Pro on Probiotics?

probioticsMy husband takes probiotics and they work for him. This is why he takes them, as explained by http://www.theralac.com/why-take-probiotics.aspx:

“For healthy people, probiotics can help boost the immune system and increase the absorption of important minerals and nutrients. For people with digestive problems, probiotics can be taken in higher doses to help regain digestive balance.”

I thought they might be worth a try, but my nephrologist disagreed.  We had our discussion about this right after I’d been a guest on a radio show during which the pros and cons of using probiotics for chronic kidney disease were discussed. This was just about the same time the information I’d requested from Kibow arrived.  This is from their website at www.Kibow.com:

“Certain probiotic microorganisms can utilize urea, uric acid and creatinine and other toxins as its nutrients for growth. Overloaded and impaired kidneys have a buildup of these poisonous wastes in the bloodstream. Probiotic microorganisms multiply, thereby creating a greater diffusion of these uremic toxins from the circulating blood across the lining of the intestinal walls into the bowel. This increased microbial growth is excreted along with the feces (which is normally 50% microbes by weight).

Enteric toxin reduction technology uses probiotic organisms to transform the colon into a blood cleansing agent, which, with the aid of microbes, indirectly removes toxic wastes and helps eliminate them as fecal matter. Consequently, a natural treatment for kidney failure is possible to maintain a healthy kidney function with the oral use of Renadyl™. The patented, proprietary probiotics in Renadyl™ have been clinically tested and shown to be safe, free of serious side effects, and effective in helping the body rid itself of harmful toxins when taken for as long as 6 months.”

Let’s slow down a bit.  We’ll need some definitions, so I turned to my favorite user friendly online medical dictionary, www.merriam-webster.com for the following:

CREATININE: (I know you know this one; this is just a reminder) a white crystalline strongly basic compound C4H7N3O formed from creatine and found especially in muscle, blood, and urine

ENTERIC: of, relating to or affecting the intestines; broadly:  alimentary

PROBIOTIC: a preparation (as a dietary supplement) containing a live bacterium (as lactobacilli) that is taken orally to restore beneficial bacteria to the body; also:  a bacterium of such a preparation

UREA: a substance that contains nitrogen, is found in the urine of mammals and some fish, and is used in some kinds of fertilizerdictionary

URIC ACID: a white odorless and tasteless nearly insoluble acid C5H4N4O3 that is the chief nitrogenous waste present in the urine especially of lower vertebrates (as birds and reptiles), is present in small quantity in human urine, and occurs pathologically in renal calculi {a little help here, this means a concretion usually of mineral salts around organic material found especially in hollow organs or ducts} and the tophi of gout

What I found on Kibow is a mouthful… and an advertisement.  I am not endorsing Renadyl.  However, there is an animation at http://www.renadyl.com/How-Renadyl-works which visually clarifies the information above. While I understood the process better after watching the animation, I’m still leery of that six month warning, especially after I found this at the bottom of one of their pages:

“* These statements have not been approved by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent disease. Results may vary.”

In addition, this product contains psyllium seed husk, something I was cautioned to avoid. It seems my nephrologist is not the only one who feels this way. http://www.metamuciladvisor.com/avoid-psyllium-and-metamucil-in-kidney-disease/ is the webpage of Metamucil, a product whose main ingredient is psyllium.  However, this conscientious company also posts this information on their website:

Psyllium Products and Their Minerals

There are certain psyllium products that contain a large amount of minerals that individuals with kidney disease cannot process. Some psyllium products contain high volumes of psyllium seed huskspotassium, sodium and magnesium, which if a person with kidney disease consumes can cause a lot of problems. If an individual’s physician gives permission on taking psyllium then they need to make sure the psyllium product follows their restricted diet.

Fluids Required With Psyllium

When consuming psyllium six to eight glasses of water must be consumed to keep from having any uncomfortable side effects. This can be a problem for an individual with kidney disease since the kidneys cannot effectively filter the fluid. Since the proper amount of fluid cannot be consumed this can cause side effects and make the natural fiber less effective.

Things to Consider

One of the number one complaints in individuals with kidney disease is constipation due to the fact fluid restrictions, vegetables and more. Since there are many restrictions an individual has with kidney disease with their diet there are other safe options to choose from. Discuss these other safe options with your physician to relieve constipation.

Maybe it’s just me, but I don’t understand why someone with kidney disease would want to take a product that will harm them.  As a matter of fact, I don’t understand why Kibow, the makers of Renadyl, don’t post such a warning on their site. Hmmm, I wonder if the  “…safe, free of serious side effects, and effective in helping the body rid itself of harmful toxins when taken for as long as 6 months” statement included in their material IS their warning.  And just how many people catch that one sentence anyway?

At http://clinicaltrials.gov/show/NCT00760162, I did find the record of a study filed by Kibow in 2009, but not the results of the six month trial.  The record was processed on November 9, 2014 which is very recent.  Either I don’t know how to find the outcomes of the trial or they are simply not there. I suspect the latter.

I have no intention of vilifying Kibow, but do find this to be another case of be careful what you choose to take, very careful.  Watch the small print, talk to your nephrologist before making any decisions, and make sure you guard whatever you have left of your kidney function.

Book CoverThank you for your continued interest in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. Keep in mind what a terrific holiday gift this is… and that next year, you’ll be able to gift the same person with What Is It and How Did I Get It? Early Stage Chronic Kidney Disease’s little sister: The Book of Blogs.

Until next week,

Keep living your life.

Life Is Just A Bowl Of Cherries

Here I was all ready to write about sulfur drugs and CKD or hearing and CKD when I received an email from  Cindy Bruggner who’d just bought some good looking bing cherries but wasn’t sure whether to eat them or not.  We all know that cherries simply don’t last that long, so – Cindy – this one’s for you.

cherries

The big issue about eating cherries when you have Chronic Kidney Disease is their potassium content. I went straight to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease to see what I’d written about this. In the Glossary (on page 134) I found this definition:

“One of the electrolytes, important because it counteracts sodium’s effect on blood pressure.”

While that’s true, we’re going to need more to help Cindy out. So I turned to Chapter 8: The Renal Diet (page 75).

“Potassium is something you need to limit when you have CKD despite the fact that potassium not only dumps waste from your cells but also helps the kidneys, heart and muscles to function normally.  Too much potassium can cause irregular heartbeat and even heart attack.  This can be the most immediate danger of not limiting your potassium….

Book Cover…Check your blood tests. 3.5-5 is considered a safe level of potassium.  You may have a problem if your blood level of potassium is 5.1-6 and you definitely need to attend to it if it’s above 6.  Speak to your nephrologist ….”

I checked with the National Kidney Foundation http://www.kidney.org/atoz/content/potassium.cfm about those levels just to be sure they hadn’t changed since the book was published.  They haven’t.

That got me to wondering why cherries are considered good for the general population, but not CKD patients. So, of course, I did a little research.  Green and Healthy at http://www.greenandhealthy.info/kidneydisease.html#ckd suggests those without kidney disease eat cherries for the following reason:

“According to research from Michigan State University tart cherries contain anthocyanins [Thought you might like to know this means natural pain relieving and anti-inflammatory properties], bioflavonoids, which inhibit the enzymes Cyclooxygenase-1 and -2, and prevent inflammation in the body. These compounds have similar activity as aspirin, naproxen and ibuprofen.”

Sounds good to me since we can’t take some of those pain relievers, but cherries have the same effect.  Something was nagging at me though.  Back to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease. As I read page 3, I realized why:

“The problem with unregulated minerals, such as sodium and potassium is that these minerals are needed to remain healthy but too much in the bloodstream becomes toxic. The kidneys remove these toxins and change them into urine that enters the bladder via the ureter.”kidney location

Well, healthy kidneys do, but just how effective are your compromised kidneys at doing this job? I went to DaVita at http://www.davita.com/kidney-disease/diet-and-nutrition/lifestyle/top-15-healthy-foods-for-people-with-kidney-disease/e/5347, but in addition to the usual warnings about potassium levels, I found this:

“1/2 cup serving fresh sweet cherries = 0 mg sodium, 160 mg potassium, 15 mg phosphorus

Cherries have been shown to reduce inflammation when eaten daily. They are also packed with antioxidants and phytochemicals that protect the heart.”

Does that mean they’re good for CKD patients?

From my reading, I’ve also garnered the information that cherries can help with iron deficiencies, lower blood pressure, improve sleep, help with gout, and lower the risk of heart disease.

Or can they? Remember that too much potassium can actually cause an irregular heartbeat or possibly stop your heart.

Oh Cindy, I’m sure I’ve only added to your confusion.  Watch your potassium levels.  Look them up on your last blood test.  Why not give your nephrologist a call, too, just to be sure.  Do you have a renal nutritionist? He or she would know far better than I since this question of whether to eat the cherries or not is so individualized.

Then we have stages.  I am stage 3, which I used to think was early stage (hence the book’s title) but now realize is moderate damage.  I don’t know what stage Cindy is, but I do know the dietary rules change when you reach end stage and I’m going to guess they’re even different for those on different kinds of dialysis and those who are transplants.stages chart

So Cindy’s question is sort of asking me which sexual position is best for her.  I’m purposely being provocative here so that you’ll see just how individualized the renal diet is. What’s best for you depends on your needs.  Call the nutritionist!

Knowing End Stage Renal Disease is not my area of expertise, I took a peek at National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)National Institutes of Health (NIH), at http://kidney.niddk.nih.gov/KUDiseases/pubs/eatright/index.aspx#potassium anyway to see what dialysis patients can eat.  Apparently, potassium could be a problem here, too. This is what I found:

“Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.”

Okay, cherries can be a problem.  Then I started wondering if it mattered what type of cherries they were. I found at least 18 different kinds, but none of the websites discussed potassium.

I learned more about cherries and potassium than I thought I wanted to.  I’m sure you did, too, but I offer you the same advice I offered Cindy: check with your renal nutritionist or nephrologist – always.  I am not a doctor, but rather someone who researches CKD on a layman’s level.  Cindy, thanks for asking.

Holy cow!  July 4th weekend is sneaking up on us!  I’m looking forward to as much water walking as we can get in since two, not one, but two neighbors have offered us the use of their backyard pools – one actually a lap pool – and we have discovered our neighborhood pool which charges only $20 per person a season.  We may not have the ocean out here, but we’ve got lots of pools.  Here’s hoping you enjoy your holiday weekend.

Kidney Book CoverWhoops!  Almost forgot to include that SlowItDown will now be sharing the book’s Facebook page, twitter account, website (http.gail-rae.com), email address (myckdexperience@gmail.com) and telephone number (602-509-4965).  I was getting run down trying to run the two separately in addition to my personal one!

Until next week,

Keep living your life!

Their Father’s Food  

GmM8B2ylPUP0lIuKR9OqrzOqFEOtJtRaf2Rpt6ncsBkHere’s hoping you all enjoyed your Father’s Day yesterday.  Although we were missing Nima who lives in New York and Kelly and Sean who both had to work, it was a very good day for us.  Lara’s love played the guitar for a sing-a-long and Darin showed us the newspaper article which quoted him.  Abby had to leave early for the Blues dance lesson she teaches, but we’d had a good, long afternoon together by that time.  Long enough that Lara finally got to really just talk with her dad.

It was all good, except the food.  Bear doesn’t have Chronic Kidney Disease and usually follows the renal diet with me anyway.  Yesterday was the exception.  Since we finally figured out that I’m not Bear’s mother and he’s not my father, this was the last Mother’s Day (He always makes me a bar b q with food I can eat.) or Father’s Day we would host. I gave him a pad and pen and said, “Write down your menu.”

Bear was raised in the Midwest and eats a lot of food that’s still strange to this ex New York Jew.  Let’s start with the honey baked ham.  Okay, he spent his childhood summers on his grandparents’ farm; I get that. I grew up not eating ham because it’s not kosher and we were practicing Jews.  But why isn’t it on the renal diet?ham

Thank you Wedliny Domowe at http://www.meatsandsausages.com/hams-other-meats/hams for this information. Ham is a processed meat.  It can be cured in a number of ways, but most include the use of salt, and nitrites, which themselves are either sodium or potassium. The dry method of curing uses salt, while the wet method uses brine. And what is brine but a solution of sodium in water? And then there’s smoking. {Ack! Smoke contains formaldehyde and alcohol.}

We know as CKDers that we need to limit our sodium intake. As I wrote in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, pages 73-4,

“Basically, sodium balances fluid levels outside your cells.  You need it because it is responsible for watering your cells.  This watering is the prompt for potassium to Book Coverdump waste [cell process by-products] from your cells….If you have damaged kidneys and cannot excrete most of the sodium you ingest, you’re up against higher blood pressure which may worsen your CKD which may further cut down on your elimination of sodium and so on and so forth in an ever spiraling cycle. In addition, for CKD patients, too much sodium causes fluid retention, thereby causing swelling, further resulting in weight gain, leading to shortness of breath.”

And let’s not forget that high blood pressure is the second leading cause of Chronic Kidney Disease.

Well, what about the potassium in the nitrite used in preserving the ham.  Why do CKDers have to limit the amount of potassium they ingest? By the way, too much sodium can increase your need for potassium.

But isn’t potassium good for you?  After all, it does help the heart, muscles, and our beloved kidneys function normally as well as dumping wastes from our cells. Here’s the kicker, an excess of potassium can cause irregular heartbeat and even heart attack.

We are not your everyday people whose kidneys can filter any excess potassium from our bodies.  We have compromised kidney function which could mean a buildup in potassium.  No wonder CKD may lead to cardiovascular problems!potassium

I’m almost afraid to look at the rest of Bear’s Father’s Day menu.  He also requested cold cuts of roast beef.  Uh-oh, that’s another cured meat.  Cold cuts also tend to be fattier cuts and have nitrates, which are different than the nitrites discussed above.

According to Dictionary.com at http://dictionary.reference.com/browse/nitrate, a nitrate is “a salt or ester [That’s an organic compound.] of nitric acid.”  Wait a minute!  Nitric acid is a corrosive liquid, as most of us learned way back in high school.

And, as Dr. Veeraish Chauhan (one of the nephrologists in Florida that received a donation of the book this past March when I was there) wrote in his April 6, 2013 {our wedding day!} blog, “… red meat could be a big source of uric acid, which has been shown to be associated with worsening of CKD.”

Red meat contains cholesterol.  Fattier cuts contain more cholesterol. This substance can clog the arteries, leading to heart problems.  We already have a higher risk of heart problems simply because we have CKD.  Why raise the risk???

And then we have the sweet potato casserole.  Sweet potatoes?  I don’t remember the last time I had one of those. Talk about potassium overload!  We already discussed the CKDers’ problems with that.sweet potato casserole

Well, what about the green bean casserole?  I didn’t have to eat the crispy, fried onions on top of it. But it’s in creamed mushroom soup.  Oh, right.  Creamed soup is high in phosphorous. The National Kidney Foundation at http://www.kidney.org/atoz/content/phosphorus.cfm tells us, although phosphorus is necessary to work with calcium for healthy bones:

“High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Phosphorus and calcium control is very important for your overall health.”

The orange mimosas seemed to delight everyone but Abby.  I didn’t even try one.  I.just.don’t.drink.  Too much alcoholism in my family history.  Anyway, while the orange juice in this drink didn’t seem to be a problem, the champagne was actually good for us, according to the National Institutes of Health.

Their MedlinePlus at http://www.nlm.nih.gov/medlineplus/news/fullstory_145838.html posted new findings about the benefits of wine.  Champagne is a wine.  Surprise!  If you have CKD, wine in moderation may help protect you from that health disease you’ve at risk of.carrot cake

I am not even going to analyze the carrot cake from Cheesecake Factory.  That is so bad for you on so many levels!  I am so glad I researched these foods AFTER the celebratory meal so I wasn’t tempted to spout this information to those enjoying the food.

I was thinking of combining the SlowItDown and book FB pages, twitter accounts, and website.  Any thoughts of your own about this?

Until next week,

Keep living your life!

Kidney Book Cover

From The Military To Potatoes

Memorial Day

Today is Memorial Day, a day to be especially grateful to those who lost their lives making sure the rest of us were safe.  I wondered if some of our fallen warriors had chronic kidney disease although the scientific history of our disease is so recent. I’ve spent the last several days researching CKD and the military in an attempt to answer my own question, yet haven’t quite succeeded.

All I know is that some of our present protectors have CKD.  This is how I discovered that:

The National Institutes of Health offered a particular Funding Opportunity Application [FOA] on December 1st, 2011, with the first submission being accepted on January 14, 2012.

“The goal of this FOA is to encourage Research Project Grant (R01) applications on prevention and treatment of obesity, diabetes, and chronic kidney disease in military personnel (active duty and retired) and their families. “

Notice “active duty” in that sentence. Both The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) participate in this study.  Unfortunately, my attempts to follow up on the study consistently brought me back to the FOA. You can read the FOA at http://grants.nih.gov/grants/guide/pa-files/pa-11-260.htmlNIH

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 this for yourself on page 27 of the document at http://www.dtic.mil/whs/directives/corres/pdf/613003p.pdf.  I cannot explain the seeming contradiction between the FOA and the Directive.

