10
Healthy living

WHAT IS IT?

If you have chronic kidney disease (CKD), healthy living is a vital part of your treatment and a way to start taking back some control over your own health. It involves a combination of healthy eating and keeping active, along with retaining a positive interest in life. Healthy eating means choosing a diet with the right balance of energy, nutrients and fibre to keep you as healthy as possible for as long as possible. This is a positive step – focus on all the foods you can eat as opposed to the foods you think you can’t.

Healthy living with CKD: main aims

•Eat healthily

•Control your weight

•Keep active

•Stay positive

•Take responsibility for your health.

DO YOU NEED TO FOLLOW A HEALTHY DIET?

Following a healthy diet should be a priority for most people with CKD. This is because:

You may have an increased risk of heart disease, and a healthy diet will help to reduce this risk.

It will help you eat the correct balance of nutrients of all kinds within your diet.

It allows you to take control of your own health – especially important if there other aspects such as your age or family history of disease that you cannot change.

You can help to prevent and treat other conditions you might have such as high blood pressure, diabetes, high blood fats, high blood cholesterol level and obesity. This is very important in protecting your kidneys from further damage and improving your health in the long term.

There are exceptions to this. If you lose your appetite or find eating difficult for any other reason, just eating enough becomes your priority – at least until things improve. In this case, it is advisable to speak to your doctor. You can then be referred to a dietitian if necessary.

HEALTHY EATING – STEPS TO SUCCESS

Eat regular meals including breakfast; don’t skip meals

This is good advice for everyone, whether you are overweight, underweight or about right. Pages 42–44 give information to help you work out your ideal weight. Breakfast can provide a significant amount of essential nutrients as well as setting you up for the day. People who skip meals often get hungry between meals or towards the end of the day and end up filling up on fatty, sugary or salty snacks. They may also binge on larger amounts of food than they would otherwise do in the latter part of the day when their hunger finally gets the better of them.

Eat less fat and fewer fatty foods

This will help to control cholesterol, which is important in reducing your risk of heart disease. If you are overweight then eating less fat can help you to lose weight (see Chapter 4).

If you eat fat, choose healthier fats

Eating unsaturated (polyunsaturated or monounsaturated) fats instead of saturated fats can lower your risk of heart disease by reducing your cholesterol level. Unsaturated fats come from plant sources, such as olive, rapeseed, sunflower or soya oils and margarine (see Chapter 4).

Eat fish regularly

The omega-3 oil found in oily fish can help to protect you against heart disease. Oily fish include herring, mackerel, salmon, sardines, trout and fresh (not tinned) tuna. These fish are also a rich source of protein. Aim to eat at least two portions (a portion is about 140 g) of fish a week one of which should be oily. You can choose from fresh, frozen or canned (in spring water, not brine). The Marine Stewardship Council (MCS) can tell you where to buy fish from sustainable sources: see Appendix 2 for the Council’s website address.

Eat less sugar and fewer sugary foods

These foods tend to be high in energy (calories) and low in other nutrients, so should be avoided if you are overweight. They can also lead to tooth decay, especially if eaten between meals.

Eat foods rich in fibre

High fibre foods include wholegrain cereals, wholemeal bread and pasta, brown rice, pulses, lentils and fruit and vegetables. They add taste, texture and interest to your meals. Eating fibre-rich food protects you against heart disease and cancer. It also helps you keep your bowels working normally and avoid constipation. Choosing these high fibre foods can help to fill you up in a healthy way as they are bulky and relatively low in calories. They also tend to have a lower glycaemic index which can help to stabilise blood sugar and reduce hunger pangs (see Chapter 2).

Eat more fruit and vegetables

Fruit and vegetables are tasty, provide vitamins, minerals and fibre and can protect you against heart disease and cancer. The general advice is to aim for five portions of fruit and vegetables each day (see Box below). Don’t worry about eating the latest ‘superfood’ or fashionable fruit or vegetables. All fruits and vegetables have valuable health benefits which differ according to the nutrients they contain. You should aim to eat as wide a range of different types and colours as you can. Eat fresh, frozen or tinned for convenience. The recipes in this book have been chosen to help you take advantage of the wide variety found in your local shops and supermarkets. Those on a low-potassium diet may need to limit the amount and types of fruit and vegetables, and prepare and cook them in a way that lowers their potassium content (see Chapter 6 for more details).

