We all know that most Americans eat too much salt, anyway, and for kidney/dialysis patients, salt is the big bugaboo.I don't necessarily agree with the first part of this statement. Sorry, but doctors love to state this as fact, and some very articulate and talented scientists, science writers, and medical doctors have been refuting the 'dangers of salt' argument for years. Like so many dearly held beliefs that take hold in this country and are then impossible to extract from the collective ideology, the argument for sodium restriction was based on a huge but ultimately faulty study. For dialysis patients, salt will have an effect on thirst, and that is a danger for in-center dialyzors. However, there is no agreement in the scientific community that average American salt intake will damage general health, nor is there agreement that salt restriction is free of dangerous side effects.
Yes, I completely agree with you that openly writing about any issue is brave, at least in my estimation. I don't know enough about the politics of nephrology to say there is anything extraordinarily courageous in advocating for better dialysis - I would have to assume that most nephrologists (especially the ones that do not own dialysis clinics) would agree with him. More of them should add their voices to this push, it sounds well within their job description to register an expert opinion.
However, he is currently advocating for nephrologists to lecture patients on salt intake, with the implication that if they eat out, they must not want to control their salt that much; further implying that we are not smart enough to handle restaurant eating and make our own choices within our own dietary limits. That is the sort of statement that would have seen him sacked as my nephrologist. I don't eat out that often, but this all or nothing approach is detrimental to patients. It does not help that I do not believe there is strong enough science to support salt restriction in my particular case, and I would not appreciate a one-size-fits-all recommendation regarding diet or anything else.
I am all about patient autonomy and empowerment, so if that is his ultimate goal, then I am sure I will eventually come to the same conclusion that you have.
I'm surprised that you are not more aware of the "politics" of nephrology these days. You only have to look at Bill Peckham's and Hemodoc's blogs to see that there is a real battle between providing better dialysis and getting the funding for it. Patient outcomes vs profit. Read Bill's entries about EOD dialysis; this shouldn't even be an issue.I understand the politics of profit vs. optimal dialysis, I guess what I was trying to say is I do not understand what makes it brave for a nephrologist to advocate for better treatment for his patients. I remember reading that gobsmacking article about a nephrologist who dared open a non-Davita clinic near their Colorado headquarters and was being sued to within an inch of his life. Aside from opening himself up to written criticism, is there some consequence that The Kidney Doctor could face within the renal community? Are there people trying to silence him? Does he run his own clinic? I feel like I'm missing something here. I don't know loads about dialysis nephrologists, but the transplant ones, the field is microscopic. Gwyn could tell you about the time that I told the wonderboy about this nephrologist I detested, because this cretin had told me I would die horribly if I underwent the trial. I do not know what possessed me to open my mouth and confess this to my doctor. I knew better! Anyway, the surgeon immediately said "Oh, are you talking about Madison? Dr. XXXX?" (D'oh! Then I had to nod along as the wonderboy defended this jerk.) They will not criticise each other, but that is not what The Kidney Doctor is doing as far as I've seen. If he were publicly calling out his peers, OK then, I get how that is taking a gigantic risk.
Cariad, it would be very interesting if you were to go to the Kidney Doctor's blog and tell him just what you've posted here, which is what I have done. You'll notice that I opined that this idea of don't eat out, ever, is unhelpful. If you do choose to add your own comment, please don't post as "anonymous".OH MY GOD!!! WHAT??!!
Why not judge? Tell him you think he's full of crap and that his opinion is based on crap science. If that's what you believe, you may well be right. Why not say this to him? If he's brave enough to open himself up to online criticism, then you can comment as you see fit. I'm sure he could learn something from not only you but also from any of us who are actual patients.
I was unaware that the salt issue is so controversial and that salt restriction is so perilous.I have been researching this for Public Health, because the EMT who wants to be a doctor asked me for proof that salt was not a significant factor in blood pressure. I would not say salt restriction is so perilous across the board, I would say that salt restriction as a public policy, and especially as a knee-jerk response to a patient in renal failure, could have negative consequences. It's nice to hear that yours is not like this. My first Milwaukee nephrologist was.
I don't know if there is some consequence The Kidney Doctor could face from the renal community as I don't know the extent of his financial involvement with any particular medical institution. But I personally applaud anyone who goes online and advocates for a frail population against big corporate concerns, particularly in this day and age where anyone can pretty much post anything, and oftentimes does with a particularly vicious and snarling tone.Well, advocating for patients would suggest that he wants to see change, and would be for patient education, empowerment, autonomy, etc. I really do not see how anyone could be called an advocate in this age without being for those things. So, again, I have barely read anything from this person and wrote about my initial confusion about this person's place in the renal world. However, if he IS advocating, then he is doing more than most and like I said, I'm sure I'll come to the conclusion that he is an excellent addition to the pro-kidney patient side.
Bill, I don't think there is anything horrible about eating out; I treated myself to lunch out today, and it's a practice I intend to continue. But I think you are reiterating the point, and that is that most of our salt consumption comes from restaurant foods, and if you are looking to radically reduce your intake (which I understand most dialysis patients should do, but maybe cariad is right in that this is just a bunch of hooey), then your neph should be telling you that cutting back on eating out will be helpful. That is all. 8)Let's not conflate what I am saying - that there is compelling evidence that salt restriction is not healthy for the entire country, and not even for all renal patients - with what Bill is saying, which is that dialyzors who no longer urinate need to limit salt, and that there is really no controversy over that particular issue. I defer to his vastly greater knowledge on this. :) I, too, find salt fascinating. (Definitely, food as a topic in anthropology is huge. I had a prof who used to say that all anthropologists ever study is food, sex, and death.) I guess in rereading The Kidney Doctor's post, he is not saying that all kidney patients need to limit salt, so I don't want to put words in his mouth. Suggesting that doctors tell renal patients to stop eating out - I am having a difficult time not taking this as an insult. That to me assumes that renal patients cannot handle the challenge of negotiating restaurants and diet restrictions.
BTW Anna is totally on the Salt Institutes list ... if anything ever happens to her that's where I am looking first.[/left]
Are there really people out there who haven't heard the sodium/fat/calories rhetoric to death?
What would be the point of being alive, if you could not do anything you liked on occasion. We dont eat out much, but that is the way I was raised, the woman cooked. Plus, I do enjoy cooking and such. The point of the whole thing is to still enjoy yourself and enjoy your life.
I don't mind eating out once in awhile. You can usually make healthy choices. But my wife wants to go out to eat all the time. She brings home fast food for me, even though I tell her not to do so. She's a cardiac nurse, a charge nurse, but when it comes to food she has zero self-control. I usually go for the pasta. It has salt and potassium in the tomato sauce, but less phosphate.