Diet changes, it is complicated

[Bassetmommer]

I had a slip in my GFR in November. I had an gastritis this fall and although I did not take anything, it may have impacted me. I also had fallen away from my diet as we sometimes do in time. I thought it was appropriate for a tune up. I went to see the renal dietician I saw 3 years ago. She is an expert and highly recommended in my area. I took a diary of my food for the last month or so.

She is totally now plant based. She lost a ridiculous amount of weight in the last months, and I think she looked gaunt and frail. She said she did it by eating only 500 calories a day and only plant based. She was honest and said she would not recommend that calorie level for me. (Phew, wasn't going to happen)

But she did have some things to recommend. First of all, she said no fats, none zippo, nada. Well, I agree in principal, there are certain foods and things that need some fat. But I certainly can cut that down. Also no dairy. Yikes, my beloved cheese was on the block. Ok, I can do that. She was basically warming me up to totally no animal products. I still will enjoy my cream cheese "Laughing Cow" product but not every day. NO eggs, even egg whites only. Well, that was going to be a big deal. But, I have stopped for now. And absolutely no milk. I do not drink milk but use Natural Bliss in my coffee. I only have one big cup a day. she recommended almond milk. No Chicken, no fish and no broth, either. I am ok with that for now but my homemade soup is chicken based broth and I am not throwing it out.

She cut my protein level down from 55-70 which was her recommendation 3 years ago to under 47 or lower. The desire was 15% of my intake of calories. Totally doable.

Then it got interesting. She starting recommending foods for me. First up was zucchini. I said no can do, too high in potassium. She disagreed until we looked it up on her computer and I was right. She said eat only a half a cup. Really, why bother? Broccoli was high in protein. Too bad, I thought. Not much else out there in the winter. She listed some other vegetables, and I do consume most of them.

Then she said that oatmeal was fabulous for me. Now this was in complete turn around from 3 years ago. Matter of fact, her recommendation was for everything carb being full on whole grain and bran. Now of course they want you to eat this oatmeal you cook for hours on the stove, but ... not going to happen. Brown rice and whole wheat pasta, which was a no no before, is now good. She again explained about that phosphorous is halved in plant based foods and now they are beginning to do research in the actual amount of potassium absorbed from foods. She said potatoes and some citrus was fine. Not going to take a chance on those with their high potassium. I said I just do not eat them. She said swap them out for other high potassium foods. I said what high potassium foods? I just do not eat them. It was not like I was eating chicken four times a week. She said legumes were great but high in potassium, eat small amounts. Honestly, I was getting a bit frustrated at this point. I was there an hour and half.

We talked more about the fat. She said nuts and nut butters were good for me until I told her I have had diverticulitis and do not eat them. I do not understand how the high fat in nuts is ok, but not olive oil. She said anything that is processed is bad. EVERYTHING. If you do not make it yourself, do not eat it. ( That was ridiculous to some extent. I could see why she lost 50 pounds in 4 months)

And one more good point: Intermittent fasting. I was doing that before and then started eating rice rollers with my coffee in the am. (Rice rollers are a no no because they are processed, even thought they are only rice, and sugar) She said, and I already do this, no food after 6 pm and nothing before 11 or noon. I am back to doing that and its not that hard. I was getting hungry in the am but now I am not.

So I have limited myself even more. Funny thing is I am actually feeling pretty good. She said that often when you change to this diet at first you feel crappy. She said that was because of the toxins being release into you body to eliminate. I will admit that a constipation issue is totally fixed and so that's good. I dropped 2 pounds last week. That's good.

But, and I left her with this. I said, " right now, I am on a short list of longevity. I do not know how long I can go without dialysis, now that my GFR dropped to 13. And we all know how hard that is. So there will be days when food wins. Not every day. But I am not giving up my popcorn with butter on Saturday movie night and I have never met a piece of chocolate cake I didn't love. She agreed that even with her self imposed restrictions that life happens. I wanted to say, but did not, that it is easy to restrict and do a 500 calorie diet if you only do it for 3-5 months. I said this is for life for me.

By the way, 500 calories is what they fed the people in concentration camps.

[rabbit01]

Wow, she certainly doesn't seem like someone I would be taking any notice of! I am only going on what you have said.

[Bassetmommer NKF Ambassador in reply to rabbit01]

She really is an expert in the renal world. I thin she is swayed because she is now part of the an organization that promotes plant based foods. They provide classes and consultation but it is very expensive. I looked into before. When ever you talk with someone like a dietician, you have to factor in that they are not living your life. These are recommendations, not a prescription.

