DIET FOR PATIENTS WITH KIDNEY DISORDERS

DIET FOR PATIENTS WITH KIDNEY DISORDERS

Most kidney disorders are caused by patients with poorly controlled diabetes or hypertension.  As such, it is important to eat a healthy diet which is low in salt and fat (to reduce the risk of high blood pressure) and low in sugar (to reduce risk of diabetes).

Do also refer to our health articles on Diet for Hypertension and Diet for Diabetes if you also have hypertension or diabetes.

When you have kidney damage or on dialysis, the kidneys will have difficulty removing waste and fluid from your body. A good diet will help provide energy for your daily tasks, maintain a healthy weight, prevent muscle-mass loss and slow down the progression of kidney disease.

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A kidney-friendly diet refers to eating the right amount of protein, phosphorous, calcium and potassium as well as drinking appropriate amount of fluids to control the build-up of waste and fluids in your body. You need to discuss with your doctor or dietitian on how to limit the amount of:

  • sodium in foods and drinks
  • protein in your diet
  • high-phosphorus foods
  • canned foods or fruits (best to avoid)
  • liquid to prevent fluid build-up in your body which cause ankle swelling

Vitamins

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When you have kidney disease, you may not be getting enough minerals or vitamins in the food groups you are eating.  Vitamins which are useful for patients with kidney disorders include:

a) Vitamin B Complex. Vitamin B6, B12 and folic acid work together with iron to prevent anaemia. The other vitamin B components such as thiamine, riboflavin, pantothenic acid and niacin help your body convert foods into energy more efficiently.

b) Iron. Iron works with Vitamin B complex to prevent anaemia.

c) Vitamin D & Calcium. Vitamin D and Calcium help to maintain bone density and bone strength.

Phosphorus

Phosphorus is a mineral which works together with calcium and vitamin D for the development and maintenance of your bones.  Excess phosphorus in the blood results in calcium being pulled out of your bones making them weak and susceptible to fractures.  The normal phosphorus level in adults should be between 2.5 to 4.5 mg/dl.

Image Source: Huffpost Australia

Phosphorus is naturally found in protein rich foods such as meat, fish, poultry, dairy products, fish, legumes and nuts. Phosphorus found in animal foods is absorbed more easily by our body compared to those found in plant foods. Besides that, phosphorus is also used as additives in processed foods, canned foods and beverages. Phosphorus from food additives is completely absorbed by our body hence avoiding it can help lower your intake of phosphorus. It is usually listed on the food packaging at the ingredient labels as ‘phosphorus’ or you may look for words with ‘PHOS’.

Potassium

Potassium is a mineral which is essential in maintaining regular heart beat and muscle function. Abnormal potassium levels can cause irregular heart beat or even heart attack and muscle cramps. The recommended intake for normal adults is between 3,500 to 4,500 mg per day. A potassium restricted diet is around 2,000 mg per day. 

What is a safe potassium level in the blood?

Potassium in foods

Listed below are some good practices to help reduce potassium in your diet:

  • Chopping & slicing foods into smaller pieces, soaking them in a large volume of water for a 1 – 2 hours in several changes of water and straining the vegetables to discard the water before cooking, can leach potassium into water.
  • When using canned vegetables or fruits, drain away the brine or syrup
  • Peel off the skin from fruits
  • Do not take the gravy from vegetable dishes or soup
  • Use whole spices rather than ground spices
  • Avoid herbal and traditional remedies (ginseng roots, banana stem, akar kayu and others)

Haemodialysis patients

If you are on haemodialysis, do discuss with your doctor or dietician because you may also need to:

  • add protein to your diet because hemodialysis removes protein
  • choose foods with the right amount of potassium
  • take vitamins made for people with kidney failure
  • find healthy ways to add calories to your diet because you may experience reduced appetite

Source: www.kidney.org

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MEAL PLANNING STRATEGIES FOR DIABETES

MEAL PLANNING STRATEGIES FOR DIABETES

These are important considerations when drawing up a diabetic meal plan:

