Crooked Kitchen

In writing some of my recent posts, I felt like I haven’t offered quite the best advice, especially in the way of useful ingredients. None of my recipes feature beans or cheese, and some other ingredients are limited. I’m writing this post to explain why that is.

I have end-stage renal disease (kidney failure), and I’m on dialysis. My kidneys can’t effectively remove the toxins in my blood, and dialysis isn’t nearly as effective at removing some of them as a healthy kidney. That means that I have to take in amounts of potassium, phosphorus, protein, and water that are different than a healthy person.

Potassium, which is found in large quantities in foods like bananas, potatoes, tomatoes, milk, chocolate, and beans, is an electrolyte that’s crucial for the functioning of muscles and nerves. Dialysis removes potassium pretty effectively, but I’m only on dialysis at night. During the day, if I get too much potassium, I’m at risk for muscle weakness and heart problems. Potassium levels that are too imbalanced can even cause a heart attack.

Phosphorus is more of a problem for me. Dialysis is not very effective at removing it, so it’s important to limit it in my diet. Phosphorus is often a component of proteins – meats, dairy, beans, nuts, seeds, whole grains, and most dark sodas are high in phosphorus. I try to limit those as much as possible, and I take phosphorus binder pills to prevent some of it from being absorbed.

Too much phosphorus can cause itching and bone problems. There are exceptions: for instance, butter and heavy cream are much lower in phosphorus than milk, and meats are allowed because they’re the best source of high-quality protein.

Oddly enough, that’s one thing that makes cheap cooking hard on this diet. Dialysis leeches a lot of protein from my body, so I need to eat more protein than the average person. Good, lean meat has the best quality protein, and in general, the lower phosphorus-to-protein ratio.

I should be getting about 60 grams of protein a day, which is the equivalent of about 9.25 ounces of chicken breast. I can get some of my protein from vegetable sources, but it’s not recommended. The best vegetable protein sources are beans, soy products, nuts, and seeds, which are all high in phosphorus.

The most obvious effect of kidney failure is loss of the ability to eliminate extra water. I’m going to try to walk lightly on this one – it’s hard to talk about urination on a food blog without grossing everyone out. Up until this year, it hasn’t been a problem for me. The way my kidneys failed, I kept losing plenty of water even as my overall kidney function passed 6% (I was losing water, but not waste products). After I started dialysis, my daily volume started going down, and eventually I started retaining water. These days, I’m doing much better, with the dialysis taking off enough fluid each night.

For all these reasons, almost all of my recipes will include a good bit of meat, and I won’t likely be using beans, milk, or cheese. Potatoes might show up, but not in large quantities (don’t expect a post on baked potato toppings anytime soon!). I hope I’ve made clear my situation with respect to diet.