That’s Weird

That was my first thought when a reader asked me to write about nail fungus and chronic kidney disease. It was something I’d not only never thought about but had never occurred to me might be somehow connected to CKD.

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Surprise! It is. Let’s start exploring it in our usual manner – with a definition. This is from the Mayo Clinic:

“Nail fungus is a common infection of the nail. It begins as a white or yellow-brown spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, the nail may discolor, thicken and crumble at the edge. Nail fungus can affect several nails.”

This did not sound good at all. How, in heaven’s name, did this happen? WebMD had that topic thoroughly covered:

“You get an infection when a crack in your nail or the skin around it allows fungus to get inside and grow.

Since fungus thrives in dark, warm places, your toenails are more likely to be affected than your fingernails. Your toes also have less blood flow than your fingers, which makes it harder for your body to pick up on and prevent an infection.

You’re more likely to get a fungal nail infection if you:

• Are a man
• Are older, since nails become more brittle and likely to crack as you age 
• Have a weak immune system or ongoing health problems like diabetes
• Wear shoes that make your feet hot and sweaty
• Walk barefoot through gym showers, swimming pools, and locker rooms –places where fungus spreads easily 
• Live with someone who has a fungal infection
• Have athlete’s foot, as the fungus that causes it can spread to your nails 
• Recently had an injury or surgery on your nail, or had a previous infection
• Wear plastic gloves or keep your hands wet for long periods” 

As an older diabetic, I was getting a little bit more nervous the more I researched. I felt I needed to know the symptoms of nail fungus just as much as my reader did. So, I turned to Health.com only to find out there are different types of nail fungus with different symptoms:

“Any toenail fungus causes a range of symptoms, but some of the most common are: …

• Nail thickening
• Yellowing, browning, or discoloration
• Nail crumbling
• Abnormal or frequent breakage
• Unusually shaped nails
• Separation of the nail from the nail bed
• Pain
• Odor or bad smell

Different types of infections often cause various symptoms. For example, many mold infections aren’t painful, but yeast infections can be.

And you may notice a dark debris build-up under the nail with distal subungual toenail fungus. On the other hand, you’re more likely to see white spots or patches on the nail’s surface with white superficial toenail fungus….”

I also learned this was not something you could treat by yourself. According to the CDC:

“Fungal nail infections can be difficult to cure, and treatment is most successful when started early. Fungal nail infections typically don’t go away on their own, and the best treatment is usually prescription antifungal pills taken by mouth. In severe cases, a healthcare professional might remove the nail completely. It can take several months to a year for the infection to go away.

Fungal nail infections can be closely associated with fungal skin infections. If a fungal infection is not treated, it can spread from one place to the other. Patients should discuss all skin concerns with their healthcare provider to ensure that all fungal infections are properly treated.

Even after treatment, fungal nail infections can come back. This is more common in people who have conditions like diabetes that make them more likely to get a fungal nail infection. If you suspect an infection has returned, contact your healthcare provider.”

I was way more than halfway through writing this blog when I realized I hadn’t touched upon CKD’s role in nail fungus. It was time to rectify that. Where better to find this information than the National Nail Fungus Organization:

“Abnormal changes in nails are expected on people who are suffering from chronic kidney disease as their normal diets have also changed. Unless the patients are able to manage or slow down the progress of their kidney disease, their nails are not likely to improve.

Unfortunately, having CKD also makes them susceptible to acquiring nail fungus infection, and the risk increases for older persons and diabetic patients. For people with chronic kidney disease, they have limited options of nail fungus treatment. As their kidneys cannot flush out the toxins and clear the medications off their body, they must obtain their doctors’ approval and prescription for oral fungicidal medications.

They have the option of using topical treatments, though. And depending on the products’ ingredients, topical medications can just be as effective as oral ones without the side effects.”

While this was not exactly what I had been looking for, I deemed it important information for us to know. I also discovered that CKD does have other effects on your nails. I wanted to know why. Reset Kidney Health explained:

“The kidneys act as a filtration system, ridding our body of waste and delivering essential nutrients into our bloodstream. Unfortunately, as kidney disease progresses and function decreases, toxic substances will build up in our bloodstream and cause our nails to change color, form, and texture. High levels of nitrogen in the bloodstream often cause these physical changes.

Sometimes, chronic kidney disease sufferers will be placed on diets meant to slow the progression of the disease by limiting specific nutrient quantities to prevent a system overload on the already taxed kidneys. Unfortunately, that can result in nutrient deficiencies affecting keratin production, a protein responsible for nail strength.”

Makes sense to me. That could account for concave nails, yellow coloring, white streaking, Beau’s lines, detached, or brittle nails. I must admit I thoroughly enjoy learning about this particular side effect of CKD. I just don’t want to experience it, and I certainly hope you don’t either.

Until next week,

Keep living your life!

This is How It’s Done

For over a decade, I’ve been reading about transplant patients worried that their transplants weren’t making urine yet, or that the new [to them] kidneys started making urine right away. Making urine is important to kidney patients. I never really thought about that until it occurred to me that I didn’t know how the kidneys made urine. I find it amazing that something so basic hadn’t been on my horizon before. 

To understand this, we need to back up a bit and discover how blood goes through the kidneys. Hang on, it’ll make sense in just a bit. The National Insititute of Diabetes and Digestive and Kidney Diseases [NIDDK] tells us:  

“Each of your kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes wastes.”  

Side note: I just learned what the makeup of a glomerulus is! You will, too. Read on. 

Quick reminder: a tubule is [surprise!] a small tube.  

It’s the “removes wastes” in the information from the NIDDK that interests us today. Let’s start with what these wastes are. I turned to The University of Rochester Medical Center for more information: 

“The body takes nutrients from food and converts them to energy. After the body has used all the food components that it needs, waste products are left behind in the bowel and in the blood…. 

The kidneys remove waste products called urea from the blood through tiny filtering units called nephrons. There are about one million nephrons in each kidney. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Blood enters the glomerulus and is filtered there. This filtered fluid then passes through the tubule where substances and water are added or removed. The fluid that remains is urine.” 

It’s starting to make sense. Johns Hopkins Medicine offers more information: 

“The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine.” 

Urinary system? The National Institutes of Health’s National Cancer Institute’s SEER Training Modules helped us out here: 

“The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys form the urine and account for the other functions attributed to the urinary system. The ureters carry the urine away from kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to the outside.” 

Sometimes, our urine is not the usual color. That also tells us something about our kidney function in a round-about way. Don’t forget your kidneys need water to function properly. That’s why you keep seeing reminders to hydrate. I’ve taken salient points from Healthline to explain: 

“The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys form the urine and account for the other functions attributed to the urinary system. The ureters carry the urine away from kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to the outside.” 

“While being hydrated is a good thing, drinking too much water can rob your body of electrolytes. Urine that occasionally looks clear is no reason to panic, but urine that’s always clear could indicate that you need to cut back on how much water you’re drinking…. 

The color of ‘typical’ urine falls on the spectrum of light yellow to a deeper amber color. The urochrome pigment that’s naturally in your urine becomes more diluted as you drink water. 

Urochrome is produced by your body breaking down hemoglobin, the protein that carries oxygen in your red blood cells. In most situations, the color of your urine will depend on how diluted this pigment is…. 

Dehydration. If your urine appears orange, it could be a symptom of dehydration…. 

In general, blue urine is rare and most likely connected to something in your diet…. [Gail here, same with green urine.] 

In most cases, urine that’s dark brown indicates dehydration…. 

Cloudy urine with foam or bubbles is called pneumaturia. This can be a symptom of serious health conditions, including Crohn’s disease or diverticulitis.” 

Wait, there’s more. The smell of your urine can also tell you something about how your kidneys are functioning. MedlinePlus explains succinctly: 

“Kidney disease causes chemicals in urine to become concentrated and to cause a smell resembling ammonia. Kidney dysfunction can also cause high bacteria and protein levels in the urine, which will contribute to a foul ammonia smell.” 

Another MedlinePlus page elucidated other ways in which the odor of your urine indicates an illness: 

“Most changes in urine odor are not a sign of disease and go away in time. Some foods and medicines, including vitamins, may affect your urine’s odor. For example, eating asparagus causes a distinct urine odor. 

Foul-smelling urine may be due to bacteria. Sweet-smelling urine may be a sign of uncontrolled diabetes or a rare disease of metabolism. Liver disease and certain metabolic disorders may cause musty-smelling urine.” 

We’ve covered a lot today, from how the kidneys form urine to how to use urine’s color and/or odor to diagnose illness. Mostly, we’ve discovered that the kidneys can’t do their work without adequate water. Consider that a big hint. 

Until next week, 

Keep living your life!   

Asians too

Last week, I wrote about omitting the category ‘Afro-American’ from the eGFR equation. I thought that was the only issue with the eGFR. You can imagine my surprise when a reader contacted me to tell me her nephrologist won’t use the eGFR to stage her chronic kidney disease because she is Asian.  

Of course, I felt obliged to research the why of this for her, which means for me…. you, too. [That’s just who I am.] Researching this was not easy, but it was important. A study published in 2019 in the journal BMC Nephrology, [Bio Med Central] explains why. 

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“Asian Americans (AA)s are projected to be the second fastest growing racial/ethnic group in the U.S and are projected to nearly double to 9.3% of the total population by 2060…. Currently, AAs represent 5.8% of the overall U.S. population … and there are approximately 20.4 million Asian adults and children living in the U.S. … Furthermore based on the 2016 U.S. Census, major Asian subgroups of people reported were Chinese (except Taiwanese) (4.9 million), Asian Indian (4.1 million), Filipino (3.9 million), Vietnamese (2.1 million), Korean (1.8 million), and Japanese (1.5 million).” 

Well, what’s the problem? Why isn’t the eGFR accurate in these populations? I repeatedly read that it has to do with the lean muscle mass [Here we go again with muscle mass.] and eating little meat. I found little on the topic in medical journals and even less on websites re nephrology for lay people like you and me. However, PubMed did offer the following: 

“Low muscle mass may cause considerable overestimation of single measurements of eGFRCr . Muscle wasting may cause spurious overestimation of repeatedly measured eGFRCr . Implementing muscle mass-independent markers for estimating renal function, like cystatin C as superior alternative to creatinine, is crucial to accurately assess renal function in settings of low muscle mass or muscle wasting.” 

The “Cr” at the end of eGFR means it was calculated using serum creatinine. Serum means blood. 

And eating little meat? Whatever does that have to do with your eGFR? The National Kidney Foundation had that one covered in their Health Unlocked, 

” Well, meat (cooked) contains creatinine so when you eat meat your serum creatinine naturally increases. Serum creatinine is the serum marker whose value is usually used in eGFR calculations. And so your diet influences this eGFR measurement 

Eat less (or no meat) and your serum creatinine will probably fall. Consequently, your eGFR would improve. 

But that says nothing about your actual GFR (actual rate at which blood is being filtered). Your actual GFR is the true measure of your kidney performance, not an number which is being influenced by what you happen to be eating around that period of time. 

Indeed, you might well find your eGFR is improving (because you’ve stopped eating meat) but your GFR (which usually isn’t being tracked) is disimproving (because CKD is a progressive disease)” 

All this talk of eGFR. Let’s back track a little and talk about that. Way back in 2011, I defined the term in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, my very first CKD book:  

“Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.” 

Got it? Let’s move on to the 24 Hour Urine Test, which is what my Asian reader told me her nephrologist uses to determine her GFR. How about a definition first? This is from Johns Hopkins Medicine: 

“A 24-hour urine collection is a simple lab test that measures what’s in your urine. The test is used to check kidney function. A 24-hour urine collection is done by collecting your urine in a special container over a full 24-hour period. The container must be kept cool until the urine is returned to the lab. 

Urine is made up of water and dissolved chemicals, such as sodium and potassium. It also contains urea. This is made when protein breaks down. And it contains creatinine, which is formed from muscle breakdown. Normally, urine contains certain amounts of these waste products. It may be a sign of a certain disease or condition if these amounts are not within a normal range. Or if other substances are present.” 

Ah, now it makes sense. While creatinine is being tested, it is not the only thing being tested. Notice sodium, potassium, and urea are also being tested. Clever. 

On another note entirely, are you aware of the number of CKD Facebook Groups there are? Quite a number are hosted by James Myers, better known as Uncle Jim. Why? In his words: 

“I began to understand my role. I made a conscious choice. I wanted to help my fellow Kidney Patients. I wanted to use my loud voice to help others. I wanted to advocate for clinic mates who could not advocate for themselves. I did not like the way the dialysis clinics, the government and the care staff pushed around or neglected my fellow Kidney Patients. The last straw for me was when they began to push for the cutting of funds to dialysis patients and clinics. I looked around the room and I realized with my health and skill set, I was the only one who could help. It occurred to me that if I did not accept this responsibility, maybe no one else would.” 

 Some of his groups and the ones he frequently posts on are: 

CKD Patients Group 

Dialysis & Kidney Disease 

Encouraging Kidney Donation 

Kidney Advocates 

Kidney Cancer 

Kidney Disease Ideas and Diet 1 

Kidney Education 

Kidney Help for You 

Kidneys Stories 2 And Live Broadcasts With Uncle Jim 

Kidney Transplant Success Stories (JM) 

Kidney Writers 

Kidneys and Celebrities 

Kidneys and Climate Change 

Kidneys and Diabetes 

Kidneys and Insomnia 

Kidneys and Medicare 

Kidneys and Medications 

Kidneys and Other Surgeries 

Kidneys and Social Media 

Kidneys and Studies 

Kidneys and the Arts 

Kidneys and the Coronavirus 

Kidneys and Your Heart 

Kidneys and Your Parathyroid 

Kidneys and Vets 

Living on Dialysis 

Living with Chronic Kidney Disease (CKD) 

Love Your Kidneys!!! 

Pre-Emptive Kidney Transplants: Transplant Before Dialysis 

The Kidney Warriors 

The Relationship Between Kidneys and Your Gut 

Jim has over 95 groups, so it’s obvious I haven’t listed them all. That’s due to a lack of space rather than favoritism. I like all his groups. Surely, there’s something for you in one of these groups, so if you’re on Facebook, peruse them and see which resonate with you. 

Until next week, 

Keep living your life! 

That Delicious All-American Italian Food: Pizza

Last night, my grandson had pizza for dinner along with his vegetables and fruit. We were facetiming with him during his dinner. So, then Bear wanted pizza for dinner. I hesitated. Wasn’t even good pizza junk food? And, therefore, not on the renal diet? Why isn’t it, I wondered because I like pizza, too. 

Pepperoni, Sausage, And Black Olive Thin Crust Pizza by Jennifer Bourn is licensed under CC-CC0 1.0

Verywellfit, a nutrition and exercise site, offers the following information about one slice of pizza: 

“The following nutrition information is provided by the U.S. Department of Agriculture (USDA) for one slice (107g) of regular cheese pizza from a standard fast-food pizza chain… 

• Calories: 285 

• Fat: 10.4g 
• Sodium: 640mg 
• Carbohydrates: 35.6g 
• Fiber: 2.5g 
• Sugars: 3.8g 

• Protein: 12.2g” 

Since we are chronic kidney disease patients, let’s start with the obvious. Yes, sodium. The Ontario Renal Network suggests 2000 mg. of sodium a day for us, but also suggests we speak with our nephrologists or dietitians for a more specific individualized number. For example, men are often permitted more sodium since they have larger bodies. But that, too, is a generalization. 

I don’t know about you, but I find it hard to eat only one slice of pizza. Two slices have 1,280 mg. of sodium. That’s already 60% of my sodium intake! Don’t forget I’ll be eating two other meals, a bedtime snack [I’m a diabetic] and have sides with my pizza. 

And protein? What about protein? The usual limitation for chronic kidney disease patients is five ounces. Again, this is a generalization. Your nephrologist or dietitian will be able to individualize the amount of protein you can safely have each day. Five ounces equals about 141,748 grams. Two slices of pizza – plain, cheese pizza – only has 24.4 grams of protein. But how many of you eat plain, cheese pizza? Bear adds meatballs, ham, bacon, Italian sausage, and pepperoni [No, I don’t eat any slices from his half.]. Add up the grams of protein. I’m pretty sure the add ons will either wipe out or greatly reduce the amount of protein you can have in your other meals the day you have pizza. 

Photo by Nataliya Vaitkevich on Pexels.com

As a diabetic, I need to limit my lunch and dinner carbohydrate intake to 45 grams per meal. Two slices of pizza equal a carbohydrate intake of 71.2 grams. Since the main thrust of the diabetes diet is to keep your blood sugar on a steady level, going that far over my carbohydrate limit for lunch or dinner is going to cause a blood glucose spike. For those of you who like cold pizza for breakfast [Who? Me?], the diabetic carbohydrate limit for breakfast is 30 grams. Even if you have only one slice, you’re already over your breakfast limit for carbohydrates. 

I don’t even want to start on sugar intake as a diabetic. In and of itself, the 7.6 grams of sugar in two slices of pizza is not necessarily a problem except that again – you have to eat two other meals and a snack. They, also, are going to contain sugar and you probably don’t know how much until you decide what to eat for that particular meal. Let’s remember what the Nation Kidney Foundation has to say about diabetes: 

“Over time, having high blood sugar from diabetes can cause damage inside your kidneys. As a result, they filter out some good things along with waste. As more damage happens, kidneys will have less function and waste builds up.” 

For those of you without diabetes or CKD, diabetes is the leading cause of CKD. Avoid it by all means.   

I would say the fiber is a good thing. It seems most of us don’t eat enough fiber. Too little fiber may lead to constipation. As DaVita puts it: 

“Many people with CKD don’t get enough fiber, because many fiber sources are too high in potassium and phosphorus [Gail here: These are two electrolytes that are also limited on the renal diet]. Increasing your fiber intake, [sic] can cause gas, bloating and cramps.” 

DaVita, a CKD education and dialysis company, has a good list of foods that both contain fiber and are on the kidney diet. 

Photo by RODNAE Productions on Pexels.com

As for fat, I wasn’t too sure about what role that plays in your diet, so I turned to the American Kidney Fund for help: 

“Fat gives you energy and helps you use some of the vitamins in your food. You need some fat in your eating plan to stay healthy. Too much fat can lead to weight gain and heart disease. Limit fat in your meal plan, and choose healthier fats when you can, such as olive oil.” 

But then there’s more on the plus side of fat: 

“When we first look at a pizza, it might appear to be high in fat content. Again, research has shown that the fat content of most pizza rarely exceeds the 10% level. Compare this to a piece of steak with upwards of 20% fat, and you begin to realize just how good pizza really is. On top of all this, because vegetable oil, olive oil, and oil-based shortenings are commonly used in the crust formulation, pizza and pizza products (calzone, stromboli, and bread sticks) are good sources of polyunsaturated fat, with only modest cholesterol contributions (through meat and cheese toppings) to the diet.” 

Thank you to PMA Pizza Media, a pizza trade vehicle, for the above information. 

And finally, the caloric intake, which is a whopping 570 calories [about 46 minutes of running for goodness sake!] for two slices. Your calorie intake limitation for CKD is highly individualized, so let’s make things easy and use my 1350 to 1450 restriction. Should I eat those two slices of delicious cheese pizza [which would really be a vegetable pizza for me raising the number of calories even more], I have just eaten almost half of my caloric intake for the day. Do I – or you – really love pizza that much? I have to admit I do, although I don’t have pizza too often. 

This was fun, taking pizza apart and then putting it back together again. I suspect you’ll find another blog dealing with what is usually considered sort of a junk food soon. I’ve got to admit I’m not so sure this is a junk food anymore. 

Until next week, 

Keep living your life! 

Nailed It!

Every so often, my friend Geo asks pertinent questions or tells me about something he’s read. This week he told me about an article he’d read on nail fungus and CKD. My initial reaction was to wonder what nail fungus could possibly have to do with chronic kidney disease. Of course, what followed was my determination to find out. 

Let’s start with nail fungus. I found the Mayo Clinic has a good explanation: 

“Nail fungus is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, nail fungus may cause your nail to discolor, thicken and crumble at the edge. It can affect several nails. 

If your condition is mild and not bothering you, you may not need treatment. If your nail fungus is painful and has caused thickened nails, self-care steps and medications may help. But even if treatment is successful, nail fungus often comes back. 

Nail fungus is also called onychomycosis (on-ih-koh-my-KOH-sis). When fungus infects the areas between your toes and the skin of your feet, it’s called athlete’s foot (tinea pedis).” 

I think we need one more thing before we see how CKD is involved and that is the definition of fungus. I was surprised to discover that the National Cancer Institute had the most easily understood definition of the term: 

“A plant-like organism that does not make chlorophyll. Mushrooms, yeasts, and molds are examples. The plural is fungi.” 

The thought of something like that growing on my nails is more than a little creepy. What’s even creepier is that CKD might have something to do with it. 

I found this on ResearchGate: 

“Abnormalities of the skin and its appendage are commonly encountered in renal patients…. Other frequently observed onychomycopathies in CKD patients include onychomycosis, onycholysis, leukonychia, clubbing, and brittle nails. Onychomycosis, a commonly encountered fungal infection, also often manifests among CKD patients. Nail diseases in patients on maintenance hemodialysis are common and may affect up to 71.4 % of these patients. There is no direct relation between the dose and duration of hemodialysis and the increased prevalence of nail abnormalities. A significant incidence of nail changes among renal transplant recipients has also been described with a reported overall frequency of 56.6 %. Nail pathology increases with age and correlates with longer duration of immunosuppression. The most commonly encountered nail changes in renal transplant recipients include leukonychia, absence of lunula, onychomycosis, longitudinal ridging, and Muehrcke lines.” 

Now before you start wondering why I’m taxing you with all these medical terms, the only one you need to deal with is “onychomycosis,” which, as the Mayo Clinic has already explained, is also called nail fungus. 

Seems pretty clear to me so far… except for what CKD has to do with it. The Global Nail Fungus Organization remedied that problem: 

“CKD patients may experience abnormal fingernail and toenail changes due to malnutrition. Nails are made up of protein, which people suffering from chronic kidney disease are likely lacking of in their diet. As damaged kidneys lose their ability to excrete wastes and toxins out of the body, they cause sufferers to lose vitamins and other nutrition, all of which are necessary for healthy growth of nails. They are also at high risk of zinc deficiency, which is related to nail changes. 

Therefore, CKD sufferers often experience abnormal nail changes, which include getting brittle nails, pitted nails, yellow or white coloring, and white streaks or spots on the nails. The most common nail disorders people with CKD often get are absent lunula (the crescent-shaped white area of the bed of a nail) and half and half nails (half white and half red, pink or brown color appearance of the nail with an apparent demarcation line). 

Since abnormal changes to the nail are consequences of having chronic kidney disease, even with known nail treatments, the nails are unlikely to go back to normal unless the kidney disease is treated successfully. 

Onychomycosis in Patients with Chronic Renal Failure 

Patients with chronic renal failure may also experience onychomycosis, or nail fungi infection. In one study aiming to assess the frequency of onychomycosis in CKD patients undergoing hemodialysis (the process of filtering wastes and other toxins from the body using a machine), it found out that the frequency of nail fungi infection among the 100 patients was 39%. The risk of acquiring the onychomycosis went up by 1.9% for each additional year in age, with diabetic patients 88% more likely to develop the infection than non-diabetic patients. 

The study did not find the association of the development of onychomycosis with the duration of hemodialysis treatment.” 

Conversely, our nails can tip us off that we have kidney disease. Walk-In Lab explains: 

“When people have kidney disease, nitrogen waste products build up in our bodies. Your kidneys are not filtering those products out properly. This can lead to changes in the look and structure of both fingernails and toenails. It’s not the ONLY cause of change though. Malnutrition and taking some medications can also contribute…. 

There are three different types of nails to be on the lookout for when it specifically comes to chronic kidney disease. 

Beau’s lines 

The name comes from a French physician, Joseph Honore Simon Beau, who first described the condition in 1846. Beau’s lines are deep grooved lines that run horizontally from side to side on the finger or toenail…. These can be signs of acute kidney disease that interferes with the growth of the nail. They can also be signs of diabetes and vascular disease.  

Ridged nails 

The official name for this is koilonychia. These are rough looking nails with ridges that are frequently spoon-shaped and concave. In the early stages of this condition, the nails may be brittle, chipping easily. Ridged nails happen when you have iron-deficiency anemia…. These type of nails can also be a sign of heart disease or hypothyroidism.   

White streaks/spots 

The medical name for this type of nail is leukonychia, which comes from the Greek words that mean ‘white nails.’ This is when white lines or dots appear on your finger or toenails. They can be many dots on one nail or it might be one larger spot that stretches across the nail…. Injury is the largest cause of white spots, but they can also be indicative of heart disease, psoriasis and arsenic poisoning, as well as kidney disease.   

Other things to look for in nails are loosening nails, black lines, redness around the nail bed, half-and-half nails (also known as Lindsay’s nails) as they can indicate other diseases besides kidney disease. 
If you look down at your nails and see any of these patterns, check with your local healthcare provider. They may want to run tests on you to see if it’s something minor or the start of something serious.” 

Well, I’m glad Geo asked. I suspected there was a connection but hadn’t expected it to be so complex. 

Until next week, 

Keep living your life! 

Dialysis & Transplant Change Your Renal Diet – Part 2

Before we start, let’s acknowledge that today is Independence Day in the U.S. For those not in the U.S., it’s the day we celebrate Congress’s Declaration of Independence from England back in 1776. The Second Continental Congress had ratified our independence just two days earlier. The most usual celebration is a fireworks display accompanied by a backyard bar-b-q with friends and family. 

That’s an easy transition to writing about your kidney [renal] diet no matter if you’re a chronic kidney disease stages 1-5 patient, a dialysis patient, or a transplantee. Last week, I wrote about two of the three p’s as I called them in my first CKD book What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. Those are the electrolytes potassium and phosphorous. 

Last week, I neglected to define electrolyte. MedlinePlus can rectify that right now: 

“Electrolytes are minerals in your blood and other body fluids that carry an electric charge. 

Electrolytes affect how your body functions in many ways, including: 

The amount of water in your body 

The acidity of your blood (pH) 

Your muscle function 

Other important processes 

You lose electrolytes when you sweat. You must replace them by drinking fluids that contain electrolytes. Water does not contain electrolytes.” 

I can practically hear you asking what electrolytes have to do with your kidneys. I turned to verywellhealth for an explanation we can all understand: 

“Electrolyte abnormalities are very common in kidney disease states for one simple reason—it is the kidney that typically has a central role in maintaining normal levels of most electrolytes. Therefore, these abnormalities are a consequence of abnormal kidney function, rather than a cause. 

Both low and high levels of electrolytes can be seen when the kidneys malfunction….” 

Aha! So, we’ve got to keep our kidneys as healthy as possible to control our electrolytes. It is a little too late to keep our electrolytes normal if we already have CKD, are on dialysis, or have a transplant. However, there’s no reason not to try. I think I already mentioned at one point that I have hyperkalemia [high potassium] for the first time. I also have a significantly lower GFR than I’m used to. You see where I’m going with this? 

Okay, let’s get to that third ‘p’ I mentioned. It’s protein. As stage 3B, I am restricted to five ounces a day. Since I’ve never had either high or low protein on my blood tests, I wonder if I am automatically sticking to that restriction. I honestly doubt it, so I’ll have to do better. Protein is hard on the kidneys. 

It’s a good thing that the National Kidney Foundation explains why so well: 

“Your body needs protein to help build muscle, repair tissue, and fight infection. If you have kidney disease, you may need to watch how much protein you eat. Having too much protein can cause waste to build up in your blood, and your kidneys may not be able to remove all the extra waste. If protein intake is too low, however, it may cause other problems so it is essential to eat the right amount each day. 

The amount of protein you need is based on: 

your body size 

your kidney problem  

the amount of protein in your urine 

Your dietitian or healthcare provider can tell you how much protein you should eat.” 

Luckily for me, I’ll be seeing my nephrologist later this week and will be sure to ask him how much protein I should be having on a daily basis. Due to the diabetes, I have gained weight. Perhaps that changed the amount of protein I should be having daily. We’ll see. Then again, there’s that change in my GFR. What will that change? Of course, I won’t know the amount of protein in my urine until I see the results from the blood tests I took previous to this appointment. 

I like to know exactly what happens in my kidneys, so let’s see what too little or too much protein can do to them. The Journal of the American Society of Nephrology has an explanation that is surprisingly easy for laypeople [that’s us: non-doctors] to understand: 

“Although there has not been a full elucidation of the underlying mechanisms by which high protein intake may adversely affect kidney function, particularly in the context of CKD, existing data suggest that glomerular hyperfiltration caused by a high-protein diet may lead to an increase in albuminuria and an initial rise and subsequent decline in GFR (Figure 2). Furthermore, growing evidence suggests that high-protein diets may be associated with a number of metabolic complications that may be detrimental to kidney health.”  Figure 2 is below. 

Reminder: albuminuria and proteinuria are not the same thing. 

Let’s take a look at the protein needs for dialysis patients. I found this on DaVita’s website: 

“Excess protein waste can cause nausea, loss of appetite, vomiting, weakness, taste changes and itching…. Dialysis removes protein waste from the blood and a low protein diet is no longer needed. Unfortunately, some amino acids are removed during dialysis. A higher protein intake is needed to replace lost protein.” 

What about protein needs after a transplant? The University of Michigan was more than helpful here: 

“For the first 6-8 weeks after transplant, you will need a high protein diet to help heal. Dialysis patients will need as much or more protein following transplant than they did during dialysis. Chronic Kidney Disease (CKD) patients not on dialysis will definitely require more protein after transplant. Protein is important for healing and strength. High doses of prednisone can cause muscle breakdown, making adequate protein intake even more crucial. Six to 8 weeks after the transplant, you should reduce protein intake to 6 to 8 ounces daily.” 

I thought we needed a little humor here, so I’ve included Australia’s Betterhealth list of protein foods: 

“lean meats – beef, lamb, veal, pork, kangaroo 

poultry – chicken, turkey, duck, emu, goose, bush birds 

fish and seafood – fish, prawns, crab, lobster, mussels, oysters, scallops, clams 

eggs 

dairy products – milk, yoghurt (especially Greek yoghurt), cheese (especially cottage cheese) 

nuts (including nut pastes) and seeds – almonds, pine nuts, walnuts, macadamias, hazelnuts, cashews, pumpkin seeds, sesame seeds, sunflower seeds 

legumes and beans – all beans, lentils, chickpeas, split peas, tofu.” 

There’s so much difference in the dietary needs amongst CKD, dialysis, and transplant patients… and we haven’t even dealt with the ‘s’ in the ‘3 p’s and 1 s.’ That’s sodium or, as we usually refer to it, salt although there is a difference between the two. That will be part 3 in this series. 

Until next week, 

Keep living your life! 

Surprise!

Last week, I mentioned that this week’s blog would be about chronic kidney disease cookbooks and food preparation blogs. That’s what I’d planned at the time. But then a guest blog appeared in my mailbox. 

Lori Hartwell, the author, is one of the first people I met when I decided I wanted to become a CKD awareness advocate. She was kind enough to publish several of my articles. Recently, we met again since we were both working on the same zoom project. We talked about swapping guest blogs… and then life got in the way, as it usually does. Being a person of her word, she didn’t forget. I’ll turn this blog over to Lori now. 

***** 

Kidney Disease Diagnosis: Help is Out There 

By Lori Hartwell 

I’ve lived with kidney disease since the age of 2, back when the medical world was first learning how to treat the disease. I was not expected to live. Dialysis was in its infancy stages back in 1968, and so was I. The medical community became my world. I earned my education as a patient, while spending so much of my time in hospitals and in being the first to try a new treatment. It was a lonely start in life as I missed many childhood experiences. I spent all my teenager years on dialysis.   

Years later, after beating all odds, I started the Renal Support Network (RSN). I did it because I didn’t want others with kidney disease to feel as lonely as I once did.  I wanted to let them know if they become knowledgeable about their illness, proactive in their care they will realize there is lots of hope! 

In 1993 I started RSN as a support network for others, like myself, who live with chronic kidney disease. Peer support is important to learn how to deal with all the emotions and to navigate this illness – “One friend can make the difference.” We have expanded our programs to help people have hope and to be proactive in their care.   

