By Nikki Sclafani, MS, RD, LD

*Before adding protein to your diet, check with your dietician.

Why So Much Protein?

You may ask yourself, or even your dietitian, why you need to consume so much protein. I once heard a patient say that if he had to eat one more egg that he would start clucking like a chicken. High-protein diets are typically recommended for dialysis patients since protein is lost during dialysis treatments. The amount of protein in your meals must be enough to replace what you lose during dialysis and to meet your daily needs.

If your diet is lacking protein, your body may begin to break down your muscles as a source of protein. This can lead to a lack of energy, muscle loss and weakness, an increase in the number of infections, slower healing and even swelling, especially of the feet and ankles. Protein is also important for tissue growth and repair and preventing anemia.

How Do I Know If I Need More Protein?

Your albumin level is drawn every month at your dialysis unit and reviewed with you by your dietitian, nurse or physician. Albumin is a type of protein in the blood. When the albumin level is low, typically less than 3.6 mg/dL, it can begin to affect your health. Low levels of albumin are linked to increased rates of hospitalization and early death in dialysis patients. It is essential to eat enough protein so that serum albumin is maintained at the desired level.

How Do I Get More Protein?

There are two kinds of protein: complete and incomplete. You need both kinds of proteins. Complete sources of protein are found in milk, eggs, meat, poultry, fish and seafood, and contain all nine essential amino acids, which are the building blocks of protein. Plant proteins come from vegetables, breads and cereals and lack some of the essential amino acids. That is why their protein is often called “incomplete.” It is recommended that at least 50 percent of your protein needs come from complete protein sources and could even be as high as 75 percent.

What if I Can’t Get Enough Protein Through My Diet?

Because your protein requirements are so high, it may be difficult to consume enough protein through diet alone. Also, kidney failure can often make protein foods taste “funny” making protein consumption difficult. That is why you may need to find alternative sources of protein in order to maintain normal albumin levels. Alternative sources are called “protein supplements.” Your dietitian is your expert in protein supplements and will give you the best knowledge about what supplement is best for you. Protein supplements come in many forms. You can get protein from a drink, powder, bar, pudding or even a cookie. 

What About Protein Drinks?

Protein supplement drinks are one of the most popular choices because they are often the most accessible. You can purchase many of these drinks from your local store. Some popular protein drinks include Boost®, Ensure® and Choice® and come in a variety of flavors. These drinks are not always right for everyone since they do have high levels of phosphorus and potassium. Based on your monthly lab tests, your dietitian will decide if this is the right choice for you.

There are also protein supplement drinks made specifically for the dialysis patient that are low in phosphorus and potassium. However, supplements are usually not available at your local store. Your dietitian usually has samples for you to try before you make the choice to purchase. Once you make a decision, your dietitian will provide you with purchasing information, which usually involves delivery to your home or pharmacy.

What About Protein Powders?

Depending on how you use it, protein powders can add protein to your meal without adding extra liquid or fat to your diet. One of the most difficult restrictions for dialysis patients is limiting their fluid intake. One can of a protein supplement drink contributes approximately eight ounces of fluid. This fluid needs to be added to your total fluid allowance for the day, which does not always leave much room for water, juice or soda. 

In addition, protein supplement drinks add additional calories and fat that may be unwanted for some patients, especially those who are trying to watch their weight. 

There are many protein powders available that do not have flavor, but do have texture. Your dietitian can also provide you with information for purchasing protein powder. Often, your dietitian may have samples for you to try. This will help you decide what protein powder works best. The best way to use protein powder is to mix it with foods or liquids where you cannot notice them, such as hot cereals, casseroles or in sauces.

Suggestions For Using Protein Powder

Before adding to foods, mix powder with a small amount of water to make a smooth paste. This will prevent clumping.

Gradually stir into foods with a texture, like pudding, hot cereal, applesauce, meat or egg salad, casserole dishes or coleslaw. 

Mix with cinnamon and sugar (1/4 cup powder, 2 teaspoons cinnamon, 1/2 cup sugar) and keep in a shaker top jar. Use as a topping on buttered toast, pancakes or waffles.

Stir into coffee as a creamer.

Mix with equal parts of margarine to use as a spread on toast, rolls or hot vegetables. You may also add spices or herbs.

In a blender, mix 1 scoop (scoop size may vary) protein powder with 1/2 cup fruit juice and ice cubes for a refreshing drink. Sweeten to taste.

Did You Say Cookies?

Many of the same companies that make protein supplement drinks and protein powders also make protein-packed desserts, like cookies and puddings. These products have come a long way in taste over the years, however they may not be as desirable as some of the other protein supplement choices available.  

You may wonder about all the nutrition bars lining the shelves of your local grocery store. Be aware that the majority of these bars are not appropriate for a person on dialysis. Many contain very high levels of phosphorus and potassium in addition to other vitamins and minerals that can be dangerous for a dialysis patient. There are nutrition bars that your dietitian can suggest that are easy to order or are available at your grocery store. Again, protein bars have also come a long way in taste and many patients find them more desirable and easier to use than protein drinks and powders.

Before trying any new product, please speak with your dietitian. Your dietitian is there to help you make the right decisions and guide you in the right direction about your diet and overall health. If you tried a protein supplement in the past or are trying one for the first time, remember that there are many products to choose from. If you do not like the taste of one, keep trying until you find one right for you!

Nikki Sclafani, MS, RD, LD, is a Renal Dietitian for Fresenius Medical Care in Glenview, Ill. Ms. Sclafani has worked in the nephrology field for four 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 2004 issue of aakpRENALIFE, Vol. 20, No. 2.

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