1.

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a condition in which the stomach

contents leak backwards from the stomach into the esophagus (the tube
from the mouth to the stomach). This can irritate the esophagus and cause
heartburn and other symptoms.
Causes
When you eat, food passes from the throat to the stomach through the
esophagus. A ring of muscle fibers in the lower esophagus prevents
swallowed food from moving back up. These muscle fibers are called the
lower esophageal sphincter, or LES.
When this ring of muscle does not close all the way, stomach contents can
leak back into the esophagus. This is called reflux or gastroesophageal
reflux. Reflux may cause symptoms. Harsh stomach acids can also damage
the lining of the esophagus.
Dietary modifications Dietary modifications are recommended to lessen the
likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal
tissue. Listed below are several recommendations that may help to manage
GERD:
Decrease total fat intake - High fat meals and fried foods tend to
decrease LES pressure and delay stomach emptying thereby increasing the
risk of reflux.
Avoid large meals - Large meals increase the likelihood of increased
gastric (stomach) pressure and reflux.
Decrease total caloric intake if weight loss is desired - Since obesity
may promote reflux, weight loss may be suggested by your healthcare
provider to control reflux. Reducing both total fat and caloric intake will aid in
weight loss.
Avoid chocolate - Chocolate contains methylxanthine, which has been
shown to reduce LES pressure by causing relaxation of smooth muscle.

 Avoid coffee depending on individual tolerance - Coffee, with or

without caffeine, may promote gastroesophageal reflux. Coffee may be
consumed if it is well tolerated.
Avoid other known irritants - Alcohol, mint, carbonated beverages,
citrus juices, and tomato products all may aggravate GERD. These products
may be consumed depending on individual tolerance.
Sample menu for GERD Diet
Breakfast
Apple juice (1/2 cup) Whole-grain cereal (3/4 cup) Banana (1/2) Whole-wheat
toast (2 slices) Margarine (1 tsp) Jelly or jam (2 tbsp) Skim milk (1 cup)
Coffee (if tolerated)/tea
Lunch
Vegetable soup (1 cup) Saltine crackers (4) Lean beef patty (3oz) Hamburger
bun (1) Reduced calorie mayonnaise (1tbsp) Mustard (1 tbsp) Lettuce Fresh
fruit salad, no citrus (1/2 cup) Snack Graham crackers (4) Skim milk (1 cup)
Dinner Green salad (4oz) Vinegar and oil dressing (1 tbsp) Broiled skinless
chicken breast (3 oz) Herbed brown rice (1/2cup) Steamed broccoli (1/2 cup)
Whole grain roll (1) Margarine (1 tsp) Low-fat frozen yogurt (1/2 cup) Medium
apple (1)

2.) CP (Chronic Pancreatitis) is defined as a continuing

inflammatory disease of the pancreas characterized by irreversible
morphological changes that typically cause abdominal pain and/or
permanent loss of pancreatic function
Cause
Excess alcohol consumption Pancreatic duct obstruction Pancreas divisum
Cystic fibrosis Hypercalcaemia Autoimmunity Gene mutations
Hypertriglyceridaemia Idiopathic

Nutritional requirements and diet

More than 80% of patients may be treated with diet and enzymes (ESPEN
(B))
High calorie intake 35 kcal/Kg Some energy (10%) may be salvaged by
colonic bacterial metabolism Moderate fat: 30% of calories Mostly
vegetable fat? No studies to support Severe fat restriction not appropriate
MCT fat
High carbohydrate Limit in diabetes High fiber may absorb enzymes
High protein 1-1.5 g/Kg

3.)

What is cirrhosis of the liver?

