The REAL reason you shouldn't eat while dialyzing

[MooseMom]

I remember my mother complaining about being told she shouldn't eat at dialysis in some clinics when she travelled.  Different clinics seem to have random rules about this, and their reasons are varied, usually somewhere along the line of "you could choke if you crashed."

Well, our dear and inquisitive boswife asked about this over on Home Dialysis Central, and Dr. Agar responded with a very interesting and reasonable answer that I had never considered, so please read!

     
     
 
Posts:16 eating during dialysis
Hubby Bo likes to have treatments quite early in the morning, (4or 5am) and have his breakfast during treatment. We were just snacking, but have now gone to the full breakfast at times. We do try to do that towards the latter part of treatment. Having a smaller protien snack seems better to me but is this ok?

Hi also has another question. He gets tired of laying down and likes to sit up with feet down on the ground. Is this allowing the fluids to be sucked out easily or should he just do that for short periods?

Thank you so much for input.   Reply With Quote .
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August 1, 2011 06:16 PM #2 John Agar
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Broadly, we do not encourage more than small snacks during dialysis … and there is a physiological ‘reason’ for this …

It all has to do with the ‘splanchnic circulation’. The splanchnic circulation (splanchnic comes from the ancient Greek word to describe the ‘visceral organs’) is that circulation that supplies the gut and the abdominal organs.

When (or after) we eat, blood is diverted into the splanchnic circulation to aid in the absorption of nutrients from our bowel as the food we have eaten is munched up and acid-dissolved by our stomachs, squirted with bile and enzymes from the gallbladder (bile) and pancreas (enzymes) to break down the fats and sugars released by the munching and dissolving of the stomach, and then is milked by a muscular squeezing process along the many feet of intestine where the nutrients are absorbed into the blood stream of the splanchnic circulation. Finally, water reabsorption and mucous secretion in the large bowel formulates our final stool (poo) for elimination at the rectum and anus.

Phew … there’s our bowel function in a single paragraph!

Eating triggers a diversion of a significant dollop of our total blood volume to this circulation … a circulation that almost runs as a parallel but ‘segregated’ circulation from our ‘systemic’ blood flow … the blood that wooshes down into our legs and arms and that supplies our kidneys (if they are there!), our brains, our lungs etc.

Eating ‘compartmentalizes’ a significant volume of our blood for absorption … and makes it relatively unavailable for the systemic circulation.

This means that the blood volume that has been redirected to the gut is less available for dialysis! Dialysis can access the systemic circulation … but not the splanchnic circulation!

You may begin to see now that this reduces the potential efficiency of the dialysis treatment as a means to ‘cleanse’ the total blood volume.

There are also blood pressure implications that can arise from splanchnic diversion, with hypotension a more likely complication of dialysis therapy delivered to a patient who has eaten on dialysis than if no eating had been permitted.

A snack? … let’s be fair … a snack is ok – but make it very light, and make it of easily digestible food. If the patient isn’t desperate to eat, then not eating is ideal. If eating is essential (some patients just can’t hang that long without something to eat) … then small amounts.

As for a full breakfast? I’d not be so thrilled, if I were your physician, to encourage that. Anyway, I reckon it’d be more enjoyable to have a full breaky after dialysis, in the sun, together, with the morning paper, and without a bunch of tubes hanging from the arm!


As for your question of whether he should have his legs down or up during dialysis … this is a question that is of enormous interest to me. We published on this – or a parallel issue – back in around 2004 (in ‘Nephrology’) and again in 2007 (in HDI) … looking at the effects on the serum albumin and on volume of recumbent versus erect (seated) dialysis. It’s a complex issue. So complex, indeed, that it is a little over-complex to deal with here … suffice to say, it is a fascinating academic ‘ride’ to delve into this murky subject.

From a practical stand-point, while there do appear to be some circualtory ‘advantages’ from recumbent dialysis, I’d not be at all worried if he wants to plonk his feet down!

In Australia, almost all conventional dialysis is semi-recumbent, at best … and many dialyse seated with their feet down. I suspect (no, I know) that this is also the case elsewhere around the world.

If he wants to sit up a while … go for it. But … as his blood volume has been changing through dialysis, he may be more easily prone to a postural change (a fall) in his blood pressure when he sits up … so do it slowly … don’t make a too-sudden change. It may help avert an unexpected ‘flat’. John Agar
http://www.nocturnaldialysis.org  Reply With Quote .
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Here's the link for the whole thread:

http://forums.homedialysis.org/showthread.php/2955-eating-during-dialysis

[Cordelia]

I have a small snack. I don't eat a huge meal. I don't think they'd let us eat a meal anyways. I used to buy a sandwhich at Tim Horton's every weekend on the Saturday evening dialysis run I was on that started about 6 pm in the evening. I sometimes brought a sandwhich in that I bought from there......they let me eat it......but anything more than a sandwhich I think that might have been a problem while dialyzing.

