Providing Answers, Support and Hope in Maryland, Virginia and the District of Columbia

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Host 0:05
Hello, welcome to The Expert Series brought to you by the Lupus Foundation of America. Our health education team is here to bring you experts in lupus to discuss topics to help you live better. Thank you for tuning in for today's episode. My name is Dwayne and I will be your host. I'm very excited to welcome Melanie Betz, who will be talking about diet, nutrition and kidney health. Melanie works in the section of nephrology at the University of Chicago, where she provides outpatient nutrition counseling to patients with a variety of kidney-related conditions, including chronic kidney disease, polycystic kidney disease and kidney stones. Melanie also manages a website, www thekidneydietitian.org, where she aims to provide easy to understand science based nutrition information to the public about kidney disease and kidney stones. She is a member of the American Kidney Fund dietitian advisory group, and helps to guide and review a KF's Kidney Kitchen content and resources. Her research interests include effective education strategies, plant-based diets, and frailty in people with kidney disease, as well as effective nutrition interventions to prevent the risk of kidney stones. And we are delighted to have you with us today. Melanie, thank you very much for joining us.

Melanie Betz 1:30
Thank you so much for having me, too. I'm excited to be here.

Host 1:35
Great. Well, let's get started. Question number one. What role does diet play in helping to keep kidneys healthy when someone has lupus nephritis?

Melanie Betz 1:46
That is a great question. And diet and nutrition can impact the kidneys in the health of your kidneys in lots of different ways. Probably the biggest thing that diet and nutrition can do for someone with lupus is to both prevent the development of chronic kidney disease because we do know that unfortunately, around half of people who have lupus will develop chronic kidney disease at some point, or a condition called lupus nephritis. And so nutrition can really play a big role in helping to prevent that from happening, as well as preventing the progression of chronic kidney disease if someone with lupus does have that diagnosis of chronic kidney disease. In addition, we all know that healthy eating is good for us in general, right? So healthy eating can help prevent or manage other chronic health conditions like hypertension, diabetes, or cardiovascular disease. And all of those things could sort of further increase your risk of developing chronic kidney disease. So there's lots of different ways that nutrition could really make a big impact. And there's lots lots of things to keep in mind. And I always like to plug that the role of dieticians for this. So a healthy diet for you is probably very different than someone else with lupus right? There's no one has one diet, because we all are different people and have different food likes and preferences and different things going on with us. And a dietitian is really the best person to kind of help you manage all those different things and figure out what's really best for you, given your stage of disease and and everything else going on with you.

Host 3:24
Well, that's very good advice, particularly a part about consulting with a dietitian so that your care can be customized for your individual case.

Melanie Betz 3:33
Yes.

Host 3:34
Our next question, are there any foods that people with kidney disease should avoid?

Melanie Betz 3:37
So I think there's really very few foods that are never right. I, I I'm definitely on everything in moderation type person. And healthy eating for your kidneys is really all about balance and learning how to build healthy eating patterns, it's not so much that there's a list of foods that you can and can't eat. It's really kind of learning about, again, that balance and building healthy meals and healthy eating patterns to help protect your kidneys and general health. I will say that oftentimes when I start working with patients, some of the first foods that I or the the foods that are sort of identified as something that maybe we tend to be eating too much of is processed meat. So that processed meat is anything that sort of is meat away from its natural state, if you will, so things like deli meat or bacon or sausage or Bologna, salami hotdogs, right and anything like that tends to have a whole lot of salt in it first of all, which isn't very good for your kidneys. And those those processed meats also tend to have a lot of something called potassium and phosphorus added to them, which can sort of further damage your kidneys and may be needed to be limited for for people with kidney disease. So I think a good place to start is kind of looking at your diet and making sure that there's not too many of those processed meats that are sneaking in there.

Host 5:03
What are the key nutrients that someone with lupus nephritis should be paying attention to?

