Chronic kidney disease (CKD) is a long-term condition where the kidneys don’t work as well as they should. In some circumstances, the loss of kidney function can get progressively worse over time but CKD only reaches an advanced stage in a small proportion of people. Although the damage is irreparable, sometimes if changes are made, CKD can be halted with no further damage occurring.

Chronic Kidney disease (CKD) is divided into 5 stages.
Stage 1 is the earliest stage whereby tests have indicated some level of kidney damage. It is important not to ignore a stage 1 diagnosis as this is the time to take action and make lifestyle changes so that the condition does not worsen. With every increase in stage, more kidney damage has been detected up until the last stage, stage 5. Stage 5 means the kidneys have lost almost all their function and it will be time for thinking about dialysis or a transplant.

What to do if your recent blood test shows a reduced kidney function.
Don’t panic, absorb the diagnosis and understand this doesn’t definitively mean your kidneys will stop working altogether. CKD should not be ignored as it can get worse over time but with careful monitoring and management it can be maintained and you can live long fulfilling lives without being unduly affected by the condition.

It is important to review your lifestyle and in particular, your diet. With early stage CKD (stages 1-3) it is paramount to be as healthy as possible and have a healthy balanced diet.

What do  I mean by a healthy balanced diet?

This includes: 

1. Consistently eating freshly cooked food for every meal
2. Limiting your intake of processed foods and avoid highly-processed foods
3. Reducing your daily salt intake
4. Having considered balanced meals – your lunch and dinner meals should contain proteins, carbohydrates and vegetables. Your portion size will depend on your  weight and if you have diabetes
5. Ensuring you have a minimum of 2-3 portions of fruits and vegetables each and every day
6. Increasing your intake of plant based proteins such as beans, lentils, tofu, soya, seitan 
7. Drinking lots of water to remain well hydrated (ensure your urine runs clear)
8. Being as active as physically possible for you
9. Avoiding non-steroidal medicines such as ibuprofen, naproxen etc.

What is a renal diet?
You may have heard of the term, renal diet. The term is used quite widely amongst those who have CKD, but personally, I am not a fan of this term. It doesn’t really mean much and can often be misused. People often think it means a diet of low protein, low salt, low potassium and low phosphate – which is pretty hard to do all at once and not always necessary. 

People newly diagnosed with CKD in particular often restrict their diet in a panic unnecessarily and in combination with online resources not being clear enough, this can cause a lot of confusion.

My advice would be to seek guidance from someone like myself, a dietician who can look at your lifestyle and individual health and work out a personalised diet plan. This will be much more achievable and as well as not feeling so overwhelming, you’ll only have to limit the foods you absolutely need to.

How do you monitor CKD?
The best way to monitor CKD is to have regular tests, either blood or urine. How often you require testing will be dictated by the stage of CKD. Your GP will determine what is best for you and it is best to ask them any medical and testing questions rather than your dietician who will focus solely on your lifestyle and diet.

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Ruth Kander is a kidney-specialist dietitian, to book an appointment with her please click here.

Weight loss has become a thriving industry and we’re bombarded constantly with unhealthy FAD diets, weight loss programmes, influencers selling teas and pills all promising to help us lose weight. Many of these are promoting quick fixes which are not advised by doctors or dieticians. It can be really hard to know what information to trust. To help navigate the sea of information (and misinformation!) surrounding weight loss, we have asked one of our GPs, Dr Belinda Griffiths, and our dietitian, Ruth Kander, their advice on how to lose weight safely and successfully. 

Firstly, it is important to note that weight loss should be consistent and gradual as it can be dangerous to lose too much weight too quickly. Dr Griffiths suggests that “a safe weight loss is 1-2 lbs or 0.5-1kg per week… Greater weight loss than this per week can lead to malnutrition, exhaustion, increased risk of gout and gallstones.” There is also an increased risk of developing an unhealthy relationship with food which, in extreme circumstances, could lead to eating disorders. 

Ruth added, “Losing weight gradually and at a healthy rate is key.” Remember, it’s all about consistency! Perseverance will amount to healthy lifestyle changes which will allow you to achieve your weight loss goal. 

Don’t underestimate diet

Both Dr Griffiths and Ruth agree that diet is the most important factor when it comes to weight loss. As Ruth explains; “having a healthy balanced diet that is lower in calories than our body uses is a good way to start the weight loss journey. If we don’t reduce calorie intake, one won’t lose weight:.”  – this is known as being in a calorie deficit. The amount of calories that will result in weight loss will vary from person to person and depend on the amount of exercise the individual does. In order to lose weight, you will need to burn more calories than are consumed and therefore restricting your calorie intake is the simplest way of losing weight. 

