CKD and the VA or It’s Not Alphabet Soup at All

Today is Memorial Day in the United States. It is not a day to say Happy Memorial Day since it is a day commemorating those who gave their lives for our freedom. Lots of us have bar-b-ques or go to the park or the beach to celebrate. No problem there as long as we remember WHO we are celebrating. I promise: no political rant here, just plain appreciation of those who serve(d) us both living and dead. Personally, I am honoring my husband, my step son-in-law, and all those cousins who just never came home again.

I explained the origins of this day in SlowItDownCKD 2015 (May 25), so won’t re-explain it here. You can go to the blog and just scroll down to that month and year in the drop down menu on the right side of the page under Archives. I was surprised to read about the origins myself.

We already know that Chronic Kidney Disease will prevent you from serving your country in the military, although there are so many other ways to serve our country. This is from The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

‘The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services establishes medical standards, which, if not met, are grounds for rejection for military service. Other standards may be prescribed for a mobilization for a national emergency.

As of September 13, 2011, according to Change 1 of this Instruction, the following was included.

‘Current or history of acute (580) nephritis or chronic (582) Chronic Kidney Disease of any type.’

Until this date, Chronic Kidney Disease was not mentioned.”

You can read the entire list of The Department of Defense’s Instruction for Medical Standards for Appointment, Enlistment, or Induction in the Military Services at http://dtic.mil/whs/directives/corres/pdf/613003p.pdf. You’ll also find information there about metabolic syndrome, high blood pressure, high cholesterol, diabetes, and pre-diabetes as conditions for non-enlistment.

This got me to thinking. What if you were had already enlisted when you developed CKD. Yes, you would be discharged as medically unfit, but could you get help as a veteran?

According to the Veterans Administration at https://www.research.va.gov/topics/Kidney_disease.cfm#research4,

“In 2012, VA and the University of Michigan began the work of creating a national kidney disease registry to monitor kidney disease among Veterans. The registry will provide accurate and timely information about the burden and trends related to kidney disease among Veterans and identify Veterans at risk for kidney disease.

VA hopes the kidney disease registry will lead to improvements in access to care, such as kidney transplants. The department also expects the registry will allow VA clinicians to better monitor and prevent kidney disease, and will reduce costs related to kidney disease.”

That’s what was hoped for five years ago. Let’s see if it really came to fruition.

Oh, this is promising and taken directly from The U.S. Department of Veterans Affairs.

“VA eKidney Clinic

The VA eKidney Clinic is now available! The eKidney Clinic offers patient education through interactive virtual classrooms where Veterans can learn how to take care of their kidneys and live a good life with kidney disease. Please visit the VA eKidney Clinic website or click on the picture below. For additional information see the eKidney Clinic Patient Information Brochure.”

The Veterans Health Administration doesn’t just provide information, although I must say I was delighted to see the offer of Social Work Services. There is also treatment available. Notice dialysis mentioned in their mission statement.

Mission: The VHA Kidney Program’s mission is to improve the quality and consistency of healthcare services delivered to Veterans with kidney disease nationwide. The VHA Kidney Program provides kidney-related services to dialysis centers throughout VA’s medical centers. Professional guidance and services are available in the form of consultation and policies developed by VA kidney experts. These experts are dedicated to furthering the understanding of kidney disease, its impact on Veterans, and developing treatments to help patients manage disease symptoms. In addition, the VHA Kidney Program provides VA healthcare professionals with clinical care, education, research, and informatics resources to improve healthcare at local VA dialysis facilities.”

I did find it strange that there was a cravat on the Veterans Administration site that they do not necessarily endorse the VHA Kidney Program, especially since it is so helpful.

 

 

 

How involved is the VA with CKD patients? Take a look for yourself at this 2015 statistics by going to https://www.va.gov/HEALTH/services/renal/documents/Kidney_Disease_and_Dialysis_Services_Fact%20Sheet_April_2015.pdf

  • All Veterans enrolled in VA are eligible for services, regardless of service connection status
  • Enrolled Veterans can receive services from the VA or from community providers under the Non-VA Care Program if VA services are unavailable
  • 49 VA health care facilities offer kidney disease specialty care (nephrology services)
  • 96 VA facilities offer inpatient and/or outpatient dialysis; 25 centers are inpatient-only. Of the 71 VA outpatient dialysis centers, 64 are hospital based units, 2 are joint VA/DoD units, 4 are freestanding units, and one is within a community based outpatient clinic (CBOC)
  • VA enrollees must be offered the option of home dialysis provided either directly by the VA or through the Non-VA Care Program
  • 36 outpatient hemodialysis centers offer home dialysis care directly.
  • 5 VA medical centers host kidney transplantation programs.
  • VA Delivered Kidney Care (Calendar Year 2013) 13,794 Unique Veterans receiving dialysis paid for by VA; representing an annual increase of 13% since 2008. 794 Veterans received home dialysis; 55percent (434) by VA facilities and 45percent (360) under the Non-VA Care Program.
  • Increasing use of telehealth services to increase Veteran access to kidney specialty care Secure messaging: 7,319 messages, Clinical video telehealth: 4,977 encounters
  • VA Kidney Research (FY ’14) the research budget for the study of kidney disease has been $18.5 million per year for the past 5 years (FY ’10-FY ’14). The VA Cooperative Studies Program has supported national clinical trials addressing the best treatment of Veterans with CKD since at least 1998.

It seems to me our veterans are covered. Now if we could only make sure the rest of us stay covered no matter what bills the current administration signs into law.

Until next week,

Keep living your life!

So That’s How It’s Decided

SlowItDownCKD’s being honored as one of the best kidney disease blogs for 2016 has had some interesting results.  The first was the health and food writer’s guest blog about hydration for Chronic Kidney Disease on March 6th. Then it was the guest blog by the Social Security Administration’s Outreach Director. This week, it’s a telephone interview with Dr. Michael J. Germain, a nephrologist from Massachusetts, about some of the suggested guidelines in the upcoming KDIGO for 2016.

Got it:  backtrack. Let’s start with KDIGO. This stands for KIDNEY DISEASE | IMPROVING GLOBAL OUTCOMES. Their homepage at KDIGO.org states, “KDIGO MISSION – Improving the care and outcomes of kidney disease patients worldwide through the development and implementation of global clinical practice guidelines.” Anyone up for visiting their offices? What an excuse to go to Belgium!

Okay, now we know what the organization is and what it does, but why Dr. Germain? I asked the same question. Although he is not on the KDIGO panel of doctors who decide what the next year’s development and implementation will be, he is well versed with the topic having published or having been part of the writing for an overwhelming number of articles in such esteemed journals as the American Journal of Kidney Disease, Kidney International, and The Clinical Journal of the American Society of Nephrology, as well as contributing to textbooks, … and he could simplify the medicalese in the guidelines to simple English for this lay person.

If you think I remind you quite often that I’m not a doctor, you should read my emails to our liaison. State I’m not a doctor, repeat, state I’m not a doctor, repeat. She had the good graces to laugh at my insecurities.

The latest guideline updates have not been released yet, so both the good doctor (over 40 years as a nephrologist) and I (CKD patient and awareness advocate for a decade) were working off the draft that was released last August.

Dr. Germain also made it a point to ensure that I understand the guidelines are based upon expert opinion, not evidence. That made sense to me since he is not only a patient seeing nephrologist, but also a research nephrologist – to which his numerous publications will attest. With me being a lay person, he “had a lot of ‘splaining to do.” I had to admire his passion when discussing the vitamin D guidelines.

In the draft guidelines, it was suggested that hypercalcemia be avoided. I know; it’s a new word. We already know that hyper is a prefix meaning over or too much; think excessive in this case. Calcemia looks sort of like calcium. Good thinking because, according to Healthline at http://www.healthline.com/health/hypercalcemia:“Hypercalcemia is a condition in which you have too high a concentration of calcium in your blood. Calcium performs important functions, such as helping keep your bones healthy. However, too much of it can cause problems….”

This excerpt from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease explains how calcium works with vitamin D and phosphorous.

“The kidneys produce calcitrol which is the active form of vitamin D. The kidneys are the organs that transfer this vitamin from your food and skin [sunshine provides it to your skin] into something your body can use. Both vitamin D and calcium are needed for strong bones. It is yet another job of your kidneys to keep your bones strong and healthy. Should you have a deficit of Vitamin D, you’ll need to be treated for this, in addition for any abnormal level of calcium or phosphates. The three work together. Vitamin D enables the calcium from the food you eat to be absorbed in the body. CKD may leech the calcium from your bones and body.”

The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 offers us more information.

“The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. Parathyroid hormone controls calcium, phosphorus, and vitamin D levels in the blood and bone. Release of PTH is controlled by the level of calcium in the blood. Low blood calcium levels cause increased PTH to be released, while high blood calcium levels block PTH release. …  Thanks to MedLine Plus at http://www.nlm.nih.gov/medlineplus/ency/article/003690.htm .”

As Dr. Germain explained, CKD patients break down vitamin D quickly since they have more of a catabolic enzyme, the enzyme that converts the vitamin D to an inactive form. Oh, right, catabolic means “any destructive process by which complex substances are converted by living cells into more simple compounds, with release of energy” according to Dorland’s Medical Dictionary for Health Consumers.

Here’s the problem: vitamin D can cause hypercalcemia. Dr. Germain phrased it, “In fact, the draft guideline recommends active vitamin D hormone therapy not to be routinely used in patients with CKD stage 3 or 4 due to increased risk of hypercalcemia and the lack of efficacy shown in studies.” Therefore, he urges nephrologists to wait until stage 4 or 5 to recommend vitamin D since hyperparathryoidism may lead to bone damage. But just as in any disease, it is harder to treat bone damage once it’s already there. His recommendation: Ask about your parathyroid level every three to six months and discuss the results of your tests with your nephrologist. By the way, his feeling – and obviously mine – is that preserving the kidney function is the most important job of the nephrologist and the patient.

I am eager to see the guidelines published so I can write more about them. The conclusion about vitamin D is based upon what nephrologists have seen in their practices since the last set of KDIGO guidelines were published in 2009. It will affect the way our nephrologists speak with us about our treatment, just as the other guidelines for 2016 will.

That will affect the way we self-manage. For example, I restrict my sun time to 15 minutes a day based on these findings. Take a look at how you self-manage. It should bring up a list of questions for you to ask your nephrologist at your next appointment.

You should also know the KDIGO deals with all stages of CKD including End Stage CKD and pediatric CKD.

Until next week,

Keep living your life!

Yet Another Possibility

Today we have yet another fitness plan? Weight loss plan? Health plan? Beauty plan? I don’t know what to call it since they offer so many different types of products. What’s that, you ask. It’s called Wakaya Perfection. It seems a great number of my friends and acquaintances have been involved in their health in this way recently. They, however, do not have Chronic Kidney Disease.

Let’s get this part out of the way: I want to go there. Yes, there. Wakaya is not only a company, but an island in the South Pacific and it.is.beautiful. Take a look at their website (wakayaperfection.com) so you can see for yourself… but, of course, that’s not what this blog is about.

The company has several different lines, so I decided to look at one product from each to evaluate them for CKD patients. Remember, should they not be viable options for CKD patients does not mean they’re not viable for those without CKD.

Let’s start with the weight loss products since that’s what’s on my mind lately. That would be the Bula SlimCap. This is what their website has to say about these caps:

“At Wakaya Perfection, when we say all natural, that is exactly what we mean. Our tropical flavors are:

  • Sugar Free
  • Fat Free
  • Gluten Free

And Contain:

  • NO Artificial Flavors, Ingredients or Colors
  • NO Monosodium Glutamate (MSG)
  • NO Insect or Animal Matter
  • NO Growth Hormones
  • NO Antibiotics
  • NO Herbicides or Pesticide

That sounds great and appeals to me. Wait a minute, natural is good, but what is it that’s natural? I couldn’t find an ingredient list other than this:

  • All Natural Flavors
  • Active Ingredients
  • Pink Fijian Ginger
  • Stevia Reb-A 98%
  • Quick Dissolve Blend

What makes it a quick dissolve blend? What are the all natural flavors? What are the active ingredients? Ginger is permissible for CKD patients, but how much ginger is in each cap? And as for Stevia Reb-A 98%, this is a warning I found on New Health Guide at http://www.newhealthguide.org/Stevia-Side-Effects.html: “The FDA has noted that stevia may have a negative impact on the kidneys, reproductive, cardiovascular systems or blood sugar control.” Uh-oh, they mentioned our kidneys.

Oh well, that’s only one product and maybe there’s some other source of ingredients somewhere. Hmmm, I’d want to know what’s in a product and how much of each ingredient is in it before I took it, especially with CKD on my plate.

Let’s switch to a fitness product. I stayed away from the protein shake meal replacements for the reasons I explained about such products in SlowItDownCKD 2016. This is the poignant part of that blog:

“Ladies and gentlemen, our protein intake is restricted because we have CKD. Why would we take a chance on increasing the protein in our bodies? Here’s a reminder from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease about why we need to limit our protein.

‘So, why is protein limited? One reason is that it is the source of a great deal of phosphorus. Another is that a number of nephrons were already destroyed before you were even diagnosed. Logically, those that remain compensate for those that are no longer viable. The remaining nephrons are doing more work than they were meant to. Just like a car that is pushed too hard, there will be constant deterioration if you don’t stop pushing. The idea is to stop pushing your remaining nephrons to work even harder in an attempt to slow down the advancement of your CKD.  Restricting protein is a way to reduce the nephrons’ work.’”

Why don’t we take a look at the BulaFit Burn Capsules? Wakaya Perfection describes them as,

“A potent combination of herbs and extracts that help you manage appetite/cravings while providing sustained energy and heightened focus throughout your day. BulaFIT BURN™ is designed to help boost fat burning and provide a sense of wellbeing that reduces cravings for food and snacking.

When combined with a healthy diet and exercise, BURN capsules promote a sense of well being and energy that reduces cravings for food and snacking. BURN can also play an important role in increasing the results of ketosis and even avoiding the ‘keto flu’ that some people may experience with other ketogenic programs.”

Huh? What’s keto flu? I figured a site with the name Keto Size Me (http://ketosizeme.com/keto-flu-101-everything-need-know/) could help us out here… and they did. “The ‘keto flu’ is what we commonly call carbohydrate withdrawal symptoms. These symptoms usually occur in people who start a low carb diet that alters their hormones and causes and electrolyte imbalances.”

Wait! Electrolyte imbalances? But we work so hard with the renal diet trying to keep these within the proper range for CKD. I went back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for a little reminder about electrolytes.

“In order to fully understand the renal diet, you need to know a little something about electrolytes. There are the sodium, potassium, and phosphate you’ve been told about and also calcium, magnesium, chloride, and bicarbonate. They maintain balance in your body….Too much or too little of a certain electrolyte presents different problems.”

Nope, not me. I’m keeping my electrolytes right where they belong. This is not looking good for the Chronic Kidney Disease patient. I vote no; you, of course, have to make up your own mind.

News of a local opportunity: This year’s first Path of Wellness Screening will be Saturday, June 17th at the Indo American Cultural Center’s community hall, 2809 W. Maryland Ave., Phoenix, AZ 85017. The free screening events can process up to 200 people.  Their use of point-of-care testing devices provides blood and urine test results in a matter of minutes, which are reviewed onsite by volunteer physicians.  All screening participants are offered free enrollment in chronic disease self-management workshops.  Help is also given to connect participants with primary care resources.  The goals of PTW are to improve early identification of at-risk people, facilitate their connection to health care resources, and slow the progression of chronic diseases in order to reduce heart failure, kidney failure and the need for dialysis.

Until next week,

Keep living your life!

Just Blend In

Well, if that doesn’t beat all! Here I thought I was juicing until a reader asked me if my nephrologist knew the difference between juicing and blending. There’s something called blending? Let’s get my doctor out of the equation right away. He may or may not know the difference between the two, but I certainly didn’t.

I heard juicing and just assumed (and we all know what happens when we assume) it meant tossing 80% vegetables – since this was prescribed for fast weight loss – and 20% fruits in the blender. Hmmm, the name of the machine I used should have tipped me off that there was a difference, but it went right over my head.

Let me tell you what I learned. Juice, according to Dictionary.com at http://www.dictionary.com/browse/juicing, is: “the natural fluid, fluid content or liquid part that can be extracted from a plant or one of its parts…” while juicing is “to extract juice from.” Uh-uh, I wasn’t doing that. There was no pulp left after the vegetables and fruits were processed in the blender. It all sort of mushed – oh, all right – blended together.

The same dictionary tells me blending is: “to mix smoothly and inseparably together.” Yep, that’s what I’ve been doing. By the way, for those of you who asked to be kept posted about any weight loss, I’ve lost five pounds in ten days. To be perfectly candid, there was one day of I’m-going-to-eat-anything-I –want! mixed in there.

Another CKD Awareness Advocate wondered just what I was doing to my electrolyte limits while on this blending (I do know that’s what it is now.) diet. I arbitrarily chose a recipe from a juicing book I got online before I realized I wasn’t juicing. The recipe called for:

2 beets (what a mess to peel and chop)

2 carrots (I used the equivalent in baby ones since my hands were already starting to hurt from dealing with the beets)

8 strawberries

7 leaves of kale – which I learned is also called Tuscan cabbage

I added a cup of water since I wasn’t taking any pulp out, so the mixture was really thick.

All the ingredients were on my renal diet. So far, so good. But the question was about my daily electrolyte limits. My limits are as follows (Yours may be different since the limits usually are based upon your most current labs.):

Calories – 2100

Potassium – 3000 mg.

Phosphorous – 800 mg.

Protein – 5 ounces (141,748 mg.)

Sodium – 2000 mg.

Nutritional Data at http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2348/2 tells me I drank this much of each of those electrolytes in the total of two drinks I had of this concoction… I mean blend. The measurement is milligrams and each drink replaces a meal.

 

 

Protein Phosphorus
Beets  1300   33
Carrots  2700   42
Kale  2200   38
Strawberries  1000   37
Totals  7200 150

 

 

 

Potassium

 

 

Sodium

Beets   267  1300
Carrots   359   2700
Kale   299  2200
Strawberries   233   1000
Totals  1158  7200

 

 Calories
Beets    33
Carrots    42
Kale    38
Strawberries    37
Totals   150

I had to backtrack a little to figure out that 8 baby carrots is the equivalent to 2/3 of a cup or a little over five oz. Thanks to http://www.fruitsandveggiesmorematters.org/how-much-do-i-need for the help there. They were also the source I used to verify that 8 large strawberries equal 1 cup or 8 oz.

The calculations were the hardest part of this blog for me. I rounded up whenever possible. Also, keep in mind that different sites or books may give you different approximations for the electrolytes in the different amounts of each different food you blend. I discovered that when I was researching and decided to stick with the simplest site for me to understand.

So, did I exceed my limits? I am permitted three different vegetables per day with a serving of half a cup per vegetable. There are only three vegetables in this recipe. I did go over ½ cup with the all of them, yet am under my limitations for each of the electrolytes. This is complicated. As for the fruit, I am also allowed three different ones with ½ cup limit on each. Or can I count the one cup of strawberries as two servings of today’s vegetables? Welcome to my daily conundrum.

Over all, I still have plenty of electrolytes available to me for my third meal today, which is to be a light meal of regular foods (provided they’re on my renal diet). I also have two cups of coffee a day which has its own numbers:

Protein  Phosphorus Potassium  Sodium   Calories

6000              14                232               9               4

Add those in and I still have plenty of food available to me with the electrolytes within the balance limits. The funny part is that I’m not hungry for hours after one of the blended drinks and, bam! all of a sudden I’m ravenous. I usually have the light meal mid-day so I’m not still digesting at bedtime. This is really important: on that I’m-going-to-eat-anything-I –want! day, I was hungier and hungier the more I ate and didn’t recognize when I was full.

The nice part about blending is that the fiber is still in the mixture. Fiber is necessary for a multitude of reasons when you’re a CKD patient. DaVita at https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/fiber-in-the-kidney-diet/e/5320 lists those reasons for us:

Benefits of fiber

Adequate fiber in the kidney diet can be beneficial to people with chronic kidney disease (CKD) because it:

  • Keeps GI (gastrointestinal) function healthy
  • Adds bulk to stool to prevent constipation
  • Prevents diverticulosis (pockets inside the colon)
  • Helps increase water in stool for easier bowel movements
  • Promotes regularity
  • Prevents hemorrhoids
  • Helps control blood sugar and cholesterol

Our fourth anniversary is Thursday. We have had numerous health problems to deal with since that date, BUT we’ve also had numerous opportunities for fun…and we’ve taken each one. Did I ever tell you we had the ceremony at 4 p.m. in our backyard and the reception at 6 p.m. in order to help us remember the date? 4/6 = April 6th. Get it?

Anyway, any help offered to make the blending and a light meal work on Saturday when we’ll be celebrating by attending the Phoenix Film Festival (http://www.phoenixfilmfestival.com/) all day and night will be gratefully accepted. Bring your copy of one of my books. I’ll gladly sign it for you.

Until next week,

Keep living your life!

