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Ep 09: How to Keep Kidneys Functioning with Michele Crosmer, MS RD

Speaker A [00:00:00]:
Hi, everyone. So today I have my colleague and friend, fellow dietitian, Michelle Krosmer. She is a renal dietitian, so she specializes in kidney health. Welcome to the Paralysis Nutrition Podcast, where changing your eating habits is the key to losing weight, improving bowel health, and feeling your best. I’m your host, Fatima Fakouri. I’m a registered dietitian who’s married to a quadriplegic and specializes in nutrition for paralysis. Get ready to be inspired, educated, and motivated so you can take control of your health using the power of food. Let’s get started.

Speaker A [00:00:35]:
This is the Paralysis Nutrition Podcast. Michelle, welcome to the Paralysis Nutrition Podcast.

Speaker B [00:00:41]:
Hi, Fatima. Thank you for having me. I’m excited to be here.

Speaker A [00:00:44]:
Awesome. So renal disease is very, very complicated. And as the wife of someone who is living with paralysis, it is something that concerns me because my husband is 18 years post injury. Everyone with a spinal cord injury has neurogenic bladder, and there’s a lot of stress put on the kidneys. And I will say this, of all of the things to think about in terms of health, me personally, I worry about the kidneys. So, I mean, not my own, but, like, my husband’s.

Speaker B [00:01:17]:
Right.

Speaker A [00:01:18]:
So today, I want you to share your expertise on kidney disease and what we can do, because a lot of people with spinal cord injury are walking around with stage one, stage two, sometimes even stage three kidney disease, and they don’t really know.

Speaker B [00:01:38]:
They don’t know it.

Speaker A [00:01:39]:
Yeah. And they don’t know it. And for anyone who’s listening who’s like, why are we talking about kidneys today? What does this have to do with anything? People with spinal cord injury have a really high risk or prevalence of kidney disease, and it’s because they have neurogenic bladder. So when you have a neurogenic bladder, a lot of people end up with obstructive neuropathy, and they have chronic UTIs and nephrosis and all these different things. And so all of my clients in the coaching program either use a catheter, like, intermittently cath, or they have, like, indwelling catheters, they have suprapubic catheters, all kinds of stuff. And it’s not that using of the catheter itself is causing the kidney disease. It’s that people don’t realize that they have to usually go more frequently than they do. Right.

Speaker A [00:02:38]:
So when people are in rehab, for example, they might be, like, unable to do it themselves. So they have, like, a caretaker. They have, like, a family member or somebody who’s taught how to do this. So it’s, like, complicated. It’s not really up to them how often they can go. And some people have sensations, some people don’t. I have heard. And this is so sad, because it happens more with women, because it’s harder to use a catheter when you’re a woman, for obvious reasons, that they don’t catheterize as often as they should.

Speaker A [00:03:10]:
And what happens is that the bladder gets too full, and now you’re backing up into the kidneys. And this pressure is one of the reasons why there is all these, you know, kidney issues. And so can you just kind of simply tell us? Because I know, you know, all the science, and you could tell us everything about it, but for just like a regular person who is, you know, using catheters and things like that, however often, what do you recommend in terms of labs? What things should we be looking for to keep our kidneys functioning, as you say. You always say keep kidneys functioning. So what are the tests? Because a lot of people don’t go to a spinal cord injury urologist because they’re not on every corner, right? Yeah. So if you’re going to a regular urologist or even just a general practitioner, what are the labs? What should we be having checked?

Speaker B [00:04:08]:
Yep. And that’s a great question. And I think even before saying that, I mean, like you’re saying the prevalence is higher with a spinal cord injury, but kidney disease is just simply more common than people think in general. And one in seven us, you know, adults have some form of kidney disease, and that’s a lot more prevalent than we think, just in general, outside of spinal cord. So whether you see a urologist or not, you can get. Typically there’s two labs that can show your kidney function. And so. So one other one is a blood test.

Speaker B [00:04:39]:
So you can get this done simply by going to any doctor and having labs drawn. But you’re looking at the. You’ll see it on there. It’s called the gfr, which is the glomerular filtration rate. And so what that number correlates with is your percent kidney function that’s remaining. So if it says your GFR is, you know, 90, then that correlates with about 90% kidney function. And that’s, you know, whether you have one kidney, two kidneys, one that’s small, one big. It’s kind of just your average kidney function.

