The Expert Series: Diet and Nutrition for Healthy Kidneys
Diet and Nutrition for Healthy Kidneys
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Host 0:03
Welcome everyone to the first week of Lupus Awareness Month. All month we're going to be highlighting ways in which lupus can be different for everyone and in many ways how the symptoms are invisible, and we are going to make lupus visible. So if you were joining us today it is our first week of Lupus Awareness Month we're really focusing on lupus in the kidneys, and we are very excited about our partnership for tonight's event with American Kidney Fund.
Lupus can affect any organ in the body and that includes the kidneys and when the kidneys become involved with lupus they call it lupus nephritis, and up to 40% of people who are diagnosed with lupus will have lupus nephritis at the time of diagnosis, and up to 50 to 60% of people will have some kind of kidney involvement during the course of their disease. So this is an extremely important topic if you have lupus or if you think you might have lupus or if you have a loved one with lupus.
Tonight is the night to learn about nutrition and how you can support kidney health if you have lupus nephritis. So without any further ado, we're gonna hop right in and I'm going to welcome our guest, Melanie Betz. She 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. She also manages the website, thekidneydietitian.org, where she aims to provide an easy to understand science based nutrition information to the public about kidney disease and kidney stones.
She's also a member of the American Kidney Fund’s dietitian advisory group, and helps to guide and review AKF’s kidney kitchen content and resources. Her research interests include effective education strategy, plant based diets, frailty, and people with kidney disease as well as effective nutrition interventions to prevent the risk of kidney stones. So if you are just now joining us, we are so excited that Melanie is on our side and we can get right to it. Welcome, Melanie.
Melanie Betz 2:12
Thank you for having me on. I'm so excited to be here.
Host 2:16
Yes, we are so excited. I mean, it's just such a pleasure to have you all working with us today and really focusing on diet nutrition with kidney so just to kind of put this out there, there's not necessarily a lupus diet. But we know that what you put in your body is really important and if you are someone who is suffering with kidney disease, there might be some things you can do in your diet with your nutrition that can help support your kidney health. So to get us started on the first question, let's figure out what can happen to the kidneys of lupus nephritis so if someone was living with lupus nephritis. Melanie, what could happen if their kidneys stop working well?
Melanie Betz 2:53
So I think it's really important to know that if you have lupus nephritis kidney disease is sort of a spectrum and it's not like if you have lupus nephritis you have kidney failure. There is a lot of space in between those two sorts of diagnoses. If lupus does impact your kidneys so much that you do have kidney failure, then you will likely need either a kidney transplant or to just start dialysis. But like I said, that does not happen for most people. In fact, nutrition is a really, really big part of helping kind of slow down that disease progression and helping keep your kidneys as healthy as possible for as long as possible.
Host 3:42
That's a great answer that really gets a spectrum of what to kind of expect. So what role does diet play in keeping the kidneys healthy when someone has lupus nephritis and specifically, are there some key nutrients that someone with lupus nephritis should be paying attention to?
Melanie Betz 3:58
Yeah, definitely. And before I dive into that, I think it's also really important to know that based on that stage of kidney disease, like I was talking about before, kind of how well your kidneys are working, a kidney friendly diet is very, very different. But some nutrients that you and your dietitian likely will sort of address or that would be brought up in a kidney friendly diet…the first one is sodium. I think that's probably the most common one, right? We all know that sodium and salt tends to be pretty bad for your kidneys. And so it's probably just good practice for all of us to try to avoid eating too much salt. So trying to aim for no more than about 2,300 milligrams per day is a good goal, which is no easy task. The average American eats around 4,000 milligrams of sodium. A whole lot more than what any of us should be eating. So that's the first one.
And then the second one is protein. So we know that people who eat a lot of protein specifically from animal sources, tend to have faster progression of kidney disease. And so if you have lupus nephritis that is one of the really important things that you can do to kind of slow down how fast that kidney disease or lupus nephritis progresses. And then there's some other sort of nitpicky things, but I would say those are kind of the two big things that probably work with your dietitian on.
Host 5:27
That's really, that's really important. Actually, you just answered the questions that popped up into the chat about, you know, are there certain things to watch for to slow the progression of kidney disease. So protein is important for that, right?
Melanie Betz 5:38
Yep, protein and it's not that we want to totally cut protein out of the diet. But we want to avoid very large amounts. And similar to sodium, most of us are eating much, much more protein than we need. The average American eats around 70% more protein than what would be recommended for someone with lupus nephritis scores for kidney disease. So yeah, so just trying to be careful that you're not having super large portions specifically of animal protein. So things like pork or those types of things.
The other really important thing to think about when we're talking about slowing progression of kidney disease is that fruits and vegetables sort of do the exact opposite of what protein does to our kidneys, they kind of help our kidneys work better. So truly the more fruits and vegetables that you can get in your diet, the better. So that's another thing to think about.
Host 6:30
That's a really good point. Okay, so when you mentioned a little bit about the protein itself, it made me think, you know, we've heard the phrase “to eat to your labs”. What, what does that mean?