Women and Water (Men, too)

Welcome to March: National Kidney Month and Women’s History Month. I’m going to fudge a bit on the ‘History’ part of that as I did last month with Black History Month. I don’t often have guest bloggers, but this month will feature two women as guest bloggers in honor of Women’s History Month. The first is Jessica Walter, who sent me the following email last month:

Hi There,

I am a freelance health and food writer, I have teamed up with a small senior lifestyle advice site, I worked with them to develop a complete guide on how to eat better and be healthier from a dietary point of view. This includes detailed information on why being hydrated is so important. … you can check out the article here:

https://www.senioradvisor.com/ blog/2017/02/7-tips-on- developing-better-eating- habits-in-your-senior-years/.

I liked what Jessica had to say and how easily it could be adapted not only for senior Chronic Kidney Disease patients, but all Chronic Kidney Disease patients.

In addition, she sent me this short article about hydration and CKD. It’s easy to read and has some information we constantly need to be reminded of.

Staying Hydrated When You Have Chronic Kidney Disease

We all know that drinking water is important for our health, and monitoring fluid intake is critical for those with chronic kidney disease. Too much water can be problematic, but so can too little. Dehydration can be serious for those with chronic kidney disease. If you are suffering from vomiting, diarrhea, fever, or diabetes, or if you urinate frequently, you may become dehydrated because you are losing more fluid than you are taking in. For those without chronic kidney disease, the solution is to increase the intake of water until the body is sufficiently hydrated.

Since dehydration can decrease blood flow to the kidneys, and as fluid intake must be controlled in patients with chronic kidney disease, it’s important to closely monitor their fluid intake and loss in these circumstances.

Recognizing The Signs

The first step is to recognize the physical signs of dehydration. You may have a dry mouth or dry eyes, heart palpitations, muscle cramps, lightheadedness or fainting, nausea, or vomiting. You may notice a decrease in your urine output. Weight loss of more than a  pound or two over a few days can also be an indicator of dehydration. If you are taking ACE inhibitors and ARBs, such as lisinopril, enalapril, valsartan, or losartan, or water pills or diuretics, these medications can harm your kidneys if you become dehydrated. It is doubly important to be aware of signs of dehydration if you are on any of these medications.

Steps to Take

To rehydrate your body, start by increasing your intake of water and ensure that you are eating plenty of fruits and vegetables. (Me here: remember to stay within your renal diet guidelines for fruits, vegetables, and fluids.)If you cannot keep water down, or if increased consumption doesn’t alleviate the signs of dehydration, contact your health care provider  immediately.

They may also recommend a different fluid than plain water since electrolytes and minerals can also be reduced if you are dehydrated, but you may still need to watch your intake of potassium, phosphorus, protein, and sodium. Your doctor may recommend an oral rehydration solution that will restore your body to a proper level of hydration. If you have a fluid restriction because you are on dialysis, you should consult your healthcare provider if you have issues with or questions about hydration. Taking in or retaining too much fluid when you have these restrictions can lead to serious complications, including headaches, swelling, high blood pressure and even stroke. Carefully monitoring your fluid intake and watching for signs of dehydration will help you to avoid the consequences of dehydration.

I’ve blogged many times over the last six years about hydration. I’m enjoying reading this important material from another’s point of view. I’m sorry Jessica’s grandmother had to suffer this, but I’m also glad Jessica chose to share her writing about it with us.

 

This June, 2010, article included in The Book of Blogs: Moderate Chronic Kidney Disease, Part 1 furthers explains:

“.…Dr. HL Trivedi of the Institute of Kidney Diseases and Research Centre (IKDRC) said, ‘…. Rapid water loss causes the kidney’s functioning to slow down, resulting in temporary or permanent kidney failure.’

Extreme heat causes rapid water loss, resulting in acute electrolyte imbalance. The kidney, unable to cope with the water loss, fails to flush out the requisite amount of Creatinine and other toxins from the body. Coupled with a lack of consistent water intake, this brings about permanent or temporary kidney failure, explain experts.”

The article can be viewed directly at http://www.dnaindia.com/health/report_heat-induced-kidney-ailments-see-40pct-rise_1390589 and is from “Daily News & Analysis.”

The CDC also offers advice to avoid heat illness:

“People with a chronic medical condition are less likely to sense and respond to changes in temperature. Also, they may be taking medications that can worsen the impact of extreme heat. People in this category need the following information.

  • Drink more water than usual and don’t wait until you’re thirsty to drink.
  • Check on a friend or neighbor, and have someone do the same for you.
  • Check the local news for health and safety updates regularly.
  • Don’t use the stove or oven to cook——it will make you and your house hotter.
  • Wear loose, lightweight, light-colored clothing.
  • Take cool showers or baths to cool down.
  • Seek medical care immediately if you or someone you know experiences symptoms of heat-related illness(http://www.cdc.gov/extremeheat/warning

It’s clear we need to keep an eye on our hydration. While we’re doing that, keep the other eye out for SlowItDownCKD 2016 purposely available on World Kidney Day on Amazon.

Until next week,

Keep living your life!

The Three Musketeers

I was in Cuba last week with very sketchy internet, so it was not possible to post a blog. But for now, I was thinking about a friend – you know, one of those Facebook friends you pic_backbone_sidenever met but you feel an instant kinship with – who told me that her surgeon warned her that her recovery from the spinal fusion surgery she’d recently had would be slow because she has Chronic Kidney Disease.

CKD…bone healing. Let’s start slowly and work this one out.  First of all, what do the kidneys have to do with your bones?

I turned to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for some answers.

FullSizeRender (2)“Both vitamin D and calcium are needed for strong bones. It is yet another job of your kidneys to keep your bones strong and healthy….Vitamin D enables the calcium from the food you eat to be absorbed in the body. CKD may leech the calcium from your bones and body….Be aware that kidney disease can cause excessive phosphorus. And what does that mean for Early Stage CKD patients? Not much if the phosphorous levels are kept low. Later, at Stages 4 and 5, bone problems including pain and breakage may be endured since excess phosphorous means the body tries to maintain balance by using the calcium that should be going to the bones.”

Whoa! Each one of those thoughts needs at least a bit more explanation. Let’s start with the jobs of the kidneys. The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 has a paragraph that mentions some of them. I turned it into a list to make it more visual.

“Our kidneys are very busy organs, indeed.  They produce urine, remove potentially harmful waste products from the blood, aid in the maintenance of the local environment around the cells of the body, kidneys5

help to stimulate the production of red blood cells, regulate blood pressure, help regulate various substances in the blood {For example, potassium, sodium, calcium and more}, help to regulate the acidity of the blood, and regulate the amount of water in the body. Mind you, these are just their main jobs.”IMG_2982

Another of those various substances in the blood they help to regulate is phosphorous. That’s where one of the connections between CKD and your bones lies. If your phosphorous is not being correctly regulated by your kidneys (since your kidneys are impaired), yes you do experience pain and broken bones, but did you notice that your body also diverts your necessary-for-bone-health calcium to regulate the other substances in your blood?

I wanted to know more about phosphorous so I turned to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2. I got a chuckle from seeing that I’d quoted from my first book in explaining how phosphorous works. I’d forgotten about that.

sparkling teeth“This is the second most plentiful mineral in the body and works closely with the first, calcium. Together, they produce strong bones and teeth. 85% of the phosphorous and calcium in our bodies is stored in the bones and teeth.  The rest circulates in the blood except for about 5% that is in cells and tissues…. Phosphorous balances and metabolizes other vitamins and minerals including vitamin D which is so important to CKD patients. As usual, it performs other functions, such as getting oxygen to tissues and changing protein, fat and carbohydrate into energy.”

FullSizeRender (3)

Talk about multi-tasking. Let’s focus in on the calcium/phosphorous connection. Kidney Health Australia at http://kidney.org.au/cms_uploads/docs/calcium-and-phosphate-balance-fact-sheet.pdf explained this succinctly:

“When your kidney function declines, you are unable to get rid of excess phosphate. (Me here: that’s what we call phosphorous except when dealing with inorganic chemistry.)  The phosphate builds up in your body and binds to calcium, which, in turn, lowers your calcium levels. When your calcium levels get too low, glands in bloodyour neck (called the parathyroid glands) pull the extra calcium your body needs out of your bones. This can make your bones easy to break. The bound phosphate and calcium get deposited in your blood vessels. It can increase your risk of heart disease and stroke. It can also cause skin ulcers and lumps in your joints.”

So where does vitamin D come in? As was mentioned in SlowItDownCKD 2015,

“’Vitamin D: Regulates calcium and phosphorous blood levels as well as promoting bone formation, among other tasks – affects the immune system.’ We know vitamin D can be a real problem for us.  How many of you are taking vitamin D supplements? Notice my hand is raised, too.  How many of you read the blogs about vitamin D?  Good!” IMG_2980

It sounds like vitamin D is in charge here. Let me get some more information about that for us. Bingo: DaVita at https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/vitamin-d-and-chronic-kidney-disease/e/5326 was able to help us out here.

“Vitamin D is responsible for:

  • Building and maintaining strong bones
  • Keeping the right level of calcium and phosphorus in the blood
  • Preventing bones from becoming weak or malformed
  • Preventing rickets in children and osteomalacia in adults

vitamin d pillsToo much vitamin D can be toxic….”

Hmmm, the three work together with vitamin D as their captain.

I wondered what foods would be helpful for my friend in her healing process.

“Calcium

Milk, yogurt, cheese, sardines, spinach, collard greens, kale, soybeans, black-eyed peas, white beans and foods often fortified with calcium: breakfast cereals, orange juice, soy milk, rice milk

Vitamin D

Salmon, mackerel, sardines, tuna, flounder, sole, cod

Phosphorusfish

Ricotta cheese, barley, soybeans, sunflower seeds, cottage cheese, lentils”

Thank you to Weill Cornell Medical College’s Women’s Health Advisor at http://www.cornellwomenshealth.com/static_local/pdf/WHA0210_BoneHealth.pdf for the above information.

But, you know, it’s never just that easy. As CKD patients, we have limits of how much protein, potassium, sodium, and – wait for it – phosphorous we can eat each day. There is no socking in all the good stuff for kidney disease patients.

I can see why my friend’s surgeon told her the recovery might be slow. Something else that keeps the bones strong is weight bearing exercise, but how can she do that right now?

Until next week,

Keep living your life!

 

It’s Unfolding Now

Remember when I was lucky enough to catch the flu just after Christmas? (She wrote sarcastically.) When I went to the Immediate Care facility my doctor is associated with, the doctor there had my records and knew I’d had pleurisy at one time. But now, he ordered a chest x-ray to check for pneumonia. What he found instead was news to me… so, of course, I’m telling you about it.

IMG_2982To quote from the final result report of the X-ray: “There is unfolding of the thoracic aorta.” Huh? In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 there’s an explanation of thorax.

“What?  The what? Oh, the thorax. That’s ‘the part of the human body between the neck and the diaphragm, partially encased by the ribs and containing the heart and lungs; the chest’ according to The Free Dictionary at http://www.thefreedictionary.com/thorax.”

Thoracic is the adjective form of thorax; it describes the aorta in this case.

Do you remember what the aorta is? I sort of, kind of did, but figured I’d better make certain before I started writing about it. MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=2295 was helpful here.

“The aorta gives off branches that go to the head and neck, the arms, the major organs in the chest and abdomen, and the legs. It serves to supply them all with oxygenated blood. The aorta is the central conduit from the heart to the body.”

Now I get the connection between Chronic Kidney Disease and the aorta. Did you catch “oxygenated blood” in that definition? And what organs oxygenate the blood? IMG_2980Right. Your kidneys. This excerpt from SlowItDownCKD 2015 may help.

““The National Kidney and Urologic Diseases Information Clearinghouse …explains.

‘Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs.  Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells.’”

With me so far? Now, what the heck is an unfolded aorta? I turned to the British site for radiologists, Radiopaedia.org, at https://radiopaedia.org/articles/unfolded-aorta for the definition. “The term unfolded aorta refers to the widened and ‘opened up’ appearance of the aortic arch on a frontal chest radiograph. It is one of the more common causes for apparent mediastinal widening and is seen with increasing age.

It occurs due to the discrepancy in the growth of the ascending aorta with age, where the length of the ascending aorta increases out of proportion with diameter, causing the plane of the arch to swivel.”

thoracic-aortaI purposely left the click through definitions in so you read them for yourself. You know the drill: click on the link while holding down your control key. For those of you who are reading the print version of the blog, just add the definition of aorta to the common terms we know: arch and ascending.

Mediastinal, according to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/mediastinum is the adjective (describing) form of mediastinum or “the space in the chest between the pleural sacs of the lungs that contains all the tissues and organs of the chest except the lungs and pleurae; also:  this space with its contents.”

Hang on there, folks, just one more definition. I searched for a new site that wouldn’t offer a terribly technical definition of pleura (or pleurae) and found verywell at https://www.verywell.com/pleura-lungs-definition-conditions-2249162.

“The pleura refers to the 2 membranes that cover the lungs and line the chest cavity. The purpose of the pleura is to cushion the lungs during respiration.

The pleural cavity is the space between these 2 membranes and contains pleural fluid.”graduation

Side note: I definitely feel like I’m back teaching a college class again.

Okay, so now we have a bunch of definitions, we’ve put them together as best we can and where does it bring us? Are you ready for this? Nowhere. An unfolding of the thoracic aorta is nothing more than a function of age.

FullSizeRender (2)However, with CKD, it’s somewhere. As was explained in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, “Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body.”  We’re already not getting enough oxygen due to our poor, declining in function kidneys.

Am I concerned about the unfolding thoracic aorta? No, not at all. It happens with age; I don’t think I can do anything about that. But, the CKD that also lowers our oxygen production? Oh yes, I can – do – and will do something about that by protecting my kidneys as best I can and keeping the remaining kidney function I have.

Kidneys.com, quoted in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, did a nice job of laying out a plan for me to do just that.

“Along with taking your prescribed blood pressure medications, lifestyle changes such as losing weight, exercising, meditating, eating less sodium,  drinking  less  IMG_2982alcohol  and  quitting  smoking  can  help  lower  blood pressure. Better blood pressure control helps preserve kidney function.”

I added using my sleep apnea machine and aiming for eight hours of sleep a night. I also stick to my renal diet – which limits protein, phosphorous, potassium, and sodium (as mentioned by kidney.com) – for the most part and keeping my kidneys hydrated by drinking at least 64 ounces of fluid a day.

Is it hard? I don’t know any more. It’s been nine years. They’re simply habits I’ve developed to live as long as I can and, sometimes, even raise the bottled waterfunction of my kidneys.

When my New York daughter was with us over the holidays, I realized how differently we eat than other people do. My husband has chosen to pretty much eat the way I do. So she actually had to go down to the market to pick up the foods that people ordinarily eat.  It would have been funny if I hadn’t been sick. I would have gone with her and laughed each time I answered, “No,” when she asked, “Do you eat this?”laughing

Until next week,

Keep living your life!

What Are You Doing for Others?

Today is Martin Luther King’s birthday. Today, more than ever, we need to heed his message. Whether you apply it to today’s bizarre political scene, your local community, your family, your co-workers doesn’t matter. What matters is the operant word: doing.

mlk-do-for-others

That picture and those words got me to thinking.  What AM I doing for others? And what still needs to be done?

My commitment is to spread awareness of Chronic Kidney Disease (CKD). As a patient myself, I know how important this is. As you know, CKD is a costly, lethal disease if not caught early and treated… and it’s not just older folks – like me – who are at risk. One out of ten people worldwide has CKD, yet an overwhelming number of them are unaware they have it.

stages of CKDWe also know the disease can be treated, just not the way you’d usually expect a disease to be treated. A diet with restrictions on protein, potassium, phosphorous and sodium is one aspect of that treatment. Exercise, adequate sleep, and avoiding stress are some of the other aspects. Some patients – like me – may have to take medication for their high blood pressure since that also affects kidney function. Imagine preventing a death with lifestyle changes. Now image saving the lives of all those who don’t know they have CKD by making them aware this disease exists. Powerful, isn’t it?

We’re all aware by now that the basic method of diagnosing CKD is via routine blood and urine tests. Yet, many people do not undergo these tests during doctor or clinic visits, so don’t know they have Chronic Kidney Disease, much less start treating it. That’s where I come in; I tell people what can be done. I tell people how they can be diagnosed and treated, if necessary.IMG_2979

I was a private person before this CKD diagnosis so many years ago. Now, in addition to a Facebook page, LinkedIn, and twitter accounts as SlowItDownCKD, I make use of an Instagram account where I post an eye catching picture daily with the hashtag #SlowItDownCKD. This brings people to my weekly blog about CKD (the one you’re reading now) and the four books I wrote about it: What Is It and How Did I Get It? Early Stage Chronic Kidney Disease (which explains CKD) and the others – The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1; The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2; and SlowItDownCKD 2015 – which are the blogs in print for those who don’t have a computer or are not computer savvy.

Healthline is a well-respected, informative site for medical information. This past year this blog, SlowItDownCKD, was a winner in their list of The Six Best Kidney Disease Blogs. That brought the hits on my page up by the hundreds. That means hundreds more people are now aware of Chronic Kidney Disease, how it is diagnosed, how it is treated, and how to live with it.badge_kidney-disease-1

But not everything is working as I’d hoped it would. Unfortunately, I am still not having success in having Public Service Announcements placed on television or radio. Nor have I been able to interest most general magazines or newspapers in bringing the disease to the public’s awareness.

It hasn’t totally been a wipeout there, though. Michael Garcia did interview me on The Edge Podcast and both Nutrition Action Healthletter, Center for Science in the Public Interest (the nation’s largest-circulation nutrition newsletter) and New York State United Teachers (membership 600,000) ‘It’s What We Do’ profiled my work spreading CKD Awareness. Profiling my work, interviewing me, mentioning the blog all bring awareness of Chronic Kidney Disease to the public. Awareness leads to testing. Testing leads to diagnosing. Diagnosing leads to treatment. Treatment leads to saving lives. This is why I do what I can to spread awareness of Chronic Kidney Disease.

friendsWhat about you? Can you speak about CKD with your family? Your friends? Your co-workers? Your brothers and sisters in whichever religion you follow? What about your neighbors? I was surprised and delighted at the number of non CKD friends and neighbors who follow the blog. When I asked why they did, they responded, “I have a friend….” We may all have a friend who may have CKD, whether that friend has told us yet or not.

There are more formal methods of spreading this awareness if that interests you. The National Kidney Foundation has an Advocacy Network.

“A NKF Advocate is someone who has been affected by kidney disease, donation or transplant and who wants to empower and educate others. These include people NKF-logo_Hori_OBwith kidney disease, dialysis patients, transplant recipients, living donors, donor family members, caregivers, friends and family members.

Advocacy plays an integral role in our mission. You can make a significant difference in the lives of kidney patients by representing the National Kidney Foundation. We give you the tools you need to make your voice heard.”

You can read more about this program at https://www.kidney.org/node/17759 or you can call 1.800.622.9010 for more information.

The American Kidney Fund also has an advocacy program, but it’s a bit different.

“There is strength in numbers. More than 5,100 passionate patients, friends, loved ones and kidney care professionals in our Advocacy Network are making a huge AKF logodifference on Capitol Hill and in their own communities. Together, we are fighting for policies that improve care for patients, protect patients’ access to health insurance and increase funding for kidney research. As advocates, we play a key role in educating elected officials and our communities about the impact of kidney disease.”

You can register for this network online at http://www.kidneyfund.org/advocacy/advocate-for-kidney-patients/advocacy-network/

Obviously, I’m serious about doing that which will spread awareness of CKD. You can take a gander at my website, www.gail-raegarwood.com, to see if that sparks any ideas for you as to how you can start doing something about spreading awareness of CKD, too. I urge you to do whatever you can, wherever you can, and whenever you can.

Until next week,

Keep living your life!

 

Starting the New Year with a Miracle

fireworksHappy New Year and welcome to 2017.  We did our usual stay in, watch movies, and toast with non-alcoholic champagne (I know that’s contradictory.) at midnight.  With our New York daughter here, it was even more meaningful.

A new year brings to mind new beginnings… and that leads me to Part 3 of the miracle series, as promised. I am so, so serious about this and hope you decide to take on for yourself causing a miracle in CKD by sharing information.

I was thinking about social media the other day. Where are the public service announcements about Chronic Kidney Disease?  I am still – nine years after my diagnose – knocking on seemingly closed doors to encourage Public Service Announcements everywhere. While the public doesn’t seem as involved with network television or radio as they were when I was younger, we now have Twitter, Facebook, Instagram, LinkedIn, and Tumblr to name just a few ways we can share.

I use a both a Facebook page and a Twitter account to post one fact about or information pertinent to those with CKD daily. Join me at newslowitdownckdfbcoverSlowItDownCKD on Facebook and @SlowItDownCKD on Twitter. I also monitored Libre’s Tweet Chat with Gail Rae 1/10/12. I knew nothing about Twitter at the time, but it was a way to share the information I had. You may not want to do this, but feel free to ‘steal’ the information posted and share it with others.

There are also Podcasts, Internet Radio Shows, YouTubes, etc. to share what the public needs to know about CKD. A YouTube can be viewed by one person who posts it on Facebook and go viral. Don’t bother looking at mine. They’re pretty painful. I’ll look into this again at a later date.

