17.1 Carbohydrates
Carbohydrate is one of the three important macronutrients needed by the body. The others are fat and protein. These macronutrients are the most essential and fundamental part of our body. Without these, the human body cannot function smoothly or healthily. Among these, carbohydrates are considered to be the most important.
17.1. 1 What is Carbohydrate?
Carbohydrate can be described as a molecule that provides energy to humans. Glucose, an important component of carbohydrates, powers the body's movements. These carbohydrates are mostly found in plant-based foods. They are also present in milk and milk products in the form of lactose.
Carbohydrates are usually abundant in bread, potatoes, and rice. They are also present in fruits, where this form of carbohydrate is called fructose. Carbohydrates play a vital role in the nutrients required for a healthy life.
In our body, reserve energy is stored in the form of glycogen, not carbon dioxide. When needed, this glycogen is broken down to provide energy. Specifically, one gram of glucose provides four calories of energy, which is essential for powering the body's functions.
Carbohydrates are present in all tissues of the body. They are abundant not only in the skin, muscle fibers, cartilage, bones, and connective tissues but also in the nervous system.
Types of Carbohydrates in Foods
Carbohydrates in foods exist in various forms, including:
- Dietary Fiber: This is a type of carbohydrate that is not easily digestible. It is found in abundance in fruits, vegetables, nuts, beans, and whole grains. Fiber supports healthy digestion and helps prevent constipation.
- Total Sugar: This refers to sugars naturally present in milk and dairy products, as well as sugars commonly found in sweets. These sugars are easily digested and completely absorbed by the body.
- Sugar Alcohols: Sugar alcohols are another form of carbohydrate. They are low-calorie alternatives to natural sweeteners and sugars. Unlike regular sugars, these are not fully absorbed by the body. They are often used in reduced-calorie baked goods and sweeteners, as their preparation involves adding alcohol to modify their structure.
- Starch: Starch, such as glucol, is a type of carbohydrate composed of large numbers of molecules linked together. It is classified as a compound sugar and is the most common carbohydrate found in the foods we consume. Starch is abundant in wheat, rice, potatoes, corn, and cassava and plays a vital role in these foods.
- Types of Carbohydrates: Carbohydrates are linked in various ways, forming different types:
o Monosaccharides: The basic units of carbohydrates, such as glucose, fructose, galactose, and xylose.
o Disaccharides: Formed when two monosaccharides combine. Examples include maltose, sucralose, and lactose.
o Polysaccharides: Made from multiple monosaccharides linked together. Examples include starch, collagen, and cellulose.
Single and double sugars are often referred to as "sugar" in common terms.
Carbohydrates You Need
Carbohydrates are essential for everyone. Their importance lies in the multiple roles they play in the body:
- The primary function of carbohydrates is to provide energy. In many countries, carbohydrates contribute to approximately 70% of daily energy intake.
- Proteins can effectively perform their role in body development and repair only when there is an adequate amount of carbohydrates available to meet energy needs.
- Carbohydrates like fiber help the intestines absorb more water, prevent constipation, and support healthy digestion.
- When the amount of carbohydrates in the body decreases, the body uses its reserves to produce energy. This process can increase acidity levels in the body, leading to potential health risks.
- Carbohydrates are essential for producing glycoproteins that boost immunity, lipids required for the cells of the nervous system, and amino acids that support chemical activities in the body.
In Summary: Carbohydrates provide multiple benefits:
- Serve as an excellent source of energy.
- Enhance digestion and improve digestive efficiency.
- Prevent muscle fatigue while supporting muscle development and movement.
- Prevent the formation of ketones.
- Aid in the creation of immune-supporting molecules.
Thus, carbohydrates are indispensable for maintaining a healthy life. However, it is important to note that consuming them in excess can lead to adverse effects.
Obesity and Carbohydrates In the current era of globalization, the number of people experiencing obesity has increased significantly. The overconsumption of carbohydrates is one of the main contributing factors to this issue. Other factors may also play a role in obesity, but excessive carbohydrate intake remains a primary concern.
