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By - Craig Mullins

Plant Based Kidney Health With Nephrologist Sean Hashmi, MD, MS, FASN & Renal Dietitian Michele Crosmer, RD CSR

Not marketing or SEO related but my pops has bad kidneys so loving the video series below:

I’m not a Dr or health professional. So talk to a professional before trying anything. Just starting to learn about this. So right now the article is just a bunch of random notes not organized in any specific way. Some info may be wrong or may even harm or kill you. If any Dr’s or dietitians want to offer me any corrections or advice it’s gladly accepted.  🙂 My advice is for someone in stage 3b. My pops is 73. Has high blood pressure, heart disease (stents, heart 2 heart attacks and quad bypass ) & high cholesterol. Not in dialysis or stage 5.

It VERY hard to get care in this field. Dr’s basically seem to only want to react to care and not take an active role and keep kidney function. They are happy to move you along the stages  to finally hit that money milestone of dialysis and kidney transplant. I’ll update this if I find that awesome care team that changes my mind.

I just saw a registered dietitian and she was basically no help at all. No explaining anything. Granted she wasn’t a renel dietitian, but the info and advice she gave me I could of done that out of 6th grade. Yep that bad…

Plant Based Kidney Health With Nephrologist Sean Hashmi, MD, MS, FASN & Renal Dietitian Michele Crosmer, RD CSR

Connect with us: Sean Hashmi, MD, MS, FASN
https://www.SELFPrinciple.org
https://www.instragram.com/seanhashmimd

Michele Crosmer, RD CSR

https://www.instagram.com/plantbased.kidneys/

Home

Terms not familiar with / acronyms of dietitians:
RD = registered dietitian
CSR = board-certified in renal nutrition
MS = masters of science
CDE = certified diabetes expert
RDN = registered dietitian
LDN = licensed dietitian (some states require licensure on top of the RD)
PHD = Doctor of Philosophy
MA = masters of arts
MPH = masters of public health
FNP = functional nurse practitioner
CSO = board-certified in oncology nutrition
CD = certified dietitian (some states require certification on top of RD)

Eat right find a dietitian
The National Kidney Foundation directory of dietitians

Most people don’t know they have kidney disease. See below for labs to get checked with your yearly physical to keep an eye out for signs your kidneys are failing. If you don’t have a dr. willing to run the tests find one who will. Or get them on your own. So many places online now days will do it. A lot of Dr’s aren’t going to be proactive in treatment. Plan on doing a lot of the legwork. Find a dr willing to answer a lot of your questions and has an online portal to ask questions. Same goes for a dietitian. So are prob going to have to beg for a referral. Then when you get a standard registered dietitian. They prob won’t tell you much. Just hand you a pamphlet and call it a day. You definitely want a renal dietitian & there aren’t that many of them. Many don’t take insurance, and they can be pricey. I’ve seen a minimum charge of $3,500 for one. It’ snot easy coming up with that much cash when you are retired and on social security.