Cirrhosis is a condition that results from permanent damage or scarring of

the liver. This leads to a blockage of blood flow through the liver and
prevents normal metabolic and regulatory processes.
image used with permission from MayoClinic.com. All rights reserved
What are the major causes of cirrhosis?
The major causes of cirrhosis are as follows:

chronic alcoholism

viral infections caused by chronic viral hepatitis (types B, C and D)

metabolic diseases such as alpha-1-antitrypsin deficiency,

galactosemia and glycogen storage disorders

inherited diseases such as Wilson disease and hemochromatosis

biliary cirrhosis resulting from diseases such as primary biliary cirrhosis

(PBC) and primary sclerosing cholangitis (PSC)

toxic hepatitis caused by severe reactions to prescribed drugs or

prolonged exposure to environmental toxins

repeated bouts of heart failure with liver congestion

Diet - liver disease

Some people with liver disease must eat a special diet. This diet helps the
liver function and protects it from working too hard.
Function
Proteins normally help the body repair tissue. They also prevent fatty buildup
and damage to the liver cells.
In people with badly damaged livers, proteins are not properly processed.
Waste products may build up and affect the brain.

Dietary changes for liver disease may involve:

Cutting down the amount of protein you eat. This will help limit the
buildup of toxic waste products.

Increasing your intake of carbohydrates to be in proportion with the

amount of protein you eat.
Taking vitamins and medicines and prescribed by your doctor for low
blood count, nerve problems, or nutritional problems from liver disease.
Limiting your salt intake. Salt in the diet may worsen fluid
buildup and swelling in the liver.

SAMPLE MENU
Breakfast

1 orange

Cooked oatmeal with milk and sugar

1 slice of whole-wheat toast

Strawberry jam

Coffee or tea
Lunch

4 ounces of cooked lean fish, poultry, or meat

A starch item (such as potatoes)

A cooked vegetable

Salad

2 slices of whole-grain bread

1 tablespoon of jelly

Fresh fruit

Milk

Mid-afternoon snack

Milk with graham crackers

Dinner

4 ounces of cooked fish, poultry, or meat

Starch item (such as potatoes)

A cooked vegetable

Salad

2 whole-grain rolls

Fresh fruit or dessert

8 ounces of milk

Evening snack

Glass of milk or piece of fruit

4.)

Atherosclerosis -hardening and narrowing of

the arteries - gets a lot of bad press but with good reason. This

progressive process silently and slowly blocks arteries,

putting blood flow at risk.
Atherosclerosis is the usual cause of heart attacks, strokes, and peripheral
vascular disease -- what together are called "cardiovascular
disease." Cardiovascular disease is the No. 1 killer in America, with more
than 800,000 deaths in 2005.
How does atherosclerosis develop? Who gets it, and why? This deadly
process is preventable and treatable. Read on, and get to know your enemy.
What Causes Atherosclerosis?
Arteries are blood vessels that carry blood from the heart throughout the
body. They're lined by a thin layer of cells called the endothelium. The
endothelium works to keep the inside of arteries toned and smooth, which
keeps blood flowing.
According to experts, atherosclerosis begins with damage to the endothelium
caused by high blood pressure, smoking, or high cholesterol. That damage
leads to the formation of plaque.
When bad cholesterol, or LDL, crosses the damaged endothelium, the
cholesterol enters the wall of the artery. That causes your white blood cells to
stream in to digest the LDL. Over years, the accumulating mess
of cholesterol and cells becomes a plaque in the wall of the artery.
Atherosclerosis usually causes no symptoms until middle or older age. But as
narrowing become severe, they choke off blood flow and can cause pain.
Blockages can also suddenly rupture, causing blood to clot inside an artery at
the site of the rupture.