[rabbit01 in reply to Bassetmommer]

I do agree that plant based only puts less load on kidneys and the whole body. I gave it a go shortly before starting dialysis and there were huge improvements to all my blood results with the exception of creatinine. But my goodness it was so hard to stick to the diet and I am not sure for me it was sustainable. I do believe that if I had started it when I was at 20% rather than 10% then I could have delayed the need to start dialysis for a long time but by golly you have to have steel will power. But the science behind it is sound. If you think about processing a steak in your body compared to processing a salad then you can obviously see that the salad is going to be easier on our system.

[Jayhawker in reply to rabbit01]

I definitely feel much better eating a modified vegetarian diet than I did the diet I was following before. But, as I just said in my initial reply to this thread, I have to be really careful that I am eating enough protein on a daily basis now. I have been told to aim for 45 grams of protein daily, and that’s a decrease of 15 grams. My dietician told me to both reduce my protein to this level and convert to a modified vegetarian diet. So far so good as far as stabilizing my renal function with an eGFR of 15-17. My kidneys are quiet and stable... However, as we each know, this can change at any time.

Jayhawker

[Bassetmommer NKF Ambassador in reply to rabbit01]

Hi Rabbit,Exactly. What I did not know was how hard milk is on the kidney. The amino acids are tough to process, as bad as red meat, just different. So no milk and very limited if any cheese. I have a friend whose nephrologist was concerned about his weight and told him to drink milk. He was eating enough protein with chicken and salmon. He had raised his GFR from 13 up to 36 over time and then it dropped and stayed pretty much around 24-27. Then he added the milk and boom, right back down. He has stopped the milk and it is back up to 24.

[rabbit01 in reply to Bassetmommer]

Unfortunately there's so little research and even less understanding about this. For example when I was first diagnosed at about 18% and asked about diet the doctor said it was not going to make any difference and I should go home and just eat normally. Even when I changed my diet and my levels improved the nephrologist dismissed any improvement as an anomaly.

[Jayhawker in reply to rabbit01]

Yes, my first nephrologist was the same with diet. The only dietary changes he had me make were to follow a low potassium diet when my potassium elevated. But nothing about meats or dairy products.

When I finally saw a renal dietician at the transplant center, I learned quite a lot about dietary changes that would support my remaining renal function. The dietary changes I have made have definitely helped a lot. But so frustrating not to have this information sooner when I had about 35% function.

Jayhawker

[rabbit01 in reply to Jayhawker]

Yes I totally agree.

[Bassetmommer NKF Ambassador in reply to rabbit01]

Absolutely... I would probably not gotten to the point I have.

[orangecity41 NKF Ambassador in reply to Bassetmommer]

I drink only Almond Milk and did find vegan cheese, some made with soy, others not. I do prefer the regular so eat no more than 1 oz serving.

[Bassetmommer NKF Ambassador in reply to orangecity41]

I looked into almond milk and the brand I saw had a lot of additives. But I am going to look for a almond creamer. I know they make it.

[Jayhawker]

Wow, just wow! So what are you now eating on a daily basis?

I have cut back to two meals a day and do find that I’m feeling better. I have suspected that that was because I am eating less so less toxins for my kidneys to remove, etc. BUT I have to be really careful. I sometimes am only eating 22 grams of protein a day. So, I am now including a 2 oz serving of a renal and diabetes friendly protein drink called VidaFuel daily. That serving has 16 grams of protein.

I do still add liquid egg whites to steel cut oatmeal which I eat for breakfast every day. I also add a single serving of no sugar added cinnamon applesauce to the steel cut oatmeal. This has been my breakfast every morning for at least the past 10 years. I love the taste of it! So, I’m curious. Why did your dietician say no liquid egg whites?

I have found that I can eat garbanzo beans in moderation in salads without elevating my potassium. I no longer eat cheese or other milk products with the rare exception of sour cream. I replaced tacos snd taco salad with a sheet pan chicken fajita recipe. (I eat boneless, skinless chicken breast 3 times a week for dinner.)

Anyway, as I read your post I wondered what you are eating on a daily basis...

And, I, too, have popcorn when I watch college basketball. (Rock chalk Jayhawk, GO KU!!) but I make the popcorn in my hot air popcorn popper and have it without butter.

Jayhawker

[Bassetmommer NKF Ambassador in reply to Jayhawker]

Hey Jayhawker, Its funny. What I cut out was minimal. No chicken, not even ground chicken. I haven't had fish in a long time. I haven't eat meat in years. The eggs were a big deal as I was eating them four times a week. No shredded cheese, but I had cut way down on that. No candy and cut way back on my animal crackers and rice rollers. I use lite butter ( except on popcorn) and switch my salad dressing most nights to spray olive oil and spray balsamic vinegar. I use a very lite ranch other times (which is a no no)

What I did add was more fruit. I was being so careful with my glucose because I am diabetic. But my morning numbers are very low and my A1c has been static for over two years at around 6. Even though I am eating pasta with my veggies, it stays low. I am not a fan of whole wheat pasta, though. I am careful to measure what I eat.