On the other hand, these are some of the social media venues that interviewed me: The Edge

Podcast 5/9/16, Online with Andrea 3/23/15 & 3/07/12, What Is It? How Did I Get It? 2/17/12, and Improve Your Kidney Health with Dr. Rich Snyder, DO 11/21/11. I never knew these venues existed before I started working towards the miracle I wanted to cause.

Lo and behold, my sharing brought others who wanted to know about CKD, so I was profiled by Nutrition Action Healthletter, Center for Science in the Public Interest 9/16, New York State United Teachers ‘It’s What We Do’  8/9/16, and Wall Street Journal ‘Health Matters’  1/13/14. Remember that Clairol commercial in last week’s blog?

Let’s say you agree that sharing can cause a miracle in Chronic Kidney Disease and want to join in living a life causing this miracle. The first thing you’d want to do is learn about CKD. The American Kidney Fund and the National Kidney Foundation both have a wealth of information written AKF logofor the lay person, not the medical community. By the way, the National Kidney Foundation also has information about NKF-logo_Hori_OBCKD globally. Maybe you’d rather join in World Kidney Day gatherings and distribute materials. Then keep an eye on World Kidney Day’s Twitter account for locations around the world.

As you can see, I’ve been creating this miracle is by writing for these organizations and more kidney specific ones, as well as guest blogging for various groups. You may not choose to do that… but you can speak at your religious group meetings, your sports league, your weekly card game, or whatever other group you’re comfortable with.

A miracle doesn’t have to be profound. You can help create this one. All you need is a little education about CKD and the willingness to introduce the subject where you haven’t before.friends

I live my life expecting miracles and I find they happen.  This miracle that I’m causing – and is happening – has been (and is) created by sharing, sharing, sharing. The more than 200 million people who have Chronic Kidney Disease need this information, to say nothing of those who have yet to be diagnosed.

kidneys5There aren’t that many organs to go around for those who didn’t know they had CKD and progressed to End Stage Renal Disease.  We know that transplantation is a treatment, not a cure, and one that doesn’t always last forever. We also know that kidneys from living donors usually last longer than those from cadaver donors. Share that, too.

We have our no cost, no pain, no tools needed miracle right on our lips… or at our fingertips. Start sharing, keep sharing, urge others to share, and help to prevent or slow down the progression in the decline of kidneys worldwide. Sharing is causing a miracle in CKD. Both deaths and hospitalizations for this disease have declined since 2008. If that isn’t a miracle, I don’t know what is. I keep saying I live my life expecting miracles; this is one of them.hearing

I was a private person before this disease. Now, in addition to the Facebook page and twitter accounts, I make use of an Instagram account (SlowItDownCKD) where I post an eye catching picture daily with the hash tag #SlowItDownCKD. This brings people to my weekly blog about CKD – as does my Instagram account as Gail Rae-Garwood – and the four books I wrote about it: one explaining it and the others the blogs in print – rather than electronic form for those who don’t have a computer or are not computer savvy. Time consuming? Oh yes, but if I expect to live a life of miracles, I need to contribute that time to share what I can about the disease and urge others to do the same.IMG_2979

I am urging you to realize you are the others I am asking to help cause a miracle in Chronic Kidney Disease. As the Rabbinic sage Hillel the Elder said, “If I am not for myself, who will be for me? If I am only for myself, what am I? If not now, when?” Now. You. Me. Others. CKD.

Until next week,

Keep living your life!

It’s a Miracle!

It’s that time of year again… the time to believe in miracles. There’s the miracle of Mary’s virgin birth at Christmas. And there’s the miracle of the Christmas TreeChanukah oil burning for eight nights instead of the one it was meant to. That got me to thinking about miracles and so, we have a different kind of several part blog beginning today. Consider it my gift to you this holiday season.

Miracles happen every day, too. We just need to take action to make them happen… and that’s what I’d like to see us do with Chronic Kidney Disease by sharing the available information.  This particular miracle is helping to alleviate the fear of needing dialysis and/or transplantation. This particular miracle is helping patients help themselves and each other. This particular miracle is helping doctors appreciate involved patients.

Yet, causing this miracle by sharing information is overlooked again and again. Chronic Kidney Disease, or CKD, is easily diagnosed by simple blood tests and urine tests (as we know), but who’s going to take them if they have no idea the disease exists, is widespread, and may be lethal? By Menorahsharing information, those at high risk will be tested. Those already in the throes of CKD can be monitored and treated when necessary. While CKD is not curable, we know it is possible to slow down the progression of the decline in your kidney function.

According to the National Institutes of Health at http://www.ncbi.nlm.gov/pmc/articles/PMC4112688,

“2014: Worldwide, an estimated 200 million people have chronic kidney disease (CKD).”

Before I was diagnosed, I had never heard of this disease… and apparently I’d had it for quite some time.  Why weren’t people sharing information about this?  Couldn’t that have prevented my developing it? At the time of my diagnose nine years ago, I meant doctors.  I don’t anymore. Nor do I leave causing a miracle by sharing to others.

This is my life. I have had Chronic Kidney Disease for nine years. As a college instructor who taught Research Writing at the time of my diagnose, I researched, researched, and researched again, but the only person I was sharing my research with was the nephrologist who treated me and FullSizeRender (2)monitored my condition. I may have expected a miracle there, but I didn’t get one. Why?

I got to thinking about that and realized he already knew what I told him. That’s when it struck me that if I expected a miracle with CKD, I would have to start sharing this information with the people who need it: the ones who didn’t know, the ones who had just been diagnosed and were terrified, and the families of those with CKD who didn’t know they also might be at risk. I went so far as to bring CKD education to the Native American Communities in Arizona since Native Americans are at high risk. I had the information and had experts willing to come to the communities to share that information.

We all know this is a costly, lethal disease if not caught early and treated… and that it’s not just the elderly who are at risk. One out of ten people worldwide has CKD, yet an overwhelming number of them are unaware they have it. We know CKD can be treated, just not the way those who don’t have it might expect. A diet with restrictions on protein, potassium, phosphorous and sodium may be one aspect of that treatment. Exercise, adequate sleep, and avoiding stress are some of the other aspects. Some patients – like me – may have to take medication for their high blood pressure since that also affects kidney function. Imagine preventing a death with lifestyle changes. Now imagine EXPECTING the miracle of preventing that death by sharing this information. Powerful, isn’t it?

We know the basic method of diagnosing CKD is via routine blood and urine tests. Yet, many people do not undergo these tests during doctor or clinic visits, so don’t know they have Chronic Kidney Disease, much less start treating it.urine container

This is where the miracle I expected in my life began for me. I started speaking with every doctor of any kind that I knew or that my doctors knew and asked them to share the information. They were already experiencing time constraints, but suggested I write a fact sheet and leave it in their waiting rooms since they agreed there’s no reason to wait until a person is in kidney failure and needs dialysis or a transplant to continue living before diagnosing and dealing with the illness.

My passion about producing this miracle multiplied threefold from that point on. So much so that I went one better and wrote a book with the facts. I was convinced we would be able to cause a miracle by sharing information about this disease. My goal was clear: have everyone routinely tested.

Dr. Robert  Provenzano, a leading nephrologist in the United States,  succinctly summed up the problem worldwide.

“Chronic Kidney Disease is an epidemic in the world…. As other countries become Westernized, we find the incidence of Chronic Kidney Disease and end-stage renal failure increases. We see this in India, and in China. We see this everywhere. …”

We repeatedly see diabetes and hypertension cited as the two major causes of CKD. Does your neighbor know this? How about the fellow at the gas bp cuffstation? Ask them what Chronic Kidney Disease is. More often than not, you’ll receive a blank look – one we can’t afford if you keep the statistic at the beginning of this paper in mind. We can cause a miracle to change this.

Sharing can be the cause of that miracle… but that’s not something we can leave to the other guy. We each ARE the other guy. More on this next week.

For now, Merry Christmas, Happy Chanukah, Happy Kwanzaa (somehow implicit in this holiday is the miracle of bringing people together), and every other holiday I’ve inadvertently missed or don’t know about.

portal_in_time_cover_for_kindleI just got word that Portal in Time – my first novel – is available on Amazon.com. Consider that as a holiday gift for those friends not interested in CKD. Of course, I just happen to have four CKD books on Amazon.com for those who might be interested in CKD. Be part of a miracle.IMG_2979

Until next week,

Keep living your life!

Updates, Anyone?

FullSizeRender (2)Several months ago, an Arizona reader asked me to meet her for lunch to talk over her Chronic Kidney Disease journey and mine. I was open to the idea and glad to be able to share ideas with each other. Uh-oh, during the conversation, while trying to share my iPhone apps with her, I discovered that one of those I use to help me is no longer available to new installers. That got me to thinking about what else may have changed in the CKD electronic world.

Time to back track just a bit. I have an iPhone and look for apps for those. Many of the apps I looked at are also available for Androids, iPads, and iPod Touch. According to GCFLearnFree.org – a program of Goodwill Community Foundation® and Goodwill Industries of Eastern NC Inc.® (GIENC®)  – at http://www.gcflearnfree.org/computerbasics/understanding-applications/1/,

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

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

Diet and Nutrition Apps

  • 02-77-6660_ebe_myfoodcoachappKidneyAPPetite– Gives daily summaries of key nutrients for kidney health, check the nutritional value of foods before you eat it, and provides printable summaries to refer to. Great for patients on a renal diet! Cost: Free,  Device: iOS
  • Pocket Dietitian– Created by a Nephrologist, allows you to choose your health conditions and dietary restrictions to see recommended foods as well as keep track of what you have eaten. You can even see your past nutrition in graph form. Cost: Free,  Device: iOS and Android
  • My Food Coach– is designed to help you understand and manage all of your nutritional requirements. This app offers personalized nutrition information, recipes and meal plans. Cost: Free,  Device: iOS and Android
  • HealthyOut– Enables you to search and order nearby healthy food and browse for healthy options while out to eat. You can even choose a specific diet such as gluten free! Cost: Free, Device: iOS and Android

kidneyapp

  • Restaurant Nutrition– Allows you to search restaurants and look at nutritional values, locate nearby restaurants, and keep a food journal. The Restaurant Nutrition application shows nutritional information of restaurant foods. Cost: Free, Device: iOS and Android

While I could easily go to most of the apps’ websites by clicking on the name while I held down the control button, this was not the case with Pocket IMG_2982Dietician. I was able to find it and lots of descriptive information about it in the Google Play store, but kept getting the message that I had no devices. The help function on the site was not helpful.

I have KidneyAPPetite on my phone, but keep using KidneyDiet instead. It keeps track of the 3 Ps (protein, potassium, and the one missing from food labels: phosphorous), sodium, calories, carbohydrates, cholesterol, and fat, and fluid intake. The very nice part of the app? You can add the foods you eat that are not on the food list provided. Unfortunately, this is the one I mentioned in the first paragraph. This is what’s presently on their website:

The KidneyDiet® app is no longer being sold or supported. It, and all your data, will continue to reside on your device unless you delete it.

Thank you for your patronage. We hope KidneyDiet® has helped you.

Sincerely,
The KidneyDiet® Team

FullSizeRender (3)I consider this a great loss for those looking for a simple nutritional app for their CKD.

What about My Food Coach? It has an extra feature that my favorite lacked: a warning when a recipe would bring you over your renal diet limits. It’s recipe oriented, which doesn’t endear it to me since I like to experiment cooking my big five ounces of protein daily with my three different size servings of different fruits that are on my renal diet. I also avoid red meat.

HealthyOut, while not specifically for CKD, does have a function for the Mediterranean diet which is more often than not recommended for us. I thought this was a hoot since it never occurred to me that you can check restaurant foods by the restaurant name. I am adding this app to my iPhone.

Restaurant Nutrition is another app offered by Google Play, which means I can’t even get into it. I did get through to the reviews and couldn’t find any positive ones. I didn’t see the point in pursuing this any further.IMG_2980

There are even kidney disease games, such as KidneyWarrior, to teach yourself and your loved ones about your disease. This is the author’s description of the game:

“A new hero emerges to fight a dreadful illness. A quest to save his father. A brand NEW approach to mobile gaming •Play as Glo, a young hero on his exciting adventure to save his father •SHOOT, SMACK, and SPIN your way through 3 different and exciting stages, packed with hours of gaming •LEARN about what kidneys do and how kidney disease affects people worldwide Created on behalf of Project ARK, an organization focused to support research efforts on combating kidney disease. As a high school organization, Project ARK seeks to raise awareness on campus and within the community.”

To borrow a term from a now defunct cigarette brand: We’ve come a long way, baby!

Until next week,

Keep living your life!

Not Your New Age Crystals

Sometimes, a reader will ask a question and I’ll research the answer for him/her, always explaining first that I’m not a doctor, don’t claim to be one, and (s)he will need to check whatever information I offer with his/her nephrologist before acting on it. There was just such a comment this week: “Just wondering if you have any advice on Gout and it’s effect on Kidney disease? Mary.” Advice? No. Research? Yes.

What is itLet’s establish just what gout is first. This is how it’s defined in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease :

“gout: particularly painful form of inflammatory arthritis characterized by a build-up of urate crystals in the joints, causing pain and inflammation.”

Urate crystals? MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=11853 defines these as: “… salt derived from uric acid. When the body cannot metabolize uric acid properly, urates can build up in body tissues or crystallize within the joints.”

Okay, what’s uric acid then? Thanks to the Merriam Webster Online Dictionary at http://www.merriam-webster.com/dictionary/uric%20acid for the definition:

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.”

Whoops, looks like I missed a definition here: tophi simply means the deposit itself.

You may be wondering what that has to do with Chronic Kidney Disease.  This paragraph from The IMG_2982Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 explains:

“Researching that brought me to an English article from Arthritis Research UK which cited an American study.  I’m going to reproduce only one paragraph of the article here because it brought home exactly what gout with Chronic Kidney Disease can do to your body.

‘The findings were presented at Kidney Week 2011 by researcher Dr Erdal Sarac. He concluded: ‘This study reveals a high prevalence of gout in patients with CKD. Male sex, advanced age, CAD, hypertension, and hyperlipidemia were significantly associated with gout among CKD patients.’”

You may need some more definitions to fully understand that paragraph, so I’m reproducing these from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

CAD: coronary artery disease

hyperlipidemia: high cholesterol

hypertension: high blood pressure

Gout sounds bad. I’ll bet you’re wondering how you can help avoid gout… especially if you have CKD. Let’s go back to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 for a moment.

“One disease, CKD, can be implicated for three others if you also have gout.  … I didn’t know that gout is also somehow in the mix of being medically compromised.  I have hyperlipidemia and hypertension and CKD.  True, I’m not an older male but should I become more vigilant about any hints of gout? ….

bottled waterI would have to be careful about my food and beverage intake. Oh, wait, I’m already doing that by following the renal diet. In both, you are urged to cut back on alcohol and drink more water instead. Purines are a problem, too, but then again I am limited to five ounces of protein {A purine food source} per day. Hmmm, avoiding sugar-sweetened drinks may help. Say, with CKD, I have to watch my A1C {How the body handles glucose or sugar in a three month period} so that I don’t end up with diabetes.  That means I’m watching all my sugar intake already. I see fructose rich fruits can be a problem.  But I’m already restricted to only three servings of fruit a day!  Oh, here’s the biggie: lose weight.  Yep, been hearing that from my nephrologist for four (Me here: it’s more like nine years now.) years.  To sum up, by attending to my CKD on a daily basis, I’m also attempting to avoid or lessen the effects of gout.

This is getting very interesting.  I also take medication for both hypertension and hyperlipidemia.  Are they also helping me to avoid gout?  It seems to me that by treating one condition {Or two in my case}, I’m also treating my CKD and possibly preventing another.  It is all inter-related.”

By the way, based upon another reader’s question I mentioned cherries and gout in The Book of FullSizeRender (3)Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

“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.”

So now, we need to watch purines and potassium, too. Aha! Following the renal diet already is helping to avoid potassium. What about purines? According to WebMD at http://www.webmd.com/arthritis/tc/diet-and-gout-topic-overview:

“Purines (specific chemical compounds found in some foods) are broken down into uric acid. A diet rich in purines from certain sources can raise uric acid levels in the body, which sometimes leads to gout. Meat and seafood may increase your risk of gout. Dairy products may lower your risk.”cherries

It seems to me a small list of high purine foods is appropriate here. Gout Education at http://gouteducation.org/patient/gout-treatment/diet/ offers just that. This also appears to be an extremely helpful site for those wanting to know more about gout.

“Because uric acid is formed from the breakdown of purines, high-purine foods can trigger attacks. It is strongly encouraged to avoid:

  • Beer and grain liquors
  • Red meat, lamb and pork
  • Organ meats, such as liver, kidneys and sweetbreads
  • Seafood, especially shellfish, like shrimp, lobster, mussels, anchovies and sardines”

Does this list sound familiar? It should if you’re following the renal diet. While not exactly the same, there’s quite a bit of overlap in the two diets.

Mary… and every other reader… I hope this was enough information for you to write a list of questions about CKD and gout to bring to your next nephrology appointment.

IMG_2980Until next week,

Keep living your life!

The Nutrition Action Health Letter Article

I am now officially excited.  I’d been getting some comments about this article which I thought wasn’t being published until September. I wondered why. It was my mistake. The article was to appear in the September issue, which I didn’t realize is published before the month begins.

The Center for Science in the Public Interest’s September Nutrition Action Health Letter is out… and younutrition can read it online, too. The URL is http://www.nutritionaction.com/wp-content/uploads/cover-Kidney-Check-How-to-Keep-Yours-Going-Strong.pdf. Many thanks to Bonnie Liebman for such a fine job of reporting and aiding in spreading Chronic Kidney Disease Awareness. It’s long, six pages, so what we have here are excerpts.

 

David White“I didn’t know that I had end-stage renal disease until I was admitted to the hospital in 2009,” says David White, who was then in his mid-40s. “A few days later, I stopped producing urine.”

Doctors told White that he had crashed. “It was scary,” he says. “I went from ‘Something may be wrong’ to ‘Oh my god am I going to die?’ to ‘I have to spend the rest of my life on dialysis.’”

And with four hours of dialysis three times a week, he never felt great.

“People call it the dialysis hangover,” says White, from Temple Hills, Maryland. “You’re so tired that you want to sleep all day after dialysis and most of the following day. And then you gear up for the next treatment.”

And White struggled with his one-quart-a-day limit on fluids. “When you drink too much, moving isn’t comfortable, laying down isn’t comfortable,” he says. “It’s hard to breathe.”

For Gail Rae-Garwood, the news about her kidneys came when she switched to a new doctor closer to herNutrition home in Glendale, Arizona.

“She decided that as a new patient, I should have all new tests,” says Rae-Garwood, now 69. “When the results came in, she got me an appointment with a nephrologist the next day. When you get an appointment with a specialist the next day, you know something is not right.”

Rae-Garwood had chronic kidney disease. “My GFR was down to 39, and apparently had been low for quite a while,” she says. (Your GFR, or glomerular filtration rate, is the rate at which your kidneys filter your blood.) “‘What is chronic kidney disease and how did I get it?’ I demanded,” recalls Rae-Garwood.

Every 30 minutes, your kidneys filter all the blood in your body. Without at least one, you need dialysis or a transplant. Yet most people have no idea how well their kidneys are working. “It’s very common for people to have no idea that they have early chronic kidney disease,” says Alex Chang, a nephrologist at Geisinger Health System in Danville, Pennsylvania.

A routine blood test sent to a major lab—like Quest or LabCorp—typically includes your GFR. If it doesn’t, your doctor can calculate it.

kidney function“A GFR is pretty routine for anyone who has blood work done,” says Chang. “But if you have very mild kidney disease, and especially if you’re older, a doctor might not mention it since kidney function tends to decline as you age.”

Doctors also look for kidney disease by testing your urine for a protein called albumin …. “That’s usually only done if you have high blood pressure or diabetes or some risk factor for kidney disease other than age,” says Chang.

Rae-Garwood’s previous doctor missed that memo. “I had been on medication for high blood pressure for decades,” she explains. “I wonder how much more of my kidney function I could have preserved if I’d known about it earlier.”

***

David White had kidney transplant in 2015. “It’s given me my life back,” he says. “No more dialysis.”

He takes anti-rejection drugs and steroids, and, like Rae-Garwood, he gets exercise and has to watch what he eats.

“I’ve changed my diet radically,” says Rae-Garwood. “I have to limit the three P’s—protein, potassium, What is itand phosphorus. I’m restricted to 5 ounces of protein a day. We have no red meat in the house. Any product above 7 or 8 percent of a day’s worth of sodium I don’t buy.

“And you know what? It’s fine. It’s been nine years now, and I’ve been able to keep my GFR around 50.”

Both patients are now advocates for preventing kidney disease. “I’ve written four books and almost 400 weekly blogs, and I post a daily fact about chronic kidney disease on Facebook,” says Rae-Garwood. White chairs the the MidAtlantic Renal Coalition’s patient advisory committee, among other things among other things.

“Get tested,” urges Rae-Garwood. “Millions of people have chronic kidney disease and don’t even know it. All it takes is a blood and urine test.”