Melanie Betz 5:09
Yeah, so as I mentioned earlier, there's really no one kidney diet. And what what nutrients are important to you is very, very dependent on sort of the stage of kidney disease that you have, as well as what your lab values are. I will say that the two nutrients that are sort of universal for everyone is sodium. So everyone with kidney disease, and lupus and actually everyone in general, though, the recommendation for all Americans is to eat a diet that isn't super high in sodium or salt. A good place to start is to try to limit how much sodium you're eating to about 2300 milligrams a day. FYI, the average American is eating somewhere closer to 3500 milligrams per day, so so if you're not intentionally limiting how much salt you're eating, chances are, you're probably eating too much, so that sodium is definitely a big one. And then the next thing is protein. So we live in a very pro protein culture, and we you know, you see extra protein and all these things, and you see protein shakes and bars, sort of touted as healthy foods. But but really, most of us are getting more than enough protein that our body needs. And actually protein should be limited for people who have chronic kidney disease who are not on dialysis. Now, if you are on dialysis, you actually have higher protein needs. But if you have kidney disease and are not on dialysis, you actually probably should be limiting the amount of protein that you eat. So the sodium and protein are good things to start thinking about. After those two, it gets a little bit nitpicky. If you Google what a kidney diet is, you'll probably see a lot of information about potassium. And potassium actually isn't important for everyone. Potassium really only needs to be limited for people who have high blood potassium levels, which usually doesn't happen until the very advanced stages of kidney disease. And in fact, a high potassium diet can be really beneficial in early stage of kidney disease, or if you have lupus and are trying to prevent kidney disease, because we know that people who eat a lot of potassium, which is essentially a lot of healthy fruits and vegetables, tend to have less kidney disease and also better blood pressure control. So potassium is really, really individualized to each person. And then another part of a kidney diet is something called phosphorus. And I could talk for hours about phosphorus alone. But just know that phosphorus that occurs in foods naturally, so things like beans and nuts and seeds, that phosphorus isn't very well absorbed. And so we don't worry about that phosphorus as much. But there is phosphorus added to a lot of different processed foods. So things like processed meats and dairy creamers, and snacky, salty chips, and frozen prepared foods. And those those types of things tend to have this phosphorus added to them. And that phosphorus, probably everyone with kidney disease should be avoided. And phosphorus again, just like potassium is individualized to your labs. And so it's really important to ask your dietitian what's best for you, you may have heard the term "Eat to your labs." I think that's sort of thrown around a lot. And that's what this means. So, you know, eating to your labs means knowing what your potassium level is, knowing what your phosphorus level is, knowing your stage. And so how much you should be restricting protein and all this different stuff. And again, a dietitian is really the best person to help figure out what it makes sense for you and help make sense out of everything that I'm saying right now.

Host 8:42
Well, it's good to know what you're putting in your body, and particularly even whether like you said, whether or not you have kidney disease, lupus nephritis, or even for a healthy person who needs to monitor the amount of sodium and so forth that they take in. So that begs the next question, how can people learn more about what's in their food? What can they do?

Melanie Betz 9:00
Yeah, so since the two big things that I'd probably recommend that people start focusing on are both sodium and protein, the best place to find that is just kind of food label. Um, sodium and protein are required to be on food labels, at least in the United States and most westernized countries and so you can just simply look at the food label and that's especially for sodium very, very important to be looking at because it's really basically impossible to know how much sodium is in your food without that food label. It can be surprising and kind of eye opening when you start looking at that sodium. So that's definitely the first place but of course, there are foods that don't have food labels, right? If you pick an apple up at the you know, in the produce section, or maybe some chicken or something like that, and if if you find yourself in that situation, um, if you just Google "Food Data Central," the very first result will be the USDA database for all things nutrients. They have practically any food you could imagine in there and more nutrients than you've ever heard of before. So that definitely is sort of the gold standard place to go look up things like sodium and protein, and those types of things for things that don't have a food label. And you'll also be able to find potassium and phosphorus or foods in that USDA database as well. So that's definitely a great resource to check out if you want to start counting things and kind of checking in to see how you're doing with these different nutrients. Again, if you just Google "Food Data Central," the very first result in Google will be be the right one.

