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.

Remember to take your binders

• It's important to 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.
• "Binders" act like sponges to keep phosphorus in your stomach and out of your blood.
• Examples of binders are Tums®, PhosLo®, Renvela® 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: watch out for potassium chloride.

Take a renal vitamin every day

• This is important because many fruits and vegetables are limited in your diet. 
• You also lose vitamins and minerals during each dialysis treatment. Vitamin deficiency increases your risk of 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. 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 such as pickles and olives; and foods you can see the salt on such as chips, crackers and pretzels.

Visit the web

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

• www.davita.com/recipes
• www.culinarykidneycooks.com

Ask your personal health coach - The "RD", Registered Dietitian

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

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 and dressing 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"

Ask your dietitian for ordering information if interested.

Eat enough calories every day

• If you don't eat enough calories every day, your body will use up fat stores and break down 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. Also use small cups.
• Spray your mouth with cold mouthwash.
• Avoid activities that cause you to become overheated or extra thirsty.
• And most importantly, eat less sodium to help control your thirst.

Eat your meat

• Protein is good for your overall health.
• Albumin is one way your protein and nutrition status are 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 them 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 short of breath.
• It is important to come on time to your treatment and stay for your entire session.
• Aim for a Kt/V of 1.4 or greater to show that you are getting adequate dialysis.
• Getting adequate dialysis also helps keep your phosphorus and potassium levels in goal range.

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.
• Consider growing your own herb garden.

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 death.
• Even small amounts of starfruit or juice can be dangerous.

Eat healthy snacks

• Healthy snacks are low in sodium and fat. Good choices include low fat, low sodium crackers or popcorn, grapes, berries, apples, bell peppers, carrots and celery with low fat dip.
• Fresh lean meat, chicken or unsalted tuna and nutrition bars or drinks are healthy snacks that are also good sources of protein.
• Healthy snacks are a great way to get enough calories and pack in extra nutrition.
• Ask your dietitian for other healthy snacks that are right for you.

Plan a home-cooked meal tonight

Dinner menu ideas:

• 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® (or Diet 7-Up® if you have diabetes)

Make enough to freeze leftovers for another day!

Buy "fresh meats" for good nutrition and protein intake

Avoid "enhanced meats." But what are "enhanced meats"?

• Fresh meats that are injected with water, salt and sodium phosphate, a solution that is made to make meat more plump, flavorful and tender.
• These products contain more than 300 mg of sodium per serving and are also high in phosphorus.

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 in the bottle... we can help.

Do not use salt substitute

• It 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.

Make lower potassium potatoes

• Peel the potatoes and dice, slice or shred into very small pieces; soak in warm water for several hours then prepare as desired.

Or there's another way without soaking:

• Place small potato pieces in a large amount of water and bring to a boil; drain, then add fresh water and boil potatoes until cooked tender. Drain water and prepare as desired.

Either method will decrease the amount of potassium but will not remove it all. Remember, portion control is important.

Exercise regularly

• Eating right and being physically active are keys to a healthy lifestyle.
• The food and activity choices made today - and every day - affect your health and how you feel 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.

Eat fresh, unprocessed foods

• Eating meals made from fresh, unprocessed ingredients helps you to limit sodium and phosphorus.
• Fresh foods you buy at the grocery store or farmer's market do not have additives or seasonings.
• You have more control over what goes in your food - and in your body.
• Plant a vegetable and herb garden with foods you can eat.
• Try growing your own fruit tree. Use patio containers if space is limited.

Be a smart shopper

• Make a grocery list based on meals you want to prepare.
• Visit DaVita.com for new recipe ideas and check the grocery sale circulars for special buys.
• Clip coupons to save money on your grocery bill.
• Read labels and avoid products containing added calcium, potassium and phosphates.
• Compare brands to find foods lowest in sodium.
• Shop for fresh breads, produce and meats using your diet handouts as a guide.
• Eat before you shop. Feeling hungry can entice you to buy foods not on your grocery list.

Beware of hidden phosphorus

• Phosphorus from food additives is more easily absorbed than phosphorus from natural food sources.
• Additives are found in many processed foods and beverages.
• Read labels carefully, and look for words such as: Phosphoric acid, pyrophosphates, polyphosphates, hexametaphosphate, dicalcium phosphate, tricalcium phosphate, sodium polyphosphate, sodium trypoloyphosphate, tetrasodium pyrophosphate, trisodium phosphate, sodium phosphate and monocalcium phosphate.

Practice portion control

• Pay attention to portion sizes to manage your diet.
• Measure or weigh your food to be sure you don't go overboard.
• Use moderation to enjoy many foods on your diet, just don't overdo it.
• Eat slowly. It takes 20 minutes for your brain to get the signal that your stomach is full.
• Overeating can result in excess intake of calories, potassium, sodium and phosphorus.