My hope is that as a result of this article, more libraries, medical schools, and nephrology practices will IMG_2982order copies of What Is It and How Did I Get It? Early Stage Chronic Kidney FullSizeRender (3)Disease, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, and SlowItDownCKD 2015. If you have a Kindle, Amazon has two wonderful low cost or free programs that may make it easier for you, your loved ones, and anyone you think could benefit from these books to read them.

This is how Amazon explains these programs:

“Kindle Unlimited is a subscription program for readers that allows them to read as many books as they want. The Kindle Owners’ Lending Library is a collection of books that Amazon Prime members who own a Kindle can choose one book from each month with no due dates.”

Barnes and Noble doesn’t have any such programs, but they do offer discount deals daily, which you can use to purchase any book.IMG_2980

I urge you to help spread awareness of Chronic Kidney Disease in any way you can. Here’s another quote from the article that may help you understand why:

“One out of ten adults have chronic kidney disease. Most don’t know it because early on, kidney disease has no symptoms. And because the risk rises as you age, roughly one out of two people aged 30 to 64 are likely to get the disease during their lives….”

Until next week,

Keep living your life!

CKD Treatment Interruptus

Recently, someone close to me experienced a major burglary.  After calling the police, he called me. That’s what my friends do and I’m thankful they do. I kept him on the phone while I threw on some clothes and sped over to his house. This is a strong, independent man who was shocked at the intimacy of the invasion of his home. When I got there, we walked from room to room, astonished at how much had been stolen.

That night, I couldn’t leave – not even to go home for my evening medications and supplements. That night, I couldn’t sleep while my buddy was in such turmoil. So we sat up staring at the empty space where the TV had been.  He’s not on the renal diet and all he had that I could eat was some chicken, no fruit, no vegetables. And I was too busy being with him to exercise. This was my good buddy of over 30 years standing.

The next morning, another friend came over to help with security devices and spend time with our mutual friend.  I got to go home, take my morning medications, and crawl into bed for ½ an hour. But then our mutual friend had to go to work, so I went back to my buddy’s house and spent the day helping him try to list what was missing, what to do about the insurance, how to handle going to work, etc. The word spread, and, suddenly, a third friend was coming to spend the night with him and another couple joined them to make dinner.  I could go home again.    friends

But I was exhausted. I ate stupidly: Chinese restaurant food with all that sodium. I even ate rice, and here I am on a low carbohydrate diet. I sat in the living room like a zombie while Bear waited on me hand and foot.

Even with all this help, my buddy needed to see me daily. I was his strength. So we ran around rummaging up some receipts he’d need for the insurance. But I could see he was feeling better. Our mutual friends were amazing, including those who couldn’t leave work to come so kept phoning and texting instead. A different someone else stayed with him overnight again.  Then he only needed to see me for a quick hug… and yet another someone else stayed with him overnight again. He didn’t really need me anymore, which is great because I started breaking down.

sad faceI have Chronic Kidney Disease. I need to sleep adequately – and with my BiPap. I need to follow the renal diet. I need to exercise. I need to rest.  I did very little of any of this during the trauma itself, and that’s alright. This is my long term buddy – as grown up and mature as he is – and he needed me. But what did I do to myself?

You guessed it. Right away, my blood pressure shot up and that’s a bad thing. Why? Let me tell you… or you can go to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, page 9.  FullSizeRender (2)

“Through my research, I began to understand what high blood pressure [HPB] has to do with renal disease.  HPB can damage small blood vessels in the kidneys to the point that they cannot filter the waste from the blood as effectively as they should. Nephrologists may prescribe HBP medication to prevent your CKD from getting worse since these medications reduce the amount of protein in your urine.  Not too surprisingly, most CKD related deaths are caused by cardiovascular problems.”

FullSizeRender (3)What about the stress?  What was that doing to my poor overworked kidneys?  I went to The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 for the answer to that one:

“First you feel the fight or flight syndrome which means you are releasing hormones.  The adrenal glands which secrete these hormones lay right on top of your kidneys. Your blood sugar raises, too, and there’s an increase in both heart rate and blood pressure.  Diabetes {Blood sugar} and hypertension {Blood pressure} both play a part in Chronic Kidney Disease.”

That’s two strikes against me. I almost hesitate to think about exercise… or the lack of it for several consecutive days.  This is one of the points about treating prediabetes (which I have and so do so many of you) from the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/treatment/con-20024420 which was included in SlowItDownCKD 2015:IMG_2980

“Losing excess pounds. If you’re overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.”

And the renal diet? We mustn’t forget about the renal diet. In The Book of Blogs: Moderate Kidney Disease, Part 1 I quoted from http://www.yourkidneys.com/kidney-education/Treatments/Living-a-full-life-after-a-chronic-kidney-disease-diagnosis/3189 which is part of Yourkidneys.com from DaVita:

“Depending on what stage of Chronic Kidney Disease you’re in, your renal dietitian will adjust the amounts of protein, sodium, phosphorus and potassium in your diet. In addition, carbohydrates and fats may be controlled based on conditions such as diabetes and cardiovascular disease. The IMG_2982CKD non-dialysis diet includes calculated amounts of high quality protein. Damaged kidneys have a difficult time getting rid of protein waste products, so cutting back on non-essential protein will put less stress on your kidneys.”

Have I done more permanent damage to my kidneys? I’m hoping not since it was just a few days and I made the conscious decision to be with my buddy instead of tending to myself. Let’s consider this a cautionary tale instead.

Until next week,

Keep living your life!

Maybe for You, But Not for Me

hairLast week, when I wrote about thinning hair, I received loads of suggestions. While I was pleased with all the interaction, it was clear to me that we had people answering from three different positions: pre-dialysis (like me at Stage 3 Chronic Kidney Disease), dialysis, and post-transplant. What also became clear is that the ‘rules’ for each position are different. That got me to wondering.

But first, I think a definition of each of these is necessary. My years teaching English ingrained in me that ‘pre’ is a prefix meaning before; so pre-dialysis means before dialysis. In other words, this is CKD stages 1-4 or 5 depending upon your nephrologist. It’s when there is a slow progression in the decline of your kidney function.

I remembered a definition of dialysis that I liked in SlowItDownCKD 2015, and so, decided to repeat it here.IMG_2980

“According to the National Kidney Foundation at https://www.kidney.org/atoz/content/dialysisinfo,

‘Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body’s needs. There are several different kinds of dialysis. Basically, they each eliminate the wastes and extra fluid in your blood via different methods.’”

And post -transplant?  Simply put, it means after having had an kidney (or other organ) placed in your body to replace one that doesn’t work anymore.

I know as a pre-dialysis that I have certain dietary restrictions.  Readers have told me some of theirs and they’re very different. It’s not the usual difference based on lab results that will tell you whether you need to cut back more on one of the electrolytes this quarter. It seemed like an entirely different system.

FullSizeRender (2)Let’s go back to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease to see what my basic dietary restrictions as a pre-dialysis CKD patient are.

 “The (e.g. renal) diets seem to agree that protein, sodium, phosphorus and potassium need to be limited. … Apparently, your limits may be different from mine or any other patient’s.  In other words, it’s personalized.”

Well, what about those on dialysis? What do their dietary guidelines look like? I found this in The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2:

“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.

“Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep FullSizeRender (3)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.”

I suspected that potassium is not the only dietary problem for dialysis and dug a bit more.  I discovered this information on MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=78054, along with the caveat that these also need to be individualized as per lab results.

  1. Fluids: Allowance is based primarily on the type of dialysis and urine output. If you have any edema, are taking a diuretic, and/or have congestive heart failure, your allowance will be adjusted.
  2. Sodium: This will be modified to maintain blood pressure and fluid control and to help prevent congestive heart failureand pulmonary edema.
  3. Potassium: Your intake of this will be adjusted to prevent your blood levels from going too high or too low.
  4. bananaPhosphorus: The majority of dialysis patients require phosphate binders and dietary restrictions in order to control their blood phosphorus levels.
  5. Protein: Adequate protein is necessary to maintain and replenish your stores. You may be instructed on increasing your intake now that you are on dialysis.
  6. Fiber: There is a chance that constipation may be a problem due to fluid restrictions and phosphate binders, so it’s important to keep fiber intake up. You will need guidance on this because many foods that are high in fiber are also high in potassium.
  7. Fat: Depending on your blood cholesterol levels, you may need to decrease your intake of trans fat, saturated fat, and cholesterol.
  8. Calories: If you are over or underweight, you will be instructed on adjusting the amount of calories that you take in each day.
  9. Calcium: Most foods that contain calcium also contain phosphorus. Due to your phosphorus restrictions, you will need guidance on how to get enough calcium while limiting your intake of phosphorus.

Big difference here!  More protein, less calcium, phosphate binders, fat and calcium. No wonder the responses I got to last week’s blog were so varied.

And post-transplant? What about those dietary restrictions? The Mayo Clinic at http://www.mayoclinic.org/tests-procedures/kidney-transplant/manage/diet-nutrition/nuc-20209734 has that one covered, with the same warning as the other two groups’ diets: your labs dictate your amounts.

  • Eating at least five servings of fruits and vegetables each dayfruits and veggies
  • Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppression medications (calcineurin inhibitors)
  • Having enough fiber in your daily diet
  • Drinking low-fat milk or eating other low-fat dairy products, which is important to maintain optimal calcium and phosphorus levels
  • Eating lean meats, poultry and fish
  • Maintaining a low-salt and low-fat diet
  • Following food safety guidelines
  • Staying hydrated by drinking adequate water and other fluids each day

So it looks like you get to eat more servings of fruits and vegetables a day, must avoid grapefruit and its juice, and be super vigilant about calcium and phosphorus levels. Notice the same suggestion to have enough fiber in your diet as when on dialysis.

Whoa! We have three different sets of diet guidelines for three different stages of CKD, along with the strict understanding that everything depends upon your lab results. That means that the post-transplant patients were right – for them – that I needed more protein.  And the dialysis patients were right – for them – too. But for the pre-dialysis patients? Nope, got to stay below five ounces daily. IMG_2982

Until next week,

Keep living your life!

The American Kidney Fund Blog

AKF logoI was honored that The American Kidney Fund (www.kidneyfund.org) asked me to write a blog for them. This is that blog. Once it was published last Thursday, I started thinking. If you share the blog and ask those you shared with to share it, too, and they asked their friends to share it, too… image how many people would become aware of Chronic Kidney Disease. Will you do that?

Slowing Down CKD—It Can Be Done

When a new family doctor told me nine years ago that I had a problem with my kidneys—maybe chronic kidney disease (CKD)–my first reaction was to demand, “What is it and how did I get it?”

No doctor had ever mentioned CKD before.

I was diagnosed at stage 3; there are only 5 stages. I had to start working to slow it down immediately. I wanted to know how medication, diet,stages of CKD exercise and other lifestyle changes could help. I didn’t want to be told what to do without an explanation as to why… and when I couldn’t get an explanation that was acceptable to me, I started researching.

I read just about every book I could find concerning this problem. Surprisingly, very few books dealt with the early or moderate stages of the disease.  Yet these are the stages when we are most shocked, confused, and maybe even depressed—and the stages at which we have a workable chance of doing something to slow down the progression in the decline of our kidney function.

I’ve learned that 31 million people—14 percent of the population—have CKD, but most don’t know they have it. Many, like me, never experienced any noticeable symptoms. Many, like me, may have had high blood pressure (hypertension) for years before it was diagnosed. Yet, high blood pressure and diabetes are the two leading causes of CKD.

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

Another critical piece of slowing down CKD is medication. I was already taking meds to lower my blood pressure when I was first diagnosed with CKD. Two more prescriptions have been added to this in the last nine years: a diuretic that lowers my body’s absorption of salt to help prevent fluid from building up in my body (edema), and a drug that widens the blood vessels by relaxing them.

For a very short time, I was also taking a drug to control my pre-diabetes, but my doctor and I achieved the same effects by changing my diet even more. (Bye-bye, sugars and most carbs.) The funny thing is now my favorite food is salad with extra virgin olive oil and balsamic vinegar. I never thought that would happen: I was a chocoholic!

Exercise, something I loved until my arthritis got in the way, was also important. I used to dance vigorously several nights a week; now it’s once a week with weights, walking, and a stationary bike on the other days. I think I took sleep for granted before CKD, too, and I now make it a point to blues dancersget a good night’s sleep each day. A sleep apnea device improved my sleep—and my kidney function rose another two points.

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

I was sure others could benefit from all the research I had done and all I had learned, so I wrote my first book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, in 2011. I began a blog after a nephrologist in India told me he wanted his newly diagnosed patients to read my book, but most of them couldn’t afford the bus fare to the clinic, much less a book. I published each chapter as a blog post. The nephrologist translated my posts, printed them and distributed them to his patients—who took the printed copies back to their villages. I now have readers in 106 different countries who ask me questions I hadn’t even thought of. I research for them and respond with a blog post, reminding them to speak with their nephrologists and/or renal nutritionists before taking any action… and that I’m not a doctor.

What is itEach time I research, I’m newly amazed at how much there is to learn about CKD…and how many tools can help slow it down. Diet is the obvious one. But if you smoke or drink, stop, or at least cut down. If you don’t exercise, start. Adequate, good quality sleep is another tool. Don’t underestimate rest either; you’re not being lazy when you rest, you’re preserving whatever kidney function you have left. I am not particularly a pill person, but if there’s a medication prescribed that will slow down the gradual decline of my kidney function, I’m all for it.

My experience proves that you can slow down CKD. I was diagnosed at stage 3 and I am still there, nine years later. It takes knowledge, commitment and discipline—but it can be done, and it’s worth the effort. I’m sneaking up on 70 now and know this is where I want to spend my energy for the rest of my life: chronic kidney disease awareness advocacy. I think it’s just that important.

IMG_1398SlowItDownCKD 2015 Book Cover (76x113)

 

SlowItDownCKD is the umbrella under which Gail Rae-Garwood writes her CKD books and blog, offers talks, participates in book signings, is interviewed on podcasts and radio shows, and writes guest blogs. Her website is www.gail-raegarwood.com.

Until next week,

Keep living your life!

Apple Cider Vinegar?

I woke up thinking, ‘apple cider vinegar.” Granted, that’s an odd thought for the first thing in the morning… or is it? Last week, I blogged about the Apple-Cider-Vinegarbenefits of drinking lemon juice in a glass of water first thing in the morning. Okay, you’ve read the blog; you know that.

What you may not know is that the blog is posted on a multitude of Facebook chronic illness sites. A reader on one of these sites commented on the blog. I don’t remember exactly what she said, but it had something to do with her taking apple cider vinegar every day to help keep her body in alkaline balance.

Ah, now that first thought of the day today is starting to make sense. Monday is blog day for me. It looks like my mind was providing me with a topic for today’s blog.SlowItDownCKD 2015 Book Cover (76x113)

I’ll bet the first question you have is why she would want to help keep her body in alkaline balance. Let’s do a little back tracking to answer that question. As per last week’s blog, Dr. Jonny Bowden, a nutritionist and health author, tells us, “Having a healthy alkaline balance helps fight germs.” No contest, I’m sure we all want to do that.

I know, I know, now you’d like to know why alkaline balance – as opposed to acidic body chemistry – does that.  I do, too.  An article on MedIndia, a respected medical site, at http://www.medindia.net/patients/lifestyleandwellness/alkaline-diet.htm explains this:

“A pH of less than 7 is acidic and a pH of more than 7 is alkaline, water being neutral with pH=7. Since one of the most important measurements of health is the pH of the body fluids, it is very important to have an acid-base balance. Any imbalance, especially those leaning towards acidic, could be associated with health disorders including obesity, tiredness, premature aging, heart disease, diabetes and cancer.”

Reminder: “The pH of a solution is a measure of the molar concentration of hydrogen ions in the solution and as such is a measure of the acidity or basicity of the solution.” Thank you, Hyperphysics at http://hyperphysics.phy-astr.gsu.edu/hbase/chemical/ph.html for the definition.

Did you catch diabetes in the MedIndia quote? That is the number one cause of Chronic Kidney Disease. This is what I wrote about that in my first What is itCKD book What Is It and How Did I Get It? Early Stage Chronic Kidney Disease,

“In fact, the U.S. has the highest rate of CKD with 210 people per million having it, and two thirds of those cases caused by diabetes or HBP.”

And that was back in 2011. Two thirds of 210 people per million. .. and we don’t know how many of them developed CKD from HBP – or diabetes. Taking no chances, I’ll opt for alkaline balance in my body, even though I already have Chronic Kidney Disease.

Next question: how does apple cider vinegar help keep a body in alkaline balance? Let’s go back to last week’s blog again.

“Body Ecology at http://bodyecology.com/articles/acidic-foods-and-acid-forming-foods-do-you-know-the-difference had exactly what I needed:

‘To clear up some of the confusion:

  • Acidic and alkaline describe the nature of food before it is eaten.
  • Acidifying foods and acid-forming foods are the same, making the body more acidic.
  • Alkalizing foods and alkaline-forming foods are the same, making the body more alkaline. ‘”

All right then, we get it that something acidic – like vinegar – could actually be alkaline once it’s ingested. And we understand that an alkaline balance can keep us healthier. But we have CKD. Is apple cider vinegar something we can take?

Kidney Hospital China at http://www.kidneyhospitalchina.org/ckd-healthy-living/961.html was helpful here, although I am still leery of websites that offer online doctor advice. They maintain that it can lower your blood pressure – a good thing since high blood pressure is not only a cause of CKD, but also can make it worse. They also consider it an anti-inflammatory, although I’m beginning to wonder if all alkaline foods are. Then they mention it helps prevent colds and removes toxins in the blood. Both will help relieve some of the kidney’s burden.

This warning was the first I’d seen in all the blogs and natural eating sites I perused for information about today’s topic… and it comes from Kidney Hospital China:

“Apple cider vinegar is high in potassium and phosphorus, so kidney disease patients who have high potassium and high phosphorus levels in blood need to avoid the intake of the drinks.”

In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1, I referred to an article entitled Vegetarian diet helps kidney disease patients stay healthy in order to point out why we need to keep our phosphorous levels low:

“Individuals with kidney disease cannot adequately rid the body of phosphorus, which is found in dietary proteins and is a common food additive. Kidney disease patients must limit their phosphorous intake, as high levels of the mineral can lead to heart disease and death.”

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In The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2, I succinctly reminded us why we want to watch our potassium intake:

“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.”

All in all, I think this might be a go. Do talk it over with your nephrologist or renal dietician before you start on a regiment of apple cider vinegar. I only research; they’ve been to medical school. By the way, many of these sites talked about the pleasing taste of this drink. I may have to try it just to see if any drink containing vinegar tastes good.

I have not forgotten that I promised to give you the link to the most recent podcast. I had thought the topic was going to be my Chronic Kidney Disease Awareness Advocacy, but the skillful interviewer – Mike G. – managed to cover every aspect of my life.

Until next week,

Keep living your life!

It’s Not Lemonade

Why drinking water with lemon is good for you screamed The Chicago Tribune at me today. Hmmm, I’d been wondering about that. Last week, happy birthdayI’d attended the 60th birthday celebration of my friend Naomi. She is studying nutritional counseling. That’s right: studying at age 60. As you can tell, no grass grows under the feet of the people in my social circle.

The celebration was held in one of the beautiful resorts out here in Arizona, The Sanctuary, in The Jade Bar to be exact. It was an odd location since this bar was long and narrow with couches and comfortable chairs lined up, but no place to mingle or chat in small groups. We ended up climbing over each other just to get to the rest room. Yet, my friend came running up to greet us.

Why? She wanted to know if I was drinking the water with lemon first thing in the morning as she’d suggested when I was a test case for one of her classes. She explained to me how important it was to people and her friends Lily and Patty leaned over to verify with their own personal anecdotes.

That, of course, got me to thinking. What was so special about this? Sure, it would warm up the vocal chords if you drank the lemon in warm water, but what else?

According to Tribune’s article at http://www.chicagotribune.com/lifestyles/health/sc-one-simple-thing-lemon-water-0420-20160415-story.html,

“Health experts say the acidity of the lemons improves digestion. Lemons contain potent antioxidants, which can also protect against disease, says Dr. Jonny Bowden, a nutritionist and health author. ‘It’s very alkalizing for the system,’ said the Woodland Hills, Calif.-based Bowden, whose lemonsbooks include “Smart Fat” and “The 150 Healthiest Foods on Earth.” Having a healthy alkaline balance helps fight germs.’”

Now this confused me. How can lemon – an acidic fruit – alkalinize your system?  Body Ecology at http://bodyecology.com/articles/acidic-foods-and-acid-forming-foods-do-you-know-the-difference had exactly what I needed:

“To clear up some of the confusion:

  • Acidic and alkaline describe the nature of food before it is eaten.
  • Acidifying foods and acid-forming foods are the same, making the body more acidic.
  • Alkalizing foods and alkaline-forming foods are the same, making the body more alkaline.”

I know, now you’re wondering what each of these terms mean. So am I…and I thought I knew. I turned to Online Biology Dictionary at http://www.macroevolution.net/biology-dictionary-aaaf.html:

“Acid – a sour-tasting compound that releases hydrogen ions to form a solution with a pH of less than 7, reacts with a base to form a salt, and turns blue litmus red…. An acid solution has a pH of less than 7.”

I used the same dictionary for the definition of alkaline, which referred me to the definition of alkali.

