Healthy eating for peritoneal dialysis

Transcription

1 Healthy eating for peritoneal dialysis Peritoneal dialysis removes water and waste products via the abdomen. It only partially replaces the functions of the kidneys, but compared with haemodialysis, it allows you to enjoy a relatively unrestricted diet. There are a number of issues relating to the food and drinks you eat that are important to consider. If you have just started dialysis, this information may be confusing. Your dietitian will go through this handout with you and can answer questions you have about your diet. This handout will give you information on the following: 1. Eating a nutritious diet. This is important to prevent you from losing weight. 2. Eating enough protein. This is important to keep you healthy and strong. 3. Preventing constipation. This is important for your dialysis to work. 4. Potassium in food. You may need more or less potassium in your diet. 5. Salt (sodium) in your diet. You may need to cut down salt in your diet. 6. Phosphate binders (tablets) may be needed when you eat food. 7. Cutting back fluid from food and drinks. This is important to protect your heart. 8. Eating right for your diabetes. This is still important while you are on dialysis. 9. Star fruit (also known as Averrhoa carambola or Five Corner Fruit) is harmful for people with kidney problems. It can cause confusion, muscle twitching, nausea, and weakness. People on dialysis should not eat star fruit. 10. Avoid eating liver. This is because liver contains large amounts of Vitamin A, which the body cannot process when the kidneys do not work properly. As a result eating liver can make you sick when you have kidney disease.

2 Eating a nutritious diet The amount of food you need to eat may change when you start dialysis. Eating enough food is important because it will: Keep your weight stable Give your body energy to do the activities you enjoy Help your body use protein for building muscles and tissues A nutritious diet is one which provides enough of the nutrients you need without causing weight gain or weight loss. To achieve this Include carbohydrate (bread, rice pasta potato or breakfast cereal) at every meal Have two pieces of fruit every day Have 5 portions of vegetables every day Eat enough protein Choose the right type of fat and don t eat in large portions Aim to have 1-2 portions of low fat dairy per day. Your dietitian can help you achieve a nutritious diet Maintaining your weight The peritoneal dialysis fluid contains dextrose (sugar); your body will absorb some of this sugar which will provide extra calories. This can cause unwanted weight gain, or can cause a decrease in appetite. To prevent unhealthy weight gain over time: 1. Limit high calorie foods that do not provide healthy nutrients. Examples: chocolates, lollies, soft drinks, cordial, sweet cakes, pastries, fried foods, potato chips and corn chips. 2. Use fats and oils sparingly, unless otherwise advised by your dietitian. 3. Avoid drinking too much fluid and/or eating foods high in salt that cause your body to hold on to water. To pull off the excess fluid, you may need to use a stronger bag. Because you absorb more calories from the high dextrose bags, you are more likely to gain weight. 4. Aim to be as active as possible Speak to your doctor before starting a new exercise plan If you are loosing weight Some people find that they feel too full to eat with the PD fluid on board. If you have this problem, try eating smaller meals more often, rather than the traditional three large meals per day. Alternatively, you may find that draining the fluid out just before meals will help with improving your appetite. If you are struggling with your appetite, feeling full or loosing weight without trying speak with your dietitian for further information.

3 Eating enough protein The amount of protein you need to eat may also increase when you start dialysis. Eating enough food is important because it will: Protect your body from illness and infection Help your body build muscles and repair tissue Keep you feeling strong and healthy The best sources of protein are: Meat, including red meat, chicken and fish Eggs Milk and milk products e.g. custard, yoghurt and cheese Eating protein-rich foods at every meal can make it easier for you to eat all the protein you need. Your dietitian will work our how much protein you need. For example: Breakfast Lunch Dinner cereal and milk/ yoghurt/eggs on toast sandwich with meat / chicken / fish and / or cheese meat, chicken or fish In times when you are eating poorly or when you need a boost, such as during episodes of peritonitis, the suggestions below may help you get the protein your body needs: Try alternatives to meat and vegetable meals. For example, omelette or soups with added milk and cheese High protein snacks: baked beans on toast, sandwiches with a protein-rich filling, like cheese or peanut butter Milk drinks and desserts: Sustagen, Milo, egg flips, custard, yoghurt, fruche Add milk powder to milkshakes to increase the protein. Try this recipe, but drink it over two days: o 600ml milk o ½ cup skim milk powder o 1 scoop of ice-cream o flavouring of your choice