Melanie Betz 6:44
There’s lots of different labs that your doctor is checking and that your dieticians would be looking at to sort of individualize that diet, for protein and probably, they might be looking at something called your BUN, your blood urea nitrogen. If that's really high, that might indicate that you might need to cut back protein a little bit. They also might be looking at something called your GFR, glomerular filtration rate, which actually sort of helps classify you into those different stages of kidney disease that I was talking about before.
And if your GFR is very low, then that might indicate that it's even more important for you to cut back how much protein you're having. Another lab they might be looking at is something called potassium. And if your blood potassium gets high, then you might need to cut back on how much potassium you're eating. But if it's not high then you don't need to cut back potassium. So kind of in a nutshell, there's some other ones but those are probably the big ones when we talk about “eat to your labs”. And that's why it really does get super nitpicky, and that's why it's so important to work with a renal dietician and really help kind of figure this all out for you because there are lots of different things that are going on.
Host 8:00
It kind of shows us that you can't really look at one one diet that's recommended even for people with kidney disease because there can be variations. I love that “eat to your labs”. So thanks for telling me.
Melanie Betz 8:14
Yes, there's no one kidney diet. It really is different for everyone, for sure.
Host 8:18
That’s pretty wild. Well, okay, so there's no kidney diet. Well, what about someone coming from the chat, I have a question. Someone who's had a kidney transplant and so they are going to start adding some protein back into the diet and some sodium foods back into the diet. Do you have recommendations for good healthy options that will have some sodium in them that’s okay?
Melanie Betz 8:44
Yeah, absolutely. I think so, if you've had a kidney transplant, then chances are you really do get to sort of liberalize your diet and you might be able to enjoy some of the foods that you had to limit before which is so wonderful.
There are so many different things. I would probably recommend checking out the American Kidney Fund’s kidney kitchen, which is a wonderful resource and there's so many really delicious looking recipes. It's a lot more exciting than just like, I don't know, boring like meatloaf, although there will be lots of really exciting looking things out there. We can probably put the URL on the chat, but I think it is https://kitchen.kidneyfund.org, if I remember correctly. Yep, there it is. It’s got really great recipes there and then that resource also kind of classifies the recipes based on high potassium, low potassium high protein so you can really learn how to “eat to your labs” and find recipes that suit your specific needs.
Host 9:49
Gosh, I love that. I'm gonna check out that thing. Because now I'm just thinking about the average American eating too much sodium. So I'm sure that's a pretty good diet and recommendations, recipes for a lot of people.
Okay, so if you're just tuning in, this is we're talking with Melanie Betz from American Kidney Fund. She's a dietitian who helps people with kidney disease to really eat better. And she's sharing with us some answers to some very pressing questions that we have received over time. So thank you so much for joining us. So another question that I have is journaling systems. So you know, with people who have lupus, they can have the flares, then go into remission. And we often as health education specialists say it's a great idea to journal flares, potential triggers, because that's really good information to take back to your provider. Is this something that you'd recommend with diets? And if so, do you have any recommendations for how to do it?
Melanie Betz 10:57
I think it's different for everyone. So when we think about journaling in terms of nutrition, we tend to think about tracking things like tracking exactly how many calories and how much sodium and protein and phosphorus and all that sort of stuff that you're eating. And I think maybe for a short amount of time, it can be useful to sort of get into your flow, like when you're first starting out and you're like, “Gosh, I have no idea how much sodium I eat, I have no idea how much protein and I just kind of need to get a handle on it.’ I think it can be a useful tool for a short amount of time. But that's definitely not something that I would recommend doing forever. Because that's no way to live to be that sort of nitpicky about everything that you're eating. And I suppose we kind of get in a pattern and you kind of know the foods that are high and low and it all sort of evens out at the end. So I think it can be a really useful teaching tool, but I don't recommend it for most people doing it long term because it's just not very fun and it takes the joy out of eating, quite frankly.
Host 11:55
Yeah, that makes total sense. Okay, well, that's really good advice for someone who's getting started. Okay, so then let's jump back a little bit to some other questions. What about water consumption? Do you really need to make changes to water consumption, if a person has kidney disease? We know that there's swelling sometimes. So what do people need to do for that or be mindful of?
Melanie Betz 12:19
For the vast majority of people that have kidney disease, until you're in those very advanced stages, you actually don't need to restrict water. In fact, you actually want to make sure that you're drinking enough water because dehydration can hurt the kidneys further. And so you actually want to make sure that you're doing a lot. Again, unless you have very advanced kidney disease or you have other health conditions like maybe liver failure or heart failure, then you would definitely have to cut back how much water you're drinking. But for most people, you actually want to drink a lot. Obviously ask your doctor what was best for you but that's generally what we recommend.
Host 12:56
That's great to hear. I'm glad to kind of get that cleared up. So if you're just joining us today, we have a few more minutes left, a few more questions for Melanie Betz of the University of Chicago and also want to just mention it's Lupus Awareness Month, so you'll want to check out some of those activities with Lupus Awareness Month you can go to this link. And we are joined today with American Kidney Fund. So we're really excited that you guys are all here. A couple of questions for you. This is really great. This is going to be recorded so I am very excited about that. What is your favorite kidney friendly food?