She said the sugar in real fruit is better than any processed product with sugar. And she said the benefits of the fiber are more important. I have added small amounts of pineapple and pears and even a no sugar fruit cup for a mid day snack. I eat an apple a day.

I don't know how this will work out. So far its pretty easy to stay around 1000 to 1260 calories a day, ( Except popcorn night) But I have only a salad on that night.

We will see how it goes.

Oh the last thing she said which made me go, "what?" was that exercise will not change your metabolic rate and that will not make you lose weight. She says being active is important though. I bought a smart watch that tracks my steps and I get in minimally 2 miles a day. And that is just shopping or stuff around the house.

[Jayhawker in reply to Bassetmommer]

Yes, my workplace has a weight loss program many complete. In that program they are told that exercise will not cause weight loss. It helps in other ways but not with weight loss. That program focuses on eating only when you’re hungry and on portion size etc.

Jayhawker

[SunshineGardener]

I would not be taking her advice, period. Bias is bias, no matter your expertise.

[Bassetmommer NKF Ambassador in reply to SunshineGardener]

Sunshine Gardener: Curious why you say that?

[SunshineGardener in reply to Bassetmommer]

In your initial description, it sounded as though she may be going through some things that might be impacting her professional advice. Even experts are human, and it sounded as if her own extreme measures (fifty pound weight loss in short period of time, 500 calorie diet, intermittent fasting) are reflective of some issues of her own which have the possibility of affecting her judgement. For me, this would lead me away from her for guidance.

[meggiemog in reply to SunshineGardener]

I would say the dietitian sounds like she has an eating disorder. Not good when she is advising other people who need help to stay well and as healthy as they can.

[drmind in reply to meggiemog]

I totally agree. Too mamy ted flags.

[drmind]

Pls be very careful about taking her advice. No one is able to sustain themselves on 500 calories a day. Isnt it odd that she needed to lose 50 lbs in such a short time? Why? She sounds as if she has an eating disorder. Sometimes extrene "plant food diets"seem cult-like to me. Her intensity and ease at restricting common foods are scary. And, even more so as she does it under the guise of professional expertise. Please be careful. All of this does not seem right. Pls keep us posted.

[lowraind]

Have you had this reviewed by your personal physician and/or your nephrologist?

[Bassetmommer NKF Ambassador]

Whoa, I did not think people would be so reactive. First of all, her desire to lose weight is her personal issue. Maybe she was pressure into it because of her association with the organization she works for who does plant based education. She said right off the start she would not recommend that rapid weight loss. And she did not try to sell me on the program. I was there for her well known and respected advice. And yes, my nephrologist totally supports her and the same organization. It is well certified. My nephrologist eats plant based. The thing to remember when dealing with diets is that it is a life style change. Short burst diets do not work as people rebound. I know, I have done it for years. Loose 20 gain 25. It is what makes the industry so profitable. I have been on Weight Watchers twice and the last time gained weight with their eat all you want points.

Diet is what sustains life, but it is not life. But when you are critical ill, what fuel you provide for your body makes all the difference.

She explained in detail the scientific reasons for why plant base eating is good for you. I did to go into it here but there is buckets of research that validate what she said. We metabolize food in a specific order. Fats are the most difficult and that is why there is a limit. I am not going to go into the science but she did with me. Then there are protein chains that also get processed by the kidneys and the type of chain makes a difference as to how it is processed. Meat and dairy are the toughest. Intermittent fasting is just a name for programmed food control. It works and it is not hard. There is a ton of literature on it as well.

Plant based diets that are not restricted by things like potassium are totally healthy and can have as much calories as any other meal plan. For someone who is restricted with potassium levels, it becomes a challenge.

My need for this change is because I have to lose weight in order to be considered for transplant. If anything should outrage people is the discrimination of people of size with medical care.

[Jayhawker]

I’m still confused by your dietician’s comments to eliminate liquid egg whites. My renal dietician said that liquid egg whites are essentially the perfect protein for those with chronic kidney disease. While the yoke contains fat and cholesterol, the whites do not. They are also “easy for our kidneys to process” according to my renal dietician.

Similarly, my dietician was firm on the need for me to eat 45 grams of protein daily, a low fat diet (with which I don’t struggle, thankfully), low cholesterol, and no less than 1200 calories daily. She gave me quite a lot of information about renal-friendly vegetarian diets. She shared current research about vegetarian diets for those with chronic kidney disease.

