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Diet Plan in Diabetes With Kidney Disease
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DIET PLAN IN DIABETES WITH KIDNEY DISEASE

 

Important aspects to be considered are -

 

CALORIES:

It is also important to make sure that one includes an adequate amount of calories.  Sufficient calories are given without increasing the protein intake by means of giving complex carbohydrates, Cereals in all forms are allowed.

 

PROTEINS:

In general, dietary protein intake should be limited to 0.6 to 0.8 grams per kilogram of body weight each day, for the patient of diabetic nephropathy.

 

FLUID:

Limit the intake of fluids, depending upon the output and the fluid retention. Generally 1000ml to 1500ml is recommended with renal failure. 

Fluids supplied as liquid foods such as milk, tea and soups should be measured and taken into account in the estimation of total fluid allowance. Foods that are liquid at room temperature, such as ice and ice cream, should be counted as fluids if consumed in their melted form.

SODIUM :

The normal kidneys under hormonal control automatically regulate the sodium needs of the body but in kidney diseases the kidneys are unable to excrete the sodium, and so the body electrolyte balance is disturbed. Thereby making it essential to keep a control over the total sodium content of the diet.

Patients with diabetic kidney disease should restrict salt intake to 3-4gm daily i.e 1.2-1.6 gm of Sodium or 51-68 m Eq of sodium chloride.

 

POTASSIUM : 

 

The kidneys excrete about 90% of potassium; with impaired renal functions the ability of the kidney to excrete potassium is decreased. When the kidneys don’t work properly potassium builds up in the body and causes the heart to beat in an irregular manner and may lead to sudden stopping of the heart. Normal diet provides about 3 to 8 gm of potassium daily. In patients with renal impairment a diet restricted in potassium is a necessary along with low protein diet. Potassium is present in almost all foods but is especially rich in high protein foods like milk, meat, eggs, and pulses (whole).

If protein intake is restricted, as is often the case in renal impairment, potassium intake automatically gets restricted. 

 

GENERAL NEEDS OF PATIENTS:

 

Depending on the need of a patient, dietary recommendations and plan has to be modified. In general most patients need to know about :

 

 

1. Salt restriction:

 

The biggest contributor of sodium in the diet is common salt that is use while cooking. By controlling the use of salt one can easily restrict the sodium intake. Along side one also needs to restrict the intake of foods that are high in salt.

 

A list of foods to avoid on a LOW salt diet:

 

  • Foods that list salt (sodium) or MSG on their packaging.
  • Processed or canned pickles, or smoked meats, which are high in sodium.
  • Using salt at the table.
  • Stock cubes, bouillon cubes and gravy granules
  • Packet and tinned soups
  • Tinned vegetables including baked beans
  • Smoked and tinned fish, including salmon, tuna and pilchards
  • Cured meats, including ham, bacon, sausages
  • Cheese, except cottage cheese.
  • Bottled sauces, ketchup, Worcestershire and Tabasco
  • Papad, pickles, salted nuts, namkeens, rock (black) salt
  • Salted butter.
  •  Foods containing baking powder or soda, like cakes, cookies, prepared mixes etc.
  • Spinach, beets, dry fruits, amaranth.

 

Below, the table gives the sodium content of some of the foodstuffs:

Sodium Content in 100 gm Food

Below 25mg

25-50mg

50-100mg

Above 100mg

Semolina- 21.0 mg

Arrow Root-30 mg

Corn-51.7 mg

Leechi-124 mg

Jowar    -7.3 mg

Black Gram –39.8 mg

Bengal Gram Dal-73.2 mg

Lotus Stem-438 mg

Puffed Rice-10.9 mg

Green Gram Whole-28 mg

Beet Root-59.8 mg

Amaranth-230 mg

Samai-8.1 mg

Red Gram-28.5 mg

Spinach-58.5 mg

Muskmelon-104.6 mg

Refined Flour  -9 mg

Bengal Gram (Roasted)-37.3 mg

Cauliflower-53 mg

 

Vermicelli-7.9 mg

Green Gram Dhal-27.2 mg

Coriander-58.3 mg

 

Bajra-10.9 mg

Lentil –40.1 mg

Fenugreek Leaves-76.1 mg

 

Maize Flour-15.9 mg

Month Beans-29.5 mg

Cow's Milk –73 mg

 

Ragi Flour-11 mg

Papaya (Raw)-23 mg

Beef –52 mg

 

Wheat Flour-20 mg

Tinda-35 mg

Liver (Goat)-73 mg

 

Whole Wheat-17.1 mg

Tomato (Green) –45.8 mg

 

 

Cowpea-23.2 mg

Radish-33 mg

 

