Early CKD Support
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The importance of iron

Hi All. Writing this in my capacity as a nutritional therapist. The topic of iron often comes up among kidney patients and here's why. The kidneys produce the hormone erythropoietin which stimulates the production of red blood cells and in turn maintains a healthy level of haemoglobin (Hb). Most of the body's iron is found in red blood cells so if they are low, it is likely your iron levels might also be low. The two usually go together which is why increasing iron tends to increase Hb and increasing Hb tends to raise iron. There are a few issues with a concentrated dose of intravenous iron. I had a bad allergic reaction to it which can be one issue. Another is that it can be too much iron at once and lead to oxidation in the body. We are not looking to increase oxidation in the body as this produces free radical cells which are essentially volatile and disruptive in the body. This is why a diet rich in 'antioxidants' is so important. However that's not to say iron infusion must be avoided, as ever, inform yourself and tune into what feels best for you.

Fatigue can be a big issue with kidney illness due to the iron and haemoglobin status. This is an important way the body carries oxygen which is vital to our energy. The NHS prescribed iron I don't usually recommend and here's why - an example of ferrous sulphate is dosed at 200mg. This is a very high dose and the high dose is due to the low bioavailability of this form, namely not much is absorbed and typically creates black stools and some constipation. I prefer to prescribe a bigylcinate form of iron that is much more bioavailable and comes with no digestive disturb.

So how to raise your iron levels? A good quality and bioavailable supplement is one way. Eating animal foods such as eggs, liver, red meat and chicken is another way but be mindful not to go overboard on these. These contain 'heme' iron which is more bioavailable to the body. For vegetarians however there are still ways to eat iron rich foods - apricots, chick peas, pinto beans, most legumes in fact but make sure they are soaked overnight and cooked well as they are high in lectins which can contribute to inflammation, dark greens with lemon juice squeezed on as the vitamin C in the citrus aids the absorption of iron. Pumpkin seeds are also handy for iron content. Nuts and seeds are a great addition to any diet if you enjoy them, just don't go crazy as they are also high fat foods and there is more research coming out now around high fat leading to dysbiosis (gut flora imbalance).

What not to eat to avoid low iron is avoiding tea and red wine around iron rich foods. The tannins in these interfere with iron absorption. I've had patients who drank a lot of tea and when that was eased off, it helped the iron status.

The other consideration that is rarely spoken of is stomach acid status - stomach acid is key to our digestion and notably with iron it is stomach acid that changes iron into an absorbable form. So you must have sufficient stomach acid and not be taking medications to suppress it.

Some possible symptoms of low iron and low Hb (essentially this is anaemia), are hair loss, shortness of breath on even slight exertion, lack of palor (absence of rosy cheeks!), inability to focus and feeling cold.

So get on some iron rich foods, be interested in your own iron, ferritin and Hb levels so you can explore what levels feel right for you. Again it will vary for everyone.

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Renal Dietician also suggested adding or sprinkling wheat germ on food and a tsp of Molasses in the morning.

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I tend to avoid advising molasses due to its high sugar content. But if you tolerate it, it is a high iron food.

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To date, no diabetes...and I don't eat sugary foods.

Giving it a try..lets see what next set of labs show. Also coming off Tacrolimus since mid June..

Thanks..

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many of the foods you mentioned aren't what people with CKD should be eating, particularly eggs.

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That's not the case. Do bear in mind I speak from both personal and professional experience. There is no reason why eggs are not suitable. Unless someone has an intolerance to them or are struggling with high phosphate. There is no one size fits all and I take a different approach to the linear dietetics.

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then I guess it would require each of us to have access to the necessary medical professionals to be able to feel our way forward confidently in terms of diet. And that might be possible in the UK if you are wealthy. However, it's a tricky job to even get local GPs interested in someone with stage 3 CKD. So, therefore what happens is that you do as much online research as you can, trying to deal with the discrepancies regarding certain food items, but if you read that egg yolk is not a good idea for people with CKD enough times, then you avoid them. There are a number of other food items, tomatoes for example, that some people involved, say you can have, while others say you cannot. So where I discover discrepancy over a certain food item, I have no choice but to avoid it simply because there is no one available to guide me personally more accurately than I am attempting to do for myself, so in that situation you have to go for the 'one size fits all' idea, I am afraid.