Speaker B [00:05:06]:
And then there’s a urine test that can be done as well. And the urine test is checking for protein leaking in the urine, because protein is not supposed to be leaking in our urine. And so if it is leaking in our urine, especially in high levels, it’s a sign of damage to the kidneys.

Speaker A [00:05:22]:
So when your kidney. Sorry, I just want to. So when your kidneys are not filtering as well as they should, you will end up with protein in your urine.

Speaker B [00:05:34]:
You can. Some people with kidney disease can and some don’t. So it’s kind of this. Yeah. So it’s one of the. It’s. If you have both. So if we’re just looking at the blood work and looking at that GFR or that percent kidney function, that’s where you can stage kidney disease.

Speaker B [00:05:48]:
So stage one through five, where.

Speaker A [00:05:50]:
Where do we start to get into the realm of like, oh, this is really serious? Because I have clients, I’ll tell you, who very casually tell me that they’ve stage three kidney disease. And I’ll tell you, they don’t get any nutrition advice from their urologist, which makes sense because their urologist is not a dietitian.

Speaker B [00:06:09]:
Right.

Speaker A [00:06:09]:
But, you know, I think when people are more advanced, then they kind of become experts.

Speaker B [00:06:15]:
Right.

Speaker A [00:06:15]:
Because it becomes very, very serious. So I don’t really have clients that are at a higher stage than, say, three. But I will tell you honestly, those people are not usually watching anything or doing anything, which is. Now that I say it out loud, to a kidney dietitian, sounds really bad. Right. So stage three, they’re not really doing much.

Speaker B [00:06:39]:
Yeah. And stage three is. I mean, it’s a huge stage. And they even. I mean, that’s anywhere from 30% kidney function up to 59%. And so there’s a big difference. Someone walking around with 58% kidney function and 32% kidney function. So it’s even broken down, you know, separate among that.

Speaker B [00:06:56]:
But regardless, any stage is important to make food and lifestyle changes because it can slow or even halt the progression of kidney disease. But definitely if. The tricky thing is, is when you get your lab work done, a lot of times when you look at your labs and it says, okay, your gfr, and it gives you a number, Some lab reports will only say, you know, if it’s less than 60. So it’s only telling you and flagging you if you’re already in stage three, which is now moderate kidney disease. Not all labs are like that, but some of them I’ve seen, and they’ll just say overse 60. And so I’ve worked with people who, it says over 60, and they’re like, good, I have normal kidney function, but they’re at like 65, even 70. And if they’re not, you know, 80 years old, that’s not normal. So it, I think it’s important to realize one, it’s just getting the labs done at least annually.

Speaker B [00:07:47]:
I mean, if you’re, if you are at high risk of kidney disease, and again, usually it’s diabetes, high blood pressure, family history, obesity.

Speaker A [00:07:55]:
Well, I’ll tell you, I’ll, I’ll tell you right there. Obesity and diabetes are also, when you have a spinal cord injury, you’re a full time wheelchair user, you have paralysis, you have a higher risk of diabetes, two and a half times higher than the general US Population. And obesity, I don’t know what the national average is in the general population, but for spinal cord injury, it’s somewhere between like 65 and 70% of adults are overweight or obese. So all these risk factors compound, you know, and that’s why, you know, I don’t talk about kidney function in my program. But of course, like watching your weight and eating the right amount of carbs and all these kinds of things will hopefully kind of, you know, we do our best with what we can. So maybe we can’t control what’s going on with our kidneys as much as we can control, you know, our weight or our blood sugar and things like that. So that is such a, I think, astute point. You know, like having a spinal cord injury puts you at higher risk for kidney disease, but so does having diabetes, so does family history, so does diabetes and all these different things.

Speaker B [00:09:09]:
And the most important thing is knowing, right? And then getting the knowledge. Because if you are, like you said, if you’re walking around and you have, even if it’s stage one or two, you can make changes, stage one, two, three, even later stages that protect your kidneys. And so I think it’s, I mean, at least getting annual labs done, especially if you are in an earlier stage or just simply at risk then, you know, have those labs done and then understand what they mean. I think that’s the other thing is a lot of times you’re, what I hear, unfortunately is people are told, yeah, your kidneys are fine, or we’ll just watch it, it’s not bad yet, we’ll just keep watching it. And it’s like slowly declining, declining, declining. And then all of a sudden there’s stage four. And you know, at that point you have less than 30% kidney function. And now their doctors saying, oh, well, now we need to talk about dialysis or this and that.