- Lack of physical exercise
- Excessive consumption of fast food and junk food
- Hereditary genetic factors
- Stress, which can also contribute to weight gain
17.1. 2 Steps to Avoid Obesity and Maintain Health
Choose foods rich in natural, unprocessed carbohydrates. Include more vegetables, legumes, whole grains, and nutritious seeds like nuts in your diet. Avoid fast food as much as possible. Practice moderation in portion sizes when eating.
Key Points to Remember
- Carbohydrates are nutrient-rich molecules that provide energy to the body.
- It is essential to understand the differences between simple and complex carbohydrates:
o Simple carbohydrates: These are low in nutrients and do not effectively support digestion. Their intake should be controlled.
o Complex carbohydrates: These are highly nutritious, sustain energy for longer periods, and can be included in the diet in larger quantities.
Carbohydrates in a Diabetic Diet For individuals with diabetes, it is essential to reduce the amount of carbohydrates in the diet. This helps in managing weight and maintaining better control over blood sugar levels.
A single serving of a carbohydrate-based diet provides approximately 60-100 calories. If you are overweight, reducing the number of carbohydrate-rich meals can help manage your weight. On the other hand, if you are underweight, increasing carbohydrate intake may be beneficial. For individuals with diabetes, controlling carbohydrate consumption is critical for maintaining stable blood sugar levels. If you are trying to manage your weight or have diabetes, consulting a dietitian can help you determine the right amount of carbohydrates for your specific needs. A dietitian can provide personalized advice on your daily carbohydrate requirements.
Carbohydrates in Kidney-Friendly Diets Carbohydrates play a unique role in diets designed for individuals undergoing dialysis.
- Carbohydrates and Hemodialysis:
For those receiving in-center or home hemodialysis, carbohydrate requirements typically make up about half of the daily diet. This translates to approximately 40- 60% of daily calorie intake coming from carbohydrates. For example: If your daily calorie requirement is 2,000 calories, 800-1,200 calories should come from carbohydrate-rich foods.This equates to approximately 200-275 grams of carbohydrates per day.
- Carbohydrates and Peritoneal Dialysis:
If you are undergoing peritoneal dialysis, your carbohydrate needs are generally lower compared to those on hemodialysis. The required amount depends on the glucose concentration in your dialysis solution and the type of peritoneal dialysis you are using, whether continuous or automated.
Understanding and adjusting carbohydrate intake based on your medical condition and treatment type is essential for optimal health.
The number of calories your body absorbs can vary. Specifically, you can determine how many calories are absorbed from one liter of peritoneal dialysis fluid, which helps in managing your dietary and energy needs.
Dextrose CAPD Calories APD Calories Concentration Absorbed Absorbed
Ratio 31-36 calories/1 20-26 calories/liter
1.5 % liter 34-43 calories/lite
58-73 calories/liter
2.5 % 51-60 calories/1
liter
4.25 %
87-102 calories/1 liter
17.2 Protein
Protein is one of the key macronutrients required for maintaining good health. Although it is vital, its availability in nutrient-dense foods varies, meaning you may not need as much as you think. Understanding the fundamentals of protein and incorporating healthy protein sources into your diet is crucial for overall well-being.
17.2. 1 What is Protein?
Protein is a fundamental component of the human body. It is present in muscles, bones, skin, and almost every organ or tissue. Protein plays several critical roles, including: Creating enzymes that drive chemical reactions in the body. Forming hemoglobin, which carries oxygen in the blood.
There are at least 10,000 different types of proteins in your body, each contributing to its structure and function. Proteins essentially make up who you are and are indispensable for life.
Proteins are made up of more than twenty fundamental building blocks known as amino acids. Since the body does not store amino acids, it produces them in two ways: either by synthesizing new ones or modifying existing ones.
Nine amino acids are classified as essential amino acids because they cannot be produced by the body and must be obtained through diet. These include: Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine.
Functions of Proteins:
- Proteins are vital for building the body, supporting growth, repairing tissues, and maintaining overall body structure.
- All enzymes, many hormones, transport carriers, and immunoglobulins (antibodies) are made of proteins.
- Proteins help regulate normal blood pressure, blood clotting, and muscle movement.
- Although not their primary function, proteins can provide energy when dietary caloric intake is insufficient. Each gram of protein provides 4 calories.
- Proteins are an important source of nitrogen, sulphur, and phosphorus, which are critical for various physiological functions.