“Any metallic hydroxide other than ammonia that can join with an acid to form a salt (or with an oil to form soap).”

I didn’t find that very helpful so I turned to my old buddy The Merriam-Webster Dictionary at http://www.merriam-webster.com/dictionary/alkali

“a soluble salt obtained from the ashes of plants and consisting largely of potassium or sodium carbonate; broadly:  a substance (as a hydroxide or carbonate of an alkali metal) having marked basic properties”

Okay, that’s a little better, but not much. Let’s try this another way. I perused site after site. What I gleaned from these is that lemons are, indeed, acidic before they are eaten, but the body metabolizes them into alkaline. There was plenty of specific science to explain this, but I didn’t understand half of it and prefer to keep it simple.

Of course, then I wanted to know why I was even bothering to research this at all. LifeHacks at http://www.lifehack.org/articles/lifestyle/11-benefits-lemon-water-you-didnt-know-about.html, a new site for me, made it abundantly clear.

  1. Gives your immune system a boost.
  2. Excellent source of potassium.
  3. Aids digestion.
  4. Cleanses your system.CoffeeCupPopCatalinStock
  5. Freshens your breath.
  6. Keeps your skin blemish-free.
  7. Helps you lose weight.
  8. Reduces inflammation.
  9. Gives you an energy boost.
  10. Helps to cut out caffeine.
  11. Helps fight viral infections.

Now, you do have Chronic Kidney Disease, so be aware that lemons are a high potassium food. Potassium is one of the electrolytes we need to limit. Also, if you are prone to kidney stones, you’ll be very interested to know lemons are full of vitamin C, something you may need to avoid.

So far, it sounds like lemon juice in water upon waking is a good thing if you keep the two caveats above in mind but I think I’ll just check into this a bit more.

I looked in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, and discovered this succinct explanation of why you want to keep the potassium levels under guard as a CKD patient:What is it

“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….

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).”

If you’re in the normal potassium range on your blood tests as I am, I say go for the lemon juice in water first thing in the morning. Of course, I’m not a doctor and – even if I were – I’m not your doctor, so check with him or her first.

Oh, hopefully by next week, I’ll be able to give you the address for the Edge Podcast I was interviewed on last week. It wasn’t just about CKD, much to my surprise… and maybe that of the Mike G’s (the interviewer), too.SlowItDownCKD 2015 Book Cover (76x113)

Until next week,

Keep living your life!IMG_1398

Not For Us

What an incredible weekend. I’m involved with Landmark Worldwide and spent a truly edifying three days at a Wisdom Unlimited Weekend (Comment if you’d like to know more about this.) and then had the pleasure of seeing my wickedly funny ventriloquist cousin – Steve Bernard – Jackperform at The Comedy Spot here in Arizona.  You may have noticed the blog is a bit late today.  Gee, I wonder why….

Before I forget, Janet Cook of JuicePlus received a response from the company’s medical advisor addressing my concerns about the amount of phosphorous and potassium in their products.

“Two Vineyard Blend capsules provide less than 30 milligrams of potassium and less than 20 milligrams of sodium, less than 10 mg of phosphorus….The potassium content of the daily recommended amount of Juice Plus+®, two Juice Plus+ Orchard Blend® capsules and two Juice Plus+  Garden Blend® capsules, will provide approximately 45 milligrams of potassium. Two Juice Plus+ Vineyard Blend® capsules provide approximately 30 milligrams of potassium. The phosphorus content of a daily adult serving of Juice Plus+  Orchard Blend® and Juice Plus+ Garden Blend® is less than 10 milligrams.”

That certainly takes care of my going over the limit of sodium, phosphorous, and potassium concerns which place the decision as to whether or not to indulge in this product smack dab back in your hands.  Thanks to Janet for quickly and efficiently getting this information to me.  I do appreciate the transparency of this company.

sad faceConfession time.  When I was a younger woman dealing with a newly diagnosed ill daughter, a difficult order of protection for my children, and an unexpected dumping by a boyfriend who had been a friend since high school, I threw up my hands and decided I needed help to control my weight – the one thing I thought I might be able to control.

A trusted friend introduced me to her new business and its products.  It was Shaklee, which is still in business over two decades later.  I can’t be certain this is the same product, but I think this was what I was taking, especially since I was a chocoholic at the time. (Ah, those were the days, my friends.) I also had never heard of soy at the time.

Shaklee Life Energizing Shake  canister

New delicious meal shake contains nutrients clinically proven to help create the foundation for a longer, healthier life. It is designed to increase your energy, help you achieve a healthier weight, and provide incredible digestive and immune support from fiber and probiotics.

Available in soy and non-soy formulas

The Shaklee Life Energizing Shake Mix comes packed with:

  • 24 grams* of protein, including 16 grams of plant-based, non-GMO protein
  • Added leucine to help preserve lean muscle and achieve a healthier weight
  • A powerful combination of prebiotics and one billion CFU of patented probiotics
  • Omega-3 (ALA) to support heart and brain health

And Life Shake:

  • Gluten free, lactose free, low glycemic, and Kosher
  • Contains no added artificial flavors, sweeteners or preservatives

* When prepared as directed with 1 cup of nonfat milk.

You can take a look at this yourself on their website at https://www.shaklee.com/us/en/shop/healthyweight/shaklee180meals/product-_p_shaklee-life-energizing-shakep. My buddy is no longer selling the product and has regained all the weight she lost and more.  Me, too.  That’s why I wonder if these ‘miracles,’ are such miracles since they don’t work if you don’t keep taking them.

Okay, enough philosophy, let’s take a look at this product through the eyes of a Chronic Kidney Disease patient.  When I clicked on Features for this product, I found more information.

  • 24 grams* of protein, including 16 grams of proprietary, plant-based, non-GMO protein with precise ratios of 9 essential amino acids, optimized for high protein quality
  • Non-soy formula contains an exclusive blend of sacha inchi, rice, pea and potato protein

As a CKD patient, I don’t think I’d like that. My renal diet allows 5 ounces of protein daily rather than the 24 grams each shake contains. I couldn’t find the information on the website, but vaguely remember having two shakes a day and a balanced meal. Two shakes? That’s 48 grams of protein. To put it in perspective, that’s less than 2 ounces a day, but I’ll pass. I can think of other ways I’d like to have my protein.

Just for fun, let’s look at the other two Ps and S, too.  The sodium is not bad at 250 mg. a day for two shakes. The potassium is 620 mg. for two shakes a day, also not despicable. As usual on nutritional labels these days, the phosphorous is not listed. However, we do know that milk, even non-fat milk, is a high phosphorous food.Label

Wait a minute, I just noticed something else. Are you prone to kidney stones? If so, you need to avoid high oxalate foods. Thought would have meant no chocolate shake for me.

I was curious about sacha inchi protein powder since it was new to me. About.com at http://altmedicine.about.com/od/herbsupplementguide/a/Sacha-Inchi.htm provided the following information.

Sacha inchi (Plukenetia volubilis) is a plant native to Peru. The term “sacha inchi” typically refers to edible seeds produced by the sacha inchi plant. sacha inchiAlso known as sacha peanut, mountain peanut, or Inca peanut, these seeds have a nut-like flavor when roasted. Often marketed as a “superfood,” sacha inchi is said to offer a variety of health benefits.

So it looks like young(er) and foolish is the way I was. There’s no double about this one: with our protein restrictions, it’s not for CKD patients.

Topic change: In keeping with my strict policy of using all the profits from my kidney books to further spread awareness of CKD and ways to slow down the progressive decline of kidney function once you have CKD, I did the smart thing. I turned to a professional indexer to index The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2.Book CoverIMG_1398

Whether they’re for you, a newly diagnosed patient, friends, family, or anyone else, these books make excellent Christmas and Chanukah presents for those in the renal community and others who want to know about CKD. By the way, you can now order them in Sweden on Bokus.com.

I hope you have a wonderful Thanksgiving. I’m sorely tempted to empty the jar of our daily gratitudes on that day, but I’ll be good and wait until New Year’s.

Until next week,

Keep living your life!

Here’s Another One…

And so the inquiry continues. Considering some of the surprising comments I’ve received, it’s time to make it clear in the very first paragraph of today’s blog that I am neither endorsing nor condemning the products  I write about. Like me, some of my readers have expressed interest in them and wondered if we could take them as Chronic Kidney Disease patients.

fruits and veggiesI liked Juice Plus, but as the first blog of the month explained, that won’t work for us for a number of reasons. By the way, Janet Cook has requested that the doctor who is the company’s medical advisor answer some of the questions I brought up in the blog. Last week, I explained why Pruvit – enjoyed by many I know – would not be a good choice for us.

This week, it’s Isagenix.  I thought it was interesting that their website is tailored according to the country in which you live. The URL for the United States is http://www.isagenix.com/?sc_lang=en-US.  I have an even more personal interest in this one since one of my daughters has just begun their program. She’s interested in becoming healthier than she is right now since, even exercising assiduously, she’s beginning to notice her changing body and the internal sensations that displease her.iasgenix

From the website and discussions with my daughter and her friends who adhere to this regiment, it seems like the shakes are the basic products. My mouth started watering when I read the names: Creamy Dutch Chocolate, Creamy French Vanilla, and Strawberry Cream.

Uh-oh, cream. That must mean milk! Sure enough, each contains both milk protein concentrate and low-heat nonfat milk. That means I’m out since I’m lactose intolerant.  But I was curious about low-heat nonfat milk since I’d never heard of it before.

Diary America at http://www.dairyamerica.com/products/grade-low-heat explained it this way.

low fatSpray Dried Grade “A” Low Heat Nonfat Dry Milk is the powder resulting from the removal of the fat and water from fresh Grade “A” Milk. It contains the lactose, milk proteins and milk minerals in the same relative proportions as they occur in fresh milk. The product is made from fresh, pasteurized nonfat milk to which no preservative, alkali, neutralizing agent or other chemical has been added.

What is more important to us as CKD patients is the chart I found when I scrolled down the page. It’s based on 100 grams.

Minerals

Calcium 1248 mg
Iron 0.4 mg
Magnesium 110 mg
Phosphorus 993mg
Potassium 1674 mg
Sodium 494 mg
Zinc 4.08 mg

The serving size of the shakes is 2 scoops which equal between 59-61 grams depending on the flavor.  The program calls for two shakes a day so we need to double that for between 118 to 122 grams a day.  I’ll be doing some rounding off here, but that means you’d be taking in about 1048 mg. of phosphorous per day. Ummm, my daily limit is 800 mg. I think there just might be a phosphorous problem with low-heat nonfat milk for CKD patients here, she understated.

Now that’s a bit convoluted and based only on the low-heat milk powder that is one of the ingredients in the Isagenix shakes.isagenix shake

Let’s try this the simple way. Each shake contains between 348 and 350 mg. of potassium.  Let’s take an average of 349. Multiply that by two since you drink two shakes a day on this plan and you have 698 mg. of potassium. That doesn’t seem so bad since my limit is 3000 mg. per day.

Oh wait, there are also snacks and a full meal required in this program – as I understand it. The IsaLean Bars (snacks) range from 130 to 480 mg. of potassium. We need to double that since two per day are necessary. Let’s say we’re partial to Chocolate Cream Crisp which has 480 mg. of potassium. That’s an additional 960 mg. of potassium. So now we’re up to 1178 mg. of potassium.  That’s not over my limit, but I still have a balanced meal to account for.  Can it be done? Sure. How? Carefully, very carefully.

salt Let’s take a look at the sodium in the products since that’s another big restriction with Chronic Kidney Disease. My limit is 2000 mg. per day. 240-265 mg. of sodium are in each shake. Double that for the two shakes a day and you have between 480 and 530 mg. daily.  Add in two snacks at between 60 and 140 mg. of sodium for another 120 to 280 mg. of sodium. Totaled, you have between 600 and 810 mg. of sodium. There’s still plenty left over for that balanced meal.

However, there are substances that are hard on the kidneys in these shakes: flax seed powder and psyllium seed powder are just two that jumped out at me from the ingredients list. The shakes also contain alfalfa leaf which is often used to increase urine production.

I am envious my daughter can use this product to get herself back to the kind of body condition she’s used to, but as a CKD patient, I’ll have to say no, I can’t use this product … no matter how much I want to. I’ll take preserving my remaining kidney function to an easier way to get back into shape any day.

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On another note, I was astounded to discover that all three of my Chronic Kidney Disease books are on sale via Amazon in a dozen different countries.  Whenever I finally think of checking on their progress, I find another country added. In addition to indexing the books, I’m considering offering the print copies on Barnes and Noble.com.  Any thoughts on that? I was also considering offering What Is It and How Did I Get It? Early Stage Chronic Kidney Disease on Nook as well as Kindle since my digital books are less expensive than the print ones. Does that ring anyone’s bell?What is it

On a personal note, I am happy to report there is no travel scheduled until next year, so I get to stay in my very own office working on kidney projects.  Oh, happy day!

Until next week,

Keep living your life!

Too Good to be True (for CKD)

fruits and veggiesIt looks like we have a theme this month.  Last week, I wrote about Janet Cook and Juice Plus, a wonderful source of fruits and vegetables, but not for those of us with Chronic Kidney Disease. There are other people in my life who are excited about what they have to offer and have urged me to explore their products, too.

Two are now involved with Pruvit, a ketogenic product. One of them, an acquaintance of several years, has often seen me politely cover a yawn at Landmark Worldwide seminars and noticed my eyes start to glaze over when brain fog set in. He introduced me to his product. When I asked for more information, he sent me to the following websites:

Ketosis Starves cancer and treats epilepsy: Dr. Dom D’Agostino TEDx (self organized) https://youtu.be/3fM9o72ykww

Overview https://youtu.be/J-4Xxx32WuUbaby-shots-5

Benefits of the Keto Diet, Dr. Josh Axe https://youtu.be/kgKiA3F-JHw

I don’t have cancer, epilepsy, or Alzheimer’s, but I certainly could use these benefits listed among others at https://pruvit.wordpress.com/the-benefits-of-keto-os-ketones/

  • Weight loss
  • Blood sugar balance and enhanced insulin sensitivitybelly fat
  • Increase satiety, and decreased food cravings
  • Improved energy levels, oxygen capacity, motor performance & athletic performance
  • Inflammation management
  • Endurance enhancement

This sounded great!  Maybe a little too great for a CKD patient?  So I did what I usually do: researched a bit more and found this at FAQ @ https://pruvit.zendesk.com/hc/en-us.

…. There is no reason that the ketones produced by the product will affect the kidneys or liver any differently than ketones produced from exogenous fats (such as when eating a ketogenic diet) or ketones produced from stored fats (such as when calorie restricting or losing weight).  Exogenous ketone scientific literature does not suggest that neither the kidney nor liver function is negatively affected by ketosis.  The major role of the kidneys when it comes to ketones is to excrete excess ketones in the urine.  This excretion will likely be highest during the first few days of keto-adaptation (either in eating the keto diet or consuming KETO//OS), but the body will retain more and the tissues will begin to preferentially burn the ketones as consumption continues.  ….Ketones will also naturally act as a diuretic, so you lose salt, potassium calcium and magnesium, and it is generally encouraged to increase sodium intake with ketones….

salt

Hmmmm, you need to increase your sodium intake with this product. But as CKD patients, we are limited here. I know I am restricted to 2,000 mg. daily which is fairly liberal as far as renal diets go.

I decided to look at the product’s nutritional label at http://pruvitnow.com/products/ketoos/

Pruvit-Keto-OS-FactsNotice one packet contains 970 mg. of sodium. As I scoured several independent distributors’ websites, it became clear you start with one packet and work your way up to three a day, one with each meal. That means three times the 970 mg. in each packet or 2,910 mg. daily without the extra sodium you’re urged to ingest.  Wait a minute. I was already 910 mg. of sodium over my limit with just the packets before adding extra.

That and the following statement convinced me that while this sounds like a terrific product, it’s not for Chronic Kidney Disease patients.

*The Food and Drug Administration has not evaluated these statements. This product is not intended to diagnose, treat, cure or prevent any disease.

*sigh* Hello again renal diet, my best friend.

While I was working on indexing The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and Part 2, my eyes got tired from all the numbers I was working with, so I played around on the internet… and look what I found!

The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1

  • I got this when it was free, but have just now gotten around to browsing through it. These are the same blogs that I read and relied on for information as I went Digital Cover Part 1down the road of chronic kidney disease. If you need to know it, it’s here or in part 2. I started with her book, What Is It and How Did I Get It? when I saw a flyer for it in my kidney doctor’s waiting room. Much like Gail, I’ve been inhaling information about this issue, since I’m not one to sit around and trust someone to just tell me what to do. She has done her research. I have a few other books about kidney disease, but this one was the one that my husband liked the best when he was curious about my condition. The blogs cover most of this territory, but broken down in nice little blog type chapters. The only thing missing is a table of contents, but as I looked for the thing I wanted, I found I was re-reading things I’d forgotten about. So, browsing this volume and the second one as well can be helpful as a refresher course so to speak.
  • This book is the only written resource I’ve found to answer the tough questions that come with Chronic Kidney Disease. Although our doctors are great at treating us, they aren’t always available to give in depth answers or really explore the whys and hows of a question. Rae-Garwood does an excellent job anticipating exactly the kinds of questions that came up for us. Give it a try.
  • If you have kidney disease, like I do, you can relate to what Gail Rae-Garwood has written here… very useful…

The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 2

  • Part 2So much information!
  • Although this was purchased for my wife, I can honestly say that there is a wealth of information in this book as well as Part 1. So many questions answered that doctors and nutritionists forget to tell patients have been researched and answered in layman’s terms. Hooray for the efforts of this author who is using her talents to help others.

What Is It and How Did I Get It? Early Stage Chronic Kidney Disease

  • Great book to help with the anxiety that comes with the diagnosisBook Cover
  • Very helpful

Until next week,

Keep living your life!

It Would Have Been Nice…

NYC I’m just back from a wonderful week in New York where people traveled great distances to see me, gladly opened their homes to me, and introduced me to interesting – very interesting – people. Between my family and friends, I haven’t felt this loved in a long time…and I always feel loved.

But one thing bothered me. I couldn’t seem to get enough fruit and vegetables each day since I was staying with people who ate differently from me, had different schedules than I did, and took me out to restaurants quite a bit.

Some days, there were no vegetables at all in my diet.  I didn’t like that, so I started playing around with ideas of how I could avoid this problem when next I travel visiting others. I seem to have no problem when I’m by myself during my travels.

This time, I had stopped at little markets on my way from one place to another, but no one was willing to sell me half a banana (for example) and, considering the timing of my market visits, some hadn’t received their fresh fruit and vegetable deliveries yet or had already sold out of them.  Mind you, I’m not talking about big chain supermarkets here. There weren’t any near the elevated or subway train stations I used.fruits and veggies

That’s when I remembered Janet Cook who is a Juice Plus representative, so I took a look at her website. On, my! This is a product I wish I had discovered before being diagnosed with Chronic Kidney Disease.

This is how Juice Plus+ describes itself on her website at http://janetcook.juiceplus.com/content/JuicePlus/en/what-is-juice-plus/what-is-juice-plus.html

Juice Plus+ is whole food based nutrition, including juice powder concentrates from 30 different fruits, vegetables and grains. Juice Plus+ helps bridge the gap between what you should eat and what you do eat every day. Not a multivitamin, medicine, treatment or cure for any disease, Juice Plus+ is made from quality ingredients carefully monitored from farm to capsule to provide natural nutrients your body needs to be at its best.

No great claims, just common sense getting the fruits and vegetables you may be missing every day.  Natural nutrients. Oh, joy! But wait… what’s this about concentrate?

The Cambridge Dictionary at http://dictionary.cambridge.org/us/dictionary/english/concentrate offers us both the noun (name) and verb (action) definitions for concentrate.

Noun – a substance from which water or other substances have been removed

Verb – to make a ​substance ​stronger or ​purer by ​removing ​water or other ​substances

We’re used to the noun definition, but did you realize that, according to the definition of the word as a verb, concentration makes a substance stronger?

I scoured the website for the concentration’s equivalence of each fruit and vegetable but couldn’t find them. Then I realized that’s futile. If they are in the mix, how can you figure out how much of it is in the concentrate?

Janet was quick to offer me the name and email address of their consulting doctor when I explained my quandary to her. I liked that: transparency about their product.

She’d also asked me repeatedly which fruits and vegetables I couldn’t have.  Much to my chagrin, I realized I’d never answered her. I downloaded the ingredients in two of their products and compared them to the Northern Arizona Council on Renal Nutrition Diet which I follow.

 Juice Plus+ Orchard & Garden Blend

20 FRUITS, VEGETABLES, AND GRAINS

  • Apple • Acerola Cherry • Beet • Cranberry • Date • Orange • Pineapple • Papaya • Peach • Prune • Broccoli • Brown Rice Bran • Cabbage • Carrot • Garlic • Kale • Oat Bran • Parsley • Spinach • Tomato •

Juice Plus+ Orchard, Garden Blend & Vineyard Blend

30 FRUITS, VEGETABLES, AND GRAINS

  • Apple • Acerola Cherry • Beet • Cranberry • Date • Orange • Pineapple • Papaya • Peach • Prune • Broccoli • Brown Rice Bran • Cabbage • Carrot • Garlic • Kale • Oat Bran • Parsley • Spinach • Tomato • Artichoke • Bilberry • Blackberry • Black Currant • Blueberry • Cocoa • Concord grape • Cranberry • Elderberry • Pomegranate • Raspberry •

Again, I was taken with the transparency.  However, I found another problem for CKD patients here. I am restricted to 3000 mg. of potassium and 800 mg. of phosphorous daily.  Artichokes and dates are high potassium food. And don’t forget the products are concentrated which means the potassium count will be even higher.  Brans, bilberry, and cocoa are high in phosphorous.