Speaker B [00:09:55]:
Why didn’t you tell me when I had 5560, 70 function.

Speaker A [00:10:00]:
So upsetting to even process. Like, you could be walking around with stage two, and if you made dietary changes, you could stay at stage two for a very long time, as opposed to making absolutely no changes, going to stage three, going to stage four, and then ending up on dialysis. And let’s. Do I know the answer to this question? But once you are at, like a stage four, you can’t go back to stage three.

Speaker B [00:10:26]:
Yeah. The tricky thing with, I mean, kidney disease is a. It’s technically a progressive disease. Again, I have seen. I mean, it’s. It actually is really complicated. So there is. I mean, again, you don’t.

Speaker B [00:10:36]:
Once there’s damage to the kidneys, it’s not like there’s any regeneration of. So the nephrons are so important filtering units.

Speaker A [00:10:44]:
Yeah. For people to know because of organs regenerate.

Speaker B [00:10:48]:
Right, right. And we think of our liver. Yeah.

Speaker A [00:10:50]:
Regenerate and.

Speaker B [00:10:51]:
Yeah, you can’t. Once that functioning unit of the kidney is, you know, damaged, you can’t repair it, but you can make the remaining nephrons work more efficiently. And so that way they work longer, you know, for a longer period of time. So there’s a lot you can do at any stage. But again, don’t we understand your labs and be like, okay, I’m going to make these changes in stage one, two and three to prevent it from ever getting to stage four and prevent dialysis, you know, potentially ever being discussed and something you have to worry about in life.

Speaker A [00:11:21]:
Okay, awesome. So we want to get our GFR checked. Right. That’s our glomellar filtration rate.

Speaker B [00:11:28]:
And that’s part of your, like, a comprehensive metabolic panel that’ll check your kidney function lab. So it’s going to check. Basically there’s a lab, the creatinine, and that’s used to calculate your. It’s an estimated value. So that gfr, the glomerular filtration rate, the creatinine, is a lab on the comprehensive metabolic panel, um, which tests some other things like your electrolytes, your potassium, sodium chloride and all of that. But that’s something that can be done. And then they’ll give you that estimated value. And typically, unless you, I mean, have.

Speaker B [00:11:57]:
You’re like, staged into kidney disease and probably stage two or three, then that’s when they would be checking your urine or if you have diabetes or something like that, that’s a high risk factor for kidney disease, then they would definitely be checking your urine and Checking for protein, because you can be stage. You can have stage one through five kidney disease and not have high levels of protein leaking in the urine, but you have a worse. You have a worse prognosis if you have high protein leaking in the urine at any stage of kidney disease.

Speaker A [00:12:26]:
I see. Okay, so. So those are the two things. We want to check the protein in your urine and we want to check your gfr. So anyone who is listening, who does not know if they’ve ever had those things checked, you want to go do that, and you can do that at a regular doctor. Actually had my regular blood work done. And GFR is good. It was on the list.

Speaker A [00:12:48]:
I was just taking a look. But yeah, it’s so interesting when you read labs, you’re just looking for extremes. And what was interesting was that I’m a dietitian and I’m interested in these things. So I asked my doctor’s office to send me a copy of my labs because I want to look at them. I wanted to know in detail because I know that a lot of times they’ll call you and say, yep, everything’s fine. That’s because everything is not horrible, right?

Speaker B [00:13:23]:
It’s not being flagged in the red.

Speaker A [00:13:25]:
Yeah, it’s not being flagged in the red. And so it’s super interesting to me that it depends on where you get your labs done, like, where the cutoffs are for different things. So, like, for me, I’m always concerned about, like, personally, just like my vitamin D, I’m concerned about my blood sugar. And it’s so interesting that you can be, like, on the cusp of something. And the doctor’s office, even, you know, good doctors, they’re not like, oh, it’s looking. They’re not looking. They’re not looking. They’re just looking for really exaggerated numbers that are flagged.

Speaker B [00:14:00]:
And that is the thing, too. I mean, especially with kidney health is the trend in your lab. So one GFR being low, for example, it doesn’t usually. They’re not like, oh, diagnosed. They’re going to repeat and they’re going to check the lab again. Because especially, I mean, it’s an estimated number. There’s different. Your age, the creatinine, your, you know, different things are going into this equation.