4 Preventing Constipation Constipation can affect the positioning of the tube and therefore how well you dialyse. By eating adequate fibre you can maintain good bowel habits. Fibre is found in: wholegrain cereals and bread, fruit and vegetables. Remember, when you are on dialysis your bowels need to open everyday and need to be soft. There are four main factors which affect bowel movements. These are: 1) Fibre in food too much or not enough fibre can cause irregular bowel movements Fibre supplements might be helpful such as Benefibre, Psyllium Husk or Metamucil Try to include fibre at every meal. For example, Pear Juice at Breakfast, high fibre bread at lunch time and vegetables at dinner time 2) Water fluid helps to soften stools This can be difficult if you are on a fluid restriction. Talk to your dietitian for tips. 3) Exercise physical activity helps to keep us regular Regular exercise is important just 30 minutes walking a day can help. 4) Medications some can cause constipation, others can help to open your bowels Your doctor may ask you to take some tablets to help your bowels open regularly. It is important to know the symptoms of constipation. These can include: Nausea or vomiting Straining to open bowels Infrequent bowel movements Feelings of incomplete emptying after bowel movements Rectal pain When opening bowels Abdominal pain or discomfort; and Hard stools Managing your constipation: Contact your doctor or dialysis unit Take medication prescribed by your doctor Talk to your dietitian if you have questions about your bowels

5 Potassium in food Too much potassium is not usually a problem for people on peritoneal dialysis, however it is important that you monitor your monthly blood results. Everyone is different and you may need to increase or decrease the amount of potassium you eat depending on your blood results. High and low levels of potassium are very dangerous, and may cause your heart to beat irregularly and even stop beating. Below is a table of high and low potassium foods. Food Group High Potassium Foods Low Potassium Foods Breads and Cereals All Bran, any cereal with dried fruit and nuts (i.e. muesli), Cornflakes, rice bubbles, porridge, white bread, rice Fruit Vegetables Meat and Meat Alternatives Banana, mango, juices All, stone fruit, kiwi fruit, pineapple Potato, pumpkin, sweet potato, broccoli, cauliflower, tomato, avocado. Snapper Nuts all types Dried beans and peas Apple, oranges, strawberries, tinned fruit, pears Lettuce, cucumber, corn, capsicum, carrot, peas, green beans, Eggs Dairy Foods Milk, yoghurt, custard Rice Milk, Cheese Other Vegemite, coffee, Sweets and biscuits soup, salt substitutes, (not chocolate or nut chocolate based) Your dietitian can discuss potassium restriction in more detail if you are having problems controlling the level of potassium in your blood. Other vitamins Some vitamins are lost during dialysis Fruits and vegetables are great sources of these vitamins. It is recommended that you eat up to 5 serves of vegetables and 2 serves of fruit each day. To maximise the variety of nutrients you consume, try and incorporate a wide variety of different coloured fruit and vegetables into your diet. You may also require certain vitamin supplements. However, some vitamins can be harmful in large amounts, especially when on dialysis. Ask your doctor or dietitian for advice before buying any.