As RSN’s President and Founder, it is my goal to give people living with chronic kidney disease (CKD) tools to take control of the course and management of this life-threatening illness. It’s hard to believe through our patient engagement programs we have grown to reach millions of people.  

It is important to be aware of the epidemic of kidney disease. The Center for Disease Control states that more than 15% of the adult population in the United States live with chronic kidney disease (CKD). It’s possible to have kidney disease and not know. Don’t be afraid to get tested. Kidney function can be maintained, and the progression of the disease can be slowed down if caught in the early stages. Don’t be afraid to get tested; it is a simple blood test. An ounce of prevention is worth a pound of cure.     

It is also believed that people with CKD tend to have higher levels of anxiety and depression than others. They often feel isolated because of their outward appearances which make them different than their peers. They also have different priorities in life. When others are thinking about “the big game” or which nail salon offers the best manicure, people with CKD are struggling to understand the disease and learn how to live a full life despite the fact that they have CKD.   

Help is out there! Having even one friend can really make a difference. Connect with the Renal Support Network where you’ll find a variety of national, online patient support group activities to curb the loneliness that so often affects those with CKD. Chances are you’ll find more than one friend if you make that connection. And always be careful about depression. It can sneak up on you! Read the book, “Chronically Happy – Joyful Living in Spite of Chronic Illness,” and be inspired. It is my personal story of deciding to take simple, logical steps to live a full life and realize one’s dreams.  

Perhaps you are having difficulty understanding kidney disease. Knowledge is power! Listen in to the Essentials of Chronic Kidney Disease podcast to hear Dr. Stephen Fadem, a nephrologist in Houston, Texas, speak as he sheds light on CKD. He talks about the steps you can take in collaboration with your physician to either delay the progression of your disease or, in many instances, prevent it. Many people are not even aware that they have CKD, so be sure to be tested during your annual physical. Worried about your diet? The CKD Diet – What to Know Based on New Science by Dr. Kam Kalantar will be helpful.   

Learning can be fun, and you’ll see how when you check out the animated video, “Share Your Spare.” You’ll be introduced to Neff and Nuff, the two “kidney pals” who talk about what it means to donate the “gift of life.” If you share the video with your friends and family, it may encourage them to register to become organ donors. Watch the entire animated series on our website.  

Or maybe you are one of the many people living with CKD who need help with your diet. If so, this podcast, the “What’s for Dinner” blues, is for you! There’s been talk about low-protein diets, but keep in mind that your body still needs a certain amount of protein. Adding more plant-based sources of protein may help. It’s important to talk to a renal dietitian to know what is right for you.  

I have seen the evolution of this illness for 5O plus years of living kidney disease.  Although living with CKD can be difficult, the illness is manageable, especially when you have the opportunity to learn from other people’s experiences and wisdom, so make connections!  

Visit https://www.rsnhope.org/ today, join us and hang onto hope!  

**** 

Yet again, many thanks to Lori for all she offers to those of us who suffer from CKD, just as she does. As you can see, CKD awareness advocates like to work with each other. 

Until next week,

Keep living your life!

Leftovers

The last time Easter, Passover, and Ramadan coincided was 33 years ago. This year, Passover started on the evening of April 15, Easter Sunday – the end of Holy Week – fell on either April 17 (for Western Christendom) or will fall on April 24 (for Eastern Orthodoxy), and the month-long fast of Ramadan began on April 2. That’s a lot of special food for the kidney diet. 

True, most of these holidays are over, but what to do with the leftover special food? Let’s take a look. I’ll start with Passover food since that’s what I’m most familiar with. First thing you should know is that Jews do not eat leavened bread, only matzoh which is unleavened, during the seven or eight days of Passover. That symbolizes that the Jews needed to leave Egypt quickly, so quickly that there wasn’t time for their bread to rise.  

My mother made terrific matzoh ball soup… and she made a lot of it. Enough so there would be plenty left over for us to store in the refrigerator and send some home with guests. You can do the same providing it’s low sodium. After all, it’s just chicken stock, carrots, celery, and matzoh balls, although you may make it a little differently.  Did you know that low sodium matzoh ball mix is readily available? 

Photo by cottonbro on Pexels.com

The main course for Passover in my home was baked chicken and roasted vegetables. This is so easy. If you’ve cooked with no sodium spices instead of salt, all you need to do is warm up the leftovers. No wonder my mother made so much. She didn’t have to cook for the rest of the week!  

When I started hosting the seders as an adult, I did the same thing. Once I was diagnosed with chronic kidney disease, I found myself surprised at how little change I had to make to this meal to ensure it was kidney friendly. All I had to do was keep it low sodium. Sometimes, the warmed-up leftovers even tasted better than when they were originally served. 

Easter celebrates the resurrection of Jesus for Christians. I’ve made one or two Easter meals for my husband, stepdaughters, and sons-in-law. This was a little more difficult because it was a meat meal. They preferred a standing rib roast. I’m not much of a red meat eater so I had to ask the butcher what it looked like and then I needed to look up recipes. Despite how many of us were at these Easter dinners, there were leftovers. You guessed it, having used sodium free spices in the cooking, all I had to do was warm up the leftovers. Well, that’s not exactly true, just as with the Passover meal, I had to be careful about how much of the chicken for that meal or the standing rib roast for this one I had. Everyone’s different, but my nephrologist keeps me capped at five ounces of protein per day. 

We had served only kidney friendly vegetables with this but had no leftovers. So, we made a fresh salad with carrots, a few mushrooms, and just a bit of spinach to go with the standing roast leftovers. Simple, tasty, and kidney friendly. We used few mushrooms and spinach because they are high in potassium, one of the things CKD patients need to be aware of.  

Photo by George Dolgikh @ Giftpundits.com on Pexels.com

Come to think of it, the only problem with the leftovers for both Passover and Easter was the desserts. DaVita has a tasty recipe for Apple Cinnamon Farfel Kugel for Passover. They also have a mouthwatering recipe for Strawberry Pie for Easter. I’m offering you these suggestions because I usually don’t bother with dessert, serving fresh fruit and coffee instead. I do acknowledge that dessert is the crowning glory of meals, especially holiday meals, for some people whether they are CKD patients or not. The Peeps and chocolates my kids brought to the meal offer proof of that statement. 

Now to tackle a Ramadan meal. First, you need to know that Muslims fast from dawn to dusk each of the one-month days of Ramadan. That means the meals are extra special. There are many recipes for the before dawn meal, but scrambled eggs seem to be the quickest and easiest. Yes, you can make enough to have leftovers. You just need to remember to spice it with no sodium spices (Think something like Mrs. Dash spices.) and watch your protein limit. 

Photo by Vivaan Rupani on Pexels.com

Breaking the fast after dusk requires something an empty stomach can handle. One such food is Rice Roti, as Americans call it. You may already be aware of the ingredients: water, oil, rice flour. [This is a good recipe for me since I have a wheat sensitivity.] You may know it as Tandal Achi Bhakri or Pathiri. It’s low potassium and saltless the way CKD patients make it. Be careful of the accompaniments you choose. You are watching your sodium, potassium, phosphorous, and protein intake, right? It’s usually cooked on a tava or cooking pan. You may know it as a sac or saj. You can use a frying pan instead if you’d rather. 

Okay, so what do you do with the leftovers? Since they are already salt and potassium free, you simply warm them up and add the accompaniments. One could be cranberry dip with fresh fruit, providing you don’t have hyperkalemia [high potassium]. Another might be corn idlis. DaVita has some good recipes with electrolyte counts included. Oh, but we’re taking about leftovers, aren’t we? Again, heat or chill your accompaniments as needed. 

The one thing to be careful about is the desserts. Many are made with dried fruits. These are extremely high in potassium since potassium becomes concentrated in such foods.  

Maybe living life on the kidney diet is not as hard as we may have thought. Leftovers certainly are easy if the food is cooked according to the kidney diet in the first place. As for cooking – even special holiday foods – there are numerous websites and cookbooks to help. Hmmm, maybe that should be the topic of next week’s blog. 

Until next week, 

Keep living your life! 

It’s the Month of….

World Kidney Day was March 10^th this year. While I publicized it widely on social media, I didn’t blog about it because I have just about every year for the last 11 years or so. Just scroll to ‘World Kidney Day’ on the topics dropdown to the right of the blog and you can read last year’s blog about it. 

By now, we all know March is National Kidney Month as well as Women’s History Month. Did you know it’s also National Nutrition Month? National Day Calendar tells us there is much more being celebrated this month: 

“Asset Management Awareness Month 

Developmental Disabilities Awareness Month 

Endometriosis Awareness Month 

Irish-American Heritage Month 

Multiple Sclerosis Awareness Month 

National Athletic Training Month 

National Brain Injury Awareness Month 

National Breast Implant Awareness Month 

National Caffeine Awareness Month 

National Celery Month 

National Cerebral Palsy Awareness Month 

National Cheerleading Safety Month 

National Craft Month 

National Colorectal Cancer Awareness Month 

National Credit Education Month 

National Flour Month 

National Frozen Food Month 

National Kidney Month 

National Noodle Month 

National Nutrition Month 

National Peanut Month 

National Sauce Month 

National Trisomy Awareness Month 

National Umbrella Month 

National Women’s History Month 

National Social Work Month” 

I’ll admit I had to look up Trisomy. I figured it was three something since tri means three. The Medical Dictionary backed me up: 

“the presence of an additional (third) chromosome of one type in an otherwise diploid cell (2n +1).”   

Now, I’ll agree with you that some of these seem pretty silly, but I also think it’s no accident that National Kidney Month and National Nutrition Month are both in March. Wait, before I forget, you can also use the topic dropdown to read last year’s blog on National Women’s History Month. 

I haven’t written about the basics of chronic kidney disease treatment in a while, but nutrition is one of them. I’ll let the National Kidney Foundation explain about the first of the ‘3 Ps and 1 S’ as I called them in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. 

“Protein 

Your body needs protein to help build muscle, repair tissue, and fight infection. If you have kidney disease, you may need to watch how much protein you eat. Having too much protein can cause waste to build up in your blood, and your kidneys may not be able to remove all the extra waste. If protein intake is too low, however, it may cause other problems so it is essential to eat the right amount each day. 

The amount of protein you need is based on: 

your body size 

your kidney problem  

the amount of protein in your urine 

Your dietitian or healthcare provider can tell you how much protein you should eat.” 

My first nephrologist limited me to 5 ounces of protein daily 13 years ago. That still hasn’t changed. 

What about that one S? I thought the National Kidney Fund would be helpful here and they were, as long as you remember sodium, the 1 S, is one of the two elements of table salt: 

“Salt makes you thirsty and can make your body retain fluid. Having more fluid in your body can raise your blood pressure. When you have high blood pressure, your kidneys must work harder to filter blood. Over time, this can lead to kidney damage. 

Too much fluid in your body also puts more strain on your heart, lowers your protein levels, and leads to difficulty breathing. Taking steps to limit excess fluid buildup, and thereby controlling blood pressure, is vital to improving your health. 

If you have high blood pressure, eating a low or no added salt diet can help to lower it. Increasing your daily physical activity and taking blood pressure medicines if prescribed by your doctor are other ways to manage your blood pressure. Taking steps to keep your blood pressure at a healthy level may help keep kidney disease from getting worse.” 

2 Ps to go. One of them is potassium. I went right to my old and trusted site WebMD for information: 

“Every time you eat a banana or a baked potato with the skin on (not just the tasty buttered insides), you’re getting potassium. This essential mineral keeps your muscles healthy and your heartbeat and blood pressure steady. 

If you have a heart or kidney condition, though, your doctor may recommend a low-potassium diet. Your kidneys are responsible for keeping a healthy amount of potassium in your body. If they’re not working right, you may get too much or too little. 

If you have too much potassium in your blood, it can cause cardiac arrest — when your heart suddenly stops beating. 

If you have too little potassium in your blood, it can cause an irregular heartbeat. Your muscles may also feel weak.” 

Hang on, here’s the last P – phosphorous. That’s the one element you usually don’t find on food labels. For CKD patients, that’s pretty annoying since you may have to keep track of all 3 Ps and 1S at your nephrologist’s or renal dietitian’s direction. Mayo Clinic, another trusted site I’ve been consulting for over a dozen years, explains: 

“Phosphorus is a mineral that’s found naturally in many foods and also added to many processed foods. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Healthy kidneys remove extra phosphorus from the blood. 

If your kidneys don’t work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death …. 

How much phosphorus you need depends on your kidney function. If you have early-stage kidney disease or you’re on dialysis, you may need to limit phosphorus. Nearly every food contains some phosphorus, so this can be hard to do.” 

While National Nutrition Month is for everyone, we – as CKD patients – need to pay more than usual attention to our nutrition if we don’t want our chronic kidney disease to go spiraling out of control. Naturally, our diets need to be individualized based on the stage of our disease and diet is not all there is to slowing down the progression of the decline of your kidney function (the definition of CKD), but it’s a start. 

Until next week, 

Keep living your life!  

What Are the Basics, Anyway?

Happy New Year! You know, the only way for it to be happy is for you to make it happy. For us, that includes taking care of our chronic kidney disease in the most basic ways. “Remind me; what are those?” my good buddy asked when I said that to her. So, this will be a back to basics blog to begin the new year. 

We all know that what we eat has a lot of influence on our kidneys. Way back when I was writing What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I called this influence “the three p’s and an s.” That’s an easy way to remember what I’ll explain next. Remember though, we are each unique patients and you and your nephrologist will decide to what extent you follow these suggestions.  

Okay then. Let’s start. MedlinePlus has a comprehensive explanation of potassium: 

“Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium’s harmful effects on blood pressure…. 

Your kidneys help to keep the right amount of potassium in your body. If you have chronic kidney disease, your kidneys may not remove extra potassium from the blood…. You may need a special diet to lower the amount of potassium that you eat.” 

Then there’s protein. We’re pretty familiar with the definition, but what does it has to do with your kidneys? The National Kidney Foundation has that one covered: 

“…. Protein is used to build muscle, heal, fight infection, and stay healthy. Protein needs vary based on your age, sex and overall general health. Protein in the diet comes from both animal and plant sources…. 

You need protein every day to meet your body’s needs, but if you have kidney disease, your body may not be able to remove all the waste from the protein in your diet. Excess protein waste can build up in your blood causing nausea, loss of appetite, weakness, and taste changes…. 

The more protein waste that needs to be removed, the harder the kidneys need to work to get rid of it. This can be stressful for your kidneys, causing them to wear out faster. For people with kidney disease who are not on dialysis, a diet lower in protein is recommended.” 

The final ‘p’ is phosphorous. I turned to WebMD for help with this one: 

“Phosphorus is a mineral, likeiron [sic] or potassium. You have more of this mineral in your body than any other except calcium…. 

It plays an important role in keeping you healthy, so it’s an important part of your diet. One of its main tasks is to serve as a building block for healthy teeth and bones. You may think that’s calcium’s job. But calcium needs phosphorus to make your teeth and bones strong. 

Phosphorus also helps your nerves and muscles do their jobs. It’s a buffer that keeps the pH level in your blood balanced. Phosphorus also helps you turn fat, carbs, and protein into energy…. 

When they work well, your kidneys remove extra phosphorus your body can’t use. 

If you have a kidney condition like chronic kidney disease, you may have high levels of phosphorus. This can cause your bones to lose calcium or calcium deposits to form in your blood vessels, eyes, heart, and lungs. If you have too much phosphorus in your body for a long period of time, your chance of a heart attack or stroke goes up.” 

Wow, and we’re not done yet. There’s sodium, too.  The to the MayoClinic for the following: 

“The body needs some sodium to function properly. Sodium plays a role in: 

The balance of fluids in your body 

The way nerves and muscles work 

The kidneys balance the amount of sodium in the body. When sodium is low, the kidneys hold on to it. When sodium is high, the kidneys release some in urine. 

If the kidneys can’t eliminate enough sodium, it builds up in the blood. Sodium attracts and holds water, so the blood volume increases. The heart must work harder to pump blood, and that increases pressure in the arteries. Over time this can increase the risk of heart disease, stroke and kidney disease. 

Some people are more sensitive to the effects of sodium than are others. That means they retain sodium more easily, which leads to fluid retention and increased blood pressure.” 

Now you can understand the plethora of kidney diet cookbooks. Or you can limit these electrolytes yourself. That’s what I did until I developed diabetes. I’ve had CKD for 14 years, so some of the estimating had become rote. Honestly, now I’m back to needing help to combine the renal and diabetes diet. 

Dealing with “the three p’s and one s” is the beginning of taking care of your CKD. There’s also exercise, sleep, avoiding stress, rest, watching your weight, avoiding alcohol and smoking, and keeping tight control of your diabetes, heart disease, and high blood pressure. Oh, limiting your sodium will help you with your high blood pressure, too.  

There isn’t enough space in this particular blog to write about each of those. Let me know if you’d like a blog explaining more about the items in the previous paragraph. Meanwhile, see what you [or you and doctor] can do to help with them. 

Welcome to 2022, the year you take a bigger part in making yourself happy by taking care of your CKD. 

Until next week, 

Keep living your life! 

Not Your New Age Crystals

I was perusing the Facebook Chronic Kidney Disease online support groups as I usually do in the morning when I ran across a post that caught my eye. The person posting wanted to know if he were going to die because he had crystals in his urine. I’d never thought about that before. He sounded really scared, so I decided to take a look at this condition.

First of all, some basic information from Study.com at https://bit.ly/34n3W6H:

“Crystals in the urine is known as crystalluria. Sometimes crystals are found in healthy people and other times they are indicators of organ dysfunction, the presence of urinary tract stones of a like composition (known as urolithiasis), or an infection in the urinary tract.”

Ummm, I wanted a bit more information so I turned to Healthline.com at https://www.healthline.com/health/urine-crystals.

“Crystals can be found in the urine of healthy individuals. They may be caused by minor issues like a slight excess of protein or vitamin C. Many types of urine crystals are relatively harmless.

In some cases, however, urine crystals can be indicators of a more serious underlying condition. Symptoms that would indicate a more serious condition could include:

• fever
• severe abdominal pain
• blood in the urine
• jaundice
• Fatigue”

Serious conditions? What does that mean? The organ dysfunction Study.com mentioned? Which organs? Urolithiasis? An infection? Can you die from any of these?

Time to slow down. Since this is a Chronic Kidney Disease blog, let’s start with the kidneys.

“Crystal-induced acute kidney injury (AKI) is caused by the intratubular precipitation of crystals, which results in obstruction. Crystal-induced AKI most commonly occurs as a result of acute uric acid nephropathy and following the administration of drugs or toxins that are poorly soluble or have metabolites that are poorly soluble in urine …. Other drugs or medications may be metabolized to insoluble products such as oxalate (ethylene glycol, vitamin C), which are associated with precipitation of calcium oxalate crystals within tubular lumens and kidney injury.”

Thank you UptoDate.com at https://bit.ly/3j3BT0k for this information, although we’ll need some explanation in order to understand it. I get it that crystals can produce obstruction in the tubules (Wikipedia: The renal tubule is the portion of the nephron containing the tubular fluid filtered through the glomerulus), rather than being passed out of the body in the urine. It makes sense that if the crystals do produce obstruction, the urine may back up… right into the kidneys. That’s when you have the AKI. Remember, this in not chronic. The condition remains until it’s remedied, but it can be remedied.

What about urolithiasis? I must thank the National Kidney Foundation at https://www.kidney.org/atoz/content/hydronephrosis for their easily understood information about a condition called hydronephrosis which will explain how both urolithiasis and/or an infection would affect your kidneys.

“Hydronephrosis is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. (Gail here: such as the blockage caused by crystals which results in AKI.) Hydronephrosis can occur in one or both kidneys.

The main function of the urinary tract is to remove wastes and fluid from the body. The urinary tract has four parts: the kidneys, the ureters, the bladder and urethra. The urine is formed when the kidneys filter blood and remove excess waste materials and fluid. Urine collects into a part of the kidney called the renal pelvis. From the renal pelvis, the urine travels down a narrow tube called the ureter into the bladder. The bladder slowly fills up with urine, which empties from the body through another small tube called the urethra. Hydronephrosis occurs when there is either a blockage of the outflow of urine, or reverse flow of urine already in the bladder (called reflux) that can cause the renal pelvis to become enlarged.

Hydronephrosis may or may not cause symptoms. The main symptom is pain, either in the side and back (known as flank pain), abdomen or groin. Other symptoms can include pain during urination, other problems with urination (increased urge or frequency, incomplete urination, incontinence), nausea and fever. These symptoms depend on the cause and severity of urinary blockage.

How is Hydronephrosis Caused?
Hydronephrosis is usually caused by another underlying illness or risk factor. Causes of hydronephrosis include, but are not limited to, the following illnesses or risk factors:

• Kidney stone
• Congenital blockage (a defect that is present at birth)
• Blood clot
• Scarring of tissue (from injury or previous surgery)
• Tumor or cancer (examples include bladder, cervical, colon, or prostate)
• Enlarged prostate (noncancerous)
• Pregnancy
• Urinary tract infection (or other diseases that cause inflammation of the urinary tract)”

Kidney stones? MedicalNewsToday at https://www.medicalnewstoday.com/articles/154193 helped us out with that one:

“Kidney stones are the result of a buildup of dissolved minerals on the inner lining of the kidneys.

They usually consist of calcium oxalate but may be composed of several other compounds.

Kidney stones can grow to the size of a golf ball while maintaining a sharp, crystalline structure.

The stones may be small and pass unnoticed through the urinary tract, but they can also cause extreme pain as they leave the body.”

There is quite a bit more information about kidneys stones at this site. What we needed to know is that, again, it’s a buildup – as in not passed from the body via the urine – that causes kidney stones.

Will the person who posted the comment about crystals in his urine die, whether or not he develops symptoms? It seems to me that’s not necessary IF he seeks treatment and follows medical advice.

Back to Healthline, but this time at https://www.healthline.com/health/urine-crystals#prevention, for their take on this question:

“Urine crystals that aren’t caused by underlying conditions like liver disease or genetic conditions can often be prevented. In some cases, even crystalluria triggered by genetic causes can be reduced with lifestyle or diet changes.

The most effective way to prevent urine crystals is to drink more water and stay hydrated. This helps dilute the chemical concentrations in the urine, preventing crystals from forming.

You can also make certain changes in your diet. Your doctor can help you determine what changes to make based on the type of crystals that you have. They may recommend cutting back on protein, for example, or reducing foods high in oxalate (as is the case for calcium oxalate crystals).

Avoiding salty foods can also help prevent a number of different urine crystals, so eliminating processed foods can be beneficial.”

I’m going to add today’s blog to the things-I-never-knew part of my brain.

Until next week,

Keep living your life!

We Know They Do, But How?

• “aluminum- and calcium-containing antacids
• anticonvulsants
• calcium channel blockers
• diuretics
• iron supplements
• narcotic pain medications
• medicines used to treat Parkinson’s disease”

I ask you what do these drugs have in common. Healthline at https://www.healthline.com/health/what-does-constipation-feel-like#takeaway tells us they all may cause constipation.

This is one of those topics we don’t like to talk about, but have probably each experienced at one time or another. There are other causes of constipation, but today, we’ll stick with that caused by drugs. Mind you, we’re not talking about party drugs. Rather, it’s the drugs that are prescribed for you that may cause constipation which I’m writing about.

Well, how do you know if you have constipation? The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253 explains:

• “Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum”

According to the International Foundation of Gastrointestinal Disorders at https://www.iffgd.org/diet-treatments/medications/medications-that-can-affect-colonic-function.html,

“Constipation can be caused by a variety of medications. These medications affect the nerve and muscle activity in the large intestine (colon) and may also bind intestinal liquid. This may result in slowed colonic action (slow and/or difficult passing of stool).”

Let’s see if we can get more specific information on how constipation works. I went to Medscape at https://emedicine.medscape.com/article/184704-overview#a4 and discovered there are quite a few different kinds of constipation:

“The etiology [Gail here. That means the cause of the disease.] of constipation is usually multifactorial, but it can be broadly divided into two main groups …: primary constipation and secondary constipation.

Primary constipation

Primary (idiopathic, functional) constipation can generally be subdivided into the following three types:

Normal-transit constipation (NTC)

Slow-transit constipation (STC)

Pelvic floor dysfunction (ie, pelvic floor dyssynergia)

NTC is the most common subtype of primary constipation. Although the stool passes through the colon at a normal rate, patients find it difficult to evacuate their bowels. Patients in this category sometimes meet the criteria for IBS with constipation (IBS-C). The primary difference between chronic constipation and IBS-C is the prominence of abdominal pain or discomfort in IBS. Patients with NTC usually have a normal physical examination.

STC is characterized by infrequent bowel movements, decreased urgency, or straining to defecate. It occurs more commonly in female patients. Patients with STC have impaired phasic colonic motor activity. They may demonstrate mild abdominal distention or palpable stool in the sigmoid colon.

Pelvic floor dysfunction is characterized by dysfunction of the pelvic floor or anal sphincter. Patients often report prolonged or excessive straining, a feeling of incomplete evacuation, or the use of perineal or vaginal pressure during defecation to allow the passage of stool, or they may report digital evacuation of stool.”

We won’t be dealing with secondary constipation today since that doesn’t include drugs in its etiology.

What does happen in your body during constipation? This is what the Cleveland Clinic at https://my.clevelandclinic.org/health/diseases/4059-constipation has to say:

“Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body.

To back up a bit, as food normally moves through the digestive tract, nutrients are absorbed. The partially digested food (waste) that remains moves from the small intestine to the large intestine, also called the colon. The colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. This gives the colon more time – too much time – to absorb water from the waste. The stool becomes dry, hard, and difficult to push out.”

Imagine, drugs to improve your health taxing your health. Luckily, since you need to take the prescribed drugs to alleviate whatever your medical diagnosis is, there are methods to relieve your constipation. Here’s WebMD’s (https://www.webmd.com/digestive-disorders/constipation-relief-tips) advice:

“One way to keep things moving is by getting enough fiber in your diet, which makes stool bulkier and softer so it’s easier to pass. Gradually increase the amount of fiber in your diet until you’re getting at least 20 to 35 grams of fiber daily.

Good fiber sources include:

• Bran and other whole grains found in cereals, breads, and brown rice
• Vegetables such as Brussels sprouts, carrots, and asparagus
• Fresh fruits, or dried fruits such as raisins, apricots, and prunes”
• Beans

While you’re having an issue with constipation, limit foods that are high in fat and low in fiber, like cheese and other dairy products, processed foods, and meat. They can make constipation worse.

And on the subject of diet, water is important for preventing constipation, too. Try to drink at least 8 glasses of water a day.

Also, exercise regularly. Moving your body will keep your bowels moving, too.”

Wait a minute. We’re Chronic Kidney Disease patients. That’s means some of the foods listed above may not be allowed on our renal diets. For instance, dried raisin, apricots, and prunes are too high in potassium for CKD patients. You need to speak with your renal dietitian before changing your diet.

As Benjamin Franklin stated, “an ounce of prevention is worth a pound of cure.” Let’s see what we can find on prevention.

• “Increasing your fiber intake: Fiber-rich foods, such as fruits, vegetables and whole grains, all help improve gut function. If you have bowel sensitivity, you’ll want to avoid high-fructose fruits, such as apples, pears and watermelon, which can cause gas.
• Getting more exercise: Regular exercise can help keep stool moving through the colon.
• Drinking more water: Aim for eight glasses daily, and avoid caffeine, as it can be dehydrating.
• Go when you feel like it: When you feel the urge to go, don’t wait.”

Thank you to Johns Hopkins Medicine at https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation-causes-and-prevention-tips for this information. Will you look at that? Prevention methods for constipation are almost the same as how to treat constipation. Better get started, folks.

Until next week,

Keep living your life!

Lovely, Lovely Medicinal Food

A few weeks ago, I received some interesting emails from a company called Flavis. I hadn’t heard of them before, so I followed my curiosity and emailed back. It turns out they’re a company that produces low protein, potassium, phosphorous, and sodium carbohydrates. Hmmm, as Chronic Kidney Disease patients we need to keep a lid on our intake of these electrolytes. Could this company and others like them help?

They were kind enough to send samples of their wares. Some of it tasted like medicinal food, but oh those cookies. It would be dangerous for me to keep them in the house. My husband, who doesn’t have CKD, loved them, too. I enjoyed their pasta products, too. Now, lest you get the wrong idea, I am not endorsing this company because I don’t know what others like it are available. However, I wanted to know about their products… which may very well be similar to the products of other such companies and, therefore, helpful to CKD patients.

According to my thinking, logically the first thing to do was look at their website. You can find it at http://www.Flavis.com just as I did. I’m going to copy and paste the parts of their Chronic Kidney Disease material that will help us understand more about this product.

“FLAVIS kidney-friendly foods are starch-based and have reduced protein, phosphorus, sodium, and potassium content. They reduce the kidneys’ workload, and they have the same look, taste, and calorie Content as the foods they replace. These products include pasta, rice, bread, bread products (breadsticks, crostini, rolls, sliced bread, crackers), sweets, and flour. They are suitable for patients in all stages of CKD, especially in the conservative management at stage 3-4.”

I have to admit, the bread was not bad at all and, if Bear had liked the taste more, I would have been perfectly happy using only their pasta products. I liked their taste. Unfortunately, I automatically cooked the rice in the electric rice cooker, apparently a no-no, so I can’t say anything about the taste of the rice.

My goodness! I am endorsing Flavis. Why? Look what I found on the National Kidney Foundation website:

“FLAVIS and the NKF Team-Up to Promote Kidney Health Through Diet

FLAVIS, the kidney friendly food brand, and the National Kidney Foundation partner to promote medical nutrition therapy to help maintain residual kidney function among chronic kidney disease patients

New York, NY – April 8, 2019 – Dr. Schar USA’s (Lyndhurst, NJ) kidney friendly food brand, FLAVIS is teaming up with the National Kidney Foundation to promote the benefits of special dietary foods for people with chronic kidney disease (CKD). FLAVIS, offering a wide portfolio of kidney friendly breads, pasta, snacks, and baking products provides nutrition solutions for patients following a diet low in protein, phosphorus, sodium and potassium, and support to kidney healthcare professionals. The National Kidney Foundation is the largest, most comprehensive and longstanding patient-centric organization dedicated to the awareness, prevention and treatment of kidney disease.

CKD affects 15% of the U.S. adult population. This disease progresses to higher stages as kidney function declines. Some studies show that medical nutrition therapy (MNT) using a low protein diet, under the direction of a nephrologist and registered dietitian nutritionist (RDN), may slow this decline. Through this partnership, FLAVIS and the National Kidney Foundation will provide educational outreach to healthcare professionals that promotes the importance of MNT and proper nutrition for CKD patients to improve dietary adherence and quality of life.

Medical nutrition therapy for CKD, as implemented by a registered dietitian nutritionist, emphasizes an individualized diet plan based upon each patient’s clinical status, goals, and preferences.  MNT for CKD patients includes one or more of the following: decreased sodium, phosphorus, and protein intake, along with sufficient energy, high fiber, and decreased saturated fat intake.  Potassium may also be restricted if the patient has high serum potassium levels. The benefits of MNT include decreasing the risk of complications from high blood pressure and diabetes, reduced uremic toxin levels, and preserved kidney function over time. Studies of MNT in Americans with CKD have shown only about 10% of those eligible receive this nutrition counseling support. FLAVIS’ products are a good source of energy and fiber, and are low in protein, sodium, phosphorus and potassium. These products may help people with CKD preserve kidney function and improve disease outcomes. In partnering with the National Kidney Foundation, FLAVIS aims to provide education and awareness about the benefits of MNT to promote improved quality of life in the CKD population.  For more information about this partnership visit kidney.org/FLAVIS.

Kidney Disease Facts

In the United States, 30 million adults are estimated to have chronic kidney disease—and most aren’t aware of it.  1 in 3 American adults are at risk for chronic kidney disease.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of African American, Hispanic, Native American, Asian, or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end stage renal disease (kidney failure).”

 

I am happy to have found this. I remember – even though it was a decade ago – how hard it was to adapt my regular diet to the kidney diet and how often I had to respond, “No, thank you,” after asking the ingredients of a certain meal. Thank you Dr. Shar for helping my fellow CKD sufferers and me enjoy guilt free meals when we feel like having pasta.

