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Definition
The liver is the most metabolically active organ in the body. It has many functions, including:
Metabolizes and stores all nutrients, including carbohydrate, lipids, and proteins
Helps to control blood glucose levels by storing glycogen
Manufactures bile (needed for fat digestion)
Synthesizes albumin and other body proteins
Detoxifies the body of drugs and alcohol
Damage to the liver can occur from injuries, illnesses, alcohol abuse, toxins, and medications. High levels of nutrients such as vitamin A can also lead to liver damage. Severe liver disease will result in permanent dysfunction of the liver if left untreated, and death ultimately will occur. However, some forms of liver disease can be reversed if the damage is not extensive. |
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Definition
Inflamation of the liver
most often caused by a virus
can also be cause by overconsumption of alcohol, exposure to drugs or toxic chemicals, herbs, and autoimmune diseases.
Some cases of viral hepatitis may be asymptomatic, which makes it easy to spread to others.
Symptoms of hepatitis may include fatigue, nausea, anorexia (lack of appetite), pain in the liver area, jaundice, fever, diarrhea, muscle pain, skin rashes, and elevated liver enzymes. |
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| is a condition caused by bilirubin buildup in the blood. It is one of the main symptoms of liver disorders. It is characterized by yellowing of the skin, mucous membranes, and the whites of the eyes. |
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Definition
| There are 3 main types of viral hepatitis: A, B, and C. Hepatitis A is usually associated with the consumption of food contaminated with feces, including shellfish such as oysters and clams that were harvested from contaminated sea water. Hepatitis B and C are usually spread by infected blood, tattoo needles, or sexual contact with an infected person. |
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Definition
Fecal-oral (food or beverage contamination usually); oysters
Very Good (usually resolves within a few months)
has vaccine |
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Definition
Blood contact (including infected needles, tattoos); sexual contact
Good for adults (90% recover); poor for infants (10% recover)
has vaccine |
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Definition
Blood contact
Leads to chronic liver disease or death in 80-90% of cases
no vaccine |
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| Nutrition therapy for Hepatitis |
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Definition
| Nutrition therapy for viral hepatitis is individualized. If a person becomes malnourished, they would need a high calorie, high protein diet. Small, frequent meals are helpful for those lacking appetite, and liquid supplements can help to boost calories in between meals. Fluids and electrolytes need to be replaced if there is chronic vomiting. Treatment also includes avoiding drugs, alcohol, and many medications. |
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can be caused by excessive alcohol consumption, diabetes, obesity, excessive weight gain or rapid weight loss, inadequate intake of protein, infections, malignant diseases, and long-term TPN
Fatty liver is normally asymptomatic. It can be accompanied with inflammation (steatohepatitis) and enlargement (hepatomegaly). Fatty liver is usually reversible. The best way to treat fatty liver is to eliminate what is causing it and restore adequate nutrition. If obesity is the cause, weight loss may help as long as the weight is not lost too rapidly. Control of blood glucose levels is important for a diabetic person. Obviously, the person must abstain from alcohol, which can severely damage the liver. Damage and scarring can occur if the cause is not eliminated, and the fatty liver may progress to cirrhosis. |
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Definition
Cirrhosis is end-stage liver disease characterized by damaged liver tissue that cannot be regenerated.
The liver will shrink in size and scarring occurs. With the liver cells losing function, its ability to concentrate ammonia to urea and make the blood proteins fail. The result is high blood ammonia levels and low serum albumin.
Portal Hypertension occurs as blood 'backs up' in the portal vein.
In the end stages, the liver is unable to make the proteins that clot blood. Edema and ascites almost always occur when there is liver damage. Earlier in the disease, the person may develop anemia and bruise easily.
A serious complication that can occur from cirrhosis is hepatic encephalopathy, which is caused by ammonia buildup in the brain. The person will experience altered neurological functioning, including personality changes, reduced mental abilities, and disturbances in motor function. Amnesia, seizures, and coma also may develop. Hepatic encephalopathy is usually the last complication before liver failure and death occurs. |
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Definition
an accumulation of fluid in the abdominal cavity believed to be caused by portal hypertension and low blood albumin.
Ascites is often visible in the abdominal area and worsening of the condition is measure with abdominal girth. Cirrhosis is the cause of ascites in the majority of cases, and about 50% of cirrhosis patients will develop it within ten years of disease onset. The development of ascites indicates that liver dysfunction has reached a critical stage. A low sodium diet should be recommended to help manage ascites. |
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| A person with cirrhosis must abstain from alcohol or their condition will rapidly worsen. However, many people with cirrhosis are alcoholics, so often the person does not stay away from alcohol. Treatment includes diuretics for the edema, medications to stimulate the appetite, and multivitamins. Laxatives and antibiotics can be given to help control blood ammonia levels. Herbs and megadoses of vitamins and minerals must be avoided. |
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Definition
| the main gallbladder disease is the formation of gallstones |
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Definition
Cholelithiasis refers to the formation of gallstones. Bile (needed to digest fat) is produced in the liver and stored in the gallbladder. Any disorder that obstructs the liver's ability to release bile can damage the liver or cause the formation of gallstones.
Risk factors for gallstone formation include:
Obesity / Overweight
Female (especially during the mid to late reproductive years)
Pregnancy (including afterwards)
Rapid weight loss
Ethnicity (Pima Indians, Scandinavian, Chileans, and Native Americans)
High blood triglyceride levels
Estrogen Replacement Therapy
Long-term TPN use
To think of a "typical" candidate for gallstones, think of the three "F's": Fat, Female, and Forty.
The main symptom of a gallstone is upper abdominal pain, which may also be associated with nausea, vomiting, or bloating. Cholecystitis (inflammation of the gallbladder) can also occur if the gallstone gets stuck in the bile duct. Cholescystitis can lead to infection, fistulas, perforation of the gallbladder, and possible damage to liver tissue if not promptly treated. |
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Definition
Surgery to remove the gallbladder is usually needed to treat gallstones in order to prevent serious complications. The only function of the gallbladder is to store bile, and a person can live a healthy life without one. If the gallbladder is removed, the bile will be kept in the liver instead and released from there when needed. Ursodeoxycholic acid therapy and shock wave lithotripsy are alternate methods of treatment, but are usually only effective in treating smaller gallstones.
After gallbladder surgery, a person will usually need a fat restricted diet. The severity of the fat restriction is individualized based on the persons level of discomfort after meals, and may be needed for just a few months, or permanently in some cases. The liver can become overwhelmed when faced with large amounts of any fats, especially saturated fats and hydrogenated fats (the bad types). Also, the person should not overeat or eat under stress.
Complications can sometimes occur after gallbladder surgery, with the most common one being pain or discomfort after eating. Bile reflux occurs when the digestive fluid produced by your liver (bile) rises up from your small intestine through the pyloric value into your stomach, and then from your stomach into your esophagus. Bile reflux and acid reflux often go hand-in-hand, occurring together, which is why bile reflux is often overlooked. Unlike acid reflux, however, bile reflux will often cause stomach pain (gastritis). The primary cause of bile reflux is damage to the pyloric valve, most commonly the result of surgery. |
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Definition
| Alcohol is not a nutrient. It is not needed by the body, and it is not stored in the body. Alcohol does provide calories, however. Alcohol provides 7 calories per gram, close to the 9 calories per gram that fat provides. Alcohol is a popular beverage because it makes people feel good, if it is not consumed in excess. Alcohol is classified as a drug because it is a sedative and a central nervous system depressant. Although alcohol can have some benefits, it can also have detrimental effects on the body if it is abused. |
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Definition
Unlike food, alcohol is absorbed first, then digested.