Host 10:36
So what's your favorite kidney friendly food?

Melanie Betz 10:39
That's a great question. I think I'd probably have to say beans. Beans are a wonderful source of plant protein, which we know tends to be much easier on your kidneys than animal protein. And I just really love beans, I think that they're really versatile. I think you can put them in soups, you can throw them on salads, you can do all sorts of different things. And they're really easy. you can find the no salt added canned beans and open it up, rinse them off, and you're good to go. I think my very favorite thing to do with them is to make homemade dorito bowls essentially. So put some rice in there and then throw some black beans. And then I love to put tomatoes and cilantro and onion, maybe some salsa, a little bit of cheese and a dollop of sour cream and you're good to go.

Host 11:24
Well, as a dietitian, I'm sure you have some good go to recipes or places to find kidney friendly recipes. Can you share that with our audience, please?

Melanie Betz 11:33
Sure, I think I'll put a plug in for my own website, because I do have quite a few kidney-friendly recipes up there. And that's thekidneydietitian.org. I also really love the American Kidney Fund's Kidney Kitchen website. They have a lot of really wonderful, kidney-friendly recipes that are labeled as low sodium or low phosphorus or potassium, so you can kind of figure out what works best for you. Um, so I would check out that resource as well.

Host 12:02
Well, that's very good. I appreciate the information. And then my next question is if someone living with lupus nephritis gets a kidney transplant, should they continue to eat a kidney-friendly diet?

Melanie Betz 12:14
So I would say yes, but likely the kidney friendly diet that someone should be eating after a transplant is very different than what they would be eating before they got the transplant because likely before the transplant, you maybe were on dialysis or had more advanced chronic kidney disease than you do after a transplant, of course. And so I think it is it is definitely important. But that diets likely going to be very, very different and likely way less restrictive than the diet that you were on whether you run dialysis or had advanced chronic kidney disease. A healthy diet can help protect that new kidney, which is which is a really big deal, right? So again, nutrition can help protect or help prevent your high blood pressure or diabetes and generally just keep you healthy to help that kidney going as long as possible.

Host 13:05
Okay, well, here's our final question for this program. And I think one that will be of interest to many people in our listening audience. Can lupus nephritis be reversed with diet?

Melanie Betz 13:17
That's a great question. And then something that I get a lot for kidney disease in general. And I will say that there is, unfortunately, nothing that we can do on that actually that food or medicine can do to reverse lupus nephritis. However, diet and nutrition can play a really, really big role in stopping it from getting any worse. We know that nutrition can can be very powerful in terms of stopping that kidney disease and slowing the progression of kidney disease. So although we can't reverse it, we can help keep it where it is and stop it from getting worse.

Host 13:51
Well, this has been very good information that will certainly be of great interest and assistance to our audience. And I want to thank you very much Melanie for your time today, and for helping us to understand the importance of the diet for kidney health. Our listeners can find more information on lupus on the National Resource Center on Lupus by visiting lupus.org/resources to listen to additional episodes as the expert theories you can visit lupus.org/TheExpertSeries where you can also subscribe to get alerts when podcasts are released. If you would like to speak to one of our Health Educators specialists, you can go to lupus.org/healtheducator or call them at 1-800-558-0121. And finally, to connect with others with lupus from all over the world, check out our online support community Lupus Connect where you can talk with others. Find the emotional support and discuss practical insights for coping with the daily challenges of lupus. You can find the community at lupus.org/resources/LupusConnect. Thank you and have a wonderful day.

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Providing Answers, Support and Hope in Maryland, Virginia and the District of Columbia

The Expert Series: Diet, nutrition, and kidney health