The Kidney Kitchen: Sodium and the Renal Diet

  Thank you for sticking with me, and welcome to part 4 of my renal diet series.  Today we're going to look at sodium.
  We all know the dangers of consuming too much salt...high blood pressure, a higher risk of heart disease and stroke, a higher risk of congestive heart failure.  People with kidney disease can also experience swelling (called edema), puffiness in the face and difficulty breathing.  I had no idea that the shortness of breath I was suffering with before I started dialysis was due to all the excess fluid my body was hanging onto.  Consuming too much salt can make you feel very thirsty and want to drink more, which can lead to fluid weight gain and the above-mentioned symptoms.
  Sodium is found in almost all pre-packaged and processed foods.  Some examples of high sodium foods are:
  - canned soups (the so-called "healthy" soups have even more sodium in them than their regular full-fat counterparts)
  - breakfast and deli meats
  - frozen dinners
  - pre-made sauces
  - fast food
  - some canned vegetables
  - snack foods such as chips and pretzels
  - packaged side dishes
  - low-fat products such as cream cheese, salad dressings and
The easiest way to limit sodium intake is to simply avoid pre-packaged and processed foods.  I make almost all of my meals using fresh ingredients.  That includes snack foods too.  I have found a few low-sodium packaged snacks that I can enjoy without consuming sodium (unsalted pretzels and unsalted corn nuts that I get from Bulk Barn are two of my favourites).  I also modified the following recipe to make it kidney-friendly and low sodium.  I'm posting both the original version and my kidney-friendly version.  As they say in the Twix commercials: try both and pick a side!

Honey-Glazed Snack Mix
  - 5 cups Crispix cereal (you can also use Rice Chex, Corn Chex or a mixture of both)
  - 3 cups mini pretzels
  - 2 cups peanuts
  - 2 cups Cheerios
  - 1/2 cup butter or margarine, melted
  - 1/2 cup honey

  1.  Heat the oven to 300 degrees.
  2.  In a jelly roll pan or large roaster, combine cereals, pretzels and peanuts; set aside.
  3.  In a small bowl, mix together the melted butter and honey.  Pour over cereal mixture and stir until everything is well coated.
  4.  Bake for 10 minutes, and then stir.  Continue baking for 10 to 15 minutes, stirring every 5 minutes, or until cereal is glazed and all of the honey mixture has been absorbed.  Immediately pour snack mix out onto waxed paper and cool completely.  Break into pieces and store in an airtight container.

Kidney-Friendly Honey-Glazed Snack Mix
  - 5 cups Crispix cereal
  - 3 cups unsalted mini pretzel twists
  - 2 cups unsalted corn nuts
  - 1/2 cup melted margarine
  - 1/2 cup honey

  1. Heat the oven to 300 degrees.
   2. In a jelly roll pan or large roaster, combine cereals, pretzels and peanuts; set aside.
   3. In a small bowl, mix together the melted butter and honey. Pour over cereal mixture and stir until everything is well coated.
   4. Bake for 10 minutes, and then stir. Continue baking for 10 to 15 minutes, stirring every 5 minutes, or until cereal is glazed and all of the honey mixture has been absorbed. Immediately pour snack mix out onto waxed paper and cool completely. Break into pieces and store in an airtight container.

Note: Mix up your snack mix by adding unsalted popcorn, tiny crackers or other kinds of kidney-friendly cereal.

Until next time,
J.

The Kidney Kitchen: Phosphorous and the Renal Diet

  Welcome to part 3 of my kidney diet series.  This post takes a look at phosphorus.
  Phosphorous is another mineral that we get from eating certain foods.  It helps to build strong bones and teeth and muscles and nerves to work properly, convert food into energy and helps with metabolism.  If your phosphorous level is too high, it can cause your blood calcium level to drop, which can lead to brittle bones and an increased risk of fractures or breaks.  It can also cause itching all over your body, red eyes, bone pain and calcium deposits in the blood vessels and organs.  Examples of foods that are high in phosphorous include:
  - milk and dairy products
  - cola drinks and some bottled iced teas and lemonades
  - coffee
  - chocolate
  - bran
  - whole grain breads, rices and pastas
  - wild rice
  - nuts and seeds, and butters made from them
  - dried peas, beans and lentils
  - beer
  - quick breads, biscuits, cornbread, pancakes or waffles made from mixes
  - pizza, lasagna, tacos and other "fast foods"
  In addition to limiting phosphorous-containing foods, another way to help control phosphorous levels is by using phosphorous binders.  Phosphorous binders generally contain calcium.  Your body breaks down the binder and releases the calcium into the bloodstream, where it binds with the phosphorous in your blood.  It is then excreted when you have a bowel movement.  I take Ultra Tums as my phosphorous binder.
  Anyone who knows me knows that I LOVE chocolate.  So you can imagine my reaction when I found out that I would have to seriously limit my chocolate consumption.  But then I found this awesome recipe from DaVita for low phosphorous fudge! Hooray!

