Chronic kidney disease (CKD) & Diet

08.03.2022 Category: Dietitian Author: Ruth Kander

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.

Winter Nutrition Advice

01.11.2019 Category: Dietitian Author: Ruth Kander

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 020 7353 5678 if you would like to request a face-to-face appointment

Book Your Dietitian Appointment with Ruth

Veganuary

01.01.2019 Category: Dietitian Author: Ruth Kander

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.

How to reintroduce meat and alcohol back into your diet after your January challenges

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Dry January

01.01.2019 Category: Dietitian Author: Ruth Kander

Dry January grows in popularity year on year.

The campaign by Alcohol Change UK, encourages participants to give up alcohol for the entire month of January.

The dry January one-month booze-free challenge can have a significantly positive impact on your health.

Alcohol has proven to increase the risk of developing a range of health problems (including cancers of the mouth, throat and breast) and that risk increases the more you drink on a regular basis.

Ruth Kander, our dietitian, looks at what is considered a safe amount of alcohol consumption.

The UK Chief Medical Officers’ (CMOs) guideline for keeping health risks from alcohol to a low level for both men and women states that:

  • It is safest not to drink more than 14 units a week on a regular basis.
  • Regularly drinking as much as 14 units per week, it’s best to spread your drinking evenly over three or more days. 
         – If you have one or two heavy drinking episodes a week, you increase your risk of death from long-term illness and injuries.
  • Cutting down the amount you drink, a smart way to help achieve this is to have several drink-free days a week.

A useful website for more information about alcohol is www.drinkaware.co.uk

What is a unit of alcohol?

1 Unit of Alcohol as recommended by Drinkaware - Fleet Street Clinic, London

How long does alcohol stay in your body?

On average, it takes about one hour for your body to break down one unit of alcohol, however, this can vary, depending on:

  • Your weight
  • Whether you’re male or female
  • Your age
  • Your metabolism – how quickly or slowly your body turns food into energy
  • How much food you have eaten
  • The type and strength of the alcohol you have consumed
  • Whether you’re taking medication and, if so, what type
  • It can also take longer if your liver isn’t functioning normally

If I am on medicines can I drink alcohol?

People taking sedative drugs (like diazepam/valium) or antidepressants (like fluoxetine/Prozac) should avoid alcohol altogether.

There are some antibiotics; metronidazole and tinidazole which just do not mix with alcohol – drinking with these will make you sick. But for most commonly prescribed antibiotics, drinking is unlikely to cause problems so long as it is within the low-risk alcohol unit guidelines.

People taking long-term medications should be careful about drinking, as alcohol can make some drugs less effective and long-term conditions could get worse. Examples of long-term medications include drugs for epilepsy, diabetes, or drugs like warfarin to thin the blood.

(From www.drinkaware.co.uk)

What are the consequences of drinking too much alcohol?

  • Low mood/mood swings
  • Liver problems
  • Heart problems
  • Cancers (mouth, tongue, throat, oesophagus)
  • Weight gain
  • Poor sleep
  • Blood pressure instability

By Ruth Kander BSc(Hons)RD | Dietitian

If you wish to discuss ways to maintain a healthy diet and reduce your alcohol consumption, 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

How to reintroduce meat and alcohol back into your diet after your January challenges

Read more

How to reintroduce meat and alcohol back into your diet after your January challenges

01.01.2019 Category: Dietitian Author: Ruth Kander

So Veganuary and Dry January are over… what happens next?

With your January healthy challenges over, you may be feeling healthier and refreshed knowing you have managed to stay vegan and/ or teetotal for 1 month. For some of you these new eating and drinking habits are here to stay but for many of you, it is now time to reintroduce meat and alcohol back into your diet safely.

A key theme to remember is everything in moderation!

What you eat and drink forms the backbone of maintaining a healthy lifestyle, which should always be the goal of any dietary alterations. Everyone’s dietary needs are different depending on their age, size and activity so there are no concrete rules to follow.

Read my top tips on how to reintroduce food and drink safely back into your diet.

Veganuary Tips:

Plant proteins are low in fat and high in fibre which is great for your gut health and cholesterol so following Veganuary these should continue to play a key part in your diet. 

It is important to reintroduce food gradually and to start light. For the first few weeks stick with a predominantly plant protein diet and begin by introducing eggs and dairy initially. Move on to poultry and fish as these are easier for the body to digest than red meat but are high in healthy proteins. You will get the benefit of high-quality proteins and you won’t be missing out on iron.

Red meat is not bad for your body in moderation but it is calorie dense and the body digests it slower than any other food group. Your body won’t be used to the high protein content of red meats at the moment so introduce them in small quantities at first, building up so not to aggravate your digestive system.

Dry January Tips:

With regards to alcohol, it’s always nice to have a glass of wine with a meal or to relax at the weekend. But moderation is key. Try to keep within the limits of 14 units a week for both males and females and have frequent alcohol-free days throughout the week. It is important to remember not to have 6 alcohol-free days and save all 14 units to be consumed in 1 day, spread the 14 unit out evenly across the week.

An example of  responsibly consuming alcohol could look like:

Weekly Alcohol Plan

Monday Alcohol-free
Tuesday 1 medium glass wine or equivalent
Wednesday 1 medium glass wine or equivalent
Thursday Alcohol-free
Friday 3 medium glass wine or equivalent
Saturday 2 medium glass wine or equivalent
Sunday Alcohol-free

*175ml (Medium Glass) = 2 Units / 250ml (Large Glass) = 3 Units

1 Unit of Alcohol as recommended by Drinkaware - Fleet Street Clinic, London
1 Unit of Alcohol as recommended by Drinkaware 

Drinking alcohol on an empty stomach will make you hungrier and increases the likelihood of snacking and unhealthy eating. It is much more preferable to drink alcohol with a meal as eating will distract you and make you fuller meaning you’ll consume less alcohol. 

By Ruth Kander BSc(Hons)RD | Dietitian

If you wish to discuss ways to maintain a healthy vegan diet or would like more advice on how to reintroduce food back into your diet, Ruth can help. You can book a dietetics appointment online.