The by-product of alcohol degradation is fatty acids.
Excess alcohol consumption then results in excess fatty acid production, which must be removed from the liver and stored. The fat produced from alcohol is largely stored in the abdominal area. |
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Definition
| page 4 of module 4 under alcohol |
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| Alcohol and Cardiovascular Disease |
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Definition
Recent studies have demonstrated some possible benefits of moderate alcohol consumption. People who consume about one drink a day have been shown to have lower rates of cardiovascular disease than non-drinkers. Alcohol can be protective because it raises blood levels of HDL-cholesterol, the good type. Alcohol also inhibits blood clots, which can prevent heart attacks and strokes. Although red wine has been studied the most for its heart health benefits, all types of alcohol appear to be helpful. Red wine may have an added benefit from the antioxidants in the red grapes, however.
Heavy drinking causes high blood pressure, which is a risk factor for cardiovascular disease. This is why alcohol only in moderation (1-2 drinks per day) has been shown to reduce cardiovascular disease risk. |
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| Alcohol and Liver Disease |
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Definition
One of the most common and serious complications of frequent or abusive alcohol consumption is damage to the liver. The liver is the primary site of alcohol metabolism, and while the liver is pre-occupied with detoxifying the body of alcohol, it will put its other functions on hold. A person who drinks alcohol regularly is likely to develop fatty liver, alcoholic hepatitis (inflammation of the liver) and cirrhosis (end stage liver disease). Alcoholism is the main cause of cirrhosis.
Some medications can increase the effects of alcohol, and can possibly increase the odds of liver damage. Acetominophen (Tylenol) is one medication that should not be combined with alcohol due to this serious side effect. Alcohol can also increase the side effects of some medications, all of which are processed in the liver. |
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Definition
Most adults with diabetes can consume alcohol in moderation (1-2 drinks per day). However, alcohol must be consumed with food to prevent hypoglycemia. Alcohol will interfere with the liver's ability to break down glycogen in order to send glucose to the bloodstream when needed. A person on insulin therapy or oral diabetes medications is especially at risk of hypoglycemia if alcohol is not consumed with food.
Alcohol can raise blood triglyceride levels, and a person with diabetes is already at high risk of high triglycerides. Alcohol can also interfere with some diabetes medications. Like everyone else, a person with diabetes should speak with their doctor about their medical conditions, medications, and risks, in order to determine if alcohol is contraindicated for them. |
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Definition
| Alcohol can increase the risk of breast cancer in women, especially if there is a family history. Women with a strong family history of breast cancer should abstain from alcohol completely. Heavy alcohol consumption can also increase the risk of throat, esophageal, and colon cancers. |
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Definition
| Couples trying to conceive a child should limit or abstain from alcohol. In men, alcohol causes decreased testosterone secretion, resulting in less sperm production. In women, alcohol can cause infertility by disrupting the menstrual cycle. If alcohol is consumed during pregnancy, it can harm the fetus and cause malformations. With extreme alcohol abuse during pregnancy, an infant can be born with fetal alcohol syndrome, which causes growth and mental retardation, along with brain damage. Even alcohol consumed in the early stages of pregnancy can be harmful. |
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| Other Problems with Alcohol |
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Definition
Alcohol is a known irritant of the stomach and other organs. It can cause gastritis, stomach ulcers, and diarrhea. Alcohol abuse is one of the leading causes of pancreatitis, which can lead to permanent damage of the pancreas. Like other types of drugs, alcohol can kill brain cells and cause brain damage.
Alcohol consumed in moderation can cause euphoria, excitement, and a good feeling. When drinking becomes heavier, however, a person's judgement becomes impaired, they become sleepy, and their senses are reduced. Eventually, if the drinking continues, a person becomes very confused and unable to function. Gastrointestinal complications such as vomiting can occur. An extremely drunk person may lose consciousness, suffer acute alcohol poisoning, and possibly die from respiratory failure. Most deaths from alcohol occur in people under the age of 45. |
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| Nutritional Complications of Alcohol |
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Definition
Light drinkers who are healthy usually have no nutritional complications from alcohol. If you drink on a regular basis, however, your nutritional status will become compromised. Alcohol interferes with the body's ability to metabolize nutrients. Alcohol can prevent intestinal absorption of some water soluble nutrients. The cells of the liver may not be able to activate vitamin D, and also may not be able to produce and excrete bile, which may lead to fat malabsorption. The kidneys will excrete more magnesium, calcium, potassium, zinc, and folate.
Alcohol blocks formation of retinal, a compound in the eye responsible for vision in low light, therefore leading to night blindness. People who abuse alcohol tend to have low levels of iron and the B vitamins, which can lead to anemia. People who abuse alcohol regularly tend to replace food intake with alcohol, leading to protein energy malnutrition (PEM) and severe weight loss. Alcoholics are most likely to be deficient in the nutrients thiamin and vitamin B6. |
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Definition
| Alcohol "abuse" is defined as continuous use of alcohol in spite of negative consequences. While alcoholics obviously abuse alcohol, frequent binge drinking is also alcohol abuse, as is driving while impaired after already being arrested for DUI (driving under the influence). |
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Term
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Definition
| Diabetes affects more than 30 million Americans, but nearly one third of those are unaware they have the disorder. Diabetes is a condition where glucose management is impaired. Common symptoms include fatigue, increased thirst, frequent urination, and weight loss (with Type 1). Unfortunately, feeling tired, losing weight, being thirsty and urinating more are not the kind of symptoms that send people running to the doctor. You can certainly understand how this disorder goes unnoticed and undiagnosed. |
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Term
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Definition
| Diabetes is a condition in which the pancreas either does not make insulin, does not make enough insulin, or the body is unable to utilize its own insulin effectively. If the body does not utilize its own insulin effectively, this is called insulin resistance, which is most often the case with Type 2 Diabetes. Insulin is a hormone which allows glucose to enter the cells for energy. If insulin is not present or cannot be utilized quickly enough, the glucose will build up in the blood stream, leading to health complications. Too much glucose in the bloodstream is what is commonly referred to as "high blood sugar". |
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Definition
| There are 3 main types of diabetes: Type 1, Type 2, and Gestational Diabetes. |
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Definition
| Type 1 diabetes is the least common (only 5-10% of cases) but most serious type of diabetes. Type 1 is considered an autoimmune disorder where the immune system mistakenly attacks healthy tissue (the beta cells of pancreas that produce insulin, in this case). Research has identified the genetic markers for it, but not all individuals with the markers seem to develop diabetes. It is believed that an infection (such as strep) may initiate the autoimmune response. With Type 1, the pancreas completely quits producing insulin, and life-long insulin therapy is needed for survival. |
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Definition
| Type 2 diabetes is the most common type, and is marked by insulin resistance. Symptoms are less dramatic (and sometimes asymptomatic) which explains the large number of diabetics who are not diagnosed. To compensate for the reduced sensitivity of insulin in the cells, the pancreas responds by producing more and more insulin (hyperinsulinemia). Over time, the beta cells can become exhausted and insulin production can become impaired. Therefore, type 2 diabetes can be associated with both insulin resistance and deficient production of insulin. Treatment varies depending on how the body is responding, but diet and exercise are the backbone of treatment. The cause of type 2 diabetes is not completely known, but the leading risk factor is obesity. In fact, Type 2 diabetes is at epidemic levels now in the United States, most likely due to the obesity epidemic. Type 2 is now being diagnosed in children as well. |
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Definition
| Gestational diabetes is the type that occurs during pregnancy, and will go away when the baby is delivered. However, a woman who develops gestational diabetes during pregnancy has an elevated risk for developing Type 2 diabetes later as well. Gestational diabetes is a common complication in pregnancy so all women are screened between 24 and 28 weeks of gestation. Gestational diabetes typically occurs from an increase in insulin resistance during pregnancy, and if not controlled can lead to high birthweight and increase the risk for birth defects and miscarriage. Poor glycemic control during pregnancy can also increase the risk for complications in a newborn, such as jaundice, respiratory distress syndrome, and hypoglycemia. |
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Term
| High blood sugar (hyperglycemia) |
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Definition
Occurs in all types of diabetes.
