If I overeat on Thanksgiving

[ElaineJ]

I’m new to hemodialysis- just completed week 1.  And here comes Thanksgiving. I will be at my son’s house with the rest of the family. I’m not asking them to made any recipe modifications  because I don’t want to be the pain in the ass at holidays. I’m thinking one “bad” meal won’t be that harmful.  But I don’t know either which is why I’m here.  What might happen if I eat too much turkey, stuffing, & sides?  Just one meal can’t be disastrous, can it?  I’ll be at dialysis the next day.

[Paul]

It depends how good your bloods are. I'm guessing, from the fact that you are worrying about this, that you are normally very careful. If that is the case, one meal is not going to make a difference. Also, you say you are on your first week of hemo, assuming you were "caught in time", your kidneys should still be doing a reasonable amount of work, so that too means you should be OK with one naughty day. If you are worried, be extra careful the day before and the day after, to compensate.

As an example: I tend to be over careful which means my potassium/phosphate level has sometimes been too low, and I have in the past been told by my dietician, to eat more "bad stuff". Now that lets me have one naughty meal a week and still stay in the safe zone. However I never pick Saturday as my "naughty meal day" always a day with dialysis the day after (with the exception of Christmas Day every other year, when I am not dialysing until the 27th), and I am still scoring between OK and "too low" on my potassium/phosphate level.

[Paul]

Sorry, as a PS to my previous post:  I have just realised that your choice of heading was "If I overeat....." and in the post you ask "if I eat too much". You are aware that the important thing is not the total quantity, but the quantity of potassium and phosphate in the meal aren't you? This varies from food item to food item, considerably. Your neph or dietitian should have given you a chart. There are some foods you can eat a lot of, some that are OK in reasonable amounts, some only in small amounts, and a few rarely to never. I'm guessing that the worst thing on your Thanksgiving meal is going to be roast potato. If so, I'm going to have roast potatoes today for dinner (with roast beef - I'm English). Occasionally won't kill you, if your bloods are usually OK.

As an aside, I find the best tool for finding how much potassium/phosphate is in something is to do two Google searches. One for "Phosphate in XXXX" the other "Potassium in XXXX" (XXXX being the food item you are considering eating). In many cases Google will tell you the answer above the searches, in others you will have to follow a link to a health or medical site. But you will find this gets you quick, easy results.

[ElaineJ]

Paul, that was very helpful, thank you.  No, my kidneys were not actually “caught in time”. I didn’t think it important for this question but I see now from your responses, it is: I was in the hospital 2 weeks ago with kidney failure.  2nd time in 2 months because I’ve been extremely resistant to starting dialysis. After 2nd failure, I gave up the fight.  So my bloodwork was very very messed up but is good now after an intensive stay in hospital.  Also I have only 1 kidney as the other was removed with Stage 4 kidney cancer. So it sounds like I’m a mess, right? But I’m not. I’m very resilient & most people who meet me are very surprised when they learn I have any health problems at all  (and yup, I’m proud of that).  So ...

I think I would eat the “right” things, mostly but I want a small scoop of potatoes. I want a piece of pumpkin pie.  But I’m American & it’s tradition to eat a great quantity on Thanksgiving.  I’m thin so I can afford to do it but won’t I retain a lot of water if I do? Even if I keep salt to a minimum?  I’ve read horror stories about how awful it feels to have dialysis pull out a lot of water (shakes, bad cramps, nausea).  What’s the trade off?

I want my typical Thanksgiving or close to it - but I don’t want to pay the price. Lol.  Am I being ridiculous?  It’s ok, I can take any criticism.  Thank you for your help.  (I have not seen a dietician yet, sometime in the next couple of weeks they promise me.)

[Cupcake]

seems to me an easy thing to do is make the mashed potatoes yourself and start a day early, slicing the raw potatoes thinly and soak in water that you rinse several times overnight. then cook and make as usual. that washes out the potassium.

I am sure your family wouldn't be offended if you asked them to  lighten up on the sodium a little. Eat a small meal of kidney friendly foods before going so you don't eat too much. And enjoy your family, the real treasure of the holiday.

[rcjordan]

I'm preparing for 4 days of Thanksgiving and family visits away from home and skipping one treatment, Elaine.  (I assume you're here in the US and not diabetic.)  Here's what I'm doing:
#1 - Take some easy, alternate foods.  You can't do much better than Kellogg's Rice Krispie Treats as a renal-friendly snack.   
#2 - Severely limit all dairy, baked goods, and most fruits.  Canned pineapple or pears in their own juice are ok-ish. Cranberries & cranberry sauce are ok.
#3 - Eat 4 oz center-cut meat, no skin. Uses fats instead of gravy, if necessary.  Preferably roasted. No mixed meats like bologna, pepperoni, salami.
#4 - Eat iceberg lettuce, peppers, and onions.  Be careful about the dressings. Vinegar & oil is the best. Thousand Island is ok-ish.
#5 - Mayo, eggs, and celery are ok. Yellow mustard is salty but it doesn't impact the diet much in small quantities, so deviled eggs are ok-ish. No Dijon musterd, it's very salty.
#6 - Stay away from stuffing, pickles, and casseroles.
#7 - Most jams & preserves are OK.  Butter is ok.
#8 - Cool Whip is renal-friendly.
#9 - Stay away from the potatoes, pumpkin pie, and particularly gravies & sauces, and chocolate.

[rcjordan]

<added>
Take your binders if your doc has prescribed them, that'll likely be for phosphorus.  Potassium and sodium are the immediate problems, though.  Potassium overload will put you in the hospital fast.  I've not heard of anyone overloading in one day, but i have heard weekends doing it -particularly holidays and/or chocolate.