 

Green Peas –7.8 mg

Carrot-35.6 mg

 

 

Peas Dried 20.4 mg

Jack Fruit-35 mg

 

 

Roasted Peas –14.7 mg

Apple-28 mg

 

 

Onions-4 mg

Banana 36.6 mg

 

 

Colocasia-9 mg

Mango-26 mg

 

 

Potato –11 mg

Mango (RAW)-43 mg

 

 

Sweet Potato-9 mg

Jambu –26.2 mg

 

 

Topioka-7.5 mg

Pineapple-34.7 mg

 

 

Yam (Garadu)–9 mg

Watermelon –27.3 mg

 

 

Bottle Gourd-1.8 mg

Mutton –33 mg

 

 

Cucumber-10.2 mg

 

 

 

Par war –2.6 mg

 

 

 

Brinjal –3 mg

 

 

 

Bitter Gourd-2.4 mg

 

 

 

Ridge Gourd-2.9 mg

 

 

 

French Beans-4.3 mg

 

 

 

Lady’s Finger-6.9 mg

 

 

 

Spring Onion-2.2 mg

 

 

 

Banana (Raw)-15 mg

 

 

 

Pumpkin –5.6 mg

 

 

 

Tomato (Red)-12.9 mg

 

 

 

Guava-5.5 mg

 

 

 

Orange-4.5 mg

 

 

 

Papaya-6 mg

 

 

 

Pomegranate –0.9 mg

 

 

 

Amla-5 mg

 

 

 

Lemon –7 mg

 

 

 

Peach –2 mg

 

 

 

Plum –0.8 mg

 

 

 

Chickoo-5.9 mg

 

 

 

Phalsa-4.4 mg

 

 

 

Pears-6 mg

 

 

 

Buffalo Milk –19 mg

 

 

 

To make salt restricted diet palatable following  may help:

·         Freshly ground black pepper in small amounts.

·         Lemon juice in vegetables, if potassium is not restricted.

·         Ginger, garlic and spring onions with mixed vegetables.

·         Olive oil and vinegar with salad and vegetables in limits.

·         Mustard powder or nutmeg.

·         Different homemade sauces instead of gravy - such as onion sauce made with milk and garlic.

·         Curry and other spices.

 

2.  Proteins :

Protein intake is restricted and should be limited to 0.6 to 0.8 grams per kilogram of body weight each day. Thus a person with 70 kg needs to take 40 to 55grams of proteins per day. Food with a high protein content like white  of egg, sprouts, most non vegetarian  dishes should be restricted.

3. Water intake:

Total intake of fluids, depending upon the output and the fluid retention. Generally 1000 ml to 1500ml is recommended with renal failure.

How to count water intake and how to reduce it

 

Fluids supplied as liquid foods such as milk, tea and soups should be measured and taken into account in the estimation of total fluid allowance. Foods that are liquid at room temperature, such as ice and ice cream, should be counted as fluids if consumed in their melted form.

 

An easy method for estimation of the total fluid intake is:

 

·         Measure the total amount of fluid allowance recommended for 24 hours and fill up a bottle with this.

·         Whenever water is needed, be it for taking medicines or after meals use only from this measured quantity.

·         Now throughout the day whenever any fluid other than water is consumed discard away an equal amount of water from the bottle i.e. the measured water.

·         In this manner it becomes less cumbersome to keep an account of the total fluid intake.

 

4. Potassium restriction:

 

Potassium is widely distributed in foods such as meat, dark green leafy vegetables, whole grain bread, cereals and fruits. Potassium is present in almost all foods but is especially rich in high protein foods like milk, meat, eggs, and pulses (whole).

If protein intake is restricted, as is often the case in renal impairment, potassium intake automatically gets restricted. Most commercially available salt substitutes are very high in potassium. Fruits too have high potassium content so; limit the intake of fruit to 1-2 servings each day and your intake of vegetables to 2 servings each day.

Few Points To Reduce Potassium In The Diet:

 

v      Potassium content can be reduced in vegetables by cooking chopped vegetables in excess water and then discarding off the water.

v      Spices and condiments should be used in small quantities, as they are rich in potassium.

v      Potassium is soluble in water, so the foodstuffs should be thoroughly boiled in water and that water should be discarded.

v      Cheese, paneer, chakka can be used in the prescribed quantities instead of milk as the potassium is lost in the whey.


