By Amy McCallister, RD

"Well, what can I eat?"

Every dietitian has heard it; every kidney patient has said it. Often referred to as the Low-Everything diet (low potassium, low phosphorus, low sodium, low fluid and, of course, controlled protein), the renal diet has an incredibly negative connotation. It is time for a new, updated and positive program of good eating. This will allow the person with kidney failure to live well with chronic illness and its treatment. Kidney failure is an intense journey that involves many lifestyle changes, including dietary changes. This is where your dietitian can offer you information, support and hope in your journey toward good food choices.

Who is your renal dietitian? He or she has a specialized degree in dietetics and is required to pass a national exam to be deemed a Registered Dietitian (or RD). Your dietitian is an active part of the medical team during pre-ESRD treatment, dialysis and transplantation. The RD can enable and empower patients to feel in control of their own health. With a little help from the RD, a little moderation and a little planning, you can feel in control of your diet and still enjoy meals by making good food choices.

Experts on the psychology of eating explain that when restrictions are placed on anything, including food, what a person will want most is this forbidden food. You should not have to deprive yourself of your comfort foods or favorite foods. With this in mind, discuss the foods you like with your RD. He or she can assist you in developing a meal plan or menu to fit your preferences and your lifestyle. With the knowledge of appropriate portion sizes, rarely is there a forbidden food.

It is essential to know your monthly lab values to make good food choices. Pay special attention to potassium, phosphorus and protein levels. It is just as important to become well versed in the amounts of potassium, phosphorus, protein and sodium found in the foods you eat. Make an effort to know and understand your potassium level and how much potassium is in certain fruits and vegetables. With this knowledge, you can work with the RD to schedule a cheat-time for your favorite high-potassium food. Your dietitian has many tricks-up-the-sleeve, such as using nondairy creamers as a substitute for milk on cereal or freezing grapes to help control thirst. Remember, one renal diet does not fit all. Discuss your degree of dietary flexibility with your RD.

Kidney failure can create changes in one's personal identity. With a "special diet," you may feel different from your family and friends. To avoid becoming a short-order cook, your RD can develop meal ideas that are healthy for you and your family. For example, a simple dinner of grilled herbed chicken, a green leafy salad and steamed rice can be a healthy meal for many. A weekend breakfast of poached eggs, English muffins and chilled berries can also be a good choice for you and your family. Involve your close family or friends in developing healthier eating habits with the RD.

Not only can the RD help you make good food choices at home, he or she can also offer ideas for dining out, parties and potlucks. Plan, plan, plan ahead! Become familiar with the restaurants you frequent; ask how a food is prepared, or ask that it be prepared without salt. Your knowledge of potassium and phosphorus also comes in handy here. Restaurant food can be loaded with salt, causing thirst and excess fluid intake. The server only thinks she is being nice by refilling your glass! Just simply let her know you've had plenty to drink. Call ahead to ask about the selection of foods they offer. Also, ask your dietitian for publications regarding dining out. For parties and potlucks, it is not a bad idea to eat a small meal at home beforehand so as to not indulge once the festivities begin. You could also bring a few kidney-friendly dishes using recipes from your RD (one great source is www.ikidney.com). Work with your RD to relieve any anxiety about dining out!

Finally, with 15,000-20,000 new food products hitting the market each year, including green ketchup and oatmeal made for women, it is important to utilize your RD for the most current and reliable nutrition information. Keep an ongoing list of diet-related questions for your dietitian, especially if you only see the RD weekly or monthly. Discuss any new foods or supplements with your RD before delving into the unknown.

Your RD is trained and experienced to help you discover what you can eat and the proper amounts. Living well means eating well. Utilize your dietitian to find ways to include your favorite foods, understand your monthly lab values and create new ideas for eating out and at home. The renal dietitian is there for you and will help you in your journey toward good food choices.

Amy McCallister is a registered dietitian for Fresenius Medical Care in Phoenix, AZ. Amy has worked closely with Native American and Hispanic dialysis populations in northern and central Arizona and is currently pursuing her board certification as a specialist in renal nutrition.

This article originally appeared in the March 2002 issue of aakpRENALIFE, Vol. 17, No. 5.

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