EVER HEAR OF THE “renal” diet or the 60-90-60 diet? Maybe you have heard of the “liberal” renal diet? The 60-90-60 diet refers to 60 grams of protein, 90 mEq of sodium, and 60 mEq of potassium. This was the diet ordered for a person admitted to the hospital with any kidney affliction, regardless of degree of kidney function or muscle mass, or whether the person was even receiving renal replacement therapy. This was back in the day when “butterballs” were recommended as snacks. Individualization of diet for someone with kidney disease had yet to materialize. The “renal” diet evolved next. What was the protein allowance? Was the “renal” diet appropriate for someone on peritoneal dialysis associated with greater protein needs? Was a fluid restriction included in the “renal” diet? Only the other day I heard of the “liberal” renal diet for someone who resides in a nursing home and is receiving dialysis. The dietitian who shared this with me presumed it included a 2 to 4 gram potassium allowance for the day. Really? The diet for those suffering from kidney disease certainly is evolving! Is the pendulum swinging too far to the left? Can all foods fit into the diet of someone with kidney disease? Perhaps.
The NKF K/DOQI Nutrition Guidelines of 2000 suggest the daily recommendations listed in Table 1 for those on dialysis.1 Just as the renal dietitian is becoming savvier regarding foods safely fitting into the meal plans of those with kidney disease, so has the food manufacturer. In March 2008, Frito Lay launched a new low-sodium version of its top-selling snack chip. The new Pinch of Salt line meets their number one consumer request for low-salt snack chips. All of these products provide no more than 75 mg of sodium per serving. This is 30% to 50% less sodium than in their original products (depending upon the product). This certainly increases the consumer's options for foods fitting into a healthier lifestyle, or the choices for someone with chronic kidney disease. See Table 2 for a detailed listing of snack foods from Frito-Lay, Snyder's of Hanover, General Mills, and Old Dutch Foods.
RDA, recommended daily allowance; N/A, not available.
Product manufacturers: Frito-Lay, Inc., PO Box 660634, Dallas, TX 75266-0634 (telephone: 1-800-352-4477; website: www.fritolay.com); Snyder's of Hanover, PO Box 6917, 1250 York St., Hanover, PA 17331 (telephone: 717-632-4477; website: www.snydersofhanover.com); General Mills, PO Box 9452, Minneapolis, MN 55440 (telephone: 1-800-248-7310; website: www.generalmills.com); Old Dutch Foods, Inc., 2375 Terminal Rd., Roseville, MN 55113 (website: www.olddutchfoods.com).
It appears we are only beginning to understand the wide variations of phosphorus bioavailability in foods. According to Uribarri and Calvo,5 phosphorus is less absorbed in plant sources of food, 30% to 60% absorbed in milk, and higher in meat sources. In contrast, in highly processed foods, 100% of phosphorus is absorbed!
Determining the phosphorus content of most foods is even trickier, because this information is not often found on most food labels. In addition, most nutrient composition tables do not include phosphorus from additives, and this can lead to an underestimation of phosphorus content.5 Lastly, according to a Frito Lay spokesperson, the phosphorus information is based on the recommended daily allowance (RDA) for phosphorus, which is 1,000 mg of phosphorus, and not the dietary reference intake (DRI), which is 700 mg of phosphorus.6, 7 Thus the 4% phosphorus found on the label is 4% of 1,000 mg of phosphorus, or 40 mg in that particular serving.
Wow! The area of nephrology nutrition certainly is evolving! Improved technology, increasing clearances through more efficient dialyzers, daily short or nocturnal dialysis, and now a greater availability of lower-salt snack foods allow the renal dietitian to say “Okay!” to foods previously frowned upon. So now, when your patient who proudly proclaims she eats a low-salt diet approaches you with a bag of Fritos Pinch of Salt Corn Chips, you will not have to reproach her for this, but rather commend her for reading the nutrition labels and selecting a snack food more appropriate for her diet—that is, in moderation, of course!
References
1. 1National Kidney Foundation: K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2000;35:S40–S45(Suppl 2).
2. 2National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney Dis. 2003;42:S63–S68(Suppl 3).
3. 3Biesecker R, Stuart N. Nutrition management of the adult hemodialysis patient. In: Byham-Gray L, Weisen K editor. A Clinical Guide to Nutrition Care in Kidney Disease. 1st edition. American Dietetic Association; 2004;pp. 43–55.
4. 4McCann L. Nutrition management of the adult peritoneal dialysis patient. In: Byham-Gray L, Weisen K editor. A Clinical Guide to Nutrition Care in Kidney Disease. 1st edition. American Dietetic Association; 2004;pp. 57–69.
5. 5Uribarri J, Calvo MS. Hidden sources of phosphorus in the typical American diet: does it matter in nephrology?. Semin Dial. 2003;16:186–188. MEDLINE |
CrossRef
6. 6National Research Council . National Academy of Sciences: Recommended dietary allowances. 9th ed.. Washington, DC: National Academy of Sciences; 1980;.
7. 7National Academy of Sciences: Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. Washington, DC: National Academy Press; 1997;(available at www.fnic.nal.usda.gov).
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