GENERAL RECOMMENDATIONS
The American Heart Associations (AHA) current dietary and lifestyle
guidelines recommend:

Balance calorie intake and physical activity to achieve or maintain a

healthy body weight. (Controlling weight, quitting smoking, and exercising
regularly are essential companions of any diet program. Try to get at least 30
minutes, and preferably 60 - 90 minutes, of daily exercise.)
Eat a diet rich in a variety of vegetables and fruits. Vegetables and
fruits that are deeply colored (such as spinach, carrots, peaches, and berries)
are especially recommended as they have the highest micronutrient content.
Choose whole-grain, high-fiber foods. These include fruits, vegetables,
and legumes (beans). Good whole grain choices include whole wheat,
oats/oatmeal, rye, barley, brown rice, buckwheat, bulgur, millet, and quinoa.
Eat fish, especially oily fish, at least twice a week (about 8
ounces/week). Oily fish such as salmon, mackerel, and sardines are rich in
the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA). Consumption of these fatty acids is linked to reduced risk of
sudden death and death from coronary artery disease.
Get at least 5 - 10% of daily calories from omega-6 fatty acids, which
are found in vegetable oils such as sunflower, safflower, corn, and soybean
as well as nuts and seeds.
Limit daily intake of saturated fat (found mostly in animal products) to
less than 7% of total calories, trans fat (found in hydrogenated fats,
commercially baked products, and many fast foods) to less than 1% of total
calories, and cholesterol (found in eggs, dairy products, meat, poultry, fish,
shellfish) to less than 300 mg per day. Choose lean meats and vegetable
alternatives (such as soy). Select fat-free and low-fat dairy products. Grill,
bake, or broil fish, meat, and skinless poultry.
Use little or no salt in your foods. Reduce or avoid processed foods that
are high in sodium (salt). Reducing salt can lower blood pressure and
decrease the risk of heart disease and heart failure.
Cut down on beverages and foods that contain added sugars (corn
syrups, sucrose, glucose, fructose, maltrose, dextrose, concentrated fruit
juice, honey).
If you consume alcohol, do so in moderation. The AHA recommends
limiting alcohol to no more than 2 drinks per day for men and 1 drink per day
for women.
People with existing heart disease should consider taking omega-3
fatty acid supplements (850 - 1,000 mg/day of EPA and DHA). For people with
high triglyceride levels, higher doses (2 - 4 g/day) may be appropriate. The
AHA recommends against taking antioxidant vitamin supplements (C, E,
beta-carotene) or folic acid supplements for prevention of heart disease.
WOMEN
Women who are pregnant or breastfeeding should avoid eating fish that is
high in mercury content (shark, swordfish, mackerel, and tile fish). Choose
fish and shellfish that are lower in mercury content and eat about 12

ounces/week. (The AHA recommends a higher weekly fish amount for women
than for men. However, women of childbearing age should limit tuna to 6
ounces a week to reduce the risks for mercury contamination.)
CHILDREN
Atherosclerosis, the build-up of plaque in the arteries, begins in childhood. It
is important for children and adolescents to adopt a heart-healthy diet to
help prevent the development of heart disease later in life. Children should
eat foods that are low in saturated fat, trans fat, and cholesterol. These foods
include:

Fruits and vegetables

Whole grains
Low-fat and nonfat dairy products
Beans, fish, and lean meats

Heart Health: Managing Heart Disease through Diet

What is Heart Disease?

Heart disease, also known as cardiovascular disease or coronary heart
disease, is a broad term for conditions that result in narrowed or blocked
blood vessels that may lead to chest pain, heart attack, or stroke. Common
cardiovascular diseases include atherosclerosis (hardening of the arteries),
hypertension (high blood pressure), and heart failure, all of which are related
and often coexist. Other conditions such as arrhythmia (irregular heart beat),
heart valve problems, or congenital heart defects, also fall under the
definition of heart disease. Despite being a mostly preventable disease,
death as a result of cardiovascular disease is the number one killer in the
United States.
What Causes Heart Disease?
Most often, heart disease occurs due to poor lifestyle choices including lack
of physical activity, tobacco use, or an unhealthy diet. Risk factors such as
age, gender, and family history also play a major role. Heart disease may
also occur as a result of infections or genetic abnormalities affecting the
heart, not related to lifestyle choices.