If too much carbohydrate is consumed (or too little medication administered), glucose cannot get into the cells and remains circulating in the blood stream.
most often caused by poor diet/medication management, infections, or stress.
When blood glucose levels exceed approximately 200 mg/dL, the glucose starts to "spill" into the urine, known as glycosuria. |
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Term
| Low blood sugar (hypoglycemia) |
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Definition
| can also develop in all types of diabetes, but is most common in type 1 where both extremes of highs and lows are likely. As we discussed in module 2, hypoglycemia is a disorder alone as well as a complication of diabetes. As a symptom in diabetes, hypoglycemia is usually related to poor diet and medication management. Skipping meals, administering more insulin than necessary for food intake, exercising heavily, etc. can all lead to low blood sugar. |
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Term
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Definition
If glucose does not get into the cells (as is the case in diabetes), it cannot be used as an energy source.
The body must then break down glycogen stores, lean tissue and fat for its energy.
The condition of ketoacidosis is an acidotic state caused by high levels of ketones(high nlood acidity)
The high acid environment alters body functions, and can be life-threatening. Prevention of ketoacidosis is generally fairly simple with appropriate management of diet, insulin, and exercise. However, extenuating circumstances such as illness can present unique challenges. |
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Definition
| page 3 of diabetes in module 4 |
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Definition
Diabetes is diagnosed through a fasting blood test. Although a diabetes screening will only need a drop of blood, to officially diagnose a person with diabetes a full blood test is needed and the person must abstain from food and liquids for at least 8 hours. Their fasting blood glucose would then be drawn to determine if there is a true blood sugar problem. Fasting blood glucose levels above 126 mg/dl is a sign of diabetes. Blood glucose below 100 mg/dl is normal and does not reflect a problem. Fasting blood glucose between 100 mg/dl and 125 mg/dl reflects pre-diabetes, or impaired fasting glucose. People with this problem are likely to develop full-blown diabetes eventually. Two separate tests of high blood sugars is needed for a diagnosis.
The normal fasting blood glucose range is 70 mg/dl to 100 mg/dl. Fasting glucose above 126 mg/dl, or any random blood glucose above 200 mg/dl is diagnosis criteria for diabetes.
A glucose tolerance test may be given to test for diabetes or hypoglycemia. During such a test, the person would consume a set load of glucose first thing in the morning, and then their blood glucose levels would be checked at hour intervals afterwards to determine how their body is reacting to the glucose. Most often, glucose tolerance tests last for about 3-4 hours, but may be longer. Pregnant women are usually required to undergo a glucose tolerance test during their 6th month of pregnancy to check for gestational diabetes. |
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| Low blood sugar (hypoglycemia) |
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Definition
| can also develop in all types of diabetes, but is most common in type 1 where both extremes of highs and lows are likely. As we discussed in module 2, hypoglycemia is a disorder alone as well as a complication of diabetes. As a symptom in diabetes, hypoglycemia is usually related to poor diet and medication management. Skipping meals, administering more insulin than necessary for food intake, exercising heavily, etc. can all lead to low blood sugar. |
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Term
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Definition
If glucose does not get into the cells (as is the case in diabetes), it cannot be used as an energy source.
The body must then break down glycogen stores, lean tissue and fat for its energy.
The condition of ketoacidosis is an acidotic state caused by high levels of ketones(high nlood acidity)
The high acid environment alters body functions, and can be life-threatening. Prevention of ketoacidosis is generally fairly simple with appropriate management of diet, insulin, and exercise. However, extenuating circumstances such as illness can present unique challenges. |
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Term
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Definition
| page 3 of diabetes in module 4 |
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Term
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Definition
Diabetes is diagnosed through a fasting blood test. Although a diabetes screening will only need a drop of blood, to officially diagnose a person with diabetes a full blood test is needed and the person must abstain from food and liquids for at least 8 hours. Their fasting blood glucose would then be drawn to determine if there is a true blood sugar problem. Fasting blood glucose levels above 126 mg/dl is a sign of diabetes. Blood glucose below 100 mg/dl is normal and does not reflect a problem. Fasting blood glucose between 100 mg/dl and 125 mg/dl reflects pre-diabetes, or impaired fasting glucose. People with this problem are likely to develop full-blown diabetes eventually. Two separate tests of high blood sugars is needed for a diagnosis.
The normal fasting blood glucose range is 70 mg/dl to 100 mg/dl. Fasting glucose above 126 mg/dl, or any random blood glucose above 200 mg/dl is diagnosis criteria for diabetes.
A glucose tolerance test may be given to test for diabetes or hypoglycemia. During such a test, the person would consume a set load of glucose first thing in the morning, and then their blood glucose levels would be checked at hour intervals afterwards to determine how their body is reacting to the glucose. Most often, glucose tolerance tests last for about 3-4 hours, but may be longer. Pregnant women are usually required to undergo a glucose tolerance test during their 6th month of pregnancy to check for gestational diabetes. |
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Definition
Dietary modification is necessary for all persons with diabetes, regardless of the type. However, sometimes a person may consume a healthy diet and their blood sugar can remain too high. Therefore, medication is often needed.
Insulin therapy is required for ALL people with Type 1 diabetes, since the pancreas does not produce any insulin.
The other insulin preparations have various ranges of peak action. These types of insulin are used to handle the carbohydrate consumed at meals times. The peak action can vary some depending on the body mass of the individual.
Exercise is an important part of diabetes treatment. Exercise usually will decrease a person's blood sugar both immediately and long-term. Exercise can reduce the insulin resistance that a person with Type 2 diabetes is experiencing. |
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Term
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Definition
| a small device (resembling a beeper) that a person wears 24 hours a day. The device is attached to narrow plastic tubing which is inserted into the skin (anywhere there is an adequate amount of adipose tissue), continuously delivering insulin (called their "basal rate") into the bloodstream. A bolus of insulin will also be given through the pump when food is consumed. |
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| Dietary Rec. for Diabetes |
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Definition
| Page 5 under "Diabetes" Module 4 |
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| Meal Planning for Diabetes |
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Definition
Carbohydrates are the backbone of the diet for treating diabetes.
A person with diabetes should NOT follow a low-carbohydrate diet.