The hospitals where I'm from usually have a sandwhich/donut/muffin shop of some kind in them, so it was just so convenient to have supper from there once in awhile. I hated having to eat at like 4 pm in the afternoon before I left to be at the hospital before 6 pm.  It took 45 mins just to get to the hospital.

[Cricket]

This is an interesting subect, as it has been one of great controversy at my center.
I'm diabetic - and have discovered that dialysis lowers my blood sugars dramatically, so much so that 2 hours into treatment I MUST have a snack or two!  Without the snack, I'd crash in insuln shock or reaction and I know (for a fact) the center does NOT STORE fruit juices to avoid the crash.   Further, I asked a nurse if I could store juices or fruit cups in their readily available refrigerator and she almost took my head off! 
And so, I bring my fruit cups, crackers, etc and keep them in my tote bag, no matter what they say.
I AM IN CHARGE of my own health - and that includes diabetic low sugar issues.  Been diabetic since 14 yrs. old (57 now) and no one's going to tell me to stop looking after myself independently, no matter how weird or strict the "rules" are. 

[Pam]

When I started dialysis 2 yrs ago, I asked about snacks etc. I told them I needed to have something in case my BS dropped. The nurse told me not to worry they would give me glucose if that happened. it has not been a problem. My time starts at 6:30 am and I eat before I get there. I am starved when I am done and have to eat as soon as I leave. I carry my own monitor, apple juice, ritz bitz crackers and glucose tablets. I sit in he back in a corner and no one pays attention.
Pam





EDITED: Icon error corrected - Bajanne, Moderator

[Cordelia]

My unit has a bowl of crackers and they offer water and coffee or tea.     

[sullidog]

I quit eating on the machine do to it was making me nausous even just a small snack

[MooseMom]

This is an interesting subect, as it has been one of great controversy at my center.
I'm diabetic - and have discovered that dialysis lowers my blood sugars dramatically, so much so that 2 hours into treatment I MUST have a snack or two!  Without the snack, I'd crash in insuln shock or reaction and I know (for a fact) the center does NOT STORE fruit juices to avoid the crash.   Further, I asked a nurse if I could store juices or fruit cups in their readily available refrigerator and she almost took my head off! 
And so, I bring my fruit cups, crackers, etc and keep them in my tote bag, no matter what they say.
I AM IN CHARGE of my own health - and that includes diabetic low sugar issues.  Been diabetic since 14 yrs. old (57 now) and no one's going to tell me to stop looking after myself independently, no matter how weird or strict the "rules" are. 

If you click on the link and read the rest of the thread, Dr. Agar does in fact address the issue of snacks for diabetics.  He does not suggest that you go into shock for lack of a small snack to keep your blood sugar level!

I suspect that if you dialyze at home, there may be a greater temptation to eat more than is prudent.  I just wanted to provide some information about what is happening to the body if you are digesting and dialyzing at the same time, all in response to boswife's question.  I have never heard the explanation given by Dr. Agar provided by clinic staff.  Has anyone else had this issue addressed in this manner?  Maybe this is common knowledge that I missed somewhere along the way!

[jagermiester]

Just curious what this doctor meant when he said "an unexpected ‘flat’."  Is he talking about a drop in the BP?

[jbeany]

I knew that full meals made it harder to get good results because of the shift in blood circulation to aid digestion.  I guess I thought it was common knowledge, but maybe not.

The last time I went back up north where I lived pre-transplant, I dropped into my old center to say hi to the staff members I was friends with.  I noticed they had covered a HUGE bulletin board with a full set of instructions about acceptable snacks, right down to having pinned ziplocs with appropriate amounts of certain snacks to the board as an example.  I nodded at it and asked what was up with the lecture, since, as a diabetic, I had always had a full complement of snack foods available for my own use, and had never heard a peep from any one when I went there.  It was a two word answer.

"Pizza deliveries."

Too funny!

[MooseMom]

It SHOULD be common knowledge!  Well, ya learn something every day.  I had suspected that there was some blood-related reason that one shouldn't eat a big meal while dialyzing, but I had never really thought about it.  Again, I guess the real danger is if you're dialyzing at home and your spouse is feeding you pizza while you dialyze.