17.3 Nitrogen Balance
Positive Nitrogen Balance:
- This is the stage where nitrogen intake exceeds output.
- A large amount of nitrogen is retained in the body. So the net increase in body protein is accordingly.
- A positive nitrogen balance is seen in growing children, pregnant women, or those recovering from serious illness.
Negative Nitrogen Balance:
- This is the stage where nitrogen output is greater than intake.
- Nitrogen levels are lost from the body, reducing body protein.
- Prolonged negative nitrogen balance can be life-threatening.
- This condition is seen in children suffering from kwashiorkor or marasmus protein
deficiency.
- A negative nitrogen balance can occur if the diet is insufficient in protein (a particular
amino acid is depleted) and tissue destruction or severe disease occurs.
- Growth-stimulating hormone and insulin promote positive nitrogen balance.
Corticosteroids, on the other hand, adjust to negative nitrogen balance.
- Cancer and uncontrolled diabetes adapt to negative nitrogen balance.
17.3. 1 Why Are Nutritional Values of Proteins Classified?
The nutritional values of proteins are classified based on the following factors:
- Protein Efficiency Ratio (PER)
- Biological Value (BV)
- Net Protein Utilization (NPU)
- Chemical Value
Protein Requirements: The requirement for protein intake, its nutritional value, and calorie needs depend on various factors, including physiological conditions like growth, pregnancy, and lactation.
- For adults, 0.8 to 1.0 grams of protein per kilogram of body weight per day is
sufficient.
- Growing children, pregnant women, and lactating women require roughly double the
amount of protein compared to adults. Recommended dosages in food Protein - 1.2 g / kg /1 day of which at least 50 percent should be high quality protein. Calorie- 35 kcal/kg/1 for those less than 60 years 30-35 kcal/kg/1 day for those 60 years or older Total Fat- 25 %-35 % of total power 25-35 % Saturated Fat <7% Sodium (salt)- 80-100 ml mol Potassium - < 1 mmol/kg Cholesterol - < 200 mg if overdose Total fiber- 20-30 g / 1 day Food Sources of Protein:
- The amount of protein in food varies depending on the type of diet: o Cereals: 6-12% o Legumes: 18-22% o Meat: 18-25% o Eggs: 10-14% o Milk: 3-4% o Vegetables: 1-2%
- Proteins in meat are higher than those found in vegetables.
Recommended Daily Allowance (RDA):
- The Recommended Dietary Allowances (RDA) indicate the amount of nutrients that should be included in the diet to maintain health and physical performance.
- The RDA for men is 20% higher than for women.
Chronic Kidney Disease and Protein Intake:
- Protein is essential for building muscle, repairing tissue, and fighting infection.
- However, if you have kidney disease, it's important to monitor your protein intake. Too much protein can lead to the accumulation of waste in your digestive system, and your kidneys may struggle to remove the excess waste, potentially causing kidney damage.
Dietary Guidelines for Chronic Kidney Disease:
- Daily protein intake: 0.6 - 0.8 grams per kilogram of body weight
- Calorie intake: 30 - 35 kcal per kilogram of body weight
- Fat: Less than 30% of total energy intake from fat
- Fiber: 25 to 38 grams per day
- Salt: 2 to 3 grams per day
- Potassium: Potassium intake should be limited in the diet depending on the amount of bleeding.
- Calcium: 1500 mg of calcium per day.
- Phosphorus: 0.8 to 1 gram of phosphorus per day.
Medical Nutrition Therapy: Six types of nutrients are regulated:
- Protein
- Sodium
- Potassium
- Phosphorus
- Calcium
- Fluid Volume
Recommended Dose of Potassium:
- Patients undergoing peritoneal and hemodialysis require a protein intake of 1.0 - 1.2 g/kg body weight per day.
- For chronic kidney patients who have not yet started dialysis, a protein intake of 0.6 to 0.8 g/kg/day is recommended.
- For chronic kidney disease stage 1 and 2, it is now recommended to limit dietary protein to no more than 0.8 grams per kilogram of body weight.