Carbohydrate intake is not about how many grams per day a person consumes, but rather how much is consumed at one time that is important. Consistency of carbohdyrates is the most important aspect of meal planning with diabetes.
It is best if a person with diabetes consumes around 50% of their calories from carbohydrate, which is within the general recommendation of 45-65% of calories. However, women with gestational diabetes have stricter guidelines, and should keep carbohydrate around 45% of calories during pregnancy.
A person with diabetes should try to limit concentrated sweets, but does not need to avoid sugar completely.
The recommendation is to limit the "added sugars" while fitting the natural sugar sources into the diet. |
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Term
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Definition
The best way to ensure that carbohydrates are consistent (the same amount and correct amount at each meal) while maintaining adequate amounts of fat and protein is to follow the exchange list. The diabetic exchange system classifies foods by nutrients and amount of carbohydrates they contain, and encourages portion control. Most people find they can lose weight easier as well when following an exchange diet.
Starches, fruits, and milk are the "carbohydrate exchange" groups, meaning that they contain the most carbohydrate, with an average of 15 grams per serving. A serving of one of these food groups is often called a "carbohydrate exchange" |
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Term
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Definition
This type of diet therapy follows some of the same principles as the exchange list. It actually uses the same list of foods and serving sizes as the diabetic exchange list. The difference in carbohdyrate counting is that only the "carbohydrate servings" are counted. Instead of listing the number of starch, fruit, vegetable, milk, meat and fat servings are required for each meal, the dietitian would simply identify a number of carbohydrate servings to consume at each meal.
Carbohydrate Counting Meal "Example": (4 carbohydrate servings per meal)
½ large baked potato 2 carbohdyrate servings
3 ounces baked chicken
1/2 cup steamed carrots
1 small apple 1 carbohdyrate serving
1 tsp. margarine;
1 tsp. sour cream
8 ounces milk 1 carbohdyrate serving |
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| General Dietary Guidelines for Diabetes |
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Definition
Carbohydrate Consistency: Eat the same amount of carbohydrates at each of the meals.
Eat at least every 4-5 hours: Eating on schedule is important to prevent hypoglycemia (low blood glucose) and to prevent overeating when you get to the next meal. Eating frequently will also help improve metabolism.
Do NOT skip meals: As discussed in previous modules, skipping meals will NOT help with weight loss long term, and will usually lower a person's metabolic rate, increasing the odds of future weight gain.
Do not overeat: Eating too much of anything is not good. Portion control is crucial to maintaining calories, and weight. Overeating can result in weight gain, which makes insulin resistance even worse.
Get a balance of carbohydrate, protein, and fat: As with everyone else, all of the macronutrients are important and getting too little or too much of any of them can result in health complications.
Control calories in order to achieve a healthy body weight: The amount of calories a person needs varies from person to person depending on their age, size, and activity level. |
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Term
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Definition
| Ketoacidosis is a condition in which ketones build up in the blood, causing the blood to become very acidic. Ketoacidosis is an indication that the body is "starving" and that glucose is not entering the cells for energy due to lack of insulin. |
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Term
| Hyperglycemia (high blood sugar) |
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Definition
| Hyperglycemia can occur if a person eats too much, eats the wrong foods, or doesn't take their insulin or medication. It can also occur because of illness or stress. |
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Term
| Hypoglycemia (low blood sugar) |
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Definition
| Hypoglycemia can occur if a person does not eat on schedule, does not eat enough carbohydrates, or takes too much insulin or diabetes medication. It can also occur from exercise, especially if the person does not have a meal or snack before exercising. |
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Term
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Definition
| A diabetic coma occurs if a person's blood glucose levels become extremely high, which often is fatal. Blood glucose above 600 mg/dl can often lead to a diabetic coma for a person with Type 1 diabetes, although it rarely occurs with a person with Type 2 diabetes. |
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Term
| Hyperosmolar Hyperglycemic State (HHS) |
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Definition
| HHS is a condition that develops in the absence of ketosis. Unlike diabetic ketoacidosis, it often evolves slowly, and is most often associated with Type 2 diabetes. Blood glucose levels can exceed 600 mg/dl and often as high as 2000 mg/dl. |
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Term
| Long-term complications that can occur include the following |
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Definition
Cardiovascular disease: Cardiovascular disease, especially heart disease, is the leading cause of death for diabetic people.
Chronic infections (including skin and vaginal infections): Diabetic people are very prone to infections, which are very difficult to treat. In severe cases, infections can lead to gangrene and result in amputations of toes, feet, legs, and fingers.
Neuropathy (nerve damage): Diabetic people often suffer from neuropathy, especially in the extremities (feet, hands, etc.). Because of this, the risk of infections increases. Checking the feet daily is a very important part of diabetes care, since a person may cut themselves and not even feel it. Due to the poor circulation and risk of infection, this can lead to serious problems. People with diabetes should never go outside barefoot.
Retinopathy (eye damage): Neuropathy of the eye can occur from high blood glucose, leading to impaired vision. Uncontrolled diabetes is the leading cause of blindness worldwide.
Sexual dysfunction (impotence, etc): High glucose levels can lead to impotence in men, as well as lack of sex drive in women.
Nephropathy (kidney damage): Diabetes is a leading cause of kidney disease. Nephrotic syndrome, or early stage kidney damage, is a common problem among all people with diabetes. Nephrotic syndrome will be discussed further in the next module.
Blood glucose control is the best way to prevent the complications of diabetes. With proper education, meal planning, medications, and exercise, a diabetic person may be able to live a long, healthy life. |
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Term
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Definition
Hypoglycemia is defined as blood glucose under 70 mg/dl. It is a common short-term complication of diabetes. Hypoglycemia can also occur without diabetes, although it is considered a risk factor for developing Type 2 diabetes someday since both are considered to be conditions of glucose intolerance.
Symptoms of Hypoglycemia Include:
Weakness
Dizziness
Shakiness
Heart Palpitations
Sweating
Mental Confusion
Slurred Speech
Personality Changes |
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Term
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Definition
caused by over-secretion of insulin by the pancreas in response to a rapid rise of blood sugar. Symptoms often occur about 4 hours after a meal.
To prevent reactive hypoglycemia or treat the symptoms, a person should do the following:
Avoid or limit foods high in sugar, especially on an empty stomach
Eat small meals and snacks about every three hours
Exercise regularly
Eat a variety of foods, including meal, poultry, fish, starches, fruits, and vegetables
Choose foods high in fiber
Causes of hypoglycemia among diabetic people include:
Delayed meals or snacks
Inadequate food or carbohydrate intake
Excessive amounts of insulin or diabetes medication
Prolonged exercise
Consuming alcohol without food
Treatment of hypoglycemia consists of about 15-20 grams of fast-acting carbohydrate (sugar). For example, this could include about 4 ounces of juice, ½ can regular soda, or 8 ounces of low-fat milk. Beverages are better than food because they are absorbed quicker. Candy can also be used, but it needs to be without fat, since fat will slow down the absorption of the carbohydrate. Therefore, chocolate would not be an effective treatment for hypoglycemia. Many diabetic people carry glucose tablets with them to treat hypoglycemia if it occurs. After the treatment, the blood glucose should be rechecked in 15 minutes, and if it is still low, the treatment should be repeated until it returns to normal.
