Acknowledgements
Throughout the writing of this book we have been guided and supported by many people.
We are grateful to Richard Warner who initiated and believed in the task of publishing a cookbook for kidney patients, and to all the staff at Class Publishing for their help over the past few years. At the other end of the process we have been fortunate in our editor, Richenda Milton-Thompson who has contributed so much to the finished product.
We have been lucky to have a number of expert healthcare professionals and advisors who helped by reviewing the manuscript. We would like to thank the following for their comments and contribution to the book: Gemma Bircher, Barbara Engel, George Hartley, Sam Kanisius, Althea Mahon, Andy Stein, Louise Wells and Janet Wild.
We are also very grateful to the following patients, relatives and friends who brought the unique insights of personal experience: Lisa Brereton, Angela Dennis, Deryk Draughn, Lisa Mairs, Andrew Roberts, Laurence Spicer, Michael Watts and Norma Watts.
We greatly appreciate the help and support of our renal and dietetic colleagues at St George’s and King’s College Hospitals and the invaluable experience in meeting, learning from and working with kidney patients at both hospitals.
Last, but not least, a particular and heartfelt thanks to our friends and families for their love, help and support. With patience, enthusiasm and fortitude, they have tasted multiple versions of our chosen (and rejected) dishes, completed all those chores left undone and, uncomplaining, allowed a rival, ‘The Book’, to take much of our time and attention.
Helena Jackson
Annie Cassidy
Gavin James
Appendix 1
Useful addresses and websites
National Kidney Federation
6 Stanley Street
Worksop
Nottinghamshire
S81 7HX
Tel: 01909 487795
Fax: 01909 481723
Helpline: 0845 601 02 09
Website: www.kidney.org.uk
Kidney Research UK
King’s Chambers
Priestgate
Peterborough
PE1 1FG
Tel: 0845 070 7601
Helpline: 0845 300 14 99
Email: info@kidneyresearchuk.org
Website: www.kidneyresearchuk.org
Diabetes UK
10 Parkway
London
NW1 7AA
Tel: 020 7424 1000
Fax: 020 7424 1001
Helpline: 0845 120 29 60
Website: www.diabetes.org.uk
The British Dietetic Association
5th Floor
Charles House
148–9 Great Charles Street Queensway
Birmingham
B3 3HT
Tel 0121 200 8080
Fax 0121 200 8081
Website: www.bda.uk.com
Appendix 2 – Nutritional analysis of recipes per portion
Recipe |
Protein |
Energy |
Potassium |
Phosphorous |
Sodium |
Sodium/ |
Apple and cinnamon oat crumble |
5 |
407 |
245 |
113 |
21 |
11 |
‘Bakewell’ muffins |
4 |
297 |
83 |
141 |
106 |
119 |
Beef and mushroom stroganoff |
34 |
652 |
654 |
379 |
325 |
98 |
Breakfast muffins |
5 |
142 |
106 |
72 |
75 |
123 |
Butterscotch shortbread |
2 |
203 |
43 |
25 |
7 |
16 |
Carnival chicken with peppers and rice |
27 |
538 |
790 |
214 |
142 |
27 |
Carrot, leek and goats’ cheese tarts |
15 |
526 |
311 |
174 |
546 |
205 |
Cauliflower and chickpea curry |
15 |
417 |
548 |
231 |
367 |
160 |
Cauliflower cheese with red peppers |
15 |
570 |
382 |
300 |
360 |
109 |
Cheesy cheat’s pizza |
16 |
269 |
438 |
284 |
571 |
272 |
Cheesy mashed potato |
8 |
241 |
442 |
146 |
211 |
118 |
Chicken and mushroom pastry parcels |
23 |
823 |
417 |
241 |
428 |
159 |
Chicken with capers |
34 |
477 |
836 |
391 |
423 |
111 |
Chilli burgers with relishes |
21 |
306 |
420 |
263 |
424 |
231 |
Cinnamon rice pudding |
5 |
563 |
186 |
127 |
48 |
19 |
Cranachan |
4 |
560 |
260 |
123 |
27 |
13 |
Crispy tangy fish |
34 |
383 |
636 |
415 |
417 |
154 |
Crunchy olive and lime plaice |
24 |
252 |
479 |
278 |
464 |
251 |
Felafel |
15 |
352 |
438 |
238 |
488 |
200 |
Fish steaks with orange and mustard |
21 |
251 |
469 |
276 |
168 |
109 |
Flavoured butters: |
||||||
Chilli and lime |
0 |
63 |
12 |
3 |
3 |
21 |
Lemon and parsley |
0 |
63 |
24 |
4 |
3 |
25 |
Florida fruit cake |
3 |
226 |
66 |
125 |