BMI (kg/m2) Category / Energy Requirements kcal/kg/d Body Mass Index Category Required Caloric Intake 35 40 < 15 30 35 15 19
20 29 20 25
>30 15-20
Recommended daily protein intake Protein Requirement (grams per kilogram of ideal body weight per day) Medical Condition 0.75
Healthy Condition: 1.0 1.5 Surgery, Accidents, and Other
1.2 1.4
Critical Situations: 1.3 1.5 Blood Purification: Peritoneal Dialysis:
Continuous Dialysis / Obesity: 1.7 2.0
17.4 Sodium and its Sources Sodium and Kidney Disease:
Salt Intake
- Sodium is an important mineral naturally present in our bodies.
- It helps maintain blood pressure and fluid balance.
- For dialysis patients, doctors and dietitians recommend reducing the amount of salt
in the diet, depending on the individual's sodium levels.
- Common salt is called sodium.
17.4. 1 Where is Sodium Transported From?
- Sodium is naturally present in most foods.
- Table salt contains about 40% sodium and 60% chloride.
- Sodium is often added to processed foods to preserve or enhance flavor.
- This salt is found in highly processed, frozen vegetables, cured meats, and pickles.
- It is used in butter, cheese, bread, salad dressings, and many other breakfast foods.
17.4. 2 How is Curing Salt Used?
- Salt is used in various ways in the diet, especially in processed foods.
- Manufacturers of prepared, frozen, and processed foods often use sodium to
enhance the flavor of their products.
- Sodium plays an important role in food security and as a material in food
preservation. Sodium's Role in the Body:
- Regulates blood pressure and blood volume.
- Aids in muscle movement.
- Regulates acid-base balance of blood and body fluids.
- Maintains intracellular water balance.
- Consuming too much sodium can lead to leg swelling or water retention.
- The normal range for sodium is 135 - 145 mEq/liter.
17.4. 3 How Does Sodium Affect People with Kidney Disease?
- If you have kidney disease, your kidneys may be unable to remove excess sodium and
fluid from your body.
- Increased blood pressure and elevated sodium and fluid levels can make you feel
unwell.
- This can lead to high blood pressure, potentially causing further damage to already unhealthy kidneys.
- Ongoing kidney damage reduces kidney function, leading to more fluid and waste retention in the body. Symptoms of this condition develop as a result.
Problems Caused by High Sodium Intake:
- Heart failure
- Swelling in hands and feet
- Shortness of breath
Sodium Recommendations by the World Health Organization (WHO):
- Maximum sodium intake should be 2 g/day.
- Sodium in salt is 2.5g per 5g of salt.
These recommendations may vary based on your health status. Points to Note:
- Use common salt in proper quantities.
- Avoid using "lona" salt.
- Do not add salt while cooking or at the table.
- You can add flavoring and sodium-free spices to your food.
- Try to avoid fast food.
FDA-Approved Sodium Content in Food:
- Sodium-Free Food Only a very small amount of sodium per serving.
- Very Low Sodium 35 mg or less per serving.
- Low Sodium 140 mg or less per serving.
- Reduced Sodium Foods with 25% less sodium.
- Light in Sodium Foods with at least 50% sodium reduction.
17.4. 4 Sodium-Rich Foods:
- Processed meats
- Processed, frozen, or canned foods
- Cheese, butter, sauces, breads, pasta mixes
- Commercial rice varieties
- Meals served in restaurants, processed foods, and packaged foods are usually high in sodium.
- Smoked meats, sea fish
- Confections like Rolled Chub, Salted Ilkut, Salted Popcorn, Namkans
- Baking soda, sodium bicarbonate, sodium benzoate
- Varieties of pickles
- Salted food additives like ready-made masalas
- Dry fruits and nuts
- Beverages such as cold drinks, energy drinks, chocolate drinks, and pudding mixes
- Animal meats like pork, ham, lamb, etc.