By the way, I’m not ignoring COVID-19, I assure you. I’m sifting through all the information I can find before I write about it. As you know, that information changes daily. I’ve ordered my masks and searched out my gloves from the garage. I stay at home except when I have to go out for chemotherapy… and those trips concern me.

Until next week,

Keep living your life!

 

Missing the Connection

During this second week of National Kidney Month, we have another reader directed blog. She had stumbled across The Long Awaited Sulfa Blog and had some questions about it and NAC. Hold on, I’ll get to NAC in a moment. Let’s start with sulfite, which I had always thought was not the same as sulfa. Did our reader mistype? Her verbatim question was, “Have you heard anything about NAC and CKD with sulfite sensitivity?”

According to MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=27721:

“Sulfite sensitivity: Adverse reactions of an allergic nature to sulfites. Sulfites occur in fermentation and also occur naturally in a number of foods and beverages including wine. Sulfites are used for their preservative properties. Sulfite sensitivity occurs most often in asthmatic adults — predominantly women. It is uncommon in preschool children. Adverse reactions to sulfites in nonasthmatics are rare. Sulfite sensitivity reactions range from mild to severe and may include skin, respiratory, or gastrointestinal signs and symptoms. Bronchoconstriction with wheezing is the most common sensitivity response in asthmatics.”

While I do know this reader is a woman, I do not know if she is asthmatic or a wine drinker.

Let’s move along to NAC. Healthline at https://www.healthline.com/nutrition/nac-benefits#section12 (Yes, that is the same Healthline that chose SlowItDownCKD as best kidney blog two years in a row.) tells us, it is N-Acetyl Cysteine and explains what this supplement is and what it can do for you. I added asterisks next to definitions you may need.

“Cysteine is a semi-essential amino acid.

It’s considered semi-essential because your body can produce it from other amino acids, namely methionine and serine. It becomes essential only when the dietary intake of methionine and serine is low.

Cysteine is found in most high-protein foods, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds and legumes.

N-acetyl cysteine (NAC) is a supplement form of cysteine.

Consuming adequate cysteine and NAC is important for a variety of health reasons — including replenishing the most powerful antioxidant in your body, glutathione. These amino acids also help with chronic respiratory conditions, fertility and brain health.

Here are the top 9 health benefits of NAC.

1. Essential for Making the Powerful Antioxidant Glutathione

NAC is valued primarily for its role in antioxidant production.

Along with two other amino acids — glutamine and glycine — NAC is needed to make and replenish glutathione.

*Glutathione is one of the body’s most important antioxidants, which helps neutralize free radicals that can damage cells and tissues in your body.

It’s essential for immune health and fighting cellular damage. Some researchers believe it may even contribute to longevity ….

Its antioxidant properties are also important for combatting numerous other ailments caused by oxidative stress, such as heart disease, infertility and some psychiatric conditions….

2. Helps With Detoxification to Prevent or Diminish Kidney and Liver Damage

NAC plays an important role in your body’s detoxification process.

It can help prevent side effects of drugs and environmental toxins….

In fact, doctors regularly give intravenous (IV) NAC to people with an acetaminophen overdose to prevent or reduce kidney and liver damage ….

NAC also has applications for other liver diseases due to its antioxidant and anti-inflammatory benefits ….

3. May Improve Psychiatric Disorders and Addictive Behavior

*NAC helps regulate levels of glutamate — the most important neurotransmitter in your brain….

While glutamate is required for normal brain action, excess glutamate paired with glutathione depletion can cause brain damage.

This may contribute to mental health conditions, such as bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD) and addictive behavior….

For people with bipolar disease and depression, NAC may help decrease symptoms and improve your overall ability to function. What’s more, research suggests that it may play a role in treating moderate to severe OCD ….

NAC supplements can also help decrease withdrawal symptoms and prevent relapse in cocaine addicts ….

4. Helps Relieve Symptoms of Respiratory Conditions

NAC can relieve symptoms of respiratory conditions by acting as an antioxidant and expectorant, loosening mucus in your air passageways.

As an antioxidant, NAC helps replenish glutathione levels in your lungs and reduces inflammation in your bronchial tubes and lung tissue.

People with chronic obstructive pulmonary disease (COPD) experience long-term oxidative damage and inflammation of lung tissue, which causes airways to constrict — leading to shortness of breath and coughing.

NAC supplements have been used to improve COPD symptoms, exacerbations and lung decline ….

Those with chronic bronchitis can also benefit from NAC.

Bronchitis occurs when the mucous membranes in your lungs’ bronchial passageways become inflamed, swell and shut off airways to your lungs….

By thinning mucus in your bronchial tubes and boosting glutathione levels, NAC may help decrease the severity and frequency of wheezing, coughing and respiratory attacks ….

In addition to relieving COPD and bronchitis, NAC may improve other lung and respiratory tract conditions like cystic fibrosis, asthma and pulmonary fibrosis, as well as symptoms of nasal and sinus congestion due to allergies or infections ….

5. Boosts Brain Health by Regulating Glutamate and Replenishing Glutathione

NAC’s ability to replenish glutathione and regulate brain glutamate levels can boost brain health.

*The brain neurotransmitter glutamate is involved in a broad range of learning, behavior and memory actions, while the antioxidant glutathione helps reduce oxidative damage to brain cells associated with aging….

Because NAC helps regulate glutamate levels and replenish glutathione, it may benefit those with brain and memory ailments ….

NAC supplements appear to improve both dopamine function and disease symptoms such as tremors ….

6. May Improve Fertility in Both Men and Women

Approximately 15% of all couples trying to conceive are affected by infertility. In almost half of these cases, male infertility is the main contributing factor ….

Many male infertility issues increase when antioxidant levels are insufficient to combat free radical formation in your reproductive system. The oxidative stress can cause cell death and reduced fertility ….

In some cases, NAC has been shown to improve male fertility….

In addition, NAC may improve fertility in women with polycystic ovary syndrome (PCOS) by inducing or augmenting the ovulation cycle ….

7. May Stabilize Blood Sugar By Decreasing Inflammation in Fat Cells

High blood sugar and obesity contribute to inflammation in fat tissue.

This can lead to damage or destruction of insulin receptors and put you at a higher risk of type 2 diabetes ….

8. May Reduce Heart Disease Risk by Preventing Oxidative Damage

Oxidative damage to heart tissue often leads to heart disease, causing strokes, heart attacks and other serious conditions.

NAC may reduce heart disease risk by reducing oxidative damage to tissues in your heart ….

It has also been shown to increase nitric oxide production, which helps veins dilate and improves blood flow. This expedites blood transit back to your heart and can lower your risk of heart attacks ….

9. Ability to Boost Glutathione Levels May Improve Immune Function

NAC and glutathione also boost immune health.

Research on certain diseases associated with NAC and glutathione deficiency suggests that immune function might be improved — and potentially restored — by supplementing with NAC….

High levels of NAC in your body may also suppress HIV-1 reproduction.

For your body to make the amino acid cysteine, you need adequate amounts of folate, vitamin B6 and vitamin B12. These nutrients can be found in beans, lentils, spinach, bananas, salmon and tuna.

While most protein-rich foods, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds and legumes, contain cysteine, some people choose to supplement with NAC to increase their cysteine intake.

NAC has low bioavailability as an oral supplement, meaning that it’s not well absorbed. The accepted daily supplement recommendation is 600–1,800 mg of NAC ….”

Okay, I don’t get it. Have I missed something about the connection between sulfite sensitivity and NAC? If you can find what I missed, please let us know.

Ah, if only I could have been more helpful.

Until next week,

Keep living your life!

Meatless Monday and the Rest of the Week, Too

Whoa, baby! Lots and lots of reader interaction lately. One reader even wrote me to thank me for a blog I wrote years ago about sulfa… and here I was wondering if my blogs were being helpful. Thank you all for letting me know they are.

Talking about my blogs being helpful, another reader needs help with her non-animal protein diet. As a child, my brothers and I were cooked meat meals whenever my dad could afford it. I remember Mom cooking lots of hamburgers. That was the first food I learned to cook. As I got older, I realized I didn’t like the fatty taste of meat nor how much it needed to be chewed, so I ate it less and less. Now, since my husband is a meat eater, we have it once a week. He knows I don’t like it, but he does. I eat as much of it as I can before giving the rest to him. It isn’t very much. I think I’m going to learn quite a bit for myself, as well as my reader, in writing today’s blog.

Oster, the makers of the blender I use, at https://www.oster.com/blog/archive/2014/october/5-fruits-and-veggies-that-pack-the-protein.html#?sortby=newest offers us this information:

“1. Avocado 
Like tomatoes, avocados are fruits that are commonly thought of as vegetables. But regardless of how you categorize it, an avocado carries more protein than a glass of milk, about 4 grams according to the United States Department of Agriculture. Although some avoid this fruit because it has a relatively high fat and calorie content, it’s full of a variety of nutrients such as zinc, folic acid, potassium, fiber and healthy fats….

2. Lentils 
   Legumes are the most protein-rich group of vegetables available. On average, legumes can offer closer to animal products than many other vegetables in how much protein they offer. Among legumes, lentils are one of the highest in protein with about 47 grams of protein per cup, the USDA noted.
3. Apricots 
   Either raw or dried apricots can add protein to your meals as well as sweetness, though there’s debate over whether fresh or dehydrated is better. Although a raw apricot has more protein, dried apricots have more protein per bite because they’re more compact. Either way, you can’t go wrong. It’s a tasty, sweet way to add protein to your yogurt, oatmeal or other dishes. The USDA explained that 1 cup of sliced apricots has more than 2 grams of protein.
4. Spinach 
   This tasty leafy green is well known for being nutritious, but did you know it has nearly 3 grams of protein per every 100 grams of spinach, according to the USDA? But eating 100 grams of raw spinach can be hard…. Spinach is also rich in vitamin B6, riboflavin, niacin, vitamin C, a variety of minerals, and has minimal calories and fat.
5. Soybeans 
   Soybeans pack a walloping 68 grams of protein per cup, according to the USDA. Eat them raw, steam them or roast them for a tasty, protein-filled meal that has more of the nutrient some types of meat [have]. Soybeans are legumes, and also have significant daily amounts of iron, fiber and vitamin K.”

Notice the sentence about potassium in 1. Avocado. Hmmm, do we need to limit or cut out any of these other foods according to the renal diet? I went to SFGATE at https://healthyeating.sfgate.com/lentils-harmful-kidneys-12272.html for some answers.

“Are Lentils Harmful to the Kidneys?

Written by Meg Campbell; Updated November 28, 2018

Lentils are nothing but good news for the average person. The small, disc-shaped legumes are a low-fat, cholesterol-free source of high-quality protein, complex carbohydrates and several vitamins and minerals. Lentils are considered a diabetic-friendly, heart-healthy food because their high fiber content promotes normal blood sugar and cholesterol levels. Because they’re also rich in potassium, phosphorus, purines and oxalate, however, lentils aren’t an ideal choice for people affected by chronic kidney problems….

Lentils don’t harm healthy kidneys, just as they don’t damage unhealthy kidneys. Rather, people with chronic kidney problems may need to watch their intake of lentils because their kidneys are less able to adequately process certain nutrients. If you have chronic kidney disease, ask your physician for a detailed diet plan. Eating the right foods can help slow the disease’s progression, according to the Centers for Disease Control and Prevention. Likewise, if you’re prone to kidney stones, talk to your doctor about your diet. Some physicians only recommend limiting purines from animal sources. You also may be able to limit the amount of oxalate you absorb from lentils by consuming them with high-calcium foods.”

So it seems that protein heavy foods can be bothersome for their potassium and phosphorous content. But wait. We are Chronic Kidney Disease patients. We eat according to our labs. If your potassium/phosphorous blood content is in the normal range, you can eat foods containing these electrolytes, but in specified amounts. Ask your renal nutritionist which you can eat and how much of each of these permissible foods you can eat.

 This time I went to NDVTFoods at https://food.ndtv.com/food-drinks/healthy-diet-4-fruits-that-are-relatively-rich-in-protein-2071683. (So many new websites for me today.)

“1. Raisins: This humble dried fruit is a fixture in all the festive offerings and is also added to a whole range of desserts. The golden raisins are nothing but de-hydrated or dried grapes.  A 100 gram portion of raisins contains 3 grams of proteins, as per the data by United States Department of Agriculture.

Guava:This Vitamin C-rich fruit is savoured raw or in salads, and is even added to juices and drinks for a flavourful punch. Guava is rich in fibre as a 100 gram portion of the fruit contains 5 grams of it, according to USDA, and the same portion contains 2.6 grams of proteins.

2. Dates:This sugary sweet fruit has been consumed in Middle-eastern countries as a staple for centuries now. Pitted dates are stuffed with a variety of ingredients and are even consumed in the form of a sweetening paste for milkshakes and baked goods as well. A 100 gram portion of dates contains 2.45 grams of protein, along with 8 grams of fibre, as per data by the United States Department of Agriculture.
3. Prunes:Another dried fruit that is relatively rich in protein is the prune. These are made by de-hydrating ripened plums and it contains a wide-range of essential minerals and vitamins, along with some important macro-nutrients. This includes 2.18 grams of protein per 100 grams, along with 7 grams of dietary fibre.”

Don’t forget legumes and grains in your non-animal fat protein diet. The same caution about eating according to your labs applies to every category of food you eat. This is not a complete guide to non-animal protein foods and is getting to be a very long blog already. Let me know if you want more information about this topic.

Until next week,

Keep living your life!

Another Kind of Kidney Disease

While I’m still recuperating, I’ve had plenty of time to read Twitter articles, among other things. One topic I’ve been reading about is lupus nephritis. I think we’ve all heard of lupus, but just in case, here’s a definition from MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=8064.

“A chronic inflammatory disease that is caused by autoimmunity. Patients with lupus have in their blood unusual antibodies that are targeted against their own body tissues. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system.”

Did you catch the mention of kidneys in the above definition? That’s where the nephritis part of the condition comes in. By now, we’re all probably tired of being reminded that ‘neph’ means relating to the kidneys (although in non-medical terms, it means relating to the clouds) and ‘itis’ means inflammation. Nuts! I just reminded you again. Let’s ignore that. So, lupus nephritis actually means

“… a kidney disorder [which] is a complication of systemic lupus erythematosus.”

Thank you to MedlinePlus at https://medlineplus.gov/ency/article/000481.htm for the definition. Oh, “systemic lupus erythematosus” refers back to autoimmune disease. Still, the word “erythematosus” puzzled me. I finally figured it out after realizing I probably wasn’t going to get a definition since almost all the entries were for lupus erythematosus. Remember, I studied Greek & Latin roots way, way back in college. It means red and is from the Greek. I get it. Sometimes, lupus patients have a red rash in butterfly form across their face.

So, how do you develop this particular kidney disease? What better place to find out than Lupus.org at https://www.lupus.org/resources/how-lupus-affects-the-renal-kidney-system#.

“Inflammation of the nephrons, the structures within the kidneys that filter the blood, is called glomerulonephritis, or nephritis. Lupus nephritis is the term used when lupus causes inflammation in your kidneys, making them unable to properly remove waste from your blood or control the amount of fluids in your body.”

Hmmm, no lupus equals no lupus nephritis. However, if you do have lupus, you may develop lupus nephritis.

Let’s say hypothetically that you or a loved one (or even your neighbor down the block) has lupus and is concerned about developing lupus nephritis. How would they know if they were developing it? I had to look no further than the National Kidney Foundation at https://www.kidney.org/atoz/content/lupus.

“Lupus nephritis can cause many signs and symptoms and may be different for everyone. Signs of lupus nephritis include:

• Blood in the urine (hematuria): Glomerular disease can cause your glomeruli to leak blood into your urine. Your urine may look pink or light brown from blood.
• Protein in the urine (proteinuria): Glomerular disease can cause your glomeruli to leak protein into your urine. Your urine may be foamy because of the protein.
• Edema: Having extra fluid that your kidneys cannot remove that causes swelling in body parts like your legs, ankles, or around your eyes.
• Weight gain: due to the fluid your body is not able to get rid of.
• High blood pressure

I know these may also be the symptoms of Chronic Kidney Disease, but if you have lupus, then they may be symptoms of lupus nephritis. To make things even more complicated, there are five different kinds of lupus nephritis depending upon which part of the kidney is affected.

I was wondering about tests to diagnose lupus nephritis, like we have blood and urine tests to diagnose CKD. Healthline (Now do you see why I was so thrilled to receive their Best Kidney Blogs Award two years in a row?) at https://www.healthline.com/health/lupus-nephritis#diagnosis cleared that up.

Blood tests

Your doctor will look for elevated levels of waste products, such as creatinine and urea. Normally, the kidneys filter out these products.

24-hour urine collection

This test measures the kidney’s ability selectively to filter wastes. It determines how much protein appears in urine over 24 hours.

Urine tests

Urine tests measure kidney function. They identify levels of:

• protein
• red blood cells
• white blood cells

Iothalamate clearance testing

This test uses a contrast dye to see if your kidneys are filtering properly.

Radioactive iothalamate is injected into your blood. Your doctor will then test how quickly it’s excreted in your urine. They may also directly test how quickly it leaves your blood. This is considered to be the most accurate test of kidney filtration speed.

Kidney biopsy

Biopsies are the most accurate and also most invasive way to diagnose kidney disease. Your doctor will insert a long needle through your abdomen and into your kidney. They’ll take a sample of kidney tissue to be analyzed for signs of damage.

Ultrasound

Ultrasounds use sound waves to create a detailed image of your kidney. Your doctor will look for anything abnormal in the size and shape of your kidney.

Yes, I know these are the same tests that are used to diagnose CKD, but if you have lupus, they also can diagnose lupus nephritis.

Okay, now the biggie: How do you treat it if you do have it? The MayoClinic at  https://www.mayoclinic.org/diseases-conditions/lupus-nephritis/diagnosis-treatment/drc-20446438 had some sobering news for us:

“There’s no cure for lupus nephritis. Treatment aims to:

• Reduce symptoms or make symptoms disappear (remission)
• Keep the disease from getting worse
• Maintain remission
• Avoid the need for dialysis or a kidney transplant

Conservative treatments

In general, doctors may recommend these treatments for people with kidney disease:

• Diet changes. Limiting the amount of protein and salt in your diet can improve kidney function.
• Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can help control blood pressure. These drugs also prevent protein from leaking from the kidneys into the urine. Drugs called diuretics can help you get rid of excess fluid.

However, conservative treatment alone isn’t effective for lupus nephritis.

Immune suppressants

For severe lupus nephritis, you might take drugs that slow or stop the immune system from attacking healthy cells, such as:

• Steroids, such as prednisone
• Cyclosporine
• Tacrolimus
• Cyclophosphamide
• Azathioprine (Imuran)
• Mycophenolate (CellCept)
• Rituximab (Rituxan)

When immunosuppressive therapies don’t lead to remission, clinical trials may be available for new therapies.

Treatment options for kidney failure

For people who progress to kidney failure, treatment options include:

• Dialysis. Dialysis helps remove fluid and waste from the body, maintain the right balance of minerals in the blood, and manage blood pressure by filtering your blood through a machine.
• Kidney transplant. You may need a new kidney from a donor if your kidneys can no longer function.”

Help! Running out of room (but we’re done anyway),

Until next week,

Keep living your life!

Is it Blood Sugar or the Pancreas?

We all know diabetes raises your risk of developing Chronic Kidney Disease. But why? What’s the mechanism behind the fact? As far as I’m concerned, it’s time to find out.

Let’s start with diabetes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), which in turn is part of The U.S. Department of Health and Human Services at https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes offers this explanation.

“Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes ‘a touch of sugar’ or ‘borderline diabetes.’”

Having just had a tumor removed from my pancreas, I’m well aware that it produces insulin as well as digestive enzymes. Without a pancreas to produce insulin, you would need insulin injections several times a day.

I got what diabetes is, but how it causes CKD was still not clear.

Well, not until I read the following from The American Diabetes Association at https://www.diabetes.org/diabetes/complications/kidney-disease-nephropathy.

“When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).”

Hmmm, now that we know what diabetes is and how it can cause CKD, maybe we need to look at ways to attempt to avoid diabetes.

• “Losing weight and keeping it off. Weight control is an important part of diabetes prevention. You may be able to prevent or delay diabetes by losing 5 to 10 percent of your current weight. For example, if you weigh 200 pounds, your goal would be to lose between 10 to 20 pounds. And once you lose the weight, it is important that you don’t gain it back.
• Following a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It’s also a good idea to limit red meat, and avoid processed meats.
• Get regular exercise. Exercise has many health benefits, including helping you to lose weight and lower your blood sugar levels. These both lower your risk of type 2 diabetes. Try to get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional to figure out which types of exercise are best for you. You can start slowly and work up to your goal.
• Don’t smoke. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If you already smoke, try to quit.
• Talk to your health care provider to see whether there is anything else you can do to delay or to prevent type 2 diabetes. If you are at high risk, your provider may suggest that you take one of a few types of diabetes medicines.”

This is a list from NIH: National Institute of Diabetes and Digestive and Kidney Diseases posted on MedLinePlus at https://medlineplus.gov/howtopreventdiabetes.html. Notice it’s mentioned that this is for type 2 diabetes.

There are 11 different kinds of diabetes. Types 1 and 2 are the most common. WebMD at https://www.webmd.com/diabetes/guide/types-of-diabetes-mellitus#1 explains what type 1 and 2 are.

“Type 1 diabetes is an autoimmune condition. It’s caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn’t make insulin…. With Type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body’s needs, or the body’s cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells.”

This is all starting to make sense.

Until next week,

Keep living your life!

Stay in the Blood, PLEASE

Let’s finish out this lazy, hazy summer month of August with another reader question. This one was quite straight forward:

“Any advice to slow down protein leaking into urine. Hard to build muscle when you keep excreting protein”

The condition of leaking protein into your urine is called proteinuria. That’s almost self-explanatory. The root of the word actually says protein while the suffix (group of related letters added to the end of a word which changes its meaning) is defined as,

“-uria.

1. suffix meaning the “presence of a substance in the urine”: ammoniuria, calciuria, enzymuria.
2. combining form meaning “(condition of) possessing urine”: paruria, polyuria, pyuria.

Thank you to the Medical Dictionary at https://medical-dictionary.thefreedictionary.com/-uria for the definition of uria.

Okay, so we know that protein is leaking into the urine. Not good. Why? We need it in our blood, not excreted in our urine. The following is from a previous blog on proteinuria. I used the dropdown menu in “Topics” on the right side of the blog page to find it or any other topic listed there. You can, too.

“According to WebMD at https://www.webmd.com/men/features/benefits-protein#1:

‘Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. Your body uses protein to build and repair tissues. You also use protein to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.’”

Got it. Our reader is correct; it is hard to build muscle if you’re “excreting protein.” Now what? I usually stick to medical sites but this comment from Healthfully at https://healthfully.com/170108-how-to-reduce-excess-protein-in-the-kidney.html caught my eye.

“Continue monitoring how much protein your kidneys are spilling for several months. Since colds and infections can cause transient increases in protein, you will want at least several months of data.”

As Chronic Kidney Disease patients, we usually have quarterly urine tests… or, at least, I do. My urine protein level is included. I did not know that colds and infections are a factor here. Here’s an old urine analysis of mine. You can see Protein, Urine fourth from the bottom.

Component	Your Value	Standard Range
Color, Urine	Yellow	Colorless, Light Yellow, Yellow, Dark Yellow, Straw
Clarity, Urine	Clear	Clear
Glucose, Urine	Negative mg/dL	Negative mg/dL
Bilirubin, Urine	Negative	Negative
Ketones, Urine	Negative mg/dL	Negative mg/dL
Specific Gravity, Urine	1.013	1.007 – 1.026
Blood, Urine	Negative	Negative
pH, Urine	7.0	5.0 – 8.0
Protein, Urine	Negative mg/dL	Negative mg/dL
Urobilinogen, Urine	<2.0 mg/dL	<2.0 mg/dL
Nitrite, Urine	Negative	Negative
Leukocyte Esterase, Urine	Negative	Negative

Let’s say our reader did not have a cold or infection. What else could she do to slow down this loss of protein via her urine?

The American Kidney Fund at http://www.kidneyfund.org/kidney-disease/kidney-problems/protein-in-urine.html suggests the following:

“If you have diabetes or high blood pressure, the first and second most common causes of kidney disease, it is important to make sure these conditions are under control.

If you have diabetes, controlling it will mean checking your blood sugar often, taking medicines as your doctor tells you to, and following a healthy eating and exercise plan. If you have high blood pressure, your doctor may tell you to take a medicine to help lower your blood pressure and protect your kidneys from further damage. The types of medicine that can help with blood pressure and proteinuria are called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs).

If you have protein in your urine, but you do not have diabetes or high blood pressure, an ACE inhibitor or an ARB may still help to protect your kidneys from further damage. If you have protein in your urine, talk to your doctor about choosing the best treatment option for you.”

So far, we’ve discovered that frequent urine testing, determining if you have a cold or infection, keeping your diabetes and blood pressure under control, and/or ACE inhibitors may be helpful. But here’s my eternal question: What else can slow down the spilling of protein into our urine?

The Kidney & Urology Foundation of America, Inc. at http://www.kidneyurology.org/Library/Kidney_Health/Proteinuria.php has some more ideas about that:

“In addition to blood glucose and blood pressure control, restricting dietary salt and protein intake is recommended. Your doctor may refer you to a dietitian to help you develop and follow a healthy eating plan.”

As CKD patients, we know we need to cut down on salt intake. I actually eliminate added salt and have banned the salt shakers from the kitchen. No wonder no one but me likes my cooking. You do lose your taste for salt eventually. After all these years, I taste salt in restaurant food that makes that particular food unpalatable to me.

Hmmm, it seems to me that a list of high protein foods might be helpful here.

POULTRY…

• Skinless chicken breast – 4oz – 183 Calories – 30g Protein – 0 Carbs – 7g Fat
• Skinless chicken (Dark) – 4 oz – 230 Calories – 32g Protein – 0 Carbs – 5g Fat
• Skinless Turkey (White) – 4 oz – 176 Calories – 34g Protein – 0 Carbs – 3.5g Fat
• Skinless Turkey (Dark) – 4 oz – 211 Calories – 31g Protein – 0 Carbs – 8.1 g Fat

FISH…

• Salmon – 3 oz – 119 Calories – 17g Protein – 0 Carbs – 5.5g Fat
• Halibut – 3 oz – 91 Calories – 18g Protein – 0 Carbs – 3g Fat
• Tuna – 1/4 cup – 70 Calories – 18g Protein – 0 Carbs – 0g Fat
• Mackerel – 3 oz – 178 Calories – 16.1g Protein – 0 Carbs – 12g Fat
• Anchovies (packed in water) – 1 oz – 42 Calories – 6g Protein – 1.3g Fat
• Flounder – 1 127g fillet – 149 Calories – 30.7g Protein – 0 Carbs – 0.5g Fat (High Cholesterol)
• Swordfish – 1 piece 106g – 164 Calories – 26.9g Protein – 0 Carbs – 1.5g Fat (High Cholesterol)
• Cod – 1 fillet 180g – 189 Calories – 41.4g protein – 0 Carbs – 0.3g Fat (High Cholesterol)
• Herring – 1 fillet 143g – 290 Calories – 32.9g Protein – 0 Carbs – 3.7g Fat (High Cholesterol)
• Haddock – 1 fillet 150g – 168 Calories – 36.4g Protein – 0 Carbs – 0.3g Fat (High Cholesterol)
• Grouper – fillet 202g – 238 Calories – 50.2g Protein – 0 Carbs – 0.6g Fat (High Cholesterol)
• Snapper – 1 fillet 170g – 218 Calories – 44.7g Protein – 0 Carbs – 0.6g Fat (High Cholesterol)

BEEF…

• Eye of round steak – 3 oz – 276 Calories – 49g Protein – 2.4g Fat
• Sirloin tip side steak – 3 oz -206 Calories – 39g Protein – 2g Fat
• Top sirloin – 3 oz – 319 Calories – 50.9g Protein – 4g Fat
• Bottom round steak – 3 oz – 300 Calories – 47g Protein – 3.5g Fat
• Top round steak – 3 oz – 240 Calories – 37g Protein – 3.1g Fat

PORK…

• Pork loin – 3 oz – 180 Calories – 25g Protein – 0 Carbs – 2.9g Fat (High in cholesterol)
• Tenderloin– 3 oz – 103 Calories – 18g Protein – 0.3g Carbs – 1.2g Fat (High in cholesterol)

GAME MEATS…

• Bison – 3 0z – 152 Calories – 21.6g Protein – 0 Carbs – 3g Fat
• Rabbit – 3 oz – 167 Calories – 24.7g Protein – 0 Carbs – 2.0g Fat
• Venison (Deer loin broiled) – 3 oz – 128 Calories – 25.7g Protein – 0 Carbs – 0.7g Fat

GRAINS…

• Cooked Quinoa – 1/2 cup – 115 Calories – 4.1g Protein – 22 Carbs – 2g Fat
• Cooked Brown Rice – 1/2 cup – 106 Calories – 2.7g Protein – 23 Carbs – 0.7g Fat
• Regular Popcorn (Air Popped no oil) – 1 cup – 60 Calories – 2g Protein – 11 Carbs – 0.6g Fat
• Steel cut Oatmeal – 1 cup – 145 Calories – 7g Protein – 25g Carbs – 2.5g Fat
• Multi grain bread – 1 slice – 68.9 Calories – 3.5g Protein – 11.3g Carbs – 0.2g Fat

BEANS (All nutrition values calculated for cooked beans)…

• Tofu – 1/2 cup – 98 Calories – 11g Protein – 2g Carbs – 6g Fat
• Lentils – 1/2 cup – 119 Calories – 9g Protein – 20g Carbs – 0.3g Fat
• Black beans – 1/2 cup – 115 Calories – 7.8g Protein – 20 Carbs – 0.4g Fat
• Kidney beans – 1/2 cup – 111 Calories – 7.2g Protein – 20.2 Carbs – 0.4g Fat
• Lima beans – 1/2 cup – 110 Calories – 7.4g Protein – 19.7 Carbs – 0.3g Fat
• Soy beans – 1/2 cup – 133 Calories – 11g Protein – 10 Carbs – 5.9g Fat

DAIRY…

• Skim milk – 1 cup – 90 Calories – 9g Protein – 12g Carbs – 4.8g Fat
• Low fat Yogurt – 1 cup – 148 Calories – 12g Protein – 17Carbs – 3.2g Fat
• Non fat Yogurt – 1 cup – 130 Calories – 13g Protein – 16.9 Carbs – 0.4 Fat
• Cheddar cheese – 1 oz – 116 Calories – 7g Protein – 0.4 Carbs – 9.2g Fat
• Low fat Cottage Cheese – 1/2 cup – 82 Calories – 14g Protein – 3.1g Carbs – 0.7g Fat
• One large egg – 73 Calories – 6.6g Protein – 0 Carbs – 6g Fat
• Low fat Milk – 1 cup – 119 Calories – 8g Protein – 12 Carbs – 4.6g Fat

NUTS & SEEDS…

• Raw Almonds – 1 oz about 22 whole – 169 Calories – 22g Carbs – 6.2g Protein – 1.1g Fat
• Raw Pistachios – 1 oz about 49 Kernels – 157 Calories – 7.9g Carbs – 5.8g Protein – 1.5g Fat
• Pumpkin seeds – 1 oz – 28g about 100 hulled seeds – 151 Calories – 5g Carbs – 6.0g Protein – 2.4g Fat
• Raw Macadamia nuts – 1 oz about 10- 12 kernels – 203 Calories – 4g Carbs – 2.2g Protein – 3.4g Fat
• Chia seeds – 1 oz – 137 Calories – 12.3g Carbs – 4.4g Protein – 0.9g Fat
• Walnuts – 1 cup in shell about 7 total – 183 Calories – 3.8g Carbs – 4.3g Protein – 1.7g Fat
• Raw Cashews1oz – 28g – 155 Calories – 9.2g Carbs – 5.1g Protein – 2.2g Fat

MORE HIGH PROTEIN FOODS…

• Natural peanut butter – 1 oz – 146 Calories – 7.3g Protein – 10g Carbs – 1.6g Fat
• Natural almond butter – 1 tbsp – 101 Calories – 2.4g Protein – 3.4 Carbs – 0.9g Fat
• Natural cashew butter – 1 tbsp – 93.9 Calories – 2.8g Protein – 4.4 Carbs – 1.6g Fat
• Hummus – 1 oz – 46.5 Calories – 2.2g Protein – 4.0g Carbs – 0.4g Fat
• Tempeh Cooked – 1 oz – 54 Calories – 5.1g Protein – 2.6g Carbs – 1.0g Fat

There’s a vegan list on the same site. Be leery of protein sources that are not on your kidney diet.

