VEGGIE DIET LOWERS PHOSPHORUS IN CKD PATIENTS

[okarol]

VEGGIE DIET LOWERS PHOSPHORUS IN CKD PATIENTS
2
Posted in News, Nutrition, Clinical & Pharma, Clinical Journal Of The American Society Of Nephrology (CJASN), Chronic Kidney Disease (CKD) Print
WASHINGTON—Phosphorous levels plummet in kidney disease patients who stick to a vegetarian diet, according to a study published online Dec. 23 in the Clinical Journal of the American Society Nephrology (CJASN).

The results suggest that eating vegetables rather than meat can help kidney disease patients avoid accumulating toxic levels of this mineral in their bodies, according to the study.

Individuals with kidney disease cannot adequately rid the body of phosphorus, which is found in dietary proteins and is a common food additive. Kidney disease patients must limit their phosphorous intake, as high levels of the mineral can lead to heart disease and death. While medical guidelines recommend low phosphorus diets for patients with chronic kidney disease (CKD), phosphorus content is not listed on food labels.

Sharon Moe, MD (Indiana University School of Medicine and Roudebush Veterans’ Affairs Medical Center) and her colleagues studied the effects of vegetarian and meat-based diets on phosphorous levels in nine patients with CKD. Patients followed a vegetarian or meat-based diet for one week, followed by the opposite diet two-to four- weeks later. Blood and urine tests were performed at the end of each week on both diets.

Despite equivalent protein and phosphorus concentrations in the two diets, patients had lower blood phosphorus levels and decreased phosphorus excretion in the urine when they were on the vegetarian diet compared with the meat-based diet. While the investigators did not determine the reason for this difference, a grain-based diet has a lower phosphate-to-protein ratio and much of the phosphate is in the form of phytate, which is not absorbed in humans.

The authors concluded that their study demonstrates that the source of protein in the diet has a significant effect on phosphorus levels in patients with CKD. Therefore, dietary counseling of patients with CKD must include information on not only the amount of phosphorous but also the source of protein from which it derives.

“These results, if confirmed in longer studies, provide rationale for recommending a predominance of grain-based vegetarian sources of protein to patients with CKD. This diet would allow increased protein intake without adversely affecting phosphorus levels,” the researchers wrote.

http://www.renalbusiness.com/news/2010/12/veggie-diet-lowers-phosphorus-in-ckd-patients.aspx?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed:+RBTSiteFeed+(Renal+Business+Today+Site+Wide+Content+Feed)&utm_content=Twitter

[MooseMom]

Well that's just dandy, but what happens to your potassium level after eating all those veggies?

[Jean]

Sounds great, but what happened to all the high phos veggies we are not supposed to eat. Confusing as all get out isnt it?

[galvo]

Yes, it is, Jean. This whole renal diet routine is bloody impossible.

[greg10]

Sounds great, but what happened to all the high phos veggies we are not supposed to eat. Confusing as all get out isnt it?

Most vegetables as we know it do not have high levels of phosphorus, the exceptions are the nuts and seeds (brans are seeds) which many would not consider as 'vegetable'.  If you stay with the greens, you are generally safe with phosphorus, although there are many greens with high oxalic acid which can cause problems.

Here are some of the crazy high phosphorus additives and foods, specifically stay away from baking soda/powder, processed foods and cola drinks.

http://nutritiondata.self.com/foods-000121000000000000000.html
1 Leavening agents, baking powder, double-acting, straight phosphate
Phosphorus: 38890mg 
2 Leavening agents, baking powder, low-sodium
Phosphorus: 14160mg 
3 Mollusks, clam, mixed species, canned, liquid
Phosphorus: 11402mg 
4 Leavening agents, baking powder, double-acting, sodium aluminum sulfate
Phosphorus: 8268mg 
5 Apple cider-flavored drink, powder, low calorie, with vitamin C, prepared
Phosphorus: 2400mg 
6 Carbonated beverage, low calorie, cola or pepper-types, with sodium saccharin, contains caffeine [pop, soda, soft drink]
Phosphorus: 2200mg 
7 Carbonated beverage, low calorie, cola or pepper-type, with aspartame, without caffeine [pop, soda, soft drink]
Phosphorus: 2000mg 
8 Coffee, brewed, espresso, restaurant-prepared, decaffeinated
Phosphorus: 1400mg 
9 Puddings, all flavors except chocolate, low calorie, instant, dry mix
Phosphorus: 1353mg 
10 Cereals ready-to-eat, QUAKER, KRETSCHMER Toasted Wheat Bran
Phosphorus: 1314mg

[MooseMom]

Again, I don't know why potassium is being ignored...

[Zach]

Again, I don't know why potassium is being ignored...

Remember, this diet is for pre-dialysis patients.

[MooseMom]

Again, I don't know why potassium is being ignored...

Remember, this diet is for pre-dialysis patients.

I know.  I'm pre-dialysis, but potassium is an issue for me.  I'd love to go on a vegetarian diet, but I really don't know how I can do that and not have my K explode.




Edited: Fixed quote tag error - okarol/admin

[KarenInWA]

I'm Pre-D also, and my neph wants me to stay around 1500mg of K a day.  I don't know if I do or not.  But, my K is usually around 4.5 - 5.3 . I hate this disease and its joke of a "diet".