Then there’s the problem that our kidneys are not so great at filtering waste from our bodies when we have CKD. That means the excess potassium and phosphorous stay in our bodies longer and more of it stays.

Globe-ArtichokeAccording to WebMD at http://www.webmd.com/a-to-z-guides/hyperkalemia-causes-symptoms-treatments?page=2

Hyperkalemia {That’s the medical term for excess potassium.} is a common cause of life-threatening heart rhythm changes, or cardiac arrhythmias. It can lead to an emergency condition called ventricular fibrillation. In this condition, the lower parts of your heart flutter rapidly instead of pumping blood.

Untreated, an extremely high amount of potassium in your blood can make your heart stop beating, causing death.

Excess phosphorous is a bit more complicated. Healthline at http://www.healthline.com/health/phosphorus-in-diet#TooMuchPhosphorous6 informs us of the following.cocoa

According to the NIH {This refers to the National Institutes of Health.}, it’s rare to have too much phosphorus in your blood (NIH, 2011). Typically, this problem only develops in people with kidney disease or those who have problems regulating their calcium.

However, too much phosphate can be toxic. An excess of the mineral can cause diarrhea, as well as a hardening of organs and soft tissue.

Having too much phosphorus in your blood can also cause it to combine with calcium, forming mineral deposits in your muscles.

High levels of phosphorus can also affect your body’s ability to effectively use other minerals, such as iron, calcium, magnesium, and zinc.

What is itThere’s more discussion of how CKD can affect the amounts of what we can tolerate and why in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. This is one of the topics I found the most confusing when I was first diagnosed.

Am I disappointed that I can’t take this product? A little, but not enough to take the chance of hastening the decline of my kidney function even further. Everything we put in our mouths – food or medication – affects our CKD.

Say, were you part of the book giveaway?  Would you like me to congratulate you publicly on the blog? Let me know.  And look for another giveaway when the indexes for the twins are done.IMG_1398

Until next week,

Keep living your life!

Aha! It is Possible.

What is itI’ve written periodically about the difficulties I was having combining the renal diet and the prediabetes diet. My usual renal dietician was unavailable for this year’s second (Thank you, Medicare.) appointment, so I saw someone else… and am I glad I did!

My first renal dietician introduced me to weights, measures, and what to eat in the first place.  Needless to say, this was all new to me and I wasn’t so happy with all these numbers, but she calmly, patiently kept explaining until I understood.  By the way, she’s quoted in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

This is the renal diet she devised for me as a brand new Chronic Kidney Disease patient. It’s based on The Northern Arizona Council on Renal Nutrition’s diet.

Scan0003

(Seems I see things off kilter. Scan0002

Just tilt your head a bit, if you will.)

As you can see, it was very exacting… just what I needed when I was so confused with all this new information and having to completely change the way I ate.

But then it became clear I also suffered from pre-diabetes, so my PCP sent me for diabetic counseling. Yes, I did know quite a bit already, but I did not know everything about diabetes…specifically, how to combine the two diets.  This is something my first renal dietician, good as she was, couldn’t answer. Well, maybe the diabetes counselor could.

Remember, this time we were not dealing with keeping sodium, potassium, and phosphorous under control to spare the kidneys. This time we were concerned with blood sugar.

I got some useful suggestions about herbs and spices I could use instead of salt.  This was not helpful for me since I’d already done some successful experiences with herbs and spices and discontinued the use of salt eight years ago when I was first diagnosed with CKD.

I was warned against hypertension and urged to keep it under 140/80, something I’d already been doing since my CKD diagnose. I was urged to avoid stress and work on weight management.  Again, been doing that for years.  Then I was educated about the value of sleep… again, nothing new here. But what about combining the two diets?

Scan0001Well, we did get to a meal plan. But it was unacceptable with the CKD. I was on a 1200 calorie diet to lose weight. Here I was urged to eat 1500 calories to lose weight and 1843 to maintain. But what really dissuaded me from adopting this meal plan was that it called for over four servings of fruit and four of vegetables when the renal diet limited me to three of each. I wasn’t willing to ingest that much phosphorous/potassium. In addition, it called for six fats a day, whereas the renal diet calls for five.

*sigh* So that wasn’t the way to combine the renal and pre-diabetes diets.

But then I went to the second renal nutritionist just last week and started to understand how to combine the two diets. Finally! She dealt solely with carbohydrates without specifying whether they be fruit, vegetable or grain. She explained that 15 gms. is a carbohydrate portion or choice. She explained that they should be paired with protein or fact to control my blood sugar. Now that was news to me.

While the diabetes counselor offered the same information about eating three meals with two snacks in between, it didn’t work for me because of the amount of food – most with potassium and phosphorous counts that were too high for the CKD – but here I was eating what I could with specific carbohydrate distributions for each meal or snack.

black breadIt was the same portions as the CKD diet, only with the gram count added.  For example, a slice of bread, 1/3 cup cooked pasta, 1/2 cup cooked cereal, or 3 cups of popcorn (no salt) are each one portion of my grain allotment daily just as they are on the prediabetes diet. The three allotments of fruit and vegetable, too. While I don’t care for dairy, I could still have the same amount of milk – if I drank milk, that is.  I had three carb choices at breakfast and lunch, but two at dinner.  There was also a carb unit for each snack.

There were no carb units assigned to meats or fats because they don’t affect blood sugar, but I still needed to pay attention to them for the CKD.  Well, that could be done just as I’d done it since my diagnosis: little or no red meat and keep it to five or six ounces. As for the fats, same cautions as with the CKD diet: avoid saturated fats and eliminate trans fat.

The hardest part about combining the two diets for me is consistency.  For the pre-diabetes, eating at the same time each day is preferable. I was used to eating whenVictorian clock I got hungry… before I saw the diabetes counselor. Then after taking her advice, right after I woke up and no longer than six hours – at the most – between meals or meals and snacks.

While that’s certainly feasible, I’m a writer.  I don’t like to leave the computer when I’m popping.  But now I do.  If I want to keep on being a writer, if I want to keep on being alive (okay, so that’s a bit dramatic), I have to take care of myself. So now I eat more often, try to be consistent about when I eat and sometimes even set an alarm on my phone to remind me to get up and go eat something. I’ll live. Well, that is the point: to live.

By the way, I’m having such fun devising the index for both The Books of Blogs: Moderate Stage Chronic Kidney Disease, Part 1 and The Books of Blogs: Moderate Stage Chronic Kidney Disease, Part 2 that I wonder if maybe, just maybe, I’m taking a little more time than I need to.  It’s okay to think that’s weird, you know. I’ve heard it before.

IMG_1398

Until next week,

Keep living your life!

 

Do I or Don’t I?

cruiseThree weeks ago, Bear and I embarked on my very first cruise.  For years, he’s been asking me to take a cruise.  For years, he’s been asking me to go to Alaska.  For years, he’s been asking me to ride on the Alaska Railroad. This is my second anniversary gift to him.

What makes it even better is that friends and family came together to take care of the wondrous cancer-free Bella in our home for the whole time we were away. There were people in and out at all times of the day and night to be with her.IMAG0269 (1)

Which brings us to today’s topic. Months ago, I wrote about a test my nutritional counselor suggested I take in order to take care of myself. I was warned it would be six weeks or more before I received the results of this blood draw. They’re finally arrived.

The test is Genova Diagnostics’ NutrEval for FMV amino acids. What was tested were antioxidants, B vitamins, minerals, essential fatty acids, digestive support, other vitamins, and amino acids. Pretty comprehensive, huh?

GenovaSince I need to research how Chronic Kidney Disease interplays with what supplements were recommended for me, I thought I’d share the ‘high need’ ones with you. First on our hit parade is in the antioxidant category. I’m glad I don’t need CoQ10 since that was in the normal range. Now I know why I ignore those tablets in the pharmacy. Vitamin A/Carotenoids, Vitamin C (Uh-oh, must have gone overboard avoiding this after the kidney stones), Vitamin E/Tocopherols were all in the borderline range, where I’ll let them stay for now.

a-Lipoic Acid, which is the same as alpha lipoic acid, however was in the high need range… as in a suggested dosage of 200 mg. Apparently the main food sources of this are:

organ meats which are high in phosphorouscpy broccoli.2

spinach which is one of the highest potassium foods

broccoli which I eat like it’s going out of style.

Lesser food sources are tomatoes, peas, Brussels sprouts and brewer’s yeast.

Davita.com has this to say about phosphorous. You can read more about it at http://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/high-phosphorus?-investigate-the-cause-when-you-have-kidney-disease/e/8003

Phosphorus is the second most common mineral in the body after calcium and is needed for good health. However, people with chronic kidney disease (CKD) have difficulty eliminating extra phosphorus from their bodies.

I’ve only got three servings of vegetables a day on the renal diet so I don’t want to waste them on high potassium choices or vegetables I don’t care for.  As for organ meats, I rarely eat red meat and don’t like the taste of these (Funny how I can remember how they tasted when I’ve lost so many other memories, isn’t it?). I can understand the deficiency.

Now this is peculiar. In researching this, I came across http://www.AlphaLipoicAcid.com which clearly states:

thiaminIf you’re deficient in thiamine (vitamin B1), a condition often associated with alcoholism, you shouldn’t take alpha lipoic acid.

The latest sources listed on their site are from 2007. That’s too long ago.

While I don’t drink, the NutrEval also showed I was deficient in and had a high need for Thiamin – or B1 – to the tune of 50 mg. I’d have to find another source to see if I can take this supplement.

I went to WebMD which is usually helpful to me. Hmmm, their latest source is 2012 but the site warns about taking this supplement with diabetic medication. It’s never easy, is it?

I seem to be going in circles here, so I’ll try this another way. According to my NutrEval Interpretation,

a-Lipoic Acid plays an important role in energy production, antioxidant activity (including the regeneration of vitamin C and glutathione), insulin signaling, cell signaling and the catabolism of a-keto acids and amino acids.

Mind you, this was taken from the Interpretation At-A-Glance for the patient.  The physician’s is even more detailed. I just looked at seven differentIMG_1229 sites, some selling this supplement, and read parts of three different books. Each one declares that a-Lipoic Acid should not be taken if you have a thiamine deficiency.

So do I take the supplement or not? Since I’m still worried about taking it when it’s suggested I not take it while being B1 deficient, I will send the physician report to my nephrologist.

Let’s flip this baby and see if I get anywhere researching thiamin deficiency.

Oh, my goodness!!!! I went to the Mayo Clinic at http://www.mayoclinic.org/drugs-supplements/thiamine/interactions/hrb-20060129 only to discover that thiamin and Metformin – which I take for pre-diabetes – don’t mix.

Caution is advised when using medications that lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Furthermore, there’s a caution on the site that supplements are not approved nor regulated by the FDA. All that’s offered are approximate dosages by age and length of duration that are LIKELY acceptable.  I’m becoming very uncomfortable with this.

So I am deficient in a-Lipoic Acid – whose supplementation may also affect my blood glucose – but am urged not to take it if I have a thiamin deficiency. Then I am urged not to take thiamin supplementation since it may interfere with the Metformin.  Or is this a hearty suggestion to stop the Metformin?  Sorry, folks, this is something for my nephrologist to help with.  I guess we’ll just have to wait until I can contact him.

It’s not life threatening and we were in Vancouver for five days before boarding the ship which gave me a lot of time to ruminate. I’m wondering if this test is the deciding point between alternative medicine and my nephrologist’s kind of medicine.

VancouverShould push come to shove, I’m not ready to leave my nephrologist and rely on alternative medicine. I’ve done well at keeping my CKD at stage 3A for the last eight years… with the help of my nephrologists. I’m not saying that you should do as I do, simply that this would not be my choice and I’d urge you to think carefully if it’s your choice.

I’m going back to looking at our pictures of Alaska’s Inside Passage.

Until next week,

Keep living your life.Digital Cover Part 2 redone - CopyDIGITAL_BOOK_THUMBNAIL

Water, Water Everywhere

11194487_10206480685479477_4614482644786730988_oYesterday was Mother’s Day here in the U.S.  Here’s what I posted on that day:

When I grew up, mothers were all married women. Not anymore! Happy Mother’s Day to the moms who are moms in a lesbian relationship, the dads who are moms in a gay relationship, the single dads who are both mother and father, the moms in straight relationships, the older siblings bringing up their brothers and sisters, the single moms and those who have lost their child. You’re all still mothers and I relish enjoying this day with you.

I hope yours was a very happy one, even if your children are far away like my Nima who is in New York. Nima

This mother (two biological daughters, two step-daughters, two significant others) has been writing about sea sickness remedies, both medical and natural, for the past two weeks.  That got me to thinking about another kind of water and why we need it.

I’ve mentioned that I see a nutritional counselor to help me prevent my pre-diabetes from becoming diabetes. We all know I need 64 oz. of fluid intake a day as a Chronic Kidney Disease patient, but it’s not all water.  There’s my beloved 16 ounces – or two cups – of coffee a day plus any solid that turns to a liquid when melted (think ices) and the liquid in fruits such as watermelon.  By the way, did you know that our bodies are 50-75% water depending upon our health and age?diabetes equipment

Debbie, my nutritional counselor, kept hitting the need to hydrate.  Until she realized I already take this into account daily, she asked me to keep count of the number of eight ounce glass of water I drank each day.  That’s how important she felt it was.  We know that; we’re CKD patients.

But, have you ever wondered why it’s so important that we keep hydrated?  That’s one of those questions that was answered when I was first diagnosed, but – being who I am – I don’t remember the answer.  And that got me to wondering if you did.

The most obvious answer is that we need water so that our metabolism can function at its best. This is important so we have energy and build new cell materials. Let’s explore this a bit more.

The Oxford Dictionary defines catabolism (love that name) as

the breakdown of complex molecules in living organisms to form simpler ones, together with the release of energy; destructive metabolism.

In this case, ‘destructive’ is a positive.  No destruction of complex molecules = no release of energy.  Heaven knows we already have enough problems with energy as CKDers.

I used the Medical-Dictionary at http://medical-dictionary.thefreedictionary.com/anabolism for an explanation of anabolism.

The phase of metabolism in which simple substances are synthesized into the complex materials of living tissue.

So catabolism is the function of metabolism which breaks down complex molecules for energy and anabolism is the function that builds up cell material.metabolism

Oh, almost forgot – metabolism simply means change. How can I remember a college etymology lesson from fifty years ago, but not remember what my nephrologist told me seven years ago????

All right, but why the need to hydrate? While a commercial site, Nestle Waters at http://www.nestle-waters.com/healthy-hydration/water-fonctions-in-human-body (I did wonder about that ‘o’ in fonctions.) lists the five reasons we need water.  Notice number five and remember that toxins need to be eliminated, too.  That’s the job of the kidneys… and they need water to do it.water to cells

  1. Cell life
  2. Chemical and metabolic reactions
  3. Transport of nutrients
  4. Body temperature regulation
  5. Elimination of waste

As I researched, I hit medical sites, sports sites, pregnancy sites, elder care sites, and even pediatric sites.  All included hydration in their how-to-stay-healthy advice.

As CKDers, we know that an excess of sodium, phosphorous, potassium, and protein is not good for us.  Guess what flushes out the excess.  That’s right.  Your kidneys filter it from your blood, it’s converted to urine, and leaves your system.  Of course, you don’t want to overtax your already compromised nephrons by going over your daily limits of each of the above.

We’ll pause for a moment here while you go get a drink of water.

409px-Glass-of-waterRefreshed?  Okay.

Did you know there are different types of water? Many thanks to Consumer Reports for the following chart.

Artesian

Water obtained from a well that taps a confined aquifer, an underground layer of rock or sand that contains water. Example: Fiji Natural Artesian Water.

Distilled

Water that has been boiled and then recondensed from the steam that the boiling produces. Distillation kills microbes and removes minerals, giving water a flat taste. Example: Glacéau Smartwater.

Mineral

Groundwater that naturally contains at least 250 parts per million of dissolved solids. All minerals and other trace elements must be present in the water when it emerges at the source. Example: Calistoga.

P.W.S.

Public water source, also known as municipal water supply, or tap water. Fun fact: Aquafina, one of the top 10 selling domestic brands, used to say “P.W.S.” on its label—but changed that in 2007 under pressure from Corporate Accountability International to make clear that the water came from a public supply and not some pristine mountain spring called P.W.S.

Purified

Water from any source that has been treated to remove chemicals and pathogens according to standards set by the U.S. Pharmacopoeia. Must contain no more than 10 parts per million of dissolved solids. Distillation, deionization, and reverse osmosis are all purification methods. Examples: Aquafina, Dasani. (Note from me: recently, Dasani has started added minerals to their water.)

Sparklingbottled water

Water that contains carbon dioxide at an amount equal to what it contained when it emerged from its source. Carbon dioxide lost during the treatment process may be added back. (Carbonated waters such as soda water and seltzer are considered soft drinks, not bottled waters.) Example: Perrier.

Spring

Water derived from an underground formation from which water flows naturally to the Earth’s surface. Spring water must be collected at the spring or through a borehole tapping the underground formation (aquifer) feeding the spring. Examples: Arrowhead Mountain Spring Water (Nestlé), Evian. (Hmmm, Nestle also has minerals added now.)

I stick to either spring water or osmosis filtered water.  Be wary of any water with minerals added. You don’t really need more of those.

Digital Cover Part 1

 

Book Cover

It’s contest time.  Post a picture of you reading any of my three books in the most unusual place you can think of and win a copy of Part 2The Book of Blogs: Moderate Stage Chronic Kidney Disease, Part 1.  You can post your pictures at https://www.facebook.com/WhatHowearlyCKD which is SlowItDownCKD’s Facebook page.  Make sure the title and your face are clearly visible. Keep it clean and keep them coming!  The contest ends on May 31.  Thank you to inspired reader, Geo De Angelo, for sparking the idea in my mind. I’m eager to see how creative you can get.

Until next week,

Keep living your life!

Never Heard of It

Before I write about what I never heard of, let me tell you what I have heard of: The National Kidney Foundation of Arizona Kidney Walk this Kidney Arizonacoming Sunday. Our t-shirts are ready, the banner is on the way, and all we need is you!  Pre-register for Team SlowItDownCKD at kidneywalk.kintera.org or just show up at Chase Stadium to register at 8:00 a.m.  Religious?  No problem; services will be held at the walk if you’d like to attend them.

So what have I never heard of?  The NutrEval (FMV Amino Acids) with Nutrient & Toxic Elements. This is a test my pre-diabetes counselor ordered for me. It consists of a blood drawer and a first void urine sample.

That in itself is interesting.  If you remember, when you have a 24 hour urine test for Chronic Kidney Disease, the first void is not used since this urine has been accumulating in your bladder the whole time you’ve been sleeping.  Apparently, this same accumulated urine is important for this urine containertesting.

You and I are exploring this together today. I hadn’t seen the blood drawer orders yet when I was walked into the lab directly from the counselor’s office.  Luckily, Jody Navarro, the tech on duty that day at this Sonora Quest Lab., pointed out that lipids were being tested  – which meant fasting.  I’d already eaten breakfast and lunch.

With a little mental rearranging, I saw I could just come back the next day.  Then Jody emphasized that I needed to bring the first urine void with me. Surprising, I thought.

The next day, back to the lab I went – although I knew the specimens would be sent out to Genova Diagnostics for the actual testing – with my refrigerated urine sample.  I tend to get up early and knew I wasn’t going to eat within half an hour of waking since this was a fasting test, so I wasn’t hurrying anywhere. Hence, the refrigeration.

Both Jody and Abigail Grimwade, who made the actual blood draw practically painlessly, greeted me and gave me copies of everything I asked for, which was everything.  I’m serious about understanding my health.

Okay, let’s backtrack a bit here. According to Genova Diagnostics’ website at https://www.gdx.net/product/nutreval-fm-nutritional-test-blood-urine, this is what the tests cover:

Metabolic Analysis assessment provides information on 45 key organic acids. These biomarkers are grouped into easy-to-understand categories, and provide insight for functional support in the areas of: malabsorption & dysbiosis; cellular energy & mitochondrial metabolism; neurotransmitter metabolism; vitamin deficiencies; and toxin exposure & detoxification need.protein

Amino Acids analysis features either plasma (37 total) or urine (41 total) amino acids. This assesses nutritionally essential and non-essential amino acids, as well as intermediary metabolites that augment an understanding of B vitamin need, and need for support of protein digestion & absorption.

Essential and Metabolic Fatty Acids Analysis provides a high level overview of the balance of various families of fatty acids in relation to each other: Omega 3, 6 and 9 Fatty Acids; Saturated Fatty Acids; and Monounsaturated Omega 7 and Trans Fats. It also provides key ratios for understanding cardiovascular risk, including the Omega 3 Index.