Until next week,

Keep living your life!

 

But Why?

As Chronic Kidney Disease patients, we all know that proteinuria is one indication of our disease. Would you like a reminder about what proteinuria is? Here’s one from The American Kidney Fund at http://www.kidneyfund.org/kidney-disease/kidney-problems/protein-in-urine.html:

“Healthy kidneys remove extra fluid and waste from your blood, but let proteins and other important nutrients pass through and return to your blood stream. When your kidneys are not working as well as they should, they can let some protein (albumin) escape through their filters, into your urine. When you have protein in your urine, it is called proteinuria (or albuminuria). Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.”

I used to think that’s all it was: an indicator of CKD. That is until my occupational therapist and I got to talking about the edema caused by neuropathy.

Ah! Flash! We did also talk about Havimat which I wrote about last week and I checked on a number of sites to see if it were safe for an active tumor. The consensus of the sites agreed it was safe to use on someone with an active tumor that was being treated as long as it was not used on the location of the tumor itself. I feel better now about having had three sessions with Havimat since the occupational therapist was careful not to use it anywhere near my pancreas – the site of the tumor.

But I digress. Back to the topic at hand: proteinuria. It seems that protein is needed in the body, rather than being excreted in the urine. You guessed it. My question became the topic of today’s blog: But Why?

According to WebMD at https://www.webmd.com/men/features/benefits-protein#1:

“Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. Your body uses protein to build and repair tissues. You also use protein to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.”

Okay, got it that protein is very necessary but what does that have to do with the chemotherapy I had that seemed to cause the proteinuria problem?  After looking at bunches of different sites (Today’s blog is taking a very long time to write.), I gleaned a little hint here and a little hint there until I figured out that certain types of chemotherapy may make proteinuria worse if you already have it, or cause it. Boo for me; I lost on that one since I already had proteinuria.

Well, what about the edema from the neuropathy? Was proteinuria affecting that in some way? Or did I have it backwards and it was the neuropathy that was causing the edema. I went to eMedicineHealth at https://www.emedicinehealth.com/neuropathy/article_em.htm#what_is_neuropathy for some help with this.

“Certain drugs and medications can cause nerve damage. Examples include cancer therapy drugs such as vincristine(Oncovin, Vincasar), and antibiotics such as metronidazole (Flagyl), and isoniazid (Nydrazid, Laniazid).”

This little tidbit is from MedicalNewsToday at https://www.medicalnewstoday.com/articles/323481.php :

“Chemotherapy can damage nerves that affect feeling and movement in the hands and feet. Doctors call this condition chemotherapy-induced peripheral neuropathy (CIPN). Symptoms can be severe and may affect a person’s quality of life.”

By the way, diabetic neuropathy is another form of peripheral neuropathy.

Uh-oh, now what do I do? The HonorHealth Research Institute in Scottsdale, Arizona, where I’m being treated offered both the gabapentin for the pain (which I skipped since I want to try non-drug treatment first) and occupational therapy. Let’s see what that might do for me. Please note that occupational therapy works at reducing the pain of the neuropathy.

I have a bag of toys. Each has a different sensory delivery on my hands and feet. For example, there’s a woven metal ring that I run up and down my fingers and toes, then up my arms and legs. I do the same with most of the other toys: a ball with netting over it, another with rubber strings hanging from it. I also have a box of uncooked rice to rub my feet and hands in… and lots of other toys. The idea is to desensitize my hands and feet.

I was also given physical exercises to do, like raising my fisted hands above my head and straightening out my fist several times.  This is one of many exercises. Do you remember the old TV show, E.R? It takes me slightly longer than one 43 minute episode to complete the exercises.

When I go to see the therapist, she uses the Havimat (electrical stimulation), another machine that sucks the chemo out (no kidding… and it doesn’t hurt either.), and a third that pulses. I am amazed at how the edema disappears when she uses these. But, unfortunately, the effect doesn’t stay very long. Compression socks have helped and, despite their not-so-pleasing appearance are quite comfortable.

Wow! Proteinuria is so much more than just an indication that you may have Chronic Kidney Disease.

Ready for a topic change? The following is part of an email I received from KDIGO (Kidney Disease – Improving Global Outcomes).

“We … invite your comments at any time.  Suggest topics, look for opportunities for KDIGO to implement its work in your area, bring new ideas to us, and help us become more relevant to the lives of patients like you. As a global organization, we seek to continue to develop communication channels to patients throughout the world.  This is difficult to do from one perspective, but if we work together we can build a robust base of individuals and ideas that will help us plan and carry out our mission.

KDIGO doesn’t have any members or local entities to whom we are accountable.  We only are accountable to you, our patients.  Outcomes of your care are our mission.  We can do it better if you work with us and give us your constructive input.

Again, thanks for letting us know you’d like to be a part of this global effort.  Your ideas are welcome and will be taken into account. “

Keep those comments coming, folks. Their email is kdigocommunications@kdigo.org.

Until next week,

Keep living your life!

Chemo and My Kidneys

 As most of you know, I am extremely protective of my kidneys. When I was first diagnosed with Chronic Kidney Disease 11 years ago, my eGFR was only 39. Here’s a quick reminder of what the eGFR is from my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

“GFR: Glomerular filtration rate [if there is a lower case ‘e’ before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.”

39. That’s stage 3B, the lower part of stage 3B. During the intervening 11 years, I’ve been able to raise it to 50 (and sometimes higher for short periods) via vigorously following the renal diet, exercising, avoiding stress as much as possible, maintaining adequate sleep, and paying strict attention to the medications prescribed for me. While the medications were the ones I had been taking for high blood pressure prior to being diagnosed with CKD, they worked in my favor.

This excerpt from The National Center for Biotechnology Information (NCBI) part of the United States National Library of Medicine (NLM), a branch of the National Institutes of Health (NIH) at https://www.ncbi.nlm.nih.gov/books/NBK492989/ will explain why:

“The decision of whether to reduce blood pressure levels in someone who has chronic kidney disease will depend on

• how high their blood pressure is (when untreated),
• whether they have diabetes, and
• how much protein is in their urine (albumin level).

A person with normal blood pressure who doesn’t have diabetes and hardly has any albumin in their urine will be able to get by without using any blood-pressure-lowering medication. But people who have high blood pressure, diabetes or high levels of albumin in their urine are advised to have treatment with ACE inhibitors (angiotensin-converting enzyme inhibitors) or sartans (angiotensin receptor blockers). In people who have diabetes, blood-sugar-lowering medication is also important.”

When I was first diagnosed with pancreatic cancer early last month, it changed my medical priorities. With my nephrologist’s blessing, my primary focus was the cancer… not my kidneys. It took constant reminders to myself not to be so quick to say no to anything that I thought would harm my kidneys. In other words, to those things I’d been saying no to for the last 11 years.

For example, once diagnosed with CKD, I ate very little protein keeping to my five ounce daily limitation. Not anymore. Protein is needed to avoid muscle wasting during chemotherapy with a minimum requirement of eight ounces a day. I even tried roast beef and other red meats. After 11 years, they no longer agreed with me so I eat ground turkey, chicken, cheese, and am considering soy.

Another change: I preferred not to eat carbohydrates, but was warned not to lose weight if I could help it. All of a sudden I’m eating Goldfish, bread, and pasta. I can’t say that I’m enjoying them, but I am keeping my weight loss to a minimum. Other limitations like those on potassium and phosphorous have also gone by the wayside. I’ve eaten every childhood favorite, foods that I’ve avoided for the last 11 years, and anything that might look tempting in the last month, but none of them really taste that good. I like the foods on the renal diet now.

Oh, the only thing I have not increased is salt. My daughter takes me to my chemotherapy sessions. There’s a Jewish style restaurant across the street and we showed up early one day. I wanted to try a toasted bagel with butter, the way I ate it before CKD. The damned thing was salty! I hadn’t expected that.

Back to chemo and my kidneys. I admit it. I was nervous. What was this combination of poisons going to do to my kidneys? If it was so caustic that I had to have a port in place so that it wouldn’t be injected directly into my veins for fear of obliterating them, what about my kidneys?

I anxiously awaited my first Comprehensive Blood Panel, the blood test that includes your GFR. Oh, oh, oh! My kidney function had risen to 55 and my creatinine had lowered to 1.0. Let me explain just how good this was.

A GFR of 55 is the higher part of stage 3A. 60 is where stage 2 of CKD begins. My kidneys were functioning better on chemo. And the creatinine? Let’s get a quick definition of that first. According to The National Institute of Diabetes and Digestive and Kidney Diseases at https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis:

“Creatinine. Creatinine is a waste product from the normal breakdown of muscles in your body. Your kidneys remove creatinine from your blood. Providers use the amount of creatinine in your blood to estimate your GFR. As kidney disease gets worse, the level of creatinine goes up.”

Yet, mine went down. How? I asked and it was explained that all the hydration used to clear my veins of the caustic chemotherapy had worked this magic. I had two hours of hydration before the chemo-therapy  itself, two hours afterward, and another two hours the next day. My kidneys had never been this hydrated!

But wait, there’s more. I have diabetes. The pancreas is the organ that produces insulin. Could my diabetes be from the tumor blocking the production of insulin by my pancreas? I truly don’t know, but my glucose level is within the standard range for the first time since I’ve been diagnosed with diabetes.

Would I recommend chemotherapy to raise your GFR, and lower your creatinine and your glucose level? Of course not. But I am feeling so very lucky that my kidneys are not coming to any harm during the chemotherapy necessary to save my life. I can’t begin to tell you how relieved I am.

Until next week,

Keep living your life!

To Continue…

National Kidney Month is just flying by. This is actually the last week and I doubt I’ll be able to post the rest of the 1in9 chapter before next month. But then again, it’s always Kidney Month for those of us with Chronic Kidney Disease. By the way, thank you to the reader who made it a point of telling me she can’t wait to read the rest of the chapter. Sooooo, let’s get started!

***

Nephrologist switch. The new one was much better for me. He explained again and again until I understood and he put up with a lot of verbal abuse when this panicky new patient wasn’t getting answers as quickly as she wanted them. Luckily for me, he graciously accepted my apology.

After talking to the nephrologist, I began to realize just how serious this disease was and started to wonder why my previous nurse practitioner had not caught this. When I asked her why, she responded, “It was inconclusive testing.” Sure it was. Because she never ordered the GFR tested; that had been incidental! I feel there’s no sense crying over spilled milk (or destroyed nephrons, in this case), but I wonder how much more of my kidney function I could have preserved if I’d known about my CKD earlier.

According to the Mayo Clinic, there are 13 early signs of chronic kidney disease. I never experienced any of them, not even one. While I did have high blood pressure, it wasn’t uncontrollable which is one of the early signs. Many, like me, never experienced any noticeable symptoms. Unfortunately, many, like me, may have had high blood pressure (hypertension) for years before CKD was diagnosed. Yet, high blood pressure and diabetes are the two leading causes of CKD. I find it confusing that uncontrollable high blood pressure may be an early sign of CKD, but hypertension itself is the second leading cause of CKD.

Here’s the part about my researching. I was so mystified about what was happening and why it was happening that I began an extensive course of research. My nephrologists did explain what everything meant (I think), but I was still too shocked to understand what they were saying. I researched diagnoses, descriptions of tests, test results, doctors’ reports, you name it. Slowly, it began to make sense, but that understanding only led to more questions and more research.

You’ve probably already guessed that my world changed during that first appointment. I began to excuse myself for rest periods each day when I went back East for a slew of family affairs right after. I counted food groups and calories at these celebrations that summer. And I used all the errand running associated with them as an excuse to speed walk wherever I went and back so I could fit in my exercise. Ah, but that was just the beginning.

My high blood pressure had been controlled for 20 years at that time, but what about my diet? I had no clue there was such a thing as a kidney diet until the nutritionist explained it to me. I’m a miller’s granddaughter and ate anything – and I do mean anything – with grain in it: breads, muffins, cakes, croissants, all of it. I also liked lots of chicken and fish… not the five ounces per day I’m limited to now.

The nutritionist explained to me how hard protein is on the kidneys… as is phosphorous… and potassium… and, of course, sodium. Out went my daily banana—too high in potassium. Out went restaurant burgers—larger than my daily allowance of protein. Chinese food? Pizza? Too high in sodium. I embraced an entirely new way of eating because it was one of the keys to keeping my kidneys functioning in stage 3.

I was in a new food world. I’d already known about restricting sodium because I had high blood pressure, but these other things? I had to keep a list of which foods contain them, how much was in each of these foods, and a running list of how much of each I had during the day so I knew when I reached my limit for that day.

Another critical piece of slowing down CKD is medication. I was already taking meds to lower my blood pressure when I was first diagnosed with CKD. Two more prescriptions have been added to this in the last decade: a diuretic that lowers my body’s absorption of salt to help prevent fluid from building up in my body (edema), and a drug that widens the blood vessels by relaxing them. I take another drug for my brand new diabetes. (Bye-bye, sugars and most carbs.) The funny thing is now my favorite food is salad with extra virgin olive oil and balsamic vinegar. I never thought that would happen: I was a chocoholic!

Exercise, something I loved until my arthritis got in the way, was also important. I was a dancer. Wasn’t that enough? Uh-uh, I had to learn about cardio and strength training exercise, too. It was no longer acceptable to be pleasantly plumb. My kidneys didn’t need the extra work. Hello to weights, walking, and a stationary bike. I think I took sleep for granted before CKD, too, and I now make it a point to get a good night’s sleep. A sleep apnea device improved my sleep—and my kidney function rose.

I realized I needed to rest, too. Instead of giving a lecture, running to an audition, and coming home to meet a deadline, I slowly started easing off until I didn’t feel like I was running on empty all the time. The result was that I ended up graciously retiring from both acting and teaching at a local college, which gave me more time to work on my CKD awareness advocacy.

***

There’s so much more to tell you about my personal CKD journey… and you’ll read more of it next week. Although, I should remind you that the entire book is available in print and digital on both Amazon.com and B&N.com, just as the entire SlowItDownCKD series of books is.

Until next week,
Keep living your life!

National Kidney Month, 2019

Anyone remember LOL? It’s older internet shorthand for Laughing Out Loud. That’s what I’m doing right now. Why? Because, after all these years of blogging, I’ve just realized that I compose my opening paragraph as I’m waking up. Still in bed, mind you. Still half asleep. Isn’t the brain wonderful?

This is my half asleep composition for this morning: March is National Kidney Month. That’s not to be confused with March 14^th, which is World Kidney Day. So, today, we address the nation. Next week, the world.

As usual, let’s start at the beginning. What is National Kidney Month? Personalized Cause at https://www.personalizedcause.com/health-awareness-cause-calendar/national-kidney-month has a succinct explanation for us. By the way, while I’m not endorsing them since the site is new to me, I should let you know they sell the green ribbons for National Kidney Month that you’ll probably be seeing hither and yon all month.

“National Kidney Month, observed in March and sponsored by the National Kidney Foundation, is a time to increase awareness of kidney disease, promote the need for a cure, and spur advocacy on behalf of those suffeing (sic) with the emotional, financial and physical burden of kidney disease. The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families, and tens of millions of Americans at risk.” That, of course, prompted me to go directly to the National Kidney Foundation’s information about National Kidney Month at https://www.kidney.org/news/monthly/Focus_KidneyMonth.

“Focus on the Kidneys During National Kidney Month in March

March is National Kidney Month and the NKF is urging all Americans to give their kidneys a second thought and a well-deserved checkup. Kidneys filter 200 liters of blood a day, help regulate blood pressure and direct red blood cell production. But they are also prone to disease; 1 in 3 Americans is at risk for kidney disease due to diabetes, high blood pressure or a family history of kidney failure. There are more than 30 million Americans who already have kidney disease, and most don’t know it because there are often no symptoms until the disease has progressed. During National Kidney Month in March, and in honor of World Kidney Day on March 14, the NKF offers the following health activities to promote awareness of kidneys, risk factors and kidney disease:

• Free Screenings: On World Kidney Day and throughout the Month of March, NKF is offering free screenings to those most at risk for kidney disease – anyone with diabetes, high blood pressure or a family history of kidney failure. Locations and information can be found on the calendar on our website.
• ‘Are You at Risk’ Kidney Quiz: Early detection can make a difference in preventing kidney disease so it’s important to know if you’re at risk. Take the online kidney quiz!
• Live Twitter Chat with Dr. Joseph Vassalotti: The National Kidney Foundation’s Chief Medical Officer, Dr. Joseph Vassalotti, will be hosting an interactive kidney Q&A on World Kidney Day, Thursday, March 14, from 12-2 pm ET. Ask your questions at www.twitter.com/nkf using the hash-tag #WorldKidneyDayNKF.”

Wow, so much going on. This is also the month of kidney walks, like the one my daughter Nima participated in on the East Coast in my honor, or the one for which I organized a team several years ago. Actually, it’s the month specifically for anything and everything that will raise awareness of kidney disease. I’ve mentioned that I contributed a chapter to the book 1in9, which is about kidney disease. You’re right. The book launch is this month, March 6^th to be specific.

The American Kidney Fund at http://www.kidneyfund.org/take-the-pledge/ is also taking part in National Kidney Month. They have a form to fill out to take a pledge to fight kidney disease.  I signed up; you can, too, if you’d like to. I’m not comfortable with the word “fight,” but I’m not going to let that stop me from spreading awareness of the disease. I wanted to share this quote from the AKF with you, both as a CKD awareness advocate and a woman:

“‘Kidney disease is a silent killer that disproportionately affects women who are often the primary caregivers for loved ones with the disease, are more likely to become living donors but less likely to receive a transplant, and are at higher risk for CKD,’ said LaVarne A. Burton, president and chief executive officer of AKF. ‘Because women with kidney disease may also face other health issues, including infertility, pregnancy complications, bone disease and depression, AKF is using Kidney Month to let women know we are here to support them and to provide resources that will answer their questions and concerns.’”

The Renal Support Network at https://www.rsnhope.org/ is working even more emphatically to spread kidney disease awareness this month, too:

“March is National Kidney Month. This is a special time set aside to raise awareness about kidney health and activities. RSN invites members of the kidney community, our friends and our families to join in the conversation.”

This on top of their usual. For those that are not familiar with this group, the following statement is from their website.

“Since 1993 RSN has created and continues to produce a vast collection of information about kidney disease. Feel free to share our National Kidney Month page, a favorite story, KidneyTalk™ show or awareness image on social media using the hashtag #KidneyMonth and be sure to tag us @RSNhope.”

DaVita Kidney Care at https://www.davita.com/education/resources offers many resources (as the website’s title assures us) to help understand both CKD and dialysis. Some of their offerings are:

• “Organizations and Programs
• Education
• Advice & Inspiration
• Recipes & Nutrition
• Specific Kidney Diseases
• Resources 
• Health Related Portals”

If you click through on the link offered above, each item will open on a new page.

As for me, I’ll blog my brains out until more and more people are aware of kidney disease. Same goes for the Instagram, Facebook,Twitter, Pinterest, and LinkedIn accounts. It’s all about kidney disease.

Until next week,

Keep living your life!

Pancreas + Kidneys = ?

31 years ago, my father died of pancreatic cancer. For some reason, I remember him asking me what electrolytes were as soon as he was diagnosed. I didn’t know. I do now, but I don’t know if there’s a connection between the pancreas and the kidneys. Of course, I mean other than the fact that they are all organs in your body.

Oh, sorry, I didn’t give you the definition. This is from Healthline at https://www.healthline.com/nutrition/electrolytes  :

“’Electrolyte’ is the umbrella term for particles that carry a positive or negative electric charge ….

In nutrition, the term refers to essential minerals found in your blood, sweat and urine.

When these minerals dissolve in a fluid, they form electrolytes — positive or negative ions used in metabolic processes.

Electrolytes found in your body include:

• Sodium
• Potassium
• Chloride
• Calcium
• Magnesium
• Phosphate
• Bicarbonate

These electrolytes are required for various bodily processes, including proper nerve and muscle function, maintaining acid-base balance and keeping you hydrated.”

Ummm, you have Chronic Kidney Disease. These are the electrolytes you need to keep an eye on, especially sodium, potassium, and phosphate. But why did Dad ask me about them?

I plunged right in to find the answer and immediately found a journal article… on a pay site. Not being one to pay for what can be found for free (and is 30 years old, by the way), I decided to look for as much information on the pancreas as I could find and see what we could figure out together.

Let’s start at the beginning. According to the Sol Goldman Pancreatic Cancer Research Center of Johns Hopkins Medicine – Pathology at http://pathology.jhu.edu/pc/basicoverview1.php?area=ba:

“What is the pancreas?

The pancreas is a long flattened gland located deep in the belly (abdomen). Because the pancreas isn’t seen or felt in our day to day lives, most people don’t know as much about the pancreas as they do about other parts of their bodies. The pancreas is, however, a vital part of the digestive system and a critical controller of blood sugar levels.

Where is the pancreas?

The pancreas is located deep in the abdomen. Part of the pancreas is sandwiched between the stomach and the spine. The other part is nestled in the curve of the duodenum (first part of the small intestine). To visualize the position of the pancreas, try this: touch your right thumb and right ‘pinkie’ fingers together, keeping the other three fingers together and straight. Then, place your hand in the center of your belly just below your lower ribs with your fingers pointing to your left. Your hand will be the approximate shape and at the approximate level of your pancreas.”

I tried that. It’s not as easy as it sounds.

So now we sort of know what and where it is, but what does it do? No problem, Columbia University Irving Medical Center has just the info we need at http://columbiasurgery.org/pancreas/pancreas-and-its-functions:

“Exocrine Function:

The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile that are released into the duodenum, help the body to digest fats, carbohydrates, and proteins.

Endocrine Function:

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.”

The kidneys? Now it’s starting to make sense. We need whatever specific electrolyte balance our lab work tells us we need to keep our kidneys working in good stead and we need a well-functioning pancreas to regulate our blood sugars. Hmmm, diabetes is one of the two leading causes of CKD. It seems the pancreas controls diabetes since it creates insulin.

What could happen if the pancreas wasn’t doing its job, I wondered.  This is from the Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-20360227,

“Pancreatitis [Me here: that’s an inflammation of the pancreas] can cause serious complications, including:

• Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
• Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
• Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
• Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
• Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
• Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
• Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Did you catch kidney failure and diabetes? I believe we now know how the kidneys and pancreas are related to each other. Ah, if only I’d known how to research 31 years ago….

Until next week,

Keep living your life!

A Creatinine Christmas Present

Tomorrow is Christmas and a Merry Christmas to those of you who celebrate. The day after Christmas Kwanzaa begins, so a Happy Kwanzaa to those of you who celebrate. But back to Christmas right now: today’s blog is a present to a reader who joined me way back when I first started blogging and has since become a close online friend.

You see, her creatinine is rising but she’s barely eating and – since she has multiple physical conditions – can’t exercise. She’s flummoxed and so was I because food and muscle waste are the two usual causes of rising creatinine levels in the blood. I decided to try to help her sort this out now even though she’ll be seeing her nephrologist right after the New Year.

A good place to start is always at the beginning. By this, I wonder if I mean the beginning of my Chronic Kidney Disease awareness advocacy as the author of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease and the blog or if I mean the basics about creatinine. Let’s combine them all. The following definition is from the book which became the earliest blogs:

“Creatinine clearance: Compares the creatinine level in your urine with that in your blood to provide information about your kidney function”

Hmmm, that didn’t exactly work. Let’s try again. Bingo! It was in SlowItDownCKD 2014,

“Creatinine: chemical waste product that’s produced by our muscle metabolism and to a smaller extent by eating meat. {MayoClinic.org}”

Red meat? No, that’s not it. My friend doesn’t eat meat at all, as far as I know. Beaumont Hospital Kidney Centre at http://www.beaumont.ie/kidneycentre-forpatients-aguidetokidneydisease-die offers the following information concerning food and creatinine:

“Protein intake from the diet is important during the progression of chronic kidney disease and also when you commence dialysis. The protein we eat is used for tissue repair and growth. Any unused protein is broken down into waste products, including urea and creatinine. As your kidneys are unable to excrete urea and creatinine properly, they build up in your blood and cause symptoms such as nausea and loss of appetite.

By eating large amounts of protein foods e.g. meat, fish, chicken, eggs, cheese, milk and yoghurt before commencing dialysis [Me here, that means those of us who are pre-dialysis like me], you will affect the buildup of urea and creatinine in your blood. An appropriate daily intake of protein should be advised by your dietician.

However, once dialysis treatment has commenced it is important to make sure that your body is getting enough protein to prevent malnutrition. Some of your stores of protein are lost during the haemodialysis and CAPD sessions. How much protein you need depends on your body size and is specific to each individual.”

And the ‘muscle metabolism’ in our definition? This deals with the way muscles use energy. The waste product of this process is creatinine.

Medical News Today at https://www.medicalnewstoday.com/articles/320113.php had something to say about exercise and creatinine:

“Strenuous exercise, such as weight training or resistance exercise, may cause high creatinine levels.

Muscle activity produces creatinine; the more the muscles work, the more creatinine is in the blood. While regular exercise is essential for good health, overexertion can cause the creatinine levels in the blood to spike.

A 2012 study noted that intense exercise increased creatinine levels in the bloodstream temporarily. It may be best for people to avoid strenuous activity until they have completed any treatment for the cause of the high creatinine levels.

However, people should not avoid exercise altogether, except in some extreme circumstances.

To maintain their exercise regimen, people who like weight training or resistance exercises could switch to yoga and body weight exercises during treatment. People who prefer cardio exercises, such as running or cycling, could consider changing to walking or swimming.”

My friend does not exercise. So what else could it be that is raising her creatinine? I went to New Health Advisor at https://www.newhealthadvisor.com/causes-of-elevated-creatinine.html which was quite comprehensive in answering the question.

“Kidney diseases or disorders can lead to high creatinine levels. Since the kidneys are the filters of wastes from the bloodstream, kidney damage means that there will be a buildup of creatinine beside other waste products in the body. Kidney conditions such as glomerulonephritis, acute tubular necrosis, kidney infection (pyelonephritis) and kidney failure can cause high creatinine levels. Reduced blood flow to the kidneys can also have a similar effect.

Other causes of elevated creatinine levels in blood include shock, dehydration, and congestive heart failure. These conditions lead to a reduction in blood flow to the kidneys, which interferes with their normal functions. High blood pressure, diabetic neuropathy, muscular dystrophy, rhabdomyolysis, eclampsia, and preeclampsia can also cause elevated serum creatinine.

In case a patient with renal dysfunction gets an infection like pneumonia, urinary tract infection, intestinal infection, or a cold, the creatinine level may rise within a short time.

Urine abnormalities such as long-term hematuria and proteinuria can also lead to high creatinine levels.

Taking drugs that have renal toxicity properties can also raise the levels of creatinine in the bloodstream. Such medications include chemotherapy drugs, ACE inhibitors, and NSAIDs like aspirin and ibuprofen among others.”

They also included excessive exercise, too much protein in the diet, fatigue, and inadequate rest.

I noticed each site I looked at mentioned that creatinine increase could be temporary. Perhaps a re-test is in order for my friend.

I know you’re already asking why she was surprised to find this on her lab report. She already has CKD which could be a cause of high creatinine levels. What worried her is that they are rising. Is her CKD getting worse? Or did she neglect to get adequate rest (as one possibility) before this particular blood test?

I can’t answer that since I’m not a doctor, although I hope I’ve been able to alleviate her worry until she gets to go to her nephrologist next week. Here’s hoping this was a welcome Christmas present, my friend.

Until next week,

Keep living your life!

Something New and Entirely Different

I sit here trying to write this week’s blog and being interrupted every five minutes by a long involved commentary about one thing or another. Why do I tolerate it? Because it’s Bear, my Bear, my husband who is interrupting. Why not just ask him not to, you say. Well, it’s involved. Basically, it’s because he has Alzheimer’s, doesn’t know how long winded he’s being, and feels terribly insulted when I ask him not to interrupt so I can write.

Sometimes, we can have a conversation without the interruptions and without the involved commentary. Obviously, not right now, but during one of these conversations, I explained to him that I had been asked to write about his Alzheimer’s but felt I needed to preserve his privacy. This good man blew that up. He said something to the effect that if it’s going to help even one person to know what he experiences, what I experience, with this disease, then I was obliged to write about it. His privacy wasn’t more important than that.

Now you have just an inkling of why I love him… and I do, Alzheimer’s or not. Since this is my kidney disease blog, it would make sense to look for any connections between Alzheimer’s and kidney disease. If they exist, that is.

I was not happy to find the following on The National Kidney Foundation’s page at https://www.kidney.org/news/ekidney/august08/Dementia_august08

“People with albuminuria were about 50% more likely to have dementia than people without albuminuria, Dr. Joshua I. Barzilay, at Emory University School of Medicine in Atlanta, Georgia, and his research team report. The association between the two conditions was still strong after controlling for age, education and risk factors, such as high blood pressure, diabetes, smoking, and cholesterol levels. There was a weaker relationship between albuminuria and mild cognitive impairment.”

By now it’s common knowledge to my readers that diabetes is the foremost cause of Chronic Kidney Disease with high blood pressure (hypertension) being the second.

How about some reminders right about now?

The American Diabetes Association at http://www.diabetes.org/diabetes-basics/common-terms/?loc defines the most common type of diabetes in the following manner:

“diabetes mellitus (MELL-ih-tus)
a condition characterized by hyperglycemia resulting from the body’s inability to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.”

As for high blood pressure, also known as hypertension, The National Library of Medicine PubMed Health was able to help us out:

“It happens when the force of the blood pumping through your arteries is too strong. When your heart beats, it pushes blood through your arteries to the rest of your body. When the blood pushes harder against the walls of your arteries, your blood pressure goes up.”

Keep this in mind for later. Here’s the definition of albumin from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

Albumin: Water soluble protein in the blood.

As mentioned in SlowItDownCKD 2013, “according to the physicians’ journal BMJ: ‘albuminuria [is] leakage of large amounts of the protein albumin into the urine.’”

Many of us with CKD have albuminuria at one time or another. Does that mean that 50% of us are going to develop dementia? No, not at all. According to the National Kidney Foundation, that 50% of us with albuminuria are MORE LIKELY to develop dementia, not GOING TO.

I get it. By now, most of you are probably asking what Alzheimer’s has to do with dementia. I popped right over to the Alzheimer’s Association’s (my new best friend) website at https://www.alz.org/alzheimers-dementia/what-is-alzheimers  for an explanation.

“Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.”

I’ll bet you want a definition of dementia now. Let’s go to Healthline.com at https://www.healthline.com/health/dementia for one:

“Dementia is a decline in cognitive function. To be considered dementia, mental impairment must affect at least two brain functions. Dementia may affect:

• memory
• thinking
• language
• judgment
• behavior”

It’s not surprising that the two definitions look so much alike. Alzheimer’s is one of the ten kinds of dementia that I know about. Different websites have different numbers for how many different kinds of dementia there are. I used the information from MedicineNet at https://www.medicinenet.com/dementia/article.htm#what_are_alzheimers_vascular_and_frontotemporal_dementia

Did you keep the definition of albumin in mind? The key word in that is protein… and that’s where the connection between Alzheimer’s and CKD lies. The information is from an unusual source for me to use, Science Magazine at https://www.sciencemag.org/news/2018/01/alzheimer-s-protein-may-spread-infection-human-brain-scans-suggest:

 “Tau is one of two proteins—along with β-amyloid—that form unusual clumps in the brains of people with Alzheimer’s disease. Scientists have long debated which is most important to the condition and, thus, the best target for intervention. Tau deposits are found inside neurons, where they are thought to inhibit or kill them, whereas β-amyloid forms plaques outside brain cells.”

I realize this is getting very technical and may concentrate on particular elements of this connection in future blogs, but right now, I’d like to remind you that the National Kidney Fund is hosting a webinar “Eating healthy with diabetes and kidney disease” in recognition of National Diabetes Awareness Month on Wednesday, November 28, 2018 from 1:00 – 2:00 p.m. EST.