Speaker B [00:14:21]:
And so if you’re severely dehydrated, you can have a higher creatinine, which can lead to a lower gfr. So it’s usually, again, it’s important to get your labs done, but then also look at your trends over time, because if you’re slowly creepy. You know that GFR is going down gradually. That’s not a good sign. Or if it’s. Even if it’s stage, you know, two, but it’s stable and it stays there, then that’s. That’s great. So I think that’s.

Speaker A [00:14:46]:
Yeah, I think that’s such a good point. Is, like, if you get one number and it’s okay, you should look at your next number. Is it the same number? Is it slightly less? Is it 5 points, 10 points less? Because you might not get flagged for a 10% difference.

Speaker B [00:15:04]:
Right.

Speaker A [00:15:05]:
You know, because you’re not quite at that. Like, you said 60%. So you mentioned being dehydrated. This is something that I think is a big struggle with my clients, because you can’t just drink as much as you want when you have to cath, right? So it’s like. And then it’s dangerous if you don’t catheterize because, you know, all that pressure, they go into autonomic dysreflexia, which is super, super dangerous. You can have a stroke. So it’s challenging for people, I think, to get on a schedule so that they can drink enough water cath when possible. And not every bathroom is accessible, so you can’t just roll into any bathroom.

Speaker A [00:15:47]:
You have to have all your supplies with you. And that’s why I think it is good that technology is getting better. And there’s different things. You know, there’s smaller catheters. There’s, you know, there’s different types of procedures that people are having, like bladder augmentation, surgeries. I mean, these are not things to be taken lightly, and. But people do them because it’s just. It’s a challenge, all of this.

Speaker A [00:16:13]:
So I tell people in my program at least 2 liters of water a day. Now, that’s just based on a couple of things. One, so that’s two liters, right? 64 ounces. I say that’s a starting point because, you know, when we do the fluid calculations for anyone, weight is a part of that. So 64 ounces is, like, for someone who’s around 130 pounds, right. Most of my clients are more than 130 pounds, but it’s hard to drink enough water. So I say two liters. Now, I looked for data because I wanted to know how many people with spinal cord injury have kidney disease and how many are extreme and how many are just stage one.

Speaker A [00:16:59]:
Yeah. Okay. It’s impossible. I just know that the. Like, I just know that one of the hot, like, One of the, I think most overlooked things is hydration, because people get into healthy eating, Right. But then hydration is like this whole other thing. So, for example, when do fluid needs change? Like at stage one, are your fluid needs different or is it stage two or three, when is it that your fluid needs might change?

Speaker B [00:17:29]:
So typically, the only time you want to be well hydrated with kidney disease, but also think of even just outside of kidney disease preventing kidney stones and, you know, things like that. Proper hydration is very important. A lot of times fluid restrictions come up with kidney disease, but that is not until usually someone’s on dialysis or maybe stage five, where they have less than, you know, maybe 10 or 15% kidney function. And again, that’s very individualized because it’s typically based on really just the kidneys alone. It’s based on if someone’s urinating or not. So if they’re not peeing anymore because their kidneys aren’t functioning, then they start to build up and they can get swelling and edema. So that’s typically when there’s plenty of people on dialysis that still pee normally and they can drink more fluid. So I think in general, especially looking at early stages and even stage four, up to stage one of kidney disease, you want to be well hydrated, you don’t want to be dehydrated because that is making.

Speaker B [00:18:25]:
That is putting more stress on the kidneys because with being dehydrated. So usually it’s not until late stage or even dialysis where someone has a restriction. Again, everyone, you know, it has to be individualized, but typically it’s not a concern until that point.

Speaker A [00:18:39]:
All right, so we don’t need extra, extra, extra water for our kidneys. We just need proper, adequate hydration.

Speaker B [00:18:47]:
Yep. And I think the thing too, to think about, like you said, at minimum of 64 ounces, like, that’s not a lot enough for a lot of people. It might be enough for some for.

Speaker A [00:18:56]:
Most of my clients. And I’ll tell you, I don’t like to give people. Like, just the other day I was onboarding a new client, and I was like, okay, this person is drinking like 20 ounces of water a day, and I’d like this person to drink about 80. I told him 64, because going from 20 to 64 is not just about, oh, don’t forget to drink water. It’s like, oh, I have to be home in order to cath. Like, Michelle, the number of conversations that I’ve had with people on coaching calls about timing fluid intake Like, I did not see that one coming, you know, because a lot of my clients, you know, when I started group coaching, like, a year and a half ago, it was. Everyone was on lockdown, so nobody was leaving their house. Everybody was.

