By Akhila Gullapuram, MS, RD, Chief Dietician, NephroPlus Dialysis Centres
Many patients on dialysis are quite aware of the popular fruits which are allowed and safe on dialysis. Whenever I review their monthly labs, some of them tell me that though they have not been eating any fruits, their potassium levels are high. It’s my common observation that patients tend to eliminate eating even allowed fruits at first, in an effort to decrease potassium levels. There are several foods which can cause high potassium levels.
Diabetes and high blood pressure are some of the leading causes of people being on dialysis. Several patients do not eat fruits for fear of spiking sugar levels in the blood. Many diabetics do not see a dietitian to manage their diabetes prior to dialysis. They correlate sweetness of the fruit to increase in blood sugar. Some patients prior to dialysis, learn not to eat any fruit if they were diabetic and want assurance several times before including it on dialysis. Some patients do not eat fruits at all even if their potassium and sugar levels are within the range.
Eating fruits is beneficial to combat the oxidative stress in the body. When oxygen is metabolized in the body to produce energy, the process creates “free radicals”. Free radicals cause cellular damage. Some free radicals are eliminated by the body processes. However, excessive free radicals are linked to certain cancers and heart diseases. Free radicals may also cause some of the degenerative conditions like inflammation of joints, nerve cell damage and acceleration of aging process. Many studies indicate that antioxidant system is impaired and gradually altered with the degree of renal failure. Fruits in general are low in sodium and rich in antioxidant elements which may decrease the oxidative damage in the body.
Eliminating fruits from the diet altogether most of the time without understanding the causes of high potassium or sugar may not be a good decision. Potassium level lower than recommended range can be equally bad. A well planned diet with the help of a dietitian will ensure the required potassium intake and will help to keep the potassium levels in the recommended range. Diabetics on dialysis can plan their diets so that the potassium and blood sugars can be controlled despite consuming some fruit.
Here are three fruits which are safe and beneficial on dialysis. Sometimes when we understand the benefits of eating these fruits, we tend to consciously plan our meals even if it means little more effort and time.
A medium size apple has 45mg of sodium, medium range of potassium and is a good source of fiber and iron.
Apples have compounds like polyphenols, flavonoids and catechins which are rich antioxidants and have anti-inflammatory properties too. Many studies have proven to decrease the risk of cancers due to these compounds. Patients on dialysis are predisposed to heart diseases. Its soluble fiber content can help to decrease total cholesterol and bad cholesterol, and decrease the risk of heart diseases. Insoluble fiber helps to prevent constipation. Apart from cancer fighting properties and fat lowering effects, apples can provide satiety. Its low glycemic index makes it a good choice of fruit for patients on dialysis with diabetes.
1 medium size Guava has 8mg sodium, medium range of potassium and is an excellent source of fiber and vitamin C.
Guavas are inexpensive and available easily. They are rich in phenolic acids, flavonoids and have seven times the recommended range of vitamin C per day! This makes the fruit perfect to fight against any infections such as cold, flu and protect against even cancers. Rich antioxidants can also slow down the aging process. Many dialysis patients have issues of constipation. The rich insoluble dietary fiber in guavas can resolve the issues of constipation. Well planned meals on dialysis which include guavas as part of the meals can lower the bad cholesterol effectively. High fiber in guavas makes it suitable for diabetics.
1 cup of papaya chunks have 9mg of sodium, medium range of potassium and are a very good source of fiber, vitamin A & C.
Papaya’s rich color can make its inclusion in a meal plan very interesting. It has excellent antioxidant capacity and builds healthy immune system. Its soluble fiber is higher than apples and decreases high cholesterol and heart diseases. Its insoluble fiber, although lower than guavas, is still very effective in improving digestive health. Many studies have associated papaya with reduced colon cancers. Certain enzymes in papaya are known to provide anti-inflammatory effects as well.
There are other fruits which can be included in a meal plan carefully planned by your dietician. If one is prepared to learn potassium needs of the body and the ways to obtain it, the limited choice of fruits may be expanded.