruits • Berries • Apples Vegetables • Broccoli • • • Green beans Cabbage Summer squash Bread, cereals & grains ©2010 DaVita Inc. All rights reserved. 33

Eat the Rainbow for Good Health

red, orange, yellow, green and purple

Anti-inflammatory, high antioxidants Vitamin C Vitamin E Beta-carotene

• • Fruits • Apples • • • • • • Blueberries Cherries Cranberries Raspberries Red grapes Strawberries Vegetables • Cabbage • • • • Cauliflower Garlic Onion Red peppers ©2010 DaVita Inc. All rights reserved. • • Fruits • Grapefruit • • • Lemon Strawberries Tangerine Vegetables • Bell peppers • • Broccoli Greens • • • Cabbage Celery Zucchini • Oils • Canola • • • Sunflower Wheat germ Vegetable • • 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

Support

• • • Educate family and friends Join a support group Start a recipe/meal exchange

Vary Meals

• • • Experiment with new herbs and spices in familiar foods Explore unfamiliar foods Try new recipes

Commit to Change

• • • • Start small Acknowledge successes Keep records/food diary Focus on benefits and motivation sources ©2010 DaVita Inc. All rights reserved. 35

Kidney Diet Tools and Resources

Possible Sources Kidney Friendly Recipes • • • • Websites* Newsletters Books Kidney organizations Online Meal Planners and Trackers Diet and Nutrition Education Kidney Community ©2010 DaVita Inc. All rights reserved. • • • DaVita Diet Helper* Videos Magazine articles • • Blogs Discussion forums* *Available at www.davita.com

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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

©2010 DaVita Inc. All rights reserved.

Thank you!

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