National Nutrition Month

Eat a variety of foods from your allowed food list

• Include a source of protein at each meal. 
• Good sources of protein for dialysis patients are eggs, meat, fish and poultry.

Get ready for the game

• Plan ahead — eat your meal and take your phosphorus binders before leaving for the game.
• Save some fluid allowance for the game — cheering can easily cause a dry mouth.
• Select your beverage carefully: Sprite®, Diet Sprite®, 7-UP® or Diet 7-UP®, water, ginger ale or coffee are all okay.
• Take your own snacks:  popcorn without salt, unsalted pretzels, vanilla wafers, animal crackers, fresh apples, grapes or cherries.

Remember your phosphorus binders

• Take your phosphorus binders with all meals and snacks as prescribed by your physician. Too much phosphorus can harm your heart and make your bones weak.
• Phosphorus binders act like sponges to keep phosphorus in your stomach and out of your blood. 
• Examples of phosphorus binders: Tums®, Phoslo®, Renagel® and Fosrenol®.

High potassium can be trouble

• To keep your heart healthy, avoid eating too much potassium. 
• A few examples of high potassium foods to avoid are bananas, oranges and spinach.
• Check your diet sheet for allowed foods lower in potassium and those foods you should limit.
• Read labels for added potassium.

Take a renal vitamin every day

• This is important because many fruits and vegetables are limited or cut out of your diet.
• You also lose vitamins and minerals during each dialysis treatment. Vitamin deficiency increases your risk for infection. 
• There are special vitamins made for people on dialysis. Examples of renal vitamins are Nephrovite® and Nephrocaps®. 
• For best results, take your renal vitamin after dialysis or in the evenings. Take it at the same time every day to make it a habit.   

Limit your fluid intake

• 32 ounces per day = one quart per day.
• Excess fluid affects your blood pressure, causes your heart to work harder and can cause shortness of breath. 
• Trying to remove this excess fluid can cause cramping during dialysis treatments. 

Limit high phosphorus foods

• Too much phosphorus in your blood triggers your bones to release calcium. This can harm the heart and weaken your bones.
• Some high phosphorus foods are cheese, milk and dairy products, cola, nuts, peanut butter, dried beans or peas and whole grains. Remember to take your binder every time you eat a meal or snack as directed.

Watch your sodium

• Foods high in sodium will make you very thirsty. 
• Examples of high sodium foods are frozen dinners, cured meats such as ham, bacon and sausage, foods in a brine including pickles and olives, and foods you can see the salt on such as chips, crackers and pretzels.

Why is it important to come and stay for the entire dialysis treatment?

• Dialysis clears the toxins that build up in your blood between treatments.
• Phosphorus, at high levels, is a toxin. It can damage your heart, blood vessels and lungs.
• Cutting a treatment short means that you are walking out the door with a higher phosphorus level.

Ask your personal health coach — the "RD" Registered Dietitian 

• When you have questions, concerns or want to know something more about your diet, ask your RD. 
• Your DaVita dietitian health coach is here to help you stay healthy and live longer.
• You will see the registered dietitian at monthly lab reviews — or any other time you have a need.
• Just let someone know you have a question.

Visit the web  

There are several great websites for renal nutrition. Three sites to get you started are:

• DaVita.com
• KidneyOptions.com
• CulinaryKidneyCooks.com

Dine out with confidence

• Choose a restaurant where food is “made to order".
• Look over the menu and ask how food is prepared.
• Request “No salt, please,” and for sauces to be served “on the side”.
• Ask for a doggy bag if portions are really big — or share with a friend.

Enjoy renal diet cookbooks

Some titles include:

• “Cooking for David”
• “Creative Cooking for Renal Diets”
• “The Renal Gourmet”
• “Kidney Friendly Comfort Foods”

Ask your dietitian for ordering information if interested.

Eat enough calories every day

• If you don’t, the body will use up all its fat stores, then it will start to break down your muscles to get enough energy to function. 
• Try to eat balanced meals, or use nutrition supplements if recommended by your doctor or dietitian.                                                                     
• Carbohydrates are a good source of calories. Bread, rolls, rice, grits and animal crackers are examples of carbohydrates to eat.

Hints for fluid control

• Drink only if you are truly thirsty.
• Chew gum, or suck on hard candy, frozen grapes or lemon wedges.
• Sip, don’t gulp, when drinking.
• Use small cups.
• Spray your mouth with cold mouthwash.
• Eat less sodium to help control thirst.
• Avoid activities that cause you to become overheated and extra thirsty.

How does dialysis treatment help my bones?