A fruit or vegetable portion is about 80 g or roughly a ‘handful’

•A whole small banana or medium-sized apple

•A slice of melon

•Two plums or similar-sized fruit

•A small handful of grapes, cherries or berries

•A cereal bowl of salad

•Three heaped tablespoons of vegetables (raw, cooked, frozen or tinned).

Eat less salt

We are all advised to eat less salt and this is true, too, for most people who have kidney disease. Avoid adding salt to food and in cooking, as well as keeping clear of salty foods such as processed meat, salted biscuits and bottled sauces. Chapter 5 includes more information on cutting down on salt. All the recipes in this book have been chosen to show you this in practice.

Drink alcohol in moderation only

Unless your doctor advises you to avoid alcohol altogether, you should be able to include alcohol in moderate amounts if you wish. As a general guide, it is advisable to limit yourself to a maximum of 21 units per week for men (no more than 4 units in one day) and 14 units per week for women (no more than 3 units in one day). A unit is equal to half a pint of standard strength beer, a single pub measure of spirits or a small glass of wine. Be aware that drinks you pour yourself are usually larger than standard pub measures. Alcoholic drinks can also be high in calories so cutting down can help with weight loss. You may be advised to limit certain alcoholic (and non-alcoholic) drinks if your blood potassium level is high.

MAINTAINING A HEALTHY WEIGHT

A healthy weight is usually taken to mean the weight at which you have neither too much nor too little body fat. One way to estimate your healthy weight is to calculate your body mass index or BMI which compares your weight with your height (see the chart, overleaf). A BMI of between 20 and 25 is generally recommended as healthy so there will be a range of weights considered to be healthy for your particular height. A BMI of 26–30 is overweight, whereas a BMI over 30 indicates obesity.

Example: Agatha is 1.66 m tall and weighs 78 kg

So Agatha is overweight. A healthy weight range for this height would be 55–69 kg

Measuring waist circumference

Waist measurement and health outlook

	Increased risk to health	Even greater risk to health
Men	More than 94 cm (37 in)	More than 102 cm (40 in)
Women	More than 80 cm (32 in)	More than 88 cm (35 in)

*In Asian adults these values differ as follows: 90 cm (35 in) or more in a man, 80 cm (32 in) in a woman would be associated with a greater risk to health. If you are in any doubt about your personal risk, speak to your doctor.

Waist circumference

Measuring your waist (as shown in the diagram) is an easy way to find out whether the fat on your body is stored in places that put your health at greater risk. Individuals who hold most of their fat in and around their abdomen (apple shaped) have a greater risk of developing conditions such as heart disease and diabetes. Whereas people who carry most their fat around their hips (pear shaped) are linked to a lower risk of developing these diseases.

Weight changes with kidney disease

If you have kidney disease, you may retain water in your body which makes your ankles swell. The weight of this water will also mean that you appear to weigh more than you normally do. If you suffer from water retention ask your doctor to help you calculate your BMI with your true weight, which does not include this extra water.

Aim for a healthy weight

If you need to lose weight, the best way to start is to follow the healthy eating guidelines (see pages 40–42). Make sure you are aiming for a realistic and healthy weight while increasing your activity levels as much as you can safely. Some people find that group weight-loss classes or meetings are helpful. Before joining up you will need to make them aware of your medical condition and it is wise to check that their dietary advice is in line with the recommended healthy eating guidelines. Your doctor, nurse or dietitian will always be happy to discuss a suitable approach to weight loss with you and answer any questions you might have.

On the other hand, you may be underweight or have a small appetite and find yourself losing weight without meaning to. In this case you should see your doctor, who may refer you to a dietitian to work out a treatment plan. You will probably be advised to eat more regularly, include snacks between meals and eat more high-energy (calorie) foods.

Weight control and fad diets

‘I’ve found a great diet to help me lose weight – should I use it?’

Fad diets can be very tempting. They usually offer ‘quick and easy’ ways to lose weight, but weight loss should not be quick. Unfortunately, there is no magic solution to losing weight. If any product sounds too good to be true, it probably is – and it’s just the same with weight-loss diets.

If you thinking about trying a weight-loss diet, you need to be careful, particularly if you have kidney disease. If any of the following points apply to the diet you are considering, then don’t use it:

•Does it offer a ‘miracle’ cure or quick fix?