 

Below, the table gives the potassium content of some of the foodstuffs:

Potassium in 100 gms of Food

Low Potassium 

0 to 100 mg

Medium Potassium

101 to 200mg

High Potassium

Above 200 mg

100 gm Food Items

(mg)

100 gm Food Items

(mg)

100 gm Food Items

(mg)

Cereals

 

Cereal

 

Cereals

 

Semolina

83.0

Jowar

131.0

Bajra

307.0

Arrow Root

20.0

Corn

151.0

Maize Flour

286.0

Root Vegetables

 

Puffed Rice

154.0

Ragi Flour

408.0

Beet Root

43.0

Samai

129.0

Wheat Flour

315.0

Vegetables

 

Refined Flour

130.0

Pulses

 

Green Peas

79.0

Vermicelli

138.0

Bengal Gram (Roasted)

808.0

Fenugreek Leaves

31.00

Root Vegetables

 

Bengal Gram Dal

720.0

Bottle Gourd

87.0

Radish (White)

138.0

Black Gram

800.0

Cucumber

50.0

Carrots

108.0

Green Gram Whole

843.0

Mango (Raw)

83.0

Onions

127.0

Green Gram Dhal

1150.0

Par war

83.0

Vegetables

 

Lentil

629.0

Ridge Gourd

50.0

Cauliflower

138.0

Month Beans

1096.0

Tinda

24.0

French Beans

120.0

Peas Dried

725.0

Fruits

 

Lady's Finger

103.0

Red Gram Dal

1104.0

Apple

75.0

Onion Leaves

109.0

Cowpea

1131.0

Banana

88.0

Beans

117.0

Root Vegetables

 

Guava

91.0

Banana (Raw)

193.0

Colocasia

550.0

Jambu

55.0

Pumpkin

139.0

Potato

247.0

Orange

9.3

Tomato (Green)

114.0

Sweet Potato

393.0

Papaya

69.0

Bitter Gourd

171.0

Tapioca

764.0

Pineapple

37.0

Brinjal

200.

Lotus Stem

3007.0

Pears

96.0

Fruits

 

Yam (Garadu)

237.0

Milk

 

Leechi

159.0

Vegetables

 

Buffalo Milk

90.0

Watermelon

160.0

Amaranth

341.0

 

 

Pomegranate

133.0

Celery Leaves

210.0

 

 

Tomato (Red)

146.0

Coriander

256.0

 

 

 

 

Drumstick Leaves

259.0

 

 

Milk

 

Jack Fruit

328.0

 

 

Cows milk

140

Drum sticks

259

 

 

Goat Milk

110

Green Chilli

217.0

 

 

Non Veg

 

Red Chilli

530.0

 

 

Liver (Goat)

160.0

Fenugreek Seeds

530.0

 

 

 

 

Turmeric

300.0

 

 

 

 

Cumin Seeds

980.0

 

 

 

 

Fruits

 

 

 

 

 

Amla

225.0

 

 

 

 

Lemon

270.0

 

 

 

 

Mango

205.0

 

 

 

 

Peach

453.0

 

 

 

 

Plum

247.0

 

 

 

 

Chickoo

269.0

 

 

 

 

Muskmelon

341.0

 

 

 

 

Phalsa

 

 

 

 

 

Sweet Lime

490.0

 

 

 

 

Coconut Water

314.0

 

 

 

 

Non-Veg

 

 

 

 

 

Beef

214.0

 

 

 

 

Mutton

270.0

 

 

 

 

 

 

 

 


 

Frequently asked questions:

 

Q 1.      Which fruits to prefer ?

A.:        When there is potassium restriction then consume fruits only that are low in potassium such as guava, pineapple, apple, papaya, and pear.

 

Q. 2.     Can LONA salt be consumed in any amount?

A:         No. Although Lona is a salt substitute, half its composition consists of sodium chloride. Therefore one needs to take this into account this fact and then accordingly consume it within the prescribed amounts. 

 

Q. 3.   Which vegetables to prefer ?

A:         As green leafy vegetables have a high potassium content these need some preparation to  reduce their potassium content. Potassium content can be reduced in vegetables by cooking chopped vegetables in excess water and then discarding off the water.

All other vegetables besides these may be safely consumed.

 

Q. 4.     How help full is addition of Soya floor / Besan etc in wheat floor? 

A:         This is not recommended when there is diabetic nephropathy.

 


 

Q. 5.     How can a person know his protein intake?

A:         In general, dietary protein intake should be limited to 0.6 to 0.8 grams per kilogram of body weight each day, for the patient of diabetic nephropathy.

 

Q. 6.     Is milk, butter milk , curd etc is ok,  what to prefer ?

A:         For individuals on a potassium restricted diet curd & paneer are preferred as potassium is leached out in the whey. As is most cases there may be fluid restriction curd and paneer may be used instead of milk to meet the protein requirement.

 

 

 
  
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