Time for some trivia ... What pair of organ's is described as bean shaped and sits on either side of the spine the left one sits higher than the right because of the liver They are responsible for filtering minerals from the blood Maintaining overall fluid balance. Excreting waste products and regulating blood volume just to name a few about one third of all blood leaving the heart passes into these organs for filtration That's an impressive 52 gallons of blood daily which means every minute 44 ounces of blood is being cleaned by these little guys So did you guess what we're talking about today If you guess the kidney You're right Now if you're anything like me nephrology was always the topic that caused the greatest anxiety and dread So before you say Well Coleen, i don't work in nephrology so this isn't really relevant for me hold on and let me tell you why you need to listen to this episode I'm Coleen [00:01:00] sloan Uh, pediatric pa and registered dietician and this is the exam room nutrition podcast where each week i help you navigate nutrition topics to help you become a more confident compassionate clinician 37 million americans have kidney disease and over 800,000 americans are living with kidney failure more than 562,000 americans are on dialysis And nine out of 10 people with kidney disease are unaware that they have it About one in three adults with diabetes May also have kidney disease as diabetes is the top cause of kidney failure causing nearly half of new cases And one in five adults with high blood pressure may have kidney disease So did i get your attention friend Well good I hope you stayed with me today because to help us understand how nutrition plays a part in kidney disease prevention and management samantha DOB Is with me Samantha is a seasoned registered [00:02:00] dietician nutritionist based in new york city with over eight years of expertise Armed with a master's degree in clinical nutrition from the city university of new york lehman college With a gift for unraveling nutritional intricacies of chronic conditions samantha helps patients with chronic kidney disease You can connect with her on instagram at CKD nutritionist And at the time of this recording it's march Which means it's also national kidney month so samantha i am so excited to have this conversation with you thank you so much for being here welcome to the show
Thank you so much. I'm so excited to be here and to be connecting with you and talking all about the kidney world.
Yeah, I'm so excited. And in my intro, I know a lot of my listeners are like, ah, nephrology, run, run, run, because it is, it's that dreaded topic in school. Not many of us are in the specialty of nephrology, but I hope I caught your attention guys on that intro.
You might have some patients that have kidney disease brewing secretly behind the scenes. Now, I first want to clear up some terminology,
When a [00:03:00] clinician orders a renal diet, what does that mean?
So it's such a good question. I feel like I get that one a lot, you know, there's the renal diet and you hear the kidney diet, you hear the dialysis diet, So I think the biggest thing to keep in mind,you really want to think about protein. That's probably your number 1. you want to look at the potassium and phosphorus. Your fluids, and your sodium and the biggest thing is that they don't automatically have to be restricted.
it's really an individualized plan. So,it's based on the kidney function. It's based on the patient's medical history and their nutrition requirements But these are the components that you're really looking out for. You're going to be honing in on, if the protein needs to be increased or decreased, potassium, do I need to restrict it?
Do I not?
.
I can't stress enough that this is individualized. So a Renal dietitian, getting a dietitian on board is super important, but I really want to [00:04:00] hit some high points for our clinicians who might be dealing with these patients in the office, who just kind of throw them like a random nutrition question so that they're armed with appropriate answers to patients.
Before we dive into those specifics of the renal diet, I'm curious about dialysis. So once someone is on dialysis. How is their diet different? Do they still need to be on this renal diet or can they kind of eat anything because that dialysis machine is, you know, cleaning their blood for them?
So it's a great question. so the diet can change, Once you are on dialysis. But this actually depends on the type of dialysis that you're doing. So, a lot of times we're referring to hemodialysis or HD dialysis. but the big push is to do a peritoneal dialysis.
and so that can give you a little bit more, of a liberal diet,
you know, think about this, the dialysis machine is now working as your 24 hour kidney. And if you are now doing, hemodialysis. [00:05:00] Now you're going from having a 24 hour kidney working for you all the time, filtering out all these different, nutrients.
so now it's going to just doing three times a week, three to four hours, So if you're doing hemodialysis then you're really having to manage your potassium and phosphorus, your fluids, things like that, because it's now staying in the body. If you're doing peritoneal dialysis, you're doing that basically every single day.
So it is functioning a little bit more like your kidney. so you have a little bit more liberalization when you are, trying to manage the potassium, phosphorus, and the protein, and your fluids and your sodium intake.
all right, let's get into the meat of this topic and that's discussing the different nutrients and the different components of a renal diet. So let's start with sodium, talk to me about the sources of sodium. Do we need to really, monitor how much salt our patients are consuming and [00:06:00] what would be some high salt foods that we need to, suggest that they avoid?