Low Phosphorous Fudge
  - 2/3 cup half & half creamer
  - 1-2/3 cups granulated sugar
  - 1 cup marshmallow crème
  - 1-1/2 cups semi-sweet chocolate chips
  - 1 teaspoon vanilla extract

  1.  Grease a 9" square pan with nonstick spray or butter.
  2.  Combine half & half and sugar in a large heavy saucepan. Bring to a boil; reduce heat to medium. Stir constantly and continue a rolling boil for 5 minutes.
  3.  Remove pan from heat and add marshmallow crème, chocolate chips and vanilla. Stir until marshmallow crème is melted.
  4.  Quickly pour into a greased pan. Cool; cut into 3" x 1-1/2" pieces, making 18 pieces.

Until next time,
J.

The Kidney Kitchen: Potassium and the Renal Diet

  Welcome to part 2 of my 5-part series on my kidney diet.  This post will look at potassium and why I have to limit my potassium intake.
  Potassium is a mineral which helps your nerves and muscles to work properly. It also keeps electrolytes and the acid/base content of your blood in balance, promotes muscle growth and sustains healthy brain function. You need some potassium for good health, but too much or too little can affect your heartbeat. When your kidneys don't work properly, they can't regulate the potassium levels in your blood, and it can build up. A potassium level that gets too high (or hyperkalemia) can lead to a heart attack. A potassium level that is too low (also called hypokalemia) can cause muscle weakness or cramps, or even muscle paralysis.  By controlling my intake of potassium, I can help prevent these problems. Examples of foods that are high in potassium include:
- potatoes: red, white, sweet...they're all high in potassium
- dried peas, beans, nuts and seeds
- dairy products such as milk, pudding, ice cream and cheese
- dried fruit such as apricots, dates, figs and raisins
- fresh fruit like bananas, cantaloupe, oranges and kiwi
- tomatoes and tomato products like ketchup, tomato sauce and tomato juice
- All-Bran and other bran cereal
- whole grain breads and cereals
- salt substitutes that contain potassium chloride
- sodium-free baking powder
- sweets like black licorice, chocolate and molasses
- vegetables such as artichokes, spinach, pumpkin and large amounts of mushrooms
You may be thinking that the list of what I can't eat is longer than what I can eat. Well, you'd be right. But there are ways that I can still eat my favourite foods. Take, for example, the humble potato. There are ways that I can cook potatoes to reduce the amount of potassium. One method is to cut the potatoes into small pieces and double cook them. To double cook potatoes, you bring them to a boil and then drain and rinse them and continue cooking them in fresh water. Another option is to leach them in water for 3-4 hours (leaching is a fancy term for soaking). Leaching is what I do when I prepare the scalloped potatoes below.
  Potassium can be hard to control, because it's found in most fruits and vegetables.  But there are still lots of options that I choose from: peaches, sweet peppers, cabbage, apples, celery, turnip...and this is just a few.
  And when I feel like treating myself a little< I make these scalloped potatoes.  In place of milk, I use unfortified Rice Dream rice beverage as the "cream" component.

Jen's Kidney-Friendly Scalloped Potatoes
Ingredients:
2 medium potatoes, peeled and thinly sliced
1 medium onion, thinly sliced (add more or less onion, depending on your tastes)
4 tbsp. margarine
4 tbsp. flour
2 tsp. no-salt seasoning of your choice (I like either Epicure Fine Herbes blend or Clubhouse No Salt Added Original blend)
2 cups unfortified rice milk
4 tbsp. herb and garlic cream cheese, optional

1. Slice the potatoes and put them to soak in a bowl of cold water for at least 3 to 4 hours, draining and rinsing the potatoes after 2 hours and putting them in fresh water.
2. When you're ready to make the potatoes, drain and rinse them and let them dry for a few minutes. Preheat the oven to 350 degrees. Grease a 6"x9" baking dish and layer the potatoes and onions in it; set aside.
3. Melt the margarine in a medium-sized pot. Whisk in the flour and seasoning until smooth, then whisk in the rice milk. If desired, add in some herb and garlic cream cheese. Heat the sauce until it boils and thickens, stirring often to keep the sauce from sticking and/or burning.
4.  Pour the sauce over the pan of potatoes and onions.  Bake at 350 degrees for 25 to 30 minutes, or until potatoes are softened.  Then enjoy!

