Marissa Meshulam is a NYC-based registered dietitian with a background in clinical dietetics. In this article, she explains how she views the role of low protein medical foods in a CKD diet plan and provides tips for utilizing them with patients.
As an inpatient RD, you are exposed to patients with a myriad of health problems. Out the door goes your case study from grad school where the patient has diabetes OR CVD, and in walks a 58-year-old man with CKD stage 4, uncontrolled diabetes and limited culinary and nutrition knowledge to begin with.
We have all sat with this patient before. The man who was told by his endocrinologist to watch refined carbs and bump up the fiber by switching to whole wheat products. He was instructed to balance his carbs with enough protein to slowdown his blood sugar response.
After throwing away his white bread and stocking up on lean proteins, he then had an appointment with his nephrologist who now warned him against the phosphorus in whole grains and educated him on a low protein diet.
CKD currently affects 15% of the US population and it is well understood that nutrition intervention is a vital component of slowing the advancement from CKD to ESRD [1]. Enter our role as an RD, where we must navigate the murky waters of medical nutrition therapy for patients with many diseases that’s traditional advice might be contradicting. Dietary changes for CKD are very nuanced and not intuitive, leaving many patients feeling exhausted by the very thought of food.
Given the field of nutrition is a relatively young science, it is our job to keep up with the research and provide our patients with the best evidenced based guidance we can. Currently, for CKD patients, all signs point towards a plant-dominant low-protein diet [2].
"I view our roles as dietitians to un-complicate the world of food and nutrition. We spent years studying biochemistry, physiology and psychology. We are food experts."
And despite our knowledge and years studying, sometimes I am at a loss too. Sometimes it is hard to find foods that fit exactly what I need.
And that is why I am so grateful to brands like Flavis that make food easy again for patients living with CKD. With Flavis Hearty Brown Bread, my patients don’t have to choose between enough fiber or too much phosphorus. Instead, they are getting a bread that will control their blood sugar with 6grams of fiber, while simultaneously take it easy on their kidneys with 0% phosphorus, 0% potassium and 0 grams of protein. After years of being told they cannot have sandwiches, my patients are able to enjoy food again!
Try one of Marissa's Favorite Kidney-Friendly Recipes!
Recipe: Veggie Sandwich on Flavis Hearty Brown Bread
Serving: 1
Ingredients:
- 2 slices of Flavis Hearty Brown Bread
- 1 tbsp hummus
- 1 ounce feta cheese crumbles (96mg phos)
- 2 sliced radishes
- Butter lettuces
References
- Kramer, H., Jimenez, E. Y., Brommage, D., Vassalotti, J., Montgomery, E., Steiber, A., & Schofield, M. (2018). Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. Journal of the Academy of Nutrition and Dietetics, 118(10), 1958–1965. https://doi.org/10.1016/j.jand.2018.05.023
- Kalantar-Zadeh, K., Joshi, S., Schlueter, R., Cooke, J., Brown-Tortorici, A., Donnelly, M., Schulman, S., Lau, W. L., Rhee, C. M., Streja, E., Tantisattamo, E., Ferrey, A. J., Hanna, R., Chen, J., Malik, S., Nguyen, D. V., Crowley, S. T., & Kovesdy, C. P. (2020). Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients, 12(7), 1931. https://doi.org/10.3390/nu12071931
Marissa Meshulam, MS, RD, CDN, uses a simple and inclusive approach for disease management and nutrition. After years of working as an inpatient clinical dietitian, she has founded her private practice, MPM Nutrition. For more information about her work, check out her website!
