Smart dining out choices for dialysis patients

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Smart dining out choices for dialysis patients
Monday, November 01, 2010
By Pohla Smith, Pittsburgh Post-Gazette

Kidney specialist Cynthia West and renal dietitian Allyson Almeida try not to forbid their patients on dialysis from eating foods high in sodium, potassium or phosphorus, even though they're generally bad for them.

Rather, they encourage moderation.

"Our belief is once you tell someone they can't have something, psychologically they crave things they know they can't have ... and then when they eat it, they might go overboard," Dr. West said.

With that philosophy, the two Washington, Pa.-based specialists wrote "Dialysis Dining on the Go!" The easy-to-follow, 36-page guide helps patients occasionally enjoy fast food meals at Wendy's or Taco Bell and casual dining at Eat'n Park without causing an accumulation of harmful waste products handled by the kidneys. The guide also includes convenience foods such as Lean Cuisine, Healthy Choice and Smart Ones entrees.

"If [the diet] is less onerous, they're more likely to follow the instructions," Dr. West said.

The guide is meant for dialysis patients only, Dr. West and Ms. Almeida stressed. "A diet for chronic kidney disease is quite a bit different, especially in protein content," which is lower, the doctor said.

Each eatery or convenience food company in the book is given a page or two listing "Go!," "Stop" or "Caution" foods, along with occasional extra tips to help patients stay within dietary guidelines.

Most dialysis patients are encouraged to eat about 100 grams of protein a day, if not more, depending on body weight, Ms. Almeida said. Sodium is limited to between 2,000 and 4,000 milligrams, but that's based on a patient's blood pressure.

Restrictions on potassium and phosphorus also are based on individual needs.

Foods high in phosphorus, for example, include dairy, cola, bran cereals, beans, and nuts and peanut butter.

Foods high in potassium include oranges and orange juice, potatoes, bananas, tomatoes, dried fruits, chocolate and melons.

"The other thing is fluid restriction," Ms. Almeida said. "About 99 percent of the patients are limited to 40 ounces of fluid per day. That's five 8-ounce cups per day." Any substance that is liquid at room temperature, like ice cream or gelatin, counts toward the total.

The book starts with general guidelines. Topics include "When I Don't Know What to Choose," which lists things like scrambled eggs or Egg Beaters as "Go!" foods for breakfast and ham, sausage or bacon as "Stop" items. Yellow mustard or mayonnaise are "Go!" condiments, but Dijon mustard, which is high in potassium, is a "Stop." General tips include grilled or broiled foods and shared entrees as OK, but dark-colored sodas, fried foods or all-you-can eat buffets as items to be avoided.

There also are pages of general advice on better fluid control, what to eat off salad bars, choosing desserts and how to read a food nutrition label.

It took Dr. West and Ms. Almeida a year to put the book together. The work wasn't just a matter of looking up and analyzing nutrition guides on the products' websites. Ms. Almeida also called company dietitians to try to get additional information, like potassium and phosphorus levels, which weren't generally listed on the Web.

They also had to get permission from the corporations to use their food items, images, icons and trademarks. About five declined, and McDonald's never answered any e-mail requests at all. More than 20 participated.

The two took the guide to the National Kidney Foundation annual meeting in Orlando, Fla., in April, where it drew very positive reactions, Ms. Almeida said.



"Dialysis Dining on the Go" can be ordered by e-mail at alleycat2001rd@yahoo.com. Cost is $9.95 per book plus $3 shipping and handling.

For more information, 412-334-6558.

Pohla Smith: psmith@post-gazette.com or 412-263-1228.


Read more: http://www.post-gazette.com/pg/10305/1099312-114.stm#ixzz144mQsTz7