Speaker A [00:19:42]:
I know. And it was, like, super interesting. Like, I have a client who got a new job during the pandemic, and now she’s like, oh, I’m going back to the office. And I don’t even know if they have a handicap, like, stall. And these conversations, I think, are difficult, and they’re important, but I wanted you to kind of reiterate the importance of the hydration. And then we also need to recognize, I think, not just as, like, healthcare practitioners, but like, as human beings living on this earth that, like, not everyone has an easy time, you know, going to the bathroom. Like, it’s dietitians. We’re always like, drink more water.

Speaker A [00:20:22]:
You know, drink more water. Do this, do this. And it’s like, oh, these are the things that sometimes I think you have to kind of. If, you know, you know, so, like, figuring out, when can I get the water? How long before I’m going to have to pee? So, like, we’re coordinating commutes around the water and, you know, making conversation. You know, making these calls to HR and saying, like, hey, by the way, I’m a wheelchair user. You’ve never met me in person. Do you have a bathroom for me? So all of these things are just very. I think it gets emotional, you know, like, I don’t want to make a phone call and say anything to my employer about pee.

Speaker A [00:21:01]:
You know, it’s like, who wants to do that? But it’s really, really, really important, because kidney disease is super, super serious. Right. And I will tell you this as a person who is married to somebody who’s been quadriplegic for 18 years, you gotta look at what’s the long game, you know, like, what are these things that we need to really be concerned about? And, you know, cardiovascular disease, things like kidney disease. Kidney disease used to be, like, the number one reason why people with spinal cord injury didn’t have as good longevity. But now, because of advances in medicine and things like that, kidney disease is like, I think, again, finding these lists and this data is not easy. It’s knocked down to number three or four. And I think the same can be said about things like cardiovascular disease, that it’s a combination of things.

Speaker B [00:22:01]:
Yep.

Speaker A [00:22:02]:
It’s not just, what are you eating? It’s how much do you weigh? And do your parents have heart disease? Did your grandparents have heart disease? You know, what’s your age? All of these factors really compound. So I will say this. I have a number of clients that over the course of my program have said I’m stage two, I’m stage three at that point. Michelle, what are the dietary changes that we need to be making to keep our kidneys functioning?

Speaker B [00:22:30]:
So a couple things with that. One of the big ones that always comes up, and I know obviously you talk about this with your clients is protein intake. And if in an earlier stage, I mean, again, I work with people with, you know, 5, 10, 15% kidney function, sometimes very, very, very different. But still, if someone who has kidney disease, even an early stage, then it’s avoiding excessive protein intake. And we live in this like society where we’re obsessed with, you know, the gym and protein shakes and I need to have, you know, 10 ounces of, you know, meat at my meal and protein powder. And we are like people are having, you know, 200 grams of protein a day. And that is excessive and so excessive really. I mean, the main thing with kidney health and preserving kidney function, a big part of it of it is the protein, both the quantity as well as the quality and plant.

Speaker B [00:23:22]:
Whole food, plant based proteins create less nice nitrogenous waste and uremic toxins. And so there’s less filtering that the kidneys, less work they have to do. But I mean, definitely with earlier stages, it’s more, I would say looking at your diet and how much animal protein and protein in general you’re actually consuming, sometimes we think, oh yeah, I’m not, I don’t have that much. But then you look at, okay, three meals a day plus a snack, you’re having different forms of animal protein. And so that’s, that’s one of the big things as well as the lack of fruits and vegetables. So fruits and vegetables and fiber, which I know you’re very about fiber and Big on fiber.

Speaker A [00:24:01]:
Yes, big on fiber because all of my clients are constipated. Right. And let’s be honest, almost nobody eats enough fiber unless you are tracking it, unless you are, you know, really working on it. Right. So yes, the fiber and I think so we. Michelle is her on Instagram is plant based to talk kidneys. And so she talks a lot about quality of protein. So when you say excess protein, I know what you mean.

Speaker A [00:24:30]:
But tell the people who are listening what’s excess protein? Because I’ll tell you, I get people who eat one meal a day, sometimes two meals a day, and they’re not eating enough Protein. Right. And then I vary in my population. I very rarely get people who are eating way too much unless they are doing supplementation. So I say most people in my program somewhere around 60 to 80 grams, sometimes a bit higher than 80, almost never over 100 unless you have a pressure sore. So would you say in terms of kidneys, anything above, like above what number freaks you out?