An unhealthy diet and lack of physical activity can lead to conditions that are
often precursors to heart disease such as: high blood cholesterol, high blood
pressure, diabetes, and obesity. High blood cholesterol, often from a high fat
diet, can lead to plaque formation in vessel walls. Plaque buildup occurs with
no symptoms and causes narrowing of the arteries, high blood pressure, and
may lead to a heart attack without warning. An unhealthy diet may also lead
to obesity and diabetes. For more information on how dietary fat and
cholesterol affect blood cholesterol and triglyceride levels, see fact
sheet Cholesterol and Fats. For more information on how dietary patterns
affect ones risk for hypertension, see fact sheet Diet and Hypertension.
Reducing the Risk for Heart Disease
Heart Disease Management and the Diet:
The following tips are general dietary recommendations for the prevention
and management of heart disease. Most importantly, one should attempt to
maintain a healthy body weight by balancing caloric intake and physical
activity, as these guidelines are aimed at meeting this overarching goal.
These tips should be used alongside the American Heart Association (AHA)
general lifestyle recommendations for managing heart disease and the
United States Department of Agriculture (USDA) Dietary Guidelines for
Americans.

1.
2.

3.
4.

Important Dietary Tips for the Prevention and Management of Heart

Disease
Consume a diet rich in vegetables, fruits, and whole-grains.
Limit the amount of saturated fat, trans fat, and cholesterol in the diet.
a. Read the Nutrition Facts on food labels.
b. Choose lean meats and plant-based protein sources.
c. Cook meals that are low in saturated fat, trans fat, and cholesterol.
Limit foods and beverages with added sugar.
Choose foods with low salt content.
1. Consume a diet rich in vegetables, fruits,and whole-grains:
Fruits and vegetables help to regulate appetite and are naturally low in fat.
Fiber and various plant compounds found in fruits, vegetables, and wholegrains may have cholesterol-lowering properties. For in-between meal
snacks, it is important to choose fresh, frozen, or canned fruits and
vegetables without added salt and sugar, instead of high calorie snack foods.
Antioxidants: Research indicates that consuming a diet rich in fruits and
vegetables may help to lower blood cholesterol levels and aid in healthy

weight maintenance. Certain properties in fruits and vegetables known as

antioxidants may be responsible for this effect. In particular, beta-carotene
and vitamin C are both important antioxidants that play a role in heart
disease prevention.
Phytonutrients: Various phytonutrients that promote heart health can be
found in fruits and vegetables. Soybeans and products made from soy such
as tofu and tempeh contain phytonutrients that may reduce the risk for heart
disease. This is especially true when plants that contain phytonutrients are
consumed instead of products high in saturated fat.
Plant Stanols and Sterols: These compounds are naturally found in fruits
and vegetables, and can help lower low-density lipoprotein (LDL) bad
cholesterol. They work by inhibiting the bodys absorption of cholesterol in
the intestine.
Fiber: Research has shown eating foods rich in soluble fiber may decrease
LDL cholesterol levels. Fiber acts by binding to cholesterol in the intestine
and passing it out of the body. Foods high in soluble fiber include beans,
peas, legumes, fruits, vegetables, grain products, oatmeal, rice, oat and
wheat bran, and barley. Fiber supplements have no known benefits for heart
disease prevention. For more information on fiber, see fact sheetDietary
Fiber.
2. Limit the amount of saturated fats, trans fat, and cholesterol in
the diet:
Healthy individuals without heart disease should limit saturated fat to less
than 10% of total daily calories, while those with heart disease, diabetes, or
high LDL cholesterol should limit intake of saturated fat to less than 7% of
total daily calories. All individuals should limit trans fat to less than 1% of
total daily calories. Cholesterol should be limited to less than 300
milligrams daily for healthy individuals and less than 200 milligrams daily for
those with heart disease, diabetes, or high LDL cholesterol. Following a diet
low in saturated fat, trans fat, and cholesterol may lower ones risk for
cardiovascular disease by reducing LDL cholesterol levels.
Recent research indicates that following the Mediterranean Diet (which
includes plant-based fat sources such as nuts and olive oil that contain
healthy unsaturated fats, as opposed to harmful saturated fats) can reduce
cardiovascular disease events by up to 30%.

