Copyright: Raymond and Audrey Sorensen, 1998. You may reproduce this document in whole or in part without our permission provided that you do not receive any money for it, you do not alter it, and you attribute the authors.

DISCLAIMER
The authors accept no responsibility for the improper use of this program, It is to be used as a guideline only, and is not to be considered medical advice. If you need to be on a renal diet, you should be under the care of a renal doctor and have the advice of a renal dietitian.

CREATING THE PROGRAM
This program was designed by two non-medical people who were suddenly faced with the problem of having to learn about a renal diet. We were told to eat less protein, fewer dairy products, no nuts, and to eat more carbohydrates. We had no idea what to do and had a million questions.
After much anxiety and with the help of a good friend, we got in contact with a dietitian and were put on the right track. There were still problems, though, because just reading labels did not give enough nutritional information. After searching book stores, nutrition stores, the Internet, and asking questions of anyone who would listen, we got the information we needed.
The next problem that arose was how to manage the numbers. Looking up each food item in all this information became very burdensome.
Being computer people, a computer program seemed to be the answer. So here it is. We hope it works for you and will help to relieve some of the stresses of being on a renal diet.

PURPOSE
The purpose of this program is to help you plan daily menus which will provide you with the proper number of calories and amounts of protein, sodium, potassium, phosphorus, and other nutrients that you need, and to allow you as much variety as possible. The program may be used by anyone, healthy or not, wishing to plan and control their diet. We will present some general guidelines, but to know what are the proper amounts of these substances for you as a renal patient, you should see your doctor and renal dietitian.

WHAT THIS PROGRAM DOES
This program will help you figure out what your daily nutritional goals should be - all you do is give the computer some personal information.
This program will allow you to choose what you want to eat from a list of around 700 items.
This program will then produce a menu from your list of foods and will compare their nutritional content with your personal goals. You can then change amounts of food, add or subtract food, until your daily menu is one that is healthy for YOU.
This program will allow you to input your favorite recipe and break it down to the nutritional content for one serving.

Click here for instructions to download the program.

WHY A SPECIAL DIET?
Your kidneys normally remove waste products and extra fluid from your blood which come from the foods you eat and liquids you drink. With reduced kidney function, some of the waste products and extra fluid remain in your blood and increases the workload of your kidneys, which may lead to total kidney failure. However, by following your doctor's orders carefully and by eating a proper diet, you may be able to slow down this process.
You can help control the buildup of waste products and fluid in your blood by following a proper diet and, therefore, decrease the workload of your kidneys. This diet may also help slow down the loss of kidney function.
If you are on dialysis, you will lose a lot of your nutrients and will need to include higher amounts of protein and other nutrients in your diet.
Your doctor and a renal dietitian, who has special training in diet for kidney disease, will work together to determine which areas of your diet should be controlled. The dietitian will direct you in how to do this and will give you the correct goals for your daily menus.

The areas of your diet that need to be controlled might include some or all of the following.

PROTEIN: Your body uses the protein in the foods you eat for growth, building muscles and repairing tissue. If you take in more protein than your body can use, the waste product urea is formed. If your kidneys are not functioning up to par, they may not be able to get rid of the urea. You may need to reduce the amount of protein you eat to avoid buildup of urea in your body. When your are on dialysis, you will need to increase the amount of protein you eat because dialysis removes some protein from your system.

There are two types of protein in food:

High Quality Protein:

• Cannot be made by the body;
• Is needed every day in our diet;
• Is found in poultry, meat, seafood, eggs, milk, cheese and other dairy products.

Rule of thumb for the amount of high quality protein contained in different foods:

• meats: 7 grams per ounce;
• cheese: 7 grams per ounce;
• milk: 1 gram per ounce, 8 grams per serving.

Low Quality Protein:

• Can be made by the body;
• Is found in foods from plant sources such as breads, cereals, other starches and grains, and fruits and vegetables (kidney and like beans are considered low quality protein, but mixed properly with other foods can become high quality protein).

Rule of thumb for the amount of low quality protein contained in different foods:

• starches: 3 grams per serving;
• vegetables: 2 grams per serving.

SODIUM: Sodium is an element which can be used to regulate blood pressure and fluid retention. High blood pressure, kidney disease and sodium are often related.
Sodium is found in almost all of our foods, but we obtain most of our intake from salt in preserved and canned foods and salt added to food at the table or in cooking.

To reduce sodium in your diet:

• eliminate the amount of salt in cooking and do not use salt at the table;
• avoid high salt food such as processed meats (cold cuts, bacon, ham, sausage, hot dogs), canned soups, canned vegetables and salty snacks;
• avoid convenience foods and fast foods;
• read labels.

POTASSIUM: Potassium is an element found in muscles and red blood cells and is necessary for the proper functioning of the heart. The amount needed by the body will vary and depends upon body size, kidney function, and prescribed medications.

Potassium is found in many foods. Foods that are high in potassium are:

• Fruits: Orange, grapefruit, prune juices and nectars, banana, apricots, honeydew, cantaloupe, grapefruit, nectarines, oranges, peaches, tangerines, kiwi, all dried fruits;
• Vegetables: artichokes, pinto, kidney and lima beans, beets, beet greens, broccoli, Brussels sprouts, cabbage, collard greens, Swiss chard, kale, mushrooms, mustard greens, all potatoes*, spinach, acorn, butternut and winter squash, tomatoes (and sauce, paste, juice), pumpkin, yams, zucchini.
• Breads, cereals, starches: bran cereals, Grape Nuts, Fruit & Fiber, fortified oat flakes, wheat germ, rolled oats, whole grain breads, dark or pumpernickel bread, flavored instant cooked cereals.

*To reduce potassium in potatoes: cut peeled potatoes into small pieces, soak them at least two hours in a large amount of warm water, drain, and cook.

PHOSPHORUS: Phosphorus is an element that combines with oxygen and calcium to help build bones. If your kidneys are not able to remove excess phosphorus, the level of phosphorus in your blood may become too high. A high blood phosphorus level may cause you to lose calcium from your bones. This may weaken your bones and cause them to break easily. Eating fewer foods that are high in phosphorus will help control the phosphorus in your blood.

Foods high in phosphorus are:

• dairy products such as milk, cheese, pudding, yogurt and ice cream;
• dried beans and peas such as kidney beans, split peas and lentils;
• nuts and peanut butter;
• beverages such as cocoa, beer, and cola soft drinks.

CALORIES: Calories are very important for giving you energy. Lowering your intake of protein as a pre-dialysis kidney patient will give you fewer calories, therefore, you will need to compensate for this loss. Your renal dietitian will help you find replacement calories. This might include adding fat and sweets which you may have previously been asked to limit.

INFORMATION SOURCES

• Nutrition Almanac/Nutrition Search, Inc. John D. Kirschmann, Director; Lavon J. Dunne. - 3rd ed. "Third McGraw-Hill paperback edition" ISBN 0-07-034912-6 (found in health food stores)
• Food Values of Portions Commonly Used by Bowes & Church -17th ed./ revised by Jean A.T. Pennington. Publisher: Lippincott
• The Pocket Protein Counter by Annette B. Natow, Ph.D., R.D. and Jo-Ann Heslin, M.A., R.D. ISBN 0-671-00380-1 Publisher: Simon & Schuster Inc.
• The National Kidney Foundation
• Microsoft Encarta 98 Encyclopedia (Nutrition, Human)

Search the web on your computer:

http://www.kidney.org/CRN
http://www.renalnet.org/renalnet/esrd

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Click here for sample menu.
Click here for instructions to download the program.