Elemental Profiles provide information in two categories: Nutrient Elements which evaluates intracellular nutrient status, and Toxic Elements which evaluate short-term toxic element exposure.

Oxidative Stress biomarkers highlight the body’s current state of oxidative stress and reserve capacity. Markers of oxidative injury assess cell membrane (lipid peroxides) and DNA (8-hydroxydeguanosine/8-OHdG) damage, while direct measurement of glutathione and CoQ10 provide insight into antioxidant reserve available to counter free-radical impact. Additional markers are available in our Oxidative Stress 2.0 profile.

Why did we need to know all this? Well, it seems that chronic disease – as in Chronic Kidney Disease – can be caused by nutritional deficiencies… and these tests could find them.  I know my pre-diabetes counselor’s eyes were lit up like the statue of Liberty at night when NYCshe realized she could order this testing for me.

Some of my readers have mentioned that this is state of the art testing that isn’t readily available and that they didn’t know Medicare would pay for this.  Looks like I lucked into this by simply choosing the counselor I did.

I would urge anyone with pre-diabetes to get this kind of nutritional counseling if your insurance covers it.  I have a far better understanding of how my blood glucose works now and what I can do to control it… and then there’s this testing to see what can be done about my chronic health problems.

What I found especially interesting is that the Creatinine, Urine (a CKD marker and stager) is present in this testing. I also noticed Potassium on the list of what’s tested for both deficiencies and toxicities. I am eager to receive my results and have them explained in detail, but that could take up to 14 days total, which means I need to wait for possibly 10 days.

Every time I research the test, I’m directed to Genova Diagnostics or a lab that sends the specimens to them.  While this test formerly cost thousands, the price seems to have come to the high hundreds in recent times. In attempting to plot the history of the test, I drew blank after blank.  This is considered pioneer bio testing.Genova

Maybe the best thing to do here is wait for my results and then explain them to you, so you may see if they have any relevance to your own health.

I was curious about first void urine being tested and speculated that it might be more concentrated. Medical Technology Avenue at http://medicaltechnologyavenue.blogspot.com/2008/12/first-morning-specimen.html confirmed my speculations.

The first morning urine is the ideal screening specimen because it is more concentrated than the random specimen.Part 2Book CoverDigital Cover Part 1

You’ll definitely see another blog about this once I review my test results.  Meanwhile, read my books!  Buy them on Amazon, borrow them, ask your library to order them if you don’t know anyone who has them (What!) and don’t have the money to buy them, but read them… and then write reviews.  The idea is to spread this info.  We all know I’m not going to get rich here, but I would like to see the information out there.

Until next week,

Keep living your life!

Auld Lang … Ah Choo!

Happy middle of Kwanzaa.  I hope your Hanukkah, Christmas, or whatever else you may celebrate that I don’t know about was merry, too. Ours was…maybe even too merry.  Even with cutting out overt sugar and dairy and sticking to the renal diet, I felt like I was getting sick.  Too much running around?  The stress of this happy season?  Who knows, but there it was.Kwanzaa

One of my daughters heard it in my voice and asked me why I just didn’t take Airborne and nip whatever this was in the bud.  I knew I couldn’t, but I’d forgotten why.  Hello, today’s blog. This is not a blog to vilify this product, but one to inform you why we – as Chronic Kidney Disease patients – cannot take any product of this ilk.

Let’s start at the beginning.  According to their website at http://www.airbornehealth.com/how-it-works, this is the short list of what’s in Airborne.

Vitamins and Minerals

  • Vitamin C: Antioxidants that go to work on the cellular level to quench free radicals and support cellular health.  Vitamin C also supports the function of immune cells throughout your body.
  • Vitamin E:Naturally-occurring antioxidant nutrients that inactivate harmful free radicals
  • Vitamin A:Phyto-nutrients that work as antioxidants, on the cellular level, to promote immunity and protect DNA
  • Zinc: An essential nutrient that works as a trigger for over 200 different enzymes and supports the number and function of several different immune cells.
  • Selenium, Manganese, Magnesium: All minerals that support immunity

airborneOkay, so what is the problem here? I needed more information since their website called this the “short list,” so I marched into my pharmacy, took a look at the ingredients, and physically backed up.

I already knew that Vitamin C could promote kidney stones and that I was prone to those, having already had one.  Wait a minute. 1633% of the daily value?  We all know I’m not a doctor, but that sounds like asking for a kidney stone to me.

This is not to say you need to completely avoid Vitamin C.  You need it; just not in such high doses.  The per cent I quoted above is for one dose, but the instructions for Airborne direct you take this up to three times a day.  In other words, triple that percentage.

Backtrack time.  This is why you need this particular vitamin.

Vitamin C, also known as ascorbic acid, is necessary for the growth, development and repair of all body tissues. It’s involved in many body functions, including formation of collagen, absorption of iron, the immune system, wound healing, and the maintenance of cartilage, bones, and teeth.

Vitamin C is one of many antioxidants that can protect against damage caused by harmful molecules called free radicals, as well as toxic chemicals and pollutants like cigarette smoke. Free radicals can build up and contribute to the development of health conditions such as cancer, heart disease, and arthritis.

Thank you to WebMD at http://www.webmd.com/diet/features/the-benefits-of-vitamin-c?page=3 for that information.

Potassium caught my eye right away, too. That’s something I need to limit as a CKD patient, so why would I want to add extra?  Maybe if I had a deficiency I would, but this is not usually the case with us. I relied on What Is It and How Did I Get It? Early Stage Chronic Kidney Disease to remind myself just what this is and why it’s important.

One of the electrolytes, important because

it counteracts sodium’s effect on blood pressure.Book Cover

This is not looking so good, is it?

Uh-oh, it has 10% of your daily value for sodium… for one serving.  Multiply that by three and you get a whopping 30% or 690 mg. of salt/day.  Hmmm, I’m only permitted 1500 mg. daily.  This accounts for getting close to 50% of my daily sodium allotment.

On mykidney.com {A kidney blog which seems to be defunct now.} at http://mykidney.com/06032008-1, Krissi – the writer of the blog – has the following to say about Airborne’s Vitamin E content.

If taken as recommended, “Airborne” will provide 300% of the safe daily dose. And like Vitamin A, Vitamin E is also a fat-soluble vitamin and can quickly build up into toxic levels.

However, the ‘safe daily dose’ for a CKD or ESRD patient is only 8-10mg per day. Just one dose of Airborne actually provides not 300%, but 900% of the safe daily dose for kidney patients.Airborne pix

Back to me here. Notice the herbal ingredients listed at the bottom of the label. What amounts of each are in one dosage?  How about in three? And just what do they do to your kidneys? Did you notice that the FDA was in no way involved with this product? And why no clinical studies?

Well, now I know why I can’t take Airborne or any other product like it and so do you.

Whoa!  Did you know about this?

Airborne Health, a Bonita Springs, Fla.-based herbal supplements firm, has agreed to pay $23.3 million to settle a class-action lawsuit brought against the company for falsely claiming its vitamins prevented colds.

Now, let’s be fair here.  This was back in 2008.  You can read the entire New York Times article at http://www.nytimes.com/inc_com/inc1204579617407.html  Checking into any changes to their formula since then, I could only find changes in their advertising from ‘miracle cold cure’ to ‘immunity booster,’ but not for us.  We can’t handle all the extra bursts of all that good stuff.

new-years-eve-celebrations-live-streamOh my!  This is the last blog for 2014.  May your new year bring everything you want for yourself… including the best health you can achieve.  I always say go for 150%. I wonder if that’s to ensure you reach 100%.

This is also the last blog to be included in the new book The Book of Blogs: Moderate Stage Chronic Kidney Disease.  Don’t look for it yet since it still needs to be edited, but soon.  That’s my New Year’s present to myself.  There’s also another radio interview coming up in March, but we’ve got plenty of time to talk about that.

Until next week,

No, until next year,

Keep living your life!

It’s Different

Sometime ago, I mentioned that Dr. Andrew Weill was my health guru.  I felt that way after my now deceased best buddy introduced me to the wonders of healthy eating. I miss her… and him.Dr. Andrew WEil

Why him?  As you know a healthy diet is not a renal healthy diet.  I still subscribe to his Nutrition Newsletter.  Today, vegetables and fruits were discussed including some excellent advice, but not for us as Chronic Kidney Disease patients.

Colorizing Your Diet

Phytonutrients – the chemical compounds in plants that appear to protect health, but are not established as essential nutrients – are generally concentrated in the skins of many vegetables and fruits, and are responsible for their vibrant hues, scents and flavors. Some phytonutrients are powerful anti-inflammatory agents; others modulate and enhance immune function, maintaining the body’s healing system while keeping abnormal inflammation in check; and still others boost antioxidant defenses to protect DNA and other cellular components from toxic insults that can cause direct harm, or can promote abnormal inflammation leading to tissue damage.

veggiesIn order to get the full range of protective phytonutrients, you should “colorize” your diet: include fresh produce from all parts of the color spectrum and aim for one serving per day (one-half cup cooked or one cup raw) of a fruit or vegetable from all the various color groups (red, red-purple, orange, orange-yellow, yellow-green, green and white-green).

Okay, we’re pretty sure CKD is an inflammatory disease so this would make sense.  We already have compromised systems, so we can use that immune function enhancement.  And we certainly won’t say no to something that can protect our cells and DNA from toxic insults.  So what’s the problem?

Let me answer it this way.  In Chapter 8: The Renal Diet of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease on page 73

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.

So it’s not just eating the fruits and vegetables from each color group.  We need to analyze the electrolytes in each serving, especially the phosphate and potassium.  I also can only eat three servings of fruits and three of vegetables rather than the seven Dr. Weil recommends.Book Cover

Why the restrictions of the electrolytes?

Let’s take a look at potassium. Potassium is not a bad thing if you don’t have CKD.  It dumps wastes from your cells and helps the kidneys, heart and muscles to function normally.  However, too much can cause irregular heartbeat and even heart attacks. Your kidneys are not doing an effective job of filtering the potassium in your blood.  You have CKD.  This should explain the connection between CKD and cardiovascular events.

And phosphorous? I’ll quote from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease again here since I like the simple direct way I explained it on page 76.

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.

water melonTo complicate matters even more, CKD patients are limited to different servings sizes of different fruits and vegetables, not the straight across the board ½ cup cooked or 1 cup raw of each Dr. Weil suggests.  For example: I can eat ½ cup of broccoli, but only 1/3 cup of raisins.  It depends upon the electrolytes in the particular fruit and vegetable and how much of that specific electrolyte you’ve eaten that day.

*sigh* I miss the days of having Dr. Weil as my health guru.

I found even more reviews and all five stars!  I am so enjoying this. Thank you all for the reviews.firworks

I was just diagnosed with Chronic Kidney disease Stage 4 a few weeks ago and I want to THANK YOU very much for this book. I put it on my Kindle. It is written in a way that one newly diagnosed and not in the medical field can understand.

Gail Rae has provided a good insight to the bombshell that befalls millions of unsuspecting humans worldwide. A CKD victim myself with years of experience under my belt, found the book extremely informative and a great reference when providing peer support to newly diagnosed sufferers of this silent killer.

So much good information for Chronic Kidney Disease Patients, from beginning to end. Thank you Gail Rae.

Ms. Rae knows, in my opinion, what she is talking about. She is direct-to the point-and the book is easily understood. She has just a hint of humor in her writing which keeps the reader engaged. Will keep this in my reference library.

Until next week,

Keep living your life!

Smokin’!

When I was in college a million years ago, this was a compliment.  I’d wear the new dress my mother bought me, go to a dance or a party, dance my brains out, and find some guys whispering this under their breath as I passed them.early headshots

Not anymore.  True, Mom’s long gone, I’m married, and if anyone whispered this to me now, I’d think they were asking me if I smoked…and that’s a big no-no these days, especially with Chronic Kidney Disease.

We’ve taken for granted for years now that people just don’t smoke anymore. That’s not true, you know.  Other countries still find smoking acceptable, although not all.  There are also people who are so addicted that they just can’t stop.  Today we’ll take a look at what might help.

But first, we need to go back to the basics – as usual. On my very first visit to a nephrologist, I was told to stop smoking, even social smoking.

But why?  DaVita at http://www.davita.com/kidney-disease/overview/living-with-ckd/smoking-and-chronic-kidney-disease/e/4897 offered a succinct answer to my question:

Blood Oxygen Cycle Picture 400dpi jpgHow smoking can harm kidneys

Here are some of the possible ways smoking is thought to harm kidneys:

  • Increases blood pressure and heart rate
  • Reduces blood flow in the kidneys
  • Increases production of angiotensin II (a hormone produced in kidney)
  • Narrows the blood vessels in the kidneys
  • Damages arterioles (branches of arteries)
  • Forms arteriosclerosis (thickening and hardening) of the renal arteries
  • Accelerates loss of kidney function

In addition to tobacco, smoking allows other toxins into the body. And according to the American Association of Kidney Patients (AAKP), studies have shown that smoking is harmful for the kidneys, and can cause kidney disease to progress and increases the risk for proteinuria (excessive amount of protein in the urine).

To make this a little more comprehensive, here are some definitions from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:The Table

Arteries: Vessels that carry blood from the heart.

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

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

Renal: Of or about the kidneys

Sounds drastic, doesn’t it?  So, what can be done to help those people who are so addicted they can’t stop smoking on their own?

An Israeli PhD student at Weizmann Institute of Science in Rehovot, Anat Arzi, has a novel idea.  She believes that exposing smokers to the smell of smoke and other unpleasant odors while they sleep can make them less eager to smoke.  In her own words, “”This research stems from recent findings suggesting that novel associations can be learned during human sleep and retrieved upon awakening.”sleepWhile this was only a small study with 76 people, I can’t remember reading about any other cease smoking study that deals with aversive conditioning during REM sleep.  Aversive conditioning is {surprise!} just what it sounds like: using unpleasant stimuli – like the rotten fish Arzi used – to cause some kind of change in behavior.  Quick reminder, REM means Rapid Eye Movement and occurs during the second stage of falling asleep.

You can read about the study yourself at http://www.m.webmd.com/a-to-z-guides/news/20141120/sleep-addiction-cigarettes?page=2

Then, there’s the FDA approved, safe, natural product Smoke Remedy offered on the internet.  You need to remember that FDA approved, safe, and natural does not necessarily mean safe for CKD. I applaud the fact that they list their ingredients, but this is not safe for us.

The homeopathic medicines in Smoke Remedy™ come from several different plant and mineral sources that include:

  • Avena sativa – to help with the addiction to nicotine and tobacco;
  • Caladium seguinum, Daphne Indica, Eugenia jambosa, Ignatia, Calcarea phosphorica, and Plantago major – these help to stop the craving and desire to smoke;
  • Kali phosphoricum, Nux vomica, and Staphysagria – to help prevent the withdrawal symptoms you may experience when quitting;
  • The product also contains purified water, citric acid and potassium sorbate.

For example, that last ingredient, potassium sorbate caught my eye because we know that we, as people with CKD, need to limit our potassium.  It turns out to be a preservative and nothing I’d want in my body whether the FDA approves it or not. The Calcarea Phosphorica made me pause, too.  As CKD patients, we do not need more phosphorous, as you already know.

I’m not saying don’t use homeopathic remedies, but I am saying you need to research each and every ingredient AND bring the list of side effects to your nephrologist before you do. Your doctor may not be familiar with homeopathic medicines, which is why you are doing the research to bring to him or her.Nicotine gum and crossed tobacco.

Of course, there’s always the patch or special gums, but they have their own problems.  Most feed slow doses of nicotine into your body. That’s the element of tobacco that injures your kidneys. This is to address the withdrawal symptoms.

I went to http://www.stopsmoking.net/free-nicotine-patch.html to see if there are side effects. Don’t you just love products with full disclosure? Here’s what I found:

“It’s worth noting that many of the top nicotine patches often produce undesirable side effects. Common side effects include headaches, dizziness, upset stomach, nausea, chest pain, breathing problems, anxiety, and irregular heartbeat. Furthermore, some people have nicotine patch allergies. The skin becomes red, and their body becomes severely irritated by the patch. If this ever happens, you need to contact a doctor right away. Nicotine patch allergies can produce damaging results.”

Now here’s an eye opener I found at http://thechart.blogs.cnn.com/2012/01/09/study-nicotine-gums-patches-only-help-with-withdrawal/:

“The perception of the public using the product is that these are good forever – that these will result in you not smoking in three, five, 10 years,” says Greg Connolly, Director of the Center for Global Tobacco Control at the Harvard School of Public Health. “Well, they were never designed to do that. They were designed to treat withdrawal, which is a symptom that occurs from stopping to probably six months, and then it usually ends.”

I never realized how really hard it is for addicted smokers to stop.  Now I fully appreciate my father who decided there wasn’t enough money 923117_10151599924904491_1034557671_ncoming in for him to waste it on cigarettes when he had three children.  He simply stopped. Or so I thought.  (This was way before 1996 when the patch and gum first made their appearance.) Thank you, Dad; this must have been really hard.

Until next week,

Keep living your life!

Up and Down…and Up…and Down

I usually base the blog upon what’s happening in my medical life or those of my family members and friends.  I thought I wouldn’t have anything to write about today. But then I got my latest lab results.  Ugh!

eGFR MDRD Non Af Amer >59 mL/min/1.73 47

There’s been some variation in my eGFR for the last few months and it hasn’t all been good.  What’s the eGFR, you ask.  Let’s start with the GFR and use the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {page 132} for the definition:

Glomerulus-Nephron 300 dpi jpg“Glomerular filtration rate [if there is a lower case “e” before the term, it means estimated glomerular filtration rate] which determines both the stage of kidney disease and how well the kidneys are functioning.”

Wonderful, except we need to know what glomerulus means since the suffix ‘ar’ tells us that glomerular is an adjective or word that describes a noun – a person, place, thing, or idea.  In this case, the noun is glomerulus.   Thank you dictionary.reference.com for the following:

“Also called Malpighian tuft, a tuft of convoluted capillaries in the nephron of a kidney, functioning to remove certain substances from the blood before it flows into the convoluted tubule.”glomerulus

Yes, yes, I know more definitions are needed.  Back to the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease {page 134 this time):

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

A tubule, as you’ve probably guessed, is a very small tube.  This is when having been an English teacher for decades pays off in my kidney work!

Maybe we should define capillary too, in case you’ve forgotten what it is. This time I used Merriam-Webster.com at MedlinePlus.

“a minute thin-walled vessel of the body; especially: any of the smallest blood vessels connecting arteriole with venules and forming networks throughout the body.”

In other words, they’re the smallest blood vessels in the body.

Alright, we’ve got our vocabulary in place; now why is the eGFR so important? As stated in the definition above, it is used for staging your Chronic Kidney Disease.  Different stages require different treatment or no treatment at all.  There are five stages with the mid-level stage divided into two parts.  The higher the stage, the worse your kidney function.stages chart

Think of the stages as a test with 100 being the highest score.  These are the stages and their treatments:

STAGE 1: (normal or high) – above 90 – usually requires watching, not treatment, although many people decide to make life style changes now: following a renal diet, exercising, lowering blood pressure, ceasing to smoke, etc.

STAGE 2: (mild) – 60-89 – Same as for stage one

STAGE 3A: (moderate) – 45-59 – This is when you are usually referred to a nephrologist {kidney specialist}. You’ll need a renal {kidney} dietitian, too, since you need to be rigorous in avoiding more than certain amounts of protein, potassium, phosphorous, and sodium in your diet to slow down the deterioration of your kidneys. Each patient has different needs so there is no one diet.  The diet is based on your lab results.  Medications such as those for high blood pressure may be prescribed to help preserve your kidney function.

STAGE 3B: (moderate) – 30-44 – same as above, except the patient may experience symptoms.

STAGE 4:  (severe 15-29) – Here’s when dialysis may start. A kidney transplant may be necessary instead of dialysis {artificial cleansing of your blood}. Your nephrologist will probably want to see you every three months and request labs before each visit.

STAGE 5: (End stage) – below 15 – Dialysis or transplant is necessary to continue living.

Many thanks to DaVita.com for refreshing my memory about each stage.

Back to my original concern about the GFR results in my labs.  Why did it fluctuate from 53 in August of last year, to 47 in February of this year, to 52 in May, to 56 in August, and to 47 last week? All the values are within stage 3A and I know it’s only a total fluctuation of six points, but it’s my GFRfluctuation so I want to know.  And that’s what started this whole blog about GFR.

I discovered that different labs may use slightly different calculations to estimate your GFR, but I always go to the same lab, the one in my doctor’s office.  Nope, that’s not my answer.

According to the American Kidney Fund, “…this test may not be accurate if you are younger than 18, pregnant, very overweight or very muscular.”  No, these situations don’t apply to me either.

Maybe I’m going about this all wrong and should look at the formula for arriving at GFR. The National Kidney Disease Education program lists the formula which includes your serum creatinine.  Aha! Maybe that’s the cause of the variation.  First a reminder: creatinine is the chemical waste product of muscle use. {This is a highly simplified definition.}

You’ll find this on your Comprehensive Metabolic Panel Blood Results, should you have your results. The normal values are between 0.57 and 1.00 mg/dL.  Mine were above normal for each test, a sign that I have CKD.  As if I didn’t already know that. These results were also lower each time my GFR was higher.

iPadI researched and research.  My final understanding is that not only can CKD elevate your creatinine, but so can dehydration, diabetes or high blood pressure.  If your creatinine is elevated, the results of the GFR formula will be lowered.  That’s enough information to allow me to rest easy until I see my doctor next week.