17.5 Potassium
Potassium is another essential mineral found in the foods you eat. It is also an electrolyte, which conducts electrical impulses throughout the body. Potassium plays a crucial role in the body's vital functions, including:
- Blood pressure regulation
- Normal water balance
- Muscle movement
- Nerve function
- Digestion and bowel movements
- Heart rate
- Acidity/alkalinity balance
Your body naturally produces potassium, but it is important to consume the right amount of potassium-rich foods and drinks. Blood Levels of Potassium:
- Normal level: 3.5 to 5.0 mEq/L
- High level: 5.1 to 6.0 mEq/L
- Dangerously high level: Above 6.0 mEq/L Potassium Level (MEq/L)
Normal Range: 3.5 - 5.0
High Range: 5.1 - 6.0
Dangerously High Range: > 6.0
Foods Rich in Potassium:
- Dry fruits and nuts
- Blackcurrant, jaggery, jam
- Black tea, black coffee, fruit juices, squashes, and bottled drinks
- Coconut water and related foods
- Squashes, ketchup, and canned foods
- Pudina chutney and coconut chutney
- Green vegetables, such as green salads
- Ragi and its products
- All types of soups.
- Fruits High in Potassium: Orange, Mango, Banana, Pomegranate, Date
- Avocado, Dried Apricot, Gooseberry
- Potatoes
Helpful Tips to Reduce Potassium Levels in Your Diet:
- Vegetables: Wash and peel vegetables, then soak them in boiled water for at least 30 minutes. After soaking, filter the water and cook the vegetables by boiling them in fresh water. Discard the cooking water.
- Fruits: Most fruits are high in potassium. Opt for fruits such as apple, guava, papaya, and pear, which are lower in potassium. Limit intake to 2-3 pieces per day.
- Spices: Since spices are high in potassium, reduce their use.
Vegetables High in Potassium:
- Amaranth
- Coriander leaves
- Coast types
- Potatoes
- Sweet potatoes
- Tapioca
- Drumstick
- Eggplant
- Tomatoes
Vegetables Low in Potassium:
- Fenugreek leaves
- Yellow squash
- Zucchini
- Broad beans
- Cucumber
- Thread col
- Peas
- Ridge Gourd
- Snake Gourd
- Chow Chow
Fruits High in Potassium:
- Mango
- Sapota
- Paddy
- Melon
- Pomegranate
- Red banana
- Dates
Fruits Low in Potassium:
- Apple
- Papaya
- Guava
- Watermelon
Nuts High in Potassium:
- Almonds
- Pistachio nuts
- Pumpkin seeds
- Flax seeds
- Brazil nuts
- Dried, roasted peanuts
Nuts Low in Potassium:
Phosphorus Levels: Phosphorus is absorbed into the blood by the kidneys and helps maintain the body's normal acid/alkaline balance. Increased blood levels of phosphorus during renal failure can lower calcium levels in the peripheral blood, leading to weak bones. Phosphorus is found in many foods. In healthy kidneys, it is excreted in urine efficiently. However, in renal failure, phosphorus levels can rise, leading to issues such as:
- Muscle aches and cramps
- Weakening of bones, making them brittle
- Heart, skin, joints and clotting of calcium in blood vessels
- Usually, 1000 mg per day in your diet. Only phosphorus is present. It is best to cut
down on foods high in phosphorus. Avoid high-phosphorus foods that include:
- Dairy products
- Dry beans and lentils
- Cured meats, red meat
- Pork, beef
- Fatty fish, and shellfish
- Milk, yogurt, cheese, yeast varieties
- Dry fruits and vegetables
Liquids:
Liquids don't just mean water. Your kidneys' main job is to remove waste from the body. With a well-functioning urinary system, excess water is excreted through the urine. Since your kidneys are very active, they can excrete the required amount of fluid according to the body's functions and store it in the right amount. This is an amazing performance.
When kidney function declines, it becomes unable to remove excess fluid. So, there is a risk of excess fluid in your body. For people with kidney problems and those undergoing dialysis, the amount of urine output will be greatly reduced. So, the fluid in the body increases and can be dangerous.
Unexpected Problems May Appear:
- Swelling all over the body
- Increase in blood pressure
General Notes:
- If the amount of thiram in the body is too low, the blood pressure may decrease. This also stresses the kidneys further.
- Water is an important nutrient. The kidneys play an important role in regulating this fluid balance in our body.
- In between sessions on dialysis, patients are expected to gain some weight due to the increased water content in the foods they eat.
- Dialysis removes waste from the body and prevents excess fluid from accumulating in the body.
- You should be careful about your total fluid intake. Note that tea, milk, rice flour, water, and any other liquid form (including thin sambar, rasam, buttermilk) are included in the calculation.
- Count frozen foods that thaw at room temperature as additional data.