NimaAlthough, when my daughter Nima Rosensfit– researcher par excellence – asked me if I had a particular request for Mother’s Day, I asked her for research on the early history of CKD.  She found there wasn’t very much until fairly recently.  The fact that the first set of clinical practice guidelines (K/DOQI comprised Chronic Kidney Disease: Evaluation, Classification and Stratification) wasn’t published until February, 2002, may account for the lack of information from the military.These may be found at http://www.kidney.org/professionals/kdoqi/pdf/prot.pdf

While my information is inconclusive (at best), I sincerely hope that our warriors – whether on active duty or retired – have the same kind of care for their CKD as those of us who are civilians do.  Thank you again… and again…and again to our protectors, including my Bear. 2013-05-10 14.53.10-6

Yesterday, we were invited to several events.  One of these was a birthday brunch for my step-daughter, Lara Garwood.  Her sweetheart made certain there was food I could eat.  When my eyes lit up at the sight of baby potatoes (I’m Russian by heritage.), he commented, “I leached the potatoes, sort of.”

Book CoverLet’s go back to basics here for a moment. On page 134 (Do a word search instead of relying on the page number if you own a digital copy of the book.) of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I define potassium as,

“One of the electrolytes, important because it counteracts sodium’s effect on blood pressure.”

Dictionary.com tells us that electrolytes are:

“…any of certain inorganic compounds, mainly sodium, potassium, magnesium, calcium, chloride, and bicarbonate, that dissociate in biological fluids into ions capable of conducting electrical currents and constituting a major force in controlling fluid balance within the body.”

Potassium is necessary for the nerves and muscles. The heart is a muscle. But our compromised kidneys cannot eliminate enough potassium from the blood before it travels back to the heart. This may lead to heart attack… or kidney failure. It’s a chicken and the egg kind of thing.

These are the acceptable values of potassium in your blood. As you can see, there is a difference in the values for adults and children of various ages. Thank you everydayhealth.com at http://www.everydayhealth.com/health-center/potassium-k-in-blood-results.aspx for the chart.

Potassium (K)
Adults: 3.5-5.2 milliequivalents per liter (mEq/L) or 3.5-5.2millimoles per liter (mmol/L)
Children: 3.4-4.7 mEq/L or 3.4-4.7 mmol/L
Infants: 4.1-5.3 mEq/L or 4.1-5.3 mmol/L
Newborns: 3.7-5.9 mEq/L or 3.7-5.9 mmol/L

 

depression-cause-heart-attack-1I went to Kidneys.com at http://www.yourkidneys.com/kidney-education/Diet-and-nutrition/Potassium-and-early-stage-kidney-disease/3191 to see what, if any, the symptoms of high potassium levels are.

  • Nausea
  • Weakness
  • Numbness or tingling
  • Slow pulse
  • Irregular heartbeat
  • Heart failure

Now, keep in mind that at early stages of CKD you may not have high levels of potassium.  The idea is to keep your levels low so that you do not do damage to yourself since your kidneys are not doing such a great of eliminating it.

But here’s the kicker: raising potassium levels could lower your blood pressure. Remember high blood pressure is the second leading cause of CKD.  Just like riding a bicycle, it’s all a matter of balance.

Since being diagnosed, I’ve leached the potassium out of potatoes by cutting them into pieces, soaking them in water for four hours, changing the water, and letting them soak again or soaking them in the refrigerator overnight.  That’s a lot of time involvement, time I knew my almost son-in-law did not have in his schedule.potatoes

So I researched for a less time consuming method that I could mention to him.  I wanted to eat what he prepared, but only if it didn’t cause my CKD to progress. I was surprised to discover that the only effective way to leach potatoes and other vegetables is to double boil them.  Thank you to Kidneycoach.com at http://www.kidneycoach.com/356/potassium-leaching-study-shows-not-all-leaching-methods-work/  for this new, researched, effective method.

However, I find that new research disparaging. Sure, the potassium is out, but boiled potatoes?  And other vegetables since all contain some level of potassium?  How is that appetizing?  Then again, I like being alive, I like not being on dialysis, so I will just cope.

Talking about coping, electronic sales of the book are doing so nicely.  Feel free to share them with friends and tell others where you got them.  The name of the game is get the information about slowing down the gradual decline of your kidney function out to the public.  After all, that’s how SlowItDown was named.SlowItDown business card

Until next week,

Keep living your life!

Another Holiday

Holidays abound! Or maybe it just feels that way. No sooner did my Russian Jewish almost son-in-law and I co-host our Seder then it was time to get ourselves together for Easter. Sometimes it’s a lot of work to have such an integrated family.

passover This time, no one stepped up to bat and I soon found out why. Another almost son-in-law had minor surgery, but was still in pain and not ready for people. A third adult child had weekend guests and had to work Sunday evening. But one couple wanted an Easter celebration.

So I quickly figured out that I could go to the weekly Sustainable Blues dance lesson that my youngest, Abby Wegerski, taught every week AND make dinner for these adult children if I planned carefully. That’s when I realized I wasn’t weighing and measuring or looking at my renal diet Bible before cooking. All the ingredients I needed were renal friendly and readily available in our house.blues

What a relief! It took almost seven years for this information and this way of being to become part of me. The point here is that the renal diet has become a way of life, one I don’t often think about too much anymore. I can easily remember a time I needed to pull out the diet list to see what I could eat, then another list to see if the protein, potassium, phosphorous, or sodium (3 Ps and and S, as I call them in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease) levels were too high and finally the KidneyDiet app to make sure I hadn’t gone over my limits for each of these and a calorie count.

This wonderful revelation doesn’t mean that I don’t hit my own ‘refresh’ button periodically to make sure I really am correctly eye judging the amounts of each food I use in cooking and eating or that I don’t need to occasionally check to see if I’m right about the amount of whatever is in it.

I still carry all three of these – Northern Arizona Council on Renal Nutrition Diet, AAKP Nutrition Counter, and KidneyDiet app – as my talismen. There’s a certain security in knowing I have them if I need them. I also find that sometimes I just don’t remember exactly what I read in each, so it’s a comfort to have them at hand.Book Cover In Chapter 8: The Renal Diet of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I offer an example of the intricate and annoyingly painstaking little notebook I devised to keep track of my CKD nutrition. Ladies and Gentlemen: I am pleased (for CKD sufferers) to announce this is now obsolete!!!

One of the very first apps I purchased was KidneyDiet. It is not the same as my little notebook, but works equally well. The only thing it doesn’t do is tell you if you’ve reached your daily limit in each category of food (milk, meat or meat substitutes, grains, fruits, vegetables, and fats).

android_welcomeYou’re an intelligent person. You can figure out just by looking at a display of your entries if you’ve had your one four ounce serving of milk, five ounces of meat or meat substitutes, however many servings of grain (depends upon your sex, weight, and whether or not you want to lose weight), your three servings each of fruits and vegetables and your fill of fat intake. You’re the one entering your limits (as prescribed by your dietician), and they show up red if you’ve gone over them. Calories and cholesterol are also included, as is fluid intake. The nicest part is that if there’s a food you like which isn’t on the pre-existing list that comes with the app, you can add it. Do that once and you have the information for that food every time you enter it.

No, I do not own stock in the KidneyDiet app, although that might not be such a bad idea. I am thrilled that life keeps getting easier for us as CKD patients. I know I’ve written about the app before, but each time I use it, I’m grateful for how it’s made my life easier.

Wait a minute! I just realized the next holiday on the calendar is Mother’s Day. This should be interesting because I’m not cooking for that. If Bear does, no problem. He knows my dietary restrictions almost as well as I do. But if it’s one of the kids, especially one of the newer additions to the family…. Maybe it’s time to be more stringent when they ask me what I can eat, or better yet, tell them in advance.

When we went to Florida and stayed with my brother, Paul, and sister-in-law, Judy Peck (she of the magnificent cooking), Judy asked me what I could eat. So I sent her the renal diet I follow. It was overwhelming to her, just as it is to new CKD patients. As usual, she successfully simplified the matter. By asking me what I could eat instead of adhering to the list, she saved herself from having to pick and choose from a double sided page of dietary restrictions and I (of course) only told her the foods Bear and I liked. The moral of the story: everyone was happy once this was briefly discussed. photo (2)

The theme of today’s blog is that life is becoming easier for CKD patients but we’ve got to keep talking, keep exchanging ideas, keep each other updated about new information. CKD is part of me now, but it sure isn’t all of me.

About keeping each other informed: The Free Health Screening by Path to Wellness is on Saturday, 4/26 from 8:30 to 1:30 at The Golden Gate Community Center 1625 N. 30th Ave. in Phoenix, Az. While it is free you need to call for an appointment – the number if you speak English is 602 840 1644. For Spanish speakers, the number is 602 845 7905. You must be over 18 and have a family member with diabetes, heart or kidney disease, or have diabetes or high blood pressure yourself.

Have you looked at Dr. Mario Trucillo’s American Recall Center (www. recallcenter.com)? That was the site discussed in last week’s blog. I’d be interested to hear what you think of it.

I challenged myself to create a business card for SlowItDown doing all the formatting and graphics myself.  This is the final product:SlowItDown business card

Feedback?

 

Until next week,

Keep living your life!

March and National Kidney Month are Hare, I Mean Here.

My wake up alarm is the song ‘Good Morning,’ and that’s exactly what this is.  The sun is out, it’s warm but not hot, I’m listening to some good music, and I’m alone in the house for the first time since Bear’s October surgery.  I am thankful that he is driving himself to his doctors’ appointments. That is progress!   desktop

Talking about progress, it’s National Kidney Month and you know what that means… a recap of many of the organizations listed in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease that may help with your Chronic Kidney Disease.  Ready?  Let’s start.

{I’m only including online addresses since this is on online blog.}

 

American Association of Kidney Patients (AAKP) 

https://www.aakp.org

MARCH IS NATIONAL KIDNEY MONTH (from AAKP’s website)

This is an advocacy group originally started by several dialysis patients in Brooklyn in 1969.  While they are highly involved with legislation, I see their education as the most important aspect of the group for my readers.

“Take some time and browse through our educational resources including our Resource Library that contains past and present published information from the American Association of Kidney Patients. Educate yourself on specific conditions, medicine, lifestyle improvement and get the latest news and information from the renal community.”

kidney-month-2014-v1  The American Kidney Fund

     http://www.kidneyfund.org/

While they work more with end stage Chronic Kidney Disease patients, they also have an education and a get tested program.

“The mission of the American Kidney Fund is to fight kidney disease through direct financial support to patients in need; health education; and prevention efforts.”

National Kidney Disease Education Program

www.nkdep.nih.gov

This is an example of the many videos available on this site.  They are also available in Spanish.

What is chronic kidney disease? Approach 1 A doctor explains what chronic kidney disease (CKD) is and who is most at risk. Learn more about diabetes, high blood pressure, and other kidney disease risk factors. Length 00:53  Category CKD & Risk

One of my favorites for their easily understood explanations and suggestions.  Their mission? “Improving the understanding, detection, and management of kidney disease.”  They succeed.

National Kidney Foundation

www.kidney.org

http://www.youtube.com/watch?v=s2U2iZQxkqI#t=1 (This is the link to their National Kidney Month Rap with Sidney the Kidney)

I have guest blogged for them several times and been glad to work with them whenever they need me.  The website is thoroughly helpful and easy to navigate. This is what you find if you click on ‘Kidney Disease’ at the top of their home page. What I really like about this site is that it’s totally not intimidating.  Come to think of it, none of them are, but this one feels the best to me.  (I can just hear my friends now, “Oh, there she goes with that spiritual stuff again.”  One word to them: absolutely!) Notice the Ask the Doctor function.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

www.kidney.niddk.nih.gov  National Institute of Diabetes and Digestive and Kidney Diseases Logo.

“Just the facts, ma’am,” said Sergeant Friday on an old television show and that’s what you get here.

This is their mission statement:

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services.

Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

And let’s not forget

 Renal Support Network

www.rsnhope.org

This was initiated by a Chronic Kidney Disease survivor.  The part I like the best is the Hopeline.  While I have not called myself, I have referred people who were newly diagnosed and, well, freaking out.  I couldn’t tell them what the experience of dialysis is like, but these people can.

Renal Support Network (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD)….  Call our Hopeline (800) 579-1970 (toll-free) Monday through Friday from 10am to 6pm (PT) to talk to a Person who has lived kidney disease.

Baxter Healthcare Corporation.

http://www.renalinfo.com/us

“… web site designed and developed to provide information and support to those affected by kidney failure. Renalinfo.com is supported through and educational grant from Baxter Healthcare Ltd, a company that supplies dialysis equipment and services to kidney patients worldwide.

They have all the information a newly diagnosed CKD patient could want and, while funded by a private company, do not allow paid advertisements.  Their site map is proof of just how comprehensive they are.

While many of the other sites offer their information in Spanish as well as English, if you click through the change language function here, you’ll notice there are many languages available.

Rest assured that these are not the only organizations that offer support and education.  Who knows?  We may even decide to continue this next week, although that’s so close to March 13th’s World Kidney Day that we’ll probably blog about that for next week.

I interrupt myself here to give you what I consider an important commercial message.  Remember that game I play about using the money from the book to pay off what I paid to produce the book so I can put more money into donations of the book?  There was a point when sales covered the cost of publishing.  Now they’ve covered the cost of digitalizing the book so it could be sold as an e-book.  Another milestone!  (Now there’s just about $15,000 worth of donations to pay off.)54603_4833997811387_1521243709_o

While I’m at it, I find I cannot recommend Medical Surgical Nursing: Critical Thinking for Collaborative Care, 4th Ed. but only because it was published in 2002.  The world of nephrology has changed quite a bit since then and continues to change daily. While I enjoyed the information, I’m simply not convinced it’s still applicable.

For those of you who are newly diagnosed, I sincerely wish these websites give you a starting point so you don’t feel so alone. (I’m sorry the book isn’t interactive.)

Until next week,

Keep living your life!

Control That Chronic Condition

NKF-logo_Hori_OBThe National Kidney Foundation referred this reporter to me to discuss how I handle my chronic kidney disease.  Once she’d interviewed me, she decided to save the material and quotes I’d given her to use in an article on patient participation in their illnesses.

I have one thing to say to you, Laura Landro:  thank you.  Thank you from the bottom of my heart for making it clear that we CAN slow down the decline of our kidneys.  Thank you from the bottom of my heart for getting that message to so many people in one fell swoop.  And thank you from the bottom of my heart for making certain people know about SlowItDown.

While I added the images for the blog, this is the article as it appeared in the Wall Street Journal last Monday:  wsj

Patients Can Do More to Control Chronic Conditions

In the absence of cures, people can learn how to slow kidney disease, diabetes and other ills

By Laura Landro

By the time Gail Rae-Garwood was diagnosed with chronic kidney disease at age 60, it was already too late for prevention, and there is no cure. But Ms. Rae-Garwood decided she could do something else to preserve her quality of life: slow the progression of the disease.

For the millions of Americans over 50 who have already been diagnosed with chronic ailments like kidney disease, diabetes, heart disease, rheumatoid arthritis and chronic obstructive pulmonary disease, careful management can’t turn back the clock, but it can buy time. It takes adherence to medications, sticking to recommended diet and exercise plans, and getting regular checkups.

As simple as that sounds, experts say, patients often don’t hold up their end of the bargain, and doctors don’t always have the time to help between visits. Chronic ailments may also lead to depression, which itself is associated with poor adherence to medication across a range of chronic illness, according to a 2011 study in the Journal of General Internal Medicine.

“The whole goal in conditions that are lifelong, and aren’t going to go away, is to stabilize them and keep them as stable as possible for as long as possible,” says Edward Wagner, a researcher and founding director at Seattle-based Group Health Research Institute.

Patients’ Role

Dr. Wagner developed a protocol known as the chronic-care model in the 1990s, which has been increasingly adopted by many health-care providers. One of its primary goals, in addition to careful monitoring, is teaching patients self-management skills. “Evidence is mounting that the more engaged and activated patients are in their own care, the better the outcomes,” Dr. Wagner says.

Take kidney disease. One of the fastest-growing chronic conditions world-wide, it affects 26 million Americans, and millions of others are at increased risk, according to the National Kidney Foundation. Over time, the kidneys lose their ability to filter waste and excess fluid from the blood; the condition may be caused by diabetes, high blood pressure and other disorders. But patients may not have symptoms until it is fairly advanced. As dangerous levels of fluid and wastes build up in the body, it can progress to so-called end-stage renal disease, or kidney failure. Without artificial filtering, known as dialysis, or a kidney transplant, the disease can be quickly fatal.

But especially in earlier stages, lifestyle changes that ease the burden on the kidneys can have a marked effect, including eating less salt, drinking less alcohol and keeping blood pressure under control. Doctors may suggest a “renal diet” that includes limiting protein, phosphorous and potassium, because kidneys can lose the ability to filter such products.