[willowtreewren]

This is very interesting and I can understand the reasoning behind it.

On the other hand, when Carl was dialyzing, he almost always had his regular dinner near the beginning of his treatment every night. That was about the only way we could schedule everything!

His labs and numbers were always great and his doctor was always pleased with how well he was doing. Perhaps those numbers might have been better had we waited until after dialyzing for dinner, but Carl would have passed out by then. LOL

Aleta

[KarenInWA]

I do in-center D 3 times a week in the late afternoon/early evening.  I always bring in something to eat, usually a bowl of clam chowder from a local fish 'n' chips place.  I need to eat, because by that time, lunch is usually gone.  If I don't eat, I'll end up so hungry by the end of my 4 hours that I'll be shaking.  I don't like that.  My center has no problems with patients eating.  I won't eat a full meal, but I do need to eat *something*.

KarenInWA

[Riki]

My unit offers digestive cookies if you get hungry, and if your fluid goals aren't too high, they'll even offer you a drink. They have coffee, tea, juice or ginger ale. Some bring in their own snacks.  I usually have hard candy, and another fellow brings a bag of peppermints in with him.  They do prefer that you don't have anything more than a muffin or a few cookies while you're on, and the reason given was a simplified version of what's above... *G*

[MooseMom]

It would certainly be stupid to allow yourself to pass out during dialysis because you haven't had time to eat anything.  We all know that we have to take the information that's relevant and fit it into our own circumstances the best we can.  It's just that I have a very distinct memory of someone on IHD talking about how great it was to do NxStage at home, in his own time, on his own schedule while having his wife serve him up his favorite dinner.  I though, "Oh yeah, I can see how that would be very tidy, indeed.", but now I see it's not such a brilliant plan.

[Ang]

its a bit hit and miss with each idividual.

my story is as follows, in the beginning of dialysis,say 3 months in, i was on the graveyard shift 7pm-midnight.
about 10 pm, i started to feel a little ordinary, not one to complain, i stupidly put up with it, next thing i know is i'm sweating so much and it feels like someone is choking the life out of me, had enough energy to raise my hand,lucky the nurse spotted me,woke up with oxygen.

there were 2 of us on the graveyard shift,strictly forbidden to eat for minimum 3 hours before dialysis, only given a sandwich during treatment.
food and dialysis just don't  mix for some people

[boswife]

Thanks MM     I loved haveing Dr Agar take the time to explain.  The explanation i had gotton from both the 'center' and our nxstage nurse did not satisfy a very good WHY of not eating a full on meal or even a snack. (we had been told that it wasnt very sanitary, he could choke, and possible blood pressure drop) Neither refused anyones snack and the center actually  encouraged it due to many were diabetic and all.  But!!!!!   Im one (as you are) who likes to know how things work, the nitty gritty, and wish they had informed me better so i would have had a real reason to not pack up the food for Bo and others at the center.    It's nice to hear that others had better explanations from their techs or other  

ps.... lol, you just posted and geesh, if it wasnt me who posted about "fixen dinner and serving him up his favorite", well, it could have been.  Kinda glad i got this 'new' information.  I was beginning to feel a bit of a hostess..hehe   oh yea, now im just his foot massuse and 'snack' maker.. still, a bit easier than the full on meal deal though..

[RichardMEL]

Thanks for reposting John Agar's comments. It's nice to hear a real pyhsological reason that makes some sense rather than random excuses.

For the tecord there were never really any restrictions on us eating while on D in the unit. They provided (bad) sandwiches (which oddly enough I actually miss from time to time  ) and a cup of tea/coffee and/or ice and maybe some fruit. We can bring in our own stuff. I guess the staff would have got a bit funny if someone brought in a pizza, or a roast chicken or something, but I never saw that. Mostly I had some peppermints in a jar, and more staff ate them than me!

In general I was fine with food before and during D - like Ang says everyone is different which doesn't help matters.

[Riki]

When I was in NY, no one in the unit there said anything about food or drink.. now that I know more about it, because I didn't the last time I was there, we won't do what we normally do..