124 |
177 |
Garlic and herb mashed potato |
3 |
164 |
482 |
58 |
12 |
7 |
Garlic chicken |
22 |
286 |
548 |
152 |
91 |
39 |
Ginger and cherry flapjacks |
3 |
203 |
86 |
80 |
12 |
25 |
Golden spiced couscous |
4 |
158 |
67 |
148 |
3 |
1 |
Grilled marinated chicken |
31 |
203 |
502 |
291 |
436 |
274 |
Lamb boulangère |
29 |
430 |
962 |
348 |
102 |
25 |
Lemon and blueberry creams |
5 |
640 |
129 |
69 |
103 |
55 |
Lemon surprise pudding |
6 |
299 |
126 |
109 |
61 |
51 |
Mandarin cheesecake |
3 |
509 |
163 |
80 |
236 |
165 |
Mustard mashed potato |
4 |
174 |
446 |
70 |
272 |
162 |
Pears in white wine |
1 |
208 |
251 |
43 |
81 |
47 |
Pineapple with rum and ginger |
1 |
145 |
179 |
13 |
6 |
5 |
Pitta crisps with tzatziki |
5 |
158 |
141 |
78 |
226 |
288 |
Plaice with a creamy coriander topping |
22 |
254 |
453 |
263 |
258 |
151 |
Pork with a honey and mustard glaze |
28 |
470 |
471 |
269 |
163 |
93 |
Pork with basil and egg noodles |
31 |
459 |
674 |
385 |
175 |
77 |
Pork with caramelised apple and crème fraîche |
30 |
650 |
599 |
298 |
93 |
33 |
Stilton spread with Melba toast |
4 |
223 |
109 |
89 |
237 |
395 |
Stir-fried noodles, tofu and vegetables |
20 |
491 |
566 |
307 |
517 |
135 |
Tabuleh |
15 |
405 |
712 |
388 |
478 |
167 |
Tandoori style kebabs |
43 |
450 |
948 |
478 |
607 |
169 |
Thai fishcakes |
40 |
535 |
872 |
348 |
407 |
111 |
Thai fragrant rice |
4 |
199 |
112 |
71 |
5 |
8 |
Tricolore pasta |
11 |
357 |
276 |
184 |
78 |
78 |
Tuna pasta Niçoise |
29 |
609 |
479 |
329 |
520 |
203 |
Tuna pâté |
11 |
116 |
199 |
122 |
260 |
322 |
Tuna steaks with caramelised shallots |
30 |
205 |
548 |
300 |
62 |
35 |
Vegetable frittata |
15 |
201 |
288 |
213 |
217 |
120 |
All nutrient analyses in the table on pages 148–9 have been calculated using Dietplan6 with additional data from the USDA website (United States Department of Agriculture – www.usda.gov). They are based on food weight and food selection according to available data, recipe specification or standard food portion sizes as defined in Food Portion Sizes, 2nd edition, by the Ministry of Agriculture, Fisheries and Food,1993. It should be borne in mind that food portions served at home are likely to vary slightly in size, but every effort has been made to be as accurate as possible within this limitation.
The codings categorise recipes by nutrient content and are adapted from British Dietetic Association members’ guidelines. They are intended as a general guide only, not as recommendations for any one individual’s diet. Suitable choices for each individual will depend on complete daily food selection, medical condition and other factors. Please see your doctor or dietitian for individualised advice.
Text © Helena Jackson, Annie Cassidy and Gavin James 2006, 2009
Typography © Class Publishing Ltd 2009
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of the publisher of this book.
The authors have asserted their rights as set out in Sections 77 and 78 of the Copyright Designs and Patents Act 1988 to be identified as the authors of this work wherever it is published commercially and whenever any adaptation of this work is published or produced including any sound recordings or files made of or based upon this work.
The authors and publishers welcome feedback from the users of this book.
Please contact the publishers.
Class Publishing, Exchange House,
Express Park, Bristol Road, Bridgwater TA6 4RR UK
Tel 44 (0)1278 427800
Fax 44 (0)1278 421077
email: post@class.co.uk
www.class.co.uk
The information presented in this book is accurate and current to the best of the authors’ knowledge. The authors and publisher, however, make no guarantee as to, and assume no responsibility for, the correctness, sufficiency or completeness of such information or recommendation. The reader is advised to consult a doctor regarding all aspects of individual health care.
