Published on June 9th, 2020 | by Michaelw0
Why your RENAL DIET is all wrong
Hello, this is Katherine, welcome to 00Kidney.
There’s a lot of dangerous misinformation about the renal diet out there,
so today I’ll show you why you should eat more bananas, mangos and even oatmeal to repair your kidneys.
And I’m not even kidding, alright?
These foods are full of healthy antioxidants, fiber and vitamins, they can even lower your blood pressure.
But, as you may already know, in order to avoid High Potassium and phosphorus Levels, Kidney Disease patients are told by their doctors to completely avoid healthy fruits such as Banana, mango, orange and even many healthy whole grains, such as oatmeal and quinoa.
This will not only make your life harder; it may also make it harder to improve your kidney health.
And I’m not the only one thinking it this way.
There’s science to prove what I’m saying. I’ll show you in a moment.
Watch on Youtube: https://www.youtube.com/watch?v=_nYu2YG6Wvg
Because, saying that bananas are not bad for a kidney patient may seem a strong statement, I know,
but I’ll show why I’m convinced potassium in fruit is not the potassium you should be worried about.
And I’ll also show you how to use this info at your advantage, to repair your kidneys.
Because, you know, when I see patients starting to take care of themselves, advocating for their health and eating in an informed way, I’m always positive that they’re going to get the best outcome possible.
References and sources of the studies in the video
Khanagavi J, Gupta T, Aronow WS, et al. Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes. Arch Med Sci. May 12 2014;10(2):251-257. An JN, Lee JP, Jeon HJ, et al. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care. Nov 21 2012;16(6):R225. Jain N, Kotla S, Little BB, et al. Predictors of hyperkalemia and death in patients with cardiac and renal disease. Am J Cardiol. May 15 2012;109(10):1510-1513. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. Aug 15 2005;62(16):1663-1682. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. Mar 2011;26(3):377-384. Chaitman M, Dixit D, Bridgeman MB. Potassium-Binding Agents for the Clinical Management of Hyperkalemia. P T. Jan 2016;41(1):43-50. Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nat Rev Nephrol. Nov 2014;10(11):653-662. Kovesdy CP. Epidemiology of hyperkalemia: an update. Kidney Inter. 2016;6:3-6. Sarwar CM, Papadimitriou L, Pitt B, et al. Hyperkalemia in Heart Failure. J Am Coll Cardiol. Oct 04 2016;68(14):1575-1589. Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. ch Intern Med. Apr 27 1998;158(8):917-924. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. Oct 15 2013;62(16):e147-239. Schaefer JA, Gales MA. Potassium-Binding Agents to Facilitate Renin-Angiotensin-Aldosterone System Inhibitor Therapy. Ann Pharmacother. Jun 2016;50(6):502-510. Sarafidis PA, Blacklock R, Wood E, et al. Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. Clin J Am Soc Nephrol. Aug 2012;7(8):1234-1241. Sterns RH, Grieff M, Bernstein PL. Treatment of hyperkalemia: something old, something new. Kidney Int. Mar 2016;89(3):546-554. Allon M. Disorders of Potassium Metabolism. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation's Primer on Kidney Diseases. Sixth ed. Philadelphia: Elsevier Saunders; 2014:90-99. Kovesdy CP. Management of Hyperkalemia: An Update for the Internist. Am J Med. Dec 2015;128(12):1281-1287. VELTASSA [Package Insert]. Redwood City, CA, USA: Relypsa, Inc. Relypsa. Veltassa Media Fact Sheet. [Fact Sheet]. 2015; http://www.relypsa.com/file.cfm/111/docs/Veltassa_MediaFactSheet_Dec16.pdf. Accessed February 13, 2017. AstraZeneca. FDA accepts for review New Drug Application for sodium zirconium cyclosilicate (ZS-9) for the treatment of hyperkalaemia. 2016; https://www.astrazeneca.com/media-centre/press-releases/2016/fda-accepts-for-review-new-drug-application-for-sodium-zirconium-1810201. Accessed February 13, 2017, 2017. Epstein M, Pitt B. Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer. Expert Opin Pharmacother. Jul 2016;17(10):1435-1448. Pitt B, Bakris GL, Bushinsky DA, et al. Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors. Eur J Heart Fail. Oct 2015;17(10):1057-1065. Anker SD, Kosiborod M, Zannad F, et al. Maintenance of serum potassium with sodium zirconium cyclosilicate (ZS-9) in heart failure patients: results from a phase 3 randomized, double-blind, placebo-controlled trial. Eur J Heart Fail. Oct 2015;17(10):1050-1056. Sarafidis PA, Georgianos PI, Bakris GL. Advances in treatment of hyperkalemia in chronic kidney disease. Expert Opin Pharmacother. 