Sometimes modest changes can make a difference. Even small amounts of activity such as walking 60 minutes a week might slow the progression of kidney disease, according to a study published last month in the Journal of the American Society of Nephrology.

There are plenty of resources to help kidney patients manage their disease, including the kidney foundation website (kidney.org) and classes offered by the dialysis division of DaVita HealthCare Partners Inc.  The company says it educates about 10,000 patients annually at free “Kidney Smart” classes across the country.

Getting the Word Out                     Book Cover

Ms. Rae-Garwood says she decided to become engaged in her own care and share what she learned with fellow patients, after she was diagnosed in 2008 with Stage 3 kidney disease.

“People need to be educated and learn how to manage it so that they are not immediately on dialysis or on death’s door,” she says.

Ms. Rae-Garwood wrote a 2011 book, “What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,” and started a blog to offer its contents free online. She developed an educational program, kidney-book-coverSlowItDown, which is used by health educators to provide free classes in various communities such as the Salt River Pima-Maricopa Indian Community in Phoenix.

She acknowledges that it isn’t always easy to follow her own advice. “The disease is somewhat in control, but I’m getting older,” Ms. Rae-Garwood says. “And while I can control my renal diet, it’s harder to lose weight, and exercise isn’t always an option since I’ve hurt this or that on my body.” She takes blood-pressure and cholesterol medications, and tries to keep stress levels down.

She retired from both a college teaching post and acting last year but still keeps up a Facebook page, Twitter account and her blog to get the word out. “I’m serious about getting the necessary education to the communities that need it,” she says.

The article was published while I was still in Los Angeles after a Landmark Worldwide weekend.  I had no car, didn’t really know where I was, and had no idea how to get to a newsstand… if those even still exist.  Luckily, my daughter Nima – all the way on the other side of the United States – had gotten a print copy.  She’ll be mailing it to me any day now. (Right, Nima?).

I’m old fashioned enough that even if I’ve printed a copy of the article from the internet, I want to feel the pulp of the paper (if that’s what paper is still made from) in my hands and let it yellow with age in my files.  I am one happy Chronic Kidney Disease advocate these days.

Until next week,

Keep living your life!

Book It!

With the holidays over and more time to think about what I’d like to write, I decided this would be a good time to update you about whatever other books are available that also concern Chronic Kidney Disease.

You know there are many out there, too many to mention here, so I eliminated any book that couldn’t be understood by a lay person (those without specific training in a certain field – in this case, medical) and renal diet books.  You can easily find those for yourself by going to Amazon.com and B&N.com. I also excluded those I found to be dubious… the spelling errors were a dead give-away that these were not professional.

I’m not going to tell you about What Is It And How Did I Get It? Early Stage Chronic Kidney Disease since you already know about it from this blog.  Let’s change that, I will tell you one or two things.  First, the books included in ‘Additional Resources’ (Chapter 13) won’t appear here, as good as they are.Book Cover

And – pay attention – students, be aware that both Campus Book Rentals and Chegg are attempting to rent the book to you for more than it costs to buy it.  The digital edition – when I was teaching college, my students always seemed to prefer the digital edition – is even less expensive.

Don’t forget about The KindleMatchBook program which allows you to buy the digital version at 70% discount if you’ve ever bought the print copy. Gather your classmates: pool your money so you can save. One of you buy the print edition, then the others can get the digital edition at deep discount (I have no idea why, but I love that phrase).

Disclaimer:  I am not a doctor, have never have claimed to be one , AND am not endorsing the following books, simply letting you know they exist. For the most part, the descriptions were written by the author. The ‘Look Inside!’ function only works if you follow the link to Amazon.com – sorry! I have been dreaming about this list, so let’s get it out of my dreams and on the blog:

510smylYevL._SL160_PIsitb-sticker-arrow-dp,TopRight,12,-18_SH30_OU01_AA160_Ford, Mathea A., RD (Registered Dietician) Kidney Disease: Common Labs and Medical Terminology: The Patient’s Perspective (Renal Diet HQ IQ Pre-Dialysis Living) (Volume 4)

New to kidney failure? Have no idea what your physician just said about your kidneys? Kidney disease labs and terminology can quite often be a challenge to understand and digest. Did your doctor use the “stages of kidney disease”? Did you physician refer to “eGFR”? What does all this mean for your health and future with kidney disease, lifestyle and nutrition choices. This book is the basic platform for understanding all the common labs and terminology that your doctors and nurses will use. This book with give you and your caregivers the confidence to manage your condition knowing that you have an understanding of all the ins and outs of the nephrology jargon. (Mrs. Mathea seems to have an entire series of books about CKD.)

Hunt, Walter A. Kidney Disease: A Guide for Living. 

When Hunt learned he had kidney disease, he was overwhelmed by the prospect of facing kidney failure. He had so many questions: Why are my kidneys failing? Is there anything I can do to save them? How will I know when my kidneys have failed? What will it feel like? 41nNk5SdqIL._AA160_What treatments are available for me? Is there a cure for kidney failure? The good news, as Hunt found out, is that kidney failure is highly treatable. People with the disease can lead full and productive lives, and Hunt’s readable and empathetic book will help them do just that. It discusses the latest scientific and medical findings about kidney disease, including what kidneys do; the underlying diseases that cause failure; diagnosis, treatment, and prevention; dietary factors; clinical trials; and the future direction of research on kidney failure. Kidney disease is difficult, but as Hunt’s narrative reveals, people living with it can take control of their health and their future. By understanding kidney failure — what causes it, how it may affect their lives, and what treatment options they have — people with the disease can improve their quality of life and achieve the best possible outcome.

51nUIkG8kSL._AA160_Lewis, Dr. Robert. Understanding Chronic Kidney Disease: A guide for the Non-Specialist.

This is meant for primary care physicians, but can be easily understood by the layman. I looked under the covers of this one and was delighted to see that the information we, as patients with CKD, need to know is also what our primary care physicians need to know. (I wrote this description.)

National Kidney Foundation of Southern California. Living Well With Kidney Disease.

The first edition of “Living Well With Kidney Disease” was developed and published by the National Kidney Foundation of Southern California. Based on the handbook “When Your Kidneys Fail” (originally published in 1982), this new and 41jxZoYLGzL._AA160_updated edition provides detailed information specifically intended for people coping with Kidney Disease and other renal failure, as well as their friends and families. The question and answer format provides a clear and manageable guide for those seeking support and answers. Among the topics covered are the principles of kidney function, methods of treatment, transplantation, and financial resources available to patients. With all of the ramifications of kidney failure and the rise of Chronic Kidney Disease and Type 2 Diabetes, there is a growing population of people afflicted with kidney failure. Although it was written with the patient in mind, family members, friends and health care professionals will also find this handbook a valuable resource.

517GaXFXNPL._SL160_PIsitb-sticker-arrow-dp,TopRight,12,-18_SH30_OU01_AA160_Synder, Rich DO (Doctor of Osteopathic Medicine) What You Must Know About Kidney Disease: A Practical Guide to Using Conventional and Complementary Treatments

The book is divided into three parts. Part One provides an overview of the kidneys’ structure and function, as well as common kidney disorders. It also guides you in asking your doctor questions that will help you better understand both status and prognosis. Part Two examines kidney problems and their conventional treatments. Part Three provides an in depth look at the most effective complementary treatments, from lifestyle changes to alternative healing methods. The diagnosis of kidney disease is the first step of an unexpected journey.

*Yes, this is the same Dr. Rich Snyder who interviewed me on his radio show twice since What Is It And How Did I Get It? Early Stage Chronic Kidney Disease was published.

It’s always hard to find good books about CKD that non-medical personnel can understand.  I hope this four (and mine!) help you feel more comfortable and knowledgeable about your diagnosis.

Here’s a little hint about your own health.  I’m back to no sweets or desserts and, I hate to admit it, but I’m feeling better.  Don’t you just hate when that happens?sugar

Until next week (when I’ll in in Culver City for a weekend of Landmark),

Keep living your life!

A Healthy Diet is Not Necessarily a Renal Healthy Diet

Many people have asked me why I just don’t follow a healthy diet for my kidney disease.  It’s one of those questions we hear again and again as early stage chronic kidney disease patients … and not just from those who think they know better, but from those who genuinely care about us and want to help. Today’s blog is meant to answer that question.imagesCALEX9DU

There were many food guides from the government before the introduction of the one we usually hear about, the USDA’s 1992 Food Pyramid. (See http://www.huffingtonpost.com/2011/06/02/usda-food for a fascinating history of the older ones if that interests you.) Although updated in 2005, this was the gold standard for a healthy diet.  We’ll be dealing with the 2005 revised version in this blog.

Michelle Obama changed all that in 2011 when she supported MyPlate as the new U.S. nutrition guideline in an effort to help control the obesity epidemic.  By then, I was already on the renal diet so didn’t really pay attention.

I wanted to use the government’s website since both Pyramid and MyPlate are their concepts, but since that wasn’t up due to the government shut down (didn’t expect to see that again in my lifetime), I relied on http://www.usaring.com/health/food/food.htm for information about the 2005 Pyramid and http://www.medicinenet.com/myplate/page2.htm#difference for the MyPlate information.  The renal diet information is from the diet my own renal nutritionist helped formulate. food plate

So what are the differences you ask?

measuring cupsLet’s start with the base of the Food Pyramid which includes 6 oz. of bread, cereal, rice and pasta a day with the stipulation that half of these be whole grain.  Sounds like heaven for a miller’s grand-daughter like me.  MyPlate suggests the same amounts. However, my renal diet considers a portion of pasta as 1/3 cup, not the ½ cup in the other two eating guides… however many calories a day I can eat.

That makes a difference because of the phosphorous and potassium CKD patients need to curb, to say nothing of our daily calorie limits.  Even the protein adds up.  For example, I’m limited to 60 grams of protein a day.  That doesn’t mean just meat.  My favorite angel hair pasta has 7 grams of protein for a 2 oz. serving.  Let’s say I’d like half a cup.  That’s 4 oz. and already 14 of my 60 protein grams.  Got to save some of those protein grams for the meat (turkey) balls!

Sometimes my 1200 calories seem like an awful lot, but not on the days I eat pasta or rice. You also need to keep in mind that the USDA bases their portion suggestions on a 2000 calorie diet. That means I, for one, will need to eat less food in each category and so will you if you don’t require 2000 calories a day.colander

What about vegetables?  Those are healthy, right? The 2005 Pyramid suggests 3-5 cups a day.  I can’t do that.  MyPlate suggests 2.5 cups daily, but their cup for leafy salad greens is actually two cups.  For the renal diet, one serving is ½ a cup. The government also recommends beans and sweet potatoes which CKD patients cannot eat due to their high phosphorous and potassium levels.    We need to stick to vegetables that are low carb and to limit or avoid salty ones.veggies

Are you with me so far?  The pyramid suggests two cups of fruit a day, while MyPlate suggests 2-4.  That wouldn’t be a problem except for the serving sizes which are different between these two and the renal diet.  So no matter how healthy these are, I’m limited to three ½ cup servings a day.  What does that look like?  Today it was half a banana, ½ cup of blueberries, and one very small mandarin orange. As CKD patients, we need to be careful about (yep, here it comes again) phosphorous and potassium.  As a matter of fact, bananas are a once in a great while treat due to their high potassium content.

Meat and Beans is a little bit of a joke since beans are a no-no for us.  The pyramid suggests including nuts and seeds, too.  Uh, not for CKD patients.  Why?  Because of the (you know it!) phosphorous and potassium.  There’s also the calorie consideration here.  MyPlate has the same difficulties for us, although they suggest lean meat.  We are urged not to have red meat too often and cheese – I know it’s a dairy product – is included in our meat group.  As renal patients, protein is not our friend with many of us being limited to 5 oz. This group is where you get most of your protein.salt

Hang in there, almost done. The pyramid recommends 3 cups of dairy. MyPlate recommends 2 to 3 servings and they include cheese.  (I find myself wondering if they mean real cups or MyPlate cups.) The most glaring difference is that the renal diet allows ½ cup of milk or plain yoghurt per day. I use a substitute since I’m lactose intolerant, but that’s still only 4 oz. Why such drastic limitations?  Tricked you.  This time, it’s not only the phosphorus and potassium, but also the sodium.

As far as oils, although nothing is mentioned about them on the actual plate for MyPlate, the pyramid does mention they should be used sparingly.  The renal diet restricts them to 4 or 5  one teaspoon servings a day and is quite specific about which to use and which to avoid.

Whee, what a trip that was.  You do need to understand that this blog is based on MY renal diet for MY weight with MY restrictions at MY stage of the disease.  Other CKD patients’ diets will vary, but none of us can “just eat a healthy diet.”

The TableSlowItDown continues to educate in The Salt River Pima – Maricopa Indian Community and has been invited to present at their November 5th Health Fair.  Follow us on Twitter and Facebook.  I see big things in our future.

Likewise, book sales – both digital and print at Amazon.com and B&N.com – are holding their own especially in India and Germany where the book is considered the cheapest (hey!) form of self-education about CKD.

I’m hungry.  Now let’s see, maybe there’s a vegetable unit – low carb, of course – in today’s menu.  Better go check my KidneyDiet app.android_welcome

Until next week,

Keep living your life!

Back To Basics

My daughter Abby and I just spent the weekend at Landmark Education’s Access to Communication Course.  If I weren’t already a Landmark graduate, I’d say I couldn’t believe what I learned.  Since I am a Landmark graduate, I’ll share with you my delight at learning just how simple and loving communication can be. people talking

Of course, I’d urge you graduates reading this blog to register for this course and those of you who aren’t yet graduates to explore the Landmark Forum.  You might get an idea of how forceful this work is when I tell you that my upcoming marriage is a result of it.

As a matter of fact, there’s an introduction this Wednesday night at the Scottsdale center from 7 – 11.  The address is 16100 North Greenway-Hayden Loop, Suite 108, and the phone number is 602-222-1110. You can always contact me and we can go together.

I chose communication about CKD as the topic for this week’s blog because I have been doing just that… and being startled over and over again at the number of people I’ve spoken with that know nothing about Chronic Kidney Disease.  So, this week, we go back to basics.

Anyone know what the kidneys are and what they do?  Will the gentleman with his hand raised in the back of the room answer the question, please?  Oh, it’s my future son-in-law, Sean, and he’s quoting me!

kidney locationOn page 1 of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, Gail Rae wrote, “Later, I learned that the kidneys were two reddish brown organs which lay on the muscles of the back on either side of your spine above hipbone level and below the diaphragm… Some have compared their size to that of a clenched fist or a large computer mouse, and the right one lies lower than the left since the liver is on that side.” [You can order digital copies of the book at Amazon.com and B&N.com.  Print copies are available at Amazon.com and myckdexperience@gmail.com.]

I couldn’t have said it better myself.  [ Ha Ha. Get it?  I DID say it.] Now about their function… Ah, lady on the left side of the room. Estelle, my dear East Coast buddy, I didn’t know you were here.

According to The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) at http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys, “Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.” Nice job!

What else do they do?  Nima?  Yes, you may answer questions even though you’re my daughter.  Well then:

  • Control your body’s chemical balance
  • Help control your blood pressure
  • Help keep your bones healthyBook signing
  • Help you make red blood cells

You’ve learned well.  What was your source?  The American Kidney Fund at http://www.kidneyfund.org/kidney-health/kidney-basics/your-kidneys.html.

That’s a good one, as are all the others mentioned here.  They each contain far more information than we’ve included in today’s blog and can make you a sort of neophyte kidney expert.  Well, maybe someone who knows about his/her early stage chronic kidney disease or that of someone you know and/or love might be a more realistic title.

More?  Okay.  How many people have chronic kidney disease?  Look there.  Lara, my step-daughter, who is in very good health (thank the powers that be) is here.  Ummm, I did tell you that number but it’s changed a bit since then.  It’s 26 million in the USA alone and raising.  Those are the diagnosed people.  There are millions of other who have not yet realized they have CKD according to The National Kidney Foundation at     http://www.kidney.org/kidneydisease/aboutckd.cfm#facts

How do you know if you have it?  Excellent question, Kelly. As another healthy person, my step-daughter has asked an important question. Since there are rarely symptoms, it’s all about blood and urine tests.  A simply stated E-how article at http://www.ehow.com/how_2051919_test-kidney-disease.html explains without overwhelming.  Basically, your doctor is looking for protein in your urine and at the following values in your blood test: GFR (glomerular filtration rate) and bun (blood urea nitrogen).  I don’t advocate eHow for medical information, but this one is not that bad.

I will, Bear, right now.  The wonderful man I’ll be marrying in April asked me to make certain I write about the renal diet.  He follows it with me so we don’t have to cook two different meals when we do cook and he lost 60 pounds in the first several months of doing so.  I could hate him for that, except that I already love him.