• Vitamin D is given during treatment. 
• Vitamin D is used to help control your PTH level.
• Stay for all of your dialysis treatments to achieve a Kt/V of 1.4 or higher and to help control your phosphorus level.

Eat your meat

• Protein is important to your overall health.
• Albumin is one way your protein and nutrition status is measured.
• The goal for albumin is at least 4.0.
• Good sources of protein are eggs, meat, poultry and fish.

Play it safe with food

• Prepare, handle and store food properly to keep you and your family safe.

Time your phosphorus binders 

• The time you take your medicine is important. 
• You should always take your phosphorus binders every time you eat (meals and snacks unless told otherwise).
• Be sure to take phosphorus binders when you’re eating out and on the dialysis machine. 
• Take your phosphorus binders during the meal or no longer than 10 – 15 minutes before or after you eat.

Stay for your entire dialysis treatment

• If you skip a dialysis treatment, poisons can build up in your body.
• This can make you feel tired, weak, sick to your stomach and can cause shortness of breath.
• It is important to come on time to your treatment and to stay for your entire session.
• Aim for a Kt/V of 1.4 or greater to indicate that you are getting adequate dialysis treatment.

Enjoy herbs and spices

• There are a variety of seasonings to use to add flavor to your meals. Use pepper, garlic or onion powder, oregano, basil or dill to perk up your foods.
• Be sure to avoid salt substitutes that contain potassium.

Avoid starfruit

• Starfruit is also called carambola.
• This fruit can be very hazardous for dialysis patients.
• It has been known to cause agitation, confusion and possibly even death.

Knowledge is power

• Calcium and phosphorus are minerals that build strong bones.
• Good news if that happens inside your bones — bad news if that happens outside your bones.
• Watch your calcium phosphorus product. Calcium phosphorus product is your calcium number multiplied by your phosphorus number.
• When calcium or phosphorus are high in your blood, hard deposits may build in your blood vessels.
•  If calcium × phosphorus is above 55, you are at risk for hard, bone-like material to build in the wrong places, such as your blood vessels, eyes, lungs and heart.

Leach your potatoes

This helps decrease the potassium content.

How do you leach potatoes?

1. Peel and dice the potatoes.
2. Soak them in a large amount of water for 4 hours, or overnight. 
3. When you are ready to use the potatoes:  drain the water, add a large amount of fresh water and boil the potatoes.
4. Continue to prepare as desired.

Remember, this will decrease the amount of potassium but will not remove it all.

Plan a home-cooked meal tonight

Dinner menu idea:

• Green salad with vinegar and oil dressing
• French roll
• Chicken, fish or beef
• Rice or leached potatoes
• Vegetables such as green beans, zucchini or cauliflower with margarine
• Small glass of 7-UP® (Diet 7-UP® if diabetic)

Make enough to freeze leftovers for another day.

Buy fresh meats for good nutrition and protein intake

Avoid enhanced meats.

What are enhanced meats?

• Sometimes, fresh meats are injected with water, salt and sodium phosphate, a solution that is used to make them more flavorful and tender.
• These products contain more than 300 mg of sodium per serving, which is more than recommended.

Limit calcium-fortified foods

• Too much calcium is not good. 
• Read labels, and avoid foods that have extra calcium added to them.
• If you need additional calcium, it will be recommended for you.

Tell your doctor or dietitian if you use herbal supplements

• Although they are natural, herbs and other nutritional supplements may react with your medications or alter your blood test levels.
• If you’re not sure what you’re taking, just bring the bottle to dialysis, your renal dietitian can help.

Do not use salt substitute

• Salt substitute is made with potassium and can build up to dangerous levels in your body.
• Season your foods with garlic, lemon juice or herbs and spices.

Keep an eye on calcium

• Too much calcium may be unhealthy. What is your calcium level?
• If your calcium level is greater than 9.4, it may be time for some changes — talk to your doctor or dietitian.
• If your diet is high in calcium, limit natural calcium from dairy products. Many foods have added calcium, so choose wisely.
• Read labels to find calcium. Talk to your renal dietitian and bring in foods and drinks that are in question.
• Know your medications — they may contain calcium. Many over- the-counter and prescribed medications may have calcium — just ask your doctor, pharmacist or dietitian if you are unsure.

Exercise regularly

• Eating right and being physically active are keys to a healthy lifestyle.
• The food and physical activity choices made today — and everyday — affect your health and how you feel today and in the future.
• Regular physical activity is important for your overall health and fitness plus it helps control body weight, and promotes a feeling of well-being.