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Diet in Dialysis: Myths & Realities

Myths & Realities

nephroplus | July 1, 2016

By Mrinal Pandit, Chief Dietician, NephroPlus

Get the scoop and the truth behind common dialysis diet related misconceptions.

Myth: As salt is restricted in dialysis diet, patients can use salt substitute with no quantity restriction.

Reality: If you are advised to restrict potassium intake be careful about using salt substitutes as most of them are high in potassium. Irrespective of the type of salt you use, quantity restriction will always be there. General recommendations for salt or salt substitute will depend on your clinical parameters. Check with your doctor or dietitian before using any salt substitute.

Composition of some commonly available salts per 100 gm.

 

Brand Name Sodium content in g Potassium content in g
Lona 23 28
Sendhav 38 5
Lite Salt 33.2 7.8
Common Salt 38.7 0

Myth: Low hemoglobin count in ESRD patients is only due to poor intake of iron rich foods.

Reality: Erythropoietin prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. When function of the kidneys is impaired, they do not make enough erythropoietin. As a result, the bone marrow makes fewer red blood cells, causing anemia. The other factors which can lead to anemia are iron, B12 and folic acid deficiency.
Unfortunately, oral dietary intake of iron does not play major role in elevating the hemoglobin level as iron given intravenously does. So even if high iron content foods are ingested in the diet it will not make much change in Hb level.

Myth: Intake of rice in diet increases fluid retention.

Reality: This is a very common myth I come across when I go for unit visits. There is no evidence to support this myth. Brown rice and hand milled rice are high in potassium and phosphorus due to the presence of barn. Once the barn is separated from the kernel the refined white rice can definitely be a part of your meal when you are on dialysis. Rice is better digested than wheat products due to absence of gluten. Rice has very low content of sodium, potassium and phosphorus as compared to other cereals and millets.

Myth: Ragi Malt is good for health and controls heat.

Reality: Yes, Ragi malt helps controls body heat. It is very good drink to beat rising temperature. Daily consumption of malt is not recommended in ESRD as it is high in potassium. And moreover it is thin in consistency which adds to fluid retention.

Myth: In ESRD, low protein diet will help decrease the waste product accumulation in the body.

Reality: Depending on the GFR the stage of kidney function can be determined and the amount of protein to be ingested can be planned. When GFR reduces, waste product from protein digestion builds up in the body. In this case protein restriction is required. In ESRD, dialysis is required to take over the failed kidney functions. The good thing about regular dialysis is, it removes all the waste and toxic products from the body and the bad part is, it loses around 6-8 grams of good proteins per session. A high protein intake is required to replace the protein loss and maintain health.

Myth: You can eat whatever you want when on dialysis.

Reality: All the foods can be taken in moderation if clinical parameters are in normal limit.

Myth: Urine output is less because of less fluid intake.

Reality: The urine output can be less due to stage of kidney disease, sweating, water loss during dialysis session. If the kidney is not functioning well, drinking excess water will not increase urine output. On the contrary, body will retain excess fluids and lead to unnecessary complications.

Myth: Low sodium levels are due to restricted salt intake.

Reality: It is observed that low food intake for many days leads to drop in blood sodium level. Diet as per recommendation by a Nutritionist can help you maintain electrolytes within normal limits. Do not increase the consumption of table salt without consulting your doctors as this may have a bad impact on blood pressure and lead to water retention.

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