People with Type 1 diabetes can be treated with an injection of glucagon, which is a hormone that acts opposite insulin. It can bring blood glucose levels up very rapidly. Glucagon injections are not effective on people with Type 2 diabetes, however. Family members of children or other people diagnosed with Type 1 diabetes are often trained on how to use a glucagon kit. |
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Term
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Definition
| Cardiovascular disease (CVD) is any disease affecting the heart or blood vessels. It is the leading cause of death in the United States, accounting for 40% of the deaths, as well as 1/3 of deaths worldwide. It includes atherosclerosis, coronary heart disease (CHD), myocardial infarction (MI, or heart attack), and stroke. |
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Term
| Coronary Heart Disease (CHD) |
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Definition
CHD is most often caused by atherosclerosis, which is an accumulation of plaques along the inner arterial walls, which can obstruct blood flow. Atherosclerosis can damage tissues and raise blood pressure. Usually the plaques start as lipids and cholesterol, and eventually they may harden. When a blood vessel in the heart becomes blocked, it will obstruct blood flow to the heart and cause a heart attack. Sometimes plaques can break of from coronary (heart) arteries and travel to other parts of the body as well. If a blood clot travels to the brain, it leads to stroke.
Oxidized LDL and damage to arteries (including that from high blood sugar and shear stress from high blood pressure) attracts the immune response and platelet formation. The phagocytes engulf the LDL becoming foam cells (known as fatty streaks). Smooth cells from the arterial walls proliferate, digest LDL and produce fibrous material. Calcium and cholesterol accumulate, crystallize and harden. Arteries with large lipid core will usually enlarge, allowing blood flow to continue, but they are unstable and likely to rupture (increase blood clotting, blocked vessels, and heart attacks). |
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| Oxidized LDL and damage to arteries (including that from high blood sugar and shear stress from high blood pressure) attracts the immune response and platelet formation. The phagocytes engulf the LDL becoming foam cells (known as fatty streaks). Smooth cells from the arterial walls proliferate, digest LDL and produce fibrous material. Calcium and cholesterol accumulate, crystallize and harden. Arteries with large lipid core will usually enlarge, allowing blood flow to continue, but they are unstable and likely to rupture (increase blood clotting, blocked vessels, and heart attacks). |
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Definition
Major Risk Factors for CHD (not modifiable)
Increasing age
Male gender
Family history of premature heart disease
High blood LDL cholesterol
Low blood HDL cholesterol
Hypertension (high blood pressure)
Diabetes
Obesity (especially abdominal obesity)
Physical inactivity
Cigarette smoking
An "atherogenic" diet (high in saturated fats and low in vegetables, fruits, and whole grains) |
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| Page 2 cardiovascular Module 4 |
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| Other treatment for CHD includes |
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Definition
Exercise: Cardiovascular exercise is promoted as a way to strengthen the heart muscle. Regular exercise will also promote weight loss, raise good HDL blood cholesterol levels, lower blood pressure, and help control diabetes. People with heart disease need to be careful not to overexert themselves during exercise, however. Daily walking is usually recommended for most people.
Quit Smoking: Smoking is a leading risk factor for heart disease, so obviously the person should quit immediately or their condition will worsen.
Lose Weight, if needed: It is best for a person to keep their BMI below 25. Even modest weight loss can significantly lower a person's blood pressure.
Drug Therapy: Many medications can be given to reduce the risk factors for heart disease. Statin medications can significantly lower blood cholesterol levels, along with diet and exercise. Blood pressure medications should definitely be prescribed for those who cannot control hypertension through diet therapy alone. Aspirin and anticoagulant medications (blood thinners) are often prescribed to prevent blood clot formation. Unfortunately, some medications can be very costly and may carry health risks. Elderly people are especially at risk for diet-medication interactions.
There are some herbs that may help to lower the risk of cardiovascular disease as well. Studies show that garlic may reduce cholesterol levels and lower blood pressure, although the results may be modest and short. For garlic to be effective, it needs to be consumed daily and is best if consumed fresh. Hawthorn is an herb that is sometimes prescribed because it can intensify the action of blood pressure medications, and therefore lower the amount of medication needed. Black and green teas have also been shown to lower the risk of CHD because they contain natural antioxidants. Unfortunately, many doctors do not know much about herbal therapy to treat disease and are therefore unlikely to prescribe herbs for patients. |
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| is one of the most important ways to prevent or treat coronary heart disease. Consuming a poor diet throughout life can significantly increase the odds of problems such as atherosclerosis, heart attack, high blood pressure, and stroke. After being diagnosed with CHD, most people will drastically need to change their diet and lifestyle or face the fact that their condition may worsen and ultimately lead to death. |
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| To prevent or treat CHD, nutrition therapy includes |
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Definition
Fat: Total fat should be kept below 35% of total kcalories per day with the majority coming from unsaturated sources, especially omega-3 fatty acids.
Saturated and Trans fat contributes more to blood LDL levels than any other dietary factor. Since LDL is a large factor in atherosclerosis, prevention is aimed at lowering it. Research suggests that for every 1% increase of saturated fat in the diet, blood cholesterol increases 2%. The good news is that the opposite is also true. If you decrease saturated fat by 1% in the diet, it decreases blood cholesterol by 2%. To prevent or treat heart disease dietary saturated fat should be less than 7% of kcalories. Research on trans fat continues, but no specific recommendations have been made by the government other than to consume little or no trans fat. Research by the American Heart Association suggests that while saturated fat increases LDL, trans fats not only increases LDL but lowers HDL (making the ratio of LDL to HDL worse). Therefore, the AHA has recommended trans fats should be limited to less than 1% of total kcalories. The bottom line is that saturated and trans fat are both considered bad and need to be limited in the diet. Choosing a food that is higher in saturated fat just to avoid trans fat, is a bad option.
Dietary cholesterol impacts blood cholesterol less than saturated and trans fat. Nonetheless, it does contribute to it and should be considered in the diet. Cholesterol intake should be less than 200 mg per day.
Unsaturated Fats are considered the 'good' fats. Research on the benefits of them is ongoing and not conclusive. The omega 3 fatty acids, however, do seem to have fairly good evidence of benefits in heart disease. In those with previous heart attacks, a diet rich in omega 3 fatty acids may suppress the inflammatory response, reduce blood-clotting time, stabilize heart rhythm and lower triglycerides. The American Heart Association recommends eating two servings of fatty fish per week for CHD risk reduction. Although fish is the best source of heart healthy omega-3 fatty acids, routine fish oil supplementation is not recommended for everyone. Plant sources of omega-3 fatty acids include flaxseed, walnuts, soybean and canola oil.
Carbohydrates: The diet should include foods rich in complex carbohydrates and fiber, while being low in refined carbohydrate and sugar, which can elevate blood sugar and triglycerides levels. Fiber may help to lower LDL cholesterol levels, while the minerals found in most high fiber foods may help to lower blood pressure.
Vitamins and Minerals: Consuming a diet with adequate calcium, magnesium, and potassium can help to lower blood pressure. The intake of sodium should be less than 2,000 mg per day, especially if the person has high blood pressure. The B-vitamins folic acid, vitamin B6, and vitamin B12 can all help to reduce high homocysteine levels. Taking megadoses of antioxidant vitamins such as vitamin E is not scientifically supported and can even cause harm. However, eating a diet that is rich is rich in antioxidants is not harmful and may help prevent oxidation of LDL.