  • Timing of meals and snacks. In general, diabetic should take more frequent but smaller sized meals. Patients on insulin may need a bed time snack to prevent night time hypoglycaemia or an additional afternoon snack. DO NOT go for no more than 4 hours without eating
  • Remove refined carbohydrates and added sugars from your diet. This means less fast foods and more home cooked meals where you know every ingredient that goes into your meal

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  • Include healthy food types such as complex carbohydrates (whole grain), fibre (vegetables and fruits), lean protein (fish and chicken)
  • Follow ‘plate method’ to estimate portion sizes
  • Keep a food diary by either taking photos or documenting the meals eaten to discuss with your dietician

Here are few choices of meal plan strategies for diabetic patients:

Choice A: Constant Carbohydrate Meal Plan

Image Source: Diabetic News Now

This meal plan is inclusive of counting grams of carbohydrate a person with diabetic needs daily. The carbohydrate is then distributed evenly at mealtimes. In the constant carbohydrate meal plan, consistency in keeping the amount of carbohydrate for each meal including snack everyday is the key. The types of carbohydrate may vary from day to day.

Choice B: Carbohydrate Counting Meal Plan

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Carbohydrate counting involves giving a matching dose of medication with the grams of carbohydrate taken daily. One carbohydrate serving is equal to 15 grams of carbohydrate. People with diabetes can get help from a dietitian to figure out the counting plan that meets the specific needs. A common plan for an adult normally consists of three to four carbohydrate choices for main meals and one to two for snacks. This meal plan is most useful for people who take multiple daily injections of insulin because it allows greater freedom and flexibility in food choices.

The formula for Insulin to carbohydrate ratio is 1:15. For example, 1 unit of rapid acting insulin would be given for each 15 grams carbohydrate eaten. If the meal consists of 60 grams of carbohydrates, 4 units of insulin would need to be given.

Choice C : Exchange Meal Plan (most commonly used)

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The Exchange System classify foods into three broad groups namely carbohydrate, meat and fat listing items which contain similar macronutrient composition. This equality allows the exchange of food on each list making it easier for patients to use as reference.  Most vegetables can be considered free foods if their energy contribution is minimal when eaten in moderation.

Carbohydrate Exchange List

  1. Cereals, grain products and starchy vegetables

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Each item contains 15g carbohydrate, 2g protein, 0.5g fat and 75kCal

1 cup is equivalent to 200 ml

1 tablespoon is equivalent to 2 teaspoons

2. Fruits

Each item contains 15g carbohydrate and 60kCal

3. Milk

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This food contains varying amount of carbohydrate, fat and protein depending on which type of milk.

Self-monitoring

Image Source: Diabetes Health Page

Despite being on treatment, it is estimated that over 30% patients DO NOT achieve good glucose pressure control despite being on medication. As such, healthcare practitioners also recommend lifestyle modification which includes 30-60 minutes of exercise daily (click and read article “How Much Should We Exercise Daily”) and self-monitoring. Do consult and connect with your healthcare practitioners such as your doctor, dietician or fitness trainers.

While at home, check your blood glucose regularly and take charge of your health. Do self-monitor your weight and blood sugar on TELEME TrackME Health Tracker mobile app.

References: Malaysians’ Dietitian Association. 2005. Medical nutrition therapy guidelines for Type 2 Diabetes. Nutrition Recommendations and Interventions for Diabetes”. American Diabetes Association. My Health.

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DIET FOR DIABETES

DIET FOR DIABETES

Click below to watch video on Diabetic Food List

A diabetic meal plan is a healthy eating plan which consists of balance nutrition in the right amount of calorie requirement and the right amount of food types.

The aim of a diabetic meal plan is to help people with diabetes attain quality of life similar to healthy people by:

  • making it easier to achieve blood glucose control
  • reducing dependency on more diabetic medication or insulin injections
  • reducing the risk of complications or hospital admission associated with diabetes
  • achieving the same lifespan as normal individuals

Why is diabetic control important?