Speaker B [00:25:13]:
Well, I mean, of course that depends on the size of the person. So usually what’s recommended? And again, I mean, I don’t know if people are calculating themselves, but what’s considered an adequate protein intake is 0.8 grams per kilogram of body weight. And you do need kilogram, kilogram people.

Speaker A [00:25:30]:
Not per pound.

Speaker B [00:25:31]:
Right.

Speaker A [00:25:32]:
A kilogram is 2.2 pounds.

Speaker B [00:25:34]:
Right. And you need to be adjust that as well for someone that is overweight or obese. Right, exactly. But in general that’s considered adequate with kidney disease and maybe stage, I mean, sometimes it’s 3 3a, but usually 3b and lower. We are going lower than that. But usually if you’re around that, I’d say not more than one gram per kilogram of your body weight as far as protein goes. So people can, you know, calculate that on their own. But so it’s, that’s anything above that potentially, depending if they are trying to heal wounds or they have other things going on.

Speaker A [00:26:08]:
I’ll tell you, it gets real complicated sometimes. If somebody has a pressure sore, you know, the protein is very, very high and then they get constipated because so many of their calories are coming from protein. And I always say we have to prioritize the skin, we have to prioritize the wound. So it’s not going to be forever that we’re going to be on this protein and of course drink a lot of water, you know, to flush that from your system. Right. So I agree with you. I say somewhere between 0.8 to 1 gram. And it’s difficult because people with paralysis also don’t metabolize carbs in the same manner.

Speaker A [00:26:48]:
So we can’t go too high on the carbs. We also don’t want to go too high on the fat. This is why I have like a love hate relationship with my fitness pal, because I think it’s great for tracking if you have a professional helping you with the numbers. If you’re just putting in your height and weight and like your activity level, which there is no paralysis option. I think it’s sedentary. But let’s be honest, a person who works a desk job but walks around and does everything every day that’s sedentary. It’s not a wheelchair user. So it’s complicated.

Speaker A [00:27:20]:
But I think that is such a good point about excess protein. And the culture these days is like, everything has to be extra protein, extra protein.

Speaker B [00:27:32]:
It’s pushed for weight loss.

Speaker A [00:27:34]:
It is, it is. And I sort of get it because most people now, Michelle doesn’t do weight loss. I do weight loss. And so I noticed that most people eat way too many carbs. So getting adequate fiber, right? So like the carbs that are like you said, fruits and vegetables and whole grains, like, we want to get those so that we get enough fiber. There’s like a bunch of things going on, you know, like with my clients, they’re constipated, so they absolutely need the fiber and fluid, but they can’t have so many carbs. So we’re not, we’re not like on some low carb diet, but we’re also getting adequate protein. And I, I think, yes, it is a fine line sometimes between enough protein and then like too much protein.

Speaker A [00:28:18]:
Yeah, right. So anything over 100, I’ll tell you. For me, I don’t like it. I don’t like to see anything. And yes, of course, it depends on your weight. But let’s say, you know, someone is coming into my program, they start tracking, they start eating healthy, and then I start to see the protein going like over 80, 85. I let them know, like, okay, we don’t need to have that much protein. Like, we need to balance these macros and stuff.

Speaker A [00:28:45]:
So can you tell us? I love plant based proteins. Actually, somebody just today in my client Facebook group asked me about impossible burgers. So I’m going to get back to her on that. So plant based proteins, what are your favorites? Because you specialize in this plant based kidneys, you know, is your Instagram. So less stress on the kidneys is always a good thing. And also less saturated fat. You know, I’m very into plant based proteins. What are some of your favorites?

Speaker B [00:29:18]:
So my favorites are legumes, tofu and tempeh. I’d say those are probably the easiest ones to prepare and incorporate and their whole food and not processed. And I know that obviously with the carbs coming in with the legumes, but again, depending on the stage, I mean, legumes still provide amino acids and provide protein and they give fiber. So I think with that it’s the balance of, I mean, again, tofu and tempeh are a lot higher in protein than your beans are. And so depending on the stage of kidney disease, someone, ultimately, you want to have diversity and variety. And so you don’t want to be like, I’m only going to eat tofu as my plant protein option. And whether beans are your protein source or not, I think beans are something, too, that are great to include in the diet to give to help boost the fiber as well. And so I’d say those are probably the main ones.