Again, diabetes… the number one cause of Chronic Kidney Disease. Read more about CKD, diabetes, and hypertension (as well as many other topics) in the SlowItDownCKD series and What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. All eight books are available in print and digital on Amazon.com and B & N.com.

Did you know that the first day of Chanukah is December 3^rd? We start celebrating Chanukah the night before the first day and celebrate for eight nights… and there are eight books. What a coincidence! (Just planting a seed here, folks.)

Until next week,

Keep living your life!

Only One?

Loads of good things have been happening in my family lately, among them a couple of marriages. That, of course, brings new people into the family. There’s always that obligatory meet-the-new-in-laws dinner.  At one of these, a just added family member mentioned that she only had one kidney. Then she asked me what that means as far as Chronic Kidney Disease… and I didn’t know. Today’s blog is for her.

Let’s jump right in with this explanation from the U.S. Department of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at https://www.niddk.nih.gov/health-information/kidney-disease/solitary-kidney.

When a person has only one kidney or one working kidney, this kidney is called a solitary kidney. People born with kidney dysplasia have both kidneys; however, one kidney does not function (top right). When a kidney is removed surgically due to disease or for donation, both the kidney and ureter are removed (bottom right).

Well that was pretty straight forward. I wondered if she should be taking any kind of special cautions. According to the National Center for Biotechnology Information of the U.S. National Library of Medicine, National Institutes of Health, PubMed at https://www.ncbi.nlm.nih.gov/pubmed/16985610,

Removal of one kidney leads to structural and functional changes by the remaining kidney, including increased filtration of the remaining glomeruli. These functional changes have generally been considered beneficial because they mitigate the reduction in the total glomerular filtration rate that would otherwise occur, but experimental evidence suggests that these changes may have an adverse effect on the remaining kidney.

That sounded great… until I got to ‘adverse effect.’ So, naturally, I wanted to know what they meant. The Kidney and Urology Foundation of America, Inc. at http://www.kidneyurology.org/Library/Kidney_Health/Solitary_Kidney.php told me what I wanted to know.

If having a single kidney does affect your health, the changes are likely to be so small and happen so slowly that you won’t notice them. Over long periods of time, however, these gradual changes may require specific measures or treatments. Changes that may result from a single kidney include the following:

• High blood pressure. Kidneys help maintain a healthy blood pressure by regulating how much fluid flows through the bloodstream and by making a hormone called renin that works with other hormones to expand or contract blood vessels. Many people who lose or donate a kidney are found to have slightly higher blood pressure after several years.
• Proteinuria. Excessive protein in the urine, a condition known as proteinuria, can be a sign of kidney damage. People are often found to have higher-than-normal levels of protein in their urine after they have lived with one kidney for several years.
• Reduced GFR. The glomerular filtration rate (GFR) shows how efficiently your kidneys are removing wastes from your bloodstream. People have a reduced GFR if they have only one kidney.

In the nephron …, tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

You can have high blood pressure, proteinuria, and reduced GFR and still feel fine. As long as these conditions are under control, they will probably not affect your health or longevity. Schedule regular checkups with your doctor to monitor these conditions.

Wait a minute! Those are also the effects of Chronic Kidney Disease. And as you read on, you’ll see that the precautions are the same as those for someone who already has CKD.

What, then, is my new in-law supposed to do since she has a solitary kidney? I went to Medic8, a new site for me, at http://www.medic8.com/kidney-disorders/solitary-kidney.htm for the following suggestions.

Monitoring

Your doctor should monitor your kidney function by checking your blood pressure and testing your urine and blood once a year.

• Normal blood pressure is considered to be 120/80 or lower. You have high blood pressure if it is over 140/90. People with kidney disease or one kidney should keep their blood pressure below 130/80. Controlling blood pressure is especially important because high blood pressure can damage kidneys.
• Your doctor may use a strip of special paper dipped into a little cup of your urine to test for protein. The colour of the “dipstick” indicates the presence or absence of protein. A more sensitive test for proteinuria involves laboratory measurement and calculation of the protein-to-creatinine ratio. A high protein-to-creatinine ratio in urine (greater than 30 milligrams of albumin per 1 gram of creatinine) shows that kidneys are leaking protein that should be kept in the blood.
• … scientists have discovered that they can estimate a person’s GFR based on the amount of creatinine in a small blood sample. The new GFR calculation uses the patient’s creatinine measurement along with weight, age, and values assigned for sex and race. …. If your GFR stays consistently below 60, you are considered to have chronic kidney disease.

Controlling Blood Pressure

If your blood pressure is above normal, you should work with your doctor to keep it below 130/80. Great care should be taken in selecting blood pressure medicines for people with a solitary kidney. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are two classes of blood pressure medicine that protect kidney function and reduce proteinuria. But these medicines may be harmful to someone with renal artery stenosis (RAS), which is the hardening of the arteries that enter the kidneys. Diuretics can help control blood pressure by removing excess fluid in the body. Controlling your blood pressure may require a combination of two or more medicines, plus changes in diet and activity level.

Eating Sensibly

Having a single kidney does not mean that you have to follow a special diet. You simply need to make healthy choices, including fruits, vegetables, grains, and low-fat dairy foods. Limit your daily salt (sodium) intake to 2,000 milligrams or less if you already have high blood pressure. Reading nutrition labels on packaged foods to learn how much sodium is in one serving and keeping a sodium diary can help. Limit alcohol and caffeine intake as well.

Avoid high-protein diets. Protein breaks down into the waste materials that the kidneys must remove, so excessive protein puts an extra burden on the kidneys. Eating moderate amounts of protein is still important for proper nutrition. A dietitian can help you find the right amount of protein in your diet.

Avoiding Injury

…. Having a solitary kidney should not automatically disqualify you from sports participation. Children should be encouraged to engage in some form of physical activity, even if contact sports are ruled out. Protective gear such as padded vests worn under a uniform can make limited contact sports like basketball or soccer safe. Doctors, parents, and patients should consider the risks of any activity and decide whether the benefits outweigh those risks.

I am happy to say I think our new relative is going to find this a comforting blog. I know I did.

Oh, talking about one. I have one desk copy of the now retired The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 left. Leave a comment if you’d like to have it. All I ask is that you not have received a free book from me before.

Until next week,

Keep living your life!

 

Coming Home

I’m not a joiner. I’ve never been one. That’s why I was so surprised that I joined the American Association of Kidney Patients… and even more surprised to find myself attending this year’s conference in Tampa Bay, Florida. Readers had been suggesting I do so for years, but I’m not a joiner. Let’s change that; I wasn’t a joiner. The AAKP conference made the difference.

What’s that you ask? Of course, you need to know what they are. This is from their website at https://aakp.org/,

“THE INDEPENDENT VOICE OF KIDNEY PATIENTS SINCE 1969™

The American Association of Kidney Patients is dedicated to improving the quality of life for kidney patients through education, advocacy, patient engagement and the fostering of patient communities.

Education

The American Association of Kidney Patients (AAKP) is recognized as the leader for patient-centered education – continually developing high quality, professionally written, edited and reviewed educational pieces covering every level of kidney disease.

Advocacy

For nearly 50 years, AAKP has been the patient voice – advocating for improved access to high-quality health care through regulatory and legislative reform at the federal level. The Association’s work has improved long term outcomes in both quality of health and the ability for patients and family members affected by kidney disease to lead a more productive and meaningful life.

Community

AAKP is leading the effort to bring kidney patients together to promote community, conversations and to seek out services that help maximize patients’ everyday lives.

An IRS registered, Sec. 501(C)(3) organization, AAKP is governed by a Board of Directors. The current board is comprised of dialysis patients, chronic kidney disease patients, [Me here: You did notice ‘chronic kidney disease patients,’ right?] transplant recipients, health care professionals and members of the public concerned with kidney disease. The board and membership are serviced by a staff of five employees under the direction of Diana Clynes, Interim Executive Director, at the AAKP National Office located in Tampa, Florida.”

What’s not mentioned here is that the organization was started by only six patients. I find that astounding, but I’ll let them explain their history:

“Founded by Patients for Patients

King County Hospital, New York

The American Association of Kidney Patients (AAKP) has a rich history in patient advocacy and kidney disease education. AAKP started in 1969 with six dialysis patients at King County Hospital in Brooklyn, New York. They wanted to form an organization that would elevate the kidney patient voice in national health care arena, provide patients with educational resources to improve their lives and give kidney patients and their family members a sense of community. They met twice a week in the hospital ward and while hooked up to primitive dialysis machines for 12 to 18 hours at a time they brainstormed, researched and eventually formed AAKP.

The group originally called themselves NAPH (National Association of Patients on Hemodialysis, which later changed to AAKP). AAKP joined forces with other patient groups to fight for the enactment of the Medicare End-Stage Renal Disease (ESRD) Program, testifying before congressional committees, seeking public support and creating a newsletter (the forerunner of today’s AAKP RENALIFE) to keep everyone informed. This effort was crowned with success in 1972 when Congress enacted the program that continues to provide Medicare funding for dialysis and kidney transplantation.

After winning the initial and critical battle for the Medicare ESRD Program, AAKP turned its attention to other important issues — the need to establish a secure national organization to preserve the visibility and influence of patients with Congress and to develop national, educational and supportive programs.

Today & Beyond

AAKP has grown into a nationally recognized patient organization that reaches over 1 million people yearly. It remains dedicated to providing patients with the education and knowledge necessary to ensure quality of life and quality of health.”

This former non-joiner has found her association. I originally avoided the conferences because I thought they would be focused only on dialysis and transplant patients. Boy, was I ever wrong. Here are some of the outbreak (small group) sessions that dealt with other aspects of kidney disease:

Social Media (You’re right: I signed up for that one right away since I identify as a CKD awareness advocate.)

Dental Health

How Kidney Disease Impacts Family Members

Managing the Early Stage of CKD

Understanding Clinical Trials

Treatment Options

Staying Active

Veterans Administration

Caregiver’s Corner

Living Well with Kidney Disease

Avoid Infections

Of course, there were many outbreak sessions for dialysis and transplant patients as well. And there were two opportunities to lunch with experts. That’s where I tentatively learned about governmental aspects of our disease. There were opportunities to learn about nutrition, medications, working, and coping. I’ve just mentioned a few of the 50 different topics discussed.

The general sessions, the ones everyone attended, informed us of what the government’s national policy had to do with kidney disease, legislation, nutrition, patient centered care, and innovation in care (Keep an eye out for Third Kidney, Inc.’s August guest blog.).

I have not covered even half of what was offered during the conference. Did I mention renal friendly food was available and you could dialyze near the hotel if need be? The exhibitors went beyond friendly and explaining their products to being interested in who you were and why you were there. This was the most welcoming conference I’d been to in decades.

AAKP President Paul Conway summed up my feelings about the conference when he was interviewed by The Tampa Bay Times on the last day of the conference,

“This meeting is a way for us to bring patients together and educate them on trends that could affect their own health.”

I met so many others who have kidney disease and so many others who advocate for different types of kidney disease and patients’ rights. I was educated about so many areas, especially those I previously had known nothing about, for example, legislation. It was like coming home. Would I attend again? You bet’cha. Would I urge you to attend? At the risk of being redundant, you bet’cha.

I was so excited about AAKP that I almost didn’t leave myself enough space to tell you about yet another freebie. The Book of Blogs: Moderate Chronic Kidney Disease, Part 1 is no longer in print since it has been divided into SlowItDownCKD 2011 and SlowItDownCKD 2012. But I still have a desk copy. Let me know if you’d like it. My only restriction is that you have not received a free book from me before.

Until next week,

Keep living your life!

Eating Makes Me Hungry

I couldn’t figure it out. I had my renal diet down pat (That only took ten years, she thought snidely.) When the foods I’m sensitive to had to be removed from that diet, I worked the new-reduced-possibilities-for-food-choices diet out pretty quickly, too. But then I noticed that I was hungry pretty much only after I ate.

I’d prefer to eat only if I’m hungry, but some of my medications require food first. Okay, so I knew I had to eat at least twice a day and graze several times during the day to keep my blood glucose level. I thought I took care of that by eating a small breakfast, lunch as my main meal when I got hungry, and a much smaller, almost snack type meal for dinner.

So why did eating make me hungry? Was I not taking enough food in? Nope. I counted calories to check and was not much under my allotted 1,200 per day. So what was it?

Women’s Health at https://www.womenshealthmag.com/food/g19920742/foods-that-make-you-hungrier/ named the following seven foods that make you hungrier:

1. Whole wheat bread
2. Fruit juices
3. Egg whites
4. Green smoothies
5. Non-fact dairy
6. Pickles
7. Whole wheat crackers

Hmmm, between the renal diet and my food sensitivities I don’t eat any of these. Wait, I do eat whole eggs which contain egg whites, but I think Dr. Caspero meant only the whites for the purposes of this list.

Of course, I wanted to know why these foods make you hungrier. This quote is from the same article.

“For the most part, fat, fiber, and protein help with satiation,” says Alex Caspero, R.D. “So foods without those components will likely leave you searching for your next meal in no time.”

Reminder: R.D. means registered dietician.

I don’t eat whole wheat anything because I have sensitivity to it, but doesn’t it have fiber? That’s a yes and no answer. It does have fiber, but is more processed than regular flour which means less fiber. Fiber helps to fill you up. Side bar here:  Did you know that flour of any kind has wheat in it since it’s made from one or more of the three parts of the grain? That’s mean no bread for me.

Nope, Dr. Caspero didn’t answer my question as fully as I wanted it to be answered. Back to the drawing board, boys and girls.

Wait a minute. This from the BBC at http://www.bbc.co.uk/guides/zt22mp3 looks like it’s getting close to answering my question.

“Different types of food we eat affect the brain in various ways. For example, fatty foods trick the brain into believing that you have eaten fewer calories than you actually have, causing you to overeat. This is because fatty foods such as butter and fried foods contain a lot of densely packed energy.

However, other foods give a lasting sense of fullness. Fibre triggers the release of gut hormones that make you feel full. A low fibre diet though, with little or no wholemeal produce or fruit and vegetables, may leave you open to feelings of hunger.

Foods with a low GI (glycaemic index) such as nuts, vegetables and beans release energy more slowly than high GI food such as white bread and sugar. Eating more low GI foods will suppress your hunger by increasing levels of gut hormones that help you feel fuller for longer.”

Foods with a low GI, huh? This brings me back to the lessons from the Diabetes Nutritionist my family doctor sent me to when she discovered I was (and still am four years later) pre-diabetic. Okay, I can take a hint. What are some of these low GI foods?

The American Diabetes Association at http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html  was able to help us out here:

“Low GI Foods (55 or less)

• 100% stone-ground whole wheat or pumpernickel bread
• Oatmeal (rolled or steel-cut), oat bran, muesli
• Pasta, converted rice, barley, bulgar
• Sweet potato, corn, yam, lima/butter beans, peas, legumes and lentils
• Most fruits, non-starchy vegetables and carrots

Medium GI (56-69)

• Whole wheat, rye and pita bread
• Quick oats
• Brown, wild or basmati rice, couscous

High GI (70 or more)

• White bread or bagel
• Corn flakes, puffed rice, bran flakes, instant oatmeal
• Shortgrain white rice, rice pasta, macaroni and cheese from mix
• Russet potato, pumpkin
• Pretzels, rice cakes, popcorn, saltine crackers
• melons and pineapple”

According the renal diet I follow, the Northern Arizona Council on Renal Nutrition Diet, I could eat all of these foods. According to my food sensitivities, I could only eat oatmeal, some fruits, and vegetables. Maybe that’s why eating makes me hungry.

Take a look at this. Redbook (and to think I smirked at my mom for reading this magazine when I was a teenager) at https://www.redbookmag.com/body/healthy-eating/g2819/foods-that-make-you-hungry/?slide=1 explains about fruit making you feel hungrier:

“’Fruit juice may already be on your no-go list, but if you’re eating more than one serving of the whole variety (i.e. one banana or one cup of berries), you may want to scale back. It may have nutritional benefits, but fruit is not going to help suppress your appetite,’ says Perlmutter. ‘It contains both fructose and glucose, which won’t signal insulin, causing your appetite to rage on.’”

Perlmutter is David Perlmutter, MD, a board-certified neurologist and author of Brain Maker.

Got it: More fiber, less sugar. Now the only question is can I get myself to adhere to that… and can you if you choose to stop being hungrier after eating than you were before.

Talking about magazines, Arizona Health and Living at https://issuu.com/arizonahealthandliving/docs/arizona_health_and_living_magazine__9a2d374f4dffc2 is helping me spread awareness of Chronic Kidney Disease. This is in their June 2018 issue.

 

Guess what I found when I was preparing my non-CKD book for last Thursday night’s reading at our local The Dog Eared Pages Used Book Store. You’re right. It’s a copy of the newly minted (um, printed) SlowItDownCKD 2017. Would you like it? All that I require is your address and that you haven’t received a free book from me before.

Random thought: I cannot believe I just chose a Father’s Day gift for my son-in-law’s first Father’s Day. Add my youngest’s upcoming nuptials and this is a very happy world I live in. Here’s hoping yours is a happy one, too.

Until next week,

Keep living your life!

All of Me, uh, Us

When I was a little girl, I liked to listen to my father whistle ‘All of Me,’ written by Marks and Simon in 1931 when Charlie, my father, was just 16. Only a few years later, it became a sort of love language for my mother and him. Enter a former husband of my own and my children. When my folks visited from Florida and my then husband’s side of the family journeyed over to Staten Island from Brooklyn to visit them, they all sang the song with great emotion. (By then, Bell’s palsy had robbed my father of the ability to whistle.)

To this day, I start welling up when I hear that song. But then I started thinking about the lyrics:

“All of me
Why not take all of me?”

Suddenly, it popped. For us, those with chronic kidney disease, it should be:

“All of us

Why not take all of us?”

For research purposes. To “speed up health research breakthroughs.” For help in our lifetime. To spare future generations whatever it is we’re suffering… and not just for us, but for our children… and their children, too.

The National Institutes of Health has instituted a new research program for just that purpose, although it’s open to anyone in the U.S. over the age of 18 whether ill with any disease or perfectly healthy. While only English and Spanish are the languages they can accommodate at this time, they are adding other languages.

I’m going to devote most of the rest of this blog to them. By the way, I’m even more inclined to be in favor of this program because they launched on my first born’s birthdate: May 6. All of Us has its own inspiring welcome for you at https://launch.joinallofus.org/

This is how they explain who they are and what they intend to do:

“The goal is to advance precision medicine. Precision medicine is health care that is based on you as an individual. It takes into account factors like where you live, what you do, and your family health history. Precision medicine’s goal is to be able to tell people the best ways to stay healthy. If someone does get sick, precision medicine may help health care teams find the treatment that will work best.

To get there, we need one million or more people. Those who join will share information about their health over time. Researchers will study this data. What they learn could improve health for generations to come. Participants are our partners. We’ll share information back with them over time.”

You’ll be reading more about precision medicine, which I’ve written about before, in upcoming blogs. This is from All of Us’s website at https://www.joinallofus.org/en, as is most of the other information in today’s blog, and makes it easy to understand just what they are doing.

How It Works

Participants Share Data

Participants share health data online. This data includes health surveys and electronic health records. Participants also may be asked to share physical measurements and blood and urine samples.

Data Is Protected

Personal information, like your name, address, and other things that easily identify participants will be removed from all data. Samples—also without any names on them—are stored in a secure biobank.

Researchers Study Data

In the future, approved researchers will use this data to conduct studies. By finding patterns in the data, they may make the next big medical breakthroughs.

Participants Get Information

Participants will get information back about the data they provide, which may help them learn more about their health.

Researchers Share Discoveries

Research may help in many ways. It may help find the best ways for people to stay healthy. It may also help create better tests and find the treatments that will work best for different people.

I’m busy, too busy to take on even one more thing. Or so I thought. When I read the benefits of the program (above) and how easy it is to join (below), I realized I’m not too busy for this and it is another way to advocate for Chronic Kidney Disease awareness. So I joined and hope you will, too.

Benefits of Taking Part

Joining the All of Us Research Program has its benefits.

Our goal is for you to have a direct impact on cutting-edge research. By joining the program, you are helping researchers to learn more about different diseases and treatments.

Here are some of the benefits of participating in All of Us.

Better Information

We’re all human, but we’re not all the same. Often our differences—like age, ethnicity, lifestyle habits, or where we live—can reveal important insights about our health.

By participating in All of Us, you may learn more about your health than ever before. If you like, you can share this information with your health care provider.

Better Tools

The goal of the program is better health for all of us. We want to inspire researchers to create better tools to identify, prevent, and treat disease.

You may also learn how to use tools like mobile devices, cell phones and tablets, to encourage healthier habits.

Better Research

We expect the All of Us Research Program to be here for the long-term. As the program grows, the more features will be added. There’s no telling what we can discover. All thanks to participants like you.

Better Ideas

You’re our partner. And as such, you are invited to help guide All of Us. Share your ideas and let us know what works, and what doesn’t.

Oh, about joining:

Get Started – Sign Up

Here’s a quick overview of what you’ll need to do to join.

1

Create an Account

You will need to give an email address and password.

2

Fill in the Enrollment and Consent Forms

The process usually takes 18-30 minutes. If you leave the portal during the consent process, you will have to start again from the beginning.

3

Complete Surveys and More

Once you have given your consent, you will be asked to complete online health surveys. You may be asked to visit a partner center. There, you’ll be asked to provide blood and urine samples and have your physical measurements taken. We may also ask you to share data from wearables or other personal devices.

Before I leave you today, I have – what else? – a book give away. The reason? Just to share the joy that’s walked into my life lately. It’s easy to share the troubles; why not the joys? If you haven’t received one of my books in a giveaway before, all you have to do is be the first person to let me know you want this copy of SlowItDownCKD 2017.

 

I need to get back to that online health survey for All of Us now.

Until next week,

Keep living your life!

 

Something Else I Didn’t Know

One of the members of a Facebook Chronic Kidney Disease support group and I got into a bit of give and take about last week’s blog. It started with one topic and, as conversations are wont to do, ended up being about something entirely different: mgus. This is what I ended up responding:

“I don’t know mgus, either. I think the only way I can be of any help to you is to suggest you speak with your renal nutritionist and make sure she knows you also have mgus. Sorry! Hmmm, maybe I should learn about mgus and blog about it.”

As the week went on, I realized there was no “maybe” about it. So let’s learn about mgus together.

According to my old time favorite The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/mgus/symptoms-causes/syc-20352362, mgus is:

“Monoclonal gammopathy of undetermined significance (MGUS) is a condition in which an abnormal protein — known as monoclonal protein or M protein — is in your blood. The protein is produced in a type of white blood cell (plasma cells) in your bone marrow.

MGUS usually causes no problems. But sometimes it can progress over years to other disorders, including some forms of blood cancer.

It’s important to have regular checkups to closely monitor monoclonal gammopathy so that if it does progress, you get earlier treatment. If there’s no disease progression, MGUS doesn’t require treatment.”

Whoa! Looks like we need a lot of backtracking here. Let’s start with monoclonal. We know ‘mono’ means one and the ‘al’ at the end of the word means of or about. Now let’s deal with the unknown: ‘clon’. Dictionary.com at http://www.dictionary.com/browse/clone tells us it’s really clone (which you’ve probably already guessed) and means:

1. a cell, cell product, or organism that is genetically identical to the unit or individual from which it was derived.
2. a population of identical units, cells, or individuals that derive from the same ancestral line.

Oh, clone… as in Dolly, the sheep back in Scotland in 1995. Got it.

And gammopathy? That ‘o’ in the middle is just a connective so we’re really dealing with ‘gamm’ and ‘pathy’. You probably already know ‘pathy’. The Free Dictionary at https://www.thefreedictionary.com/-pathy offers a few definitions.

1. indicating feeling, sensitivity, or perception: telepathy.
2. (Pathology) indicating disease or a morbid condition: psychopathy.
3. (Pathology) indicating a method of treating disease: osteopathy.

Number two is what we need for our purposes.

That leaves us with ‘gamm’, which I thought was part of gamma considering the definition of the disease. The first medical definition in The Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/gamma was helpful here.

“of or relating to one of three or more closely related chemical substances

• the gamma chain of hemoglobin

• γ-yohimbine

—used somewhat arbitrarily to specify ordinal relationship or a particular physical form and especially one that is allotropic, isomeric, or stereoisomeric (as in gamma benzene hexachloride)”

I’d have to agree if you’re thinking this is getting a bit too technical to continue down this particular road. Let’s go back to the disease itself and see what it may have to do with CKD. Hmmm, protein is mentioned in the definition and proteinuria can be a problem in CKD. Is that the connection?

We Are Macmillan, a cancer support group from England at https://www.macmillan.org.uk/information-and-support/diagnosing/causes-and-risk-factors/pre-cancerous-conditions/mgus.html, tells us:

“People with MGUS make an abnormal protein, called a paraprotein or M-protein, which is found in the urine or blood.”

I see. This M-protein does show up in the urine.

That did it. I jumped right back to the Mayo Clinic and learned that Chronic Kidney Disease may be a complication of MSUG. But, then again, so may blood clots and bone fractures.

Feeling a bit frustrated, I thought maybe symptoms would be helpful. The University of Rochester Medical Center at https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=121 offers this list.

Symptoms of monoclonal gammopathies vary among these conditions, but can include:

• Anemia or low red blood cells counts
• Lack of energy (fatigue) or tiredness
• Weakness
• Pain in the bones or soft tissues
• Tingling or numbness in the feet or hands
• Infection that keeps coming back
• Increased bruising
• Bleeding
• Weight loss
• Headache
• Vision problems
• Swelling
• Mental changes

Anemia and fatigue may also be symptoms of CKD. Yet, both MSUG and CKD are often symptomless.

To complicate matters, there’s also a disease called monoclonal gammopathy of renal significance. That’s when the monoclonal gammopathy causes the CKD. It sounds like this was not the case with the reader. She just happens to have both monoclonal gammopathy and CKD.

I’m going to switch gears here. I received an email from the American Kidney Fund (AKF) asking me if I would write about their upcoming webinar on Depression. Who could say no to that request?

“Each month, AKF hosts an educational webinar for kidney patients and their loved ones about living well with kidney disease…. Experts cover important topics and there is always a live Q&A session afterwards where viewers can send in their questions. You can find more information about the upcoming webinar here: http://www.kidneyfund.org/training/webinars/

Our next webinar for May 23rd is Depression: the overlooked complication of kidney disease.”

I’ve watched some of the webinars and found them helpful. I think you will, too.

You know that promise I made about separating my unwieldy The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 into two separate books – SlowItDownCKD 2013 & SlowItDownCKD 2104 – with larger print and a more comprehensive index? You know, just as I did when I separated The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 (now ‘retired’ as a book no longer in print is called) into SlowItDownCKD 2011 & SlowItDownCKD 2102. I am proud to announce that I’ve actually started that process.

For a retired person, my calendar sure is full and busy seems to be my middle name. I vow to have the SlowItDownCKD series completed (until it’s time to publish SlowItDownCKD 2018, that is) by the end of the summer.

Happy Mother’s Day this coming weekend. I’m going to enjoy the fact that it’s my step-daughter’s first…. and hope we get to meet The Little Prince sooner rather than later. Living in two different states was never this hard before his birth.

Until next week,

Keep living your life!

Compliance 101

Welcome to the last blog of National Kidney Month 2018. We all know I rarely write about dialysis or transplant, but a friend who is awaiting a transplant brought this book to my attention. This particular section of the book sparked my interest since non-compliance can be an issue in any stage of kidney disease. One part of my mission is to create awareness among Chronic Kidney Disease patients, their friends, families, and loved ones of how important compliance with their medical team is. Dr. Michael B. Fisher is a nephrologist who thinks the same way.

Today’s blog is mostly an excerpt from the upcoming book Surviving Kidney Disease. According to his book’s web page:

“Dr. Fisher received his medical degree from SUNY in 1968 and did his nephrology fellowship at UCLA in 1972. He has been the Medical Director of Acute Dialysis at Santa Barbara Cottage Hospital from 1984 to present. He has done 131 teaching lectures at this hospital including topics such as management of malignant hypertension, renal management of toxic shock syndrome, and NSAID drug-induced renal failure. Dr. Fisher was voted by the medical residents the outstanding teacher of the year on 1988. He is active in promoting well-being among renal patients and educating them on care options.”

Dr. Fisher, the floor (er, keyboard) is yours:

“Each patient is unique. A teenager will have different issues than a professor in his fifties, or an elderly diabetic lady whose understanding of English is limited. Therefore, the only effective way to deal with non-compliance is to understand the issues that will interfere with the learning curve for a patient and then customize the lesson plan for the specific needs. The goal is to prevent major non-compliance by initiating a program of education where the patient and family learn why it is critical to make the sacrifice and are motivated to follow doctor’s orders.

The patient will gradually feel better over time after just having started dialysis and that is when the teaching really begins. If the patient is a transplant candidate, discussion of how to get a kidney is uplifting and sets the stage for the need to follow the prescription, no matter how difficult.

The truth is this is a difficult challenge because of the complex nature of kidney disease and the human mind.  I have found that by immediately presenting the possibility for a kidney transplant while also explaining why the need for a strict diet and appropriate fluid restriction, people begin to see a way out of their predicament, spirits soar, and their inner source of strength takes over.  Hope inspires people to find the how to overcome the most daunting challenges.

Here is a synopsis of a recent patient care meeting with a 22 year -old, father of 2 who has been on hemodialysis for 5 years. He is on the transplant list and could be called at any time. If he were called tomorrow, he would be rejected because his parathyroid hormone level (PTH) is ten times above the target number.

He appeared at a patient care meeting, attended by our full staff. When we reminded him that his PTH level was 2000 and that we had been aiming for 200 he was unfazed. Then I explained to him again that even though he felt well, at any time he might suffer from severe bone pain from a disease which is silent even though it is damaging the bones and every organ system. I discovered that he works five days a week despite having dialysis treatments three times in a week. His mother-in-law prepares his lunch every day which consists of a half of a chicken which provides high quality protein and with it an enormous amount of phosphorus. He also failed to take a drug called Sensipar which lowers PTH.

He has felt well, looks muscular, and rather healthy, so in his mind why fix it if it doesn’t seem broken?  I must have finally reached him when I told him what likely happening to his bones and other organs. The most powerful argument that I presented was that he was so close to being called for a kidney transplant, his ticket to a normal life, one where he could eat and drink that things he loved the most.

The bell rang in his mind. He asked questions, took notes, made an appointment to see me to further discuss kidney transplant, his diet and medicines. The social worker connected with him as did the dietician who was going to talk to the mother-in-law about reducing phosphorus in the diet and placing his pills in an organizer. He left with more knowledge and hope that if he talk (sic) ownership of his diet, he would soon receive that kidney transplant that would change his life forever.”

When I was a high school English teacher in New York City a million years ago – or so it seems – my feeling was that you have to meet the student at whatever level they are and start their education from there. I carried that feeling with me into my CKD Awareness Advocacy. It seems Dr. Fisher does, too. As CKD patients, we are each unique.

That’s one of the many and varied reasons I cover so many different topics and often revisit a topic several years later. Just as with my high school students, CKD patients may not be ready to hear medical advances or suggestions to make living with CKD easier the first, second, third, or even 99^th time they hear – or read – it. They may gloss over it when it’s presented one way, but glom onto it when presented another.

Just in case you’re wondering how Dr. Fisher knows what a patient feels like, this is from his website at http://www.michaelfishermd.com/:

“I suddenly became a patient myself and came face-to-face with the idea that I was no longer a part of the ‘temporarily healthy.’ Walking in the slippers of my patients allowed me to more fully understand the challenges they faced and the courage that they found to overcome them….”

Although not a renal patient, he could see for himself just how brave you need to be to listen, to comply, to ask questions, to make suggestions as a patient who is probably scared out of your mind with your diagnose to begin with.

Here’s to all of us: the nephrologists, renal nutritionists, phlebotomists, schedulers, and the patients themselves. May this be your month for learning all you can about Chronic Kidney Disease.

Until next week,

Keep living your life!