[rcjordan]

<added 2>
I forgot drinks. 

No teas or coffee. ZERO colas. No wine. No beer (maybe next time, once you get your diet straight).  Ginger ale, Mountain Dew work for me.  Water as a last resort, heh. Try to keep your intake to around 32oz / day.

[Paul]

I want a small scoop of potatoes. I want a piece of pumpkin pie.

From what you are saying about your bloodwork, I would not think this would be a problem.

I’m American & it’s tradition to eat a great quantity on Thanksgiving.......but won’t I retain a lot of water if I do? Even if I keep salt to a minimum?

All food contains liquid, the more you eat, the more you need to take off. BUT that can be managed WITHIN REASON. Eating too much is not as bad as drinking too much and the extra can be taken slowly over time (say half a litre a session) or in a worst case situation they could schedule you an extra dialysis session.

Stay away from the potatoes, pumpkin pie,

No teas or coffee. ZERO colas. No wine. No beer

Most of what rcjordan says makes sense, but I disagree strongly with these two comments (see my closing comments to see why I think following these things is a very bad idea) Limit these things, do not have too much of them, but small portions will not kill you. (P.S. for the rest of the year, be very careful of all these except tea. Tea is a recommended drink by most dietitians and I have no idea why rcjordan included it in this list. Also beer and wine: light colours are better than dark. My dietitian's rule, back when my liquid allowance was high enough to allow this, was a daily maximum of one glass of white wine or one pint (UK pint, slightly smaller than US pint) of lager, but NO red wine, NO bitter NO dark lagers.)

Take your binders if your doc has prescribed them, that'll likely be for phosphorus.

I would go one further than that and say: Even if they have not yet been prescribed, take them. You can get calcium carbonate over the counter under various trade names (most anti-indigestion medicine is calcium carbonate), or, in Britain you can order it on Amazon, and I'm assuming it will be the same in the USA. As rcjordan says, phosphorus is not a big problem, but it will make you itch, and you do not want to be at a family gathering and scratching like a dog with fleas. Also, in case you do overdo it, have some antihistamine (hay-fever medicine) on you, as that will help prevent the itching if too much phosphorus gets through.

Closing Comments: Coming here and asking is the second most sensible thing you have done, you cannot control this thing without knowledge. However the number one most sensible thing you have done is decide that this is not going to be allowed to ruin your Thanksgiving. The worst part of dialysis is not the limited diet, it is not the limited liquid allowance, it is not the cramps, it is not even having to give up three days a week to treatment; it is the depression that comes from knowing this is the "new normal". Any sane human being can live with these sacrifices in return for a life expectancy, but that does not stop it getting you down. If you go through old threads on this board you will see several threads that start with a variation on "I have decided I can no longer take this, I'm going to refused dialysis and let nature take its course." If you are too strict with yourself that will be you in a few years time. You MUST make it a rule to allow yourself to "be normal" OCCASIONALLY (but not too often). That is why I came down against rcjordan saying "No..." on a special occasion "NO" is seriously bad thing psychologically. I'll give you a couple of real life examples.

The first Christmas after I was put on the special kidney diet, my sister and I sat down and worked out how to fit in a traditional British Christmas dinner without breaking the rules. Now one traditional Christmas vegetable in Britain are brussels sprouts. And I really like brussels sprouts. Before Christmas we worked out that I could have five brussels sprouts. Normally I'd have a mountain of brussels sprouts, and as I watched my sister count out just five sprouts onto my plate, I got really depressed. It is a stupid little thing, but it ruined Christmas for me. And it ruined the next few months for me too. In March I was still a bit depressed and whining "Is this what my life has come to? Just five brussels sprouts for Christmas dinner?" The following Christmas I had a reasonably big portion of sprouts, it not only prevented several months of depression, it also felt like a small victory ("F*** you dialysis, I'm gonna eat all these brussels sprouts!").

When you get seen by your dietitian, one of the foods he/she will warn you about is the humble banana. This poor little fruit is so full of potassium that it is more forbidden that that fruit in the garden of Eden. Now there is a woman on the same dialysis unit as me, who is in a much worse condition that I am. She has cancer which has caused them to remove both her kidneys and cancer has taken away her ability to walk. She is also lactose intolerant which is a real pain because most non-dairy milks are really high in potassium. But what she really misses is the humble banana. On her birthday last year, she carefully worked out her diet so that (amongst other treats) she could have one banana. The following day she wheeled herself around the waiting room telling everyone who would listen (and anyone who wouldn't) "I had a banana yesterday." I have never seen her look so happy.

So in short: Once you get to see your dietitian, stick to the diet he/she gives you, mostly. But do not forget to cheat occasionally. Remember: If you give up; all bad foods, drinking alcohol, etc. it still won't make you live forever, but it will bloody feel like it. And when you do come to die, it will make you grateful to go.

[ElaineJ]

Thank you everyone for your help. Every answer was truly helpful from preparing renal-friendly potatoes myself to remembering the true joy of Thanksgiving is being with family.  Rcjordan, that list was really good, I’m printing it out. Paul, that was just what I needed to hear. I already did see a couple of depressing “can’t take it anymore” posts and I can definitely understand where those folks are coming from. I want to do whatever I can to not get to that point.  The QOL issues are important and some silly things like eating what I want on Thanksgiving matter - to me.  So thank you for the profound insights. I’m printing that out too.

[Hereware]

My apologies I am not so familiar with the diet needed for diabetics and the like. Just wanted to know why potassium is forbidden?TIA

[Michael Murphy]

Kidneys remove potassium, too much potassium not good for heart.