Diet

A modified low-phosphorus weight loss program can safely broaden the dietary choices for dialysis sufferers – Healio

August 21, 2020

2 min read

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The study results showed that hemodialysis patients who received a modified diet low in phosphorus had similar levels of phosphate to those who received the standard diet, with the modified diet expanding patient choices and increasing fiber intake.

According to Fiona Byrne, PhD, The traditional attempt by the Department of Nutrition and Dietetics at Cork University Hospital in Ireland and colleagues is to limit all dietary phosphorus intake. Often this is done by moderating protein intake, restricting foods high in phosphorus (such as dairy products, whole grains, legumes, and nuts), and avoiding foods with added phosphates.

Mediterranean cuisine

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However, the researchers wrote: “(e) The merging of opinion supports the introduction of more vegetable protein in the form of whole grains, legumes and nuts, in which the phosphorus is largely bound by phytate and therefore not as readily available for absorption … as is a strong linear relationship between dietary protein and phosphorus intake, protein prescribing is essential. This serves both to meet the increased protein requirement and to avoid excessive consumption of protein, which carries an obligatory phosphorus load. It should be possible to ensure adequate protein intake while limiting phosphorus. "

To test this "emerging evidence", the researchers randomized 74 patients to either the standard low-phosphorus diet or a modified one. Key changes in the modified diet included replacing animal proteins with plant-based proteins (such as replacing meat with legumes), adding whole grains and cereals, encouraging more fish to eat, and limiting the consumption of fish Milk consumption. Additionally, while the guidelines recommend avoiding all additives, the modified diet suggested looking only for foods with phosphate E numbers.

"This modified diet introduced legumes, peas and nuts and eased restrictions on whole grains," the researchers explained about the health benefits of legumes, the kidney protective effects of plant-based diets, and the idea that dieting liberalization could improve the lives of patients with kidney disease.

For 12 months, the researchers saw no significant difference in the change in serum phosphate between the two groups.

Further results showed that while total dietary phosphorus intake was similar between groups, phytate-bound phosphorus – commonly found in legumes, nuts, and whole grains – was significantly higher in the modified diet group.

Other benefits of the modified diet included higher fiber intake and increased bowel movements.

Researchers found no significant differences in the change in serum potassium or reported protein intake between the two diets, and both were similarly well tolerated.

Based on the results, Byrne and colleagues suggested that the standard kidney diet should be more closely aligned with the Mediterranean diet, although nutrient recommendations should always be tailored to the individual patient. They also stressed that the results should be interpreted "carefully" for patients with hyperkalemia.

"While this advice may need to be used more cautiously in hyperkalemic patients, our study in a dialysis population provides an important first step towards safely reducing restrictions and examining the effects of a particular diet on biochemical parameters and tolerance," the researchers concluded. "The current study shows that it is feasible to conduct a large-scale study of longer duration to demonstrate the effectiveness of a dietary intervention."

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