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Hi I agree I found the same, diets for CKD are so confusing. My NHS dietician, which I managed to get 1 appointment with only, said just to eat a healthy diet and not worry about diet so much. Because when you reach CKD 4 that is when your diet will change considerably! Confused.

I was also told I needed an iron supplement from my doctor who advised Vit D capsules. Yet I then found out with CKD the kidneys will no filter it. Even more confused.

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Hi Bee, I can imagine that if you are in the UK... my GP stared at me, smiled, and said 'a lot of people of your age with worse CKD then you just eat what they like.' I smiled back and thought how NOT reassuring that is. Did your doctor test your haemoglobin level at all? Generally as a rule of thumb, if you pull back your lower lid and look at the colour there, it'll give you a rough indication. If it looks rosy that's good, if it looks pale then you probably do need iron. I used to run a blood bank in Africa and I was always on the look out for people with good Haemoglobin because we dealt with malaria by blood transfusion.

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Yes, the diets are confusing. I continue to staunchly believe that if there were more clarity and a definition by the medical community regarding what defines a "healthy diet" for someone with CKD, we would not reach stage 4 (or at least many of us would not).

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Agree Bee28, that diet can be confusing. On original Medicare allowed 1 appointment with dietitian per year unless level 4 and above. I am at 3. Diet is restricted on tomato and eggs also. I also have to take Vitamin D, which may or may not be doing any good. RBC in low range still.

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I fully understand and know it can all be very confusing indeed. My hope and intention is to widen the knowledge from mainstream medicine. There is a movement called social prescribing that is sponsoring through the NHS a lot of community endeavours, so for example as I am also a yoga teacher, I have started two community yoga classes that are free to the community to attend and my rate is NHS funded. These people have the ears of the Chief Executive of the NHS and his leadership team and I'd really like to drive nutrition courses too for the community based on cutting edge latest research and tailored to specific groups so it is relevant and practical. I share this as it does indicate a shift is happening and more we all can call for clarity, the more our systems must serve us better. Around the globe there is far more research going on, for example the benefits of COQ10 for kidney disease and I read of one report that half the test group were able to cease dialysis from the improvement in their kidneys. So my point is there are many avenues to explore to keep people well. I know it can be disheartening but there are people that care and from my perspective having gone through the whole journey I am so keen to use my experience to help others so they can thrive more and the information is more clear. What I always suggest is for patients to have access to their labs and to get to know what suits them. Some people for example have no issue metabolising potassium and so tomatoes are absolutely fine. You are unique like we all are and so just continue to explore. If I can help further at all, please let me know.

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Egg whites?

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Thanks...

I eat alot of the beans, chickpeas, hummus and legumes that you menioned..love them!

As far as the molasses, I limit it to 1 tsp a day. Lets see if it effects my glucose in November. I do add the wheat germ.

I am not a candidate for iron or meds due to IBS.

If you have any other thoughts, please share!

Thanks!

Bet

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HI Bet - I'm sure if you are not really having much other sugar this is fine at just 1 teaspoon daily. With a presentation of IBS some gut work will be useful as it is for us all. On that note just tune into whether wheat is a trigger for you in that regard.

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It can be deceiving because not all ckd patients suffering from anemia - are iron deficient. Prior to my transplant, my iron count was fine but Hb was low. The answer for me was injections of epogen. My kidneys were not telling my bone marrow to produce more red blood cells.

I guess my point is, only your doctor can tell you if you are iron deficient. Iron is not the answer for everyone, as it was not for me.

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I agree which is why I reference to know your Hb, ferritin and iron. Some people are very effective at how they use iron in the body so it might be their iron runs quite low but Hb is fine. Whilst they are linked they don't always present in that same relationship for all people. When I prescribe iron is it on the basis someone has had a diagnosed insufficient iron reading. Iron otherwise as I mentioned can have an oxidative effect. My role is not to diagnose so just to be clear on that, when I work in this context it is addressing imbalances and for most of my patients/clients I will have lab results if they are working with a particular chronic condition. Whilst I specialise in kidneys I work with a broad range of people. And each person really is unique not just physically and genetically but emotionally and mentally too.

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Very true WYOAnne that only your Doctor can tell you are iron deficient.

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Agreed!

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Thanks again for good post. I read it again and gained more info. My latest blood work shows possibly anemic and go for follow-up visit. This gives me food for thought on questions for the Doctor.

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That's wonderful. Keep in that dialogue with the doctor. Well done! So glad it's helpful.

Best,

Ciara

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