I think sodium is, in general, a really big topic, right? when you're having too much salt, if you ever notice, you're, holding on to extra fluid. And so, especially in the kidney patient, you really want to be aware of that. So the reason that we focus on salt is, we're really trying to help lower your blood pressure. places that we really look for high sodium foods, that's really going to be like your canned soups, things like that. A lot of canned items.
You really are looking for, The no salt added when you're trying to grow grocery shopping, or, you know, think about like your fast food that's heavily salted, also a big one is like your pickles and your olives.
So just different things that you can do is you can look for the canned items or frozen items, and just make sure that they don't have any sauces in them.
you know, they're just plain. you can always season them how you [00:07:00] like. One of my really big things that I like to talk about is, you know, if I'm trying to flavor something, you know, I'm missing salt. But a good way to flavor something is by using, an acid. So using lemon, you know, that's kind of what you're missing, flavor wise.
the other thing that I, I really like to, to add to is using like caramelized onions on a sandwich, or even doing parsley on chickpeas, you know, that gives it a little bit more flavor.
Oh, I love that. Those are great ideas. so since, you know, we're trying to preserve those kidneys, we talked a little bit about sodium. Let's move on to the next big component of the renal diet, and that's potassium. So what are some of those high potassium foods that our, our patients should be avoiding?
the high foods that our patients should be not necessarily avoiding, but Just to be on their radar really are your avocados, potatoes, obviously, that's always been a thing. pumpkin, cantaloupe, I feel like that's a big [00:08:00] one.
one that I think is really hidden is coconut water. that's a something that people are always shocked by. and, you know, you have your oranges, things like that, but in the same sentence, like, we talked about earlier, everything is individualized. It's really based on your labs and, you know, you're looking to see, Do I need to kind of cut down on the portion size, not completely omit
so, you know, you're looking at your serving sizes. So if you really want your oranges, I'd say have a half an orange or even, you know, a good substitute for it would be a Clementine. if you're thinking that, Oh, I just can't live without my potatoes, one of my favorite things to do is.
look for the canned potato that's been soaked, that's no salt added, So then you want to maybe soak it again and you're going to what we call leach it, leach the potassium out. And so you can soak it, cook it, and you're basically [00:09:00] double boiling it, and then cook again with it.
And so I like to suggest, let's say you have the round potatoes, put them in the air fryer, put them in the oven, and then they're nice and crispy and you're not missing out on your potatoes.
That's such an awesome suggestion because even as I'm just thinking about, you know, this diet and the renal diet in general, it. can feel so restrictive. And as practitioners, it's really easy to just be like, okay, here's a renal diet. Here's a piece of paper. You can't have any of these foods from all these different food groups.
And it really is the majority of the foods that people eat. So it can be really disheartening, overwhelming, and honestly quite depressing to say to someone like, you can't have any of these foods anymore. So I love your suggestions because it's very practical and real. So following the labs, I think is key from what I'm hearing from you because we don't just need to tell everybody, Hey, you can never have potatoes.
You can never have your favorite orange ever again, because if their labs are fine, let them enjoy that. So I love that suggestion with potatoes just [00:10:00] to limit and decrease some of that potassium and still allowing our renal patients to enjoy their favorite foods. All right, let's move on to phosphorus.
This is kind of one that's not always on our radar. Like a lot of us know what high salt foods are. A lot of us know what you know, the common high potassium foods are, but phosphorus is kind of those weird ones. So what are some high phosphorus sources of foods that we need to be aware of? Processed?
So this is actually like one of my favorite things, phosphorus. I, I feel like it gets people very confused. but I think in recent, years, it's so exciting because the big push here is for our added phosphorus, the preservative phosphorus, as opposed to our natural phosphorus.
Forever we've been told no beans. Don't eat them. Don't eat nuts. We can't have wheat bread because there's phosphorus So there's naturally occurring phosphorus, which is like your organic phosphorus, so that's gonna be like your natural meats, your dairy, your vegetables. And so your body is really absorbing only about [00:11:00] 40 to 60 percent of phosphorus. And that's a really big difference as opposed to your added phosphorus, which is going to be, your preservatives, your inorganic phosphorus.