Alcohol: Alcohol in moderation (1-2 drinks per day) may reduce the risk of CHD by raising good HDL blood cholesterol and preventing blood clot formation. In excess though, alcohol may have other damaging effects on the body (see module 9).
Soy: Consuming at least 25 grams of soy protein daily can lower LDL cholesterol levels.
Plant Sterols: Sterols are plant substances that can reduce blood cholesterol levels naturally by reducing the intestinal absorption of cholesterol. Sterols are sometimes added to food products such as margarines, cheese, salad dressings, and chewable supplements. The Benecol® brand of products includes plant sterols. |
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| Coronary Heart Disease (CHD) |
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Definition
CHD is most often caused by atherosclerosis, which is an accumulation of plaques along the inner arterial walls, which can obstruct blood flow. Atherosclerosis can damage tissues and raise blood pressure.
Oxidized LDL and damage to arteries (including that from high blood sugar and shear stress from high blood pressure) attracts the immune response and platelet formation. The phagocytes engulf the LDL becoming foam cells (known as fatty streaks). Smooth cells from the arterial walls proliferate, digest LDL and produce fibrous material. Calcium and cholesterol accumulate, crystallize and harden. |
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Nephrotic syndrome is a term used to describe any kidney disorder that results in proteinuria exceeding 3.5 grams per day.
It can develop when damage to the glomerular capillaries increases their permeability to plasma proteins, allowing protein to escape in the urine. Consequences of nephrotic syndrome include edema, increased risk of developing heart disease and stroke due to elevated LDL and VLDL levels, loss of immunoglobulin resulting in increased infections, and loss of vitamin-D binding protein resulting in potential rickets and osteomalacia. The graphic below summarizes these effects. |
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| treatment for Nephrotic Syndrome |
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Definition
Nephrotic syndrome is managed with medications and medical nutrition therapy. Drug therapy includes anti-inflammatory agents, ACE inhibitors, immunosuppressants, antihypertensive agents, diuretics and lipid-lowering medications. Medical nutrition therapy includes a daily protein intake of 0.8-1.0 g/kg (near the RDA), adequate kcalorie intake, and a diet low in saturated fat, cholesterol, sodium, and refined sugars.
As discussed in module 4, anytime protein is used as an energy source or stored as fat, the amino acids are stripped of their nitrogen containing group. The resulting ammonia must be concentrated by the liver and excreted by the kidneys, putting extra work on both organs. Without adequate kcalories, protein will be used for energy resulting in nitrogen production and extra demand on the kidneys. In the same way, providing excessive amounts of dietary protein will result in storage of amino acids as triglyceride, causing increased nitrogen and work on the kidneys. At least half of the protein should be from high quality sources such as dairy, meat, eggs, poultry or fish.
Fat, especially saturated fat should be minimized due to the effects of high levels of blood lipids found with nephrotic syndrome. Saturated fat is limited to no more than 7% of total kcalories and cholesterol is restricted to less than 200 mg/day. Simple sugars can also increase triglycerides and should be minimized in the diet.
Lowering sodium in the diet is effective in decreasing the effects of edema. Typically sodium is restricted to 1,0000-2,000 mg per day (or 1-2 grams/day). If diuretics are used as part of the treatment, potassium losses can be problematic. Patients are encouraged to eat foods rich in potassium such as bananas, and potatoes. In medical nutrition therapy of renal failure, we will discuss the sodium restricted diet in more details. Supplements of vitamin D and calcium may also be necessary to prevent rickets in children. |
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| There are two types of renal failure: acute and chronic. Depending on the type and severity, renal failure can be treated by removing the cause or contributing factor(s) such as an arterial blockage or kidney stones, by conservative intervention such as hospitalization and mild dietary restrictions, or by aggressive intervention such as dialysis. Dialysis is the process of "cleaning" or filtering the blood by diffusion. Hemodialysis uses a dialyzer to filter the blood, while peritoneal dialysis uses the body's peritoneum as a filter. |
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Acute renal failure is a sudden halt in renal (kidney) function, usually for a few days or weeks, which may be reversible. Signs and symptoms vary in each patient, and are due to retention of substances usually secreted in the urine. About 50% of people with acute renal failure die, most often from infection.
There are 3 classifications of acute renal failure: Pre-renal, Intra-renal and Post-renal:
Acute pre-renal failure is caused by a decreased flow of blood to the kidneys, which may be due to shock, burns, hemorrhaging (bleeding), and gastrointestinal or renal malignancies (cancers/tumors).
Acute intra-renal failure is related to kidney damage from substances such as drugs, heavy metals, certain plant and animal substances, x-ray dyes or environmental agents such as pesticides. Intra-renal failure may also be caused by inflammation, immune disorders, trauma, obstruction, hemolysis (a condition characterized by ruptured red blood cells), systemic and vascular (blood system) disorders, and complications related to pregnancy.
Acute post-renal failure occurs when urine is prevented from leaving the body. It can be caused by kidney stones, prostate problems, congenital (birth) abnormalities, or mass occupying lesions (tumors). |
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| Consequences of Acute Renal Failure |
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Definition
Renal function declines
The composition of blood and urine changes
Kidneys are unable to regulate the levels of electrolyte acid, nitrogenous waste in blood.
Quantity of urine may be diminished in quantity or be absent
Edema is frequently an early symptom of acute renal failure, causing puffiness in the face and hands and swelling of the feet and ankles
Half of patients experience oliguria during the initial stage of kidney failure, producing less than 400 milliliters of urine per day
Sodium retention also contributes to the development of edema
Other electrolytes are also retained in the body, causing elevated blood levels of potassium, phosphate and magnesium
In addition to reduced electrolyte excretion, excessive amounts of these electrolytes are released into the bloodstream due to the tissue breakdown.
Hyperkalemia (elevated potassium) is a concern because potassium imbalances can alter the heart rate and lead to heart failure
Hyperphosphatemia (elevated phosphate levels) can cause increased secretion of parathyroid hormone and a reduction in blood calcium
Waste products such as blood urea nitrogen (BUN), creatinine, and uric acid accumulate in blood (called uremia).
Uremia causes symptoms such as fatigue, lethargy, confusion, headache, anorexia, a metallic taste in the mouth, nausea, vomiting and diarrhea.
More serious cases may cause problems such as rapid pulse, elevated blood pressure, seizure, delirium, or coma. |
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| Treatment of Acute Renal Failure |
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Definition
The primary goal for treatment of acute renal failure is to prevent further damage to the kidneys. A combination of medical nutrition therapy, drug therapy, and dialysis may be needed to restore fluid and electrolyte balances, and to minimize blood concentrations of toxic waste products.
