I have interstitial cystitis. Can I take organic protein plant supplement before my daily workout at the gym? I am 66 years old. I am losing so much weight with my diet.

It seems that there is not a lot of research into the best dietary approaches according to the interstitial cystitis association web site: http://www.ichelp.org/Page.aspx?pid=995 which advises to have a balanced diet and avoid foods which seem to cause a flare up. Acidic foods, coffee, and alcohol may cause irritation according to Escott-Stump, S. “Nutrition and Diagnosis Related Care”. I don’t see why you couldn’t take your organic protein plant supplement before a workout, unless it is something which bothers you. Best wishes.

Is it fine to substitute plant based proteins for animal based proteins on occasion? My dietitian is against it, but her nutritional text is from 1987. I have read that in other countries like India and Southeast Asia, they eat more beans and lentils instead of meat and do very well. I have concerns with the amount of meat that I have to eat an the amounts o phosphorous and potassium in some varieties of beans are fairly low.

A recent article was in the Journal of Renal Nutrition – Product Update Volume 51 No. 5 2011 pp25-29, “Will the real “super food” please stand up? Legumes and beans”, by Nadiya Lakhami, RD, LD.

This article mentions that research does support the benefit of choosing plant based proteins for people with chronic kidney disease. Another advantage is that the phosphorus in legumes is not absorbed as well as the phosphorus in meats or food additives. The article lists the nutrient values including potassium, phosphorus, and protein for dozens of legumes. While I personally have not worked with many vegetarians on dialysis and no vegans on dialysis, I do think it is possible to substitute plant based proteins for some animal based proteins. Also you mentioned on occasion, not all of the time. Remember that legumes can be high in potassium as well as phosphorus and measure your portion sizes. You can look up food values for legumes also on this web site: http://nutritiondata.self.com/.

Work with your health care team for which choices are best for you.  Getting enough protein and enough high biologic value is a concern for people on dialysis. There are protein supplements and even vegan protein powders which can be used if needed.  

I have stage 4 CKD. My phosphorus level is 4.1(Range 3.6-5.2). Do I have to watch my intake of high phosphorus foods as long as my level remains about the same?

I would suggest you talk to your physician about this. Most of the phosphorus in the body is stored in the bones; the phosphorus in the blood is only a small amount and not a good reflection of your body’s phosphorus stores. The K/DOQI recommendation for phosphorus is 800 – 1,000 mg per day for stages 3 and 4 of CKD.

An elderly friend has just been diagnosed with stage 3 CKD. This was found due to her struggle to control high blood pressure. She would like to know if there is a limitation as to how much water to drink (currently drinking 80 ounces daily). She also notices her skin is very dry & itchy. Is this a side affect of CKD?

I would suggest she asks her physician about this. Since you mentioned she is elderly, she may also have a heart condition which would affect her fluid needs. Itchy skin can occur in dialysis patients from uremia, which is a high BUN level - blood waste products building up in the blood, or a high blood phosphorus level – however I am not sure if these would occur in stage 3 CKD. Dry skin could be related to dehydration, however her physician should assess this for the causes and best treatment to alleviate the discomfort.

What is the current opinion on the low-protein diet for CKD?

A diet which is too low in protein can increase the risk for malnutrition. The current recommendation is 0.8 gm. of protein per kg of body weight, which is the same as the RDA for adults (although typically Americans eat much more protein than this).

I got kidney transplanted 50 days ago. Everything is ok for now. How can I keep my new kidney healthy for a long time?

Congratulations, that is wonderful. I can provide some general guidelines. Often people feel so much better after a kidney transplant, and their appetite improves. It is important to maintain a healthy weight and also be physically active (according to your transplant surgeon’s guidelines). Developing diabetes after a kidney transplant (post transplant diabetes mellitus) occurs in 15% of transplant recipients after one year according to this NKF patient booklet, which will provide more information: http://www.kidney.org/atoz/pdf/new_onset_diabetes.pdf .