Things to do to preserve and reduce kidney disease:
1. Stop smoking – It raises blood pressure, creates plaque on arteries, makes arteries hard and doesn’t allow them to dilate. A huge cause of erectile dysfunction – who wants that.
2. Lose weight – Get to the lower end of your recommended BMI (25 and under) and lower end of a healthy fat range. I love those new smart scales that can tell you that. Lose a pound a week. My pops is 5′ 7″ So he should be somewhere in the 150 – 170 pound range.
3. Eat for what your body needs today. Eat based on what your labs are showing you.
4. Exercise. Walk at least 30 minutes a day every day. Try to work up to an hour. Get your heart rate up a bit. Don’t do hardcore weight lifting. It’s hard on the kidneys and produces extra creatine (weight lifting might drop your score 10 points for 3 days – so if your doing labs, wait  at least 3 days before weight lifting) ; a bad thing. You should be able to hold a conversation, but def be breathing a lil bit hard. a 15 – 17 minute mile maybe where you want to be at. If you have a heart monitor try to get heart rate to 100 – 120 beats per minute. Maybe have an end goal of 10,000 steps a day. Slowly work up to it. It doesnt have to be traditionial exercise. Shopping counts! Try swimming, do some gardening, volunteer somewhere. For weight loss you may need 60 – 90 minutes a day.
5. Check your blood pressure in the morning when you wake up, before lunch and before dinner every day and put in in an excel sheet. You may want to check it 3 times each time and average the number or use the lowest one. Ask your dr. Try to keep it around & under 130 / 80. No higher.
6. If you have diabetes, get it under control ASAP. It’s another leading cause of kidney disease.
7. Know what macro nutrients you MAY need to limit putting in your body; potassium, phosphors, sugar, protein, sodium, fats and carbs. Stay away form artificial colors, flavors and preservatives. Your gonna have to start looking at labels with an eagle eye.
8. Reduce stress – Go for a walk, meditate, try out one of those new apps, whatever it is you enjoy that relaxes you. I like to go hiking every day.
9. Stick with water for liquids. Limit dairy. Orange juice is high in potassium. NO SODA. Try True Lemon Packets. Walmart has em.  64 oz of water is a good amount of water to get a day. Ask your Dr if you need to limit water.
10. Fiber is great. Try to get in 30 grams a day minimum. Try Benefiber with every glass of water.
11. Sodium – stick with under 2,000 mg a day. 1,500 is better. Sodium is in EVERYTHING. Sodium will raise blood pressure.
11. a: Monitor your blood pressure and work to lower it. quit smoking. Diet and exercise may be enough. If not get on medication. Uncontrolled blood pressure is a leading cause of continued damage to the kidneys.
12. Read labels. Check how many servings are in a meal. If it has 3 servings on the label and you eat it all. You have to triple all the numbers on the label.
13. Go organic if you can.
14. Watch multivitamins, minerals, herbs and supplements. Ask your DR for an approved one based on your labs. A lot are super high in nutrients you don’t need and can damage your kidneys. Some can interact with prescription drugs (make them not work or make them stronger or less strong. So you may not be able to take them at all or have to time when you take them. Some herbs may even kill you depending on the meds you take.
15. Vitamin d is a popular one prescribed for kidney disease. Try to get at the upper limit. I take 5000 IU of Vitamin D3 daily. Always get your levels checked before starting. Your dr. may put you on a high dose in the beginning to get your levels up then you will get a maintenance dose.
16.  Their are no CHEAT DAYS! Every day you needs to be perfect. One cheat meal might screw you up for weeks or months.
17. No NSAIDS – No ibuprofen, advil, motrin, naproxen, aleve, high dose aprin.  . So many people have got kidney disease just from taking Advil daily for a year. Even tylenol (probably the safest) if you can avoid using it.
18. Get enough sleep. 7 – 8 hours. Generally no more no less.
19. Minimize caffeine. Don’t drink those energy drinks; monster, rock star, red bull…
20. Minimize alcohol. Less then a drink a day.
21. The FDA has a warning for all deodorants that contain aluminum. Aluminum hydroxide may cause issues with dialysis patients. They have natural ones available. Check the ingredients.
22. Itchy skin could be serious. It may mean you are eating too much
phosphorus and your kidney function is declining. If you have too much phosphorus it will pull calcium out of your bones and make them weak and brittle.   You may need to take phosphorus binders to further reduce the phosphorus you ingest if you have too much phosphorus. That calcium can then be deposited into your hear, organs and blood vessels, leading to a heart attack or stroke or hardening of the arteries. Who wants clogged arteries!
23. Be careful if you drink water from a water softener. They have sodium softeners and potassium softeners. Don’t use either at home form drinking water. It adds either sodium or potassium to your water – both things you don’t want.
24. Optimize cholesterol – Get a fractionalized lipid panel. It will give you much more detailed and useful info then the standard lipid panel. Numbers to aim for. Take a statin if needed or / and an ace inhibitor if needed. input recommended levels.
25. Food diet and exercise tips to optimize cholesterol: Need more info. sugar and carbs effect it a lot. Don’t eat as much and the bad numbers will drop like a rock.
26. If getting an RX ask if it’s a renel dose prescription level.
27. Proton pump inhibitors can be bad ask what ones are safer.
28. Ask if the antibiotic is safe for your kidneys.
29. Be careful with contrast dyes and contrast agents when doing imaging like MRI’s or CT’s. It’s VERY bad for your kidneys. Tell the rep you have kidney damage. They may have alternatives to use. They may also be able to do IV sodium bicarbonate to help flush out of system.
30. Don’t get a bladder infection. If you do get it taken care of right away.
31. ProRenal+D With Omega 3 is a popular renal vitamin recommended by national kidney foundation.
32. CoQ10 – Can be a good supplement.
33. I like Himalayan sea salt if I am adding any salt. Not regular iodized table salt in the blue tub.
34. vitamin B6
35. Vitamin B12
36. Omenga 3
37. No potatoes ever
38. Skip canned food. Why, because most canned foods in the USA are lined with BPA. Or find BPA free canned food. Always jump the fluid out and wash the food before eating it for those you can.
39. See if turmeric is ok to use.
40. Take fish oil / Omega 3’s. ask about the recommended dose. Most people use 2,000 – 3,000 but always check with doc.

