By Mrinal Pandit, Chief Dietician, NephroPlus
The Guest on Dialysis needs special attention when it comes to nutrition. The requirement for calories, carbohydrate and fats remains more or less same as compared to those not on dialysis, but the requirement varies for proteins. For normal individuals, the requirement for protein is 0.8 g-1 g per kg body weight per day but for those on dialysis, the requirement is much more.
This will require proper menu planning to incorporate proteins in the diet, understand the type of protein suitable and food groups to be included. The major drawback with high protein diet is it may lead to bloating and gaseous distention, raised blood phosphorus levels and increased body heat. A dietician can help you overcome all these symptoms and guide you in planning your meal taking into account the laboratory investigations and considering your dietary preferences, taboos and religious restrictions.
How much protein?
Those on long term hemo-dialysis need about 1.2 g/kg/Ideal body weight of protein whereas the protein requirement on Peritoneal dialysis can reach up to 1.5 g/kg/Ideal body weight.
For example, if a person on hemodialysis has a dry weight of 60 kg, his protein requirement will be 60 X 1.2 = 72 g/day.
What type of proteins?
More than 50 % of the required protein should come from animal protein to achieve positive nutritional balance. Proteins used more completely in metabolism without raising nitrogen loss are considered to be of higher biological value.
In general, meat and egg provide protein of high biological value, and so do dairy products, whereas protein of plant origin tends to be of lower quality because of incomplete amino acids composition. However, soybean and other legumes e.g. lentil and certain beans and nuts provide very high biological Value (BV) protein. The BV of plant protein may be modified further by other constituents that interferes with digestion.
How much quantity of Dairy Products can we take?
If you are a vegetarian than milk and milk products can help improve your protein intake. It is advisable to monitor your phosphorous levels as excess consumption of milk products can derange you blood phosphorous levels.
How do I manage my protein intake with high phosphorus levels?
Restricted amount of milk and milk products can be taken depending on the phosphorus values. High BV food can be included in your meal on the day of dialysis as prescribed by the dietician.
Are there any High protein supplements available?
Yes. There are many high protein supplements in market which are specially modified to serve the clinical needs of the guest on dialysis. These formulas are high in proteins and less in potassium, sodium and phosphate. The serving size and type of supplement can be decided during your diet recall. Your Consultant / Nutritionist can help you plan the same.
How do I reach prescribed dietary protein if my intake is poor?
Usually, if the appetite is altered due to fever, GI distress, swallowing difficulty or any other reason, and the guest is not able to ingest prescribed amount of protein and calories for more than 2-3 week, the consultant may advice TPN (Total Parenteral Nutrition). The quantity of TPN will depend on the degree of malnourishment, amount of protein to be administered and fluid restriction.
Can I still eat protein if I have Heart disease?
Yes. You can continue with high protein diet even after diagnosed with CVD or Diabetes. Depending on the cholesterol and triglycerides level your Dietician may allow you to eat lean meat with restricted amount of fat.
List of food rich in Protein:
|Cheese||1 Cube||6||130||High sodium content|
|Chicken, boneless||100g/ 3-4 medium size||22||120|
|Dal||100 g, Cooked||7-8||100||High Potassium content|
|Dry Fruits||5-6 in no.s||4||120||High Potassium content|
|Egg Whole||1||6.28||99||High Cholesterol content|
|Fish||100 g / 1 Medium size||20||200|
|Fresh Green Peas||100g||7.2||139|
|Milk||1 Cup 120ml/||3.4||100||Check fluid restriction|
|Skimmed Milk Powder||2 tsp.||3.8||100|
Note: While choosing high protein foods, values for other factors like sodium, potassium and fluid also needs to be considered.