“There is so much conflicting › wp-content › uploads › 2020 › 09 › PKD-webi… · FAQs...
Transcript of “There is so much conflicting › wp-content › uploads › 2020 › 09 › PKD-webi… · FAQs...
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“There is so much conflicting
information about diet & PKD...
What is the right approach ?”
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manage symptoms medication find a Dr info on diet
You are not alone !
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This presentation will cover:
1. What diet to follow and why
2. What to avoid and why
3. FAQs about diet and PKD
4. Where to get more info
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THE BASICS
PKD results in damaged kidneys
We measure the damage to kidneys using the eGFR (estimated Glomerular Filtration Rate)
We categorise kidney function into 5 stages using eGFR
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WHAT DOES THIS HAVE TO DO WITH WHAT I EAT ?
The dietary recommendations are based on the stage of kidney disease
The dietary prescription will change over time
Knowing what stage of kidney disease you have is important if you are looking for dietary info
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Stage of kidney disease eGFR range Role of diet
1 kidney damage normal function
> 90 ml /min Control risk factors and prevent disease progression
2 kidney damage mild loss function
89-60 ml/min
3a mild-moderate 59-45 ml /min
3b moderate-severe 44- 30 ml / min Symptom control
4 severe 29 – 15 ml /min
5 kidney failure < 15 ml / min Symptom control & manage side effects of treatment
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WHAT DIET DO I FOLLOW IN ONE SENTENCE ?
Stage 1-3a or transplant: Healthy diet in accordance with AGHE or Mediterranean pattern. Reduced salt. Adequate fluid.
Stage 3b-5: Diet reduced in protein, salt, phosphate, with modification of fluid and potassium. Still adequate fruit, veg, breads & cereals but reduced in meat & dairy
If on dialysis: Diet high in protein, low in salt, phosphate, with modification of fluid and potassium. Still adequate fruit, veg, breads & cereals but increased in meat & reduced dairy
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WHAT FOODS CAN I CHOOSE ?
Stage 1-3a or transplant:
✓ 2 pieces fruit (fit in palm of hand)✓ 2.5 cups vegies (5 handfuls)✓ 4-6 serves bread/ cereals ✓ Palm size portion meat / chicken / fish / eggs / legumes✓ 3-4 serves dairy eg 1 cup milk, 1 piece cheese✓ Fluid to thirst eg 2-2.5L of water ideally each day✓ Reduced salt and do not add at table
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WHAT FOODS CAN I CHOOSE ?
Stage 3b-5:
✓ 2 pieces fruit (fit in palm of hand). Low-mod potassium✓ 2.5 cups vegies (5 handfuls). Low-moderate potassium✓ 4-6 serves bread/ cereals. May be low-mod potassium✓ Very small portion meat /chicken / fish / eggs / legumes✓ ~1 serve dairy eg 1 cup milk, 1 piece cheese✓ Usually fluid restricted eg 1500ml. SEE YOUR NEPHROLOGIST
AS THIS IS INDIVIDUALISED . Ideal fluid water✓ Reduced salt and do not add at table
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WHAT FOODS CAN I CHOOSE ?
If on dialysis:
✓ 2 pieces fruit (fit in palm of hand). HD:Low-mod potassium ✓ 2.5 cups vegies (5 handfuls). HD:Low-moderate potassium✓ 4-6 serves bread/ cereals. HD:May be low-mod potassium✓ Large portion meat / chicken / fish / eggs / legumes✓ ~1 serve dairy eg 1 cup milk, 1 piece cheese✓ Usually fluid restricted eg 1500ml. SEE YOUR NEPHROLOGIST
AS THIS IS INDIVIDUALISED . Ideal fluid water✓ Reduced salt and do not add at table
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
YES1. Osmolar load is important
Diets high in animal protein increase urea, acid load, phosphate and solutes = increase cyst growth
Plant based diets do not have the same effect
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High osmolar diet ie lots of salt, protein and molecules
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WHAT DOES THIS ALL MEAN ?
Avoid high protein diets and reduce animal protein intake eglarge serves of meat, chicken, fish
Don’t need to be vegetarian but eat lots of plants and plant based products
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
2. Ketogenic diets – experimental evidence in mice only
If followed as 90% fat/ very small protein & carbs…can lead to increased B-hydroxybutyrate (BHB) …leads to reduced cyst growth
Authors: added BHB to normal diet of mice and found positive effects on cyst growth
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
2. Ketogenic diets – experimental evidenceIf we were to translate these experimental findings to humans…It would mean:No fruit, breads, cereals, Very small protein, limited vegiesLots & lots & lots of fat
Warning: Commercial BHB supps- can be high in protein and osmolar load
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
3. Intermittent fasting – experimental evidence in rats
Depriving body of glucose in PKD slows cyst growth
Only experimental evidence – unsure in humans
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
4. Caffeine – experimental evidence
Shown to increase cAMP = increase cyst growth
No studies in humans to demonstrate this
Recommendation: drink 2 or less cups of coffee / 4 or less cups of tea/day. Limit cola drinks to small amounts
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IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?
5. Oxalate – increased risk kidney stones in PKD
Can cause injury to kidney
Recommendation: Avoid large volumes of fruit juice esp green leafy juices
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What are the take home messages ?
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1. EAT LESS ANIMAL PROTEIN
2. REDUCE OSMOLAR LOAD
- read and use food labels to eat less salt - do not add salt at table- target high salt items and reduce or do not use
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Nutrient Average contentPer serve (30g)
Average contentPer 100g
Energy 420 kJ 1400kJ
Protein 3.6g 12g
Fat 0.8g 2.8
Carbohydrate (total) 19g 64g
Sugars 0.9g 3.2g
Sodium 85mg 280mg
Potassium 100mg 340mg
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They are all still salt !
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DO NOT USE THESE
**HIGH IN POTASSIUM**
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https://usafoods.com.au/products/mrs-dash-seasoning
https://usafoods.com.au/products/mrs-dash-seasoning
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1. EAT LESS ANIMAL PROTEIN
2. REDUCE OSMOLAR LOAD
- read and use food labels - do not add at table- target high salt items
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Top 10 contributors to salt intake in Australia . EAT LESS OF THESE
1. Processed meat eg pie, sausage roll, ham, bacon, deli meats, hot dogs
2. Bread
3. Sauces and dressings
4. Cheese
5. Processed veg eg canned, pickled, frozen, potato based
6. Biscuits & cookies
7. Milk products
8. Chips, crisps, popcorn
9. Margarine & butter
10. Spreads & dips, vegemite
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3. EAT 2 SERVES FRUIT AND 5 SERVES VEGIES EACH DAY
4. DON’T OVERDO CAFFEINE, ALCOHOL, SOFTDRINK
5.SEE A RENAL DIETITIAN FOR MORE INDIVIDUALISED ADVICE
6.TRACK YOUR USUAL INTAKE FOR A FEW DAYS eg see Easy Diet Diary and enable renal options
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Easy Diet Diary
Download and enable
renal options
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More information
https://pkdcure.org/living-with-pkd/nutrition/
https://pkdcure.org/living-with-pkd/nutrition/
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You can find me at: [email protected]
Twitter: @drkellylambert
Any questions?
Thanks!
mailto:[email protected]