 

Chronic Kidney Disease (CKD) and are on a Kidney Disease diet (Renal Diet) – What can I eat?
1. plant-based protein doesn’t put as much stress on your kidneys and can actually help your kidneys to heal and regain functionality, improving your GFR.
2. Vegan is great. You may want to limit soy.
3. Vegan mayonnaise
4. Don’t ever eat starfruit.
5. Limit protein. As your disease progresses, your doctor WILL lover your kidney disease protein limit. Too much protein, especially animal based protein, will increase your BUN and creatinine levels, lowering you calculated GFR.
6. Be careful with processed foods, microwaved meals and canned goods. It’s usually loaded with crap.
7. limit phosphorus 700 – 1200 mg daily – too much it pulls calcium form bones making them brittle. also leads to deposits it organs and arteries. Makes you itch. Hard to tell if your not getting enough see calcium for better info.
8. limit potassium 1700 – 2700 mg daily – to much symptoms fatigue / shortness of breath – Things to avoid food – portion control is important. read the servings. – avocado, banana , melons, oranges, potato – any, tomatoes, sauce, salsa, tomato juice, you cna eat a lil of this but def limit it. brown or wild rice, brussel sprouts, prunes, prune juice, dried apricots,  lentils, raisins, split peas, spinach, milk, bran products, low sodium cheese, whole wheat products including pasta and bread, nuts, beef, chicken, tuna,  3 oz is a serving for the meats. Max to eat at any one meal.  7 oz of meats max per day. – medications can cause body to retain potassium esp blood pressure meds or include potassium in them. exercise – high intensity exercise can increase potassium in blood ( 3 days to go back to normal so delay labs if hard exercise). Remember too much is bad, but too little is just as bad.
9. limit sodium to 1,500 – 2,000 mg daily
10. Limit protein – Need to calculate it based on you.
11. Calcium 1,000 – 2,000 mg a day – symptoms of not enough calcium or phosphorous is pulling calcium out of bones. Muscle cramps or spasms. numbness and tingling around the mouth. Bone and joint pain. weak bones,  rash, itching.

How to lower your creatinine levels:
1. No heavy weight lifting. No marathons. Nothing vigorous.
2. Don’t take creatinine supplements.
3. Reduce protein
4. Eat more fiber. Benefiver Healthy Shape helps.
5. Drink more water, but not before labs.
6.

Labs to get and check:
1. Put everything in an excel spreadsheet. So you can see trends. Are you getting better or worse or stable. test, date, your result. high range, low range.
2. Get advice from your DR. Don’t let him push you in and out of the office like a piece of cattle.If he refuses find a new Doc. Go over every item in the lab work. You paid for it. It’s his job to explain it.
3. Glucose
4. A1C
5. Bun – Lower is better. Caused by eating too much protein. Not enough fiber.
6. Albunin spelling
7. Potassium – regular range 3.5 – 5 generally safe. Caution 5.1 – 6.0 – danger zone 6.1 – or higher – This one changes fast like a couple days after making a diet change.
8. phosphorus – regular range  2.5 – 4.5  mg/dl generally safe caution This changes in a couple days in blood work.
9. GFR – It will fluctuate quite a bit like the stock market. High is better. lower BUN and Creatinine will increase GFR
10. Creatinine – lower is better. Caused by eating too much protein. Not enough fiber.
11. Urine ph – Under 6.5 is acidic. Caused by eating too much protein. Not enough fiber.

What allergy medicines are safe to take? anti-allergy medicines, seasonal allergies
1. Most all Eye drops and Nasal Sprays are safe and provide fast relief. Afrin / flosnase
2. Your prob best with Claritin / Loratadine – This one may take a day or 2 to work tho.
3. One to avoid –  Zyrtec / cetirizine  esp if your  kidney function is below 50%; def check with your Kidney doctor first. you may need to reduce the dose or only take it every other day, or avoid it altogether. Just avoid Zyrtec. This one is my fav allergy medicine cause it’s so fast acting. Unfortunately no more.
4. Most of them raise your blood pressure which is hard and damaging to your kidneys.
5. Read all ingredients. Make sure they do not contain any NSAIDs.
6. Benadryl can cause fluid retention & if you have a bladder infection, it could to travel to your kidneys. so be careful on that one as well.