The renal diet is only one part of the treatment. [There’s also exercise, adequate sleep and lack of stress.] I thought the one at Buzzle (http://www.buzzle.com/articles/diet-for-chronic-kidney-disease-ckd.html) was a good example until I realized there was no potassium restriction on this diet.  I follow that of the Northern Arizona Council of Renal Dietitians. What this tells us is that you need to pay attention to the specific renal diet the nephrologist (kidney and high blood pressure expert) has given you or your loved one, friend, and/or co-worker.water melon

Basically, sodium, phosphorous, protein, potassium and fluids are restricted. Sometimes, I feel like my fluids are exaggerated rather than restricted – like when I’m writing – and have to remind myself to drink so I can meet my 64 ounces/per day ‘limit.’

My neighbor and friend, Amy, just asked me to backtrack a bit and discuss the causes of CKD.  That would be helpful, wouldn’t it?

eMedicine at http://www.emedicinehealth.com/chronic_kidney_disease/page3_em.htmers this.  Two thirds of ckd is caused by high blood pressure or diabetes, but they neglected to mention that sometimes ckd is simply a result of growing older – as in my case.

You know the people I mentioned are not in my office as I write this blog, so here’s a public thank you to each of them for the loan of their names.  I kind of think they would have offered those answers or asked these questions if they were here with me right now.

Check out those websites.  They offer quite a bit of information.

Until next week,

Keep living your life!

Good Bye To 2012 And Its Obesity

Today is the last day of 2012.  That means you can start your new year’s resolutions tomorrow.  When you’re done laughing, think about it.  We new-years-eve-celebrations-live-streammake resolutions intending to keep them – at least I do – but something happens right about March something or other.  We tend to forget what they are.

We could look at it another way.  Pollyanna over here likes this way better.  What has become part of your life as a former new year’s resolution?  For me, it’s the renal diet and exercise.  I actually feel bad when I can’t exercise now.

There’s hope for me in the form of a possible cortisone injection to lubricate that hip that has eroded so much that it is bone on bone. I know you were really worried about that [she wrote tongue in cheek].

Sometimes we need motivation to even think of resolutions.  Jody Charnow provided that for me in the Dec. 26th issue of Renal and Urology News:

 

Overweight, Obesity Raise Kidney Disease Risk

A large study conducted in Thailand corroborates previous findings showing that overweight and obesity are associated with an increased likelihood of chronic kidney disease (CKD).

Subjects with CKD had a significantly higher mean BMI than those without CKD (25.36 vs. 24.04), as well as a significantly higher prevalence of abdominal obesity (35.7% vs. 25.3%). The investigators defined abdominal obesity as a waist circumference of 90 cm (That’s 35 7/16 inches for the math challenged like me) or greater for men and greater than 80 cm (This one is about 31 and a half inches) for women.

You can read the rest of the article at http://www.renalandurologynews.com/overweight-obesity-raise-kidney-disease-risk/article/273848/#

IMAG0093My poor dog, Bella, keeps waiting for me to walk with her.  Can’t be done until the hip is taken care of.  Believe me, I tried.  But it’s not just Bella’s disappointment, it’s mine too.  I saw the pictures from Christmas Eve.  Not good, boys and girls.  How am I going to get my BMI under control without exercise?

Just in case you don’t remember, BMI means Body Mass Index or a way of measuring the fat content of your body based on your height and weight.  If you have the fortitude, you can make use of the BMI calculator at http://nhlbisupport.com/bmi/  I just did and I can tell you this is not for the faint of heart. I was a thinner young woman.  I can even prove it!  early headshots (Pardon the cigarette pix.  This was a long, long time ago.) My goal is to lose weight and be healthier.  This picture is another motivation (thank you for finding it, Nima), even though I realize my thinner 65 year old body is not going to look anything like my thinner 25 year old body.

So why all the whining about not being able to exercise, you ask.  Read that article excerpt again.  I already have stage 3 Chronic Kidney Disease.  How much worse do you think a lack of exercise – which leads to weight gain – is going to make my ckd?  Technically (I just had to qualify that), I already am obese.  I’m not that vain, but I want to stay at stage 3 for the rest of my life and avoid dialysis completely.  This is not the way to do it.

Let’s try this another way – for those of you who can walk – untreated hypertension (high blood pressure) may also be one of the causes of ckd.  According to http://www.nydailynews.com/life-style/health/easy-steps-reduce-blood-pressure-article-1.1226714, exercise can lower your blood pressure.  We already know that obesity is another possible cause of ckd.  Here’s the good part: while you’re walking to lower your blood pressure, you’re also exercising which means you’re losing weight if you’re consistent enough. Wow!  Two for one here!

I found surprising information in that article.  Who knew that fructose raises your blood pressure?  The only time I’d heard it mentioned as a medical deficit is at the immunologist’s. According to http://www.immunologist.com, an immunologist is, “A specialist concentrating on allergic diseases and those disease processes that involve the immune system.”  She had warned me that fructose should be avoided if you have allergies.

Potassium may also be a key in lowering your blood pressure.  I’ve been draining my canned fruit and only occasionally having a fresh (oh, all right, HALF a fresh) banana to control my potassium intake.  Guess what.  My blood pressure has gone up.  Maybe I shouldn’t be that surprised.

Oh no! The article also suggests losing weight.  Looks like it always comes back to the same thing.  A thinner body is a healthier body as long as we don’t go past thinner to obscenely thin.

Book CoverAh, I forgot to mention other new year’s resolutions that have become part of my life.  I blog about ckd every week.  This started out as a way to publicize What Is It And How Did I Get It? Early Stage Chronic Kidney Disease (Amazon.com and B&N.com – print and digital), but soon took on a life of its own. Another new year’s resolution that has become a way of life is posting some ckd related news on the facebook page for the book (https://www.facebook.com/WhatHowearlyCKD).  Say, that’s not bad for new year’s resolutions.

You know how some people announce the addition of grand-children?  I do believe we’re going to be announcing our new grand-animals for quite a while before we get to grand-children. Here’s the newest, as yet unnamed, addition to the family, Lara’s new pal. Each of my biological daughters has a cat and my other step-daughter has both a dog and a cat. We are a pet loving family.Lara and Dog

Until next YEAR,

Keep living your life.

Back To The Salt Minds

Here we are right smack in the middle of Chanukah with Christmas and Kwaanza coming up. We’ve read all the health articles about how to plan our party eating

including the Menorahmenorah lighting and latkes one at our house later this week – and we all know to avoid sodium since it causes so much havoc with blood pressure which causes further problems, right?  Maybe not.

Be prepared to have your minds blown (ahem, I am a child of the 60s):

Scant Evidence That Salt Raises BP, Review Finds

Published: December 04, 2012

The evidence for health benefits associated with salt reduction is controversial and the “concealment of scientific uncertainty” is a mistake, researchers suggested.

salt

Because this is such a treatment shattering controversy, I decided to let the experts speak for themselves. Do go to the following link and listen to them yourselves. (Notice the doctors insist that sodium restriction needs to depend upon the individual patient, not that it should be universally discarded.)

You can read the rest of the article and hear the doctors at: http://www.medpagetoday.com/Cardiology/Hypertension/36248?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-12-05&eun=g596983d0r&userid=596983&email=myckdexperience@gmail.com&mu_id=5721543

So, what does this mean for us as Chronic Kidney Disease patients?  Well… let’s go back to CKD basics for a moment.  We are restricted as far as the three ps (protein, potassium, phosphorous) and sodium, not to mention fluid intake and – for some of us – caloric intake.  {That’s odd, these restrictions don’t seem that complicated anymore, but when I type them, they look a bit daunting.}

Okay, so sodium.  Too much sodium can lead to hypertension (or can it?), which may lead to CKD. You already have CKD.  You are still at risk for edema, which is swelling caused by fluid retention in the tissues of the body.  Since this is already a potential problem for CKD patients, why exacerbate it?

This is what I wrote about sodium in What Is It And How Did I Get It? Early Stage Chronic Kidney Disease:

“What makes it worse is that there is no internal mechanism that tells us if we need more or less salt.  CKD sufferers are in a spot because the kidneys are the only route by which to eliminate excess salt.

Basically, sodium balances fluid levels outside your cells.  You need it because it is responsible for watering your cells.  This watering is the prompt for potassium to dump waste [cell process by-products] from your cells. Sodium does deal with other functions of the body, but this is a pretty important one.

If you have damaged kidneys and cannot excrete most of the sodium you ingest, you’re up again higher blood pressure {is that still true?} which may worsen your CKD which may further cut down on your elimination of sodium and so on and so forth in an ever spiraling cycle.  In addition, for CKD patients, too much sodium causes fluid retention, thereby causing swelling, further resulting in weight gain, leading to shortness of breath. That’s why your nephrologist asks if you’ve experiences shortness of breath.”

It gets worse.  Too much sodium can increase your need for potassium. While potassium is a necessity since it “dumps waste from your cells, but also helps the kidneys, heart and muscles to function normally.  Too much potassium can cause irregular heart beat and even heart attack.  This can be the most immediate danger of not limiting your potassium.” (also from my book)                                                                bbq-chips-beer-230

That is a simple, direct and universally accepted explanation of the horrors of sodium for CKD patients.  But is it still true for you?  With these newly uncovered controversies, who knows?  Speak with your nephrologist, but use common sense, too. I would not recommend running for the salt shaker under any circumstances, but is it safe to eat the fresh made potato chips you ordered at the local brewery (not that I drank any beer. Oh – I mean, not that you drank any beer.) when you tasted a bit of salt on them?

We are not an overly social couple, yet we have our Chanukah party, a friend’s huge pot luck, Bear’s work holiday social (Let’s hear it for Rockler’s!  They know how to do it right.), Christmas eve at Sean and Kelly’s (wow, another family tradition torch passed to the next generation) and now I’m playing around with the idea of a quiet champagne and caviar – neither of which I can eat – new year’s eve if that’s something the Arizona grown children and the assorted fiancés and boyfriends or best friends would be interested in.  That’s a lot of food intake planning.

I thought about taking it party by party and that has worked well for me.  Prior to that, I had a forbidden list I carried around in my head.  That was a total bust.  I would become frustrated at all the foods I couldn’t eat even though they were beautifully and enticingly displayed in front of me and just go whole hog.  Then I had to deal with the guilt, to say nothing of the bodily discomfort, that I felt after.

Yes, party by party is better for me. But that’s not all.  I am analytic, so I peruse the offerings and then – slowly – mentally check off what I can ingest, all the while socializing. That works for me. So does the old dieter’s motto: do-not-stay-seated-at-the-table-with-that-wonderfully-aromatic-food-in-front-of-you.  Feeling well armed to go to your holdiay parties with sodium intake well in hand?  Go party!

Until next week,

keep living your life!                       1129852_Christmas_Buffet_Smoked_salmon_Ham_Mini_quiches___Sausage_rolls_Pizza_Mincemeat_Lattice__nibbles_etc

Appy Trails To You

As any of my family members will tell you, I may not be the first around here to try something that’s electronically new but I like exploring and am always delighted to find one app (application) or another that makes my life easier.  For example, I’ve written several times about KidneyDiet, the app for counting electrolytes, fluids and calories.    

In the book What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, I wrote about carrying a pad and pen to keep track of these.  Obviously, that was before the app was developed. Now all I need is my phone… or iPad if I have it with me.  I could always check it out on my laptop, too. The point is I’m not tied to my desktop to use the app.

Apparently, doctors have started to see the electronic light, too.  According to the August 19, 2012, NY Times, apps may become part of your prescription and – get ready – be paid for by your insurance.  I bought my KidneyDiet app this year and had intended to claim it on my taxes as a  health cost, but to have my insurance pay for it?  That’s not only interesting, it’s astounding at the moment.  Of course, any new concept is.  Here’s to seeing this become part of our medical futures!

In addition to KidneyApp, I recently read about other apps. Being pre-diabetic, I was particularly interested in the one dealing with that disease. I thought it was another keeping-track-of-what-you-eat app. According to the article I mentioned, it reads as if it’s a doctor in your phone, or iPad, or laptop, or desktop.  In other words, it does a lot more than track.

This app, called DiabetesManager, does collect information about blood sugar levels, meds (medication) and diet as we’d expect but it can do so by wirelessly linking with the patient’s glucose monitor.  One of the biggest reasons I don’t use KidneyApp consistently is that information needs to be manually entered.

I realize this is nothing more than laziness on my part but I’m human – glucose monitors are not. That also means no chance of human error in entering the information, say as in a finger slip so that the incorrect information is being entered.

I was still being amazed that such a thing could be done (remember I’m 65.  I didn’t grow up with electronics.) when I was mentally blown out of the water by this statement:

“DiabetesManager then gives advice to a patient, perhaps suggesting the best food after recording a low midday blood-sugar reading. It also uses an algorithm to analyze the medical data and send clinical recommendations to the doctor.

WellDoc  [That’s the developer of DiabetesManager] says that in a clinical trial, DiabetesManager was shown to reduce significantly the blood sugar levels in diabetes patients. “

It gets even better.  According to the company, as of August of this year, two unidentified insurance companies agreed to pay the hefty $100 per month cost of the app.  Let me get this straight – diabetics get a doc in the pocket that insurance pays for?  Sign me up!  Oh wait, I don’t have diabetes.

There are similar apps being developed for heart problems, too, as well as for physical therapy and rheumatoid arthritis.  Maybe it has to do with my age, which means a history of personal doctor visits for information – then library research – on to internet research – and learning to track by hand, that I find this incredible.  I know it’s at hand, but I keep thinking it’s the science fiction of my youth.

While the FDA has already approved DiabetesManager, it won’t be available by prescription – yes, your doctor must prescribe it – before 2013.  You can read the article at: http://www.nytimes.com/2012/08/20/technology/coming-next-doctors-prescribing-apps-to-patients.html?pagewanted=2&_r=0&seid=auto&smid=tw-nytimeshealth.

Have you submitted your entry for the two contests we’re running until Wednesday?  One is to find the most creative use for this garden tub which is in my master bathroom and will be staying there and the other is to be the first person to find the reason it’s called a garden tub when it’s in a bathroom. The first contest is creative; the second factual.  Looks like I’ve got both parts of the brain covered.

You can submit your entries as comments here, emails to myckdexperience@gmail.com, posts on the Facebook Community Page “What Is It And How Did I Get It? Early Stage Chronic Kidney Disease,” or at http://Pinterest.com  The prizes are (what else?) personally inscribed copies of the book What Is It And How Did I Get It? Early Stage Chronic Kidney Disease.  

Pinterest is new for us so it’ll take a bit of time to get that straight.  Bear with us, please.

Bear!  Talking about Bear, I wanted to let you know how very enjoyable it is to realize we’ve turned the Thanksgiving torch over to his youngest and her fiancé. It was strange at first not to be the one scurrying around to organize the dinner, but I quickly got used to it. I’m beginning to see that age has its privilege.

Here’s something to make you jealous, Sean was the organizer and called me beforehand to find out what my eating restrictions are.  You are a welcome addition to the family, Sean.  Kelly knows I can only eat potatoes if they are soaked several times before cooking (to cut down on potassium) and automatically does that before making her delicious mashed potatoes. Thank you, Kelly.  That’s just another reason I love you.

Until next week,

Keep living your life!

Fruits, Vegetables, and Staten Island.

I brought up my daughters on Staten Island which is still part of New York City.  Staten Islanders often call themselves “the forgotten borough.”

I have been riveted to my computer for news of friends and family and to pass information about them to others even further away than I am.  Hurricane Sandy has not been kind to the island.

Now that people have electricity, phone service and cell service (for the most part), I wonder if those with early stage chronic kidney disease are able to get the food on their diet.

Nima, my Staten Island daughter, and I talked last night about how the food that defrosted in the freezer during the no electricity time has refrozen now that the power is back on. Sometimes, people don’t realize that defrosted frozen food must be tossed, not refrozen; it’s no longer safe to eat.

You can see (and smell) that most of the refrigerator food is no longer edible after five days without electricity.  I wouldn’t trust the rest of it.  There’s a reason we refrigerate food.

According to the United States Department of Agriculture’s Food Safety And Inspection Service, these are guidelines to follow:

“Always keep meat, poultry, fish, and eggs refrigerated at or below 40 °F and frozen food at or below 0 °F. This may be difficult when the power is out. [This is me here: Or impossible with five days of no electricity even if you’ve kept the refrigerator and freezer doors closed.  Please, take no chances.]

Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature. The refrigerator will keep food safely cold for about 4 hours if it is unopened. A full freezer will hold the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed.”

You can find food safety charts on their website at: http://www.fsis.usda.gov/Fact_Sheets/Keeping_Food_Safe_During_an_Emergency/index.asp

There’s been new research that indicates fruits and vegetables are more important to ckd patients than originally thought.  Keep this in mind when you restock your refrigerator.

This article appeared in The Kidney Group of South Florida’s blog a few days ago. They originally located the article in HealthDay News. (San Diego hosted the American Society of Nephrology’s annual meeting this past weekend, which was the source of quite a bit of new information.)

