NN&I - July 2010
www.nephronline.comJuly 2010 Nephrology News & Issues 23 Nutrition Update our days educating patients, so per -haps counseling patients to consume more unleavened breads, made with-out yeast, such as pitas, naan, or matza may be part of our counseling strategy and will enhance a patient's diet over the current restrictions. All in a day's eating Dialysis patients are faced with choices at each meal. Let's create a typical scenario. Anne is a dutiful and compliant hemodialysis patient who wants to make a healthy selection for lunch. She really would like to eat the homemade bean burrito made by her family, but instead she selects a chicken sandwich from McDonald's and has a Lipton iced tea because she believes this is a healthier choice. Had Anne selected a bean burrito she would have consumed and absorbed approximately 140 mg of phospho-rus. Instead, she consumed more than 450 mg of phosphorus by choosing the McDonald's chicken sandwich. Food additives also provide huge quantities of potassium. An innocent sounding frozen meal of chicken car -bonara made by Lean Cuisine pro- vides 850 mg of potassium. Most fro-zen meals provide an average 600 mg of potassium, even when made with 'allowed' ingredients.9-11 A dreaded glass of orange juice, which all dialy- sis patients fear, provides 248 mg of potassiuma large amount. Currently, no phosphorus content measurement is available for frozen meals and most canned soups. While the renal community has been reading about added phosphorus and starting to create and share some home grown information, most of the handouts and glossy posters have not been changed in years. The "don't eat" column still contains oatmeal, pizza, beans, dairy foods, and nuts while the "do eat" column lists few and some-what questionable options of chicken, iced teas, and popcorn. Fast food restaurants can further confuse the renal practitioner and our patients. In 2007, Butt et al. published a list of phosphorus-friendly selections at various fast food restaurants and found Dominos, Papa John's, and Pizza Hut pizza had many more options for the renal patient than the seemingly healthier restaurant, Boston Market. At Burger King, the only phosphorus-friendly option is a green salad, hold the chicken.10We need to change the renal diet. But how? In conducting the research for this article, I convinced myself that an update to the renal diet is very timely. But the inconsistent use of food addi-tives makes it difficult (see dietary advice, page 22). To all the creative, artistic minds, I send this challenge to you: -mation into a neatly marketed, easy-to-understand renal diet? "do" and "don't" list that is user-friend-ly and translates easily into improved food choices? Let's work together to provide updated educational materials so our patients can improve their diet while consuming a wider variety of food options. References1. Sherman, RA, Mehta O. Phosphorus and potassium content of enhanced meat and poultry products: implications for patients who receive dialysis. Clin J Am Soc Nephrol, 2009. 4(8): p. 1370-3. 2. Uribarri J, Calvo MS. Hidden sources of phos-phorus in the typical American diet: does it matter in nephrology? Semin Dial, 2003. 16(3): p. 186-8. 3. United States Department of Health and Human Services. United States Food and Drug Administration. [cited 2010; Available from: http://www.fda.gov/Food/ GuidanceComplianceRegulatoryInformation/ default.htm. 4. Reddy NR et al. "Nutritional consequences of phytates." 1989, Phytates in cereals and legumes. CRC Press. p. 80-110. 5. Kalantar-Zadeh K. et al. Understanding sourc-es of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol, 2010. 5: p. 519-530. 6. Sullivan CM, Leon JB, Sehgal AR. Phosphorus-containing food additives and the accuracy of nutrient databases: implications for renal patients. J Ren Nutr, 2007. 17(5): p. 350-4. 7. Sullivan C et al. Effect of food additives on hyperphosphatemia among patients with end- stage renal disease: a randomized controlled trial. JAMA, 2009. 301(6): p. 629-35. 8. Scholz-Ahrens KE et al. Prebiotics, probi-otics, and synbiotics affect mineral absorp- tion, bone mineral content, and bone structure. J Nutr, 2007. 137(3 Suppl 2): p. 838S-46S. 9. Butt S et al. The prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. J Ren Nutr, 2007. 17(4): p. 264-8. 10. ConAgra for Healthy Choice 2010 [cited 2010; Available from: 11. Stouffers Lean Cuisine [cited 2010; Available from: www.leancuisine.com/product/nutritional- sPC.xls Nutrition Update_NNI0710_7.indd 23 6/16/10 2:59:07 PM
You must have JavaScript enabled to view digital editions.