6 Salt (sodium) in your diet Salt makes you thirsty, which will make it difficult for you to keep to your fluid allowance. Here are some tips for reducing the amount of salt you eat. Some foods labelled reduced salt can still contain high levels of sodium. Check the nutrition panel sodium (Na) content less than 150 mg per serve is desirable. Add a little in cooking if you wish BUT avoid using it at the table. Choose fresh, home-cooked meats Use Salt Reduced or No Added Salt products Avoid salty foods like: - processed meat (bacon, sausages), smoked fish or smoked meats - salted biscuits, nuts and crisps - packet and tinned soups, packet sauces - most take-away foods Phosphate binders (tablets) Phosphate is a mineral that combines with calcium to form the hard structure of bones and teeth. Normally the kidneys control the levels of phosphate in your blood, when your kidneys are not working the level of phosphate in your blood can build up. High levels of phosphate can cause severe itchiness, red eyes, brittle bones and painful joints. The main way to control blood phosphate levels in kidney disease is with medication. Medications work by binding the phosphate in food so that less is absorbed from your intestine (and it passes out in your bowel motions). It is important to take your phosphate binders (Caltrate, Calsup, Alutabs, Renagel, Fosrenol) with food - especially foods high in protein. It is important to chew your binders for them to work. Renagel does not need to be chewed. To work properly, phosphate binders must be taken just before each meal or snack which contains foods high in phosphate. Fresh food is known to have less phosphate than processed food, ask your dietitian for recipes to try. Also making lower phosphate food choices where possible can also help to lower the level of phosphate in your blood. Examples include choosing: Non cola soft drinks such as lemonade, orange squash Sugar based lollies instead of chocolates or caramels Tea or coffee instead of hot chocolate, Milo or other drinks that use a lot of milk Jams, honey and conserves instead of peanut paste, Nutella or Vegemite Low-salt tinned spaghetti instead of baked beans If you have snacks during the day, ask your dietitian if you need to take extra tablets. Talk to your dietitian if you have questions about the amount of phosphate in foods.

7 Cutting back fluid from food and drinks It is important to cut back your fluid intake so that excess fluid does not build up in your body. If you drink too much you may need to use stronger bags to pull off the fluid. Having to use stronger bags means you absorb more calories (from the dextrose) and makes weight gain more likely. Fluid includes all liquids and anything that becomes liquid at room temperature. For example: water, ice, tea, coffee, milk, ice cream, iceblocks, custard, juices, soft-drinks, cordials, soups, gravy, and jelly. Some solid foods, such as porridge, rice, pasta and fruit, contain large amounts of fluid. If you eat large serves of these foods, count these as part of your allowance. Changes in your weight that occur over a couple of days are usually due to your fluid intake. Changes in your weight that occur slowly over longer periods of time (weeks to months) are more likely to be changes in your actual dry body weight. You may be able to drink up to approximately 1000ml (or 1 Litre) per day; however this will be different for each person. Your Doctor or dietitian can tell you how much fluid to cut back on. Hints for fluid control Use jugs and measuring cups to accurately measure your fluid intake Spread your fluid allowance over the day - don't drink it all at once! Drink from small rather than large cups Stay out of the heat. If you need to go outside, choose the cooler part of the day. Choose foods low in salt - fruit, fresh vegetables, fresh meats, chicken, fish, eggs, porridge, rice, pasta and low salt or no added salt foods. Look for sodium content less than 150 mg per serve on the nutrition panel. Keep a moist face washer in the fridge or freezer and use it as a rub down to keep cool. Brush your teeth to freshen your mouth. Suck on lollies or a slice of lemon instead of drinking. Try mints, peppermints or chewing gum. Keep lips from getting dry by using lip balm. Freeze some of your fluid allowance. Ice or iceblocks, sucked slowly, last longer than a drink, and are better at quenching thirst. You can freeze water, lemon juice and soft drinks. Remember that ice is fluid and should be measured eg. 1 cup of ice equals ½ cup water.

8 Eating right for your diabetes If you have diabetes, it is still important for you to control your carbohydrates in the foods you eat. To do this, make sure you: Check your blood glucose levels Take your diabetes medication Attend regular diabetes appointments Ask your dietitian for more information about diabetes and being on dialysis. Heart health It is very important for everyone with kidney disease to maintain a healthy heart and blood vessels. Eating the right kinds of fats and oils can help. Remember if using fat, choose a polyunsaturated or monounsaturated fat as these are best for your cholesterol levels. Saturated fats increase your cholesterol and so should be avoided. Recommended Unsaturated Fats Most vegetable oils eg. Safflower oil, sunflower oil, olive oil, canola oil, etc. Omega 3 e.g. sardines, salmon, tuna or fish oil supplements Not Recommended Saturated Fats Butter, ghee, dripping, lard, copha, suet Fat on meats and chicken Solid vegetable cooking fat eg. Supafry, Hifry Cream Coconut and palm oils Talk to your dietitian You may need to see the dietitian if: You have more questions about your diet. Your appetite is poor or you re losing weight without trying to. If your fluid, potassium and phosphate levels out of range. You should see your dietitian at least once every 6 months. Your Dietitian is: Contact Phone Number: