There was a time when doctors predicted that Cameron Green, a cricketer who plays for Royal Challengers Bangalore in the IPL, would only live to be 12 years old. That was because he was born with Chronic Kidney Disease (CKD), which had progressed to stage II within the first few years of his life, leaving him suffering from severe cramps and poor health. However, with a strict diet and relentless exercise regime, he has not only become a cricketer, but also an example of how lifestyle changes can delay the progressive disease by years, and save his life.
Green's mother used to cook kidney-friendly meals for him, and although Green didn't like them much, he is grateful for her diet. If Vani Krishna, a sports nutritionist at Manipal Hospitals in Bangalore, is to be believed, a consistent meal plan that doesn't put too much strain on the kidneys can slow down the damage associated with the disease. “Green says that only 60% of his kidneys are functioning, yet he continues to play professional sports. You can live a normal life for decades, and barring the initial damage, CKD doesn't necessarily get worse. If you neglect checkups and aren't as compliant, you may need dialysis after a few years,” she says.
What is Chronic Kidney Disease?
The kidneys' function gradually declines as they filter waste products and excess water from the blood and excrete it in urine. “CKD is irreversible but can be managed, treated, controlled and slowed down with medication, diet, exercise and follow-up care by a nephrologist. Unless it is a congenital or developmental issue as in Green's case, it is caused by high blood pressure and diabetes,” says Dr Deepak Kumar Chitrali, Senior Consultant Nephrologist and Transplant Physician, Manipal Hospitals.
What is a kidney-friendly diet?
The aim is to avoid putting too much strain on the kidneys, which are left with waste products that they cannot excrete. “You need to watch your intake of protein, fat, sodium, potassium and even water to ensure that end products do not build up in the body. In the early stages, there is not much need to intervene other than reducing foods high in salt and potassium. In the later stages, you need to reduce your intake even further,” adds Dr Chitrali. Diet can help lower creatinine levels, which are a sign of kidney disease.
What are the dietary standards?
If you're between stages 1 and 3, meaning your creatinine levels haven't spiked above 1.4 mg/dL, your protein intake should be 0.8 g per kg of ideal body weight. “Height-to-weight ratio is key here. For example, if you're 160 cm tall and weigh 80 kg instead of 60 kg, then your protein allowance would be 0.8 g x 60 kg or your ideal body weight. Also, it should be spread across multiple meals rather than crammed into one sitting. Energy should be 25-30 kcal per kg of ideal body weight. Sodium intake should be less than 3 g per day, phosphorus less than 1,000 mg per day and potassium less than 3,000 mg per day,” says Krishna.
In layman's terms, she suggests avoiding organ meats, processed meats and sausages and instead consuming more plant-based proteins. “You have to limit your sodium, potassium and phosphorus intake, so limit your intake of potatoes, bananas, kidney beans, kidney lentils, avocado, drumsticks, spinach, leafy vegetables, ragi, jowar and bajra. Safe vegetables are bottle gourd, zucchini, cucumber and pumpkin, which are rich in fibre. Consume non-citrus fruits,” says Krishna. Carbohydrates should be complex foods like whole grains.
To make a low-sodium diet palatable, use spices and seasonings such as garlic, onion, lemon juice, bay leaves, tamarind pulp, vinegar, cinnamon, cloves, nutmeg, black pepper, and cumin, but avoid salt substitutes as they are high in potassium.
However, if a patient is in an advanced stage and has to undergo dialysis, the protein requirement is higher at 1.2 g/kg ideal body weight and this too needs to be spread out throughout the diet, adds Mishra.
Can I build muscle mass?
Greene builds muscle mass while keeping salt and protein to a minimum, then slightly increases his salt intake while performing on the field. He requires lean proteins such as whole eggs and skinless chicken or turkey.
“Egg whites, cottage cheese, 100-150ml milk, tofu and soaked pulses (pulses are soaked in water and 50-60% of sodium and potassium are lost; the slurry is discarded) can help build muscle mass. If this doesn't work, oral nutritional supplements should be taken up after consulting a doctor or nutritionist,” says Dr Chitrali. In stages 4 and 5 of CKD, the above tolerance limits should be further reduced to 1.5 litres of fluid intake per day.
This diet has other benefits as well, such as controlling blood sugar and blood pressure.
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