When you have chronic kidney disease, it’s important that you watch and plan what you eat.
PEOPLE eating out with those having chronic kidney disease (CKD) need not tiptoe around their dietary needs. With a good grasp of some basic dietary principles, they can still enjoy a hearty meal.
That was the message sent out by a dietitian at one of the workshops organised by a private hospital to educate people with pre-dialysis (early stage) kidney problems and their caretakers.
Starting off with a low-protein, low-salt, six-course meal in a Chinese restaurant, participants at the workshop were given an example on how to eat healthily at a restaurant.
I was surprised at the choices. Contrary to usual belief, the health food served was tasty; they were not devoid of meat, or oil. It was just like home-cooked food, with small portions of meat and some fried dim sum.
Healthy food need not be bland after all.
“When we say low salt, low sodium and low potassium, we did not say no salt, no sodium and no potassium,” said Teng Yu Yuet, chief dietitian of a local private hospital. “Sometimes, we tend to be too strict in our diet.”
The secret is, as Teng put it, “not to overeat, and not to over-restrict.”
People with chronic disease like cancer and kidney problems often fear eating out because they could not control the way food providers prepare the food, Teng said.
“We want them (those with CKD) to know that it is okay eating out and we don’t want them to feel deprived, because it is really a matter of mixing and matching (of food),” she added.
What is chronic kidney disease?
CKD can be described as an irreversible deterioration of kidney function, Teng said.
In other words, the kidneys of a person no longer work efficiently to remove waste products from his/her blood.
People who smoke, have diabetes, high blood pressure and have a family history of kidney failure are more likely to have the disease.
Telling signs of CKD are frequent urination or passing less urine, swelling in the legs, ankles, feet, face or hands, fatigue, loss of appetite and leg pain or muscle cramps. People having early stage CKD may not have symptoms at all.
As all these symptoms are progressive in nature, many patients notice them quite late after having the disease.
Some laboratory tests can indicate early loss of kidney function. Traces of protein in repeated urine tests may indicate impaired kidney function. Increased creatinine and blood urea nitrogen levels in blood tests are also suggestive of kidney impairment.
However, medical practitioners should interpret these tests carefully as the results can be affected by various lifestyle factors.
There is no cure for CKD – the goal of treatment is to keep the kidneys functioning as long as possible by detecting and treating the disease at its early stages. Sometimes, if treated early, all that may be needed is a change in your diet, control of your blood pressure and/or some medication.
Due to their weakened kidney function, the purpose of a special diet for people with pre-dialysis (early stage) CKD is to ease the burden on their kidneys, avoiding further deterioration.
A CKD diet has three basic principles. However, all these guidelines are general and one should not impose restrictions without the proper guidance of a doctor and dietitian.
The kidney processes waste products from our body, especially those derived from the breakdown of dietary protein. It is only logical to deduce that when we control our protein intake, the production of waste products will be reduced, making the kidney work less and “live” longer.
Most patients experience weight loss due to reduction in protein intake, which leads to reduction in energy intake. That is why it is important for people with CKD to get their energy from fats and carbohydrates, Teng said.
“Sometimes, patients cut down a lot of their protein intake when they are on a low-protein diet (LPD).” This practice is not healthy as proteins are major building blocks for muscles and the immune system, she added.
Patients on a very low protein diet are often supplemented with ketoacid supplements to prevent the shortage of essential amino acids as a result of the low-protein diet.
Sodium is a mineral needed in various functions of the human body, including maintaining the fluid balance in the body. Practically speaking, when your sodium level is high, you will feel thirstier and retain more water.
The water you take will go mostly into your bloodstream. This will cause the amount of blood to increase, and the kidneys need to process more blood and work harder. A limited intake of sodium can avoid fluid retention in the body and help control high blood pressure, which is damaging to the kidneys.
“Sodium is not just limited to salt (sodium chloride); tomatoes for instance, have a high content of sodium too,” Teng said.
People without problems with high blood pressure and fluid retention may not need to go on a low sodium diet, she added.
Potassium, on the other hand, is involved in fluid balance, nerve function and muscle contractions.
A low potassium diet is normally recommended for CKD patients when they have high potassium levels in their blood, Teng said.
As high potassium levels in the bloodstream may cause the heart to beat abnormally, some CKD patients have to be careful with their potassium level because the kidney may be losing its ability to excrete excess potassium efficiently.
Examples of foods high in potassium including bananas, dried fruits, oranges, potatoes and some green vegetables such as broccoli.
“The problem is not what food you eat, but how much of it you eat,” Teng said.