Foods to focus on

Ruth recommends that “people should focus on a variety of foods when trying to lose weight”. While Dr Griffiths suggests, “focusing on a range of lean proteins (including meat and fish), vegetables, high fibre foods (such as quinoa, bran flakes etc) and fruit in moderation”. Vegetarians can substitute in lentils, nuts, beans and tofu instead of meat and fish. In general, high calorie foods such as fried food, cakes, biscuits, chocolate and sugary drinks should be avoided. 

Let’s get physical!

Although weight loss is still achievable without much exercise, incorporating exercise into your lifestyle will not only aid weight loss, but will generally improve your overall health. Any exercise is better than none whether it be tennis, swimming, or even walking, “whatever you are capable of, just do it!” is Dr Griffiths advice. Ideally, a combination of exercise is best for weight loss – this includes cardio / fat burning and resistance or weight training. Get those steps in! An easy way to incorporate more exercise into your daily routine is by aiming to walk at least 10,000 steps per day. This easy change can make a big difference and remember, as Dr Griffiths says “the more exercise you do, the greater calories are burned” – it’s as simple as that!

Don’t forget about NEAT movements! 

NEAT (or Non-exercise activity thermogenesis) movement refers to the physical movement we do day-to-day that isn’t necessarily planned exercise and “encompasses the energy that we expend by simply living”.This includes the calories we burn breathing, eating, sleeping etc. Dr Griffiths suggests that “you can increase NEAT movement easily in your everyday life by making simple changes such as taking the stairs rather than the lift, by standing rather than sitting, by walking instead of taking the train/ bus/ tube or even by carrying bags rather than having items delivered”. It all adds up! These simple swaps will increase the number of calories you burn and help facilitate weight loss. 

What to do when you plateau

The first stint of weight loss can make it seem a little too easy as you tend to lose weight more easily in the beginning, but a common issue lots of people face is when weight loss reaches a plateau. This is where you stop losing weight to the same extent you were before, or stop losing weight for a period of time. This can feel disheartening and more often than not, people tend to give up at this stage. Dr Griffiths states at this point “it is a case of persevering with calorie restriction and regular exercise and gradually weight loss will resume.” If it doesn’t, Ruth suggests “ looking at what you’re eating to see if anything has slipped”. She states “maybe you’re not taking into consideration extra calories here and there” but they all add up. See if there are any areas of your diet where you could be a little stricter, or consider starting or upping your exercise. 

Sleep and Stress

A good night’s sleep and keeping your stress levels down will be your friend when it comes to weight loss. “In order to lose weight, you need to be in the correct frame of mind and life circumstances” says Ruth. Research has shown that you tend to eat more and make poorer food choices, including seeking comfort food, when you are sleep deprived. This is because not getting enough sleep “disrupts the hormones in your brain (Leptin and Ghrelin) that control appetite” says Dr Griffiths. 

Stress can also play a part in weight loss as Dr Griffiths explains that “stress increases cortisol levels which increases gastric acid output and makes you feel anxious and hungry”. Ruth adds “there is also a theory that being stressed can limit weight loss in terms of hormonal activity in the hypothalamic-pituitary axis which can lead to the release of hormones that can limit weight loss”. Keeping it simple, “to lose weight, good sleep and minimal stress would be ideal”. 

Final thoughts

Trying to lose weight can seem complicated, confusing and difficult, but when you really break it down, the ingredients to losing weight successfully are actually very straightforward. If you stick to these simple rules and you are patient and consistent, the weight will come off and you will achieve your goals. 

If you feel that you are doing everything right and you still aren’t losing weight, or are even putting weight on, there could be something else causing this. You may have an undiagnosed underlying medical condition and we’d advise you to visit your GP to make sure everything is well. 

If you would like any extra support with your weight loss, why not book an appointment with Ruth. Or if you have any concerns over your health, please book an appointment with one of our GPs.

How to Stay Healthy This Winter

When the temperature drops outside, it’s tempting to reach for comforting, high-calorie food and avoid exercise. Feeling cold, along with short days and weight gain can lead to the onset of Seasonal Affective Disorder or depression in the winter months.
Fleet Street Clinic’s Consultant Dietitian, Ruth Kander BSc (Hons) gives some practical advice on what you can do to avoid the winter blues.

Consume a Variety of Foods

By eating foods from all the food groups, you will have all the nutrients you need to stay healthy and keep winter germs at bay whilst maintaining your energy levels.

Eat Plenty of Fruits and Vegetables 

These will give you vitamins and minerals to help your body fight winter bugs. Vitamin C is especially beneficial in the fight against colds and sore throats.  Avoid taking supplements which contain high concentrations of vitamins which can lead to medical problems. Fruit and vegetables high in vitamin C include kiwi, citrus fruits, spinach, pumpkin and sweet potato. Zinc is also a good mineral to help fight winter infections and boost the immune system. Foods containing zinc include fish, oysters, poultry, eggs, milk, unprocessed grains and cereals. If you’re short on time, using a blender to create a vegetable and fruit drink is a great way to pack your diet full of vitamins. Try combining lettuce, cucumber, spinach, ginger, berries and a dash of orange juice and water for a zingy, low-sugar start to the day.