Until next time,
J.

The Kidney Kitchen: You Want Me To Follow What Kind of Diet?

 Welcome to the first part of my five-part series on the renal diet that I follow.  I wanted to share some insight on one of the biggest ways that kidney disease affects my everyday life, and how I still manage to eat like a king on a renal diet.  **Please note that these posts are based on information I was given for my particular situation.  This information may not be appropriate for you, and you should always consult your own doctor about your particular situation.
 So... what the heck is a renal diet, anyway? In the simplest sense, it's a diet designed to help reduce the workload on failing kidneys while still allowing the person to maintain proper nutrition. You've all taken health class, and know about Canada's Food Guide and the four food groups and how proper nutrition is essential for helping us to stay healthy.  But what you may not know is that there are a lot of foods that, while they are considered healthy by Canada's Food Guide standards, may not be that good for kidney patients. As an example, consider that milk you poured on your breakfast cereal this morning.  Milk is considered to be very good for you.  It's full of calcium, potassium, phosphorous and protein and lots of vitamins.  Many Canadians (if not, most Canadians) do not consume enough milk products.  However, all of those good things that milk has in it may not be so good for someone whose kidneys don't work properly.  Milk and diary products are something that is commonly limited on a renal diet (more about this below).
  To really understand what the renal diet is trying to accomplish, you have to first understand what it is that your kidneys do.  Your kidneys perform 3 essential tasks:
  - they regulate the amount of water in your body
  - they remove wastes and excess minerals from the body
  - they produce hormones
When kidney function decreases, the kidneys are unable to perform these tasks as efficiently as they could before.  That's where the renal diet can help.  Following a renal diet can also help alleviate some of the symptoms of kidney failure. However following a renal diet can be very complicated, particularly if you have other health concerns that require a special diet, such as diabetes or food allergies.
  So that brings us back to the renal diet. Let me start by saying that there is no one renal diet. This is not a "one size fits all" type of deal. The dietary restrictions vary based on the individual and factors such as what stage of kidney failure they're in and what their lab results show. In my case, I have to control my intake of sodium, potassium, phosphorous and protein. I call it my "Low S3P diet".  Now that I am on dialysis, I also need to reduce the amount of fluid I consume, but that's a topic for another post.
  Let's look again at that milk.  Milk contains potassium, phosphorous and and protein - the 3 P's.  I can still have milk and dairy products, but I need to really limit how much I eat or drink.  (In case you're wondering, I'm allowed two 1/2 cup servings of things like milk and yogurt, or 1 oz. of hard cheese every day.)  As a result, I've been looking for products that I can have in place of milk and dairy.  Instead of white milk, I use unfortified rice milk.  Instead of ice cream, I've just discovered the most awesome triple berry sorbet (made by Chapman's - a Canadian company!).  And there is a dairy and soy-free cheese product that I want to try.  You can see five of my favourite kidney-friendly foods to cook with in this post here.
  After reading all this, you might be wondering how on earth I manage to figure out what I can and can't eat.  The most valuable resource I have is the renal dietitians at the hospital.  They can best help me figure out what I should and should not eat.  There are also lots of great resources online; I've created a list in the left sidebar of some of my favourites.  Feel free to check them out for some great kidney-friendly recipes, and don't be afraid to try some of them yourself!  Finally, I use the nutrition facts table and ingredient lists on packaged foods.  I know what I can and can't eat, and this information helps me figure out whether the item is something falls within my diet.  It's important to use both because manufacturers are not required to list potassium and phosphorous content in the nutrition facts table.  By looking at the ingredient list, you can easily see if the food contains potassium or phosphorous additives.
  If you're still reading this, thank you! I realize this is a lot of information to get through.  But I appreciate you taking the time to learn more about my diet.  In the next part of the series, I will be taking a detailed look at potassium and sharing a recipe I created.

  Until next time,
  J.