KarenInWA

[kristina]

As you probably know, I have been a vegetarian for almost 40 years,
but not with such a restricted diet as I follow now since being in ESRF with my kidneys again.
I haven't had Dialysis yet and I am scared stiff of it.

I totally agree that when we come into this stage of renal impairment,
the pre-dialysis-diet becomes an awful problem and I can testify that it is not easy at all.

I have a very strict diet and I almost eat the same three square meals every day, day after day.
There are only very slight variations.
As you can imagine this is sometimes torturous,
but my only solace is to see that my sodium and potassium are controlled
and my kidney function fluctuates between 10-12% for over two years now.

The potassium is all worked out by selecting fresh vegetables
and leaching out the potassium by boiling the vegetables in lots of water.

The phosphorus can be calculated on line.
The Sodium can be controlled by eliminating salt from the diet altogether.

It is very boring and it requires strengths to get into all this,
and once it is up and running it is torturous,
but at least I feel it gives me a chance
to stretch my pre-dialysis-phase for as long as I can hopefully do.

Good luck from Kristina.

[MooseMom]

Kristina, would you mind telling me what you eat day to day?  Thanks!

[kristina]

My daily menu is this:

Breakfast:

One bowl containing one and a half medium size apples and half a pair,
the fruit must be peeled and washed and cored.
One slice of toast cut into small squares each with a tiny wafer-thin piece of cheese,
I use a Cheddar (hard cheese which is 30% less fat).
Half a cup of weak coffee with a little milk.

Lunch:

4-5 medium sized green asparagus with stalk trimmed.
This boiled for about 15 minutes in a large sauce pan full of filtered water.
Ten small squares of fresh bread (made in my own bread-maker with no salt)
and on each piece of bread a very small wafer-thin bit of Cheddar cheese just to get the taste.
Four small pieces of toast with a little blueberry-jam on each piece (again, just for the taste).
One glass with half a freshly squeezed lime filled with water.
If I feel a little more peckish I will have another thin slice of bread on its own.

On Mondays, Wednesdays and Fridays only I have, in addition to the above lunch
half a slice of toast with one egg scrambled:
That is one egg in a bowl, a dash of pepper and half a tablespoon of milk mixed together
and scrambled in a saucepan.

Evening-meal:

One bowl of salad made-up of grated cucumber which has been peeled plus lettuce leaves,
this with a little salad sauce composed of cider-vinegar mixed with olive oil and a pinch of pepper.

A bowl of hot food as follows:
Twenty five grams lentils (measured dry, soaked overnight and well washed)
a small portion of peeled and cut carrot,
a small portion of broccoli and a small portion of green cabbage.

All the vegetables are carefully washed and cut into small pieces
and all these ingredients are put into one large pot filled to the top with water
and one tablespoon of freshly squeezed lemon-juice,
and kept filled whilst boiling for 40 minutes.
Then the water is completely drained out.

This is put on top of 100 grams (dry weight) of Couscous cooked as follows:
following the instructions for my particular Couscous I put half a tablespoon of olive oil in a sauce pan,
then add 175 ml of water which is then brought to the boil and the 100 mg of Couscous if poured in,
the heat is turned off, a dash of pepper on the top and with a fork twirl and mix everything together
and when you see the water nearly absorbed, cover and let it rest for 5 minutes.

This constitutes of my day-to-day three meals a day. You can calculate the weight of vegetables
according to the phosphorus content and by boiling you leach out the potassium
and one gets used to having no salt. I don’t use butter. 
With the egg and lentils and the little wafer-thin cheese pieces etc. I get my protein.

About once every month I go completely insane and allow myself half a doughnut
and then feel guilty for the next four weeks, as I said, it is a little torturous.

So, this is what I put up with month-in-month-out.
The details of the meals I have given are of course
relative to my size of 165 cm tall and 52,5 kg in weight.

I have been doing this for so long that my body feels quite content
and calm with just these three meals.

I also have my usual two litres of (filtered) water per day in addition.

Good luck from Kristina.

[carla13]

Hi,
i'm a vegan (transplanted now, but was following the same diet whilst on D) and never had a problem with phosphorous levels, can't say the same for my potassium levels, but 'cos I was doing APD at home I had the freedom to adjust my D to accommodate K levles.
 
I also leeched all the K out of my veg by boiling all veggies until nearly dead! Boring and a bit mushy, but it keeps us alive. Though I agree that the Dialysis die-t SUCKS!
x

[kristina]

Thank you carla13, I hope your diet suits your present situation.

I just had another thought.
I do buy all my fruit and vegetables fresh from the weekly market
rather than the super-market as I found out the super-market produce
is often stored for long periods in a freezer and that is why
when it comes out and is put on the shelf,
it immediately begins to deteriorate, or go bad,
from the inside whilst the outside still looks ok,
and, the fruit only lasts two or three days.

This may be a small point to make
but when you are sitting on the fence - like myself,
(still pre-Dialysis, kidney function 10-12%),
not knowing from day to day whether or not
you are going to be on Dialysis - or not,
every little bit of help must count!

Best wishes from Kristina.