My Vocabulary’s Expanding

I learned a new word! It’s gastroparesis. I learned it from the Facebook Chronic Kidney Disease support pages. What does it mean? According to the American Heritage Medical Dictionary, it means:

“A disorder characterized by delayed movement of food from the stomach into the small intestine because of impaired stomach motility, resulting in nausea, vomiting, and a feeling of fullness.”

Wait a minute; I forgot to tell you the winners of the Birthday Book Giveaway Contest:

Pamela Thacker’s copy of SlowItDownCKD 2016 is on the way to her. Donna Steely-Arnold, I will be only too glad to send out your copy of The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, as soon as you email your address to me. Catherine Lombard (Forgive me for referring to you as Carole; she was a famous actress back in the ‘30s.), your prize of SlowItDownCKD 2015 is also on its way to you. Congratulations to each of you on being the first three readers to comment about last week’s blog.

Okey-dokey, back to business. Of course you’re eager to know what gastroparesis has to do with Chronic Kidney Disease. Well, I am anyway.

This is from Healthline at https://www.healthline.com/health/type-2-diabetes/gastroparesis#risk-factors:

“Women with diabetes have a high risk for developing gastroparesis. Other conditions can compound your risk of developing the disorder, including previous abdominal surgeries or a history of eating disorders.

Diseases and conditions other than diabetes can cause gastroparesis, such as:

• viral infections
• acid reflux disease
• smooth muscle disorders

Other illnesses can cause gastroparesis symptoms, including:

• Parkinson’s disease
• chronic pancreatitis
• cystic fibrosis
• kidney disease
• Turner’s syndrome”

Right off the bat we can see a connection… diabetes. Remember that diabetes is the leading cause of CKD. Now look toward the bottom of this incomplete list of risk factors…kidney disease. Uh-oh.

I jumped right over to the MayoClinic at https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787 for an explanation:

“Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse.”

You remembered! Yes, high blood pressure is the second most common cause of CKD. Usually if you have hypertension, you take medication to control it. Sometimes, you take the same medication to help control your CKD even if you don’t have hbp.

According to WebMD at https://www.webmd.com/a-to-z-guides/tc/chronic-kidney-disease-medications, the following medications which are usually prescribed if you have hbp may also be prescribed if you have CKD with or without high blood pressure:

“ACE inhibitors and ARBs. These may be used if you have protein in your urine (proteinuria) or have heart failure. Regular blood tests are required to make sure that these medicines don’t raise potassium levels (hyperkalemia) or make kidney function worse.”

I still wasn’t satisfied that I understood how the CKD and gastroparesis are connected so I delved further. The Cleveland Clinic at https://health.clevelandclinic.org/2015/09/gastroparesis-know-the-risk-factors-for-this-mysterious-stomach-condition/ was a bit helpful:

“If you have diabetes, gastroparesis can cause it to be poorly controlled. Severe gastroparesis makes it difficult to manage your blood sugar.”

The American Diabetes Association at http://www.diabetes.org/living-with-diabetes/complications/gastroparesis.html further explains:

“The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged or stops working, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Just as with other types of neuropathy, diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.”

Maybe we need to understand why we have to manage our blood sugar in the first place.

“Blood sugar, or blood glucose, is sugar that the bloodstream carries to all the cells in the body to supply energy. Blood sugar or blood glucose measurements represent the amount of sugar being transported in the blood during one instant.

The sugar comes from the food we eat. The human body regulates blood glucose levels so that they are neither too high nor too low. The blood’s internal environment must remain stable for the body to function. This balance is known as homeostasis.”

Thank you for that information, MedicalNewsToday at https://www.medicalnewstoday.com/articles/249413.php. Diabetes is a condition in which your blood sugar is too high… and it can be one of many causes of gastroparesis.

Apparently, gastroparesis is of more concern if you are on dialysis. I know, define dialysis. Let’s take a look at the definition MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=2980 offers.

“The process of removing waste products and excess fluid from the body. Dialysis is necessary when the kidneys are not able to adequately filter the blood.”

And how does gastroparesis affect dialysis patients? Dr. William F. Finn, Professor of Medicine, University of North Carolina School of Medicine; Attending Physician, University of North Carolina Hospitals, Chapel Hill explained during an interview. He used terms that we, as laypeople, can readily understand.

“It has been known for many years that as patients develop progressively severe CKD, their condition may be complicated by nutritional deficiency and even overt malnutrition due to the gradual loss of appetite and inadequate caloric and protein intake…. Indeed, there is evidence that the intake of calories, including protein, decreases as renal insufficiency advances…. As a consequence, in patients with advanced CKD and in those treated with chronic hemodialysis or peritoneal dialysis, there is a high prevalence of what is referred to as “protein-energy malnutrition.” This condition may involve up to 40% or more of the patients and is an important issue because there is a strong association between malnutrition and increased risk of morbidity and mortality…. In fact, in patients undergoing dialysis, “undernutrition” is one of the most common risk factors for adverse cardiovascular events and death…. It has been demonstrated repeatedly and consistently that a low serum albumin level and decreased protein intake are strongly associated with increased mortality in patients with CKD….”

You can read the entire interview on Medscape at https://www.medscape.org/viewarticle/545157.

Until next week,

Keep living your life!

Smoke Gets In Your Hair

Last weekend I was in Las Vegas renewing my vows to Bear as my brother and sister-in-law renewed their vows to each other. It was their 50th year of marriage, our 5th. I listened to what they had to say to each other during the ceremony and realized that was what I would have said to Bear on our 50th, if we were young enough to be able to count on having a 50th. And then I began to wonder how many people do reach this milestone in their lives.

More than the ceremony, it was the smoke in the casinos, the restaurants, the shops, and the cabs that got me to thinking about this. Even our non-smoking rooms had the scent of cigarettes. I know how much harm smoking can do to my kidneys, but what was this second hand smoke doing to them? If it clung to our hair and clothes, what else was it doing to us?

The very minute I was told I have CKD, I stopped the social smoking I had been doing. I would be surprised if I smoked a whole pack of cigarettes each month back then. But I wasn’t taking any chances on not raising my GFR. It was 39% at diagnose, so the smoking had to stop. Yet, it wasn’t until this past weekend that I became concerned about second hand smoke.

It appears that I’m not the only one concerned about second hand smoke. The National Kidney Fund (NKD) at https://www.kidney.org/blog/staying-healthy/second-hand-smoke-may-be-harmful-kidneys offers the following:

“Secondhand smoking was defined as living with at least 1 person who smoked, or having an elevated level of cotinine (a breakdown product of nicotine) in their blood. The researchers found that active smoking was associated with slightly lower kidney function and higher amounts of protein in the urine. Interestingly, secondhand smoke exposure was also associated with slightly lower kidney function in this study even after taking [into] account differences in age, sex, weight, demographics and parental education level. Differences in kidney function observed in the study were relatively small, but these small differences could have important effects on risk of developing hypertension and chronic kidney disease.”

What makes it worse is that hypertension, or high blood pressure, is one of the two leading causes of CKD. So second hand smoke could lead to CKD itself and/or one of the leading causes of CKD. Either way, it sounds like a losing proposition to me.

Of course, I needed to know more about cotinine. The Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/biomonitoring/Cotinine_FactSheet.html was able to help me out here:

“Cotinine is a product formed after the chemical nicotine enters the body. Nicotine is a chemical found in tobacco products, including cigarettes and chewing tobacco. Measuring cotinine in people’s blood is the most reliable way to determine exposure to nicotine for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS). Measuring cotinine is preferred to measuring nicotine because cotinine remains in the body longer.

How People Are Exposed to Cotinine

Nicotine enters people’s bodies when they smoke or chew tobacco. When exposed to ETS from nearby smokers, smaller amounts of nicotine enter the body of the nonsmoker. Workers who harvest tobacco and produce tobacco products can also be exposed through their skin.”

While I don’t usually write about younger people and Chronic Kidney Disease, this quote from the Johns Hopkins Bloomberg School of Public Health at https://www.jhsph.edu/news/news-releases/2013/navas-acien-smoking-may-impact-kidney-function-among-adolescents.html caught my eye:

“’Tobacco use and exposure to secondhand tobacco smoke are major health problems for adolescents, resulting in short-term and long-term adverse health effects,’ said Ana Navas-Acien, MD, PhD, senior author of the study and an associate professor with the Bloomberg School’s Department of Environmental Health Sciences. ‘In this nationally representative sample of U.S. adolescents, exposure to tobacco, including secondhand smoke and active smoking, was associated with lower estimated glomerular filtration rates—a common measure of how well the kidneys are working. In addition, we found a modest but positive association between serum cotinine concentrations, a biomarker of tobacco exposure, among first-morning albumin to creatinine ratio. These findings further support the conclusion that tobacco smoke may damage the kidneys.’”

Lower estimated glomerular filtration rates???? No, thank you. I rarely go to casinos or any other place that allows smoking for that matter. I just don’t like the odor. Now I have a much more important reason to avoid such places.

Switching topics here. Something else I rarely mention is CKD cookbooks, probably because I don’t cook that often and firmly believe CKD patients need to eat according to their lab results. Months ago I received one such book in the mail and carefully explained to the author’s representatives that I don’t review CKD cookbooks on the blog. It’s an attractive book and always caught my eye just lying there on the kitchen counter for the last several months. During one of those in-the-house-trying-to-recoup-my-energy days after we got back from Las Vegas, I did the logical thing and picked it up to read.

Susan Zogheib, a registered dietitian with a Master’s in Health Science fulfilled my CKD cookbook dreams in her The Renal Diet Cook for the Newly Diagnosed in that she suggested repeatedly that we, as CKD patients, must work on our diets with our doctors and/or renal dietitians, especially if we have high blood pressure or diabetes. I also like that she clearly made the point that you have to take into account the stage of your CKD, your labs, your concurrent medical problems, and more. This, while including fairly easy recipes for some good looking meals. I never thought I’d like a cookbook. Well, there was the Betty Crocker one pre-CKD when I was a young bride still in college.

My 71st birthday is Friday. Naturally that means it’s time for a book giveaway. My birthday equals your gift. Three is my favorite number, so the first three book giveaway virgins (haven’t won a book before) to offer another bit of information about second hand smoke or CKD cookbooks win one of my CKD books. Sounds fair to me.

Until next week,
Keep living your life!

Banting

I can just about hear you asking, “What in heaven’s name is banting?” You know I like to read Victorian murder mysteries, right? The one I’m reading now is Murder on the Minneapolis by Anita Davison. In it, she has one character discuss a method of losing weight by strict eating limitations publicized by William Banting. I find it amusing that he was a celebrated undertaker, not that this had anything to do with the dietary restrictions.

According to Wikipedia – which is open to public editing –

“In 1863, Banting wrote a booklet called Letter on Corpulence, Addressed to the Public… which contained the particular plan for the diet he followed. It was written as an open letter in the form of a personal testimonial. Banting accounted all of his unsuccessful fasts, diets, spa and exercise regimens in his past, then described the dietary change which finally had worked for him, following the advice of a physician. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, saccharine matter, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets…. Initially, he published the booklet at his personal expense. The self-published edition was so popular that he determined to sell it to the general public. The third and later editions were published by Harrison, London. Banting’s booklet remains in print as of 2007, and is still available on-line. …He undertook his dietary changes at the suggestion of Soho Square physician Dr. William Harvey, who in turn had learnt of this type of diet, but in the context of diabetes management, from attending lectures in Paris by Claude Bernard.”

It’s starting to sound familiar, isn’t it? As Chronic Kidney Disease patients, and certainly if you’re also diabetic, we’re often told by our doctors to lose weight.

Have you heard of the Keto Diet? As a matter of fact, the app for that was included in last week’s blog. That’s one way to lose weight, but it’s too protein and fat heavy for CKD patients. Another way is to count carbohydrates or Bant.

I find it fascinating how the things I’m interested in seem to dovetail sometimes. For example, Chronic Kidney Disease, losing weight, Victorian murder mysteries, and banting.

I know. We need to back track a bit. Let’s start with carbohydrates. What are they anyway? According to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/carbohydrate , they are:

“any of various neutral compounds of carbon, hydrogen, and oxygen (such as sugars, starches, and celluloses) most of which are formed by green plants and which constitute a major class of animal foods”

Here’s a list of carbohydrates from The American Diabetes Association at http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html:

• grains like rice, oatmeal, and barley
• grain-based foods like bread, cereal, pasta, and crackers
• starchy vegetables like potatoes, peas and corn
• fruit and juice
• milk and yogurt
• dried beans like pinto beans and soy products like veggie burgers
• sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips

Now that we have a definition and examples of carbohydrates, why limit them? The MayoClinic at https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/low-carb-diet/art-20045831 has that one covered.

“Your body uses carbohydrates as its main fuel source. Complex carbohydrates (starches) are broken down into simple sugars during digestion. They’re then absorbed into your bloodstream, where they’re known as blood sugar (glucose). In general, natural complex carbohydrates are digested more slowly and they have less effect on blood sugar. Natural complex carbohydrates provide bulk and serve other body functions beyond fuel.

Rising levels of blood sugar trigger the body to release insulin. Insulin helps glucose enter your body’s cells. Some glucose is used by your body for energy, fueling all of your activities, whether it’s going for a jog or simply breathing. Extra glucose is usually stored in your liver, muscles and other cells for later use or is converted to fat.

The idea behind the low-carb diet is that decreasing carbs lowers insulin levels, which causes the body to burn stored fat for energy and ultimately leads to weight loss.”

Wait a minute. What are these “complex carbohydrates” they mention? This is what I found on MedlinePlus at https://medlineplus.gov/ency/imagepages/19529.htm:

“Complex carbohydrate foods provide vitamins, minerals, and fiber that are important to the health of an individual. The majority of carbohydrates should come from complex carbohydrates (starches) and naturally occurring sugars, rather than processed or refined sugars, which do not have the vitamins, minerals, and fiber found in complex and natural carbohydrates. Refined sugars are often called ‘empty calories’ because they have little to no nutritional value.”

Got it. Complex carbohydrates provide what our bodies need, but too much of them can raise our blood glucose levels or turn to fat.

If there are complex carbohydrates, does that mean there are simple ones, too? Healthline (Thank you again for including this blog among the six best kidney blogs of 2016 & 2017, Healthline.) at https://www.healthline.com/health/food-nutrition/simple-carbohydrates-complex-carbohydrates#2 was succinct in describing these:

“Carbohydrates are made up of three components: fiber, starch, and sugar. Fiber and starch are complex carbs, while sugar is a simple carb. Depending on how much of each of these is found in a food determines its nutrient quality.”

Just in case you’re not sure which foods to avoid, Everyday Health at https://www.everydayhealth.com/diet-nutrition/diet/good-carbs-bad-carbs/ has a beginner’s list for us:

• Soda
• Candy
• Cookies
• Pastries and desserts
• Sweetened beverages, such as lemonade or iced tea
• Energy drinks
• Ice cream

Before you ask, fruits and low fat or nonfat milk do contain simple carbohydrates, but these are healthy for you. You still have to include the milk in your phosphorous count on the renal diet.

This is amazing! Some blogs just flow while I get to the point of just about tearing my hair out to write others (Hey, stress is not good for CKD.) This one flowed.

Congratulations to Christine Barnard from South Africa. She was the first person to let me know she’d read last week’s blog. Instead of winning just one book, she won four: SlowItDownCKD 2012; The Book of Blog: Moderate Stage Chronic Kidney Disease, Part 2; SlowItDownCKD 2015; and SlowItDownCKD 2016. Why? Because she mentioned that there are few sources of Chronic Kidney Disease information in South Africa. Christine, please be sure to email me your physical address. Use SlowItDownCKD@gmail.com.

Until next week,
Keep living your life!

Apps Again

Last week I mentioned kidney diet apps and that I suspected the ones I wrote about in SlowItDownCKD 2016 may be outdated or not exist anymore. Let’s jump right in before I need to get up from the computer to walk around for a while. I’ve been working on another book and been sitting here a long time. We all know that’s not good for us.

This is from SlowItDownCKD 2016:

“According to GCFLearnFree.org – a program of Goodwill Community Foundation® and Goodwill Industries of Eastern NC Inc.® (GIENC®) – at http://www.gcflearnfree.org/computerbasics/understanding-applications/1/,

‘Simply put, an app is a type of software that allows you to perform specific tasks. Applications for desktop or laptop computers are sometimes called desktop applications, while those for mobile devices are called mobile apps.’

During an internet search, I found that NephCure which provides ‘detailed information about the diseases that cause Nephrotic Syndrome (NS) and Focal Segmental Glomerulosclerosis (FSGS)’ (and was one of the first organizations to interview me about CKD, by the way) – at http://nephcure.org/livingwithkidneydisease/managing-your-care/kidney-health-tracking-tools/helpful-mobile-apps/ was way ahead of me in discussing apps. This is what’s on their website:

Diet and Nutrition Apps

• KidneyAPPetite – Gives daily summaries of key nutrients for kidney health, check the nutritional value of foods before you eat it, and provides printable summaries to refer to. Great for patients on a renal diet! Cost: Free, Device: iOS

• Pocket Dietitian – Created by a Nephrologist, allows you to choose your health conditions and dietary restrictions to see recommended foods as well as keep track of what you have eaten. You can even see your past nutrition in graph form. Cost: Free, Device: iOS and Android

• My Food Coach – is designed to help you understand and manage all of your nutritional requirements. This app offers personalized nutrition information, recipes and meal plans. Cost: Free, Device: iOS and Android

• HealthyOut – Enables you to search and order nearby healthy food and browse for healthy options while out to eat. You can even choose a specific diet such as gluten free! Cost: Free, Device: iOS and Android

• Restaurant Nutrition – Allows you to search restaurants and look at nutritional values, locate nearby restaurants, and keep a food journal. The Restaurant Nutrition application shows nutritional information of restaurant foods. Cost: Free, Device: iOS and Android

While I could easily go to most of the apps’ websites by clicking on the name while I held down the control button, this was not the case with Pocket Dietician. I was able to find it and lots of descriptive information about it in the Google Play store, but kept getting the message that I had no devices. The help function on the site was not helpful.

What about My Food Coach? It has an extra feature that my favorite lacked: a warning when a recipe would bring you over your renal diet limits. It’s recipe oriented, which doesn’t endear it to me since I like to experiment cooking my big five ounces of protein daily with my three different size servings of different fruits that are on my renal diet. I also avoid red meat.

HealthyOut, while not specifically for CKD, does have a function for the Mediterranean diet which is more often than not recommended for us. I thought this was a hoot since it never occurred to me that you can check restaurant foods by the restaurant name. I am adding this app to my iPhone.”

It looks like I was wrong. Most of these are still available. Unfortunately KidneyDiet, my all-time favorite, is no more. Neither is Restaurant Nutrition. But let’s see what other apps are available for us.

If sodium (salt) is a problem for you, there’s an app for that. According to For Your Kidney at http://foryourkidney.com/en/2016/01/04/5-best-apps-kidney-health/:

“Sodium One is a user friendly Sodium Counter app. Patients with High Blood Pressure or Chronic Kidney Disease can benefit from this app a lot. The App allows you to track water intake as well as exercise and weight history. The main focus of Sodium One however, is to manage your daily sodium allowance. The tracking is actually very accurate when it comes to calorie counts. A great extra is that this app does not require an internet connection.”
This is $0.99 and only available in IOS. That’s Apple.

I do want to mention there are apps specifically for those on dialysis. I have not included them in this blog, although NephCure did include KidneyAPPetite. An internet search for ‘dialysis apps,’ or something along that line, will help you find them.

I’ve tried a few other apps that were not dedicated to those with CKD and found moderate success with them. One is Keto, which bills itself as “Stupid Simple”… and it is. However, it’s limited to carbs, fat, and protein. You’re on your own for phosphorous, potassium, and sodium. Oh, KidneyDiet, come back! The nice part of Keto is that you can scan barcodes (Is that really one word these days?) and add your own foods and meals IF you upgrade from the basic free version. Their website at https://play.google.com/store/apps/details?id=com.venninteractive.ssketo  tells you this is only available for Android, but I have it on my IOS device.

Under Armour’s MyFitnessPal at https://freepps.top/apps/health-fitness/calorie-counter-myfitnesspal has been around for a while. Again, while this is not perfect for those with CKD, it is a great help. I like that you can set goals and request reminders about your goal, as well as add foods. Of course, Premium offers you a lot more… and charges you accordingly. Articles about exercise and weight pop up, too. And then there are recipes. Again, it doesn’t do the whole trick, although it does count potassium, protein, sodium and calories . What’s missing is phosphorous. The bonuses are carb, fat (by type, no less) cholesterol, fiber, sugar, vitamins A & C, calcium, and iron counters. This is also a free Apple app.

Lose It! at https://www.loseit.com/ is not as comprehensive for the CKD patient. It allows you to track fat, carbs, protein, and calories. Here, again, you can set your goals. You can even take pictures of your food to track it. However, I find I want something more CKD oriented with potassium, phosphorous, and sodium counters included. This looks like it may be a good app for weight loss, but I’m wondering how much help it is for the CKD patient.. This is a free Android app.

At this point, I stopped checking out apps. There are so many more in just a little over the year I last looked at apps. But they’re not quite for the likes of us. It looks like MyFitnessPal is the closest we can come to a kidney app, unless you’re on dialysis. Then I’d go for KidneyAPPetite.

Before I go, here’s a shameless plug for my new book. It’s Sort of Dark Places, available on Amazon and is not CKD related at all. I’ve fictionalized the stories people have told me about their most difficult times. I found it cathartic to write even though these are not my stories. Advance readers have told me they did, too. Give it a try.

In honor of the great Dr. Martin Luther King’s birthday, the first person who hasn’t already won a free book that lets me know they’ve read today’s blog wins a copy of SlowItDownCKD 2012.

Until next week,
Keep living your life!

The Elusive Diet Plan

I find it amazing, absolutely amazing, how limited my diet has become in the last decade. It’s not just the renal diet, or even the renal diet with the prediabetes way of eating added. I had some testing done and found ‘food sensitivities’ as well as out and out allergies that needed attention. And now? It turns out I have Irritable Bowel Syndrome or IBS, which requires I change my eating habits yet again.

When I was first diagnosed with Chronic Kidney Disease, I was introduced to the Northern Arizona Council on Renal Nutrition Diet. I reproduced that in SlowItDownCKD 2015 and here it is again…still crooked. (Can I blame that on macular degeneration? No? Oh well.) Unfortunately for me, I can’t just “limit,” which is what the second column on each page suggests, so I have to avoid. One exception leads to a second and then a third, so to me, “limit” means Do.not.eat.

I understood I had to limit my phosphorous, potassium, protein, and sodium to preserve my kidney function and was scared enough by my diagnosis to follow this diet religiously, recording the amounts I ate in a little notebook. Nowadays, there are apps that will help you track these electrolytes. I listed a few in SlowItDownCKD 2016, but that list surely needs updating a full year or more later. Perhaps I should write about that next week.

Back to the renal diet. This meant changes for me, lots of them. My staple – bread – would now be limited, as would potatoes. I am so the grandchild of my grandfather, a Russian miller. I am also lactose intolerant so those limitations were not a problem since I didn’t eat dairy in the first place. The measuring is what I had to get used to in all categories… and I did, to the point where I can eye measure just about all the foods.

Then came the pre-diabetes dietary changes. My A1C was continually elevated. I didn’t want to develop diabetes, so I knew this test that measures blood glucose had to start registering lower readings. Hmmm, I was able to adhere to the renal diet. I’ll just modify that with these new changes, I thought.

Writing The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2  helped me  understand how to do this:

“Ahh! So all carbohydrates, whether from starches or sugars break down into sugar glucose. This is starting to sound familiar. When I brought my pre-diabetes to the nutritionist at my nephrologist’s office, she gave me quite a bit of information and a handout from DCE, a dietetic practice group of the American Dietetic Association. Did you know that starchy vegetables, fruits, juices and milk also contain carbohydrates? It hadn’t occurred to me…. The Mayo Clinic has a good diet plan for diabetes, but it won’t work for Chronic Kidney Disease patients as it is. For example, whole wheat flour raises your blood glucose less than white flour, but has too much phosphorous for us, so we are warned to avoid it. Yoghurt, cheese, beans, and nuts are no-nos on my renal diet, but are often recommended in diabetes diets.”

My diet became noticeably more limited. But I was still willing to work on it. I remembered that CKD can cause diabetes, just as diabetes can cause CKD. I had enough trouble without diabetes, thank you very much.

Boom! Enter food allergies and sensitivities. Lettuce? I was living on salads at this point, but no more unless I could get a spinach salad. I wouldn’t necessarily miss lima beans, brazil nuts, buckwheat, celery, cherries, corn, cucumbers, lamb (ugh), oranges, red raspberries, and watermelon. Whine: some of my staples were on the list, too: rice, shellfish, vanilla, and yeast. Oh yeah, the little bit of mustard I cheatingly ate every once in a while was on the allergy list, too. *sigh*

It took quite a bit of telling myself I could do this and referring to this NEW list constantly to get my now three purpose diet under control. It was especially hard during sad times in my life.

As happens (thank goodness), the sad times with their emotional eating passed and I could get back to doing what my body needed. So why was I feeling so unwell? Was it a UTI? An ulcer? Something worse?

Welcome to eating modification number four. It’s Irritated Bowel Syndrome… and stress can be the source. The stress was caused by sadness in my case: my brother’s death, a bad outcome for testing on another family member, a third one’s hospitalization, a friend’s death, another’s illness. Now that my sad times were ended, at least temporarily, I had to deal with the aftermath.

While the disease is self-explanatory and the causes apparent, I still needed to know how to treat it. The MayoClinic at https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064 was helpful, but also informed me that each person with IBS may need different treatments and that there were different kinds of IBS and different tests for each kind. This is the information I found most helpful, although two more of my staples – broccoli and cauliflower – are no longer available to me.

“Your doctor might suggest that you eliminate from your diet:

• High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli and cauliflower.
• Gluten. Research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley and rye) even if they don’t have celiac disease.
• FODMAPs. Some people are sensitive to certain carbohydrates such as fructose, fructans, lactose and others, known as FODMAPs — fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are found in certain grains, vegetables, fruits and dairy products. Your IBS symptoms might ease if you follow a strict low-FODMAP diet and then reintroduce foods one at a time.”

I’m laughing right now. This could not get more complicated. Uh, maybe I shouldn’t say that. Don’t want to draw attention from the diet gods, do I? At any rate, I see this as a challenge. Until I get tired, that is. Then it’s a formidable task.

Until next week,
Keep living your life!

To Eat It Or Not To Eat It

Merry Christmas… and for tomorrow, Happy Kwaanza. Oh, all right, let’s throw in Happy Chanukah although that’s already passed this year. What all these celebrations – yes, and New Year’s Eve, too – have in common is food. And food has potassium and phosphorous in it. Those are two of the electrolytes that Chronic Kidney Disease patients have to curtail.

Let’s backtrack a little bit and find out what these are. Each was included in the glossary of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

“Phosphorus: One of the electrolytes, works with calcium for bone formation, but too much can cause calcification where you don’t want it: joints, eyes, skin, and heart.

Potassium: One of the electrolytes, important because it counteracts sodium’s effect on blood pressure.”

Now, let’s see if we can get a bit more information about the ill effects of having too much of either one.

This is from SlowItDownCKD 2011:

“Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones.”

And potassium? SlowItDownCKD 2012 has the answer:

“Too much potassium can cause irregular heart beat and even heart attack. This can be the most immediate danger of not limiting your potassium.”

We all have limitations on these (as well as sodium and protein) based upon our latest blood and urine lab results. Since my lab results registered normal for both electrolytes, I have pretty generous daily limitations: potassium: 3000 mg; phosphorous: 800 mg. If you’re like me, the numbers didn’t mean much.

Let’s try this another way. My husband’s traditional family Christmas dinner consists of standing rib roast, sweet potatoes baked in orange juice with marshmallow topping, string bean casserole, dinner rolls, tea or coke, and apple pie. (I added salad so there would be something I could eat.)

We’ll need a list of high potassium and high phosphorous foods before we can to analyze the meal. Luckily, there is one for phosphorus in SlowItDownCKD 2015:

HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID

Beverages:
ale                                                    beer
chocolate drinks                           cocoa
drinks made with milk                dark colas
canned iced teas

Dairy Products:
cheese                                              cottage cheese

custard                                            ice cream

milk                                                 pudding

cream soups                                  yogurt

Protein:
carp                                                crayfish
beef liver                                       chicken liver
fish roe                                          organ meats
oysters                                           sardines

Vegetables:
dried beans and peas                  baked beans
black beans                                   chick peas
garbanzo beans                            kidney beans
lentils lima                                    northern beans
pork’n beans                                 split peas
soy beans

Other foods:
bran cereals                                brewer’s yeast
caramels                                      nuts
seeds                                            wheat germ
whole grain products

Now we need a list of high potassium foods. The National Kidney Foundation at https://www.kidney.org/atoz/content/potassium was helpful here. They also have a list for “Other Foods.”:

Fruits and Vegetables:
Apricot, raw (2 medium) dried (5 halves)    Acorn Squash
Avocado (¼ whole)                                           Artichoke
Banana (½ whole)                                             Bamboo Shoots
Cantaloupe                                                          Baked Beans
Dates (5 whole)                                                  Butternut Squash
Dried fruits                                                          Refried Beans
Figs, dried                                                            Beets, fresh

then boiled
Grapefruit Juice                                                  Black Beans
Honeydew                                                            Broccoli, cooked
Kiwi (1 medium)                                                 Brussels Sprouts
Mango(1 medium)                                             Chinese Cabbage
Nectarine(1 medium)                                        Carrots, raw
Orange(1 medium)                                             Dried Beans and Peas
Orange Juice                                                       Greens, except Kale
Papaya (½ whole)                                              Hubbard Squash
Pomegranate (1 whole)                                      Kohlrabi
Pomegranate Juice                                             Lentils
Prunes                                                                    Legumes
Prune Juice                                                           White Mushrooms,

cooked (½ cup)
Raisins                                                                    Okra
Parsnips

Potatoes, white and sweet
Pumpkin  

Rutabagas
Spinach, cooked
Tomatoes/Tomato products
Vegetable Juices

(Looks like my formatting is on vacation. Sorry about that, folks.)

Okay, here comes the hard part. Let’s scan the lists to see which of the foods in the dinner my husband craved are on this list. I see canned iced teas, dark colas, orange juice, and sweet potatoes. The potassium and phosphorous in one serving (?) of each is as follows:

food                                  potassium                                    phosphorous
canned iced tea                    18 mg.                                            32 mg.
dark cola                               44 mg.                                            62 mg.
orange juice                       235 mg.                                            40 mg.
sweet potatoes                   542 mg.                                            81 mg.
totals                                   839 mg.                                          215 mg.

Doesn’t look bad at all, does it? But it’s all guesswork. Is your liquid serving an ounce? Eight ounces? What about the juice in the sweet potato dish? Surely it’s not just one ounce. And maybe not eight depending upon how much of the juice is in the size portion of the sweet potato dish you had. Maybe you had seconds. Same for the sweet potatoes.

Since this is not at all a precise science, you’re better off practicing more limiting rather than less. I’m not a doctor as I keep mentioning, but I don’t see anything wrong with a just a taste or a small serving of each.

Of course, I’m not a fan of soda or any canned drink, so I get a pass on that. If you’re not sure how much of what you can eat on a daily basis, make an appointment with your renal dietician after the holidays and just enjoy today’s Christmas meal.

Hey, that doesn’t give you free reign to eat all those things expressly not on your renal diet. I know if I decide to eat some of the standing rib roast, I’m still limited to five ounces of protein a day… including the hardboiled egg I had for breakfast.

Lay.off.the.salt.shaker.too. Sodium is not your friend if you have CKD. Ask your hostess if he or she has Mrs. Dash’s seasoning or garlic powder (NOT SALT) should you be asked if you’d like the salt. Oh, was the green bean casserole made with canned, creamy soup? That’s going to up the salt content. Just another thing to be aware of when salivating at the sight of the scrumptious meal in front of you today.

I’d go really light on the hot chocolate, too, if you were planning on having some. The message here is to enjoy, but limit, those high phosphorous and potassium holiday foods you really crave.

Until next week (and next year),
Keep living your life!