Good nutrition and activity can help to prevent this. Some medications to help prevent rejection also may increase blood sugars and blood lipids such as cholesterol and triglyceride levels. Limiting foods with saturated fats, such as whole milk, cheese, cream, fatty meats, and ice cream is recommended: choose fat free, reduced fat, or lean versions of these foods instead. Limiting desserts and avoiding sweetened beverages can help to control weight. You should have access to a registered dietitian at your transplant center, and he or she can help you with your calories needs and recommendations tailored to your medication regimen and past medical history.

My husband is 71 years young and has had type 2 diabetes for years. He was just informed that he has stage 3 kidney disease. He was told to go on a low potassium diet, however, we cannot figure out how to combine a low potassium diet with a diet for diabetes. All of the low potassium diets we have seen recommend white grains (bread, pasta, rice etc), and we have been eating whole wheat or whole grain products for years. We have been trying to follow the mediterannian diet for years which calls for no white food…..is he really supposed to start eating white food now? And, please, how do protein amounts factor into a low potassium diet?

If your husband is advised to limit potassium intake it is best to avoid or limit whole grain foods. To help with blood sugar control, measure portions and also you can try pasta with less digestible carbohydrates such as Dreamfields or Fiber Gourmet. There are many beneficial aspect of the Mediterranean diet which can be beneficial, such as limiting red meats and cheeses, and having a diet with more plant foods. Just choose lower potassium fruits and vegetables. Here is a list of some high and low potassium foods on the NKF web site which may help: http://www.kidney.org/atoz/content/potassium.cfm

Protein foods do contain potassium. Typically milk is limited, and high protein foods within his nutritional needs are included. Please consult with a registered dietitian for more specifics for his needs.

What changes do I need to make now that I have only one kidney, in terms of food and activity?

If you have one kidney and it is functioning well, you want to make sure to have regular checkups with your physician, and have your blood pressure monitored and lab work drawn to check your kidney function tests. You may be at risk for hypertension: try to keep your weight in a normal range and be active based on your ability. The D.A.S.H. dietary plan is a good plan for more fruits, vegetables, low fat dairy products, and limited lean meats and sweets – which can help prevent hypertension. This article from the National Kidney Foundation might be of use to you as well: http://www.kidney.org/atoz/content/nephrectomy.cfm

I had kidney stones in June 2012 – quite large and now I have two more. I was trying to figure out a good diet plan to prevent them from occurring. I know I don’t drink enough water. I also take liquid calcium – is that ok? I don’t think I can give up my morning tea. Is there a kind of tea that has caffeine that is better than others?

Do you know what type of kidney stones you have? Calcium oxalate are the most common. You are right, drinking plenty of water is important too help prevent kidney stones. The recommendation for people with calcium oxalate or calcium phosphate stones is to either get enough calcium from your food, or take a supplement along with a meal. Here is a link to a helpful web site from the National Kidney and Urologic Diseases
Information Clearinghouse: http://kidney.niddk.nih.gov/KUDiseases/pubs/kidneystonediet/index.aspx

As far as which type of tea would be best, this will depend on the type of stones you form. Tea contains oxalates, which should be limited by those who form calcium oxalate stones.

I’m a 23 yr old male with polycystic kidneys, diagnosed at 18 months, with one kidney. What is the best diet for me?

If you have one kidney and it is functioning well, you want to make sure to have regular checkups with your physician, and have your blood pressure monitored and lab work drawn to check your kidney function tests. You may be at risk for hypertension: try to keep your weight in a normal range and be active based on your ability. The D.A.S.H. dietary plan is a good plan for more fruits, vegetables, low fat dairy products, and limited lean meats and sweets – which can help prevent hypertension. Read up on the D.A.S.H. diet here, http://www.kidney.org/news/monthly/Dash_Diet.cfm%20

Star fruit (carambola) can have negative effects for people with renal disease and it may be best to avoid it.