And that really comes from like your processed cheeses, your processed meats, and even like your, your Coca Cola, and your body is absorbing about 90 to 100 percent of that. And the example that I like to give my, my patients is Think about like you're just pouring, preservative phosphorus into your body, and that is really difficult for the body to break down now because the kidney is not functioning the way it should be.
as opposed to if you're going to have those, nuts, or you're going to have the, the beans or your flour. your vegetables, you're getting dietary fiber from that. And so that's also going to be kind of getting eliminated from your body. and just the last thing that I just want to say about phosphorus is when you're looking at the ingredient list, you're always looking for that fuss.
That P H O S, [00:12:00] that's a big thing, it's going to be in the ingredient list, it's not listed onthe nutrition facts. So you really want to look for that. So it's going to be words like,calcium phosphate or dipotassium phosphate, or disodium phosphate.
And that should just, raise your,sense of, of what's going on and just, you know, flag it for you. It doesn't mean that you shouldn't be having it completely, but it's something to just look out for.
That's really helpful because phosphorus isn't listed on the food guide label, just like, you know, sodium is or potassium is. So it's kind of hard to track that
so definitely clinicians can be using that for their patients to educate them on what to look for, for high, phosphorus foods.
And if you wanted to learn more about how to read a nutrition facts label, especially for patients with kidney disease.
Go check out episode 30, where I had another conversation with a renal dietician, where we talked about how to read a nutrition label and exactly how to teach your patients on what to look for [00:13:00] on that label. i think you'll walk away with a lot of really great helpful information
So I wanted to move into a few myths regarding the renal diet. And you touched on a few of them already. The first one was about potatoes.
we used to think that people can't have potatoes at all anymore. You busted that myth. And then you did talk a little bit about citrus too, that, you know, you don't have to completely avoid oranges or bananas for that high potassium foods, maybe eat half or just a few bites of it, of course, depending on your patient's labs.
But the other one that I wanted to touch on a little bit was tomatoes, because who doesn't love a good pasta with meat sauce or pizza because it's got that tomato sauce or personally I love bruschetta salad. So what is the story behind tomatoes? Can our patients have them or do we need to completely recommend that they avoid them altogether?
similar to the potatoes and the citrus fruits, we still are looking out for our portion sizes. So Tomatoes, you know, yes, they can be high in potassium. And if it's something that you need to limit, then that's [00:14:00] something that you can do. But again, we're talking about portion size.
So, if you're having your tomato based, pasta or you're having your pizza, one of the things that I really like to suggest is why don't you try a, a pesto pizza or a salad pizza, and you can replace the, tomato sauce with these different things. even your bruschetta, you know, one thing that I really like to do is, what we talked about was portion, so you're not eating an entire tomato, you're eating a half a tomato and add in red peppers, and that's something that would, kind of cut down on the portion of the potassium if that's something that needs to be limited.
That's super helpful. So let's talk a little bit about plant based diets. if a patient in the clinic comes to the clinician and says, would you suggest that I follow a plant based diet or I want to be eating less meat?
Can I follow a plant based diet? what would you arm our clinicians with an answer to that question?
So I think a [00:15:00] plant based diet for CKD is a great thing. You really are looking to get, lots of good nutrients in. You're looking to really decrease the stress on the kidneys. And so with protein, you're going to be looking for, you know, less animal based proteins. you're going to be looking more for tofu or looking for, beans, things like that.
it's so good for. For patients in general, it really helps with heart health. Right? you're looking to get low saturated fat, because usually we get the saturated fat from the animal, proteins. That's going to help to decrease, the stress on the kidney for, for blood pressure.
and you're also helping, with weight management. You're really getting high fiber foods like quinoa, lentils, vegetables like that. We'll get back to this episode in just a second but i wanted to share another amazing podcast that i think you'll love are you thinking about embarking on the exciting journey of starting your own business but feel [00:16:00] unsure where to begin let the starting the business simplified podcast be your guide offering expert insights and proven strategies to navigate the entrepreneurial landscape and turn your vision into a thriving reality You can find this podcast wherever you listen to podcasts All right now back to the episode
the other thing that I talk about with plant based diets too for CKD is, you know, it doesn't necessarily have to be all or nothing.
if the patient wants to kind of move from eating meat, maybe just swapping out one meal to begin with and see if that's something that, you know, they'd be open to.
That's a good suggestion because sometimes when we think about like diets, right, we have this all or nothing mentality and especially with plant based diets, if you've been a meat eater like your whole life, it's a drastic change, right? So, I love that, that one meal a day or even one day a week is perfectly fine to transition into that more plant based lifestyle.