a. Read the 'Nutrition Facts' on food labelsThis panel on a food label

provides the necessary information to help consumers meet dietary
guidelines from the AHA and USDADietary Guidelines for Americans. The
Nutrition Facts panel lists the Daily Reference Values (DRV) for specific
nutrients including fat, saturated fat, cholesterol, and sodium.
Health Claims on Food LabelsSpecific health claims can be made for food
products that meet certain requirements such as "lean," "low fat," or "low in
cholesterol." Though these products may have reduced fat, one should still
pay attention to portion size and calories per serving size. For more
information on food labels in general, see fact sheetUnderstanding the Food
Label, and for more information on health claims and food labels for sodium,
see fact sheet Sodium in the Diet.
b. Choose lean meats and plant-based protein sourcesSelecting lean
cuts of beef and pork, along with preparing all meats in a heart-healthy way
are important tips to meet this recommendation. Adding two servings of fish
per week and incorporating protein from vegetable sources may decrease
ones risk for heart disease and high blood lipid levels (Table 1).
c. Cook meals that are low in saturated fat, trans fat and cholesterol
Preparing meals in a heart-healthy way involves recognizing hidden fat and
cholesterol sources in food items. Simply substituting olive oil and vinegar in
place of creamy salad dressings, or using other easy tips to reduce saturated
fat and cholesterol in recipes can be effective ways to lower the risk for heart
disease. The following are recommendations for reducing saturated fat, trans
fat, and cholesterol in meats, dairy, and recipes:
To reduce fat and cholesterol in meat and poultry:

Cut off all visible fat.

Thoroughly drain fat off of all cooked meats.
Make stews, broths, and stocks a day ahead of time and refrigerate.
Remove the hardened fat from the top before it is reheated or used in soups
and other recipes.
Baste with wine or tomato juice instead of drippings.
Broil rather than pan-fry meats such as hamburgers, chops, and steak.
Remove skin from chicken.
Purchase lean or extra lean meats.
Purchase white meat as opposed to dark meat.
Flavor meat with herbs and spices instead of high-fat marinades.

To reduce fat and cholesterol from dairy foods:

Choose 1% or nonfat milk instead of whole milk.

Choose fat free yogurt.
Use lower fat chesses or limit portion sizes.

To reduce fat and cholesterol in recipes:

Broil, bake, boil, steam, stir-fry, or microwave foods instead of deep

frying or pan frying.
Use lean meats in recipes.
Limit use of butter, margarine, and lard, and replace with vegetable oil.
In casseroles, use more vegetables and less meat.
Be aware of fat content in sauces.
Try cutting oil or fat in half when cooking on the stove top, as this
usually does not affect the taste of the food. Be aware that reducing oil or fat
when baking may affect the taste and properties of the finished product.
Use low-fat alternatives such as nonfat yogurt or whipped topping
made from skim milk, instead of high fat condiments like sour cream,
mayonnaise and whipping cream.
Use two egg whites instead of one yolk.

