Thursday, March 14, 2013

Chronic Kidney Disease

In primary care, we talk to patients about a wide variety of topics. From diabetes to knee pain, we cover it all. But, what we don’t seem to talk much about is chronic kidney disease, or CKD. I can say this because every time I meet a new patient and bring it up, I’m stared at and inevitably asked, “what are you talking about?” “No one has ever told me that,” they tell me. Here is a summary of the conversation that follows.

Chronic kidney disease is simply a condition that many people have in which the kidney doesn’t filter as well as it did or could. The kidney has many functions, but most importantly it filters the blood of toxins or excess electrolytes, like potassium and calcium. Some people develop chronic kidney disease sooner than others. High blood pressure and diabetes are two of the most common conditions that cause people to develop chronic kidney disease. Chronic kidney disease is measured in stages, I-V. The higher the number, the more severe the disease is. Most people never “feel” chronic kidney disease. In all likelihood, you wouldn’t even know you had it without blood work. But, it plays a role in many decisions I make in your health.

 Many medications are filtered out of the body through the  kidneys.  This means that when you have chronic kidney disease, some medications are dosed differently or even prohibited entirely. Over the counter medications such as ibuprofen(Advil or Motrin) or naproxen (Aleve) are harmful to people with chronic kidney disease, especially if used frequently. Unfortunately, many people who have chronic kidney disease also have arthritis or chronic pain. In those cases, medications like acetaminophen(Tylenol) or prescription pain medications may be more appropriate long-term choices. Some natural herb products or supplements, such as St. John’s wort, ginkgo or ones high in potassium or magnesium, need to be monitored or avoided in chronic kidney disease. Medications as basic as antibiotics can require kidney function  adjustment, so it’s very important to work with your doctor and know your kidney function.

Chronic kidney disease can also cause changes in the body, such as anemia or bone disease. The kidneys secrete a hormone that stimulates bone marrow to produce blood cells. If the hormone is not secreted adequately, anemia may develop. The kidneys also help the body use calcium and vitamin D properly. Without the full function of the kidneys, people may develop bone disease, such as osteoporosis.

Well, given all of this information, what can you do to prevent it? By far and away the most important things a person can do is regulate blood sugar and pressure. Blood pressure should be checked often and diet should be built around the DASH diet, a nationally recognized low blood pressure diet. Many resources for this diet are available online. Low sodium is key. Like I tell my patients: wherever salt goes, water follows.

The more salt, the higher the blood pressure. High sugar also damages the kidney. If you are overweight, or have  family history of diabetes, it’s important to have blood sugar checked. The DASH diet is also a good resource for sugar control. Simple sugars are to be avoided. Medications like I discussed are also to be used sparingly. Follow these guidelines, work with your doctor and you will be successful in preventing chronic kidney disease.

Andrew Eckert, D.O.
Dillsburg FamilyCare

Tuesday, March 5, 2013

Eating Healthy When You Eat Out

You are trying to eat healthy. You have it under control when you are at home or work, for the most part. You control the ingredients that go into your food. But what happens when you go out to eat? Do you know how many calories you are consuming? You want to enjoy an evening out without ruining the diet! Don't panic!

Here are some helpful tips to keep the diet in check while having someone else cook for you:

1. If possible, decide where you want to eat ahead of time so you can look up the menu. Sometimes, we are nearly salivating by the time the waiter says, "And what would you like tonight?" that we impulsively blurt out, "loaded nachos to start, cowboy burger with extra bacon and cheddar please don't hold the fries..." or something like that. Impulsive ordering gets us in trouble. Have a plan; decide ahead of time if able.

2. Eat a nutritious snack or drink a large glass of water before going to the restaurant. Just as you tend to spend more if you go to the grocery store hungry, you tend to eat more if you go to a restaurant too hungry.

3. I make it a habit to always order water. Drinks can contain many empty calories, especially alcohol. If you really must order a drink besides water, don't forget to mentally note that there are calories in that drink!

4. Ask the waiter to hold the know...those carb-loaded little numbers that stare us in the face while we wait for our food, until suddenly that overflowing bread basket is just a basket. If you particularly enjoy bread, or whatever other food item is being served, take a small portion and then ask the waiter to remove the basket.

5. Red sauces over white sauces. Baked/broiled/grilled over fried/breaded. Broth-based soups over cream-based soups. Oil dressings over sweet or creamy dressings. Often you can ask that grilled chicken (or fish) be used instead of the fried chicken they are offering on the menu in a certain dish.

6. Portion sizes are out of control at restaurants. The fancier restaurants with the teeny tiny portions are really on to something. At most places, it is simply too much food. You shouldn't be leaving the restaurant feeling like you need to unbutton your pants or suck in your gut. We really need to learn the feeling of being satisfied. This is different than "full." Either find someone to split the meal with you, or ask that half of the meal be put in a to-go container before it even comes out to you. You just got two meals out of one! Even if you can't possibly stop after a half portion, resist the urge to lick your plate clean. There is nothing wrong with stopping shy of complete and packing up a few bites to-go.

7. Carefully choose your sides. Vegetables are your lowest calorie choice. Sweet potato over white potato, without the brown sugar topping.

8. Ask for all dressings, sauces, butter, oil on the side if possible.

9. A salad is a good choice for a starter. An appetizer is usually as big as a meal should be, so forgo the appetizer, split it, or get it for your meal.

10. If you must splurge, choose an area you want to splurge in. Is the main dish most important to you? Or the appetizer? Or maybe you can't resist dessert? Or you really want that high-calorie drink? Choose one of these areas to splurge in and make sure the rest of your meal is healthy.

11. If you really need that sweet ending to your meal, split a dessert. Better yet, get one dessert for a group. Then you can each have your 1-2 bites and still get that delicious ending to your evening, without breaking the (calorie) bank.

12. If you aren't quite ready to leave the restaurant, don't get dessert simply to justify more time, order a coffee or tea and sip until you are ready to go.

Finally, if you really blow it at dinner, don't give up on your diet. Set tangible goals for the next time someone else is doing the cooking!

Jenna Henault, PA-C
FamilyCare Middletown