2015;16(14):2205-2215. Ben Salem C, Badreddine A, Fathallah N, Slim R, Hmouda H. Drug-induced hyperkalemia. Drug safety. Sep 2014;37(9):677-692. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med. Sep 2000;109(4):307-314. Noize P, Bagheri H, Durrieu G, et al. Life-threatening drug-associated hyperkalemia: a retrospective study from laboratory signals. Pharmacoepidemiol Drug Saf. Jul 2011;20(7):747-753. Rabelink TJ, Koomans HA, Hene RJ, Dorhout Mees EJ. Early and late adjustment to potassium loading in humans. Kidney Int. Nov 1990;38(5):942-947. Agarwal R, Afzalpurkar R, Fordtran JS. Pathophysiology of potassium absorption and secretion by the human intestine. Gastroenterology. Aug 1994;107(2):548-571. Moranne O, Froissart M, Rossert J, et al. Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol. Jan 2009;20(1):164-171. Einhorn LM, Zhan M, Hsu VD, et al. The frequency of hyperkalemia and its significance in chronic kidney disease. Archives of internal medicine. Jun 22 2009;169(12):1156-1162. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. Aug 5 2004;351(6):585-592. Adams KF, Jr., Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. Feb 2005;149(2):209-216. Luo J, Brunelli SM, Jensen DE, Yang A. Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function. Clin J Am Soc Nephrol. Jan 07 2016;11(1):90-100. United States Renal Data System. 2016 USRDS annual data report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,. 2016. NIH. Kidney Disease Statistics for the United States. 2016; https://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-disease-statistics-united-states.aspx. Accessed February 10, 2017. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive Summary: Heart Disease and Stroke Statistics--2016 Update: A Report From the American Heart Association. Circulation. Jan 26 2016;133(4):447-454. Centers for Disease Control (CDC). National Chronic Kidney Disease Fact Sheet, 2017. https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf. Accessed June 9, 2017. Tuot DS, Plantinga LC, Hsu CY, et al. Chronic kidney disease awareness among individuals with clinical markers of kidney dysfunction. Clin J Am Soc Nephrol. Aug 2011;6(8):1838-1844. Plantinga LC, Tuot DS, Powe NR. Awareness of chronic kidney disease among patients and providers. Adv Chronic Kidney Dis. May 2010;17(3):225-236. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factors Surveillance System (BRFSS). Website. Retrieved May 6, 2015 from http://www.cdc.gov/brfss/index.htm
And let’s see why I’m telling you this.
There are three things than can cause your potassium levels to raise at the point of causing symptoms.
This is called hyperkalemia, a dangerous condition caused by too much potassium.
Things that can cause it are
- dietary factors (high-potassium foods, additives, and salt substitutes)
- inability of the kidneys to filter excess potassium
- prescription drugs (such as (ACE) inhibitors but also beta-blockers ARBs and more)
But what’s really causing an unbalance in your potassium levels is just one of these things, IN MOST OF THE CASES.
It’s prescription drugs.
They call it drug-induced hyperkalemia, and it is considered the most important cause of high potassium in everyday clinical practice.
So the first two things can contribute to hyperkalemia, but the prescription drugs are what’s causing the problem, ok?
And this is important because nephrologists and dietitians always tell their patients to watch out for potassium in what they eat,
but how many doctors educate their patients about the bigger dangers posed by these drugs?
Because these drugs are well known to cause high potassium levels. Since they make it harder for the kidneys to remove potassium.
And there are several studies telling us exactly what pills are going to create the greatest dangers for hyperkalemia or high blood potassium levels.
Because a wide range of drugs can induce hyperkalemia, but the main culprits are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).
And maybe your doctor told you that you need to avoid potassium in your diet if you want your heart to keep beating.
What he should have told you instead is “I’m giving you pills that will mess your blood potassium levels up. But, hey, if you die it’s not my fault, it’s that half banana you’ve eaten three weeks ago.”
