Diseases and Diet modification

HYPERTENSION

High blood pressure is a common disorder occurring among the middle and old age groups. This condition has been called as Essential hypertension. The predisposing factors for hypertension are (1) Hereditary, (2) Obesity and (3) Stress and strain of modern life. Systolic pressure over 150mmhg and diastolic pressure over 100mmhg is considered as hypertension. In some other disease conditions like cardiac diseases, CVA ( Cerebro Vascular Accident), the blood pressure seems to be increased. If an uncontrolled hypertensive state may leads to further complications like brain damage. The most recommended diet for hypertension are low sodium-low fat-low calorie diets.

Kempner's rice diet:

Kempner (1948) has recommended a rigid rice-fruit-sugar diet for hypertension. It provides about 2000KCal, 5g fat, 20g proteins, 150mg sodium and 200mg calorie. All the fruit juices are permitted. The fluid intake is limited to meet the daily needs. Vitamin supplements are given to meet the daily needs of different vitamins.

RENAL CALCULI

Renal calculi consists of mucopolysaccharides, urates, calcium oxalate, calcium phosphate and calcium carbonate. Urate and oxalate stones are the most common and cysteine stones are very rare.

Aetiology

Some of the factors contribute to the formation of stones are:

• Climate
• Occupation
• Infection in the urinary tract
• Dietary habits (habitual intake of foods rich in oxalate's,calcium phosphates and purines).
• Hereditary

Diet for the prevention of renal calculi

A planned diet can prevent the occurring of kidney stones. The diet which is intended for the prevention of renal calculi should be low in oxalic acid and purine contents. The intakes of calcium and phosphates should also be reduced to a moderate level.Some of the diet that should be controlled are;

-Leafy vegetables.

-Milk and milk products.

-Whole cereals.

-Legumes.

-Nuts and oil seeds.

-Meat,fish and egg.

-Tea, cocoa.

-Rhubarb.

The subject should consume large amounts of fluids so as to increase the urine output to 2-2.5 litres per day.

Diet in Chronic Renal Failure (CRF) - Under Haemodialysis

Your diet will be very important in helping you to feel better and achieve successful treatment. The following dietary nutrients are especially important to regulate in the person receiving dialysis treatment; protein, sodium (salt), potassium, calories and fluids. A dietitian can tell you specifically which foods you should avoid and which foods would benefit you, according to their sodium, potassium and protein content. In general, there are less dietary restrictions after kidney transplant.

It is important that you follow these guidelines that have been suggested specially for you.

(A) Fluid intake

It is extremely important that you strictly adhere to the fluid intake allowance prescribed by your doctor. If you take more fluids than allowed, water will accumulate in your body, leading to serious complications such as a pulmonary edema and hypertension. Generally your fluid intake should be such that the weight gain is restricted to 1.5-2 kg between two haemodialysis sessions.

(B) Sodium (salt) intake

Your doctor will prescribed you a specific amount of salt to be taken per day. Please make sure that you consume the prescribed amount of salt (and not more) every day. Too much of salt intake will result in hypertension, increased thirst etc. Too little salt also will lead to problems such as weakness, and hypotension during dialysis; therefore it is important to take the prescribed amount of salt every day.

Salt substitutes (Lona salt) contain high potassium, hence avoid such preparations.

(C) Potassium intake

Reduce potassium intake

Increase in the potassium level of your blood will have very serious consequences and therefore, it is important that your potassium intake is restricted to the minimum possible. Following food items are rich in potassium and all of them should be avoided or taken in very restricted quantities.

(1) Fruits

Please obtain specific instructions from your dietitian regarding the restriction of these in your diet. The dietitian will help you to choose a low potassium diet which will best suit your particular requirements. Only one fruit (100 gms) can be taken per day (pineapple, apple, papaya or guava).

(2) Vegetables

All vegetables contain potassium. Wash, peel and cut vegetables into small pieces, soak in warm water for 2-3hrs, discard water and add large volume of fresh water, cook and discard water.

(3) Others

Tamarind, spices, condiments and coconut are to be used in very small quantities. They contain very high amount of potassium.

(4) Avoid

Avoid nuts, jaggery, instant coffee, chocolate, cocoa powder and salt substitutes (Lona salt)

(D) Protein intake

In the pre dialysis phase of Chronic Renal Failure(CRF) all the patients are advised to restrict protein intake. Once the patient is on regular dialysis he/she should take high protein diet (fish, chicken without fat, egg white for non-vegetarians and soya protein for vegetarians)

(E) Calorie intake

It is important that your calorie intake is adequate while you are on maintenance dialysis. Inadequate calorie intake will result in loss of weight, generalized weakness, reduced resistance to infections etc. Therefore, please check with your doctor regarding your daily calorie allowance and adhere to the recommendations given by the doctor.

(F) Dietary intake during the dialysis procedure

You are allowed to take anything you like, during the dialysis, but it must be consumed within the first hour of you dialysis. Even food items rich in potassium may be taken during this time. If you wish to take such items, please make sure that you inform the dialysis technician or nurse who is taking care of your dialysis. When you inform them, they will be able to ensure adequate removal of the excess potassium consumed during the first hour of dialysis.