Does the KETO diet work? Is the KETO diet safe? Will a cleaner modified KETO version work with Kidney Disease?

What about intermittent fasting?
1. you can only have water, unsweetened tea, and unsweetened coffee during the intermittent fasting period.
2. the common target is 16 hours of fasting with an 8-hour window for eating
3.

Why is my BUN high? What food raise BUN?

My daily Routine
Morning:
Exercise

Lunch:

Evening:
Exercise –

How often should I get my labs done:
At least once a month in the beginning.
Some things can change rather quickly so you may be able to test more. If docs will allow it.

 

Find out the requirements for a kidney transplant now. Different places have different requirements so register with as many as you can find. Maybe if you have a BMI over 30 or 35 your not even eligible. So start losing weight now.  Being a smoker might disqualify you; so stop now. Heart disease may be another. Dementia or poorly controlled mental illness. Active or resent cancer. Advanced age.

Apps to use:
https://cronometer.com/ – That is great app & I recommend the pro version where you can input everything you eat and it will tell you how much  of each nutrient you are getting for the day. You can also put in a min and max level of key nutrients your Dr has told you that you need to limit that I find really helpful.

What renal diets may work for kidney disease? Many will work; the important thing to do is eat for your labs. Here’s couple options to look into along with your DR”

Dash diet • Diabetic diets • Dialysis diet • Heart Health diets • Ketogenic diet • Low-Protein diet • Mediterranean diet • Vegetarian diet • Vegan diet • Whole-Foods Plant Based diet

Here is the EWG’s Dirty dozen list for 2019 which you should always buy organic as part of your renal diet meal plan for better kidney function:
1. Apples 2. Celery 3. Cherries 4. Grapes 5. Kale/Collard greens 6. Nectarines 7. Peaches 8. Pears 9. Potatoes 10. Spinach 11. Strawberries 12. Tomatoes

The following list of foods are often loaded with pesticides and GMOs – you should always purchase the organic versions as part of your kidney diet:
• Blueberries • Cucumbers • Hot peppers • Raspberries • Snap peas • Sweet bell peppers

Anemia Kidney Disease:
Anemia typically starts to occurs in people with chronic kidney disease (CKD) at stage 3, with the most common anemia symptoms being fatigue and problems concentrating. Anemia usually gets worse as CKD progresses.  It shows up in labs as low RBC (low rbc count) & low Hemoglobin. When it’s low, your red blood cells can’t carry as much oxygen. The heart and brain suffer causing fatigue, confusion and headaches. Your dr may give you Iron to increase your Hemoglobin. Do not take without labs and dr advice on dose & type. Your dr may also check your erythropoietin (EPO) level. It tell your bone marrow to make red blood cells. B12 and folic acid may also be prescribed to help.

What can you eat to build up your iron:
Kale & Spinach (high in Oxalates – – oxalates limit your body absorbing iron) – Dandelion greens – Broccoli (limit this one) – Asparagus (folic acid) – collard greens – swiss chard – Use an app to make sure your not getting too much of any one nutrient.
All meat & poultry contain iron. 3 oz is a portion on a renal diet. Red meat, lamb, venison, Poultry – chicken
Organ meats – grind it up wiht some other meat so you don’t notice it as much. Liver – beef tongue, heart, kidney
Seafood: oysters, clams and shrimp most iron. Salmon ok. Seafood not best source of iron.
Fortified foods: Contain iron, B12, Folic acid – white rice, pasta, cornmeal, whitebread, ready to eat cereals
Beans: Generally not recommended – kidney beans, chickpeas, pinta, black beans, peas,
Seeds: Limit seeds not recommended.
Cook with a cast iron skillet – a study showed tomato sauce cooked in a regular pan .6 mg of iron. The sauce cooked in a cast iron skillet had 5.7 mg of iron. Woo hoo.
Do not eat a high iron food when eating the following foods. These foods minimize iron absorption: Coffee, tea, eggs, foods high in oxalate’s, Vitamin c will also help your body absorb iron. Lemon could be good.
Anemia is a high priority item to fix. So if you have to go over on potassium or phosphorous to get anemia under control that may be OK for a short time.

How to lower creatatine levels naturally:
Eat more plant based protein; less animal based protein
Limit sodium / salt
Drink enough fluids – take weight in pounds, divide in half. Thats ounces per day to drink. 200 pounds, 100 oz.
Eat more fiber
Avoid processed foods
Avoid Juice and soda. Water is the way to go.
Get some exercise. Go for a walk. Nothing crazy. a good 30 minutes in the morning. Maybe another 30 in the evening.

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