Ok. this may be not funny, but overprescribing it’s not funny either.
So, what medications I’m talking about exactly:
Blood pressure drugs called angiotensin-receptor blockers (ARBs), ARB medications including losartan, telmisartan, valsartan, and irbesartan are the most likely medication to raise your potassium levels.
Blood pressure drugs called ACE inhibitors. These are blood pressure medications ending in “-il” like lisinopril, enalapril, and quinapril.
And also beta-blockers such as Sectral, Tenormin.
All these medications are used to treat high blood pressure, very common in kidney disease patients, but can cause your kidneys to retain potassium, ok?
So these 3 classes of drugs are the main responsible for high blood potassium levels in kidney patients.
Not bananas, ok?
And a disclaimer, but this is very important, since I’m talking about medications.
I know you may be tempted to just stop taking these pills, if you’re taking them.
DON’T do it. It’s really dangerous to stop taking any medicine on your own. Especially if we’re talking about medications for your heart.
Discuss all medicines that you take with your doctor.
But, in any case, there’s already something very interesting to learn here: if you don’t take these medications, chances are that you can already have all the bananas, spinach, mangos and avocados you want.
Or at least with some portion control
Now you may ask, how is this supposed to help me improving my kidney health?
Because, yes, maybe learning new things about how the kidneys work can be interesting, but…
if you’re here it’s because you want to improve your kidney health, right?
So, what’s to learn from this.
First of all, your diet is not responsible for your potassium levels .
And, in addition to impairing nutrition status and quality of life, advising patients to limit or avoid many plant-based foods, especially fruit and vegetables, may contribute to metabolic problems.
Conditions like an higher oxidative stress on the organs, inflammation, swelling, metabolic acidosis and higher blood cholesterol are all associated with a diet poor in these potassium rich fruits.
Limited potassium intake can also cause your blood pressure to raise.
What I’m basically saying is that it’s true that you can repair your kidneys eating more bananas.
Now, before starting to add potassium rich foods to your diet, get tested for potassium levels.
And consult your doctor.
If you want to know more about how to understand blood potassium levels and what foods are rich in potassium, watch this video up here.
But there’s another point to make here.
If you are actually taking one or more of these medications that are messing up your potassium levels, don’t worry, not everything is lost.
You can still find ways to reduce your need for these medications, if you can lower your blood pressure in other ways.
A better diet and lifestyle changes can greatly help you. I’ve talked more in depth about this in this video up here.
And, if nothing else works, there are still two options left:
If you have to take ARBs or ACE inhibitors, get prescribe one with hydrochlorothiazide (HCTZ).
Like for example lisinopril/HCTZ and valsartan/HCTZ.
These kinds of combo pills have one medication that raises potassium levels and another that lowers it, ultimately resulting in normalized potassium levels.
Some people may also need special medicine to help remove extra potassium from the body and keep it from coming back. These are called potassium binders and often come in the form of a powder. They are mixed with a small amount of water and taken with food.
When swallowed, they “bind” to the extra potassium in the bowels and remove it, just like phosphorus binders.
Don’t ignore your potassium levels. Make sure you are having it monitored, especially if you take any of the medications I’ve mentioned earlier.
And also avoid potassium-based salt substitutes and potassium dietary supplements but
Don’t obsess over potassium levels in vegetables and fruit.
Patients have to eat this way for life, so totally avoiding healthy fruits is not always the best choice.
So, talk to your dietician and find a way to include more healthy fruits and vegetables to make your renal diet more variated.
It’s for the health of your kidneys.
And if you want to know more about the smart way of repairing kidney damage with potassium, I’ve a made a video just about this. It’s up here.
But don’t go away yet, we’ve addressed bananas and mangoes, right?
But what about oatmeal? Is oatmeal healthy too?
Yes, it is!
Now, the other thing I wanted to talk about today is phosphorus in whole grains, like rolled oats.
There’s really a lot of misinformation about this topic. And I mean a lot.
I always tell people to eat more whole grains.
And I say it again.
Eat more oats, buckwheat, quinoa, barley, bulgur and so on.
Whole grains should be the corner stone of your diet.
Now, when I talk about this in my videos, I have two options:
I either have to make a large preamble telling people why whole grains are not unhealthy for kidney disease patients
I have to face dozens of comments telling me that I’m giving people bad advice.
