Thursday, March 21, 2019

Diet Restrictions on Dialysis: It’s all about finding a workaround

(Disclaimer: Never make any changes to your diet without talks to your doctor or dietician. The advice given here is general that may or may not apply to you.)

Most people on dialysis feel that the diet and fluid restrictions are the most frustrating part of dialysis apart from the dialysis session itself. These restrictions are so onerous that we get frustrated with the limited options we seem to have. We end up craving all the foods we cannot have. We stare longingly at someone gulping down something as simple as water.

However, the good news is that it needn’t be so difficult. The trouble is that we don’t think out of the box. Some Doctors and Dieticians also put such a negative focus on these restrictions that we tend to get scared and worry of the consequences of even a small slip up. The truth is that there is almost nothing that we cannot eat or drink by incorporating a simple workaround in our daily life provided we are getting good quality dialysis as per the doctor’s recommendation. So if we’ve been prescribed thrice weekly, four hour sessions and we stick to it, we can practically eat anything we want by  thinking creatively and figuring out ways to adjust our meals so that we still do not cause any problems to our body.

Here are some simple hacks to enjoy your favourite foods:


  • Fruits: Many dialysis patients are given a blanket restriction of “No Fruits”. This is not needed at all. If we are getting thrice weekly, four hour sessions and our Potassium levels are within the normal limit, there are ways to include a small amount of fruit in our daily routine. There are several low Potassium fruits that can be safely included. The important thing is to be aware of the Potassium content of the fruit we want to eat and ensure that the size of the portion we eat gives us a safe amount of Potassium. One hack that is used successfully is to have some fruit in the first half hour of dialysis. This allows the Potassium that gets absorbed by the body to be cleared out during that session itself. This can only be done if we have adhered to our diet plan during non-dialysis days.


  • Phosphorus: This is less of a problem for Indian patients. It is more of a problem than Potassium in countries where meat is an important part of meals. However, the best part about Phosphorus is that we have Phosphorus binders that remove the Phosphorus from our intestine and excrete it as part of the stools so that it does not remain in the blood and cause any problems. So, if we want to enjoy a certain high Phosphorus food, we must ensure that we take the prescribed Phosphorus binders along with the meal it is a part of.

  • Protein: There are several misconceptions about protein intake on dialysis. Some people believe that we need to restrict our protein intake when we are on dialysis. This is probably a hangover of our pre-ESKD days. When the kidneys are functioning sub-optimally and we are still not on dialysis, our protein needs to be restricted. However, when we get onto dialysis, we actually need a lot of protein. Since the kidneys are not functioning at all, there is no more harm that the protein intake can do. In fact, our body needs all the protein it can get as dialysis sessions themselves remove a lot of protein. Most dialysis patients don’t get enough protein. The recommended intake is close to 1g per kg body weight per day. For Peritoneal Dialysis, it is even higher. Most Indian dialysis patients don’t even reach close to that value and end up staying malnourished forever. This adversely affects their quality of life and longevity. So, we must try to have good quality protein in our diet and we don’t need to worry about getting more protein than we need. 


  • Fluid: Fluid restrictions are the most onerous part about being on dialysis for many. Most people are restricted to one liter a day. The fluid restriction imposed includes all fluid - not only water. It includes tea, coffee, the water in your dal, the water in the rice (a huge amount of rice is water), fruits (some fruits are almost 90% water), curd, ice-cream (anything that is fluid at room temperature is counted as fluid). So, how do we workaround fluid restrictions? There’s always a way. Say you are craving a Coke. Most of the time, a simple 100 ml of the fluid is enough for us to satisfy that craving. So, all we need to do is to restrict the amount of other fluids like water / tea / coffee we’re used to having and replace that with the Coke. Coke is high in Phosphorus so we must make sure our binders are at hand. Honestly, 100 ml of Coke is not going to kill us provided we’ve stuck to the recommended diet plan the rest of the day.
I strongly believe that the depression resulting from craving a certain food or drink will kill us faster than simply going ahead and having the food or drink. However, we need to get creative on how we incorporate it in our day. Adjust something here. Forego something else there. It’s all about finding a workaround. 

Doctors and Dieticians have a huge role to play in this. Some doctors simply issue blanket instructions without keeping in mind the ramifications. The discussion is centred more around what we cannot have rather than on how to have what we want to have. Doctors and Dieticians need to orient their discussion about diet and fluid restrictions around positivity. Talk about how to find ways to eat and drink what patients want. If someone wants to have a slice of mango in summer, don’t tell them “No way in hell”. Tell them how to do it. All we need is one slice. Or two. It is possible. Tell us how we can do it.

This is true of every aspect of dealing with dialysis. We can do anything we want despite being on dialysis. There is always a way. It’s all about making the effort to find it. We can sit on our bed the whole day and be depressed that we can’t do this or that. Instead, we must get up and figure out ways to do it. 

The same thing applies to food. We can cry the whole day that we are not able to eat or drink something. If we are craving it badly, we should talk to our Doctor or Dietician. We must be willing to adjust. We must be willing to compromise on something else. There will always be a way to enable us to enjoy the foods we want. It’s all about making the effort.

You can download a copy of this post here.

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