Speaker B [00:30:09]:
There’s even things, though, that you can do, and maybe it’s adding to a, you know, I don’t know, oatmeal or smoothie or something like that, like hemp seeds and chia seeds and flax seeds, where you’re getting fiber along with some plant protein as well. And I think the thing.

Speaker A [00:30:23]:
Those are good for constipation, too.

Speaker B [00:30:25]:
Yeah. And that’s the thing, too. Fiber supplements are like, you pay a bunch of money for this powdered fiber supplement that’s like 5 grams of fiber. If you have 1 tablespoon of chia seeds, that’s 4 to 5 grams of fiber. And so. And it’s way cheaper. And you also get, you know, omega 3 fatty acids. And you get all these other things.

Speaker A [00:30:41]:
You get all these other good things. Right. I know I always tell people, like, stop with the powdered, you know, gunk. Like, you are literally clogging up your system when you do that, you know, so, Michelle, I know you have to run, but I think that this has been such a, you know, for me, like a refresher, because I don’t talk about kidneys too much, but this is a concern for my population. Right. People with spinal cord injury and paralysis, they do have a higher prevalence of kidney disease. And the neurogenic bladder, it’s hard to deal with. But I think that if there were some opportunities to catch these kidney things earlier, I think people would have a better quality of life.

Speaker A [00:31:26]:
And I just think that dietitians need to be in every urologist’s office. The amount of people who tell me, oh, yeah, I just have this stage whatever of kidney disease, and then it’s like, but no one ever told me what to do. But that’s why we have you.

Speaker B [00:31:44]:
Yeah, exactly. And what I would say, I mean, like, takeaway is again, number one, is awareness. I mean, getting your labs done, understanding them and seeing where you do fall, if you even have kidney disease, but then monitoring that trend. And then, number two, as far as, you know, when you’re looking at your diet again, I think even we talk a lot about protein because it does matter. But that’s almost talking about limiting something in the diet where it’s even, I mean, the most important thing is probably making sure you’re getting plenty of fruit and vegetables, especially vegetables. Especially, you know, most people don’t consume even close to enough vegetables. Fruit’s a little easier because it’s sweet and people like it better. But the fruits and veggies are probably the two most protective things for the kidneys.

Speaker B [00:32:25]:
And so, you know, we can’t just eat that. But looking at your diet and evaluating, okay, how much protein am I really eating, how much, how many servings of fruits and veggies am I really getting? And then how much water am I really drinking? And then just on the side of that, it’s how much, you know, sodium is another thing. And we don’t have to dive too much into that. But it’s also how much are you, how much like processed, packaged fast food, restaurant food are you eating first? Home cooked meals where you control how much salts in it and all of those things play into it. And it’s not that it has to be this, especially in early stages. This like super strict exact thing.

Speaker A [00:33:02]:
Yeah, no, there’s no such thing. You have to live your life. That’s not possible.

Speaker B [00:33:05]:
But be mindful, what’s overall quality of your diet, the diversity of your diet. And again, fiber is very important for kidney health and it’s very important, you know, with your population and spinal cord injuries and paralysis and it’s important for everyone, even outside of that. So family members, you know as well.

Speaker A [00:33:24]:
But absolutely. Thank you so much, Michelle. I think that anyone who is listening, who wants to follow you can get onto your Instagram. So Michelle is at Plantbased Kidneys and thank you so much, Michelle. This was an amazing conversation. I love having other dietitians on the podcast because we’re all talking about food, but we all have our own little specialties and kidney health is such a big issue in the sci population. So thank you so much. I appreciate you.

Speaker B [00:33:56]:
Thank you for having me. And again, just being another platform to spread awareness around kidney health and kidney disease in general.

Speaker A [00:34:02]:
Awesome. Thank you. That’s our episode for today. Thanks for listening. I hope you enjoyed it and that you learned something new. Remember, if you want to lose weight with paralysis, improve your bowel health and feel your best you can. It’s possible you just have to change your eating habits. If you need inspiration on how to get started, check out the paralysis Nutrition Cookbook 101 recipes to help you lose weight and improve bowel health.

Speaker A [00:34:26]:
The cookbook comes with a bonus 30 day meal plan and is the perfect way to start eating healthier. You can find it online at paralysisnutrition.com cookbook I’ll talk to you again soon.