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Diabetic control is important to prevent the following common complications.

  • Peripheral vascular disease of the lower limbs causing ulcers and gangrene of the toes and feet
  • Peripheral neuropathy causing numbness and tingling sensation of the toes and fingers
  • Blindness due to diabetic retinopathy causing bleeding into the eye. Diabetes is most common cause of blindness in young adults
  • Kidney failure. Diabetes is the most common reason why patients are on dialysis
  • Heart disease
  • Stroke

Why is body weight important in the control of diabetes?

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Being overweight predisposes you to developing diabetes as well as making it harder for you to achieve good diabetic control because

  • Fat makes it difficult for insulin to facilitate glucose to get into the muscle efficiently and as a result the glucose remains unused in high levels in the blood stream
  • The pancreas then has to work harder to produce more insulin resulting in organ failure after 20-30 years of poor diabetic control

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Losing as little as 5-10% of your weight can reduce your risk of developing diabetes.

What is an ideal Diabetic Meal Plan?

Food is the major influence on blood sugar levels in people with diabetes and as such patients must pay attention to the food components (particularly the carbohydrates), amount eaten and timing of each meal every day. Choose foods with lower Glycemic Index (GI) as these foods do not give you a sudden surge in blood glucose after eating.

Image Source: Healthline

GI is a ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar (glucose) levels after eating. Foods with a high GI are those which are rapidly digested and absorbed resulting in big surge in blood sugar levels immediately after a meal. Low GI carbohydrates produce smaller fluctuations and is therefore ideal for diabetic patients.

Examples of Glycemic Index of some common foods

The objective of all diabetic meal plans is to achieve better control of blood sugar levels and needs to be customised with special consideration for the Type 1 (insulin dependent diabetes) Type 2 (non-insulin dependent diabetes) and diabetes during pregnancy.

There is no one perfect meal plan and each plan has to be on trial basis and evaluated and adjusted as necessary. A good diabetic meal plan is one which can help patients manage their blood glucose at normal level AND allow them to enjoy their food.

Self-monitoring

Image Source: Diabetes Health Page

Despite being on treatment, it is estimated that over 30% patients DO NOT achieve good glucose pressure control despite being on medication. As such, healthcare practitioners also recommend lifestyle modification which includes 30-60 minutes of exercise daily (click and read article “How Much Should We Exercise Daily”) and self-monitoring. Do consult and connect with your healthcare practitioners such as your doctor, dietician or fitness trainers.

While at home, check your blood glucose regularly and take charge of your health. Do self-monitor your weight and blood sugar on TELEME TrackME Health Tracker mobile app.

References: Malaysians’ Dietitian Association. 2005. Medical nutrition therapy guidelines for Type 2 Diabetes. “Nutrition Recommendations and Interventions for Diabetes”. American Diabetes Association. My Health.

Download Teleme’s mobile app and consult a health practitioner

DIET FOR HYPERTENSION

DIET FOR HYPERTENSION

Click to watch Stop Hypertension with the DASH diet

The healthy DASH (Dietary Approaches to Stop Hypertension) diet plan was developed to lower blood pressure without medication in research sponsored by the US National Institutes of Health.  Blood pressure is necessary to make our blood flow around the body to supply oxygen and nutrients to the muscles and vital organs. However, when the blood pressure gets too high, the heart has to pump harder and small blood vessels in the brain may burst causing heart failure and strokes respectively.

Image Source: The Lost Ogle

What people do not realise is that high blood pressure is a ‘silent killer’ because in the beginning there is no symptoms until it is too late. That is why health practitioners keep advising patients to self-monitor their blood pressure regularly and eat well to maintain a healthy lifestyle. Do refer to how article ‘What is hypertension’.

Classification of Elevated Blood Pressure

The DASH diet recommends correct portion size and emphasizes on fruits, vegetables, low fat or non-fat dairy. The plan follows US guidelines for lower sodium content, along with vitamins and minerals (such as potassium, calcium and magnesium). In addition to lowering blood pressure, the DASH eating plan helps lower cholesterol and makes it easy to lose weight.