Like in my video about the 5 healthiest superfoods.
Here are some of the comments I received:
Oatmeal is too rich in phosphorus
Eating oatmeal is not good
Oats are high in phosphorus how it can be a healthy diet .
And this one is very funny
I feel like oatmeal just punishes my kidneys
It’s funny because it’s not on one of my videos, it’s on davitas website.
Yes, Dieticians from davita recommend people with kidney disease to eat oatmeal too.
And they get the same reactions I get.
So, let’s make things clear here.
Because it’s absolutely true that phosphorus is not good for you if you have kidney disease.
Normal working kidneys can remove extra phosphorus in your blood but when you have chronic kidney disease, your kidneys cannot remove it.
And getting too much phosphorus from the diet can cause damage to your body and your kidneys.
So it’s absolutely true that you should avoid high phosphorus foods such as dairy and many packaged foods if you have kidney disease.
And it’s also true that the whole grains I’ve mentioned earlier contain phosphorus.
But still, this shouldn’t stop you from eating oats and other whole grains.
And this is because your body is not going to absorb all the phosphorus in whole grains and other plant based foods, ok?
There are various studies proving that the ratio between protein and phosphate in foods is what really matter to the quantity of phosphorus your body can absorb.
What this means is that you should disregard the phosphorus in whole grains, especially if they are unprocessed, since you are not going to absorb it.
Your body is just going to get rid of it after you eat.
Now, the researchers are even able to tell us how much phosphorus you are going to get from different foods.
This is from a peer reviewed article published on the journal blood purification,
A very reliable source.
Phosphate bioavailability varies between foodstuff:
in whole grains and nuts it is 20 – 50%, ok? this is what percentage of the phosphorus in these foods you’re going to absorb
in dairy, seafood, meat, and eggs it is 40-60%,
and in processed food (sodas, cheese spread) it is 90 – 100%
So your going to get just 20 to 50 percent of the phosphorus from whole grains, alright?
Let’s see what does this mean practically.
Let’s see an example.
What we have here.
A cup of rolled oats, a cup of milk and a cup of cheese spread.
Let’s keep in mind that the daily allowance of phosphorus for kidney patients is around 800mg.
Now, if you eat a cup of cheese spread, which I don’t recommend by the way, it contains 218mg of phosphorus.
And you’re going to absorb almost all of it, because it comes from additives mainly. And 200mg of phosphorus is a lot, ok?
All foods have some phosphorus, so it’s not wise to have this much from a single food item.
Now, milk is a little bit better, but you are still getting 120mg of phosphorus from a single cup.
But what if you eat a cup of rolled oats? On the paper, this contains 180mg of phosphorus, alright?
But your body is only going to get 63mg of phosphorus!
So why should anyone want to remove oatmeal from their diet is beyond my comprehension.
Now, if we take a look at this slide
About some high phosphorus foods,
I’ve divided them in 3 categories.
Bottom one is food you have to avoid.
It’s phosphorus from additives or preservatives.
So, avoid fast foods, ready to eat foods, canned and bottled drinks, enhanced meats, and most processed foods.
Phosphorus from food additives is completely absorbed.
Phosphorus additives, called phosphates, are found on the list of ingredients on the nutrition facts label. Look for “PHOS” to find phosphorus additives in the food.
In the middle we can see some dairy, and these foods should be limited.
You can have some cheese once in a while, but avoid processed dairy.
In the top category we have beans, nuts, grains and cereals.
These foods contain the phosphorus you won’t absorb.
But only if they are not processed, alright?
So, in conclusion, you can eat oats, and many more whole grains, if they are not processed and they do not contain additives.
And I hope this can be helpful to improve your diet and your quality of life.
Because there are several things you can do to improve your kidney health, but none of these involves removing healthy foods from your diet.
Because working with kidney patients there’s one thing that I’ve noticed.
They have a lot, and I mean a lot, of troubles finding things they can actually eat.
I mean, most dieticians give patients infinite lists of things they cannot eat.
And while removing salt, sugar and processed foods is always a good idea, removing plant foods is not.
So I hope this video will help you eating better for your kidneys.
And, by the way, if you want to know more about what foods are safe and healthy for a renal diet, I’ve made a video for you.
This is all for today, I hope you enjoyed this video and god bless you.
See you next Friday!