Giving Thanks

Thursday is the American Thanksgiving. This is what we were taught in grade school when I was a child:

“In 1621, the Plymouth colonists and Wampanoag Indians shared an autumn harvest feast that is acknowledged today as one of the first Thanksgiving celebrations in the colonies. For more than two centuries, days of thanksgiving were celebrated by individual colonies and states. It wasn’t until 1863, in the midst of the Civil War, that President Abraham Lincoln proclaimed a national Thanksgiving Day to be held each November.”

Thank you History.com at http://www.history.com/topics/thanksgiving/history-of-thanksgiving for that information.

Thanksgiving is celebrated in one form or another all over the world since it is basically a celebration of the harvest. For example, Canadians celebrate theirs on the second Monday of October since the harvest is earlier there. Then there’s China’s Mid-Autumn Moon Festival, Korea’s Chuseok, the Liberian Thanksgiving, Ghana’s Homowo Festival, and the Jewish Sukkot.

One thing all the different forms of Thanksgiving worldwide have in common is the delicious danger of overeating… and that is not good for our kidneys (no matter how scrumptious the food is). This report – which deals with just that topic – popped up on my news feed the other day. The source is Baylor College of Medicine at https://www.bcm.edu/news/kidney/overeating-holidays-bad-for-kidneys.

“‘The body absorbs nutrients from the gut and then the liver metabolizes them. Whatever is left that can’t be used by the body is excreted by the kidneys,” said Mandayam, associate professor of medicine in the section of nephrology. “The more you eat, the more you deliver to your kidneys to excrete, so eating a lot of substances that are very high in proteins or toxins can put a strain on your kidneys because they now have to handle the excess calories, toxins or proteins you’ve eaten.

During holidays like Thanksgiving, people tend to eat very heavy meals with lots of proteins and carbohydrates, and this can impact not only kidney function, but also liver, pancreas and cardiac function,’ Mandayam said.

‘When you consume carbohydrates, the body will use what is necessary for immediate energy release but any extra carbohydrates are converted into fat and stored underneath the skin and in the muscles and the liver. Similarly, when you eat a lot of fat, if the fat can’t immediately be converted into energy-producing adenosine triphosphate, then all of the fat will be stored in various fat deposits in the body,’ Mandayam explained.

‘The building up of fat inside your liver can lead to liver failure or cirrhosis, and fat inside your blood vessels can lead to heart attacks. Additionally, eating a lot of protein that your body can’t metabolize can lead to an increase in blood urea nitrogen, which adds stress on kidneys because they have to work harder to excrete this.

It is especially important for people with chronic kidney disease and kidney stones to not overeat,’ he said.

‘For people with kidney disease, even eating normal amounts of food puts stress on their kidneys,’ he said. ‘If you consume large amounts of carbohydrates, protein or fat the stress on an overworked, half functioning kidney will get even worse and can accelerate your kidney dysfunction.’”

It always made sense to me that overeating is detrimental to your health, but I was thinking in terms of obesity which could lead to diabetes which, in turn, could lead to CKD. I’ve also noticed that since I read this report, I’ve been eating less without making an effort. For years, I’ve been struggling with my weight and all I had to do is read this report????? Life is weird.

Let’s talk about carbohydrates for a minute. I instantly think of bread, all kinds of bread which is even weirder because I’ve been on a low carb diet for a while. I know, you thought of cakes and pies, didn’t you? Did you know that fruits and vegetables contain carbohydrates, too?

Hmmm, that was a revelation to me the first time I saw those charts. Now I’m wondering about excess calories. I’m limited to 1200 a day and find that this is fine with me. Bear is larger, being both male and bigger than I am, so his calorie limitations are higher. Your renal dietician can tell you what your ideal calorie count per day is if you don’t know.

So, why limit calories? Renal Medical Associates at http://renalmed.com/wp-content/uploads/2015/08/Nutrition-and-the-CKD-diet.pdf explain this succinctly:

  Why being overweight matters and what you can do about it.

We used to think that those “few extra pounds” were just dead weight. We now know that those extra pounds work together to disrupt your body’s normal functioning-with the goal of making you gain more weight. That’s why losing weight is such a difficult task.

I’m back. It’s important to limit your calorie limit so that you don’t add those extra pounds. The extra pounds not only make it more difficult to lose weight, but can lead to obesity… which can lead to diabetes… which can lead to CKD. This is starting to sound familiar, isn’t it?

If you already have CKD, the extra pounds you gain without calorie restrictions make it more difficult for your poor, already overworked and struggling kidneys to do their jobs.

What are those jobs you ask? Let’s take a look at Verywell.com at https://www.verywell.com/kidney-functions-514154 ‘s answer:

• Prevent the Buildup of Waste Products – The kidneys function as an intricate filter, removing normal waste products of metabolism, as well as toxins from the body. In the process of removing toxins, the kidneys may be damaged   by these substances.
• Regulate Fluid – Through holding on to fluids when a person is dehydrated, or eliminating excess fluids, the kidneys control fluid balance in the body.
• Regulate Electrolytes – The kidneys play an important function in electrolyte balance in the body, regulating the levels of sodium, potassium, and phosphate. This maintaining of optimal levels of electrolytes is referred to as homeostasis – or equilibrium.
• Regulate Blood Pressure – Through the production of a hormone called renin, the kidneys play an important role in regulating blood pressure. Learn more about the renin-angiotensin system.
• Regulate Production of Red Blood Cells – The kidneys produce a hormone called erythropoietin which controls the production of red blood cells in the bone marrow.
• Bone Health – The kidneys produce an active form of vitamin D which keeps the bones healthy.

Hey, it’s Thanksgiving. You can enjoy the holiday meal without overeating.

Until next week,
Keep living your life!

Feed Me

Over the years, I’ve seen advertisements for food preparation services. You know the ones that cook your meals and deliver them weekly. I would approach the people offering the service to see what they could do with the renal diet. That was a deal killer right there.

All right, I figured. Maybe what I should be doing is finding a chef who is willing to work with kidney patients rather than ask existing food preparation services to accommodate just me. I even had one chef who agreed that this is a valuable service and something she wanted to do. I was excited. Then she simply stopped emailing and answering calls. That was a couple of years ago.

I sort of gave up… until I ran into an advertisement for Clarence’s food service. I figured it was worth it to try again and called him. It was.

I explained to Clarence that I don’t permit advertising on my blog, but I would like other Chronic Kidney Disease patients to see how they can make use of food preparation services such as his. He was kind enough to write this guest blog for us. I’m hoping that this inspires you to approach a chef in your area to ask him/her if he/she is willing to provide such a service. Of course, not all of us want to have someone else prepare our meals or want to spend the money to do so, so this is a blog for that portion of readers who do.

Meal Planning for Those with Kidney Disease.
Clarence Ferguson, RTSM, CMTA, NT

Understanding your kidney disease, or renal disease, is the first step in taking control of your health. While I am not a doctor, I have aligned myself with those whose specialize in CKD so that I can adjust meals accordingly. When you have kidney disease, your kidneys are no longer able to remove waste effectively from your body or to balance your fluids. The buildup of wastes can change the chemistry of your body causing some symptoms that you can feel, and others that you don’t.

With kidney diseases, the first symptoms you may have are ones that you won’t feel but that will show up in tests that your doctor orders. Common problems are high blood pressure, anemia and weakening bones. It is important to find a kidney doctor (also called a nephrologist). And once you have your doctor’s recommendation that’s where we come in and prepare your meal according to his or her recommendations.

Okay Clarence, we know that but how do we navigate healthy eating?

Here are some suggestions for you and what I prepare for clients who struggle with CKD.

Make sure these snacks are readily available:
1. Fruit: apples, grapes, tangerines or strawberries; dried cranberries or blueberries; or packaged fruit cups with diced     peaches, pears, pineapple, mandarin oranges or mixed fruit. Make sure they are organic.
2. Low- or no-sodium microwave popcorn.
3. Low-sodium crackers, pita chips or unsalted pretzels.
4. Pouches of tuna or chicken and a side of Vegainse (a dairy free option for mayonnaise).
5. Kidney-friendly nutrition bars or liquid supplements, such as the ones from ID life, since they meet these guidelines.

What we do at Fit Body Foods
1. Compare brands. Sodium and potassium levels can vary significantly from one brand to another.
2. Look for low-sodium labels on packaging. Stock up on the lowest sodium broths, stocks and condiments.
3. Choose fresh vegetables, or frozen or canned veggies with no added salt or sodium.
4. Use only 1/4 as much of the tomato sauce and canned tomatoes that a recipe calls for to limit potassium and sodium.
5. Don’t use canned fish or chicken with added salt. All fish is fresh, so we can control the sodium levels by rinsing to reduce the sodium. Try to limit use of canned goods in general.
6. Avoid baking and pancake mixes that have salt and baking powder added. Instead, make a kidney-friendly recipe from scratch.
7. Use sweet pickles instead of dill pickles and check for added salt.
8. Check cold and instant hot cereals for sodium amounts. Although oatmeal contains more phosphorus than some cereals, it may be okay one to two times a week if phosphorus is well-controlled.
9. Check the ingredients in vinegar. Some vinegars, such as seasoned rice vinegar, contain added salt and sugar.
10. Avoid store-bought sauces and gravies that have mystery ingredients in them. Make our own instead from real-food ingredients.
11. Use homemade soup recipes, such as Rotisserie Chicken Noodle Soup, instead of pre-made or canned soups. Some soups contain more than 800 mg sodium per serving.
12. Low – and reduced – sodium broth is great for use in cooking. We save the homemade broth from stewed or boiled chicken or beef.
13. Don’t trade sodium for potassium. Some products replace salt with potassium chloride.
14. Limit nuts, seeds and chocolate as they are high in potassium and phosphorus.

We prepare food weekly and deliver to our clients on Sundays. We take the worry out of meal prep, our meals start at $7.99 a meal, and we can accommodate most palates. We can be reached for orders at: info@coachclarence.com.

Below is a sample recipe:
Cucumber-Carrot Salad
Diet types: CKD non-dialysis, Dialysis, Diabetes
Portions: 4
Serving size: 1/2 cup
Ingredients:
1/4 cup unseasoned rice vinegar
1 teaspoon sugar
1/2 teaspoon olive oil
1/8 teaspoon black pepper
1/2 cucumber
1 cup carrots
2 tablespoons green onion
2 tablespoons red bell pepper
1/2 teaspoon Mrs. Dash® Italian Medley seasoning blend

Notice there is nothing new here. We all know this information. What is appealing is having someone else, someone who understands our diet limitations, buy the food and prepare it for our meals. I explained to Clarence that our food needs as far as electrolytes change with each blood test and he agreed that it’s important to eat according to your numbers. That’s something he’s very willing to pay attention to. Should this interest you, why not approach a professional in your area to see if they can also provide such a service?Big news! SlowItDownCKD 2011 is now available on Amazon.com in both print and digital (and needs reviews: hint). SlowItDownCKD 2012 will not be far behind. These are the first and second parts of the reformatted, larger print, more comprehensively indexed The Book of Blogs: Moderate Chronic Kidney Disease, Part 1, (available only until SlowItDownCKD 2012 is published).

Until next week,

Keep living your life!

CKD and the VA or It’s Not Alphabet Soup at All

Today is Memorial Day in the United States. It is not a day to say Happy Memorial Day since it is a day commemorating those who gave their lives for our freedom. Lots of us have bar-b-ques or go to the park or the beach to celebrate. No problem there as long as we remember WHO we are celebrating. I promise: no political rant here, just plain appreciation of those who serve(d) us both living and dead. Personally, I am honoring my husband, my step son-in-law, and all those cousins who just never came home again.

I explained the origins of this day in SlowItDownCKD 2015 (May 25), so won’t re-explain it here. You can go to the blog and just scroll down to that month and year in the drop down menu on the right side of the page under Archives. I was surprised to read about the origins myself.

We already know that Chronic Kidney Disease will prevent you from serving your country in the military, although there are so many other ways to serve our country. This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

‘The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services establishes medical standards, which, if not met, are grounds for rejection for military service. Other standards may be prescribed for a mobilization for a national emergency.

As of September 13, 2011, according to Change 1 of this Instruction, the following was included.

‘Current or history of acute (580) nephritis or chronic (582) Chronic Kidney Disease of any type.’

Until this date, Chronic Kidney Disease was not mentioned.”

You can read the entire list of The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services at http://dtic.mil/whs/directives/corres/pdf/613003p.pdf. You’ll also find information there about metabolic syndrome, high blood pressure, high cholesterol, diabetes, and pre-diabetes as conditions for non-enlistment.

This got me to thinking. What if you were had already enlisted when you developed CKD. Yes, you would be discharged as medically unfit, but could you get help as a veteran?

According to the Veterans Administration at https://www.research.va.gov/topics/Kidney_disease.cfm#research4,

“In 2012, VA and the University of Michigan began the work of creating a national kidney disease registry to monitor kidney disease among Veterans. The registry will provide accurate and timely information about the burden and trends related to kidney disease among Veterans and identify Veterans at risk for kidney disease.

VA hopes the kidney disease registry will lead to improvements in access to care, such as kidney transplants. The department also expects the registry will allow VA clinicians to better monitor and prevent kidney disease, and will reduce costs related to kidney disease.”

That’s what was hoped for five years ago. Let’s see if it really came to fruition.

Oh, this is promising and taken directly from The U.S. Department of Veterans Affairs.

“VA eKidney Clinic

The VA eKidney Clinic is now available! The eKidney Clinic offers patient education through interactive virtual classrooms where Veterans can learn how to take care of their kidneys and live a good life with kidney disease. Please visit the VA eKidney Clinic website or click on the picture below. For additional information see the eKidney Clinic Patient Information Brochure.”

The Veterans Health Administration doesn’t just provide information, although I must say I was delighted to see the offer of Social Work Services. There is also treatment available. Notice dialysis mentioned in their mission statement.

“Mission: The VHA Kidney Program’s mission is to improve the quality and consistency of healthcare services delivered to Veterans with kidney disease nationwide. The VHA Kidney Program provides kidney-related services to dialysis centers throughout VA’s medical centers. Professional guidance and services are available in the form of consultation and policies developed by VA kidney experts. These experts are dedicated to furthering the understanding of kidney disease, its impact on Veterans, and developing treatments to help patients manage disease symptoms. In addition, the VHA Kidney Program provides VA healthcare professionals with clinical care, education, research, and informatics resources to improve healthcare at local VA dialysis facilities.”

I did find it strange that there was a cravat on the Veterans Administration site that they do not necessarily endorse the VHA Kidney Program, especially since it is so helpful.

 

 

 

How involved is the VA with CKD patients? Take a look for yourself at this 2015 statistics by going to https://www.va.gov/HEALTH/services/renal/documents/Kidney_Disease_and_Dialysis_Services_Fact%20Sheet_April_2015.pdf

• All Veterans enrolled in VA are eligible for services, regardless of service connection status
• Enrolled Veterans can receive services from the VA or from community providers under the Non-VA Care Program if VA services are unavailable
• 49 VA health care facilities offer kidney disease specialty care (nephrology services)
• 96 VA facilities offer inpatient and/or outpatient dialysis; 25 centers are inpatient-only. Of the 71 VA outpatient dialysis centers, 64 are hospital based units, 2 are joint VA/DoD units, 4 are freestanding units, and one is within a community based outpatient clinic (CBOC)
• VA enrollees must be offered the option of home dialysis provided either directly by the VA or through the Non-VA Care Program
• 36 outpatient hemodialysis centers offer home dialysis care directly.
• 5 VA medical centers host kidney transplantation programs.
• VA Delivered Kidney Care (Calendar Year 2013) 13,794 Unique Veterans receiving dialysis paid for by VA; representing an annual increase of 13% since 2008. 794 Veterans received home dialysis; 55percent (434) by VA facilities and 45percent (360) under the Non-VA Care Program.
• Increasing use of telehealth services to increase Veteran access to kidney specialty care Secure messaging: 7,319 messages, Clinical video telehealth: 4,977 encounters
• VA Kidney Research (FY ’14) the research budget for the study of kidney disease has been $18.5 million per year for the past 5 years (FY ’10-FY ’14). The VA Cooperative Studies Program has supported national clinical trials addressing the best treatment of Veterans with CKD since at least 1998.

It seems to me our veterans are covered. Now if we could only make sure the rest of us stay covered no matter what bills the current administration signs into law.

Until next week,

Keep living your life!

B.U.N. No, not bun. B.U.N.

Let’s consider this part 2 of last week’s blog since all these terms and tests and functions are intertwined for Chronic Kidney Disease patients. Thanks to reader Paul (not my Bear, but another Paul) for emphatically agreeing with me about this.

Bing! Bing! Bing! I know where to start. This is from The National Kidney Disease Education Program at the U.S. Department of Health and Human Services’ information about being tested for CKD.

“If necessary, meaning if your kidney function is compromised, your pcp will make certain you get to a nephrologist promptly.  This specialist will conduct more intensive tests that include:

Blood:

BUN –

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.”

If you read last week’s blog about creatinine, you know there’s more to the testing than that and that more of the information is in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. No sense to repeat myself so soon.

Let’s take this very slowly. I don’t think it necessary to define blood, but urea? Maybe. I found this in SlowItDownCKD 2015:

“But how can I explain blood urea?  I’ll allow the experts to do that.

http://www.patient.co.uk/health/routine-kidney-function-blood-test has the simplest explanation.

‘Urea is a waste product formed from the breakdown of proteins. Urea is usually passed out in the urine. A high blood level of urea (‘uraemia’) indicates that the kidneys may not be working properly or that you are dehydrated (have low body water content).’

In the U.S., we call this test B.U.N. or Blood Urea Nitrogen Blood Test.  So as I understand it, if your protein intake is high, more urea is produced.  But since your kidneys are already compromised by CKD, the toxins remaining in your body are not eliminated as well….”

You with me so far? If there’s suspicion of CKD, your nephrologist tests your serum creatinine (see last week’s blog) and your BUN.  Wait a minute; I haven’t explained nitrogen yet. Oh, I see; it has to be defined in conjunction with urea.

Thanks to The National Kidney Foundation at https://www.kidney.org/atoz/content/understanding-your-lab-values for clearing this up:

“Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism. It is normally removed from your blood by your kidneys, but when kidney function slows down, the BUN level rises. BUN can also rise if you eat more protein, and it can fall if you eat less protein.”

So now the reason for this protein restriction I wrote about in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease should be clear.

“So, why is protein limited? One reason is that it is the source of a great deal of phosphorus. Another is that a number of nephrons were already destroyed before you were even diagnosed. Logically, those that remain compensate for those that are no longer viable. The remaining nephrons are doing more work than they were meant to. Just like a car that is pushed too hard, there will be constant deterioration if you don’t stop pushing. The idea is to stop pushing your remaining nephrons to work even harder in an attempt to slow down the advancement of your CKD.  Restricting protein is a way to reduce the nephrons’ work.”

This is starting to sound like a rabbit warren – one piece leads to another, which verves off to lead to another, and so forth and so on. All right, let’s keep going anyway.

Guess what. Urea is also tested via the urine. Nothing like confusing the issue, at least to those of us who are lay people like me. Let’s see if Healthline at http://www.healthline.com/health/urea-nitrogen-urine#overview1 can straighten this out for us.

“Your body creates ammonia when it breaks down protein from foods. Ammonia contains nitrogen, which mixes with other elements in your body, including carbon, hydrogen, and oxygen to form urea. Urea is a waste product that is excreted by the kidneys when you urinate.

The urine urea nitrogen test determines how much urea is in the urine to assess the amount of protein breakdown. The test can help determine how well the kidneys are functioning, and if your intake of protein is too high or low. Additionally, it can help diagnose whether you have a problem with protein digestion or absorption from the gut.”

Hmmm, these two don’t sound that different to me other than what is being analyzed for the result – blood (although blood serum is used, rather than whole blood) or urine.

What about BUN to Creatinine tests? How do they fit in here? After all, this is part 2 of last week’s blog about creatinine. Thank you to Medicine Net at http://www.medicinenet.com/creatinine_blood_test/article.htm for explaining. “The BUN-to-creatinine ratio generally provides more precise information about kidney function and its possible underlying cause compared with creatinine level alone.”

Dizzy yet? I think that’s enough for one day.

In other news, the price of all my Chronic Kidney Disease books has been reduced by 20%. I think more people will avail themselves of this information if they cost less… and that’s my aim: CKD awareness. If you belong to Kindle’s share program, you can take advantage of the fact that the price there was reduced to $1.99. You can also loan my books to a Kindle friend or borrow them from one for free for 14 days. Or you can ask your local librarian to order all five books, another way of reading them free. I almost forgot: as a member of Kindle Unlimited and the Kindle Owners’ Lending Library, you also read the books for free although you do need to pay your usual monthly subscription fee.

Students: Please be aware that some unscrupulous sites have been offering to rent you my books for a term for much more than it would cost to buy them. I’ve succeeded in getting most of them to stop this practice, but more keep popping up.

Until next week,

Keep living your life!

Yet Another Possibility

Today we have yet another fitness plan? Weight loss plan? Health plan? Beauty plan? I don’t know what to call it since they offer so many different types of products. What’s that, you ask. It’s called Wakaya Perfection. It seems a great number of my friends and acquaintances have been involved in their health in this way recently. They, however, do not have Chronic Kidney Disease.

Let’s get this part out of the way: I want to go there. Yes, there. Wakaya is not only a company, but an island in the South Pacific and it.is.beautiful. Take a look at their website (wakayaperfection.com) so you can see for yourself… but, of course, that’s not what this blog is about.

The company has several different lines, so I decided to look at one product from each to evaluate them for CKD patients. Remember, should they not be viable options for CKD patients does not mean they’re not viable for those without CKD.

Let’s start with the weight loss products since that’s what’s on my mind lately. That would be the Bula SlimCap. This is what their website has to say about these caps:

“At Wakaya Perfection, when we say all natural, that is exactly what we mean. Our tropical flavors are:

• Sugar Free
• Fat Free
• Gluten Free

And Contain:

• NO Artificial Flavors, Ingredients or Colors
• NO Monosodium Glutamate (MSG)
• NO Insect or Animal Matter
• NO Growth Hormones
• NO Antibiotics
• NO Herbicides or Pesticide

That sounds great and appeals to me. Wait a minute, natural is good, but what is it that’s natural? I couldn’t find an ingredient list other than this:

• All Natural Flavors
• Active Ingredients
• Pink Fijian Ginger
• Stevia Reb-A 98%
• Quick Dissolve Blend

What makes it a quick dissolve blend? What are the all natural flavors? What are the active ingredients? Ginger is permissible for CKD patients, but how much ginger is in each cap? And as for Stevia Reb-A 98%, this is a warning I found on New Health Guide at http://www.newhealthguide.org/Stevia-Side-Effects.html: “The FDA has noted that stevia may have a negative impact on the kidneys, reproductive, cardiovascular systems or blood sugar control.” Uh-oh, they mentioned our kidneys.

Oh well, that’s only one product and maybe there’s some other source of ingredients somewhere. Hmmm, I’d want to know what’s in a product and how much of each ingredient is in it before I took it, especially with CKD on my plate.

Let’s switch to a fitness product. I stayed away from the protein shake meal replacements for the reasons I explained about such products in SlowItDownCKD 2016. This is the poignant part of that blog:

“Ladies and gentlemen, our protein intake is restricted because we have CKD. Why would we take a chance on increasing the protein in our bodies? Here’s a reminder from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease about why we need to limit our protein.

‘So, why is protein limited? One reason is that it is the source of a great deal of phosphorus. Another is that a number of nephrons were already destroyed before you were even diagnosed. Logically, those that remain compensate for those that are no longer viable. The remaining nephrons are doing more work than they were meant to. Just like a car that is pushed too hard, there will be constant deterioration if you don’t stop pushing. The idea is to stop pushing your remaining nephrons to work even harder in an attempt to slow down the advancement of your CKD.  Restricting protein is a way to reduce the nephrons’ work.’”

Why don’t we take a look at the BulaFit Burn Capsules? Wakaya Perfection describes them as,

“A potent combination of herbs and extracts that help you manage appetite/cravings while providing sustained energy and heightened focus throughout your day. BulaFIT BURN™ is designed to help boost fat burning and provide a sense of wellbeing that reduces cravings for food and snacking.

When combined with a healthy diet and exercise, BURN capsules promote a sense of well being and energy that reduces cravings for food and snacking. BURN can also play an important role in increasing the results of ketosis and even avoiding the ‘keto flu’ that some people may experience with other ketogenic programs.”

Huh? What’s keto flu? I figured a site with the name Keto Size Me (http://ketosizeme.com/keto-flu-101-everything-need-know/) could help us out here… and they did. “The ‘keto flu’ is what we commonly call carbohydrate withdrawal symptoms. These symptoms usually occur in people who start a low carb diet that alters their hormones and causes and electrolyte imbalances.”

Wait! Electrolyte imbalances? But we work so hard with the renal diet trying to keep these within the proper range for CKD. I went back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for a little reminder about electrolytes.

“In order to fully understand the renal diet, you need to know a little something about electrolytes. There are the sodium, potassium, and phosphate you’ve been told about and also calcium, magnesium, chloride, and bicarbonate. They maintain balance in your body….Too much or too little of a certain electrolyte presents different problems.”

Nope, not me. I’m keeping my electrolytes right where they belong. This is not looking good for the Chronic Kidney Disease patient. I vote no; you, of course, have to make up your own mind.

News of a local opportunity: This year’s first Path of Wellness Screening will be Saturday, June 17^th at the Indo American Cultural Center’s community hall, 2809 W. Maryland Ave., Phoenix, AZ 85017. The free screening events can process up to 200 people.  Their use of point-of-care testing devices provides blood and urine test results in a matter of minutes, which are reviewed onsite by volunteer physicians.  All screening participants are offered free enrollment in chronic disease self-management workshops.  Help is also given to connect participants with primary care resources.  The goals of PTW are to improve early identification of at-risk people, facilitate their connection to health care resources, and slow the progression of chronic diseases in order to reduce heart failure, kidney failure and the need for dialysis.

Until next week,

Keep living your life!

Just Blend In

Well, if that doesn’t beat all! Here I thought I was juicing until a reader asked me if my nephrologist knew the difference between juicing and blending. There’s something called blending? Let’s get my doctor out of the equation right away. He may or may not know the difference between the two, but I certainly didn’t.

I heard juicing and just assumed (and we all know what happens when we assume) it meant tossing 80% vegetables – since this was prescribed for fast weight loss – and 20% fruits in the blender. Hmmm, the name of the machine I used should have tipped me off that there was a difference, but it went right over my head.

Let me tell you what I learned. Juice, according to Dictionary.com at http://www.dictionary.com/browse/juicing, is: “the natural fluid, fluid content or liquid part that can be extracted from a plant or one of its parts…” while juicing is “to extract juice from.” Uh-uh, I wasn’t doing that. There was no pulp left after the vegetables and fruits were processed in the blender. It all sort of mushed – oh, all right – blended together.

The same dictionary tells me blending is: “to mix smoothly and inseparably together.” Yep, that’s what I’ve been doing. By the way, for those of you who asked to be kept posted about any weight loss, I’ve lost five pounds in ten days. To be perfectly candid, there was one day of I’m-going-to-eat-anything-I –want! mixed in there.

Another CKD Awareness Advocate wondered just what I was doing to my electrolyte limits while on this blending (I do know that’s what it is now.) diet. I arbitrarily chose a recipe from a juicing book I got online before I realized I wasn’t juicing. The recipe called for:

2 beets (what a mess to peel and chop)

2 carrots (I used the equivalent in baby ones since my hands were already starting to hurt from dealing with the beets)

8 strawberries

7 leaves of kale – which I learned is also called Tuscan cabbage

I added a cup of water since I wasn’t taking any pulp out, so the mixture was really thick.

All the ingredients were on my renal diet. So far, so good. But the question was about my daily electrolyte limits. My limits are as follows (Yours may be different since the limits usually are based upon your most current labs.):

Calories – 2100

Potassium – 3000 mg.

Phosphorous – 800 mg.

Protein – 5 ounces (141,748 mg.)

Sodium – 2000 mg.

Nutritional Data at http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2348/2 tells me I drank this much of each of those electrolytes in the total of two drinks I had of this concoction… I mean blend. The measurement is milligrams and each drink replaces a meal.

 

 

	Protein	Phosphorus
Beets	1300	33
Carrots	2700	42
Kale	2200	38
Strawberries	1000	37
Totals	7200	150

 

	Potassium	Sodium
Beets	267	1300
Carrots	359	2700
Kale	299	2200
Strawberries	233	1000
Totals	1158	7200

 

	Calories
Beets	33
Carrots	42
Kale	38
Strawberries	37
Totals	150

I had to backtrack a little to figure out that 8 baby carrots is the equivalent to 2/3 of a cup or a little over five oz. Thanks to http://www.fruitsandveggiesmorematters.org/how-much-do-i-need for the help there. They were also the source I used to verify that 8 large strawberries equal 1 cup or 8 oz.

The calculations were the hardest part of this blog for me. I rounded up whenever possible. Also, keep in mind that different sites or books may give you different approximations for the electrolytes in the different amounts of each different food you blend. I discovered that when I was researching and decided to stick with the simplest site for me to understand.

So, did I exceed my limits? I am permitted three different vegetables per day with a serving of half a cup per vegetable. There are only three vegetables in this recipe. I did go over ½ cup with the all of them, yet am under my limitations for each of the electrolytes. This is complicated. As for the fruit, I am also allowed three different ones with ½ cup limit on each. Or can I count the one cup of strawberries as two servings of today’s vegetables? Welcome to my daily conundrum.

Over all, I still have plenty of electrolytes available to me for my third meal today, which is to be a light meal of regular foods (provided they’re on my renal diet). I also have two cups of coffee a day which has its own numbers:

Protein  Phosphorus Potassium  Sodium   Calories

6000              14                232               9               4

Add those in and I still have plenty of food available to me with the electrolytes within the balance limits. The funny part is that I’m not hungry for hours after one of the blended drinks and, bam! all of a sudden I’m ravenous. I usually have the light meal mid-day so I’m not still digesting at bedtime. This is really important: on that I’m-going-to-eat-anything-I –want! day, I was hungier and hungier the more I ate and didn’t recognize when I was full.

The nice part about blending is that the fiber is still in the mixture. Fiber is necessary for a multitude of reasons when you’re a CKD patient. DaVita at https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/fiber-in-the-kidney-diet/e/5320 lists those reasons for us:

Benefits of fiber

Adequate fiber in the kidney diet can be beneficial to people with chronic kidney disease (CKD) because it:

• Keeps GI (gastrointestinal) function healthy
• Adds bulk to stool to prevent constipation
• Prevents diverticulosis (pockets inside the colon)
• Helps increase water in stool for easier bowel movements
• Promotes regularity
• Prevents hemorrhoids
• Helps control blood sugar and cholesterol

Our fourth anniversary is Thursday. We have had numerous health problems to deal with since that date, BUT we’ve also had numerous opportunities for fun…and we’ve taken each one. Did I ever tell you we had the ceremony at 4 p.m. in our backyard and the reception at 6 p.m. in order to help us remember the date? 4/6 = April 6^th. Get it?

Anyway, any help offered to make the blending and a light meal work on Saturday when we’ll be celebrating by attending the Phoenix Film Festival (http://www.phoenixfilmfestival.com/) all day and night will be gratefully accepted. Bring your copy of one of my books. I’ll gladly sign it for you.

Until next week,

Keep living your life!

Getting Juiced

I have the gentlest nephrologist in the world! Well, I think so anyway. He has been cautioning me about my weight for years. Yes, there it is again: my weight. Here I was finally coming to terms with being a chubby since nothing I was doing seemed to work to lose the weight. That’s when he tossed out a bombshell.

We all know that increased weight can raise your blood pressure which, in turn, negatively affects your kidneys. I was so pleased with myself for having raised my GFR another three points on my last blood test that I didn’t understand how I could be leaking protein into my urine at the same time. Wasn’t protein in the urine simply an indication that you have Chronic Kidney Disease? Didn’t I already know that? So why was protein leaking into my urine to the tune of 252 mg. when the norm was between 15-220 mg?

I know, I know: back up a bit. Thanks for the reminder. GFR is defined in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease this way:

“GFR: Glomerular filtration rate [if there is a lower case ‘e’ before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.”

