Transcript Combining Renal & Diabetic Diets

Combining Renal & Diabetic Diets
Emily Cannon RD, CDE
What is the Need?
According to NIDDK, 44% of kidney failure is caused by DM
National Kidney Foundation states that 1/3 of people with
diabetes will get chronic kidney disease
Who do you know that teaches both diets together well?
My Goals for Today
Help all disciplines understand the basic dietary restrictions
involved in Renal and Diabetic diets
Help RDs learn to teach the combination diet more simply and
effectively to their patients
Whose Job is it?
A. The dialysis RD
B. The CDE
C. The RN
D. The patient
E. Any RD that sees the patient
Medical Nutrition Therapy
Medical Nutrition Therapy is defined as: nutritional diagnostic,
therapy, and counseling services for the purpose of disease
management which are furnished by a registered dietitian or
licensed nutrition professional
Why is it So Hard?
• Specialty practitioners focus only on specialty
• Restrictions seems to conflict
• Complicated recommendations
• Limited good resources
• Limited time
• Less educated or motivated patients
Renal Dietary
Recommendations
Restrict Protein
Limit Sodium
Limit Potassium
Limit Phosphorus
Fluid Restriction
Extra Fat and Sugar for
calories
Translated into Foods
Restrict Protein
Limit Sodium
Limit Potassium
Limit Phosphorus
Fluid Restriction
Extra Fat and Sugar for
calories
Less meat/cheese/fish/eggs
No salty snacks
Less boxed/canned foods
Limited fruits/veggie choices
No whole grains-only white
Limited milk/yogurt
No cola drinks or beans
Limited beverages
Extra butter, oil, dressings
sugar, candy, desserts
Diabetes Dietary Recs
Smaller, consistent meals
Controlled carbohydrate
amounts
Limited simple sugars
Low fat choices
More produce and whole
grains
Translating into Food
Smaller, consistent meals
Controlled carbohydrate
amounts
Limited simple sugars
Low fat choices
More produce and whole
grains
Limited amounts of
Starch/Fruit/Milk at meals
Only small desserts/candy
Avoid drinks with sugar
Choose lean beef, poultry, fish,
Low fat milk, yogurt and cheese
Limited oils/dressings/butter
More whole fruits/vegetables
Whole grain bread/crackers
Choose beans/starchy vegetables
Compare the Recommendations
RENAL
Less meat/cheese/fish/eggs
No salty snacks, boxed, or
canned food
Limited fruits/veggie choices
No whole grains-only white
Only 1 milk or yogurt per day
No cola drinks or beans
Limited beverages
Extra butter, oil, dressings
sugar, candy, desserts
DIABETES
Choose lean beef, poultry, fish,
More whole fruits/vegetables
Whole grain bread/crackers
Limited amounts of
starch/fruit/milk at meals
Low fat milk, yogurt and cheese
Choose beans/starchy vegetables
Limited extra oils/dressings/butter
Only small desserts/candy
Avoid drinks with sugar
Sample Menu
Breakfast
1 scrambled egg
2 sl. whole wheat
toast
1/2 banana
1 C skim milk
Lunch
Dinner
1 hamburger bun
3 oz pork chop
2 oz hamburger patty
1 sweet potato
1/2 C mushrooms
1 dinner roll
½ C potato salad
1/2 C unsweet.
1 whole tomato
applesauce
1 dill pickle
1 C cooked spinach
ketchup and mustard
2 TBSP low fat
margarine
Sample Menu
Breakfast
1 scrambled egg
2 sl. whole wheat
toast
1/2 banana
1 C skim milk
Lunch
Dinner
1 hamburger bun
3 oz pork chop
2 oz hamburger patty
1 sweet potato
1/2 C mushrooms
1 dinner roll
½ C potato salad
1/2 C unsweet.
1 whole tomato
applesauce
1 dill pickle
1 C cooked spinach
ketchup and mustard
2 TBSP lowfat
margarine
Sample Menu
Breakfast
1 scrambled egg
2 sl. white toast
1 C berries
1 C 2% milk
Lunch
1 hamburger bun
2 oz hamburger patty
1/2 C mushrooms
1/3 C pasta salad
1 cucumber with
vinegar
mayo and mustard
Dinner
3 oz pork chop
2/3 C rice
1 dinner roll
1/2 C unsweet.
applesauce
1 C cooked green
beans
2 TBSP margarine
How to Simplify
Combine lists for them
Use only 1 method of meal planning
Exchanges, plate method, pick from simple lists, etc.
Focus on those foods with lowest sources of offending
nutrients
How to Simplify
Make sure you aren’t over-restricting for patient needs
Focus on foods patient eats and enjoys
Focus on what they can eat, rather than what they
can’t eat
Special Issues
• Food Group Inconsistency
• Uncontrolled Blood Glucoses (thirsty)
• Starfruit
• Malnourished patients
• Salt Substitutes (K)
• Obesity
Other Resources
www.AAKP.org “How Can I Follow My Diabetic and Renal
Diet Restrictions?” article
www.foodfitnessfirst.com “Renal Diabetic Diet Plan” (has
picture versions of the lists for less literate)
American Dietetic Association (Nutrition Care Manual) for
CKD Nutrition Therapy
www.kidneyschool.org (patient learning modules)
Questions?