3. Limit foods and beverages with added sugar:

Consumption of added sugars and sweeteners such as sucrose, corn syrup,
and high-fructose corn syrup has increased dramatically in the past few
decades, leading to an increase in total calories and weight gain in many
individuals. Added sweeteners are present in most pre-packaged food items
and processed beverages (such as soda). In order to maintain a healthy
weight, one should reduce intake of foods and beverages with added sugar.
For more information on sugar and the diet, see fact sheet Sugar and
Sweeteners.
4. Choose foods with low salt content:
Sodium, a major component of salt, plays a crucial role in blood pressure
regulation. Dietary guidelines suggest that reducing sodium intake may
prevent and control high blood pressure (hypertension) by helping to lower

blood pressure. A decreased sodium intake is also associated with reduced

risk for congestive heart failure. General guidelines for sodium intake for
adults recommend no more than 2,300 milligrams daily. Those who are
African American, over the age of fifty, or have hypertension, diabetes, or
chronic kidney disease should consume no more than 1,500 milligrams of
sodium per day. For more information on sodium and the diet, see fact
sheet Sodium in the Diet, and for more information on how the diet affects
ones risk for hypertension, see fact sheet Diet and Hypertension.
Table 1. Heart-Healthy Lean Protein Choices.
Protein
Source

Healthy Lean Choices

Why are they Heart Healthy?

Beef

Round steak, rump roast, top

ground steak and roast, tip
steak and roast, lean cubed
steak, top loin steak,
tenderloin steak, flank, sirloin,
and ground beef (lean or
extra lean).

Lean cuts of beef still contain

saturated fat and cholesterol, but
in reduced amounts. A healthy
portion of meat is 3 ounces,
roughly the size of a deck of
cards.

Pork

Leg roast (fresh ham), leg

steak, lean pork cutlets,
center rib chop and roast,
butterfly chop, sirloin roast,
tenderloin, tenderloin roast,
ground pork (lean or extra
lean), lean shoulder cubes,
lamb-leg, and loin chops.

Lean cuts of pork still contain

saturated fat and cholesterol, but
in reduced amounts. A healthy
portion of meat is 3 ounces,
roughly the size of a deck of
cards.

Fish

Cold-water fish: salmon,

herring, mackerel, and
whitefish.

Diets high in fish have been

linked to reduced risk of heart
disease. Those who include fish
in their diet tend to have lower
blood cholesterol and triglyceride
levels, most likely due to high
amounts of omega-3 fatty acids

found in fish.
Poultry

Skinless, white meat.

Eliminating the skin and dark

meat from poultry will reduce its
overall fat content.

Vegetabl Legumes, beans and bean

e Protein products such as chick-peas,
black beans, soybeans,
tempeh, and tofu.

These proteins have cholesterol

lowering qualities. They are also
low in fat, low in saturated fat,
and high in starches and fiber.
These sources are also rich in
unsaturated fatty acids, which
can replace saturated fat found
in red meats.

Table 2: Examples of Heart Healthy Dietary Patterns: DASH and

TLC.

Food Group

DASH
(servings/da
y)

TLC
Examples of 1 serving
(servings/day)

Grains

6-8

1 slice of bread
1 ounce of cereal
cup cooked rice or
pasta

Vegetables

4-5

1 cup raw vegetable

cup cooked vegetable
cup vegetable juice

Fruits

4-5

1 medium fruit, cup

dried fruit, cup fresh/
frozen/ canned fruit,
cup fruit juice

Fat-free or
low-fat dairy
products

2-3

2-3

1 cup of milk, yogurt, or

1- ounces cheese

Lean meats,
poultry, fish

Less than 6
oz.

Less than 5 oz.

3 ounces is the size of a

deck of cards

Nuts, seeds,
legumes
(beans)

4-5

Counted as
vegetable
servings

2 tablespoons of peanut
butter, seeds, or cup
dry beans

Fats and Oils

2-3

Dependent on
daily calorie
level

1 teaspoon of margarine,
1 tablespoon of
mayonnaise,
2 tablespoons of salad
dressing,
1 teaspoon of vegetable
oil

Sweeteners
and sugars

Less than 5
servings per
week

No
1 tablespoon of sugar or
recommendation jelly, cup sorbet, 1 cup
of lemonade

5.) Chronic kidney disease

The cause of chronic kidney disease isn't always known. But any condition or
disease that damages blood vessels or other structures in the kidneys can
lead to kidney disease. The most common causes of chronic kidney disease
are:

