Aunt Jean: “You have to call your Aunt Pauline. They told her to eat white bread. What’s going on? She doesn’t know what to eat. ”
Mary: “Her kidneys are failing and so she can’t have much potassium. Brown breads have a little more potassium. I’ll visit.”
You would think we dietitians always preach the conventional paradigm of healthy eating, but that is not the case. When the body’s major organ systems fail, we modify our advice. For example, my Aunt Pauline’s kidneys are on the fritz. She can’t remove excess potassium, so the level builds up. Too much can cause an irregular heartbeat and even sudden death. And so, Aunt Pauline was prescribed a low potassium diet, also low in sodium for swelling, without excessive protein for the kidneys again, with her blood glucose levels in mind for diabetes, well controlled on pills.
Aunt Pauline had two low-potassium diet sheets listing what to and what not to eat. Both sheets were a little different and, on my laptop, another sheet from the National Kidney Foundation was a little different still. The lists agreed upon the very high and very low potassium foods, but the middle range was questionable. Cooked cabbage? Maybe yes, maybe no. The same was true for whole wheat bread. Believe me, I know what it’s like to make those lists. The results depend on the makeup of the committee and the time of day.
For breakfast, according to the lists, Pauline could choose oatmeal, puffed rice, a bagel, or white toast. Oatmeal is fine, but every day? What about other cereals? The paper didn’t say. That’s when we had to look at the real numbers and make decisions case-by-case. The rule: be wary of foods with more than 250 mg of potassium per serving. Puffed rice, 6 mg of potassium, 1 mg of sodium (“too bland”); raisin bran, 357 mg of potassium (not an option); yada-yada, try this and that, and then bingo! Rice Krispies, 30 mg of potassium, 190 mg of sodium. That will do. And food-by-food, we went down the list. How much, how often, what’s it worth to you? It’s the only way to get buy-in to the diet therapy.
And, to keep life sweet, we make room for indulgences, also a personal thing.
Mary: “Check it out: Marshmallows have zero potassium and 6 mg of sodium; I’ve seen sugar-free marshmallows made with sugar alcohols. You could make Rice Krispies Treats.”
Aunt Pauline: “Really? I would like that…But what I’d really like is Peeps.”
Mary: “I’ve seen sugar-free Peeps made with sugar alcohols. You can have those too.”
Aunt Pauline: “This diet isn’t so bad after all.”
Sugar-free Peeps save the day, junk food that they are.
Your thoughts: Do you know someone who is confused by his/her medical diet?