Seniors often have multiple conditions resulting in a thorny diet problem. A good example is the combination of heart problems, diabetes, and renal failure. Heart problems and diabetes call for a for a heart-healthy diet low in saturated fat, loaded with vegetables, fruits and whole grains. But when diabetes leads to renal failure, the patient must keep phosphorous, sodium, and potassium to a minimum. Many meats that are high in protein, fruits, veggies and grains are loaded with potassium, a nutrient healthy for most people…but not those in renal failure. How can you make a healthy diet from what’s left?
Â The Contradictions
According to the National Institutes of Health (NIH) the diet goals of a patient with chronic kidney disease are to limit fluids, eat a low protein diet, and restrict salt, potassium, phosphorous and other electrolytes. Since it’s difficult to get enough calories on a low-protein diet, kidney patients are encouraged to eat lots of high-volume carbs, including breads, cake, honey, hard candy, and pie…foods diabetics should avoid like the plague.
Diabetics are encouraged to drink plenty of water, eat a lot of vegetables, and eat a diet higher in protein and low in processed carbs, basically the same diet recommended for heart patients.
The irony is that diabetes often leads to heart disease and kidney disease, and the only area where the conditions agree is in restricting sodium. The convergence of all these diverse issues is most common in the elderly, because it takes years for diabetes and other conditions to wreak this level of havoc on the body.
Part of the Problem: Confusing Information from So-Called Experts
While researching, I found a page that seemed authoritative called Nephrology Physicians, LLC, and I’d like to use it as an example of how information gathered on the web can be dangerous. The page contains food lists for Kidney and Renal failure. Sounds good, right? But it’s misleading. It’s broken down by nutrient. Consider this sentence from the low phosphorous section, All Vegetables are Low in Phosphorus. Wow, so kidney patients can eat all the vegetables they want, right? I was suspicious. I chose a few random vegetables and checked them in the nutrition data tracker at self.com. Sweet potatoes, for example, had a whopping 950 mg of potassium. That would be disastrous addition to his diet. To add to the confusion, the carbohydrate count might make a diabetic nervous as well, unless he knew that sweet potatoes are high in fiber and low on the glycemic index.
The lesson here is this: Before following any advice found on the web, make sure it comes from an authoritative source. The American Association of Kidney Patients is a great resource, loaded with information.
Â Finding a Solution
To solve this problem, I researched low phosphorous foods and then eliminated foods high in saturated fats, sodium, refined carbs, and sugar. Here’s the result:
Veggies:Â cabbage, cauliflower, beets, carrots, celery, cucumbers, eggplant, lettuce, bell peppers, onions, garlic, cucumber, eggplant, zucchini, yellow squash, turnips, radishes, and watercress.
Fruits: blueberries, raspberries, apples, cranberries, strawberries, cherries, peaches, pears, plums, watermelon, and red grapes.
Proteins: Turkey breast (not processed cooked at home to control sodium and preservatives), egg whites, and fatty, fish like salmon, albacore tuna, herring, mackerel, and rainbow trout. Limit protein intake to 1 or 2 ounces per serving.
Fats: Omega-3 and omega-6 oils, like olive, canola, sunflower, and flaxseed oil.
Grains: White bread products are on the kidney patient diet, including crackers, white bread, pasta, cake, and cookies. Unfortunately, these things are contraindicated for diabetes patients. Address this problem by incorporating small amounts (for example, one slice of bread per meal or a slice of angel cake with berries for dessert). Whole grain products should be avoided.
Dairy: Dairy products should be limited, especially for pre-dialysis kidney patients. Choose low-fat options, like skim milk, no-sugar-added ice cream, plain, low-fat yogurt, and sugar-free pudding. Limit dairy to two 1/2 cup servings per day.
Sample Meal: While researching this topic, I came across a post on a food site that addressed the potential lack of flavor in such a limited diet. Here’s a tasty recipe for Caribbean chicken and veggie kabobs that meets the restrictions for both diabetics and kidney patients.
Loss of Appetite
Loss of appetite, and resulting weight loss, are common in kidney patients. Here are a few tips to help keep your patient or loved one’s weight up:
- Small meals, eaten frequently all day. Big meals can be too much for a sick senior, but tiny plates with just a few appetizing bites are less intimidating and easier to swallow.
- Cold finger foods. Cooking smells often make sick patients feel sicker. Try cold dishes, like a scoop of egg or tuna salad with brightly colored veggies to use as scoops.
- Add egg white powder or protein powder to cooked foods or drinks to add nutrition.
Anemia is common to kidney patients, and an iron supplement may be in order. If the patient cannot get enough protein through food sources, a protein supplement will help, but check the label very carefully and bear in mind that supplements made for the seniors, like Glucerna and Boost, or protein powders designed for weight gain, are not necessarily formulated for kidney patients and may contain high levels of potassium, sugar, or some other harmful component.
Since grain products are limited, another concern may be getting enough fiber to keep digestion regular. A limited food list is notorious for gumming up the works. Only after consulting a doctor, choose a natural fiber product that has been thoroughly researched and has no known side effects or drug interactions, like brown seaweed extract.
Before taking any supplement, diabetics, heart patients, kidney patients, or anyone with an illness that requires medications should check with a doctor or nutritionist.
Once kidney disease progresses to the stage where dialysis is necessary, diet restrictions ease up a bit and patients usually find their appetites returning, but a healthy diet should still be the top priority for caregivers and patients.