Diabetes. High blood sugar levels caused by diabetes damage blood

vessels in the kidneys. If the blood sugar level remains high over many
years, this damage gradually reduces the function of the kidneys.
High blood pressure (hypertension). Uncontrolled high blood
pressure damages blood vessels, which can lead to damage in the kidneys.
And blood pressure often rises with chronic kidney disease, so high blood

pressure may further damage kidney function even when another medical
condition initially caused the disease.
Other conditions that can damage the kidneys and cause chronic kidney
disease include:

Kidney diseases and infections, such as polycystic kidney disease,

pyelonephritis, glomerulonephritis, or a kidney problem you were born with.

Having a narrowed or blocked renal artery. A renal artery carries blood

to the kidneys.
Long-term use of medicines that can damage the kidneys. Examples
include nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib
and ibuprofen, and certain antibiotics.
Diabetes and high blood pressure are the most common causes of chronic
kidney disease that leads to kidney failure. Diabetes or high blood pressure
may also speed up the progression of chronic kidney disease in someone
who already has the disease.

Nutritional Management in Chronic Kidney Disease According to Disease

Stages
When you suffer from chronic kidney disease, nutritional management is an
essential part of your treatment plan. Depending on the severity of your
disease, your recommended diet may change over time. Especially, in a
more advanced stage of your disease when your glomerular filtration rate
(GFR) continues to decrease, the amount of protein together with calories
and other nutrients (e.g. minerals and vitamins) in your diet have to be
adjusted to meet your changing needs.
Please note that the following nutrients should be carefully monitored if
you suffer from chronic kidney disease:

Protein

Phosphate

Calcium

Potassium

Sodium

Fluid

Additionally it is important, that your nutrition contains enoughcalories

(energy), because many patients develop malnutrition, particularly in
later stages of the disease.
Basically, nutrition in chronic kidney disease should contain:

Low amounts of table salt (i.e. sodium)

Low amounts of phosphate

Sufficient calories

Low amounts of protein in predialysis stages

High amounts of protein in dialysis stage

Nutritional requirements change within the different stages of CKD.

Main changes during disease progression
There are major differences in the nutritional recommendations during the
predialysis phase and the dialysis phase of chronic kidney disease.
1. Predialysis
In predialysis stages of chronic kidney disease it is advisable toreduce your
daily protein intake substantially compared to your familiar diet. High
amounts of protein would damage the nephronsin your kidneys. Every
protein ingested above the daily requirement will increase the appearance
of uraemic symptoms and enhance the progression of kidney disease. For
these reasons at least, protein should be limited to the recommended intake
of 0.7-0.8 g/kg ideal body weight/day.
However, even more efficient is a marked restricted protein intake (0.3/0.40.6 g/kg body weight/day) supplemented with essentialketo acids/amino
acids. This is indicated with a decline of GFRbelow the value of 60 to 50
ml/min. Both kinds of dietary protein restriction ensure that you will stay in a

good nutritional status. In this respect, please note that you have to receive
sufficient amounts of energy as well as adequate amounts of other essential
nutrients (e.g. minerals and vitamins).

2. Dialysis
When dialysis treatment becomes necessary, your dietary support has to
change completely. Due to the enhanced protein losses through the dialysis
procedure and excess catabolism secondary to the haemodialysis session,
your daily protein intake has to be increased to 1.2 g protein/kg body
weight/day or more.
Your daily energy intake should remain constant at 30-35 kcal/kg body
weight/day or preferably higher according to your physical activity or if you
are below 60 years of age. Of even more importance becomes the
monitoring of the intake of fluids and of specific compounds such as
phosphate and potassium. With respect to phosphate, this is a tricky topic:
increasing dietary protein intake always parallels with an increased intake of
phosphate! Please ask for the support of a trained dietician to clarify these
difficulties and to receive help in planning your diets.