Melanie Betz 13:34
There’s so many. I also just love food, so it's really hard.
Host 13:39
I mean, most dietitians love food. I mean, it's why you do what you do. And even with restrictions, you can still love food, right?
Melanie Betz 13:49
Yes, so we were talking about protein. I'm going to give you a little bit of a lesson with this. So we talked about protein and how that can be harmful to the kidneys, but plant proteins are less harmful to our communities. And my favorite way to recommend plant proteins is usually in sort of like Tex Mex type dishes. I find that beans, you know, they just go really well.
So the first thing that came to mind was actually sort of like a veggie taco, which is very appropriate because it’s 5 de mayo. I love to recommend doing just some corn tortillas because those tend to be a whole lot lower in sodium. And then roast maybe some carrots or cauliflower and poblano peppers tossed with a little bit of olive oil and some delicious spices like cumin and chili powder. Just roast those and use that as your taco then you can still put maybe a little salsa, maybe a little cheese, maybe a little sour cream depending on what you like or what your needs are. But I'd say veggie tacos have to be my very favorite kidney-friendly food.
Host 14:56
Yes, and I can tell that it's like almost dinnertime. So hopefully anyone who's getting some good ideas that they can go to kitchen.kidneyfund.org. So then thinking about that food, we know that dining out can be a huge trap for people who are trying to watch what they're eating. What recommendations do you have for dining out? What should people order?
Melanie Betz 15:28
Yeah, that's a tough one. I think probably the biggest concern when you're eating out is the amount of sodium that tends to be in the food. Just because restaurants add a whole lot more salt generally than we would add when we're cooking at home plus their ingredients tend to be higher in sodium. Like mostly they are not using a piece of chicken, mostly they’re using like a piece of chicken that's been pumped full of sodium, and usually phosphorus and potassium containing things as well.
So I think my biggest advice there is to do your homework before you go if you are worried about it. Most restaurants have nutrition information online. So you can literally look down that sodium column and try to put together at least the lowest sodium options that you can. Making little switches like you know, getting vegetables instead of fries or asking for dressing on the side. You know, those things seem small, but they really really add up when you look at the total amount of salt that you're eating.
So I would say just kind of do your homework and make the best choices that you can and also realize like it's one meal and just kind of enjoy yourself. Make the best choices but don't stress, and it's maybe not perfect and exactly what you would have would have cooked at home. Just enjoy yourself.
Host 16:45
I mean it is not necessarily something people are doing right now. But you know, maybe sometime in the future, right? I mean, we definitely still need to keep that in mind as we're kind of opening back up and stuff.
Okay, that's, that's really helpful. Let's see, I have a couple more. All right. We have a couple more minutes here. So I want to make sure that I get them in okay. Okay, so, you know, we health education specialists get questions a lot about foods that can help to take away, stop or reverse lupus. So can lupus nephritis be reversed with diet alone?
Melanie Betz 17:27
No, unfortunately, no. But it can have a lot to do with stopping it from getting any worse. And pretty much any type of kidney disease whether it be lupus nephritis or otherwise, we're always talking about slowing the progression. And what your dietitian and your nephrologist or kidney doctor would be doing is all about stopping it from getting any worse.
Host 17:52
That's good to know. Well, and I think anyone out there who's listening in I would really also recommend you know, checking out some of the resources with the Lupus Foundation of America. You can also check out all the great resources that can be found at the American Kidney Fund.
So my final question here. So you've shared a lot of really good information about diet and the things that we can really, you know, watch what they're eating. What piece of advice or recommendation would you leave people with who have lupus nephritis or have some kind of kidney involvement with their lupus?
Melanie Betz 18:46
I would say my biggest piece of advice is, if you're interested in eating more healthily for your kidneys, is to meet with a real dietitian. It is never too early. Your kidney issues are never too mild to start making changes. And so I would say ask your doctor to meet with a renal dietician and if they don't have one to recommend for you, go find one. There's a lot of dietitians that have virtual practices and we're all sort of used to sitting on zoom right now anyway. So doing your homework and meeting with them, a kidney dietitian, to make sure that you really are eating a diet that makes sense for you. Like I said, there's so many different aspects to this and it's so different for different people, you really want to make sure that whatever you're doing makes sense for you, and that you're not over restricting and you're not taking out things that you don't have to because that's no fun.
Host 19:41
That totally makes sense. Well, I would invite everyone to check out your website, thekidneydietitian.org. And then the American Kidney Fund (kidneyfund.org) as well and our lupus nephritis hub for anyone that has questions. Thank you so much, Melanie, for joining us today and for sticking through some technical difficulties so we could put together a great set of answers for folks out there. I'm really just thankful that you were able to join us and thank you to the American Kidney Fund for joining us and being our partners during Lupus Awareness Month. And for those of you who may be new to AKF, their mission is to fight kidney disease on all fronts to help those affected with kidney disease to live healthier lives. You can learn more about AKF by visiting them online. Thank you all so much for joining us. We appreciate your time.