Image Source: Pexels

Successful adoption of any new diet is about gradual change. If you now eat only one or two servings of fruits or vegetables a day, try to add a serving at lunch and one at dinner. Try to avoid canned or dried fruits as they have added sugar. Rather than switching to all whole grains, start by making one or two of your grain servings whole grains.

Take charge of how much you eat by visualising your food portions for ONE SERVING

Reduce salt in your diet

  • Sodium is salt in restricted to (note that 1 teaspoon of salt has 2,325 mg sodium)
  • Standard DASH diet (2,300 mg sodium per day which is equivalent to 1 teaspoon salt)
  • Lower sodium DASH diet (< 1,500 mg sodium per day which is equivalent to 2/3 teaspoon salt)

Image Source: Prensa Hispana

The low sodium DASH diet reduced blood pressure by average of 11 mmHg in patients with hypertension while normal people reduced by 3 mmHg.  It has been shown that the diet reduces the risk of stroke (by 29%) and heart disease (by 20%) as well as diabetes to a lesser extent.

Add exercise into your diet plan

The diet plan should also be supplemented by exercise.  Just 30 minutes of brisk walking a day for 5 days a week can reduce your blood pressure by around 13 and 18 mmHg in systolic and diastolic pressure respectively.

Click to read our article on ‘How much should we exercise daily’

References: Dash Diet, Mayo Clinic, Heart and Stroke, Heart

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LET NUTRITION DETERMINE THE WAY YOUR AGE

LET NUTRITION DETERMINE THE WAY YOUR AGE

The WHO definition of ‘Healthy Ageing’ is ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’.

Healthy ageing means maintaining a healthy weight by having a healthy lifestyle involving good nutrition and regular exercise.

What is Body Mass Index (BMI)

Body mass index (BMI) is a measure of body fat (whether you are fat or thin) based on height and weight. It allows health professionals to discuss weight problems more objectively with their patients.

How to measure your Body Mass Index (BMI)

So for a 74 kg person who is 1.6 m tall, the BMI is calculated as

What does BMI mean

Your BMI classifies you into one of several categories namely from underweight to obese.

Healthy eating

Eating healthy means having the following:

  • BALANCE (eating a combination of foods from ALL food groups
  • MODERATION (eating the recommended portions)
  • VARIETY (eating different food types from each food group)

It is quite easy to follow the general principles at home by following the Healthy Plate Guide. Half the plate should consist of vegetables, a quarter is protein and a quarter is grains. Gradually reduce fat, salt and sugar intake with each meal.

Grains: The amount of grains eaten should fit in your palm.

Try to opt for whole grains rather than refined grains as they are rich in fibre and anti-oxidants such as vitamins B & E which appear to be protective against heart disease.

Proteins such as fish, poultry or meat should fit the size of your palm.

There are many sources of proteins and the American Heart Association recommends eating fish (especially fatty fish) twice a week.

Vegetables should account for half your plate and should fit into both hands.

Practice eating 2 servings of fruits and 3 servings of vegetables everyday as they are a rich source of vitamins and fibre (which can reduce constipation and reduce fat absorption).

Vegetables and fruits with colour contain phytonutrients which are rich in anti-oxidants and anti-inflammatory properties.

Our bone mass peaks by the age of 30 years old and as we age after that, our bone density gets less resulting in osteoporosis. Calcium and Vitamin D are 2 important components required for bone growth.

The daily requirement for calcium is higher for older women especially after menopause.

What are the sources of calcium?

The daily requirement for Vitamin D is the same for male and female.

What are the sources of Vitamin D?

There are other essential nutrients such as magnesium and zinc which are necessary whereas sodium (salt) should be reduced in our diet as it can cause high blood pressure (hypertension).

Magnesium can be found in the following foods:

Zinc can be found in the following foods:
In conclusion, eating healthy is simple.  All of us can follow the principles which is
Image Source: Pantai Hospital

This is a guide only. It is recommended to be advised together with a certified dietician/nutritionist based on your health conditions.