Diuretics are usually prescribed to help control edema, which will occur since the kidneys cannot properly control fluid balance in the body. Furosamide (Lasix) is one of the most common diuretics that doctors prescribe. Hyperkalemia (excess potassium in the blood) is treated with potassium exchange resins that bind potassium ions in the gastrointestinal tract, ensuring potassium excretion in the stool. If acidosis is present, bicarbonate may be administered orally or intravenously. |
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| Chronic Renal Failure (CRF) |
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Definition
| Chronic renal failure (CRF) is a severe, irreversible loss of kidney function, which typically develops over months to years. In the early stages of chronic renal failure, the nephrons enlarge so they can handle the extra workload. With the extra workload of the larger nephrons, symptoms do not appear and diagnosis may not be evident. As more nephrons deteriorate, the kidneys are unable to function adequately and symptoms appear. More than 75% of all of the nephrons in the kidney must be damaged before illness is obvious. Chronic renal failure results in End Stage Renal Disease, or ESRD and dialysis is required. Only a kidney transplant can cure chronic renal failure. |
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| Consequences of Chronic Renal Failure |
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Definition
Renal failure is evaluated using the glomerular filtration rate (GFR), the rate at which the kidneys form filtrate. Electrolyte imbalances will occur when the GFR declines to less than 5 milliliters per minute. Secretion of the hormone aldosterone increases, which helps to maintain serum potassium levels. However, this can contribute to hypertension. The parathyroid hormone secretion increases keeps serum phosphate level normal, but it contributes to bone loss and the development of renal osteodystrophy, a bone disorder common in renal patients.
Chronic renal failure can result in uremic syndrome, the retention of waste products that are usually eliminated in urine. It develops when the GFR is below 15 milliliters per minute and BUN exceeds 60 milligram per deciliter. Untreated chronic renal failure causes major disruptions in the body's hormone, electrolyte, and acid-base balances, and can cause death. The characteristics of uremic syndrome are apparent throughout the body, resulting in the following symptoms:
Abnormal skin pigmentation and severe itching (pruritis)
Swelling of body parts (edema), shortness of breath, crackles (an indication of fluid in the lungs detected by stethoscope), congestive heart failure, pulmonary edema (a critical accumulation of fluid in the lungs), enlarged neck veins, fatigue, and anemia
Mood swings, attention loss, difficulty in problem solving, pain and burning in the legs and feet
Anorexia, nausea and vomiting, bad breath
Bone demineralization and bone pain
Sexual dysfunction and loss of sex drive
Anemia and blood clotting abnormalities
Anemia is very common among people with CRF because the kidneys are unable to produce erythropoietin. Anemia can also occur from bleeding abnormalities due to a defect in platelet function. Bruising and gastrointestinal bleeding is common. The kidneys are unable to convert vitamin D to its active form, so bone disease often occurs.
People with renal disease are at high risk of cardiovascular disease, due to hypertension, insulin resistance, and abnormal blood lipids. The elevated levels of parathyroid hormone may also cause calcification of blood vessels and heart tissue. People with uremia have poor immune responses and are at high risk of developing infections, a frequent cause of death. In addition, the person often develops protein-energy malnutrition (PEM) and wasting. |
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| Dietary Recommendations for Chronic Renal Failure |
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Definition
Energy: Calorie intake should meet the RDA. If energy demand is not met, lean tissue will be broken down so amino acids can be used for an energy source. As discussed earlier, using amino acids as an energy source or stored as fat (in excess amounts) will result in increased nitrogen and demand on the kidneys. Providing adequate kcalories is one of the most important aspects of the renal diet. Often in renal failure, the increased BUN can be related to lean tissue breakdown from inadequate kcalorie sources rather than just worsening kidney function. Preventing malnutrition can be an uphill battle with renal failure, and it begins with providing adequate kcalories.
Protein: If too little protein is consumed, the person can develop malnutrition. Too much protein causes blood urea to rise. Prior to end-stage renal failure, a protein-restricted diet that derives about two-thirds of its protein from animal sources such as eggs, milk, meat, poultry and fish is recommended (0.6 to 0.75 grams/kg/day).
Fat: Renal diets restrict total fat, saturated fat, and cholesterol to help control elevated blood lipid levels. However, adequate kcalories are essential. Low fat diets may cause kcalories to be too low with resulting malnutrition. Client education on types of fat (such as the polyunsaturated fats especially those in fish) can be helpful in maintaining kcalorie intake without worsening the effects of high blood lipids.
Sodium and Fluids: As renal failure progresses, the body excretes less urine and cannot handle normal amounts of sodium and fluids. Fluids are not restricted in renal insufficiency until urine output decreases. For the person who is not dehydrated or overhydrated, daily fluid needs are equal to the daily urine output plus 500 to 750 milliliters to provide for insensible water losses. Once a person is on dialysis, sodium and fluid intakes are controlled to allow a weight gain of about 2 pounds (of fluid) between dialysis treatments. Sodium is generally restricted to 1 to 3 grams per day.
Potassium: Potassium is generally not restricted unless hyperkalemia develops.
Phosphorus: Dietary phosphorous restriction helps control rising blood phosphorus levels. However, having so many restrictions can make it too difficult on the individual. Physicians will prescribe medications to bind phosphorus in the GI tract, called phosphate binders (Fosrenol, Renagel, and Phoslo). Calcium and vitamin D supplements are usually recommended since they can both bind phosphorus and help reduce the incidence of bone disease.
Other Vitamins: Folate and vitamin B6 should be consumed in generous amounts, along with the recommended amounts of other water soluble vitamins. Supplementation of fat-soluble vitamins other than vitamin D is usually not necessary. |
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Dialysis helps do what the kidney can no longer do adequately. The primary job of the kidneys is to remove excess fluid and waste from the bloodstream. When the kidney function is below 15% of what is normal, the patient needs dialysis to filter these items from their blood. But the kidneys have other duties as well. They make and release hormones that regulate and control certain body functions. Unfortunately, dialysis is unable to manufacture these essential hormones. Patients in the later stages of chronic kidney disease (CKD) will need medical supplements to compensate for the hormones their kidneys are unable to produce.
Dialysis is a procedure that removes excess wastes from the blood by employing the principles of simple diffusion and osmosis across a semi permeable membrane. A solution similar in composition to normal blood plasma called the dialysate is placed on one side of the semi permeable membrane; the person's blood flows by on the other side. A semi permeable membrane is like a filter; different types of membranes have pores of different sizes, and the size of the pores determine which molecules will pass through the membrane and which will not. Small molecule like urea and electrolytes will cross the membrane freely, while large molecules like proteins are less likely to cross the membranes. |
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is the main type of dialysis, in which the blood is circulated through a dialyzer machine, which acts as an artificial kidney. Most people on hemodialysis do several treatments a week at a dialysis center, lasting between three to four hours for each treatment. An alternate to hemodialysis is peritoneal dialysis. In Peritoneal Dialysis, the peritoneal membrane (the membrane that covers the abdominal membranes) serves as semi-permeable membrane. The dialysate is infused directly through a tube into the peritoneal space, the space within the person's abdomen that overlays the intestine. Fluid is kept in the abdomen for about 30 minutes and then is drained from the abdomen through a tube by gravity. The procedure is repeated with fresh fluids. One complete exchange may take about 45 minutes, and the complete treatment may require about six exchanges. Peritoneal dialysis is performed daily, and the infection rate is much higher, which is why hemodialysis is more common.
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The hemodialysis diet is designed to reduce the amount of fluid and waste that builds up between hemodialysis treatments so that the patient can feel their best. It will also reduce the risk of other health complications associated with kidney disease. In addition to enjoying a variety of nutritious foods, the hemodialysis diet will introduce a higher amount of protein into the person's eating plan, as determined by a dietitian. The person is encouraged to get protein from high quality sources such as lean meat, poultry, fish and egg whites. These high protein foods provide all the essential amino acids the body needs.
