Hemodialysis Diet

[Dejah]

Wondering is any member on dialysis? My 88 year old brother just started last week. My 87 year old s-i-l is recovering from a heart attack. I am trying to take over some of the cooking for them.
I have various pamphlets and notes from dietician, but any input would be appreciated.
 

[Darienne]

You are a good sister.  all best to your brother and his wife.

 

[Dr. Teeth]

Google ‘renal diet,’ it’s generally low protein, low salt low potassium

[rotuts]

this is a good ref:

 

https://www.kidney.org/kidney-topics/hemodialysis-and-your-diet

 

you want quality protein , and pay very close attention to the potassium and then the sodium., and phosphorus .

 

herbs and spices should be just herbs and spices w no add-ins .

 

if you are in touch w a dietitian that covers renal patients , run your Rx by them .

 

dietitians can be very helpful in these cases.

[AAQuesada]

5 hours ago, rotuts said:

herbs and spices should be just herbs and spices w no add-ins .

Spiceology has quite a variety of fun no salt blends. 

https://spiceology.com/collections/salt-free-blends?srsltid=AfmBOorKIDYEauT7elL7kZWGclFDevEs8Yk2cLxbqKiDNn4luPKYecQc

 

[rotuts]

@AAQuesada

 

nice.

 

I was not aware of them.

 

bookmarked for future use.

[Dejah]

Thank you for all your helpful responses. 
I checked out Spiceology. All look interesting, except they all contained salt and orange peel (high in potassium)
But I may order them for myself!
I've made a file, so, looking forward to the challenge.

[TdeV]

@Dejah, check SpiceTrekkers in Montréal. I have written to ask about their salt-free blends. Will let you know.

[gfweb]

You'd have to eat a LOT of orange peel to get much K+

[AAQuesada]

4 hours ago, Dejah said:

checked out Spiceology. All look interesting, except they all contained salt and orange peel (high in potassium)

 

Pretty sure I linked specifically to the salt free blends? The first one listed has neither orange peel nor salt.  my apologies if it wasn't helpful 

 

 

[anzu]

Hi Dejah, I haven't been in Egullet for a long time, but logged in specially to answer this. Actually one of the reasons for not being on Egullet so much is cooking for a dialysis diet and how restrictive it is.

 

My husband has been on hemodialysis for the last 14 years and I'm the cook in the household, so I can give perspective from my  experience. (Not a nutritionist, but had to read a lot about this over the years!)

 

Potassium is the biggest issue and the item you most need to restrict as it builds up in the body and levels that are too high can be fatal (though over time dialysis patients tend to build up a tolerance and can end up being okay with levels in the blood that would kill a "normal" person). Google high potassium foods and make a list of what you need to avoid or severely limit. By the way, the USDA nutritional database can be a highly useful resource.

 But off the top of my head, avoid or restrict:

Mushroom

Tomato

Green leafy vegetables 

Peanuts, other nuts, dried beans and legumes

Citrus fruits

Stone fruits such as peaches 

Bananas

Potatoes (but Google "leaching potatoes" to make them more possible to serve by removing some of the potassium).

Salt substitutes

Coca cola

Chocolate and cocoa

Honey

 

 

Sodium in general is not generally THAT much of an issue.

At the risk of sounding elitist, nutritional guidelines are usually written for the lowest common denominator, and a lot of people can be either not that smart and/or routinely consuming a diet filled with processed and  extremely salty food. The recommendations for avoiding salt is IMO aimed at such people. (This observation is based in my husband observing other patients and their dietary habits over the last 14 years as the vast majority COMPLETELY fail to follow any of the dietary restrictions).

 

A bit of salt in a dipping sauce, as soy sauce in the dish you are cooking, or sprinkled over something is not going to be life changing and can make the difference between enjoying ones food or not.

 

The main issue for most patients of too much salt is that it is thirst inducing, making one want to consume more liquid, and if liquid is being removed from the body only via dialysis, routinely turning up for dialysis with too much liquid in the body is bad because:

- it puts extra strain on the heart

- it can lead to extremely painful cramping during dialysis as liquid is being removed from the blood but there is a a higher amount of liquid still in the muscles

- if there is a really high amount of liquid in the body, it might not be possible to remove it all during one dialysis session, putting even greater strain on the heart.

 

Phosphorus:

You have a difficult balancing act between meat, fish  and eggs containing phosphorus, which should be limited, but it being advisable to follow a high protein diet.

You can't square a circle, and you can drive yourself nuts trying to do so, so don't worry about it too much, and concentrate more on providing the protein.

What you can do though is concentrate on avoiding other high phosphorus foods, such as preserved meats such as salami and the like. Lentils and dried beans also have a lot of phosphorus, but I think you wouldn't be serving that sort of food all that much anyway...

If in doubt, phosphate binders are available which can be stirred into water and consumed with a high phosphate meal. My husband does this once in a blue moon when he REALLY wants to eat South Indian food, such as dosa, dal, etc.

 

For what its worth, I usually cook Chinese and Indian food at home. The vegetables I use the most tend to be green or red peppers, fresh green beans, zucchini, broccoli, cauliflower. Also okra, bitter melon, Chinese or Indian gourds such as winter melon/ash gourd, ridge gourd and the like. Onions, ginger and garlic, of course.

I use what I consider a standard amount of salt and soy sauce, and tend to thicken north Indian dishes by stirring in high fat yoghurt at the very end after turning off the heat instead of the more common practice of thickening dishes by cooking tomatoes down at the beginning. Either that or leave them runnier than they would normally be.

I have no issues cooking with bought Thai curry pastes and canned coconut milk, but tend not to add extra fish sauce so as not to make it too salty.

 

Hope this helps.