“After three years, consuming fruits and vegetables or taking the oral medication reduced a marker of metabolic acidosis and preserved kidney function to similar extents. “Our findings suggest that an apple a day keeps the nephrologist away,” study author Dr. Nimrit Goraya, of Texas A&M College of Medicine, said in a university news release.”

Apparently, some ckd suffers have metabolic systems that are severely acidic. Fruits and vegetables are highly alkaline.  This may counteract the acidity in the patients mentioned above AND those that have less metabolic acidosis (acid in the body).

You can find the complete article at: http://kidneygroup.blogspot.com/2012/11/eating-fruits-and-vegetables-may-help.html

What is not mentioned in the findings of the study is whether or not the ckd patients adhered to their fruit and vegetable restrictions.  I am limited to three servings of each daily with their serving sizes limited according to the fruit or vegetable.  For instance, I can consume three apricot halves during the same day, but only two peach halves. In addition, the fruit is usually canned so I can drain away the potassium in its juices.

I’ve written repeatedly about the prevalence of chronic kidney disease.  Now the public is beginning to understand.  Hmmm, I don’t mean my writing alone did that.  Consumer Reports, a magazine you should know if you’ve ever bought a car, an electronic device or anything else you need information about before buying now has a Chronic Kidney Disease Site.  Take a look for yourself.  The address is:

http://consumerhealthchoices.org/wp-content/uploads/2012/10/ChoosingWiselyKidneyDiseaseASN.pdf

While my biopsy stitches are healing nicely, I did have to return to the ophthalmologist for a secondary membrane procedure.  I had read about it before the original cataract surgery, but hadn’t taken it into account until I realized I was having trouble seeing in one eye despite the surgery.  I found it fascinating to see what medical science can do with the human body these days.

According to the University of Wisconsin – Madison’s School of Medicine and Public Health, “The natural lens of the eye is enclosed in a clear, cellophane-like membrane called the capsule. During cataract surgery the front of the capsule is opened. The cloudy lens inside the capsule is removed. In most cases, the back of the capsule is left in one piece, and a plastic lens implant is put in place in front of the capsule. In some patients, the capsule can become thickened and cloudy over time…”

Their address is: http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126651607431.html

Wouldn’t you know I was one of those whose “over time” was only three months.  A laser was used to make a hole in the back of the capsule and I’m already beginning to see just as well out of that eye as the other one.

One last note, Libre Clothing (makers of dialysis clothing) who has been such a good friend to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease, is holding a contest on Pininterest from Nov.12-16. I’d suggest you take a look!

Until next week,

Keep living your life.

Po…Pot…Potassium? What’s that?

Here’s hoping you had a wonderful Christmas – if that’s what you celebrate – and/or Chanukah, Kwaaza or a holiday I don’t know about yet.  Everyone’s financial situation was so tight this year that I was told repeatedly, “I have never spent so little on gifts as I did this year,” or “I can’t afford any gifts. I’ll have to come up with some other ideas.”  And this year was the year that these same people gave the most thoughtul, creative and inspired gifts. From the letter telling me how my step-daughter felt about me to the afternoon spent with my daughter and all the thoughtful, really thoughtful gifts inbetween, if this is how a no-money gifting season goes, I wish we’d treat every year this way – whether or not there was money available.  Tissue alert: With my four daughters – step and biological – and my fiance, “I don’t need no stinkin’ gifts.” (Thank you, “Treasure of Sierra Madres” for the almost quote.)

Okay, you can put the tissues away again.  We did visit and go out to restaurants a bit.  This time I heard another question several times: “What’s with you and potassium?”  Just as I was framing an original post on this very subject, The National Kidney Foundation posted their potassium fact sheet.  Nothing like learning from the masters!

On Potassium and Your CKD Diet

What is potassium and why is it important to you?

Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the right amount of potassium in your body. However, when your kidneys are not healthy, you often need to limit certain foods that can increase the potassium in your blood to a dangerous level. You may feel some weakness, numbness and tingling if your potassium is at a high level. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack.

What is a safe level of potassium in my blood?

Ask your doctor or dietitian about your monthly blood potassium level and enter it here:

If it is 3.5-5.0………………………You are in the SAFE zone
If it is 5.1-6.0………………………You are in the CAUTION zone
If it is higher than 6.0……………..You are in the DANGER zone

How can I keep my potassium level from getting too high?

  • You should limit foods that are high in potassium. Your renal dietitian will help you plan your diet so you are getting the right amount of potassium.
  • Eat a variety of foods but in moderation.
  • If you want to include some high potassium vegetable in your diet, leach them before using. Leaching is a process by which some potassium can be pulled out of the vegetable. Instructions for leaching selected high potassium vegetables can be found at the end of this fact sheet. Check with your dietitian on the amount of leached high potassium vegetables that can be safely included in your diet.
  • Do not drink or use the liquid from canned fruits and vegetables, or the juices from cooked meat.
  • Remember that almost all foods have some potassium. The size of the serving is very important. A large amount of a low potassium food can turn into a high- potassium food.
  • If you are on dialysis, be sure to get all the treatment or exchanges prescribed to you.

What foods are high in potassium (greater than 200 milligrams per portion)?

The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others.

High-Potassium Foods
Fruits Vegetables Other Foods
Apricot, raw (2 medium)
dried (5 halves)
Acorn Squash Bran/Bran products
Avocado (¼ whole) Artichoke Chocolate (1.5-2 ounces)
Banana (½ whole) Bamboo Shoots Granola
Cantaloupe Baked Beans Milk, all types (1 cup)
Dates (5 whole) Butternut Squash Molasses (1 Tablespoon)
Dried fruits Refried Beans Nutritional Supplements:
Use only under the
direction of your doctor
or dietitian.
Figs, dried Beets, fresh then boiled
Grapefruit Juice Black Beans
Honeydew Broccoli, cooked Nuts and Seeds (1 ounce)
Kiwi (1 medium) Brussels Sprouts Peanut Butter (2 tbs.)
Mango (1 medium) Chinese Cabbage Salt Substitutes/Lite Salt
Nectarine (1 medium) Carrots, raw Salt Free Broth
Orange (1 medium) Dried Beans and Peas Yogurt
Orange Juice Greens, except Kale Snuff/Chewing Tobacco
Papaya (½ whole) Hubbard Squash  
Pomegranate (1 whole) Kohlrabi  
Pomegranate Juice Lentils  
Prunes Legumes  
Prune Juice Mushrooms, canned  
Raisins Parsnips  
  Potatoes, white and sweet  
  Pumpkin  
  Rutabagas  
  Spinach, cooked  
  Tomatoes/Tomato products  
  Vegetable Juices  

What foods are low in potassium?

The following table list foods which are low in potassium. A portion is ½ cup unless otherwise noted. Eating more than 1 portion can make a lower potassium food into a higher potassium food.

Low-Potassium Foods
Fruits Vegetables Other Foods
Apple (1 medium) Alfalfa sprouts Rice
Apple Juice Asparagus (6 spears) Noodles
Applesauce Beans, green or wax Pasta
Apricots, canned in juice Cabbage, green and red
Carrots, cooked
Bread and bread products: (Not Whole Grains)
Blackberries Cauliflower Cake: angel, yellow
Blueberries Celery (1 stalk) Coffee: limit to 8 ounces
Cherries Corn, fresh (½ ear)   frozen (½ cup) Pies without chocolate or high potassium fruit
Cranberries Cucumber Cookies without nuts or chocolate
Fruit Cocktail Eggplant Tea: limit to 16 ounces
Grapes Kale  
Grape Juice Lettuce  
Grapefruit (½ whole) Mixed Vegetables  
Mandarin Oranges Mushrooms, fresh  
Peaches, fresh (1 small) canned (½ cup) Okra  
Pears, fresh (1 small) canned (½ cup) Onions  
Pineapple Parsley  
Pineapple Juice Peas, green  
Plums (1 whole) Peppers  
Raspberries Radish  
Strawberries Rhubarb  
Tangerine (1 whole) Water Chestnuts, canned  
Watermelon (limit to 1 cup) Watercress
  Yellow Squash  
  Zucchini Squash  
     

How do I get some of the potassium out of my favorite high-potassium vegetables ?

The process of leaching will help pull potassium out of some high-potassium vegetables. It is important to remember that leaching will not pull all of the potassium out of the vegetable. You must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian about the amount of leached vegetables that you can safely have in your diet.

How to leach vegetables.

For Potatoes, Sweet Potatoes, Carrots, Beets, and Rutabagas:

  1. Peel and place the vegetable in cold water so they won’t darken.
  2. Slice vegetable 1/8 inch thick.
  3. Rinse in warm water for a few seconds.
  4. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.
  5. Rinse under warm water again for a few seconds.
  6. Cook vegetable with five times the amount of water to the amount of vegetable.

For Squash, Mushrooms, Cauliflower, and Frozen Greens:

  1. Allow frozen vegetable to thaw to room temperature and drain.
  2. Rinse fresh or frozen vegetables in warm water for a few seconds.
  3. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.
  4. Rinse under warm water again for a few seconds.
  5. Cook the usual way, but with five times the amount of water to the amount of vegetable.

References:
Bowes & Church Food Values of Portions Commonly Used, 17th Ed., Pennington, JA, Lippincott, 1998.
Diet Guide for Patients with Kidney Disease, Renal Interest Group-Kansas City Dietetic Association, 1990.

 
The National Kidney Foundation would like to thank the
        Council on Renal Nutrition for the development of this fact sheet.

[Me: This is a bit different from my renal diet.  There are foods on here that my diet doesn’t allow, but you’ll see when you look at your diet that most foods we need to concern ourselves with are mentioned on this list.]

On the book front, don’t forget the Twitter Chat on Jan. 9 from 8-9 EST.  Locals, come on down to Bookman’s in Mesa on Jan. 14 from 1-3 for a book signing.  Oh, KevinMD.com will be running an excerpt from the book within the next week and a half or so.  I’ll send out a bulletin when I find out the exact date.  My new year is already looking pretty bright.  That’s what I wish for you: a happy, healthy new year with lots of whatever you desire in it.

Until next week (which will actually be next year),

Keep living your life!

 
 

From Pot To Potassium

As a child of the 60s, I encountered pot (marijiuana) everywhere I went.  I was a college student and went wherever college students went.  The difference between my peers and me is that I was so naive, I didn’t recognize what I was smelling.  My folks were far more savvy on this topic than I was since my mother routinely checked my eyes whenever I came home from socializing.  I didn’t know what she was looking for, but she did.

Then, as we all did, I grew up.  I finished college, started teaching, got married,  had children, bought a house, got divorced and developed Chronic Kidney Disease.  That’s where the potassium  comes in.  You know we (as Chronic Kidney Disease sufferers) have to limit the amount of potassium we ingest. Medline delivered this incredibly informative article to my inbox this week.  It is written so well and in such a manner that even the most stunned of the newly diagnosed can understand it that I’ve reproduced most of it here.

AuthorsGeorge L Bakris, MDBarbara Olendzki, RD, MPH, LDN Section EditorGary C Curhan, MD, ScD

INTRODUCTION

Potassium is a mineral that is found in many foods. It keeps the heart beating regularly, helps to maintain fluid balance, and allows the nerves and muscles to work properly.

The kidneys maintain the correct level of potassium in the blood. People who take certain medicines or who have chronic kidney disease must limit the amount of potassium in their diet to keep their potassium level close to normal.

WHY SHOULD I REDUCE POTASSIUM IN MY DIET?

Normally, the level of potassium in your body is balanced by eating foods that contain potassium and getting rid of excess potassium in the urine. However, some people with chronic kidney disease cannot get rid of enough potassium in their urine because the kidneys do not work well.

In these people, the level of potassium in the blood can become higher than normal, causing a condition known as hyperkalemia (hyper=high, kal=potassium, emia=in the blood). Eating a low potassium diet can lower the risk of developing hyperkalemia.

The potassium level is measured by taking a small sample of blood from a vein. A typical normal range for potassium is 3.5 to 5 meq/L. A level greater than 6 meq/L is considered dangerous. A low level can be dangerous as well.

Hyperkalemia does not usually cause noticeable symptoms until the potassium level is very high. At this level, dangerous complications can develop, including an irregular heart rhythm or severe muscle weakness or paralysis.

HOW MUCH POTASSIUM DO I NEED?

In general, experts recommend eating a diet that contains at least 4700 mg of potassium per day. However, most people with chronic kidney disease should eat less than 1500 to 2700 mg of potassium per day.

A registered dietitian or nutritionist [the government pays for you to see the nutritionist attached to your nephrologist’s practice] can help to create a low potassium meal plan. An example of one such plan includes:

  • Fruit — One to three servings of low-potassium fruit per day
  • Vegetables — Two to three servings of low-potassium vegetables per day
  • Dairy and calcium rich foods — One to two servings of low-potassium choices per day
  • Meat and meat alternatives — Three to seven servings of low-potassium choices per day (approximately 15 percent of calories)
  • Grains — Four to seven servings of low-potassium grains per day

[me again: Does this remind you of your CKD diet? It should.]

HOW DO I CUT DOWN ON POTASSIUM?

  • Almost all foods contain some potassium, so the key is to choose foods with a low potassium level, when possible.
  • Notice the serving size when calculating the amount of potassium in a food; a large serving of a low potassium food may have more potassium than a small serving of a food with a high level of potassium. [here I am again: I hadn’t realized that and had to read it on some website or other. It would be interesting to hear from you about whether or not your nutritionist covered that.]
  • Drain canned vegetables, fruits, and meats before serving.

A process of “leaching” can reduce the amount of potassium in some vegetables.

You can eat low potassium foods regularly, but watch your portion size since potassium can quickly add up if you eat a large portion.

Reducing potassium levels in vegetables — It is possible to remove some of the potassium in certain vegetables with high potassium levels. Leaching is a process of soaking raw or frozen vegetables in water for at least two hours before cooking to “pull” some of the potassium out of the food and into the water. You should not eat these vegetables frequently because there is still a lot of potassium in the food after leaching.

  • Wash and then cut the raw vegetable into thin slices. Vegetables with a skin (eg, potatoes, carrots, beets, rutabagas) should be peeled before slicing.
  • Rinse the cut vegetables in warm water.
  • Soak the vegetables for at least two hours or overnight. Use a large amount of unsalted warm water (approximately 10 parts water to 1 part vegetables). If possible, change the water every four hours. Drain the soaking water.
  • Rinse the vegetables again with warm water.
  • Cook vegetables as desired, using a large amount of unsalted water (approximately 5 parts water to 1 part vegetables). Drain the cooking water.

References

Nutrition and Your Health: Dietary Guidelines for Americans. Available online at http://www.health.gov/dietaryguidelines/dga2005/report/HTML/D7_Fluid.htm.

Sample low potassium diet

   Food    Calories    Sodium content, mg    Potassium content, mg
   Breakfast
   English muffin, white 129 242 62
   Low calorie margarine, 2 teaspoons 58 65 4
   Puffed corn cereal (non-sweetened), 1.5 cup 135 247 45
   Eggs, 2 medium fresh 126 123 118
   Coffee, 1.25 cups 3 6 145
   Artificial sweetener (Splenda, any amount) 0 0 0
   Non-dairy fat-free coffee creamer, 1 ounce 20 3 0
   Snack
   Cheddar cheese (reduced fat), 1 ounce 49 270 19
   Apple, 1 medium 72 1 148
   Lunch
   White bread, 2 slices 108 234 44
   Turkey breast, 3 ounces 119 189 236
   Mayonnaise, low fat, 1 tablespoon 25 140 2
   Lettuce, 1 leaf 4 7 47
   Cheddar cheese (reduced fat), 1 ounce 49 270 19
   Egg, hard boiled 78 62 63
   Lettuce (iceberg), 1.5 cups 12 8 116
   Cucumber, peeled, 1/2 medium 12 2 137
   Water chestnuts, canned & drained, 5 pieces 17 5 54
   Carrot (raw), 1 medium 25 42 195
   Salad dressing (Italian, low fat), 1 tablespoon 27 192 4
   Snack
   Clementine, 1 35 1 131
   Dinner
   Chicken breast (skin removed, baked with breadcrumb coating and no fat), 4 ounces 221 87 287
   Green beans, cooked, no salt added, 1 cup 60 46 184
   Margarine, low fat, 1 teaspoon 29 33 2
   Rice, white, cooked in unsalted water, 1 cup after cooking 234 3 89
   Olive oil, 1 teaspoon 40 0 0
   Snack
   Oatmeal cookies (reduced fat), 2 small 56 58 22
 
TOTALS 1743 2336 2173
This sample diet would be adequate for a person who is sedentary and not overweight; a person who was active and/or overweight would need additional calories. This diet contains less than 7 percent of calories from saturated fat, and less than 30 percent of calories from total fat, making it ideal for people with coronary artery disease.