There was usually 4 of us, me, Mom, Kelly, and another friend.  I'd go to dailsysis around 6pm and be there till around 10pm.  Around 7:30 or so, Mom and the friend would go for a walk, and Kelly would stay with me.  They always came back from their walk with food for all 4 of us.  From what I understand, there's a Subway not too far away from the unit, so that's where they'd go.  I think what we'll do next time, is eat before dialysis, hopefully somewhere where it's not hard to get a cab.  Getting a cab in Manhattan around 6pm is NOT an easy task.. *L*

[billmoria]

i am a diabetic. i get transportation that picks me up at 4:10. usually we get on around 5 but it varies i was on at 455 on friday   however it can be later than 6 if unit had troubles earlier in day which produced back log. the latest was 6:30 which means a 1030 start with 30 minutes to get home the 430 to 11 rt would gurantee low sugar maybe dangerously low    however in england we are served food and drink  for our shift a sandwich and tea and cookies too. you do not have to eat they take off an extra .5 if you do drink   VERY SENSIBLE POLICY WHICH LEAVES INDIVIDUAL PATIENTS TO WHAT WORKS BEST FOR THEM

[kristina]

i am a diabetic. i get transportation that picks me up at 4:10. usually we get on around 5 but it varies i was on at 455 on friday   however it can be later than 6 if unit had troubles earlier in day which produced back log. the latest was 6:30 which means a 1030 start with 30 minutes to get home the 430 to 11 rt would gurantee low sugar maybe dangerously low    however in england we are served food and drink  for our shift a sandwich and tea and cookies too. you do not have to eat they take off an extra .5 if you do drink   VERY SENSIBLE POLICY WHICH LEAVES INDIVIDUAL PATIENTS TO WHAT WORKS BEST FOR THEM

Hello, billmoria,

I have read several of your posts and you create a wonderful picture of how fantastic your Dialysis-centre is,
and also how wonderful the services you receive, like transportation etc., are.

You are no doubt aware how problematic Dialysis can be for so many people,
therefore they may wish to experience the same wonderful service you experience.

Perhaps you could let us know what Hospital or what Dialysis-centre you go to and where it is?

Thanks from Kristina.

[Poppylicious]

If Blokey didn't eat at haemoD he wouldn't eat till nearly midnight!  Most people just eat the limp, soggy sandwiches provided, but it has been known for a couple of people to regularly pig-out on burgers, and chips, etc. despite the best intentions of the nurses and doctors.

Hello, billmoria,

I have read several of your posts and you create a wonderful picture of how fantastic your Dialysis-centre is,
and also how wonderful the services you receive, like transportation etc., are.

You are no doubt aware how problematic Dialysis can be for so many people,
therefore they may wish to experience the same wonderful service you experience.

Perhaps you could let us know what Hospital or what Dialysis-centre you go to and where it is?

Thanks from Kristina.

Kristina, billmoria's experience isn't that different from Blokey's.  Blokey is offered sandwiches/toast (dependent on time of day) and biscuits, plus two drinks.  Before you start the nurses ask if you're likely to have one or two (or no) drinks and adjust the fluid take-off according to your answer.  Transport provided by the NHS is pretty standard for those who can't get to the hospital themselves (Blokey drives, but has had to use it in the past and I understand it can be a nightmare.)

Blokey has only had experience of two dialysis units but they've both been similar to billmoria's view.  I'm not suggesting that it is a 'wonderful picture' of 'wonderful services', but it would appear to be standard within the NHS in the UK (although others may have differing experiences.)

[kristina]

Thank you for your answer, Poppylicious.

I mainly asked because I am still pre-Dialysis
and I have only heard horror-stories
about hygiene, treatment etc. at Dialysis-centres.

I also talked with Dialysis-patients who appeared very suicidal to me;
they felt their dignity was being taken away from them in their Dialysis-centre,
and it was very very sad for me to come across that.

Adding to that, I don’t know if you have recently listened
to phone-ins & discussions on the radio:
it was mentioned that
every day three people on the kidney transplant list die in the UK
and I was wondering whether that was because of bad Dialysis-services,
but reading what you and billmoria say sounds rather encouraging.

Thanks from Kristina.

[okarol]

Jenna brought in lunch or dinner nearly every time she went to dialysis. There were no restrictions at her clinic. In 3 years she never had a problem during dialysis (only trouble was afterward, when they'd remove too much fluid, even though she still urinated, we'd have to argue to keep her above her "dry weight." She'd feel wrung out and have a headache.)

[Bajanne]

At my unit in the British Virgin Islands, there is no restriction, and I have seen other patients eating a full meal during dialysis.  However, at the unit I go to in Barbados  when I am visiting there, they prefer you not to eat during dialysis.  The nurse there told me that same thing, that eating redirects blood that should be used in dialysing.

[Phil]

My snack is without a doubt the highlight of the session! lol Sandwich, coffee (espresso) and water kindly offered by our center! Suprising considering its a public hospital in Italy! lol