By Nikki Sclafani, MS, RD, LD Should I worry about fat and cholesterol in my diet? As a dialysis patient, it may be harder to limit your fat and cholesterol intake because of the increased need for protein. A low protein level can lead to a number of complications including an increase in the number of infections, slow healing, decreased energy levels and muscle weakness, which over time can cause muscle loss. It can also cause swelling, which occurs especially in the feet and ankles. Albumin is a type of protein in the blood that your dialysis unit checks when your labs are drawn. Ask your dietitian what your current albumin level is. If protein is so important, how do you eat enough of it without also eating too much fat and cholesterol? First, it is important to know what all these terms mean. Let’s look at some common types of fat you may or may not be familiar with. Fats in Your Foods: Fat is one of the three nutrients that supply calories to the body. Fat provides nine calories per gram (protein and carbohydrates each provide four calories per gram). In addition to providing calories, fat helps in the absorption of certain vitamins. Small amounts of fat are necessary for normal body functioning. However, since fat is so high in calories, it should be eaten in smaller amounts. Depending on their chemical structure, fats are primarily saturated or unsaturated. Saturated fat is found in butter, meat, lard, milk, cheese, coconut and palm oils, shortening and hydrogenated fats (fats found in processed foods). Saturated fats raise blood cholesterol levels more than anything else in the diet. Unsaturated fats are usually liquid at room temperature. Monounsaturated and polyunsaturated are two kinds of unsaturated fat. When you substitute unsaturated fats for saturated fats, you may help to lower your blood cholesterol levels. Monounsaturated fat is mostly found in foods from plants, such as olive oil, canola oil, nuts, olives, avocados and fish. Polyunsaturated fat is mostly found in plants, such as safflower, sunflower, corn, soybean, sesame and cottonseed oils. Polyunsaturated fat is also found in the oils of seafood, which is referred to as fish oil or omega-3 fatty acids. Cholesterol is only found in animal foods, such as egg yolks, milk, cheese, liver and other organ meats and in fatty meats. Dietary cholesterol, like saturated fats, tends to raise blood cholesterol levels, which increases the risk for heart disease.
Fats in Your Body: The term lipids is another word for fats and is usually used when describing the different types of fats in your body. Lipids include cholesterol, HDL, LDL and triglycerides. Cholesterol is a waxy, fat-like substance made in your liver. Cholesterol is always present in the body and essential for normal body functioning. The human body obtains cholesterol from two sources: the cholesterol it manufactures and from foods eaten. Remember that cholesterol is present only in foods of animal origin. Lipoproteins are protein-coated packages that carry fat and cholesterol through the blood. Lipoproteins are classified according to their density. High Density Lipoproteins (HDL) contains a small amount of cholesterol and carries cholesterol away from the heart and tissues to the liver where it is excreted from the body. HDL is often referred to as “good” cholesterol. Low Density Lipoproteins (LDL) contains the largest amount of cholesterol in the blood. LDL is responsible for depositing cholesterol in the artery walls. High levels of LDL are associated with an increased risk for heart disease and are often referred to as “bad” cholesterol. Triglycerides are the type of fat you burn for energy and store as body fat. You are more likely to have heart disease if you have high levels of triglycerides in your blood.
Where should my lipid levels be? Unfortunately, dialysis increases your risk for heart disease. The target levels for the various lipids are different from those who are not on dialysis. What foods should I limit in my diet? Here are some ways to lower fat and cholesterol in your diet. Meat, Fish, Poultry, and Eggs Limit high fat meats such as bacon, sausage, hot dogs and lunchmeats. Choose baking, broiling, steaming or stewing instead of frying. Trim visible fat from all meats and remove the skin from poultry. Choose lean cuts of meat like round, sirloin and tenderloin. Drain all liquid from ground meat after cooking then place meat into a strainer and rinse under hot water. Try egg substitutes or using the egg whites rather than the whole egg. If you need the yolk to enjoy your eggs, try half of an egg yolk with two egg whites.
Fats Decrease the amount of margarine, butter, sauces and gravies you use in cooking and at the table. Use nonstick pan sprays when cooking and reduced fat or fat free margarine for table use. Choose vegetable oils like olive and canola when cooking or baking rather than hard shortening. Unsweetened applesauce or plain yogurt can be used as a fat substitute when baking. Replace part of the fat in your recipe with an equal amount of applesauce or yogurt. Fat in recipes for baking can usually be reduced by 1/3 without affecting the taste or quality of the finished product. Use water to dilute condensed soups. Chill gravies or soup broth. Hardened fat can be taken off before using. If you are in a hurry, cool gravy or broth slightly and drop in a few ice cubes. Fat will harden around the ice and then can be removed.
Dairy and Nondairy Products (limit according to your meal plan): Use skim or low fat milk instead of whole milk; choose low or nonfat dairy creamers. Choose fat free, reduced fat or skim milk cheeses and cottage cheese.
What else can I do in addition to changing my eating habits? There are also a few other things that you can do to help lower your risk for heart disease. First, maintain a healthy weight. Weight loss often has a big impact on all lipid levels. Next, get moving. Regular exercise can help to raise those HDL levels, remember that is your “good” cholesterol. Also limiting your intake of alcohol and sweets can help to lower your triglyceride levels. Your dialysis clinic will usually draw your cholesterol and triglycerides a couple of times throughout the year. If you have not had HDL and LDL levels drawn, ask your dietitian or nurse if these tests are available for you at your clinic. Nikki Sclafani, MS, RD, LD is the Clinical Support Specialist for Bone Care International. Ms. Sclafani has worked in the nephrology field for three years. The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care. This article originally appeared in the September 2003 issue of aakpRENALIFE, Vol. 19, No. 2.
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