A CIP catalogue record for this book is available from the British Library
Ebook ISBN: 9781859591598
Print ISBN: 9781859591161
Edited and indexed by Richenda Milton-Thompson
Illustrations by David Woodroffe
Designed and typeset by Martin Bristow
Ebook conversion by JVR Creative, India
Foreword
Food is not only a basic need but also an important part of most peoples’ daily enjoyment. Unfortunately renal failure can change this for the person affected as well as for their family and friends. Having to take on board new dietary guidelines and cooking methods can make daily meals, eating out and entertaining increasingly difficult to cope with.
The bookshelves are stacked full of recipe books and tips for various diets but there are limited resources for a person with renal failure. Dietitians are skilled in giving practical advice but they cannot be available in the home to answer questions and give cooking ideas 24 hours a day. There is an obvious need for more information to be at hand.
After 18 years of working in the renal field I warmly welcome this book as a valuable tool for dietitians and people with renal failure alike.
I think it will make a huge contribution to the quality of life of many people presently struggling with complex dietary restrictions.
Gemma Bircher BSc, PgDip, Msc, RD
Past president of EDTNA/ERCA
(European Dialysis and Transplant
Nurses Association/European
Renal Care Association)
Introduction
This book is about food and drink and kidney failure. It is full of quick, simple and great-tasting recipes for people with kidney disease, along with their friends and families. It is intended for adults at all stages of kidney failure, from those whose kidneys are working slightly below their normal level to those whose kidneys have failed altogether and who are reliant on dialysis.
Many people with kidney failure, especially those on dialysis, will have the opportunity to discuss what they eat with a specialist kidney dietitian. This book is not designed to replace this essential personal advice. Rather, it aims to help you understand the importance of eating well. This way, you can be better informed when you see your dietitian and other health professionals. We hope that it will answer some questions that you may not think of or have time to ask in clinic, and that it will continue to provide you with additional information and support.
The book is divided into two sections. The first gives some factual information about food and nutrition, with particular relevance to kidney disease. The second includes over 50 delicious recipes to show you that eating can still be pleasurable. There are hints and tips on choosing and eating meals, including takeaways, pre-packaged meals and food for celebrations and special occasions.
As well as being tasty and simple to produce, the recipes have been chosen to help you understand how to adapt favourite recipes and make them suitable for your special diet. They have all been tried and tested, and the finished dishes have been tasted by our friends, relatives, colleagues and patients. We are grateful for the help of all our ‘tasters’ in producing the end result.
Not everyone with kidney failure will need to make drastic changes to what they eat. Reading this book will reassure some of you that your diet is fine as it is. Most people will find they need to make only small changes to the way they eat. A few readers, however, may need to make significant changes, usually because of more severe kidney failure or other health problems.
Weight loss and malnutrition can be a particular problem for some patients with kidney failure. We hope that the recipes in this book will help those for whom this is a concern.
We have based this book on our experience as people who enjoy food and as dietitians working with people who have kidney failure. We hope that it will help you take control of this important aspect of your life, giving you suggestions for using food in a way that combines health and enjoyment.
Comments on Eating Well with Kidney Failure from readers
‘I was very impressed with the content of this book. The practical chapters I found very informative, and perhaps more importantly, easy to follow.’
Laurence Spicer, London
‘I have thoroughly enjoyed reading this . . . the recipes especially suit those who work, where I have found recipes in other books take too long. The language is straightforward and understandable for those new to kidney disease and those who are more knowledgeable.’
Lisa Brereton, London
‘I found the book very readable and I expect it to help meet patients’ educational needs. It has been thoughtfully put together and contains some very useful information.’
George Hartley, Chief Renal Dietitian,
Freeman Hospital, Newcastle-upon-Tyne
‘An excellent book!’
Louise Wells, Renal Dietetic Clinical Specialist,
York University Hospitals NHS Trust
This book has been approved by EDTNA/ERCA
(the European Dialysis and Transplant Nurses’ Association/
European Renal Care Association)
The National Kidney Federation (NKF) is a charity
representing all kidney patients in the United Kingdom, it is run
by kidney patients for kidney patients. The Federation campaigns
for increased renal provision and improved treatment. The charity also
provides national services to assist all kidney patients.
Publications recommended by the NKF have to be of a high standard
and easily readable, the recommendation is not given lightly and is highly
prized. The NKF recommendation of this book was made at the time of
its publication and has to be renewed at subsequent prints in order to
retain the NKF endorsement and recommendation. Further information
about the NKF and books it recommends can be found on its website
www.kidney.org.uk.