Now, like I said in the [00:17:00] intro, nine out of 10 people with kidney disease are unaware that they have it. So prevention is key here. So I wanted to close our conversation with how can we protect our kidneys for those of us who are like floating along life, thinking everything's great.
What things can we be paying attention to within our diet to keep our kidneys healthy?
This is also such a great question. I get asked this all the time. how can we protect our kidneys? One of the biggest things is really staying hydrated, right? Like don't take that for granted you really want to make sure that you're getting enough, fluids. So you're keeping your kidney function going.
so strive to make sure that you are getting enough water, every day you really want to maintain a balanced diet. And so that really is something that's rich in, fruits and vegetables, you know, not really having a lot of sugar, not really having excess salt, like we were talking about earlier, you know, and that really leads into managing our blood pressure as well.
You [00:18:00] want to, also control your blood sugars, if you are somebody with diabetes, because that can cause more stress on the kidneys as well. you also really want to limit your alcohol intake And quit smoking because that is something that can be affecting the kidneys. And making sure that you're exercising regularly, right? That's your lifestyle factor. You want to make sure that you're getting, you know, regular physical activity.
and then finally, you really want to monitor your protein intake, making sure that you're not having An excess of it. and then just in general, you know, work with a dietitian.
Yes. I love that. You finished with my two favorite topics, and suggestions. And that was protein, because right now there's like this craze to have an excessive amount of protein. People think they need way more protein than they actually do. And you recommended a dietician. So I completely agree with you on those two suggestions there.
So thank you so much for having this conversation with me, [00:19:00] guys. know nephrology is a tough one and it's challenging and a lot of us like run from it, but hopefully today's conversation helped clarify a lot of those confusing guidelines. So if you wanted to connect with Samantha, you can find her on Instagram at CKD nutritionist. You can always find me on Instagram at exam room nutrition and Samantha, we'd love to have you back on.
Thank you so much for the gift of your time. I'm so grateful that you're here with us today.
Thank you so much. I really had a great time connecting with you.
All right guys. Now it's time for my nutrition notes.
now, as you know, I'm a pediatric physician assistant and a registered dietician, but what you may not know is prior to going to PA school, I was actually a pediatric registered dietician. On a dialysis team.
And it was An incredible experience, and I learned how to be compassionate because dialysis is hard. It's taxing on the family because they've got to come to clinic, you know, three times a week. Very often those children are hospitalized.
and kids have a hard [00:20:00] time following, you know, any diets, let alone kind of a restrictive renal diet. so my tip today is a nutrition tip, but it's also kind of an encouraging suggestion for you. and this wouldn't just apply to those who are on dialysis or have chronic kidney disease. this could be for any of your patients in general. And I would do this with my pediatric dialysis patients as I would come around and ask them, how are you doing?
and just that question alone really just show that you care. You care about the person in front of you and not just the numbers in front of you. And oftentimes as a practitioner, it's hard to remember that there's a person in front of us because we're really focusing on the numbers.
We're really focused on getting their labs down. We're focusing on their weight. But there's a person on the other side of that. So I would often ask, how are you doing? And sometimes they were taken aback and didn't quite know how to answer that and then especially for my dialysis kiddos I would ask them if there is any food that they really really miss eating [00:21:00] and I would take a look at their labs and Maybe discuss with the nephrologist on the team and say hey would it be okay if we allow You know this patient to have X, Y, and Z, whatever it was that they were really missing as just a special treat because food is so important to us as individuals, as a culture, it's a celebratory event.
And so when they have to be so limited in their diet, it can be extremely depressing and upsetting. And especially for kids, this is really a hard thing to accept. So next time you're in clinic, whether you are in nephrology or not ask your patients, Hey, how are you doing? And then maybe ask them, is there any food that you really miss that we might be able to allow you to enjoy as a special treat?
remember the renal diet is not as restrictive as we once thought. So take a look at their labs and if their potassium is great and they're really, really craving some tomatoes or they really want an orange work with them and see how you can work it into their diet.
This makes living a life with a [00:22:00] chronic disease and following a therapeutic diet so much easier
I really hope that this talk provided you with some practical tools that you can use in your clinic.
I would love if you could leave me a five star review on your favorite podcast app and share with your clinicians. This would just help others find this podcast. valuable podcast. So as always, let's continue to make our patients healthier one exam room at a time. I'll see you next time.