Foods with high levels of potassium

Grains Whole-grain breads, wheat bran, granola and granola bars
Beverages Sports drinks (Gatorade, etc.), instant breakfast mix, soy milk
Snack foods/sweets Peanut butter (2 tablespoons), nuts or seeds (1 ounce), fig cookies, chocolate (1.5 to 2 ounces), molasses (1 tablespoon)
Fruits Apricots, avocado (¼ whole), bananas (½ whole), coconut, melon (cantaloupe and honeydew), kiwi, mango, nectarines, oranges, orange juice, papaya, pears (fresh), plantains, pomegranate (and juice), dried fruits (apricots (5 halves), dates (5), figs, prunes, raisins), prune juice, yams
Vegetables Bamboo shoots, baked or refried beans, beets, broccoli (cooked), Brussels sprouts, cabbage (raw), carrots (raw), chard, greens (except kale), kohlrabi, olives, mushrooms (canned), potatoes (white and sweet), parsnips, pickles, pumpkin, rutabaga, sauerkraut, spinach (cooked), squash (acorn, butternut, hubbard), tomato, tomato sauce, tomato juice, and vegetable juice cocktail
Dairy products Milk and milk products, buttermilk, yogurt
Proteins (3-ounce serving) Clams, sardines, scallops, lobster, whitefish, salmon (and most other fish), ground beef, sirloin steak (and most other beef products), pinto beans, kidney beans, black beans, navy beans (and most other peas and beans, serving size is ½ cup)
Soups Salt-free soups and low-sodium bouillon cubes, unsalted broth
Condiments Imitation bacon bits, lite salt or salt substitutes (avoid completely)
Unless noted, one serving is ½ cup (4 ounces). These foods have greater than 250 mg of potassium per serving and should be avoided or eaten in very small portions if you have been told to eat a low-potassium diet.

Foods with low levels of potassium

Grains Foods prepared with white flour (eg, pasta, bread), white rice
Beverages Non-dairy creamer, fruit punch, drink mixes (eg, Kool-Aid), tea (<2 cups or 16 ounces per day), coffee (<1 cup or 8 ounces per day)
Sweets Angel or yellow cake, pies without chocolate or high-potassium fruit, cookies without nuts or chocolate
Fruits Apples (1), apple juice, applesauce, apricots (canned), blackberries, blueberries, cherries, cranberries, fruit cocktail (drained), grapes, grape juice, grapefruit (½), mandarin oranges, peaches (½ fresh or ½ cup canned), pears (1 small fresh or ½ cup canned), pineapple and juice, plums (1 whole), raspberries, strawberries, tangerine (1 whole), watermelon (1 cup)
Vegetables Alfalfa sprouts, asparagus (6 spears), green or wax beans, cabbage (cooked), carrots (cooked), cauliflower, celery (1 stalk), corn (½ fresh ear or ½ cup), cucumber, eggplant, kale, lettuce, mushrooms (fresh), okra, onions, parsley, green peas, green peppers, radish, rhubarb, water chestnuts (canned, drained), watercress, spinach (raw, 1 cup), squash (yellow), zucchini
Proteins Chicken, turkey (3 ounces), tuna, eggs, baloney, shrimp, sunflower or pumpkin seeds (1 ounce), raw walnuts, almonds, cashews, or peanuts (all 1 ounce), flax seeds (2 tablespoons ground), unsalted peanut butter (1 tablespoon)
Dairy products Cheddar or swiss cheese (1 ounce), cottage cheese (½ cup)
Unless noted, one serving is ½ cup (4 ounces). These foods have a low level of potassium (less than 250 mg potassium per serving on average). You can eat these low potassium foods, but be sure to watch your portion size since potassium can quickly add up if you eat a large portion.
 
Official reprint from UpToDate® www.uptodate.com
Unfortunately, there is no news on the book front.  My poor little notebook became overwhelmed by all I was asking it to do and I ended up buying a new computer.  I would urge you to avoid Best Buy since it took ten people with misinformation, five store visits and who knows how many phone calls before I decided to just return what they suggested.  Even the return presented  problems. On the upside, maybe it was just the particular store  I tried to do business with that conducts their repairs and sales this way.  That took over a week and now – with the help of my loving Bear – I’m getting up and running again.
 
Until next week,
Keep living your life!
 
Published in: on October 24, 2011 at 12:03 pm  Comments (4)  
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One Third Of The Three Ps

The book singing at Dog Eared Pages was both successful and fun.  Thank you to Melanie Tigh who invited me to join this event and, of course, to everyone who attended.  I only took a few pictures with my camera, so if you have pictures from the event you’d like me to post on the blog, please send me links to them and I will.  That’s Dawn Meyers with me in one of the pictures. 

 

 

 

 

 

 
 

I’ve written about the three Ps and salt in my book and on the blog, too. The one third of the three Ps discussed in this article from The Los Angeles Times is potassium. To refresh your memory, potassium counteracts sodium’s effect on blood pressure. There was also a banana in my breakfast; that’s one fruit unit on the renal diet and 467 mg of potassium.  That’s not bragging.  It’s to show you just how easy it is to incorporate potassium into yor meals.

 

In with potassium, out with sodium                    

People whose diets have roughly equal amounts of sodium and potassium are at the lowest risk of dying from heart attack and stroke, new study finds.

By Jill U. Adams, Special to the Los Angeles Times

July 24, 2011

For decades now, we’ve heard that too much sodium can cause hypertension and raise the risk of cardiovascular disease.People have paid far less attention to potassium, a mineral that has opposite effects on health: Get enough of it, and it can actually lower your blood pressure and protect your heart.

Now a study of more than 12,000 adults has underscored something that doctors and nutritionists have been saying for years: If you watch your sodium but ignore potassium, you’re missing an important part of the picture.

The study, published in the July 11 issue of the journal Archives of Internal Medicine, found that people whose diets had the lowest ratio of sodium to potassium (translating to roughly equal amounts of the two nutrients) were at the lowest risk of dying from heart attack and stroke. Those who consumed the highest amounts of sodium relative to potassium — 50% more, on average — had a 46% higher risk of dying from cardiovascular-related illness.

However, the study did not prove a cause-and-effect relationship, said coauthor Dr. Elena Kuklina, a nutritional epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta. “We found some relationship between diet and mortality, but since it was not a clinical trial, we can’t say for sure that diet is a
cause of mortality.” To show cause and effect, scientists would have to put people on set diets, randomly assigned, for a long period of time and follow them until they died — an inordinately difficult undertaking.

Though doctors know that potassium plays a significant role in heart health, many are reluctant to take any attention away from sodium, said Dr. Gordon Tomaselli, president of the American Heart Assn. and chief of cardiology at Johns Hopkins University in Baltimore. “Sodium is important,” he reiterated. People can improve
their cardiovascular health simply by eating less of it, he said, and any benefit from high potassium foods would be a bonus.

The new study followed 12,267 adults for an average of 14.8 years. Researchers used dietary surveys to estimate the potassium and sodium intakes at the start of the study. As expected, people who consumed the most sodium were also the most likely to die during the study — a 73% increase over those who consumed the least sodium — while people who consumed the most potassium had relatively low death rates — a 39% lower risk than those who consumed the least.

But the balance between sodium and potassium mattered, too. Those participants who got high sodium and low potassium had the highest death rates of all: a 46% higher risk of dying from any cause than those who ate equal proportions of the nutrients. They were especially vulnerable to death from heart attack, for which the risks doubled.

Tomaselli said the study was noteworthy because of the large number of participants representing a cross-section of Americans and because they were followed for long enough to include a significant number of deaths. However, dietary intake was not directly measured but was estimated based on each subject’s memory. And even assuming that the estimates are accurate, Tomaselli noted that diets heavy in sodium and light in potassium may be unhealthful in ways that have little to do directly with the two minerals.

A  previous study, published in the Archives of Internal Medicine in 2009, also found an association between cardiovascular disease and the balance between sodium and potassium. Rather than estimating dietary intake, researchers measured actual levels of sodium and potassium in the urine of 2,275 subjects with prehypertension (diastolic blood pressure between 80 and 89) and followed them for 10 to 15 years.

Again, higher sodium seemed to increase the risk of heart attack and stroke, and potassium seemed to have the opposite effect. But the only association that passed muster statistically was the balance between sodium and potassium. “The size of the effect was very similar to the CDC study,” noted study coauthor Nancy Cook, a researcher in preventative medicine at Brigham and Women’s Hospital in Boston.

Focusing on the ratio between sodium and potassium makes biological sense because the minerals are known to have opposite effects on blood pressure, Kuklina said. Sodium generally increases blood pressure and signals the body to retain fluids. Potassium, however, relaxes blood vessels, lowers blood pressure and helps rid the body of excess fluids.

The U.S. dietary guidelines recommend limiting sodium intake to 2,300 milligrams per day and even lower — 1,500 mg — for those 51 and older and people of any age who are African American or have high blood pressure, kidney disease or diabetes. (The American Heart Assn. recently switched to a target of 1,500 mg per day for everyone.)

The average daily intake of sodium by Americans is much higher than that — more than 3,400 mg per day, according to CDC estimates.

Recommended potassium intake is 4,700 mg per day, but average U.S.intake is in the range of only 2,000-2,500 mg per day, Cook said.

For those whose eyes already glaze over when told to read nutrition labels, there’s a simpler way to reduce sodium and increase potassium in your diet: Choose fresh, whole foods over packaged, processed ones.

More than 75% of American sodium intake comes in the form of processed foods, Kuklina said. And the best potassium sources are fruits and vegetables such as potatoes, bananas, grapes, carrots, greens and citrus fruits. Simply by eating fewer processed foods you can decrease your sodium intake and increase your potassium intake in one fell swoop.

“The message is to eat a healthy balanced diet,” Kuklina said. “It’s good for health in general and for cardiovascular health.”

The article’s address is: http://www.latimes.com/health/la-he-salt-potassium-heart-20110724,0,5730467.story

For those of you who are local and know a member who will invite you,  I’ll be speaking at the North Phoenix Kiwanis Club on September 20th.  That’s a week from Tuesday.  It is a lunch time meeting.
 
Until next week,
Keep living your life!

 

 

 

 

 

 

 

 

 

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Published in: on September 12, 2011 at 12:20 pm  Leave a Comment  

They’re Connected

If  you’ve had the chance to read my book yet, you’ll know there was a time when I had a low potassium count.  That’s when the nephologist gave me a list of low, medium and high potassium foods and told me to eat more of the high potassium foods.  There was no accompanying explanation for why as far as I can remember.
According to BrightHub.com’s February 13th article “The Importance of the Potassium and Sodium Balance”:
            When there is a potassium and sodium balance, cells, nerves and muscles can all function smoothly. With an imbalance, which
             is almost always due to both an excess of sodium, and a deficiency of potassium, a set of reactions occurs leading to high blood
            pressure and unnecessary strain on blood vessels, the heart and the kidneys. Research has shown that there is a direct link bet-
            ween chronic levels of low potassium and kidney disease, lung disorders, hypertension and stroke.
You can read the entire article at: http://www.brighthub.com/health/alternative-medicine/articles/43423.aspx#ixzz1TtfbTgxQ
Now that you and I know how the two minerals interact, the following article makes sense.  As a matter of fact, it makes me wonder why these guidelines were not put into place a long time ago.   Applause for Nurses.com, please! They’re the ones who have explained in terms we can all understand why the Dietary Guidelines for Americans needed to be changed.  Now, if only I could figure out how we became such a sodium loving culture in the first place….

Study: Sodium, potassium both affect mortality

Nurse.com News
Saturday July 16, 2011Americans who eat a diet high in sodium and low in potassium have a 50% increased risk of death from any cause, and about twice the
risk of death from a myocardial infarction, according to a study.
Researchers with the Centers for Disease Control and Prevention, Emory University and Harvard University said the study is the first to examine, using a nationally representative sample, the association between mortality and people’s usual intake of sodium and potassium. The study analyzed data from the National Health and Nutrition Examination Survey, a survey designed to assess the health and nutritional status of adults in the United States. Usual intake of sodium and potassium was based on dietary recall.

“The study’s findings are particularly troubling because U.S. adults consume an average of 3,300 milligrams of sodium a day, more than twice the current recommended limit for most Americans,” Elena Kuklina, MD, PhD, an investigator on the study and a nutritional epidemiologist with the CDC’s Division for Heart Disease and Stroke Prevention, said in a news release.

“This study provides further evidence to support current public health recommendations to reduce sodium levels in processed foods, given that nearly 80% of people’s sodium intake comes from packaged and restaurant foods. Increasing potassium intake may have additional health benefits.”

The 2010 Dietary Guidelines for Americans recommend limiting intake of sodium to 1,500 milligrams a day for people 51 and older, African Americans and those who have hypertension, diabetes, or chronic kidney disease — about half the U.S. population ages 2 and older. The dietary guidelines recommend that all other people consume less than 2,300 milligrams of sodium a day. In addition, the guidelines recommend that people choose more potassium-rich foods, advising 4,700 milligrams of potassium per day.

Sodium, primarily consumed as salt, is commonly added to many processed and restaurant foods, while potassium is naturally present in many fresh foods. For example, cheese, processed meats, breads, soups, fast foods and pastries tend to have more sodium than potassium. Yogurt, milk, fruits and vegetables tend to have less sodium and more potassium. Potassium-rich fruits and vegetables include leafy greens such as spinach and collards, grapes, blackberries, carrots, potatoes and citrus fruits such as oranges and grapefruit.

In general, people who reduce their sodium consumption or increase their potassium consumption — or do both — benefit from improved blood
pressure and reduce their risk for developing other serious health problems, according to the researchers. They said adults can improve their health by knowing recommended limits for daily sodium intake; choosing foods such as fresh or frozen fruits and vegetables, unprocessed or minimally processed meat or poultry, low-fat milk or plain yogurt; asking for foods with no or low salt at restaurants, and reading the nutrition labels of foods before purchasing can improve health for all adults.

The CDC is working with public- and private-sector partners at the national, state, and local levels to educate the public about the health effects of sodium and to reduce sodium intake. The agency is also enhancing the monitoring of sodium intake and expanding the scientific literature on sodium and health.

The study appeared July 11 in the Archives of Internal Medicine: http://archinte.ama-assn.org/cgi/content/short/171/13/1183. (I found this to be a dead link, but was able to locate the original AMA article at:http://researchmedicalcenter.com/your-health/index.dot?id=NRCN654756&lang=English&db=nrcn&ebscoType=healthindex&widgetTitle=EBSCO%20Health%20Library%20Index .)

http://news.nurse.com/article/20110716/NATIONAL02/107180022/-1/frontpage is the URL for the Nurse.com article.

Until Friday, watch your sodium/potassium balance and
Keep living your life!    

 

Published in: on August 2, 2011 at 11:50 am  Leave a Comment  
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Hot as Hades

My fiance has gotten into the habit of looking up the weather forecast on his super-duper telephone before we go to sleep. This is Arizona, ladies and gentlemen.  We have a low of 103 degrees with a high of 110 this week, unlike July 2 when we hit 118. 

The Irish Kidney Association posted this DaVita article on a really hot day. I was glad to learn something new from it (spraying your mouth with lemon water to keep yourself from drying out) and wondered if you might, too. 

If you do decide to get your daily 15 minutes of vitamin D via direct sun light, remmber to do it in the early morning, before the heat hits – especially if you live in a climate like mine.

Seven Summertime Precautions for People with Kidney Disease

There are certain precautions that everyone should take during the sunny and warm summer months. If you have chronic kidney disease (CKD), you’ll need to take a few additional steps to protect your health in the summertime or when visiting warmer climates.

1. Go outside and get moving

Sunny summer days are ideal for going outside and exercising. If you have kidney disease, be sure to check with your doctor  before starting a summertime exercise routine. Your physician can help you create an exercise plan that will support your health. Even if you feel tired at times, easy exercises may help you feel better. Walking and yoga are two activities that put only minimal stress on the body. To reap the benefits of having sunlight activate vitamin D in your skin, so spend 10-15 minutes in the sun before applying sunscreen.

2. Keep good fluid balance

Check with your dietitian or healthcare team for guidance about your fluid
intake and whether it should be adjusted on days that you spend more
time outdoors. Be careful of very cold beverages, which can cause stomach cramps. It’s best to avoid drinking caffeine or alcohol  or ingesting large amounts of sugar, as these can actually cause your body to lose more fluid. Try to stay cool by wearing a hat or a wet bandana around your neck to help control your thirst.[Gail’s note: When I was teaching high school in NYC, the kids had to take their Regents exams in hot and humidity. We all used the bandana trick.  Some of the students soaked their bandanas and kept them in the freezer overnight.  Now that was VERY effecitve.] You might want to
carry a small spray bottle filled with lemon water or mouthwash to spray
your mouth when you are feeling dry.

3. Save your skin from sun exposure

Everyone should wear sunscreen and apply it liberally. Unprotected sun exposure can cause skin damage. Use a sunscreen with an SPF of at least 15. Remember to reapply your sunscreen every two hours and also right after swimming or exercising. A water-resistant sunscreen will be less likely to come off if you swim or perspire. You can also protect your skin by covering up with a shirt, wearing a hat or sitting in the shade. You may want to soak up some sun before applying sunscreen to activate some of the vitamin D in your skin. Ten to 15 minutes is all it takes.

