Tuesday, September 5, 2017

A story of Proteins.

       




 Proteins. We hear plenty about them in our discussions about health and nutrition. They are another necessary aspect of diet for all individuals. For Chronic Kidney Disease (CKD) patients the discussion is even more important, and it changes as the disease progresses. 

What is a protein? Well, Webster (that’s a dictionary for you younger folk) defines protein as a nutrient found in food, such as meat, milk, eggs, and beans. Proteins are made up of chains of amino acids with varying sizes. Sounds like high school science class again. Ugh. 

Proteins and amino acids are the building blocks of life. That makes them really important. They help the body build and repair tissues. They are needed for strengthening bones, muscles, skin, and blood. If you are a dialysis patient this is extremely pertinent for all those needle sticks and the risk of infection.
   
Ok, so these proteins have chains of amino acids each of different length and combinations. (I know, science - but it will be short and will be helpful in the end)

Amino acids are broken down into three categories. 
1. Essential
2. Nonessential

3. Conditional

There are 9 essential amino acids ( I’m not going to list all the scientific names). They are they ones that the body cannot produce itself and we get them from the food we eat. 

CKD patients are tested for Albumin in their blood each month. This looks at the protein levels in the body that come from these sources.

The nonessential amino acids are ones that our bodies will produce even if we don’t get it from the food we eat. 

The conditional amino acids are ones that our bodies don’t need unless we are sick or the body is in stress

So, essential amino acids are ones that our bodies need and we have to attain through food  

Ok, a quick bit about kidney disease. CKD covers a range of patients, and the stages are designed to correlate to kidney function each individual has at a given time. You may hear your doctor or caregiver talk about your "GFR". Hold on, I'll try to make this easy. 


Glomerular Filtration Rate (see why they use the abbreviation?) is a math formula that takes into account a bunch of different things: Age, race, gender, serum creatinine rate, etc. Let's leave it at that. It's the best way to figure out how well your kidneys are filtering your blood.

If your doctors say you are in Stage 1 though 4 (Stage 5 or End Stage Renal Disease requires dialysis) you will be told to limit your protein intake. The proteins are larger molecules and the kidneys will have a hard time removing them from the blood. If you are at Stage 5, dialysis will remove the proteins from the blood, and often quite a lot of it. 


Once you are at Stage 5, you are told to start to increase your protein intake again, but in a limited manner. Remember to talk to your doctor about the specifics for you. 

That brings us to the food with these essential amino acids that are the building blocks for proteins. Have I lost you yet? I hope not because this is important stuff.

Not all proteins we eat will have all the essential amino acids. Those that do are called proteins of high biologic value. Proteins that are missing one or more of the essential parts are considered of low biologic value.  More science terms. When will it end.

Biologic value is determined by how fast and efficient the body can use the nutrients absorbed in proteins. 

Yes, this is all pretty important for our diets.

You can also combine certain foods with proteins that might be of low biologic value themselves, but together they will provide the body with all the essential amino acids and become high biologic value foods. 

I find this interesting when you look at foods throughout history that have been combined and how they make high biologic values proteins. Certain foods have lasted through long periods of time and been maintained as a staple in many diets.  

Some examples are rice and beans, hummus, pasta fagioli (pasta and beans). Typically the ingredients in these foods are inexpensive and readily available. Combining them provides all the essential amino acids the body needs - especially when meat products were not easily obtained or too expensive. 
For CKD patients these combinations also raise the level of phosphorus in our diets. Healthy kidneys will dispense of the excess phosphorus but the CKD patient does not. 

This buildup of phosphorus in our bodies can cause calcium deposits in our veins, arteries, and other organs. It can also cause changes in our bodies that lead to pulling the calcium from our bones making them weaker. 

Anyone who has been on dialysis will  tell you that phosphorus is a big concern for the patient, as we are constantly being monitored and told about our levels. In addition, your nutritionist will ask lots of question about your weekly diet to help you cut out items that may be causing an elevated level in your blood work. 

That makes some of these food combinations good on the protein count, but bad on the phosphorus count. 

But we still need to get our protein up and keep our phosphorous levels in range. Each food item is going to have a rating for essential amino acids. Some of the high biologic  level proteins are eggs, chicken, and beef. These also have higher levels of phosphorus, but often not as high as those combinations discussed above. 

We will try to provide you with recipes that can help you get those proteins with food that we hope you will enjoy, without elevated phosphorus and other danger minerals in your body.  And please remember to talk to your doctor and nutritionist to help you guide your specific needs.

Below you will find links to the recipes so far.

Recipes:

Protein Diet Program Articles and links









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