1. Combining Renal & Diabetic Diets Emily Cannon RD, CDE

2. What is the Need? According to NIDDK, 44% of kidney failure is caused by DM National Kidney Foundation states that 1/3 of people with diabetes will get chronic kidney disease Who do you know that teaches both diets together well?

3. My Goals for Today Help all disciplines understand the basic dietary restrictions involved in Renal and Diabetic diets Help RDs learn to teach the combination diet more simply and effectively to their patients

4. Whose Job is it? A. The dialysis RD B. The CDE C. The RN D. The patient E. Any RD that sees the patient

5. Medical Nutrition Therapy Medical Nutrition Therapy is defined as: nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a registered dietitian or licensed nutrition professional

6. Why is it So Hard? Specialty practitioners focus only on specialty Restrictions seems to conflict Complicated recommendations Limited good resources Limited time Less educated or motivated patients

7. Renal Dietary Recommendations Restrict Protein Limit Sodium Limit Potassium Limit Phosphorus Fluid Restriction Extra Fat and Sugar for calories

8. Translated into Foods Restrict Protein Limit Sodium Limit Potassium Limit Phosphorus Fluid Restriction Extra Fat and Sugar for calories Less meat/cheese/fish/eggs No salty snacks Less boxed/canned foods Limited fruits/veggie choices No whole grains-only white Limited milk/yogurt No cola drinks or beans Limited beverages Extra butter, oil, dressings sugar, candy, desserts

9. Diabetes Dietary Recs Smaller, consistent meals Controlled carbohydrate amounts Limited simple sugars Low fat choices More produce and whole grains

10. Translating into Food Smaller, consistent meals Controlled carbohydrate amounts Limited simple sugars Low fat choices More produce and whole grains Limited amounts of Starch/Fruit/Milk at meals Only small desserts/candy Avoid drinks with sugar Choose lean beef, poultry, fish, Low fat milk, yogurt and cheese Limited oils/dressings/butter More whole fruits/vegetables Whole grain bread/crackers Choose beans/starchy vegetables

11. Compare the Recommendations RENAL Less meat/cheese/fish/eggs No salty snacks, boxed, or canned food Limited fruits/veggie choices No whole grains-only white Only 1 milk or yogurt per day No cola drinks or beans Limited beverages Extra butter, oil, dressings sugar, candy, desserts DIABETES Choose lean beef, poultry, fish, More whole fruits/vegetables Whole grain bread/crackers Limited amounts of starch/fruit/milk at meals Low fat milk, yogurt and cheese Choose beans/starchy vegetables Limited extra oils/dressings/butter Only small desserts/candy Avoid drinks with sugar

12. Breakfast 1 scrambled egg 2 sl. whole wheat toast 1/2 banana 1 C skim milk Lunch 1 hamburger bun 2 oz hamburger patty 1/2 C mushrooms ½ C potato salad 1 whole tomato 1 dill pickle ketchup and mustard Dinner 3 oz pork chop 1 sweet potato 1 dinner roll 1/2 C unsweet. applesauce 1 C cooked spinach 2 TBSP low fat margarine Sample Menu

13. Breakfast 1 scrambled egg 2 sl. whole wheat toast 1/2 banana 1 C skim milk Lunch 1 hamburger bun 2 oz hamburger patty 1/2 C mushrooms ½ C potato salad 1 whole tomato 1 dill pickle ketchup and mustard Dinner 3 oz pork chop 1 sweet potato 1 dinner roll 1/2 C unsweet. applesauce 1 C cooked spinach 2 TBSP lowfat margarine Sample Menu

14. Breakfast 1 scrambled egg 2 sl. white toast 1 C berries 1 C 2% milk Lunch 1 hamburger bun 2 oz hamburger patty 1/2 C mushrooms 1/3 C pasta salad 1 cucumber with vinegar mayo and mustard Dinner 3 oz pork chop 2/3 C rice 1 dinner roll 1/2 C unsweet. applesauce 1 C cooked green beans 2 TBSP margarine Sample Menu

15. How to Simplify Combine lists for them Use only 1 method of meal planning Exchanges, plate method, pick from simple lists, etc. Focus on those foods with lowest sources of offending nutrients

16. How to Simplify Make sure you aren’t over-restricting for patient needs Focus on foods patient eats and enjoys Focus on what they can eat, rather than what they can’t eat

17. Special Issues Food Group Inconsistency Uncontrolled Blood Glucoses (thirsty) Starfruit Malnourished patients Salt Substitutes (K) Obesity

18. Other Resources www.AAKP.org “How Can I Follow My Diabetic and Renal Diet Restrictions?” article www.foodfitnessfirst.com “Renal Diabetic Diet Plan” (has picture versions of the lists for less literate) American Dietetic Association (Nutrition Care Manual) for CKD Nutrition Therapy www.kidneyschool.org (patient learning modules)

19. Questions?