Oh, and just in case you’ve forgotten, this excerpt from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 is a good reminder about the stages of CKD.

“Different stages require different treatment or no treatment at all.  There are five stages with the mid-level stage divided into two parts. The higher the stage, the worse your kidney function.

Think of the stages as a test with 100 being the highest score.  These are the stages and their treatments:

STAGE 1: (normal or high) – above 90 – usually requires watching, not treatment, although many people decide to make life style changes now: following a renal diet, exercising, lowering blood pressure, ceasing to smoke, etc.

 STAGE 2: (mild) – 60-89 – Same as for stage one

STAGE 3A: (moderate) – 45-59 – This is when you are usually referred to a nephrologist [Kidney specialist]. You’ll need a renal [Kidney] dietitian, too, since you need to be rigorous in avoiding more than certain amounts of protein, potassium, phosphorous, and sodium in your diet to slow down the deterioration of your kidneys. Each patient has different needs so there is no one diet.  The diet is based on your lab results.  Medications such as those for high blood pressure may be prescribed to help preserve your kidney function.

STAGE 3B: (moderate) – 30-44 – same as above, except the patient may experience symptoms.

STAGE 4:  (severe 15-29) – Here’s when dialysis may start. A kidney transplant may be necessary instead of dialysis [Artificial cleansing of your blood]. Your nephrologist will probably want to see you every three months and request labs before each visit.

STAGE 5: (End stage) – below 15 – Dialysis or transplant is necessary to continue living.

Many thanks to DaVita for refreshing my memory about each stage.”

Okay, back to the connection between spilling protein into your urine (called proteinuria) and CKD. This is from the recently published SlowItDownCKD 2016:

“In The Book of Blogs: Moderate Chronic Kidney Disease, Part 1, The National Institutes of Health helped me explain why this combination of excess weight and pre-diabetes was a problem for CKD patients:

‘High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. The urinary albumin test detects this loss of protein in the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Wastes and fluid build up in your blood instead of leaving the body in urine.’”

Let’s say you don’t have pre-diabetes, but do have CKD. Does proteinuria still make it worse? Damn! It does. This explanation is from SlowItDownCKD 2015:

“The problem is that antibodies are made up of protein. Antibodies is defined by Dictionary.com at http://dictionary.reference.com/browse/antibodies as

‘A protein substance produced in the blood or tissues in response to a specific antigen, such as a bacterium or a toxin, that destroys or weakens bacteria and neutralizes organic poisons, thus forming the basis of immunity.’

Lose lots of protein into your urine and you’re losing some of your immunity. In other words, you’re open to infection.”

I guess that explains why I magically developed a UTI after years of not having any.

I have gone so far afield from what I intended to write about on this last Monday of National Kidney Month. What was that, you ask? It was my nephrologist’s strong suggestions for immediate weight loss: juicing. I was so surprised.

After all that writing about eating the raw vegetables for roughage and sticking to only three specified amount servings of each daily, this expert in his field was telling me to ignore all that and throw myself into juicing for the immediate future. But you can bet I’ll try it; no way I’m throwing nine years of keeping my kidneys healthier and healthier out the window.

I can’t tell you if it works since I only started yesterday, but I can tell you it doesn’t taste bad. I’m learning how to use this fancy, dancy blender we got three years ago that had just been sitting on the shelf. Experimenting with the consistency has caused a mess here and there, but oh well.

My first juicing experience included kale, celery, lemons, cucumbers, and ginger. I definitely need to play with my combinations. I also think I made far too much. Luckily Bear was in the house and shouted out that the machine was making that noise because I didn’t add enough water. Water? You’re supposed to add water?

I’ll keep you posted on these experiments if you’ll get yourself tested for CKD. It’s just a blood and urine test. Fair deal?

Until next week,

Keep living your life!

Women and Water (Men, too)

Welcome to March: National Kidney Month and Women’s History Month. I’m going to fudge a bit on the ‘History’ part of that as I did last month with Black History Month. I don’t often have guest bloggers, but this month will feature two women as guest bloggers in honor of Women’s History Month. The first is Jessica Walter, who sent me the following email last month:

Hi There,

I am a freelance health and food writer, I have teamed up with a small senior lifestyle advice site, I worked with them to develop a complete guide on how to eat better and be healthier from a dietary point of view. This includes detailed information on why being hydrated is so important. … you can check out the article here:

https://www.senioradvisor.com/ blog/2017/02/7-tips-on- developing-better-eating- habits-in-your-senior-years/.

I liked what Jessica had to say and how easily it could be adapted not only for senior Chronic Kidney Disease patients, but all Chronic Kidney Disease patients.

In addition, she sent me this short article about hydration and CKD. It’s easy to read and has some information we constantly need to be reminded of.

Staying Hydrated When You Have Chronic Kidney Disease

We all know that drinking water is important for our health, and monitoring fluid intake is critical for those with chronic kidney disease. Too much water can be problematic, but so can too little. Dehydration can be serious for those with chronic kidney disease. If you are suffering from vomiting, diarrhea, fever, or diabetes, or if you urinate frequently, you may become dehydrated because you are losing more fluid than you are taking in. For those without chronic kidney disease, the solution is to increase the intake of water until the body is sufficiently hydrated.

Since dehydration can decrease blood flow to the kidneys, and as fluid intake must be controlled in patients with chronic kidney disease, it’s important to closely monitor their fluid intake and loss in these circumstances.

Recognizing The Signs

The first step is to recognize the physical signs of dehydration. You may have a dry mouth or dry eyes, heart palpitations, muscle cramps, lightheadedness or fainting, nausea, or vomiting. You may notice a decrease in your urine output. Weight loss of more than a  pound or two over a few days can also be an indicator of dehydration. If you are taking ACE inhibitors and ARBs, such as lisinopril, enalapril, valsartan, or losartan, or water pills or diuretics, these medications can harm your kidneys if you become dehydrated. It is doubly important to be aware of signs of dehydration if you are on any of these medications.

Steps to Take

To rehydrate your body, start by increasing your intake of water and ensure that you are eating plenty of fruits and vegetables. (Me here: remember to stay within your renal diet guidelines for fruits, vegetables, and fluids.)If you cannot keep water down, or if increased consumption doesn’t alleviate the signs of dehydration, contact your health care provider  immediately.

They may also recommend a different fluid than plain water since electrolytes and minerals can also be reduced if you are dehydrated, but you may still need to watch your intake of potassium, phosphorus, protein, and sodium. Your doctor may recommend an oral rehydration solution that will restore your body to a proper level of hydration. If you have a fluid restriction because you are on dialysis, you should consult your healthcare provider if you have issues with or questions about hydration. Taking in or retaining too much fluid when you have these restrictions can lead to serious complications, including headaches, swelling, high blood pressure and even stroke. Carefully monitoring your fluid intake and watching for signs of dehydration will help you to avoid the consequences of dehydration.

I’ve blogged many times over the last six years about hydration. I’m enjoying reading this important material from another’s point of view. I’m sorry Jessica’s grandmother had to suffer this, but I’m also glad Jessica chose to share her writing about it with us.

 

This June, 2010, article included in The Book of Blogs: Moderate Chronic Kidney Disease, Part 1 furthers explains:

“.…Dr. HL Trivedi of the Institute of Kidney Diseases and Research Centre (IKDRC) said, ‘…. Rapid water loss causes the kidney’s functioning to slow down, resulting in temporary or permanent kidney failure.’

Extreme heat causes rapid water loss, resulting in acute electrolyte imbalance. The kidney, unable to cope with the water loss, fails to flush out the requisite amount of Creatinine and other toxins from the body. Coupled with a lack of consistent water intake, this brings about permanent or temporary kidney failure, explain experts.”

The article can be viewed directly at http://www.dnaindia.com/health/report_heat-induced-kidney-ailments-see-40pct-rise_1390589 and is from “Daily News & Analysis.”

The CDC also offers advice to avoid heat illness:

“People with a chronic medical condition are less likely to sense and respond to changes in temperature. Also, they may be taking medications that can worsen the impact of extreme heat. People in this category need the following information.

• Drink more water than usual and don’t wait until you’re thirsty to drink.
• Check on a friend or neighbor, and have someone do the same for you.
• Check the local news for health and safety updates regularly.
• Don’t use the stove or oven to cook——it will make you and your house hotter.
• Wear loose, lightweight, light-colored clothing.
• Take cool showers or baths to cool down.
• Seek medical care immediately if you or someone you know experiences symptoms of heat-related illness(http://www.cdc.gov/extremeheat/warning

It’s clear we need to keep an eye on our hydration. While we’re doing that, keep the other eye out for SlowItDownCKD 2016 purposely available on World Kidney Day on Amazon.

Until next week,

Keep living your life!

The Three Musketeers

I was in Cuba last week with very sketchy internet, so it was not possible to post a blog. But for now, I was thinking about a friend – you know, one of those Facebook friends you never met but you feel an instant kinship with – who told me that her surgeon warned her that her recovery from the spinal fusion surgery she’d recently had would be slow because she has Chronic Kidney Disease.

CKD…bone healing. Let’s start slowly and work this one out.  First of all, what do the kidneys have to do with your bones?

I turned to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for some answers.

“Both vitamin D and calcium are needed for strong bones. It is yet another job of your kidneys to keep your bones strong and healthy….Vitamin D enables the calcium from the food you eat to be absorbed in the body. CKD may leech the calcium from your bones and body….Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones.”

Whoa! Each one of those thoughts needs at least a bit more explanation. Let’s start with the jobs of the kidneys. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 has a paragraph that mentions some of them. I turned it into a list to make it more visual.

“Our kidneys are very busy organs, indeed.  They produce urine, remove potentially harmful waste products from the blood, aid in the maintenance of the local environment around the cells of the body, 

help to stimulate the production of red blood cells, regulate blood pressure, help regulate various substances in the blood {For example, potassium, sodium, calcium and more}, help to regulate the acidity of the blood, and regulate the amount of water in the body. Mind you, these are just their main jobs.”

Another of those various substances in the blood they help to regulate is phosphorous. That’s where one of the connections between CKD and your bones lies. If your phosphorous is not being correctly regulated by your kidneys (since your kidneys are impaired), yes you do experience pain and broken bones, but did you notice that your body also diverts your necessary-for-bone-health calcium to regulate the other substances in your blood?

I wanted to know more about phosphorous so I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. I got a chuckle from seeing that I’d quoted from my first book in explaining how phosphorous works. I’d forgotten about that.

“This is the second most plentiful mineral in the body and works closely with the first, calcium. Together, they produce strong bones and teeth. 85% of the phosphorous and calcium in our bodies is stored in the bones and teeth.  The rest circulates in the blood except for about 5% that is in cells and tissues…. Phosphorous balances and metabolizes other vitamins and minerals including vitamin D which is so important to CKD patients. As usual, it performs other functions, such as getting oxygen to tissues and changing protein, fat and carbohydrate into energy.”

Talk about multi-tasking. Let’s focus in on the calcium/phosphorous connection. Kidney Health Australia at http://kidney.org.au/cms_uploads/docs/calcium-and-phosphate-balance-fact-sheet.pdf explained this succinctly:

“When your kidney function declines, you are unable to get rid of excess phosphate. (Me here: that’s what we call phosphorous except when dealing with inorganic chemistry.)  The phosphate builds up in your body and binds to calcium, which, in turn, lowers your calcium levels. When your calcium levels get too low, glands in your neck (called the parathyroid glands) pull the extra calcium your body needs out of your bones. This can make your bones easy to break. The bound phosphate and calcium get deposited in your blood vessels. It can increase your risk of heart disease and stroke. It can also cause skin ulcers and lumps in your joints.”

So where does vitamin D come in? As was mentioned in SlowItDownCKD 2015,

“’Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.’ We know vitamin D can be a real problem for us.  How many of you are taking vitamin D supplements? Notice my hand is raised, too.  How many of you read the blogs about vitamin D?  Good!” 

It sounds like vitamin D is in charge here. Let me get some more information about that for us. Bingo: DaVita at https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/vitamin-d-and-chronic-kidney-disease/e/5326 was able to help us out here.

“Vitamin D is responsible for:

• Building and maintaining strong bones
• Keeping the right level of calcium and phosphorus in the blood
• Preventing bones from becoming weak or malformed
• Preventing rickets in children and osteomalacia in adults

Too much vitamin D can be toxic….”

Hmmm, the three work together with vitamin D as their captain.

I wondered what foods would be helpful for my friend in her healing process.

“Calcium

Milk, yogurt, cheese, sardines, spinach, collard greens, kale, soybeans, black-eyed peas, white beans and foods often fortified with calcium: breakfast cereals, orange juice, soy milk, rice milk

Vitamin D

Salmon, mackerel, sardines, tuna, flounder, sole, cod

Phosphorus

Ricotta cheese, barley, soybeans, sunflower seeds, cottage cheese, lentils”

Thank you to Weill Cornell Medical College’s Women’s Health Advisor at http://www.cornellwomenshealth.com/static_local/pdf/WHA0210_BoneHealth.pdf for the above information.

But, you know, it’s never just that easy. As CKD patients, we have limits of how much protein, potassium, sodium, and – wait for it – phosphorous we can eat each day. There is no socking in all the good stuff for kidney disease patients.

I can see why my friend’s surgeon told her the recovery might be slow. Something else that keeps the bones strong is weight bearing exercise, but how can she do that right now?

Until next week,

Keep living your life!

 

It’s Unfolding Now

Remember when I was lucky enough to catch the flu just after Christmas? (She wrote sarcastically.) When I went to the Immediate Care facility my doctor is associated with, the doctor there had my records and knew I’d had pleurisy at one time. But now, he ordered a chest x-ray to check for pneumonia. What he found instead was news to me… so, of course, I’m telling you about it.

To quote from the final result report of the X-ray: “There is unfolding of the thoracic aorta.” Huh? In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 there’s an explanation of thorax.

“What?  The what? Oh, the thorax. That’s ‘the part of the human body between the neck and the diaphragm, partially encased by the ribs and containing the heart and lungs; the chest’ according to The Free Dictionary at http://www.thefreedictionary.com/thorax.”

Thoracic is the adjective form of thorax; it describes the aorta in this case.

Do you remember what the aorta is? I sort of, kind of did, but figured I’d better make certain before I started writing about it. MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=2295 was helpful here.

“The aorta gives off branches that go to the head and neck, the arms, the major organs in the chest and abdomen, and the legs. It serves to supply them all with oxygenated blood. The aorta is the central conduit from the heart to the body.”

Now I get the connection between Chronic Kidney Disease and the aorta. Did you catch “oxygenated blood” in that definition? And what organs oxygenate the blood? Right. Your kidneys. This excerpt from SlowItDownCKD 2015 may help.

““The National Kidney and Urologic Diseases Information Clearinghouse …explains.

‘Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs.  Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells.’”

With me so far? Now, what the heck is an unfolded aorta? I turned to the British site for radiologists, Radiopaedia.org, at https://radiopaedia.org/articles/unfolded-aorta for the definition. “The term unfolded aorta refers to the widened and ‘opened up’ appearance of the aortic arch on a frontal chest radiograph. It is one of the more common causes for apparent mediastinal widening and is seen with increasing age.

It occurs due to the discrepancy in the growth of the ascending aorta with age, where the length of the ascending aorta increases out of proportion with diameter, causing the plane of the arch to swivel.”

I purposely left the click through definitions in so you read them for yourself. You know the drill: click on the link while holding down your control key. For those of you who are reading the print version of the blog, just add the definition of aorta to the common terms we know: arch and ascending.

Mediastinal, according to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/mediastinum is the adjective (describing) form of mediastinum or “the space in the chest between the pleural sacs of the lungs that contains all the tissues and organs of the chest except the lungs and pleurae; also:  this space with its contents.”

Hang on there, folks, just one more definition. I searched for a new site that wouldn’t offer a terribly technical definition of pleura (or pleurae) and found verywell at https://www.verywell.com/pleura-lungs-definition-conditions-2249162.

“The pleura refers to the 2 membranes that cover the lungs and line the chest cavity. The purpose of the pleura is to cushion the lungs during respiration.

The pleural cavity is the space between these 2 membranes and contains pleural fluid.”

Side note: I definitely feel like I’m back teaching a college class again.

Okay, so now we have a bunch of definitions, we’ve put them together as best we can and where does it bring us? Are you ready for this? Nowhere. An unfolding of the thoracic aorta is nothing more than a function of age.

However, with CKD, it’s somewhere. As was explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, “Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.”  We’re already not getting enough oxygen due to our poor, declining in function kidneys.

Am I concerned about the unfolding thoracic aorta? No, not at all. It happens with age; I don’t think I can do anything about that. But, the CKD that also lowers our oxygen production? Oh yes, I can – do – and will do something about that by protecting my kidneys as best I can and keeping the remaining kidney function I have.

Kidneys.com, quoted in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, did a nice job of laying out a plan for me to do just that.

“Along with taking your prescribed blood pressure medications, lifestyle changes such as losing weight, exercising, meditating, eating less sodium,  drinking  less  alcohol  and  quitting  smoking  can  help  lower  blood pressure. Better blood pressure control helps preserve kidney function.”

I added using my sleep apnea machine and aiming for eight hours of sleep a night. I also stick to my renal diet – which limits protein, phosphorous, potassium, and sodium (as mentioned by kidney.com) – for the most part and keeping my kidneys hydrated by drinking at least 64 ounces of fluid a day.

Is it hard? I don’t know any more. It’s been nine years. They’re simply habits I’ve developed to live as long as I can and, sometimes, even raise the function of my kidneys.

When my New York daughter was with us over the holidays, I realized how differently we eat than other people do. My husband has chosen to pretty much eat the way I do. So she actually had to go down to the market to pick up the foods that people ordinarily eat.  It would have been funny if I hadn’t been sick. I would have gone with her and laughed each time I answered, “No,” when she asked, “Do you eat this?”

Until next week,

Keep living your life!

What Are You Doing for Others?

Today is Martin Luther King’s birthday. Today, more than ever, we need to heed his message. Whether you apply it to today’s bizarre political scene, your local community, your family, your co-workers doesn’t matter. What matters is the operant word: doing.

That picture and those words got me to thinking.  What AM I doing for others? And what still needs to be done?

My commitment is to spread awareness of Chronic Kidney Disease (CKD). As a patient myself, I know how important this is. As you know, CKD is a costly, lethal disease if not caught early and treated… and it’s not just older folks – like me – who are at risk. One out of ten people worldwide has CKD, yet an overwhelming number of them are unaware they have it.

We also know the disease can be treated, just not the way you’d usually expect a disease to be treated. A diet with restrictions on protein, potassium, phosphorous and sodium is one aspect of that treatment. Exercise, adequate sleep, and avoiding stress are some of the other aspects. Some patients – like me – may have to take medication for their high blood pressure since that also affects kidney function. Imagine preventing a death with lifestyle changes. Now image saving the lives of all those who don’t know they have CKD by making them aware this disease exists. Powerful, isn’t it?

We’re all aware by now that the basic method of diagnosing CKD is via routine blood and urine tests. Yet, many people do not undergo these tests during doctor or clinic visits, so don’t know they have Chronic Kidney Disease, much less start treating it. That’s where I come in; I tell people what can be done. I tell people how they can be diagnosed and treated, if necessary.

I was a private person before this CKD diagnosis so many years ago. Now, in addition to a Facebook page, LinkedIn, and twitter accounts as SlowItDownCKD, I make use of an Instagram account where I post an eye catching picture daily with the hashtag #SlowItDownCKD. This brings people to my weekly blog about CKD (the one you’re reading now) and the four books I wrote about it: What Is It and How Did I Get It? Early Stage Chronic Kidney Disease (which explains CKD) and the others – The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1; The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2; and SlowItDownCKD 2015 – which are the blogs in print for those who don’t have a computer or are not computer savvy.

Healthline is a well-respected, informative site for medical information. This past year this blog, SlowItDownCKD, was a winner in their list of The Six Best Kidney Disease Blogs. That brought the hits on my page up by the hundreds. That means hundreds more people are now aware of Chronic Kidney Disease, how it is diagnosed, how it is treated, and how to live with it.

But not everything is working as I’d hoped it would. Unfortunately, I am still not having success in having Public Service Announcements placed on television or radio. Nor have I been able to interest most general magazines or newspapers in bringing the disease to the public’s awareness.

It hasn’t totally been a wipeout there, though. Michael Garcia did interview me on The Edge Podcast and both Nutrition Action Healthletter, Center for Science in the Public Interest (the nation’s largest-circulation nutrition newsletter) and New York State United Teachers (membership 600,000) ‘It’s What We Do’ profiled my work spreading CKD Awareness. Profiling my work, interviewing me, mentioning the blog all bring awareness of Chronic Kidney Disease to the public. Awareness leads to testing. Testing leads to diagnosing. Diagnosing leads to treatment. Treatment leads to saving lives. This is why I do what I can to spread awareness of Chronic Kidney Disease.

What about you? Can you speak about CKD with your family? Your friends? Your co-workers? Your brothers and sisters in whichever religion you follow? What about your neighbors? I was surprised and delighted at the number of non CKD friends and neighbors who follow the blog. When I asked why they did, they responded, “I have a friend….” We may all have a friend who may have CKD, whether that friend has told us yet or not.

There are more formal methods of spreading this awareness if that interests you. The National Kidney Foundation has an Advocacy Network.

“A NKF Advocate is someone who has been affected by kidney disease, donation or transplant and who wants to empower and educate others. These include people with kidney disease, dialysis patients, transplant recipients, living donors, donor family members, caregivers, friends and family members.

Advocacy plays an integral role in our mission. You can make a significant difference in the lives of kidney patients by representing the National Kidney Foundation. We give you the tools you need to make your voice heard.”

You can read more about this program at https://www.kidney.org/node/17759 or you can call 1.800.622.9010 for more information.

The American Kidney Fund also has an advocacy program, but it’s a bit different.

“There is strength in numbers. More than 5,100 passionate patients, friends, loved ones and kidney care professionals in our Advocacy Network are making a huge difference on Capitol Hill and in their own communities. Together, we are fighting for policies that improve care for patients, protect patients’ access to health insurance and increase funding for kidney research. As advocates, we play a key role in educating elected officials and our communities about the impact of kidney disease.”

You can register for this network online at http://www.kidneyfund.org/advocacy/advocate-for-kidney-patients/advocacy-network/

Obviously, I’m serious about doing that which will spread awareness of CKD. You can take a gander at my website, www.gail-raegarwood.com, to see if that sparks any ideas for you as to how you can start doing something about spreading awareness of CKD, too. I urge you to do whatever you can, wherever you can, and whenever you can.

Until next week,

Keep living your life!

 

It’s a Miracle!

It’s that time of year again… the time to believe in miracles. There’s the miracle of Mary’s virgin birth at Christmas. And there’s the miracle of the Chanukah oil burning for eight nights instead of the one it was meant to. That got me to thinking about miracles and so, we have a different kind of several part blog beginning today. Consider it my gift to you this holiday season.

Miracles happen every day, too. We just need to take action to make them happen… and that’s what I’d like to see us do with Chronic Kidney Disease by sharing the available information.  This particular miracle is helping to alleviate the fear of needing dialysis and/or transplantation. This particular miracle is helping patients help themselves and each other. This particular miracle is helping doctors appreciate involved patients.

Yet, causing this miracle by sharing information is overlooked again and again. Chronic Kidney Disease, or CKD, is easily diagnosed by simple blood tests and urine tests (as we know), but who’s going to take them if they have no idea the disease exists, is widespread, and may be lethal? By sharing information, those at high risk will be tested. Those already in the throes of CKD can be monitored and treated when necessary. While CKD is not curable, we know it is possible to slow down the progression of the decline in your kidney function.

According to the National Institutes of Health at http://www.ncbi.nlm.gov/pmc/articles/PMC4112688,

“2014: Worldwide, an estimated 200 million people have chronic kidney disease (CKD).”

Before I was diagnosed, I had never heard of this disease… and apparently I’d had it for quite some time.  Why weren’t people sharing information about this?  Couldn’t that have prevented my developing it? At the time of my diagnose nine years ago, I meant doctors.  I don’t anymore. Nor do I leave causing a miracle by sharing to others.

This is my life. I have had Chronic Kidney Disease for nine years. As a college instructor who taught Research Writing at the time of my diagnose, I researched, researched, and researched again, but the only person I was sharing my research with was the nephrologist who treated me and monitored my condition. I may have expected a miracle there, but I didn’t get one. Why?

I got to thinking about that and realized he already knew what I told him. That’s when it struck me that if I expected a miracle with CKD, I would have to start sharing this information with the people who need it: the ones who didn’t know, the ones who had just been diagnosed and were terrified, and the families of those with CKD who didn’t know they also might be at risk. I went so far as to bring CKD education to the Native American Communities in Arizona since Native Americans are at high risk. I had the information and had experts willing to come to the communities to share that information.

We all know this is a costly, lethal disease if not caught early and treated… and that it’s not just the elderly who are at risk. One out of ten people worldwide has CKD, yet an overwhelming number of them are unaware they have it. We know CKD can be treated, just not the way those who don’t have it might expect. A diet with restrictions on protein, potassium, phosphorous and sodium may be one aspect of that treatment. Exercise, adequate sleep, and avoiding stress are some of the other aspects. Some patients – like me – may have to take medication for their high blood pressure since that also affects kidney function. Imagine preventing a death with lifestyle changes. Now imagine EXPECTING the miracle of preventing that death by sharing this information. Powerful, isn’t it?

We know the basic method of diagnosing CKD is via routine blood and urine tests. Yet, many people do not undergo these tests during doctor or clinic visits, so don’t know they have Chronic Kidney Disease, much less start treating it.

This is where the miracle I expected in my life began for me. I started speaking with every doctor of any kind that I knew or that my doctors knew and asked them to share the information. They were already experiencing time constraints, but suggested I write a fact sheet and leave it in their waiting rooms since they agreed there’s no reason to wait until a person is in kidney failure and needs dialysis or a transplant to continue living before diagnosing and dealing with the illness.

My passion about producing this miracle multiplied threefold from that point on. So much so that I went one better and wrote a book with the facts. I was convinced we would be able to cause a miracle by sharing information about this disease. My goal was clear: have everyone routinely tested.

Dr. Robert  Provenzano, a leading nephrologist in the United States,  succinctly summed up the problem worldwide.

“Chronic Kidney Disease is an epidemic in the world…. As other countries become Westernized, we find the incidence of Chronic Kidney Disease and end-stage renal failure increases. We see this in India, and in China. We see this everywhere. …”

We repeatedly see diabetes and hypertension cited as the two major causes of CKD. Does your neighbor know this? How about the fellow at the gas station? Ask them what Chronic Kidney Disease is. More often than not, you’ll receive a blank look – one we can’t afford if you keep the statistic at the beginning of this paper in mind. We can cause a miracle to change this.

Sharing can be the cause of that miracle… but that’s not something we can leave to the other guy. We each ARE the other guy. More on this next week.

For now, Merry Christmas, Happy Chanukah, Happy Kwanzaa (somehow implicit in this holiday is the miracle of bringing people together), and every other holiday I’ve inadvertently missed or don’t know about.

I just got word that Portal in Time – my first novel – is available on Amazon.com. Consider that as a holiday gift for those friends not interested in CKD. Of course, I just happen to have four CKD books on Amazon.com for those who might be interested in CKD. Be part of a miracle.

Until next week,

Keep living your life!

Clean…or Dirty?

My daughter brought a friend to a party we were both attending a few weeks ago. We all enjoyed each other so we talked about the possibility of going out to dinner together at some future date. Being well aware of my renal restrictions and how that sometimes limits our choice of restaurants, I asked my daughter’s friend how he likes to eat. He said, “Clean.”

I’ve heard this before, as you probably have, too. Yet, I wasn’t sure exactly what it meant. And that’s why I’m researching it today and seeing just how it does – or doesn’t – fit into our usual renal diet. Will someone get the dictionary, please?  Thanks.

According to my personal favorite, The Merriam-Webster at http://www.merriam-webster.com/dictionary/clean, clean means

: free from dirt, marks, etc.

: not dirty

: tending to keep clean

: free from pollution or other dangerous substances

Maybe it’s that last definition that applies to eating?  Hmmm, I need to take a closer look at this.

In her nutrition blog on another of my favorites – The MayoClinic – this past summer,  Katherine Zeratsky, R.D., L.D., suggested these as the main tenets of clean eating:

• Eat more real foods. Sound familiar? One of the tenets of the Mayo Clinic Diet is eating more real foods and fewer processed or refined foods. Convenience food is OK, sometimes even necessary, just make sure that what’s in that can or package is the real thing with few other ingredients.
• Eat for nourishment. Eat regular, balanced meals and healthy snacks that are nourishing and not too rushed. Eat at home more often and prepare food in healthy ways. Pack food to eat away from home when on the road, at work or activities. When you do eat out, choose wisely.
• Eat safe food. This is my addition to the idea of clean eating. Based on the name itself, clean food should be safe. Practice food safety by washing produce before consumption (you may consider buying organic as well), keeping raw meats separate from produce from the grocery store to home, cooking food to proper temperatures and chilling food quickly after service.

You can read more of her thoughts about clean eating at http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-blog/clean-eating/bgp-20200665. By the way, R.D. means Registered Dietician and L.D. is Licensed Dietitian. Most states require at least one of these in order for the person to provide nutrition or diet advice.

This sounds too simple. Let’s look a bit more. I found loads of articles on sites I didn’t recognize by people I hadn’t heard of, so I decided to take a look at a site specifically for clean eaters. This is from Clean Eating Magazine at http://www.cleaneatingmag.com/food-health/food-and-health-news/what-is-clean-eating/.

“The soul of eating clean is consuming food the way nature delivered it, or as close to it as possible. It is not a diet; it’s a lifestyle approach to food and its preparation, leading to an improved life – one meal at a time.

Eat five to six times a day – Three meals and two to three small snacks. Include a lean protein, plenty of fresh fruit and vegetables, and a complex carbohydrate with each meal. The steady intake of clean food keeps your body energized and burning calories efficiently all day long.

Choose organic clean foods whenever possible.

Drink at least two liters of water a day.

Limit your alcohol intake to one glass of antioxidant-rich red wine a day

Get label savvy – Clean foods contain just one or two ingredients. Any product with a long ingredient list is human-made and not considered part of a clean diet.

Avoid processed and refined foods – This includes white flour, sugar, bread and pasta. Enjoy complex carbs such as whole grains instead.

Steer clear of anything high in trans fats, anything fried or anything high in sugar. Avoid preservatives, color additives and toxic binders, stabilizers, emulsifiers and fat replacers.

Consume healthy fats.

Aim to have essential fatty acids, or EFAs, incorporated into your clean diet every day.

Learn about portion sizes – Work towards eating within them. When eating clean, diet is as much about quantity as it is quality.”

Wow! And there’s much more on their site.

There are just a few things that concern me here, specifically about the contents of those three meals and two to three small snacks. How can I stretch my five ounces of protein over all these meals and snacks? And my three servings each of only certain fruits and vegetables?   I suppose I could skip the protein on one of them and have only one ounce at each of the others.

Do you know what one ounce of protein looks like? One egg, ¼ tablespoon of peanut butter, or 2 bites of meat (although I don’t eat red meat), poultry or seafood. That last one is subjective; I used my food scale to test it out. I imagine it could be different if your mouth is smaller or larger than mine. I also didn’t take into account the foods not on the renal diet, such as beans and nuts.

I’m attempting to avoid carbohydrates as much as I can in order to lose some weight, but my renal diet allows for 7 or 8 choices of these a day and 3 of fruits – which I do eat in moderation.  There may be a problem with the whole grains recommended for clean eating since whole grains are high in phosphorous, something Chronic Kidney Disease patients need to watch.  Chapter 8 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease explains the renal diet I follow in detail.

Other than those objections, I like the sound of clean eating. However, I do remember going to a clean eating restaurant when they first started opening and finding I was severely limited as to what I could order. Yep, whole grains, fruits and vegetables not on my diet, and too much protein. I checked out the vegetarian dishes, but found them huge.  Funny to think of that as a negative, isn’t it?

As usual, it looks like this is something you have to decide for yourself according to your renal diet since each of us is different.  Would I try a clean eating restaurant again, sure. Would I try clean eating at home?  Maybe, although the whole grains thing bothers me.

Until next week,

Keep living your life!