Principles of Dietary Education patient on Dialysis
Minas P. Zilakos, MD,
Ioannis G. Griveas, MD, PhD
1 / How many calories do I need per day?
- per kilo of body weight 25 to 35 kcal Example: A 75 kg patient needs about 2000 kcal.
2 / How many meals do I need per day?
- Three balanced meals, ie every 4 to 6 hours.
3 / What is allowed and in what quantities?
- Meals can include all kinds of foods
- we do not lack any kind
- we apply simple rules
- we know what to avoid
- we choose alternatives
Meat
choose {fresh or frozen}:
- Veal
- pork meat
- chicken
- turkey
- fish
avoid
- ready, packaged
- pre-cooked meats
- bacon
- cold cuts
- viscera
- bones of small fish
- seafood
- Meat is a key source of protein of high biological value necessary for the patient on dialysis.
- I need protein 1 to 1.2 grams per kilogram of body weight, ie an average of 100 grams of protein per day.
- An additional source of protein of high biological value is egg and milk. indicative quantities 1 chicken breast: 30 grams of protein, 1 can of tuna: 40 grams of protein 1 egg: 6 grams of protein 1 glass of milk: 8 grams of protein.
- We calculate for each meal that includes meat, as a quantity of it, the size of the palm of one hand.
Fat-Oils
choose
- margarine
- olive oil
avoid
- animal meat fats
- butter of animal origin
- Becel pro active blue {contains a lot of potassium}
Dairy Products
choose
- almond milk
- rice milk
- Philadelphia / Cottage cheese
- cream cheese
- feta {size a matchbox-very good rinse}
avoid
- yellow cheeses
- hard cheeses
- indicative quantities
- 1 cup of milk (cow, goat, sheep)
- 1 yogurt
- 50 grams of cheese
Bread-Cereals
choose
- fresh white breads
- white spaghetti / rice (not whole grain)
avoid
- Bread and cereals rich in fiber
- ready-made products such as croissants, donuts, cookies
- products containing sesame
- indicative quantities
- two slices of bread
- a hot-dog loaf
- 2 tortillas
- a cup of rice / spaghetti
- 1 tsp. corn flower soup
Legumes-Vegetables ! peeled, cooked (roasted or boiled)
choose
- cucumber
- endives
- cabbage
- Lettuce of all kinds
- carrot
- eggplant
- cauliflower
- broccoli
- green beans
- peppers
- radishes
- corn
- onion-garlic
avoid
- Potatoes-sweet potatoes
- tomato- tomato juice
- spinach
- beets
- zucchini
- asparagus
- mushrooms
- okra
- artichoke
- avocado
- The legumes are sparing and boiled at least twice, due to their high phosphorus content! Indicative quantity: 1 to 1.5 cup
Fruits
choose
- apples (1)
- pears (1)
- peach (1)
- tangerine (2)
- pineapple (half a cup)
- plums (half a cup)
- berries (half a cup)
- strawberries (half a cup)
- cherries (10)
- grapes (15)
- watermelon (1 slice)
- chestnut (2)
avoid
- orange-grapefruit {and their juices}
- banana nectarine
- melon
- apricot figs
- dried grapes dates
- dried fruit
Juices
Apple-lemonade-peach-grape-cranberries Quantity: 200 ml (!)
other foods that contain potassium and should be avoided:
- Alcoholic beverage
- Nescafe
- Tea
- Nuts
Sweets
indicative quantities: instead of fruit a little sweet a day
choose
- Sweets, which are based on cream
- jam
- honey
avoid
- sweets, based on chocolate
- sweets, which contain fruits and nuts
- If diabetes coexists, I choose sweeteners as a substitute for sugar.
What do I do with phosphorus?
-I take, according to the instructions of the nephrologist of the unit, the phosphorus-binding pills together with the meal or up to 30 minutes after the end of the meal.
Avoid
- Packaged food
- canned food
- tahini
- Sesame
- chocolate wafers
- candies
- cola type soft drinks
- nuts (consumption of various sauces: mayonnaise, mustard, ketchup in very small quantities).
What do I do with salt?
The maximum allowed is one teaspoon a day.
It is forbidden to consume substitute salt as it contains a large amount of potassium!
Avoid
foods rich in salt:
- meat paste
- canned food
- seafood
- pickle
- tomato paste
- cooking cubes
- salted nuts
- cookies
- potato chips
- pizzas
to flavor the food I choose and replace the salt with:
- herbs
- spices
- lemon juice
- vinegar
- a spoon of sugar
What do I do with thirst?
The liquids we consume include:
- Water • Juices • Coffee • Tea • Alcoholics
- Soft drinks • Soups, etc. liquid food.
The total amount to be taken is estimated at 10 times the patient’s weight in ml, daily. that is, a 75 kg patient should consume approximately 750 ML on average per day.-
choose
- tap water
- Homemade lemonade
- homemade tea
- Greek coffee
- french coffee
- espresso
avoid
- baking soda mixed with water
- cola type soft drinks
- Nescafe
- cappuccino
- tea packed in a box
- Orange juice
- energy drinks
- alcoholic beverage
- Ways to deal with thirst
- Frequent brushing of teeth
- Consume a small amount of bread with oil or margarine
- sugar-free mastic
- water ice cubes or juice ice cubes
- slice of lemon
- consumption of drugs with less water
- mouthwash with water which, we will throw away and we will not swallow it
Ways to deal with weight loss / appetite
- eat small and frequent meals
- if our taste is reduced or the food has a bad (metallic taste), we choose egg, chicken or fish using lemon juice, vinegar and even strong spices.
- We cover calories by consuming carbohydrates with products rich in calories: sour cream, sweet mayonnaise, margarine
It is NOT recommended and we do NOT replace food, which must contain all the nutrients, with vitamin supplements.