diet for a patient

Question
QUESTION: hello nutritionist  Sarah A. Allen

i am having problem with a patient of heart disease , he is 57 yrs old, he is diabetic also, n having very low Hb level.. & also problems with kidney .. he's having very high creatinine level..

so plz can u suggest diet chart.. which foods should be avoided n allowed in that situation. ?

can u suggest the foods he should avoid totaly??

and most imp thing, can u name any kind of food/fruits/tea/anything whis is good for a kidney patient with diabetic - heart patient.. or helpful..


plz  help me out... i m really worried..
waiting for ur reply.


ANSWER: The foods which should be avoided or limited with a patient with kidney problems and heart disease and diabetes are much the same as any patient with kidney problems, which has the strictest diet of the three issues and should be most closely adhered to.  Sodium and potassium should each be limited to 2-3 grams per day, fat should be limited to 25-30 grams per day, and protein should be limited based on renal function (usually about .6 grams per kilogram of body weight per day); grams of carbohydrates appropriate for the patient's height, weight, and activity level (usually anywhere from 45-75 grams per meal and 15-30 grams at a snack prior to bed) should be spread throughout the day to keep blood sugar as consistent as possible.  Fruits, vegetables, and meat high in potassium should be avoided (bananas, avocado, spinach, most beans, nuts/seeds, lunch meat/sausage) in favor of fruits, vegetables, and meat lower in potassium (apples, grapes, berries, green beans, egg plant, cauliflower, baked poultry); more information on the potassium and sodium content of foods can be found at www.kidney.org.  I recommend no tea or coffee for renal patients, but usually up to 6oz per day can be tolerated.  Dairy should also be limited to one serving per day.  Unfortunately, there is no food that will necessarily help with the condition, just foods to avoid in order to control lab values until dialysis is needed or kidney function returns, at which time the diet can be liberalized.  If additional protein intake is required for medical reasons, there are elemental amino acids available specifically for renal patients which will not burden the kidneys as much.

Those are pretty general recommendations, but I hope that gives you a starting point.

---------- FOLLOW-UP ----------

QUESTION: hii nutritionist allen ,
Thankz a lot for replying..can u sugggest which foods should be allowed & avoided.. actually its so complicated suitation so i m asking ..hez having 40% blockage in heart.. n his creatinine is above 3 mg per dl.. & Hb is 8 gm/dl..n diabetes is also there ..so i m worried actually he is vegetarian.. n dairy products also restricted.. so please tell me very clearly which foods should be given n which foods should be completely avoided?

please help me out..
thank n waiting for ur reply ..

Answer
Unfortunately elevated creatinine and depleted hemoglobin are common with renal failure.  An oral iron supplement (such as ferrous sulfate) or an injected iron supplement (such as Procrit) may be recommended by the medical team to help with anemia/hemoglobin levels; consuming extra protein would not be recommended because the body may not be able to excrete the waste products.  Creatinine levels are difficult to control without dialysis because the level is elevated due to the body's inability to process the creatinine out of the blood as waste efficiently.  If the calcium lab value is normal, calcium supplementation may be recommended to protect bone health since bones can deteriorate due to renal disease but dairy must be restricted due to potassium and phosphorous.  The only foods which should be avoided are those high in sodium and potassium (phosphorous restrictions may also be beneficial depending on the patient).  As I mentioned, bananas, avocado, most beans and legumes, nuts/seeds, and processed meats should be avoided.  Restricted amounts of reduced sodium tofu and tempeh (2-3oz per day), whole grain cereal or bread (3-4oz per day), and reduced sodium peanut butter (no more than 2 tablespoons per day) may be consumed in the vegetarian diet since protein is necessary but only if absolutely no meat or fish is eaten.  The renal diet should meet all the needs of diabetes and the heart blockage since a renal diet is low fat and carbohydrate consistent.  I am sorry I cannot give you a more specific "eat only these foods" list, but even medically therapeutic diets are more about restriction than avoidance (with exceptions being diets for allergies or sensitivities to a specific food).  I have provided a list of high potassium foods and low potassium foods.

High Potassium:  Apricots (dried), Avocados, Bananas, Beets, Brussel Sprouts, Cantaloupe, Dates, Figs, Kiwi fruit (fresh), Lima Beans, Melons, Milk, Nectarines (fresh), Oranges, Pears (fresh), Peanuts, Potatoes, Prunes, Raisins, Spinach, Tomato products, Winter squash, Yogurt, Mushrooms (canned)

Low Potassium: Alfalfa Sprouts, Apples, Blackberries, Blueberries, White Cabbage, Carrots (cooked), Cauliflower, Celery (1 stalk), Cucumber, Cherries, Cranberries, Fruit Cocktail, Grapes, Eggplant, Iceberg Lettuce, Mushrooms (fresh), Okra, Onions, Pasta/Noodles, Peas, Green Beans, Peppers, Radish, Rhubarb, Rice, Mandarin Oranges (canned), Peaches (canned), Pears (canned), Pineapple, Plum (1 whole), Raspberries, Strawberries, Watermelon (1 cup), Water Chestnuts, Water cress, Yellow Squash, Zucchini Squash  

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