•Does it promote a limited number of particular foods such as cabbage, pineapple, grapefruit etc?

•Does it encourage you to eat an unbalanced diet which does not follow healthy eating guidelines, such as the high-protein, low-carbohydrate diets?

•Would it cost you a lot of money?

•Are there particular tablets, drinks or medication that you have to buy and which are only available from the individual or company promoting the diet?

‘Quick fixes’ rarely work, and if someone has additional health problems such as kidney disease they may cause real damage. You need to aim for permanent changes to both your diet and your weight. If you don’t, your health might suffer and you will find yourself gaining back the weight you have lost.

EXERCISE AND ACTIVITY

Exercise is an essential part of ‘healthy living’. Whether you are underweight, overweight or somewhere in between, it is important for you to think about the type and amount of exercise you do.

Exercise will help you build and maintain muscle. If you are overweight, being more active will help you to lose fat, gain muscle and reach and maintain a healthy weight.

Exercise can also help if you have trouble sleeping, feel anxious or depressed, and can lead to increased self-confidence, independence and a feeling of well-being. Exercise can improve bone strength, protect against osteoporosis and help with other conditions common in people with kidney disease, including raised blood pressure, diabetes and high cholesterol.

If you are not exercising you are missing out!

Exercise can help to:

Reduce overweight

Improve muscle size and strength

Prevent falls

Reduce insomnia and improve sleep patterns

Reduce anxiety and depression

Improve overall energy levels

Increase self-confidence

Improve bone strength

Help to control diabetes and high blood pressure

Help to control blood fats and sugars

Help with treatment for anaemia

Improve your social life

In fact, if you are not doing any form of exercise, you are missing out on a great benefit. It doesn’t have to be expensive, difficult or embarrassing. Simple lifestyle changes such as walking further and more often are cheap, easily available, and can prevent and treat many of the conditions from which you may suffer, now or in the future. Studies have shown that those people who do little or no exercise have the most to gain from increasing their daily activity levels.

What can you do?

Anything that makes you more active will provide you with exercise. Some ideas that involve you increasing your activity are:

•Getting up to change channels on the TV instead of using the remote control;

•Walking to the shops instead of driving;

•Collecting your morning paper instead of having it delivered;

•Getting off the bus one or two stops earlier and walking the rest of the way;

•Doing some housework or gardening;

•Using the stairs instead of a lift or escalator;

•Walking the dog, or offering to walk someone else’s;

•Doing ‘chair exercises’ (exercising while seated);

•Playing active games or sport with your own (or borrowed) children, grandchildren, godchildren, nephews or nieces.

You could also take up an active pastime or learn a new skill such as pilates, yoga, cycling, line dancing, gardening or aqua-aerobics. This can be a great for your social life as well as your waistline.

Becoming more active

Start by deciding what you would like to do and making a real commitment to doing it. Whatever you choose to do, it will help if it is something you enjoy. Start off gently and build up gradually – your aim is to try to make your body work a little harder, perhaps from a brisk walk rather than a stroll. Try walking in the park, the countryside or even just around the block. As a general rule you shouldn’t do anything that makes you too out of breath to talk and – obviously – you should avoid doing anything that hurts. Although you shouldn’t worry if you haven’t done any exercise for a long time, it is always a good idea to check with your GP or clinic doctor before starting any new form of exercise. Your doctor will also be able to advise you about suitable ways to increase your activity levels and direct you to information on local facilities. You could also visit your local community or leisure centre, library or place of worship, look on your local council’s website or ask your friends or family for more ideas on activities you might enjoy.

How much should I be doing?

We should all aim to be doing 30 minutes of exercise five times a week. This should be done at a moderate intensity so that your heart rate is faster than normal and you feel warm, but you should still have enough breath to talk. You can break this down into three 10-minute sessions or two 15-minute sessions if you prefer.

Barriers	Solutions
I don’t have time to exercise.	Exercise can be built into your daily routine. Every little bit helps. Start with 10 minutes and gradually build up.
I am too tired after work.	Plan to do something active before work or during the day.
I cannot afford to join a gym.	There are many types of exercise that you can do for free such as walking, using tins for weights.
It’s boring.	Find something you enjoy doing and take friends along, e.g. walking, salsa dancing.
I am too old.	You can be active at any age.