4. Wear sunglasses

Sunglasses protect your eyes in the same way that sunscreen protects your skin from harmful sun damage. Your sunglasses should block at least 99% of UVB rays and 50% of UVA rays. Wraparound sunglasses and other styles that completely cover the eyes are best.

5. Protect your access if you go swimming

If you are on dialysis and have a vascular access — whether it’s an AV fistula, a graft or a catheter — remember to cover it with a protective dressing when you swim. Ask your nurse which holds up best in water. For those with a central venous catheter (CVC), they should not submerge themselves and the CVC in the water at all. For people on peritoneal dialysis (PD), your healthcare team will show you how to properly clamp your PD catheter shut. The PD catheter should be immobilized to avoid trauma to or tension on the catheter while swimming. The dressing should be changed as soon as
you’re done with swimming. When going for a swim, do so in the ocean or a
chlorinated pool. Avoid bodies of water that aren’t chlorinated, such as ponds, lakes and rivers, which have a greater chance of hosting bacteria that can infect your access.

6. Eat healthy summer foods

Research shows that fruits and vegetables are important for good health, yet most people don’t eat enough. Summer is the perfect time to fill your plate with kidney-friendly foods that are low in phosphorus and potassium.
Remember to practice portion control as all fruits and vegetables contain some potassium. Here is a list of fruits and vegetables that can add color and flavor to your kidney diet:

Fruits Vegetables
Blackberries Carrots
Blueberries Cauliflower
Cherries Cucumber
Grapes Eggplant
Peaches Green beans
Plums Lettuce
Raspberries Onion
Strawberries Peppers (sweet and bell)
Watermelon (1 cup per day) Potatoes (leached)
  Snow peas
  Summer squash
  Radishes

Use these summertime ingredients to make delicious meals found at DaVita.com/Recipes. Try the following:

Fruit recipes Vegetable recipes
Ambrosia Chicken Lettuce Wraps
Blueberry-Peach Crisp Cucumber-Carrot Salad
Creamy Fruit Salad Eggplant Casserole
Quick Fruit Sorbet Grilled Summer Squash
Red, White and Blue Pie Picnic Potato Salad
Watermelon Summer Cooler Savory Green Beans

7. Plan your vacation to include dialysis

When you’re on dialysis you can still enjoy a summer vacation. To
accommodate treatments while you’re away, pre-planning is the key to a
successful trip. If you do in-center hemodialysis or home hemodialysis (HHD), ask your nurse or social worker how you can schedule treatments at a dialysis center close to where you’ll be staying. Home hemodialysis patients dialyzing with the NxStage System One can take their portable equipment with them and continue HHD while they’re on vacation if they prefer.

People on peritoneal dialysis can also take their equipment with them. Be sure to pack enough supplies to do your PD exchanges when you’re away. You can also work with your supplier to have dialysate delivered to your destination. Start planning at least three months before your trip, and ask fellow patients for any tips on the DaVita Discussion Forums.

Summary

By taking a common-sense approach to summer, you can enjoy long, warm
days while you support your kidney health. Taking a few summertime
precautions — protecting your skin, staying hydrated, controlling liquid
intake and planning a summer getaway — means you can have fun and
remain healthy.

If you can’t click through on the recipes, here’s the link to the original article:    

http://www.davita.com/kidney-disease/overview/living-with-ckd/seven-summertime-precautions-for-people-with-kidney-disease/e/4894

While we aren’t up to dialysis yet, I wanted you to see that there are ways to enjoy the summer even when we get there.     

Say, it’s only 10 a.m.  Maybe you can still get your 15 minutes of sunlight n before it gets too hot.

Until Tuesday,

Keep living your life.

           

Published in: on July 15, 2011 at 10:26 am  Comments (2)  

Part Two of Me Pretending To Be A Dictionary

Before the weekend, I promised more definitions of the terms you may or may not find in discussions of Chronic Kidney Disease, or to be more specific – your Chronic Kidney Disease.  Without further ado (as they say in certain circles), here they are:

Hormones:  Gland produced chemicals that trigger tissues to do whatever their particular job is.

Hypertension: A possible cause of CKD, 140/90 mm Hg is currently considered hypertension, a risk factor for heart disease and stroke, too.

Hypertensive nephrosclerosis:  Kidney damage caused by HBP.

Hypertriglyceridemia: High triglyceride [major form of fat stored in the body] levels.

ICD:  International Statistical Classification of Disease and Related Health Problems, provides the medical codes for illnesses.

Ingested:  Taken by mouth.

Integumentary: The skin and its associates like the nails.

Interaction: Food or other medications which will affect how the one being prescribed works.

Kidney Stone: Stone caused in the urinary tract and kidney when crystals adhere to each other, most of those in the kidneys are made of calcium.

Lab: Short hand for medical laboratory, the place where your biological specimens are drawn and analyzed to ascertain the state of your health [think blood and urine, usually].

Lymphadenopathy: Disease of the lymph nodes.

M.A.: Short hand for medical assistant, the one who helps your health practitioner with clinical and administrative matters in the office.

Medicaid: U.S. government health insurance for those with limited income.

 Medicare: U.S. government health insurance for those over 65, those having certain special needs, or those who have end stage renal disease.

Meds:  Short hand for medication, chemical substances in the form of a script to treat, prevent, cure, or prevent disease.

Melena: Black, tarry, bloody stool.

MRI: Magnetic Resonance Imaging – a non-invasive method of imagining [seeing] the inside of your body.

Nausea: The feeling in the upper stomach that you need to vomit or are queasy.

Nephrolithiasis:  Kidney stones.

Nephrologist: Renal or kidney and hypertension specialist.

Nephrology: The subspecialty of internal medicine which deals with the kidneys and hypertension.

Nephrons: The part of the kidney that actually purifies and filters the blood.

Nephropathy: Kidney disease.

Nondistended: Not swollen.

NSAID: Non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, Aleve or naproxen usually used for arthritis or pain management, can worsen kidney disease, sometimes irreversibly.

Oral thrush: A mouth disease that can occur in people with compromised immune systems.

Orthostatis:  Fall in blood pressure which produces dizziness upon standing.

Oxalate: A simple molecule found in foods which sometimes combines with calcium to form kidney stones.

P.A.: Short hand for physician’s assistant, someone who is licensed to practice medicine under a licensed doctor’s supervision.

Paroxysmal nocturnal dyspnea: Sudden, recurring night bouts of shortness of breath.

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. 

Po: From the Latin per os meaning by mouth, usually found in the directions for a script.

Potassium: One of the electrolytes, important because it counteracts sodium’s effect on blood pressure.

 Protein:  Amino acids arranged in chains joined by peptide bonds to form a compound, important because some proteins are hormones, enzymes and antibodies.

Proteinuria: Protein in the urine, not a normal state of being.

Purine: Compound found mainly in beef, poultry, pork and fish that is metabolized into uric acid.

Pruritus: Itching, one whose cause might be kidney disease.

Rales: Crackling, clicking or rattling sounds in the lungs.

Renal: Of or about the kidneys.

Renin: Hormone that regulates blood pressure.

Rhonchi: Dry, leathery sounds in the lungs.

Script: Short hand for lab work order or prescription [orders from a medical practitioner for a pharmacy to provide medication or a medical device] depending upon how the term is used.

Sphygmomanometer: The cuff, the measuring device and the wires that connect the two in a machine used to measure your blood pressure, commonly called a blood pressure meter.

T3: Part of the CBC which measures your triiodothyronine, which is a thyroid hormone that plays an important role in controlling your metabolism.  If the T3 reading is abnormal, then the T4 test is ordered to find out what the problem might be.

Tid:  From the Latin ter in die meaning three times a day, usually found in the directions for a script.

Ultrasound: A certain kind of X ray that requires no radiation.

Ureter:  Carries urine from the kidneys to the bladder.

Veins: Vessels that carry blood toward the heart.

Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.

The blog was a bit long today, but (hopefully) helpful.

Excuse me, I’ve got to go live my life now.  So, until Friday,

Keep living your life.

Back to the Notebook Entries

Finally! The publisher tells me the book this blog is based upon is going to be out by late March.  It’s later than I’d wanted, but I’ll wait to make sure it’s done right.  Just had to share that with you.  I’m really excited, so I think I wanted you to be, too.  Good news before the holidays can be a real stress releaser to my way of thinking – even if it’s someone else’s good news.

Here’s the notebook entry again so you don’t have to flip back to Friday’s blog while I explain it. I hate to admit it, but I have to: while I lined up the columns perfectly last week, I just can’t seem to do it this week. Maybe that’s not such a bad thing because now the entries look a little bit more realistic.

Sample (Unrealistically Neat) Page from An Earlier Notebook Entry

Monday                                              Tuesday

2 coffee      458    1500NA        2 coffee       30

3 fruit           757     3050K          6 starch      383

2 veg.           150        612 P          5 protein   20

5 protein  987      750 PRO       dairy        134

1 starch                                            2 veg.         134

dairy                                               1 fruit           34

3

121

8

19

 154

1040

The second column is a calorie count.  You can see that on Monday, I was neither rushed nor tired so I could mentally add quite a few of the individual calorie counts of the food I ate and you only see a few numbers with the grand total on the bottom [458, 757, 150 = 987].  Tuesday, a teaching day, was far busier for me so I needed to write down even the three calories of a bite of something or other.  It was easier to write it down as soon as I could and total it later. Naturally, as you can see from the length of the calorie count column, the number next to the food does not necessarily correspond to that food.

I needed to take into account my limitations on protein, potassium, phosphorous, and sodium – three peas with salt.  On Monday, you see 1500NA.  That’s sodium.  My limit for this was 200o mg. per day, so I did all right on Monday.  K is potassium which is limited to 3000 mg. daily for me.  Uh-oh, I didn’t do so well with potassium that day.  P equals phosphorous of which I could have 800 mg. per day, so those 612 mg. were not a problem.  Although protein is one of the food groups, there are also grams of protein in other foods, so you need to keep account of how many mg. you have a day in addition to how many units of the protein food group you eat each day.  Since my limit for protein is five ounces a day which equals 35 grams [one ounce of meat is about seven grams], my 60 gram limit on protein is fairly generous.  By the way, all these different limits are based on your individual weight and nutritional needs.

You can see that I didn’t fill in the elements for Tuesday.  I kept a running list of the foods I ate on the back of my notebook intending to figure out the amounts of each element in those foods when I got home.  That was not a good idea since I forgot to do it.  That was also the last time I tried that, and I do not suggest you try it.

Not only is my sample notebook page unrealistically neat, but it took much more room to type it out neatly than it actually takes when handwritten. That’s why you can fit an entire week’s worth of this sort of accounting on the front and back of one index card of your notebook.

I kept refining the way I kept the notebook and playing around with different options, but this straight forward method was the one that worked the best for me.  Depending upon your mathematical ability, you may just choose to run all the totals in your head. Or, conversely, you may choose not to keep a single tally mentally.  The choice is yours.

If you come up with a different way of keeping your counts, why not share it with us via the blog comments?

Until Friday,

Keep loving your life!

Published in: on December 21, 2010 at 5:09 pm  Leave a Comment  

More Liquids and an Idea

Ready for the quandry?  Here it is:

My sweetheart made us a treat today: strawberry smoothies which consisted of the ½ cup of strawberries that can comprise one of my three fruit units today and four ounces of vanilla ice cream or my one and only dairy unit for the day.  I count this as a fruit and a dairy, but should it also be considered part of my remaining 48 ounces of liquid?  This is the type of quandary I run into in one form or another on a daily basis. As already mentioned, dairy is, indeed, taken into account as part of your fluids.

As a non-drinker and someone who doesn’t care for soda, I had no problem eliminating those from my diet, but my beloved hot chocolate is something I now have maybe once a year. Vitamin and flavored water were just becoming popular when I was diagnosed and, I was surprised to note they are high in sodium, potassium and/or phosphorous.

The list of what to avoid included so many surprises (to me) and the list of beverages that was permitted was so unappealing to me that I’m perfectly content sticking to filtered, non-iced water and coffee.  When I go out to dinner unexpectedly, if I’ve already had my two cups of coffee, I just order hot water and lemon. In over two years, maybe one waiter has asked me to repeat that order.

I was having a dismal time adding up how much sodium, potassium, protein and phosphorous I eat each day although I’d pretty much memorized my allotted food units and the calorie counts of each of my usual foods. I don’t know if this is a subconscious revolt against all the bookkeeping or if I truly was incapable of keeping this all straight. My son-in-law told me that eventually food packages will have bar codes containing how much of each of these is in it and our phones will be able to read these labels for us.  I sure hope he wasn’t kidding.

I devised a little notebook as the CKD patient’s food helper.  My nephrologist gave me a printed copy of the AAKP Nutrition Counter.  This can also be downloaded from their website, but this one was already printed and collated.  It measured four inches high by five and a half inches wide. At about the same time, I found a notebook of three by five inch ruled index cards.  That was a close enough match for me to realize I could tape the nutrition counter in the back of the notebook and make life easier for myself.  I managed to get a week’s worth of counting calories, food units, and elements on the front and back of one index card.

I listed each food unit I ate that day and circled the unit [e.g. dairy, protein, etc.] when I reached my limit for the day.  Each time I ate something, I used the nutrition counter in which food is listed alphabetically and contains portion size for the elements and calories.  I just now am beginning to be able to quickly tabulate the amount of each element and calories in the food and keep a running total until I’d reached my limit for the day.  It is cumbersome, but I hope to get it down to a science. Then it will become second nature, just as counting food units and calories has become. If I don’t routinely pull this little helper out at the start of a meal, my daughter automatically asks me where it is.  It’s actually becoming part of who I am. I have high hopes for this helper.

Sample (Unrealistically Neat) Page from An Earlier Notebook Entry

Monday                                              Tuesday                           Wednesday

2 coffee      458    1500NA        2 coffee       30

3 fruit         757     3050K          6 starch      383

2 veg.         150     612 P            5 protein     20

5 protein    987    750 PRO      dairy          134

1 starch                                      2 veg.         134

dairy                                         1 fruit           34

3

121

8

19

 154

1040

The first column for the day (shaded) is the food group column in which I recorded the number of units of the food I’d eaten from each group.  I’ve shaded these lists so you can easily locate them. In order to make this neat enough to read, I’ve used bold lettering [rather than the circles I actually used in my notebook] to indicate when I’d reached my daily limit for that food group. The groups are listed in the order I ate the first food in that group that particular day.  On each day, coffee – not a food group but limited, so included – was the first thing I had.  Then I ate fruit next on Monday, but starch next on Tuesday.  By looking at the food unit column, I could also see where I was falling down.  For example, I ate only two portions of vegetables each day.  I knew I needed to increase that number to three on the following days.

There’s more to explain about this, but it contains NUMBERS and it’s Friday night – the start of the weekend – so I’ll explain the rest on Tuesday.

Until then,

Keep loving your life.

Published in: on December 17, 2010 at 8:58 pm  Leave a Comment  

Food and Drink Items You Might Not Have Thought About

Did you ever consider herbal supplements?  They can be a problem when you have CKD since only a few have been studied with CKD patients.  Keeping in mind that my kidneys were not functioning up to snuff, I decided to abandon them completely.  This was quite a departure from the way I usually dealt with illness, but I was frightened enough to just stop using them. I also didn’t know if any of them contained “the three peas with salt” or phosphorous, protein, potassium or sodium. I wasn’t willing to accidentally further damage my precious kidneys.

While none of this is established, the following might be toxic to the kidneys -wormwood, periwinkle, sassafras (I remember drinking sassafras tea as a child.  Did that have any effect on my kidneys?) and horse chestnut just to name a few. Then there are other  herbal supplements that might be harmful to CKD patients: alfalfa, aloe, bayberry, capsicum, dandelion, ginger, ginseng, licorice, rhubarb and senna.  There are even more, but they seemed too esoteric to include. I found I was continuing to learn information that had nothing to do with CKD, but was surprising none the less.  For instance, I’d always used a broken open aloe stalk to treat burns never once realizing it was ingestible.

While I urge you to speak with your nephrologists before eating any of these, there are several websites that may be helpful. They are http://www.herbalgram.org and http://www.nccam.nih.gov. And, as my nutritionist kept mentioning, star fruit is toxic for CKD patients.  Gulp!  I ate that, too, when I was in Nigeria.  Again, I feel like the medical student who was convinced she suffered from every illness she studied, except in my case, I think everything I ate that’s not good for CKD patients was the cause of my disease.

Most of the renal diets limit liquid intake daily, despite the fact that humans lose one liter of water through our skin daily via evaporation. We also lose fluid through breathing, sweating and feces. Men are 60% fluid, which includes not only water but blood and salvia while females are 55% fluid.  The kidneys are the organs responsible for regulating the fluids in our bodies.

As CKD patients, we do not internally control the amount of liquid in our bodies, so we have to do it externally.  If we drink too little or sweat too much, we become dehydrated.  Severe dehydration can cause sweating, diarrhea, vomiting and usually the low blood pressure that makes you feel weak and dizzy when you stand up.  On the other hand, if we drink too much, we suffer fluid overload.