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Ms. Ng Poh Mun

Ms. Ng Poh Mun

Dietician/Nutritionist

4 POPULAR TYPES OF DIETS EXPLAINED & WHO ARE THEY SUITABLE FOR

4 POPULAR TYPES OF DIETS EXPLAINED & WHO ARE THEY SUITABLE FOR

Image credit: My Protein

Ever heard of the ketogenic diet, or the Mediterranean diet? We’re pretty sure you’ve heard of at least one, and at least a person you know is on the other diet. These diets are made popular by celebrity nutritionists, Hollywood A-listers who swear by them, and some local fitness influencers who promote them.

All these diets sound healthy, and you’ve probably read that all of them can help with weight loss. But which of these should you choose? Read on to learn more about these diets and who they’re suitable for:

 

1. Ketogenic diet

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Also known as the Low Carb High Fat diet, going on a ketogenic diet means you’ll be eating very little carbohydrates, but more fats. No rice and pasta, but more healthy fats like avocado, butter, and flaxseed.

This might sound odd to many as we are used to thinking fats are unhealthy and should be reduced in our meals; whereas carbs should be consumed more as they provide the body with energy. Actually, fats can be a source of energy too; but our bodies don’t use them because of the amount of carbs we consume. Thus, this results in our bodies suing carbs for energy, while also storing the unused fats.

By lowering our carbs intake, the ketogenic diet forces the body to produce ketones – the product from the breakdown of fats. The body then burns ketones to provide us with energy.

Suitable for: Most adults, unless you are pregnant or breastfeeding, have chronic diseases, or have a BMI below 20.

 

2. Paleo diet

Image credit: The Paleo Diet

Short for “paleolithic diet”, it’s also nicknamed the caveman diet because it means only consuming food that Paleolithic humans ate. This means lots of fruits, vegetables, and meat, but no cheese, grains, and coffee.

It is believed that the the types of food our Paleolithic ancestors consumed are ones that are genetically suitable for us. Going on a paleo diet means cutting down on food made from grains, processed food, and dairy products. This is different from the ketogenic diet because you are supposed to consume carbs for the paleo diet. However, instead of getting carbs from rice and bread, you’re getting it from vegetables like sweet potatoes and pumpkin.

The good thing about this diet is that you will not be consuming any processed food at all, which can improve your health greatly. The paleo diet also requires you to be more active, so you’ll be hitting the gym more often and getting stronger too.

Suitable for: Everyone, unless you have heart, kidney, liver, and pancreatic diseases.

 

3. Mediterranean diet

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Known for being good for heart health, the Mediterranean diet involves eating food items commonly used in Mediterranean cuisines in the 1960s. This means a lot of fruits, vegetables, nuts, fish, and dairy products; but very little red meat, and no refined sugar and oil.

This diet is famous for having lots of health benefits. The selective intake of proteins ensures the body has very low levels of what is commonly called “bad cholesterol”. It is also linked to cancer prevention.

Suitable for: Everyone

 

4. Macrobiotics diet

Image credit: Healthline

Following the macrobiotic diet may be difficult. It focuses on eating locally grown food that are in season, whole grains, and fresh seafood; but no dairy, poultry and other types of meat. Oh, and no spicy food. We can hear you groan already.

Besides the food selection, this diet plan is strict even when it comes to how you eat your food. You are supposed to chew your food well and eat regularly. You also need to have a positive outlook in life and exercise regularly. This is why people who follow this call it a lifestyle instead of a mere diet plan.

Suitable for: Anyone. People who are allergic to seafood can substitute it with other types of vegetables.

It’s difficult to say which is the best diet as each one has its own pros and cons. You should not eat too much of any type of food, as too much of something is never healthy for your body. Regular exercise is also the key to a healthy lifestyle, and even more so if you want to lose weight. It’s advisable to consult a nutritionist or dietitian first before starting any of these diets as some of them may not be suitable for your health condition or body type.

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