Eating Well
with
Kidney Failure
A practical guide and cookbook
Helena Jackson, BSc, PgDip, MSc, RD
Specialist Dietitian, St George’s Hospital, London
Annie Cassidy, BSc, PgDip, RD
Specialist Dietitian, St George’s Hospital, London
Gavin James, BSc, MSc, RD
Clinical Services Manager,
St George’s Hospital, London
CLASS PUBLISHING • LONDON
1
How does kidney failure
change what you should eat?
There is no single diet for people with kidney failure. Every one of you will have different medical problems and individual tastes in food that make you unique. The level at which the kidneys function, and the speed at which they fail, varies enormously between people. For some, there comes a time when their kidney function is so poor that dialysis or a kidney transplant is needed. While this book has been written for people at all stages of kidney failure, people who have a successful kidney transplant may not need to follow all the advice it contains as they can usually eat without too many restrictions.
The need to change what you eat when your kidneys fail is linked to what your kidneys normally do. Healthy kidneys control the level of chemicals and water in the body. Some chemicals are waste products; others are minerals such as potassium, sodium and phosphate which are vital for life. When your kidneys fail, the waste products build up and can cause symptoms such as a reduced appetite and weight loss. At the same time, the balance of some minerals and other nutrients may be disturbed, causing them to rise or fall outside the levels required for health. As these substances come from the food you eat, you may need to change your diet to control their levels within your body. It is also important to continue to eat a well-balanced diet.
Dialysis is a treatment that cleans your body of waste products, excess minerals and water – something healthy kidneys would normally do. There are two main forms of dialysis, haemodialysis and peritoneal dialysis. Haemodialysis involves using a machine to clean the blood for about three or four hours every two or three days. Waste products and fluid build up between haemodialysis sessions. To limit this build-up, it is important to eat and drink the right things in the right amounts. This will prevent unpleasant symptoms and side effects between dialysis sessions.
Peritoneal dialysis, on the other hand, provides a more continuous form of dialysis. This avoids the problem of build-up between sessions. However, some restrictions on what you eat may still be necessary. Unfortunately, neither type of dialysis is as effective as normal kidneys at balancing all the substances in the body.
Kidney failure and dialysis affect different people in different ways. Some people have almost no symptoms, others feel unwell from an early stage. Those people who do suffer from symptoms often find these affect their ability and desire to eat. Symptoms can range from being tired and finding it difficult to cook after a day’s work, to experiencing severe fatigue, taste changes and sickness. This can lead to weight loss and malnutrition.
In addition, some people will have to restrict some types of food and drink although others may continue to eat normally. It is important for everyone to discuss their condition and symptoms with their doctor and dietitian.
A dietitian is an expert in nutrition, and renal dietitians have additional training and experience involving work with people with kidney failure. Not everyone who is diagnosed with kidney failure will automatically see a renal dietitian, but anyone who has difficulties eating enough, or needs to change their diet, should. In practice, most people who are on dialysis or aware that they will need dialysis in the future should expect to see a renal dietitian regularly to discuss all aspects of their diet.
A dietitian will advise on three main aspects:
•A healthy diet (a well-balanced diet) that contains all the nutrients the body needs;
•Ways of preventing – or addressing – any unintentional weight loss or malnutrition;
•The best foods to eat to control the build-up of waste products in the body.
So, almost every aspect of the diet can be affected by having kidney failure. Sometimes people find that the advice they receive is different from information they have been given about diet for other conditions (such as diabetes and heart disease). At other times, the advice seems to be constantly changing, usually in response to changes in their condition or treatment. This is why it is important for you to discuss any concerns with your dietitian, and ask him or her to explain the reasons behind any changes to your diet. You are an individual with your own dietary needs and preferences that are different from anyone else’s. You may have other additional religious, social, medical or dietary requirements that affect the foods that you can choose. These should all be taken into consideration if you need to change your diet.
2
Energy
WHAT IS IT?
Everyone needs an adequate supply of energy for the body to function normally, for growth and replacement of tissue as well as any physical activity. If your weight is to be stable over time, your energy levels must be in balance, that is:
Energy taken in (as food or drink) = Energy used up (by activity/exercise)
If you do not eat enough energy, your body will start to use up its reserve stores of fat or muscle. This will lead to weight loss and muscle wasting. On the other hand, if you eat more energy than your body needs, you will become overweight.
WHAT HAPPENS IN KIDNEY FAILURE?