It’s thirst that makes us drink in order to dilute the concentration of dissolved solids in our bodies so we can bring them back to the proper level. Unfortunately, the brain concurrently releases vasopressin, which is an anti-diuretic hormone that causes the kidneys to conserve water.  What this means is that those of us with CKD drink when we’ve thirsty as does everyone else, but we don’t produce much concentrated urine.

If you fall below the proper concentration of dissolved fluids, normally you lose interest in drinking while your urine becomes diluted and you void a great deal of it.  However, if you suffer from CKD, there’s little increase in urine flow and the urine doesn’t become diluted.   In other words, a person with CKD – like you or me – has a low concentration of dissoluble solids.

I’ve already mentioned that my fluid intake restriction is 64 ounces and that I drink two eight ounces cups of coffee daily (I think they help to keep me from feeling deprived), so I’m left with only 48 ounces of liquid. In researching for this book, I discovered that the organic soy milk I sometimes have with cold cereal in the morning and the ice cream I sometimes have are considered fluids as well as being considered dairy.

I don’t have both on the same day since my allotment is only four ounces of dairy.  That’s only half a cup.  Have you ever tried to enjoy a quarter cup of ice cream?  That’s what I’d have to do as well as limit myself to two ounces of that soy milk to enjoy (hah!) them both on the same day.

Going back to the fluid intake, between the coffee and the dairy, I only have 44 ounces of fluid left per day.  I live in Arizona where the summer temperatures go up to 115 degrees.  I’ve learned to plan when I’m going to have water and how little to have each time.  You’ll have to do the same depending upon the climate. This is one time when that old dieting adage which recommends drinking water instead of eating whenever you think you’re hungry is not apt, and it’s certainly not necessary to drink when others do just to be social.

You might need to be reminded that popsicles, sherbet and gelatin are also fluids, though in solid form.  You might need to be reminded, but I needed to learn that.  To me, a solid was a solid and a liquid was a liquid. But that’s not true for CKD patients.  Think about it. Popsicles and sherbet are frozen water with flavoring (I know I’m being too simplistic here.) and gelatin is boiled water with a powder added.  This certainly made me curious about what else I didn’t know about what I always thought I knew.

I’ve got a little quandry ready for you to solve on Friday.

Until then,

Keep loving your life!

Published in: on December 14, 2010 at 10:00 am  Leave a Comment  

News Before Dietary Restricitons

I am flabbergasted!  This month, I am the featured writer on the front (home) page of both www.KidneyTimes.com and www.RSNHope.org. Not only that, but the book this blog is based upon, “What Is It and How Did I Get It? Early Stage Kidney Disease” is now ready for print.  Hmmm, I wouldn’t mind a little help here if you know people in the right places to help expedite the process.  Anyone out there a publisher?  Agent?  Have a friend who is one?  Point me to them!

I’m laughing out loud as I re-read what I just wrote.  A little full of myself today, aren’t I?  Okay, enough of that – let’s get back to the business at hand, the renal diet.

Another potential problem concerns both salt and water.  If these are retained, you develop edema of the soft tissues of the body.  Due to gravity, this occurs in the ankles and feet during the day and the back at night.  Edema is dangerous if it occurs in the lungs.  Restricting salt [sodium] and making use of a diuretic to cause the kidneys to increase their output of both sodium and water can cure the problem, but as a CKD patient, consult your nephrologist before you take action.

Too much sodium can also increase your need for potassium. Potassium is something you need to limit when you have CKD despite the fact that potassium not only dumps waste from your cells but also helps the kidneys, heart and muscles to function normally. Too much potassium can cause irregular heartbeat and even heart attack. This can be the most immediate danger of not limiting your potassium.  Some of the highly limited foods are my favorites such as chocolate, caffeine, and chips.

Keep in mind that as you age (you already know I’m in my 60s), your kidneys don’t do such a great job of eliminating potassium. So, just by aging, you may have an abundance of potassium. Check your blood tests. 3.5-5 is considered a safe level of potassium. You may have a problem if your blood level of potassium is 5.1-6, and you definitely need to attend to it if it’s above 6.  Speak to your nephrologist (although he or she will probably bring it up before you do).

The National Kidney Foundation is one of the many places that offer a list of the amounts of potassium in certain foods.  Here’s a little piece of information you might enjoy: neither gin nor whiskey is high in potassium, but wine is. Not being a drinker, I don’t see this as important, but then again, alcohol is something CKD patients are supposed to avoid, not totally eliminate.

I found myself in exactly the opposite position: too little potassium with no reasoning behind it.  Maybe I’d been a bit too conscientious about draining the liquid from the canned fruits and vegetables I ate which is one way of avoiding potassium. I’d also been really careful about not having lots of low potassium foods at one time since that increases the amount of potassium you’re ingesting even though they are low potassium foods.

The nephrologist handed me a list of low, medium and high potassium foods and simply told me to eat more foods on the medium list.  I did, drank some of the liquid from the canned fruits I ate and served myself larger portions of low potassium foods. That seemed to solve the problem.  Had I been doing too good a job of limiting potassium rich foods?  Before this, I’d been missing bananas, the one food I craved during both my pregnancies.  When I needed to raise my potassium, I ate one and was surprised to discover it was the aroma, not the taste, which I had missed.

I have to admit I didn’t know anything about phosphorous. 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. Again, phosphorous is important for the kidneys since it filters out waste via them. 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.

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. There are other consequences, but this is the one most easily understood.

Milk and diary products contain phosphorous, which is why I’m limited to 4 ounces daily.  Other foods that I, for one, need to limit or avoid due to their high phosphorous level are colas, peanut butter (which I, unfortunately, had just discovered much to my delight before being diagnosed), nuts, and cheeses.  To give you an idea why, my phosphorous limit per day is 800 mg. Two pancakes contain 476 mg. or well over half my daily allotment.  Although both IHOP and Village Inn now make their pancakes from scratch, it’s very rarely that I spend so much of my phosphorous allotment on them.

On Tuesday, we’ll take a look at our protein restrictions.  Enjoy your weekend and  keep loving your life!

Published in: on December 3, 2010 at 12:13 pm  Leave a Comment  

The Renal Diet, as Promised

In my research, I found information that amazed me.  Apparently, the majority of the U.S. population over 50 suffers from hypertension which may lead to CKD.  How are all these people paying for their nutritionist if they do develop CKD, I wondered.  Most people think of a nutritionist as a luxury even if they do have a chronic disease.  When I pulled out my checkbook to pay my renal dietitian [RD], I was told the government will pay for her services.  That made sense.  Especially in the current economic atmosphere and for older people, the government needs to help pay our medical bills.

Crystal Barraza, the RD in my nephrologist’s Arizona Kidney Disease & Hypertension Center practice, clarified the reasoning behind the diet with the following:

“One of the most obvious messages [I’ve heard] is that when people are sick, the last thing they want to hear is what they can and cannot eat.  It makes sense.  I feel that this is also true for many who have many chronic illnesses.  I have heard, time and time again from patients like you, ‘I am not going to be able to eat anything!’ My goal for any session is to help destress people about the diet and help with better food choices.  The main goal is to help protect your kidney(s). My favorite word is moderation.  I don’t feel that eliminating favorite food from anyone’s diet is going to help anyone.  It has to be realistic for all.  So, I have learned that the best approach is to meet you where you are.”

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.  This is not the kind of balance that helps you stand upright, but the kind that keeps your body healthy.  Too much or too little of a certain electrolyte presents different problems.  Eating a larger portion than suggested in the renal diet of a low sodium, phosphate, protein or potassium food is the equivalent of eating a high sodium, phosphate, protein or potassium food.  This simply did not occur to me until I read it in one of my sources.

Sodium is pretty well known since news articles about its effects have produced an influx of low sodium foods in supermarkets.  Too little sodium can be a problem. Since most adults easily consume the estimated required minimum daily 500 mg. without adding salt to food, it’s not a common problem.  However, excessive sodium intake is.  It can lead to hypertension which can be a cause of CKD.  It also may lead to edema, or swelling, another possible problem with CKD.

What makes it worse is that there is no internal mechanism that tells us if we need more or less salt.  CKD sufferers are in a spot because the kidneys are the only route by which to eliminate excess salt.

Basically, sodium balances fluid levels outside your cells.  You need it because it is responsible for watering your cells. This watering is the prompt for potassium to dump waste [cell process by-products] from your cells.  Sodium does deal with other functions of the body, but this is a pretty important one.

If you have damaged kidneys and cannot excrete most of the sodium you ingest, you’re up against higher blood pressure which may worsen your CKD which may further cut down on your elimination of sodium and so on and so forth in an ever spiraling cycle. In addition, for CKD patients, too much sodium causes fluid retention, thereby causing swelling, further resulting in weight gain, leading to shortness of breath.  That’s why your nephrologist asks if you’ve experienced shortness of breath.

That’s also why the following are not on the renal diet or, if they are, it is suggested they be eaten  in severely limited quantities once in a great while: pizza, frankfurters, canned soup, frozen dinners, luncheon meats, cheese and smoked or cured food. There are low sodium cheeses but you have to search for them.  The most common are Swiss and provolone. I had mistakenly thought nitrates were the problem with frankfurters.  Although there are now no nitrate brands, they are still too high in sodium.

It’s also become possible to buy reduced or no sodium mayonnaise, baking powder, butter, margarine, seasonings and snacks such as crackers, cookies, pretzels and chips. Don’t go too far and use salt substitutes.  Rather than help, they’ll hurt. They contain potassium chloride which could raise your potassium levels.

This information about food seems to interest people with or without CKD the most.  It makes sense.  We are a nation of people who love to eat and can.  We have supermarkets laden with food that is readily available.  There is so much more to learn about how to make appropriate choices as CKD patients.  Especially since our healthy choices are not the same as those without CKD.  There will be at least one more post on this topic.

Until Friday,

Keep loving your life!

Published in: on November 30, 2010 at 4:56 pm  Leave a Comment  

Where It All Started

My new primary care physician – a term I use interchangeably with family doctor or simply physician in this blog – was looking at the results of current blood and urine tests when she started asking me those questions I couldn’t answer. I’d always accepted that copies of my quarterly blood tests were in my file at the doctor’s office and I’d be informed if there was a liver problem since I was taking these tests to monitor how my medication was affecting my liver function in the first place.

Pretend you are looking at my test results. On top, above the results section, was all the information needed to identify these as my tests and the information that this was a fasting test, no eating or drinking after midnight the day before the blood and urine were collected.  Following are explanations of the different parts of these tests, including what is measured in each part.

The CBC, with Diff,/with Plt:

In plain English, this test measures the concentration of white blood cells (WBC), red blood cells (RBC), and platelets (PLAT) in the blood.  All are important since the white blood cells make up your immune system, the red ones carry oxygen to the other cells in your body – so the higher the number here the better – and wastes such as carbon dioxide from them, and the platelets deal with the blood’s clotting ability by repairing leaks in your blood vessels.

Something I found interesting: white blood cells are the largest, red ones smaller and platelets the smallest and that there are five billion red blood cells – the mid sized cells – in a single drop of your blood .  Your blood is 60% plasma, which is a fluid, and 40% blood cells.  Remember the kidneys should control the amount of fluid in your body, but with CKD doesn’t do this effectively.

Furthermore, red blood cells usually live 120 days, but not with CKD so they need to be replaced more often.  You may not yet have heard of EPO (erythropoietin). This is the substance that travels via the blood from the kidneys to the bone marrow to trigger the manufacture of red blood cells.  With CKD, less EPO is produced so the bone marrow makes fewer red blood cells.  That translates into anemia. 

“DIFF.” indicates that your doctor wants the lab to describe each type of white blood cell and list how many of each type of cell is present since each performs a different function. Lymphocytes, monocytes, basophils, eosinophils and neutrophils (segmented means mature) are different types of white blood cells. Absolute means that a formula has been used to count each type of white blood cell.

Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.  I didn’t know it then, but hemoglobin is important for CKD patients. Hematocrit reflects the percentage of blood volume that is made up of red blood cells (erythrocytes), something else that is important to CKD patients.

MCV, or Mean Corpuscular Volume, measures the average volume or size of individual red blood cells. MCH, or Mean Corpuscular Hemoglobin, measures the hemoglobin content of red blood cells. MCHC, or Mean Corpuscular Hemoglobin Concentration, measures the concentration of hemoglobin in the average red blood cell. MPV, or Mean Platelet Volume, describes the size of the platelets. RDW is the red cell distribution width, also important for CKD patients since it deals with different kinds of anemia.

My explanation of the tests is a bit simplistic, but for me on this blood test, none of the results (column 2) were out of range (column 3) according to the reference ranges (column 4). This was good news for me.

 Most labs set up their reports using this four column system.  Column 1 was the name of the test.  I’ve learned to watch hemoglobin and hematocrit. It’ll be a little vague now, (all right, so it’s a little boring, too) but both have to do with anemia which can be common in people with our disease.

Amylase, Lipase

I glossed over the next section, since all was all right in my amylase – lipase world. Naturally, I had no idea what they were and didn’t care since they weren’t causing a problem for me.  But then curiosity got the better of me, so I looked them up: amylase is an enzyme that breaks starch down into sugar. Were we looking for diabetes, another cause of Chronic Kidney Disease, here?

 Lipase is an enzyme necessary for the absorption and digestion of nutrients in the intestines. I wasn’t sure why that was being tested until I researched a bit more and discovered that, even though an elevated level of this indicates a pancreatic problem, a mild increase of lipase in the blood could be an indication of kidney disease. Both tests were within range.  More good news for me.

Lipid Panel

Then I hit the Lipid Panel. Uh-oh, all these years of taking medication to successfully control my cholesterol level and the triglyceride number was out of range. These quarterly blood tests were to monitor the cholesterol lowering medication’s affect on my liver. I’d never had such a result before.  The triglycerides are one of the “bad” cholesterols like LDL cholesterol and could affect the heart and blood vessels. I was a little confused as to what this had to do with CDK.

Cholesterol, as you probably already know, is a natural substance in the body which is actually helpful – unless you have too much.  Then it threatens your heart health. Triglycerides, another natural substance in the body, can also threaten your heart health, this time via your coronary arteries. To be blunt, triglycerides are fat.

 I recognized HDL cholesterol as the “good” cholesterol and LDL as the “bad,” but what was VLDL Cholesterol? I discovered it’s “very low density lipoprotein,” a transporter of cholesterol within the body just like HDL and LDL cholesterol. I didn’t bother with ratios and percentages thinking (hoping?) they were self explanatory.

 

Comprehensive Metabolic Panel

It got worse: while my glucose (sugar in the blood), urea nitrogen (BUN) – which could indicate some kind of kidney disorder – and creatinine (a higher result could mean the kidneys were not adequately filtering this from the blood) were within range, the estimated GFR or Glomerular Filtration Rate was certainly not above 60 as it should be. The GFR is considered the best method measuring kidney function and staging of kidney disease. 

It is also important since the dosage of any medication you may be taking may have to be adjusted for this level of kidney function. Many drugs exit via the kidneys.  That means if your kidney function is reduced, these drugs are going further than they need to and you may need to take less of them.

 The percentage of kidney function is measured by comparing the amount of waste produced in your urine to the amount of waste found in your blood stream. To be perfectly clear, this test showed that my kidneys were functioning at a Stage 2 Kidney Disease Level.  Panic time for me!

Sodium, potassium, chloride, phosphate, calcium, magnesium and carbon dioxide are all electrolytes that the kidneys help keep in balance… and, according to this blood test, were. Suffice it to say, the anion gap deals with the body’s acidity. At this point, I decided the rest of the Comprehensive Metabolic Panel was just too technical for me. But the not knowing was probably worse than the knowing, so I forced myself to investigate them.

Protein, Total looks for an indication of kidney (I was right to research this) or liver function. Albumin, produced in the liver, deals with a certain pressure between blood and tissue fluids. Globulin was being tested for any degenerative, inflammatory and infectious processes (like CKD?).

I was beginning to feel I was re-inventing the wheel, but knew I was still a little too fragile to understand what the doctor was explaining, even if I did take notes. Again, I ignored ratios, deciding I could always get to that on the next round of tests if they turned out to be important, in range or not.

Calcium is more than we were told it is as children.  Yes, it does relate to bone metabolism, but it also deals with muscle contraction to name only one of its several jobs. It helps with trauma, infection and stress, too.

Alkaline phosphatase, if elevated, indicates a liver, bone or intestinal problem, possibly cancer. Alt and Ast meant nothing to me but, again, were tests to indicate liver damage or dysfunction. Bilirubin, Total is the test to see just how much of it from damaged or old, dead red cells remained in the blood when the hemoglobin broke down.

There’s far more to explain about this blood test even before we get to the urine test, but it will have to wait.  The material, while simplified, is too technical to absorb too much at one reading, so: more next time.  Have a fun, healthy weekend!