“It is also important to note that there is no one diet that fits all, and sodium or potassium restrictions depend a lot on the individual health condition.”
The trick is not to avoid “forbidden” foods completely, but to take them in small portions, not exceeding the allowed quantity.
Ask any man on the street, and the general description about food served outside would be oily, too much MSG (monosodium glutamate), too salty or too sweet.
For people with CKD, to maintain a low protein, sodium and potassium diet when eating out seems impossible.
“Not really, not if they put some effort into it,” Teng said. She and her team of dietitians gave the following tips to help make the process easier:
· Make a shopping list and understand food labels.
· Be more aware of the kinds of food you buy and the nutrients they contain.
· Protein from vegetable sources (beans, tofu) can replace meat proteins and foods high in sodium and potassium can be reduced.
· The shopping list can help you vary your dishes, and make a low-protein diet enjoyable.
· Beware of hidden proteins. Condiments such as dhal, papadam, curry and belacan contain a lot of protein!
· Be careful of the milk added to your beverages: they are also significant sources of proteins.
· If you are served more protein than you need, you can choose not to finish all of them.
· The major source of concern is the salt content in soups and gravies. Try not to consume too much of these.
· Avoid additional salt in soy sauce, chilli and pickles served with food.
· Order dishes that have a mix and match of meat and vegetables. You will consume less meat and yet enjoy the meal.
· Meat and fish cut in small pieces can also help you limit your protein intake.
· Avoid high-protein drinks such as soya milk and cocoa-based drinks.
· Share the high-protein portion (wanton, mussels, tofu) of the a la carte meal with family members.
To meet their diet needs, some people with CKD have come up with various solutions when dining out.
“I avoid eating out, unless I need to. For instance, when I eat out with clients, I order the usual dishes, and set aside one vegetable dish for myself,” said Mr Yap, who has had CKD for two years.
“I went to the kitchen to talk to the chef, telling him: low salt, not too much oil and not too much seafood,” he added.
“We can dilute the soup in wanton noodles by ordering another air suam (warm water), and dilute it ourselves!” Mr Cheong said when asked how he would approach an MSG-and-salt-laden noodle soup.
Caretakers are very important in ensuring that patients eat correctly.
“He should take only one (prawn), but he normally takes two,” says Ms Foong, a caretaker for Mr Foong who has CKD. In this case, she can remind Mr Foong to eat fewer prawns.
Dietitians, on the other hand, have a few solutions of their own.
Start with home-cooked food. That is the way you can control the way you cook and the contents of the dishes, Koh Pei Ling said while sharing tips to eat in a Chinese restaurant.
“You can schedule your protein intake. If you have a daily protein allowance of three servings, you can take one serving (e.g. one egg) of protein each meal, or you can take two servings during lunch and one serving during dinner,” another dietitian, Ho Wan Mi said.
“As long as you are still within your daily protein allowance, protein is fine.”
Diet plans are personal
“I have had one experience where I was explaining diet plans to a kidney patient in a ward. Days later, I was told that another patient in the same ward who has diabetes, was following the same diet,” Teng recalled.
The scenario may seem hilarious, but following diets without knowing our own medical condition may be dangerous.
“Do not self-impose your diet, (because) what is important is the amount (of food) that fits you. Talk to your dietitian,” she stressed.
Normally, a doctor will refer a CKD patient to a dietitian to discuss his individual dietary needs. A “tailor-made diet” will be planned by the dietitian, and everyone is different, Teng explained.
The dietary needs of CKD patients are not only different between individuals; it is also very different for the same individual in different stages of his disease.
“Patients in the early stage need a low protein diet, but when they are undergoing dialysis, they will require different amounts of protein.”
“Family support is very important,” Mr Yap said.
“My children are aware of their father’s condition, and are very understanding when we need to cut down (on meat). However, we do let the children get their protein, as they are growing children,” said Mrs Yap, who has taken care of her husband’s dietary needs for two years now.
“It is a strong motivation to eat healthily,” another CKD patient said.
People in society, especially family members, should also be educated on the diets of people with health problems, including CKD, said Teng.
“There is a stigma among caretakers at times, where they don’t allow people with CKD to eat out. We want to tell them that they should give their loved ones support and encouragement, and help them make wise food choices.”
A support group for people with CKD and their caretakers is also important, she added.
“The interaction between patients creates a synergy, and gives them the feeling that they are not alone. Here, they can talk and laugh about it (their condition).”
Hopefully, chefs and food providers can be educated on the special needs of such people.
“People with CKD are still productive, they can still live a normal life. Being Malaysians, it is important for them to enjoy food,” Teng said.