With the lockdown, many of us have had limited exposure to sunlight – what are your thoughts on vitamin D supplements?
Firstly, the kidneys have an important role in activating Vitamin D and converting what you get from sunlight into a usable form for your body. When your kidneys do not work fully, then this action is missed. The majority of people with kidney disease will be on a form of activated vitamin D called alphacalcidol. This provides your vitamin D and helps to control the calcium balance in your bones. Over-the-counter vitamin D supplements contain only small doses and, therefore, are unlikely to correct a deficiency in Vitamin D. Blood levels of vitamin D can be checked, and additional medicines can be given to correct deficiencies. If you are worried, speak to your unit or medical team.
Should people on immunosuppressant drugs be taking vitamin supplements to improve the immune system?
The majority of people should be able to get sufficient vitamins and minerals from a balanced and varied diet. Even people on restricted diets should be able to eat a varied enough diet to ensure good nutrition.
The evidence for vitamin supplements is sketchy and seems to suggest that you just produce very nutrient-rich urine! From a dietitian’s perspective, save your money! If you are worried about a lack of vitamins in your diet – please speak to your dietitian for an assessment. It may be that you would benefit from a renal-specific multivitamin via your GP (not over the counter).
Are there any dietary changes that could reduce the number of sodium bicarbonate tablets?
In short, no!
Sodium bicarbonate tablets are an alkaline that helps to neutralise the acid in your blood that your kidney is unable to deal with. If your blood bicarbonate levels are low, then you may have a high potassium level – by taking oral sodium bicarbonate, your potassium level may well improve.
Are there any tips for a low-phosphate diet?
This dietary restriction is becoming increasingly difficult as many food manufacturers are now using multiple additives that are rich in phosphate, meaning that foods traditionally thought of as low in phosphate may have higher than-expected levels. Foods that are naturally higher in phosphate (dairy products and meats) have good nutritional value and are, therefore, important for a healthy, balanced diet. Your dietitian is likely to try to reduce your intake of high-phosphate foods that offer little nutritionally (chocolate, beers, highly processed foods).
The best thing to aid in lowering phosphate is good dialysis in long sessions (nocturnal home HD pts often require phosphate supplements). People doing more frequent HD sessions (i.e. at home) tend to have lower phosphate levels with a more liberal diet. In centre sessions, which are restricted to time and frequency, do not clear phosphate very effectively.
Phosphate binder act to bind the phosphate in the meal and means that you will not adsorb it. There are many different binders available, and all have slightly different times that they should be taken in relation to meals – check on the label or consult with your dietitian. It may be that you need to take binders will all meals and snacks. These should be tailored to the phosphate content of the meal or snack (i.e. you may need more with your cooked main meal than your breakfast). Speak to your dietitian to help you decide how many should be taken with each meal or snack.
Fluid restriction tips?
From my experience of listening to renal patients over many years, this is the one aspect of diet that people really struggle with. Drinking is something very sociable, if someone comes to your house then the kettle goes on!
It is especially difficult if you also have diabetes. Gaining good control of your blood sugars is very important to manage your thirst.
If you are on a fluid restriction, I would suggest that you fill a jug with the amount in the morning. Each time you have a drink, pour the equivalent volume out. This is a visual way of monitoring your intake and what you have left for the rest of the day. You don’t want to get to 2 pm and only have 100mls left! Spreading your allowance out throughout the day should ensure that you have enough left for your bedtime tablets.
If you can swallow multiple tablets in one go, this will save small amounts of fluid throughout the day – small savings like these can make a big difference when you need that caffeine kick!
Using ice cubes, ice lollies, sugar-free sweets, chewing gum or sucking slices of lemon can all help to stimulate your own saliva production, especially helpful with dry mouths. Artificial saliva is available on prescription from you GP, I know it sounds slightly disgusting, but I have had people really benefit from it.
During the hotter months, aiming to keep cool and not overheat will help to avoid needing that glass full of cold water. If you do need glasses of water – try filling them with reusable ice cubes – these will cool the drink down but won’t melt, therefore saving precious volumes for later!
Can I avoid post-transplant diabetes?
Again, the short answer is probably not. Certain medications used after transplant to preserve kidney function can increase your chances of developing diabetes. Keeping to a normal body weight and body mass index will offer some protection. I guess it is about not being too relaxed once you’ve been transplanted and not seeing it as a golden ticket to go mad with your diet! You still have a long life ahead of you, and protecting against other lifestyle-related conditions is the best advice we can give.
Are there any foods we should avoid whilst on immunosuppressant medications?
After you have been transplanted, you will be provided advice regarding safe eating to protect against a food-borne infection. Essentially it is about good food hygiene and food safety within your kitchen. Correct food storage within your fridge and cupboards will reduce your risk.
In terms of shopping, you should avoid using the deli counters for any cheeses, meats or salads due to them being unsealed and exposed to the shop environment. Any foods that are unpasteurised should be avoided ie milks, yoghurts and cheeses.
Undercooked or raw eggs and shellfish should be avoided.
Ensure that all foods that should be cooked and served hot – are! Watch out for BBQs – these are notorious for looking cooked on the outside and being raw inside.
Get to know the correct terminology:
Use by is used on perishable foods and should not be eaten after the use-by date. Having these products after the date can be dangerous to your health.
Best before means that the quality of the product may start to decrease, but it should not pose a threat to your health.
If you are unsure about a food product, stop and think about the risk before eating.
If you have any specific questions regarding your diet – please contact your renal dietitians for help and advice. You can download and print the diet information by clicking here.