Keep the Pantry Cupboard Well Stocked

Good foods to store include:

• Tinned beans and lentils
• Tinned tomatoes
• Whole-wheat pasta
• Brown rice
• Couscous and noodles
• Wholegrain cereals – for example, Porridge and Weetabix

Plan Your Meals

Make soups and casseroles in advance and freeze. That way you can come home to a nutritious meal in the evenings. Simply take out of the freezer in the morning so that they are ready to heat up after work.

Watch Portion Sizes 

To avoid eating too many carbohydrates, try eating your meals at the table with the TV turned off, use smaller plates and reserve half your dinner plate for vegetables. If you want more after your first serving, have some soup or more hot vegetables.

Stay Active

It’s tempting to reduce your exercise regime in the colder months. But small efforts can go a long way to help stave off winter weight gain. Going for a regular, brisk walk or using an exercise video at home can be enough to maintain your weight and stay healthy over the winter.

Drink Plenty of Fluids

Try to avoid getting dehydrated. This can make you feel overly tired and unnecessarily run down. Drink plenty of fluids throughout the day that are either low calorie or calorie-free – aim for 2 litres a day. Be aware that your daily hot drink from the coffee shop can contain 360 calories or more!
Looking for an alternative to still water? Try green tea, regular tea, herbal teas, regular coffee, hot no added sugar cordial or lemon water.

Consult Fleet Street Clinic

Ruth Kander holds a virtual clinic every Friday from 9am-2pm for individual dietitian consultations and ongoing weight management courses. Please call our reception team on +44 20 7353 5678 if you would like to request a face-to-face appointment

Book Your Dietitian Appointment with Ruth

November is Mouth Cancer Awareness Month, and Fleet Street Clinic has collaborated with the charity campaign MouthCancer.org to help raise awareness of the disease.

For more information about Mouth Cancer, you can read the Q&A’s below.

What is Mouth cancer?

Mouth cancer relates to cancer found in the lips, tongue, cheek and throat.

There are, on average, almost 7,800 new cases of mouth cancer diagnosed in the UK each year. The number of new cases of mouth cancer is on the increase, and in the UK has increased by over half in the last decade alone.

Who is at risk?

Mouth cancer is twice as common in men than in women, though an increasing number of women are being diagnosed with the disease. Age is a factor, with people over the age of 40 more likely to be diagnosed, though more young people are now being affected than previously.

People with mouth cancer are more likely to die than those having cervical cancer or melanoma skin cancer. Prognosis is good if the disease is caught early.

What can cause mouth cancer?

Although mouth cancer can affect anybody, around 91% of all diagnoses are linked to lifestyle. This means that by amending our lifestyle choices, we can help cut the chances of developing mouth cancer.

There are many known contributors to mouth cancer:

• Tobacco
• Alcohol

Many cases of mouth cancer are linked to tobacco and alcohol.

If tobacco and alcohol are consumed together the risk is even greater.

• Over-exposure to sunlight can also increase the risk of cancer of the lips.
• Poor diet is linked to a third of all cancer cases. Book a Dietitian Consultation
• Experts suggest the Human Papilloma Virus (HPV), transmitted through oral sex, could overtake tobacco and alcohol as the main risk factor within the coming decade. Book Your HPV Vaccine

What is the link between HPV and cancer?

There’s growing evidence that an increasing proportion of cancer is caused by HPV infection in the mouth. Around 1 in 4 mouth cancers and 1 in 3 throat cancers are HPV-related, but in younger patients, most throat cancers are now HPV-related.
HPV doesn’t directly give you cancer, but it causes changes in the cells it’s infected (for example, in the throat or cervix) and these cells can then become cancerous.
The HPV vaccine, Gardasil 9 is available at Fleet Street Clinic for both girls and boys. The vaccine was developed to fight cervical cancer, but it is likely that it’ll also help to reduce the rates of mouth cancer.

It is advisable to give the HPV vaccine before sexual activity starts to get the best protection. The underlying principle being there has been no exposure to any HPV strains yet. You can, however, receive the vaccination later on in life, this is down to personal choice. We’d recommend a GP consultation to discuss the HPV vaccine prior to booking.

More information on Gardasil 9.

What are the signs of mouth cancer?

Mouth cancer can appear in different forms and can affect all parts of the mouth, tongue and lips. Symptoms of mouth cancer include:

• A painless mouth ulcer that does not heal normally
• White or red patch in the mouth or on the tongue
• Any unusual lumps or swellings that linger
• 1 or more mouth ulcers that don’t heal after 3 weeks
• Pain when swallowing
• A feeling as though something’s stuck in your throat

Be mouth aware and look for changes in the mouth:

It is important to visit your dentist or your GP if these areas do not heal within three weeks.