Kcalories: energy demand is the same in ESRD as was in the early stages. Approximately 35 kcals/kg/day is recommended to prevent malnutrition and lean tissue breakdown.
Protein: as mentioned, dialysis removes the nitrogenous waste products from the blood, so more protein is tolerated. In ESRD, while on hemodialysis, protein intakes should be approximately 1.2 grams/kg/day with emphasis on the high quality protein foods.
Potassium: depending on blood laboratory results, potassium is often restricted to 2,000 to 3,000 mg (2-3 grams) per day. Potassium builds up in the blood between dialysis treatments, leading to hyperkalemia. Too much potassium is very dangerous. It can cause muscle weakness and make the heart stop beating. Learning the potassium restrictions can be very difficult for some individuals because cooking methods can affect the potassium content. Later in this module we will discuss the potassium restriction in more detail.
Sodium: restricting sodium remains the same as pre-dialysis. Depending on serum levels, high blood pressure and edema, sodium is restricted to 1,000 to 3,000 mg/kg/day. If the diet is not adhered to, the result can be increased fluid retention (and visible in weight). Sodium causes the body to hold onto more fluid and raises blood pressure. The person may feel uncomfortable and short of breath if they consume too much sodium and fluid. When excess fluid is removed during dialysis, the person can get muscle cramps and feel dizzy and weak during or after treatment. Eating less sodium and drinking less fluid can help the patient feel comfortable before and after their dialysis sessions.
Phosphorus: is difficult for hemodialysis to filter from the blood. This mineral can build to high levels in the bloodstream and cause complications such as weak bones, heart problems, joint pain, or skin ulcers. Unfortunately, phosphorus is found in many foods. Following a highly restrictive phosphorus diet in addition to the other dietary restrictions may limit food selection too severely. In addition to avoiding foods excessively high in phosphorus, the doctor may prescribe a medicine called a phosphate binder to help keep phosphorus levels normal.
Fluid: The patient will be given specific instructions on the amount of fluid they can have. Fluid intake is not limited to what a patient can drink; fluid is also 'hidden' in some foods they eat. Being aware of the fluid in foods such as gelatin, ice, sherbet, watermelon, sauces, gravies, and other high liquid foods is important. Too much fluid gain between hemodialysis sessions can cause discomfort and complications. The person may experience swelling, shortness of breath or high blood pressure. The recommended amount is normally 1000 plus urine output. Fluid gain can also make the hemodialysis session uncomfortable due to muscle cramping and drops in blood pressure during dialysis. Following the recommended fluid intake is an important part of feeling better before and after a dialysis session. Educating clients in their fluid restriction can be challenging. The health care professional must consider medications needing to be swallowed, preventing/treating thirst. |
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| The Peritoneal Dialysis Diet |
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Definition
| Patients on this treatment perform dialysis at least daily. Therefore, their diet is not as strict as the hemodialysis diet. This diet is individualized, but typically is low in sodium and potassium. Fluid status and weight gain is also monitored more liberally. The dialysis solution that is used contains dextrose (glucose). Therefore, patients are at risk for gaining weight, and if they are diabetic they may have trouble with blood glucose control. As much as 800 kcalories may be obtained from the dialysis treatment. These patients will meet with a dietitian once a month to evaluate laboratory values and weight changes. |
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Definition
| Adhering to a renal diet is probably the most difficult aspect of treatment for patients with renal disease. These patients oft en require extensive counseling once multiple dietary restrictions become necessary. Depending on the stage of illness and the patient's laboratory values, the renal diet may limit protein, fluids, sodium, potassium, and phosphorus, thereby affecting food selections from all major food groups. Because these diets have so many restrictions, patient compliance is oft en a problem. Individual assessment of each patient is very helpful with dietary intervention. To maintain the restrictions of this diet, one must avoid fast foods and processed foods, while eating fresh fruits,vegetables, whole grains, and lean meats. The diet is best maintained with the individual cooking foods from scratch to know what goes into them. This involves grocery shopping and label reading. In the end stages, patients may feel very run down and sick, especially between dialysis treatments. Understanding the patient's resources (finances, ability to shop and cook and family support system) can help the patient be successful. |
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| Many people choose to wait on a transplant list and some are lucky enough to obtain a new kidney. Before surgery, the medical team tries to attain optimal nutritional status to promote healing and prevent rejection of the organ. The patient's kidney function is closely monitored after surgery and he/she will no longer need dialysis. However, the person must take anti-rejection medications for the rest of their life, which unfortunately can cause some undesirable side effects. The diet after a transplant is individualized depending on lab work and other conditions. |
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Definition
Kidney stones are the most common disorder of the kidneys in the United States. They are most prevalent among men, and can be very painful when they pass. They develop when stone constituents become concentrated in the urine and form crystals. Most kidney stones are made up of calcium oxalate, but some may composed of uric acid, the amino acid cystine, calcium phosphate, or magnesium ammonium phosphate. Unfortunately, kidney stones tend to be recurrent.
Dehydration is the primary risk factor for developing kidney stones. When the urine is very concentrated, crystallization of minerals and other compounds is more likely to occur. Other risk factors include obstruction of the urinary tract, urine acidity, metabolic factors, and renal disease.
Most kidney stones do not cause serious medical problems. However, a stone passing through the ureter can produce severe, stabbing pain called renal colic. The pain can be severe enough to cause nausea and vomiting. Medication may be needed. Blood may appear in the urine from damage to the kidney or ureter lining. Stones that are unable to pass through the ureter can cause a urinary tract obstruction and possibly lead to infection. |
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| Dietary Recommendations to Prevent Calcium Oxalate Stones |
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Definition
Kidney stones can possibly be prevented by dietary modifications. However, a person who gets recurrent kidney stones needs to pass and collect the stone and take to his/her doctor to determine its composition, since the dietary recommendations vary with the type of stones. With all forms of kidney stones, consuming plenty of fluids is the primary way to prevent them.
Calcium-oxalate stones account for about 70% of kidney stones. The person usually needs adjustments in calcium, oxalate, protein, and sodium intake. The person should consume adequate calcium (around the RDA) from food sources, while avoiding calcium supplements. Low calcium diets have not been shown to reduce the risk, and can even increase the incidence of kidney stones since calcium helps to bind oxalates and prevent their absorption.
Foods high in oxalate should be restricted. Foods high in oxalates include beets, spinach, rhubarb, strawberries, chocolate, nuts, wheat bran, and tea. Vitamin C supplements should be avoided, since vitamin C degrades to oxalate in the body. High protein diets should be avoided, which usually means avoiding low carbohydrate diets. Dietary sodium should also be restricted to no more than 3,500 mg. per day. |
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| Urinary Tract Infections (UTI's) |
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Definition
| A urinary tract infection is a bacterial infection that can occur in the kidneys and/or bladder. Urinary tract infections are extremely common, especially among women. Similar to kidney stones, dehydration is the main risk factor for developing a UTI. As with all infections, antibiotics are needed to cure a UTI. The consumption of lots of fluids, especially water, needs to be greatly increased in order to dilute the urine. Some studies show that regular consumption of concentrated cranberry juice and/or yogurt can help prevent a UTI. Good hygiene practices (wiping from front to back, urinating after sexual intercourse) and overall cleanliness are also needed to prevent the spread of bacteria into the urinary tract. If left untreated, a UTI can become severe and increase the risk for kidney stones and severe damage of the kidneys. |
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