I saw her three times as I was moving through the transplsnt evaluation process. By the last appointment, I had successfully shifted to the modified vegetarian diet to which I adhere today. This dietary change has helped my renal function as I mentioned earlier. Today I eat boneless, skinless chicken breasts (about 1/2 breast per meal) for dinner three or four nights a week. I’ve done this since October of 2019. My renal panel data has improved from an eGFR of as low as 8 to an eGFR of 15-17. My electrolytes remain in the center of the normal range. My protein is in the bottom of the normal range.

So, I hope you’ll see a modest improvement in your renal function with your dietary changes. As far as the transplant evaluation goes, I’d expect the transplant center will support a gradual, healthy weight loss. That’s certainly the mindset of the transplsnt center where I’m actively waitlisted. One of the other persons who completed evaluation when I did was approved contingent upon weight loss. When I saw her again at the one year checkin, she was doing a great job with weight management. She told me that given her blood type, etc, they had told her it would be 3 to 3 1/2 years before a deceased donor kidney would likely arrive. So, she and the dietician set goals for her weight management. They were based on her loosing 1.5 pounds a week. She’s right on track and will be transplsnt ready in another 18 months. She will have lost a total of 45 pounds by then.

Of course I wish you well. But, please be careful. Slow and steady will win this race, so to speak.

Jayhawker

[Bassetmommer NKF Ambassador in reply to Jayhawker]

I agree what you say about egg whites. That was why I was eating them. I have found people who are proponents to certain diets, i.e.: Atkins, Paleo, are all out as in "all or nothing." Again. great short term, but unsustainable for years. For now, I am going to try without and see what happens. I too am sticking with about or under 1200 calories. The thing is this about the transplant: For people with high BMI's they say the risk is in infection. So they will do robotic or arthroscopic surgery for the transplant with people with a high BMI. Unfortunately, there are only 3 places on the east coast that do it. My hospital is one. But, they only have one surgeon trained right now. So if I have a live donor, and they can schedule the surgery, I would be fast tracked, weight and all. But to get a cadaver, its 6-7 years.

I have to laugh because after every test so far they come in and say, "Geeze, you're pretty healthy." (What is not said "for a fat person"....) What a shock.

[Jayhawker in reply to Bassetmommer]

Do you have a living donor option?

[Bassetmommer NKF Ambassador in reply to Jayhawker]

Nope. Haven't even tried yet.

[Jayhawker in reply to Bassetmommer]

So it sounds like you can move forward with slower and safer weight loss even as you work to find a living donor. That approach would keep your overall health in good shape while still making progress with weight management. That would be the best of both worlds so to speak.

Jayhawker

[purejoynow]

Sounds like you are feeling better and have better numbers, so why stop now? I think you are wise to try her suggestions, they are all based on science and many are presently doing the same things she recommends, minus the nuts/nut butters. It's hard to get it going and sometimes to continue it, but you are moving in the right direction and sounds like your labs are proving this. Congratulations. I am a fellow popcorn lover, and have moved over to a spritz of bragg's aminos on my popcorn. I find when I eat less of things that are hard on my kidneys, I feel so much better. Feeling good for us is everything! I congratulate you.

[Bassetmommer NKF Ambassador in reply to purejoynow]

Thanks for the suggestion. I will probably be giving up the popcorn eventually anyways.

[Sammi_n_Munk]

Hi Bassetmommer! Wow! Loved your post. It was very informative. I’m so glad you mentioned about the zucchini being high in potassium. I seriously did not know this! I’ve been eating my home-made, what I call “zucchini stew” (which is basically more of a vegetable stew with extra zucchini in it), because I thought that zucchini was listed as a safe vegetable for kidney patients. Gosh. Here I thought I was doing a good thing. I’m somewhat shocked, but glad to know. That’s it. Guess I’m done with the zucchini! Lol!

I’m sorry to hear that you’ve been going through a rough time, and I can relate. You mentioned that your dietician was on a 500-calorie diet. Wow. I remember my oldest sister, some years back, was also following a 500-calorie diet as well. May God rest her soul, but goodness gracious, she was very difficult to live with while that was going on! Lol! Even saying hello to her was putting yourself at risk of getting a shiner! 😃 But as you say, she did lose an enormous amount of weight very quickly, however, she wound up “finding it” all again, soon after. Lol!

But I thank you so much for sharing this post with us. It’s inspired me to do a little more research on the foods that I’ve been consuming lately. I may need to update my lists. I wish you all my best. God bless. 😊👍🙏

[Bassetmommer NKF Ambassador in reply to Sammi_n_Munk]

thanks Sammi. I know it is disappointing about zucchini. I love making noodles with them.