How can mouth cancer be detected early?

Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. If mouth cancer is recognised early, then the chances of a cure are good.

It is also advised to self-check regularly for any noticeable changes in your mouth, the inside of your cheeks, the front and sides of your neck, colour and texture changes of your tongue, changes to your lips and finally, lumps and swellings on your head and neck.

How can I keep my mouth healthy?

• It is important to visit your dentist regularly, as often as they recommend, even if you wear dentures. This is especially important if you smoke and drink alcohol.
• When brushing your teeth, look out for any changes in your mouth, and report any red or white patches, or ulcers, that have not cleared up within three weeks.
• When exposed to the sun, be sure to use a good protective sun cream, and put the correct type of barrier cream on your lips.
• A good diet, rich in vitamins A, C and E, provides protection against the development of mouth cancer.  Plenty of fruit and vegetables help the body to protect itself, in general, from most cancers.
• Cut down on your smoking and drinking.

If you have any concerns about mouth cancer, you can book a GP appointment or a dental appointment with Temple Dental.

With thanks to mouthcancerawareness.org 
Statistics via Mouth Cancer Foundation Org

January is a great time to take control of your eating and help yourself to be a healthy you with the food you eat. Eating a more plant-based diet is undoubtedly recommended by many of the health professionals, however, it is essential that a healthy approach and balance is taken. Switching to a vegan diet can be unhealthy as well as healthy. In a vegan diet, it is essential to take note of particular nutrients that can get missed out which can lead to serious health consequences.

Protein

It is easy to not eat enough protein in a plant-based diet. Your body needs essential amino acids to build proteins and be healthy, so you should ensure you have a wide variety of proteins in your diet, such as:

• Soya
• Beans
• Lentils
• Seitan
• Quinoa
• Tofu
• Tempeh
• Nutritional yeast

Calcium

Calcium is an essential mineral for bone health. Insufficient calcium can lead to weak bones and bone fractures. Try and include as many calcium-containing foods each day. When choosing plant dairy alternatives try and choose those which are fortified with calcium. For milk look for at least 127mg calcium per 100g plant milk.
Foods that contain calcium include:

• Green leafy vegetables
• Tofu
• Bread
• Fortified plant milk
• Cauliflower
• Nuts
• Oranges
• Fortified plant based dairy alternatives

Iron

Iron is another essential mineral required for good health. Iron is a component of red blood cells. If we don’t eat enough iron then we can develop anaemia. This can cause severe tiredness, lethargy and generally feeling unwell.

Plant-based sources of iron include:

• Lentils
• Beans
• Tofu
• Tempeh
• Nuts
• Green leafy vegetables
• Fortified breakfast cereals

When eating these food, have with a food or drink high in vitamin C such as kiwi fruits or strawberries as these will enhance the absorption of iron.  Avoid tea and coffee as this limits absorption of iron.

If you think you don’t get enough iron a simple blood test can confirm this, do check with your GP.

Vitamin B12

Vitamin B12 is the only vitamin present in animal food products.

There are some vegan products fortified with B12 such as;

•   Nutritional yeast 
•   Yeast extract e.g., Marmite
•   Breakfast cereals

If you have been vegan for some time, it may be worth considering a blood test to check your B12 levels. Discuss this with your GP.

Iodine

Iodine can be low on a vegan diet and can affect thyroid function. Sources of plant iodine include:

• Seaweed
• Iodized salt

Omega-3

Omega-3 containing foods, especially those high in alpha-linolenic acid (ALA)  are involved with helping the body produce longer-chain omega-3s such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Foods high in ALA include:

• Chia
• Hemp
• Flaxseeds
• Walnuts
• Soybeans

However, there is controversy as to whether this conversion is good enough to meet everyday needs. Some suggest a daily intake of 200–300 mg of EPA and DHA from an algae oil supplement may be a better way to prevent low levels, however, always check with your GP before starting any supplements.

Zinc

Zinc is required for overall good health but in particular for healthy hair and nails. Plant sources of zinc include:

• Beans
• Chickpeas
• Lentils
• Tofu
• Walnuts
• Cashew nuts
• Chia seeds
• Ground linseed
• Hemp seeds
• Pumpkin seeds
• Wholemeal bread
• Quinoa

By Ruth Kander BSc(Hons)RD | Dietitian

If you wish to discuss ways to maintain a healthy vegan diet or are thinking of becoming a vegan, Ruth holds a virtual clinic every Friday from 9am-2pm. Please call our reception team on 020 7353 5678 if you would like to request a face-to-face appointment

Book Your Dietitian Appointment with Ruth.