Written by Danielle Starmer, RD LDN
This post is the first part of a series based on a recent presentation I led at the Alabama Renal RD 2024 Meeting. A huge thanks to the organizers and participants!
Living with chronic kidney disease (CKD) can be a challenge, especially when it comes to dealing with the impact it has on digestion and nutrient absorption. In fact, about 36% of CKD patients experience issues with diarrhea, 63% struggle with constipation, and 51% deal with bloating. On top of that, up to 70% have other gastric symptoms, such as nausea, vomiting, reflux, and loss of appetite. But why are these numbers so high?
Several factors contribute to these digestive troubles, like altered electrolyte balance, fluid restrictions, uremia, inflammation, certain medications, dialysis treatments, low physical activity, restrictive diet practices, altered GI motility, imbalanced gut microbiome, food sensitivities, depression and anxiety, weakened immune system, hormonal fluctuations, and fluid shifts in dialysis. These factors combined can lead to inadequate protein/energy intake, decreased absorption of nutrients and medications, inflammation of the GI tract, and a host of physical symptoms like nausea, vomiting, constipation, and diarrhea.
And the consequences? Well, it's a bit of a vicious cycle. You might experience malnutrition, altered drug efficacy, increased hospitalizations, more kidney damage, a higher risk for comorbidities like CVD, micronutrient deficiencies, altered gut microbiome, increased uremic toxins, mental health issues, and decreased treatment adherence.
But all hope is not lost! Improving your digestion can have positive effects on your overall CKD journey by reducing uremic toxins, boosting nutrient and medication absorption, decreasing inflammation, and enhancing treatment adherence and mental health.
So, let's talk about what "normal" digestion looks like, though it varies from person to person. Ideally, you'd have a bowel movement every 1-2 days that ranks 3-4 on the Bristol Stool Scale, few chronic digestive symptoms, a healthy appetite/weight, and stable energy levels and good mental health.
Now, let's dive into the nutrition strategy!
First up, carbohydrates: Aim for complex carbs like whole grains, fruits, and veggies instead of simple sugars. For fiber, men should ideally get over 30 grams per day and women over 25 grams. Incorporating more fruits, veggies, and whole grains can make a big difference!
Next, protein: Focus on plant-based proteins, which promote healthy gut bacteria growth. The general recommendation for CKD is 0.6-0.8 g/kg/day, while ESRD is around 1-1.2 g/kg/day. Adjust accordingly for additional protein needs and comorbid conditions.
Lastly, fats: Omega-3s are great for maintaining a healthy gut! Aim for 1-2 grams per day from sources like fatty fish and flax seeds. Supplements can cause side effects like bloating, burping, and reflux, so stick to natural sources when possible.
We often hear about the importance of macronutrients, but micronutrients play a crucial role in maintaining digestive health, especially for those with chronic kidney disease (CKD). Let's explore some key micronutrients that can help improve your gut health and overall well-being.
B Vitamins: The B-complex vitamins, particularly B12 and folate, are essential for DNA synthesis, red blood cell production, and maintaining a healthy gut environment. Folate can be found in various foods like green vegetables, fruits, nuts, beans, peas, seafood, eggs, dairy, meat, poultry, and grains. As for B12, you can find it in fish, meat, poultry, eggs, and dairy. If needed, B12 can also be supplemented via injection or sublingual methods.
Vitamin D: CKD patients commonly experience vitamin D deficiency, which can contribute to gut dysbiosis, intestinal inflammation, and impaired barrier function. Boost your vitamin D levels by consuming foods such as salmon, tuna, and plant milk fortified with vitamin D. However, supplementation might be necessary for CKD/ESRD patients.
Iron: Iron deficiency is prevalent in CKD patients, affecting the digestive system by altering gut microbiota composition and function. Incorporate iron-rich foods into your diet, such as meat, poultry, fish, eggs, beans, peas, lentils, tofu, and iron-rich vegetables like spinach and beets. Don't forget whole grains such as quinoa, whole oats, and whole-grain bread.
Zinc: Zinc plays a vital role in maintaining gut barrier integrity and immune function. Ensuring adequate zinc intake can help prevent gut inflammation and support overall digestive health in CKD patients. To get more zinc in your diet, focus on consuming meats, seafood, and plant-based protein sources like beans, nuts, and seeds.
Stay tuned! Next week we will be posting part two in the series: Current Research on CKD and the Gut Microbiome!
Want to work with Danielle? Schedule a FREE 30-minute discovery call to talk about your goals and find out more here.
Sources for the presentation can be found in the PDF below.
DISCLAIMER: This post is purely informational and is not a substitute for professional medical advice. Please consult your doctor or qualified health care provider with any medical concerns or questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it due to information found online.
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