Some of this was pretty technical and I couldn’t give you many exact web addresses since my computer is having its own issues today.  You may want to try an online GFR calculator just to see how it works.  You will need your serum creatinine value {serum means blood, so this is not to be confused with the urine creatinine test} to do so.  I like the one at DaVita.com.

Until next week,Book Cover

Keep living your life!

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.

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!

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.

Happy Post St. Patrick’s Day

There’s so much I haven’t yet shared with you, so I’ll do that before the actual blog.

If you haven’t listened to my latest (and best, to my way of thinking) guest appearance on a radio show, here’s your chance:

http://www.blogtalkradio.com/onlinewithandrea/2012/03/07/early-stage-chronic-kidney-disease.

To be honest, I’ve never been comfortable with the label “kidney expert.” I’m just unfortunate enough to be a Chronic Kidney Disease patient.  After this show, I realized how much I knew… and that only made me want to share the information even more.

I’d also forgotten all about my promise to share reviews of the book with you, so here’s another one:

  5.0 out of 5 stars         Dr Rich Snyder, DO. Nephrologist, March 3, 2012
This review is from: What Is It and How Did I Get It?: Early Stage Chronic Kidney Disease (Paperback)

This is a must read for anyone who has kidney disease. I had the privilege of reading Gail’s book and  interviewing her on the radio. For anyone with kidney disease, this is one of the best books around written by someone who has kidney disease. I recommend this book highly!!!!!!!
Dr Rich Snyder, DO is the author of What You Must Know About Kidney Disease: A Practical Guide to Using Conventional and Complementary Treatments. He is the host of the radio show Improve Your Kidney Health on the Voice America Health & Wellness Channel.

Okay, let’s get blogging! Now that you’ve eaten just about everything green you could find, make or buy, it’s time to remind yourself of how you should be eating on your renal diet.  We all make exceptions in our lives and St. Patrick’s Day is a grand excuse to make an exception to the diet.  Okay, over, done with, back to the straight and narrow. (She writes thinking lovingly of the chocolate cake with walnuts that was her St. Patrick’s Day exception even if it wasn’t green.)

This survey is from Canada, but is true to the renal diet as we Americans know it.  Take it and see what you’ve forgotten since you last saw your renal nutritionist. It’s short and a good reminder about the diet.  For example, I got so confused about the difference between healthy eating and the renal diet that I was still eating whole wheats instead of white bread.  Not good.

Test Your Knowledge on Nutrition

http://www.surveygizmo.com/s3/722719/Nutrition-Quiz

After taking the survey,  I went to The American Kidney Fund’s Pair Up site and found some other information about the renal diet that I can’t accept. You’ve got it, the line about eating whole wheat products.  Also, while stocking your fridge with already washed and cut fruits and veggies is a good idea, you’ve got to keep your restrictions in mind – for me it’s three servings – each serving size dependent upon the food – of each a day, but also a limited variety.  Avoid starfruit!!!! It is toxic to CKDers.

Limit the amount of red meat you eat, too. Or is that just for me?  I know my renal diet was adjusted for my likes and dislikes (thank you, Crystal Barrerra – my renal nutritionist) as yours should be, but I don’t know if this red meat restriction is a universal guideline.  Crystal agrees that you needn’t cut out your favorite foods, just cut down on them but I think you should cut down on them as a means to cutting them out entirely.  Why overwork those poor kidneys?  They’re already overburdened. Whoa! I’m beginning to become the renal diet foodie.

I do agree with everything else in the article and think it’s well worth a read.

Living Healthy: Myth vs. Reality

Make just a few simple changes to eat healthier

Myth:

It’s hard to eat healthy. It takes too much time and doesn’t taste good.

Reality:

A few simple changes can make a big difference in your diet.

Some tips:

  • Start your day off with breakfast.
  • Slow down when you eat.
    • You may notice that you enjoy your food more.
    • It takes a while for your stomach to recognize that it’s full. Slowing down will give you time to realize you’re full before you overeat.
  • Stock your fridge with fruits and veggies.
    • Snack on these instead of chips and crackers.
    • Take time on the weekend to clean and cut them so they’re ready to grab and go on busy weekdays.
  • Opt for low-fat or fat-free dairy products.
  • Switch to whole grain bread and pasta.
  • Choose lean meats.
    • Bake or grill them instead of frying.
    • Remove the skin from chicken or turkey.
    • Opt for fresh meats instead of processed meats like lunchmeat and hot dogs.
  • Challenge yourself to find healthy recipes.
  • Get creative with different combinations of foods and spices.
  • Stash your junk food in hard to reach places, like a high cupboard or top shelf of a pantry. When these foods are out of sight and less accessible, you’re less likely to indulge.
  • Instead of cutting out your favorite foods, limit how much you eat. Rather than eating half a pizza, stop after just one or two slices.
  • Avoid eating from large containers. Place one serving in a bowl and put the container away. This can help you keep tabs on your portions.
  • Drink plenty of water.
  • Eat only when you’re hungry.

This is the website for Pair Up’s diet suggestions: http://www.kidneyfund.org/pair-up/learn/live-healthy/

Have I mentioned that I’ll be at Chattanooga’s 21st Renal Symposium in the vendors’ area?  On the Facebook  page, I suggested people come visit if they’re in the area.  A kidney transplant receipent is meeting me as is another reader, who just happens to be my younger daughter’s friend from junior high (middle?) school.  The connections you make – or remake – when you become passionate about something are surprising. Now let’s see how well I do with the renal diet when I’m away from home.

Until next week,

A very happy Mom with her two daughters, Nima and Abby

Keep living your life!

World Kidney Day Is Over, But It’s Still National Kidney Month

Maybe it’s because I’m so enmeshed with anything early stage Chronic Kidney Disease, but I find myself constantly surprised by all the people who don’t know a thing about it – many of them suffering from high blood pressure (the second most prevalent cause of CKD) or diabetes (the first most prevalent cause of CKD).  I shouldn’t be.  I was one of them until I was diagnosed… and that’s why I’m so adamant about ‘getting the word out there,’ as I’ve come to call my passion.

One of my daughters, a blogger, asked me to guest blog about this issue last week.  While Nima was making her request to me, her sister – Abby – was surprising us all with a ticket for Nima to visit.  Abby and I live in Arizona; Nima lives in New York so visits are not all that frequent. I was thrilled!!!!

Unfortunatley, Abby ended up getting pretty sick, so Nima stayed with us for a few days.  And we talked, and talked, and talked.  I told her I was still angry that, because I have CKD, the chances of her (and her sister) developing it is higher.  She asked me questions about the diet and exercise.  We ended up sharing a meal each and every time we went to a restaurant and leaning more toward the food on the renal diet rather than food that isn’t. Right now, she’s walking my dog while I blog (*sigh* guess I’ll have to figure out my own exercise for today later).

Maybe today is the day to go back to basics about dealing with Chronic Kidney Disease in my blog.  Let’s start with the American Kidney Fund’s information:

Eat a diet low in salt and fat

Eating healthy can help prevent or control diabetes, high blood pressure and kidney disease.  A healthy diet has a balance of fruits, vegetables, whole grains, dairy products, lean meats and beans.  Even small changes like limiting salt (sodium) and fat, can make a big difference in your health.

Limit salt

  • Do not add salt to your food when cooking or eating.  Try cooking with fresh herbs, lemon juice or other spices.
  • Choose fresh or frozen vegetables instead of canned vegetables.  If you do use canned vegetables, rinse them before eating or cooking with them to remove extra salt.
  • Shop for items that say “reduced-sodium” or “low-sodium.”
  • Avoid processed foods like frozen dinners and lunch meats.
  • Limit fast food and salty snacks, like chips, pretzels and salted nuts.

Limit fat

  • Choose lean meats or fish.  Remove the skin and trim the fat off your meats before you cook them.
  • Bake, grill or broil your foods instead of frying them.
  • Shop for fat-free and low-fat dairy products, salad dressing and mayonnaise.
  • Try olive oil or canola oil instead of vegetable oil.
  • Choose egg whites or egg substitute rather than whole eggs.

Choosing healthy foods is a great start, but eating too much of healthy foods can also be a problem.  The other part of a healthy diet is portion control (watching how much you eat).  To help control your portions, you might:

  • Eat slowly and stop eating when you are not hungry anymore.  It takes about 20 minutes for your stomach to tell your brain that you are full.
  • Check nutrition facts to learn the true serving size of a food.  For example, a 20-ounce bottle of soda is really two and a half servings.
  • Do not eat directly from the bag or box.  Take out one serving and put the box or bag away.
  • Avoid eating when watching TV or driving.
  • Be mindful of your portions even when you do not have a measuring cup, spoon or scale.

 Be physically active

Exercise can help you stay healthy.  To get the most benefit, exercise for at least 30 minutes, 5 days of the week.  If that seems like too much, start out slow and work your way up.  Look for fun activities that you enjoy.  Try walking with a friend, dancing, swimming or playing a sport.  Adding just a little more activity to your routine can help.  Exercise can also help relieve stress, another common cause of high blood pressure.

 Keep a healthy weight

Keeping a healthy weight can help you manage your blood sugar, control your blood pressure, and lower your risk for kidney disease.  Being overweight puts you more at risk for diabetes and high blood pressure.  Talk to your doctor about how much you should weigh.  If you are overweight, losing just a few pounds can make a big difference.

 Control your cholesterol

Having high cholesterol, especially if you have diabetes, puts you more at risk for kidney disease, heart disease and stroke.  It can also cause diabetic kidney disease to get worse faster.

For most people, normal cholesterol levels are:

  • Total Cholesterol: Less than 200
  • HDL (“good” cholesterol): More than 40
  • LDL (“bad” cholesterol): Less than 100

Your triglycerides are also important.  People with high triglycerides are more at risk for kidney disease, heart disease and stroke.  For most people, a healthy triglyceride level is less than 150.

If your total cholesterol, LDL or triglycerides are high, or if your HDL is low, talk to your doctor.  Your doctor may suggest exercise, diet changes or medicines to help you get to a healthy cholesterol level.

 Take medicines as directed

To help protect your kidneys, take medicines as directed.

Some medicines may help you manage conditions that can damage your kidneys, like diabetes or high blood pressure.  Ask your doctor how to take any medicines he or she prescribes.  Make sure to take the medicines just how your doctor tells you.  This may mean taking some medicines, like blood pressure medicines, even when you feel fine.   Other medicines can harm your kidneys if you take them too much.  For example, even over-the-counter pain medicines can damage your kidneys over time.  Follow the label directions for any medicines you take.  Share with your doctor a list of all of your medicines (even over-the-counter medicines and vitamins) to help make sure that you are not taking anything that may harm your kidneys.

 Limit alcohol

Drinking alcohol in large amounts can cause your blood pressure to rise.  Limiting how much alcohol you drink can help you keep a healthy blood pressure.  Have no more than two drinks per day if you’re a man and no more than one drink per day if you’re a woman.

 Avoid tobacco

Using tobacco (smoking or chewing) puts you more at risk for high blood pressure, kidney disease and many other health problems.  If you already have kidney disease, using tobacco can make it get worse faster.

If you use tobacco, quitting can help lower your chances of getting kidney disease or help slow the disease down if you already have it.

You can find this information and more at: http://www.kidneyfund.org

This blog has a p.s. after the farewell.  Be sure to read it for a another really delightful surprise and until next week,

Keep living your life!

Nima is also my computer guru, so she showed me quite a bit while she’s here – including how to see the number of people ‘Talking About’  the Facebook page at Facebook.com/WhatHowEarlyCKD (which includes this blog).  Sit down before you read these numbers.

  • Countries
    12,968,464
    United States of America
    1,802,022
    United Kingdom
    1,324,900
    India
    997,242
    Canada
    735,784
    Australia
    718,074
    Philippines
    278,090
    Malaysia
    265,313
    Pakistan
    146,796
    Italy
    139,240
    Ireland
    137,382
    Turkey
    137,199
    Tunisia
    133,749
    Germany
    132,983
    United Arab Emirates
    131,905
    New Zealand
    122,384
    Egypt
    106,798
    Mexico
    104,727
    Saudi Arabia
    102,007
    Singapore
    90,359
    South Africa
  • Languages
    17,461,481
    English (US)
    3,197,319
    English (UK)
    248,597
    French (France)
    236,736
    Spanish
    132,372
    Turkish
    127,798
    Italian
    104,827
    German
    74,151
    Spanish (Spain)
    65,797
    Arabic
    61,022
    English (Pirate)
    52,742
    Indonesian
    51,763
    Portuguese (Brazil)
    43,362
    Thai
    31,794
    Dutch
    27,905
    Greek
    24,778
    Hungarian
    24,629
    Portuguese (Portugal)
    24,559
    Korean
    20,136
    Polish
    19,728
    Simplified Chinese (China)

Tonight’s Radio Show Is Right Here

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So That’s What It Means

I have spent almost four years researching, reading, printing, and then promptly forgetting about phosphorous.  I keep writing about the three Ps and salt and ending up having to remind myself what phosphorous is and why we need to limit our intake of it each time I write about it.  I was comfortable with protein and easily remembered what I learned about potassium, but phosphorous?  This one just plain eluded me.

I keep a log of interesting articles I run across just in case there’s a Monday that I can’t think of anything special.  That’s what I thought today was going to be.  I tried to start the blog with something about the downright beautiful Arabians we saw at the Arabian Horse Show on Saturday and couldn’t figure out where to go with that.  Then I thought I’d write something about being sick with the flu if you’re a CKDer, but worked on that one on the Facebook page. Maybe something about the wood shop being constructed in my garage?  Naw.  What does that have to do with CKD?

Before I looked over my backlog of articles, I took a quick peek at Twitter.  Bingo.  Seems that my backlog will just have to stay my backlog until the second part of this blog.  An article from Food Navigator.com caught my eye.  I understand it and it feels like I’ll remember it.  Sometimes it just works like that.  So here is the mystery of phosphorous in our daily lives solved.  The article is copy right protected so I can only give you the link, but I’d urge you to read it:

http://www.foodnavigator.com/Science-Nutrition/Phosphate-in-food-is-health-risk-that-should-be-labelled-claim-researchers

As I was scurrying around making dinner yesterday, my mind consumed with phosphorous, I noticed the bread I was munching on (You know the story: grandfather was a miller in the Ukraine, love of bread in my genes, hardest part of the renal diet for me) tasted salty.  Sure enough, when I started poking around in my files, I found this Feb. 7, 2012 article from NPR.com. Notice that last sentence reference to potassium.

To Hold The Salt, It’s Time To Hold The Bread

by Eliza Barclay

                                                            The sandwich on the left has a total of 1,522 milligrams of salt (per whole sandwich), while the other one has only 853 mg.

                          The sandwich on the left has a total of 1,522 milligrams of salt (per whole sandwich), while the other one has only 853 mg.

It’s no secret that some of the tastiest snacks around — potato  chips, french fries, and processed deli meats — are terrific vehicles  for salt. Without salt, they’d be bland, too starchy, or just plain  dull.

But would you guess that the white bread on your turkey sandwich  could be delivering almost as much as the turkey — up to 400 mg of sodium, or about one-third of  the daily recommended limit for 6 of every 10 adults?

A report out today from the U.S. Centers for Disease Control and Prevention  unmasks bread and some other sneaky sodium-heavy foods. It turns out  that 10 foods — from bread to poultry to cheese to pasta dishes — are responsible  for more than 40 percent of people’s sodium  intake.

According to  the CDC, the average American consumes about 3,300 milligrams of sodium   per day, not including any salt that may be added during a meal.  That’s way more than we need, and puts us at risk for high blood pressure, which can lead to heart disease and stroke.

The U.S. Dietary Guidelines recommend no more than 2,300 mg a day, except if you’re over 51 years  or African American or have high blood pressure, diabetes or chronic  kidney disease. For those groups, the recommendation is 1,500 mg a day.

But   it’s clearly hard to stay within the limits, especially because we can’t control the sodium in some of our foods. Some 65  percent of sodium comes from food  sold in stores, and 25 percent comes  from restaurants. The salt shaker on the kitchen table  isn’t really the problem — it’s the industrial quantities of saline  sodium and crystals that are dumped into processed food to help preserve them and boost their addictiveness.

As public health institutions and other health groups have zeroed in on sodium, sugar and other ingredients in food that can negatively impact health, they’re increasingly looking to food companies to make some changes. Some have responded with commitments. Kraft Foods, purveyor of such salty snacks as Velveeta and Ritz crackers, said in 2010 it would reduce sodium by 10 percent over a two-year period. Last  year, Walmart also said it would cut the sodium in packaged foods by 25  percent by 2016.

Food companies also need to worry about how much potassium is left in food, as Shots has reported.   It turns out that consuming a lot of salt in combination with  too  little potassium is  associated with a greater risk of death, according to researchers from  the Centers for Disease Control and Prevention, Emory and Harvard.

Phosphorous, sodium, potassium.  Apologies to protein for not including it in this blog.

Before I say goodbye, notice the buttons for both the Facebook page and Twitter beneath the blog roll.  We aim to make life easier!

Until next week,

Keep living your life!

It’s Been Raining In Arizona

Rain is not that usual out here, although I do my best to entice it by watering my palm trees every Sunday and threatening to wash my little white car with the red side bars any time I see dark, heavy clouds.  Of course that’s not the rain I’m referring to in this blog.  After a long, dormant period, new sites have been raining on my head.  Someone once told me everything happens in cycles, maybe she was right.

Merry Schiff, a new Facebook reader, brought the following site to my attention. (WAIT!  Merry read the book and wrote a review on Amazon.  How about each of you who has read the book do the same?  It will help get the book into the hands of every newly diagnosed CKD patient – the people I wrote it for.) The site is Safe Kidney Care.  Apparently, it eminated from a clinical study.  I know when I tried to submit an e-mail, it asked me for my bracelet ID, then explained that these were given to each participant of the study.  But you don’t need to have been a member of this study in order to view the site.  It contains neat, easily understood explanations of GFR, CKD, the kidneys themselves, what causes kidney disease, and urine protein.  There’s a glossary and a FAQ section.  What I liked best about it is the safety concerns issues: what to tell your doctor, pill and foods to avoid, fluid intake, drugs that are all right with CKD, heart and diabetes info, Medical follow up, x-rays and other radiological tests.  I also noticed a button for “Tests” and another for “Kidney Function (GFR) Calculator.” I tried their GFR calculator and found it accurate as far as I could tell.  Their resource list is almost as comprehensive as the one in my book, with one or two new additions (Got to go look those up.) This information was on the “About” page: The material of this website was developed and assembled by Dr. Jeffrey C. Fink, M.D., M.S., staff nephrologist, Associate Professor, and Director of the Early Renal Insufficiency (ERI) Program, in collaboration with the staff of the ERI Program and Safe Kidney Care Project, at the University of Maryland, School of Medicine. Funding was provided by grant R01 DK084017 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.  The address for the site is: http:www.safekidneycare.org/patient_family.php.

Then there’s a source I’ve come across several times in the last four years and decided it was time to let you know about it.  Live Now: Rethink Kidney Diseases is from Baxter, another resource I included in my book.  While it is generally aimed at dialysis patients, there’s still some info that will work for those of us in the early stages. The Food and Nutrition section is especially helpful.  The Living, Support, and Inspire sections – while aimed at dialysis patients as mentioned – offers some insights into early stage CKD but you’ll have to spend time gleaning them.  This website is: http://livenow.info/GetSupport.aspx.

The third site that dropped from the sky is that of a telephone application for CKD patients called KidneyDiet. As the name implies, it is simple and to the point.  I downloaded it for $4.99.  It is meant to track the phosphorus, potassium, protein, sodium, carbohydrates, cholesterol, fat, and calories of the food you eat.  You first enter the limits of each your nephrologist has given you.  This only has to be entered once. Then you enter each food you’ve eaten during each meal – item by item – and it compares your totals in each category to your limits.  Portions can be changed which is very helpful, but you cannot add new foods.  If you regularly eat foods that are not on the lists available for this app, I’m not certain this is for you.  I really like that it covers everything we need to watch as CKDers, but I wonder if I want to limit my food intake to what is on these lengthy lists.  Could it  be that I’m one of the few who has found foods on my renal diet that are not the norm?  The address for this site is: http://www.kidneydiet.com.

You’ll notice all three of these new sites have been added to the blog roll.  This is not an endorsement of any of them.  I simply want you to be aware of what is available that you might find a good fit for you.

Talking about adding, I tried to add an “Add to the cart” button for the book to the blog, but I didn’t do so well with that.  You can still direct order the book by clicking on the book title on the blog roll.  That will take you to the website for What Is It And How Did I Get It? Early Stage Chronic Kidney Disease  where there IS a functioning “Add to the cart” button.

Ah, lest I neglect to mention (as long as we’re talking about adding), there’s yet another new addition to the family.  Welcome to Temperance, Lara’s newest.  (She’s a “Bones” fan, too)

Temprance

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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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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