quinta-feira, 8 de junho de 2017

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terça-feira, 6 de dezembro de 2016

1999 dez anos da FAE na COOLMÉIA

Feira dos Agricultores Ecologistas faz Dez Anos

Texto de João Batista Santafé Aguiar, Jornalista
Especial para Informativo Comemorativo aos Dez Anos de Feiras Coolméia.
Porto Alegre - No próximo sábado (16 de outubro de 1999), vão  se comemorar os dez anos da primeira Feira da Coolméia - Cooperativa Ecológica..
Dez anos sem agrotóxicos. Após árdua articulação foi lançada em 14 de outubro de 1989, no domingo anterior ao dia 16, Dia Mundial da Alimentação e da Luta contra os Agrotóxicos, a Feira dos Agricultores Ecologistas da Coolméia. Inicialmente mensal (para fugir ao que depois seria a regra, a segunda feira realizou-se apenas no dia 9 de dezembro), depois tornou-se quinzenal e, finalmente, semanal.
O local onde viria a se instalar foi muito estudado - aonde foi lançada e se encontra até hoje não havia ocupação aos sábados: a 1ª Quadra da rua José Bonifácio, entre a av. Osvaldo Aranha e a rua Santa Teresinha. Foi uma decisão vista como temerária na época.
Hoje, não se imagina toda aquela orla da Redenção sem ocupação todo o fim de semana. Foram os produtores da Coolméia os grandes pioneiros. A vida na cidade mudou.
Exatamente um ano antes, em 16 de outubro de 1988, o associado Renato Krentz Fontoura, já falecido, participava com uma banca representativa dos produtos oferecidos pela Coolméia, como verduras, os da indústria caseira e livros, no Bric da Redenção.
TUPAMBAÉ - Mas a Coolméia começou a colocar sua cara prá fora em alguns outubros antes, em 1986, quando organizou e realizou a Iª Tupambaé - Feira Ecológica, realizada com sucesso na Redenção, em Porto Alegre. Por ali transitaram mais de dez mil pessoas com plena participação das entidades ecologistas, pacifistas e naturistas. A 2ª, em outubro de 1987, inovou colocando uma enorme tenda de circo para abrigar todos os expositores em pleno Parque Ramiro Souto. E a 3ª, de 17 a 21 de outubro de 1988, foi realizada na Pré-escola Amiguinhos do Verde.
A Cooperativa já participava de eventos, por todo o Brasil, promovendo a agricultura ecológica e os debates sobre o assunto.
A Feira dos Agricultores Ecologistas da Coolméia nasceu como fruto direto da movimentação em torno da Tupambaé. Já na primeira edição e nas seguintes, participaram cerca de 25 produtores vindos dos mais diversos pontos do Rio Grande.
Passou-se a promover cada evento como se fosse único: Festa da Fruta Tropical Sem Agrotóxicos, Festa do Kiwi, Festa do Pêssego e da Framboesa, e muitas outras.
Hoje mais de duzentas famílias, associações e agro-indústrias estão diretamente envolvidas em cada evento.
Depois, a multiplicação das Feiras Coolméias e dos eventos correlatos em todo o Estado. Visitas de comitivas de agricultores, órgãos públicos e órgãos de comunicação tornaram-se comuns. A Feira da José Bonifácio, a primeira, também tornou-se o local preferido dos ecologistas gaúchos para um bate-papo informal aos sábados. Também existem duas outras Feiras que ocorrem no mesmo lugar, mas em dias diferentes, no pátio da Secretaria da Agicultura do Estado - aos sábados pela manhã e às quartas, das 15 às 20 horas.
Dez anos sem agrotóxicos se passaram. Outros cem hão de vir!


segunda-feira, 31 de outubro de 2016

Equilibrio Ácido Básico no organismo humano

Comentário inicial: Nesse texto você verá que uma alimentação com predominância de alimentos crus (frutas, hortaliças, castanhas e sementes cruas/germinadas), você evitará acidificação do sangue, aumentando a eficiência de seu sistema imunológico.
Texto original, em inglês, aqui:
http://www.trans4mind.com/nutrition/pH.html


Há um texto detalhado sobre o efeito alcalinizante do limão, aqui:
http://geocities.ws/ggompa/saude/limao.html

_________________________________________________________________

Equilibrando alimentos ácidos/alcalinos

Um surpreendente número e variedade de problemas físicos e doencas pode ser causado pelo problema de alimentos que são produtores de acidez após a digestão.
Hoje a vasta maioria da população nas nações industrializadas sofre de problemas causados pelo estresse da acidose, porque tanto o estilo de vida moderno como a dieta promovem a acidificação do ambiente interno do corpo.

A atual dieta ocidental típica é laragamente composta de alimentos formadores de ácidos (proteínas, cereais, acúcares). Alimentos promotores de alcalinidade como os vegetais são consumidos numa escala muito menor. Estimulantes como tabaco, café, chá e álcool são também extremamente acidificantes. O estresse e atividade física (tanto o insuficiente como o excessivo) também causam acidificação.

Muitos alimentos são alcalinizantes por natureza, mas alimentos processados são na maioria acidificantes. É importante consumir pelo menos 60% de alimentos alcalinizantes em nossa dieta, para se manter a saúde.

Precisamos abundancia de frutas frescas e particularmente vegetais (alcalinizantes) para equilibrar nossa necessidade de consumo de proteínas (acidificantes).

E nós precisamos evitar alimentos processados, doces ou carboidratos simples, não apenas porque eles são acidificantes mas também porque eles elevam o índice de açúcar no sangue muito rápido (alto índice glicêmico, portanto engordam); além de serem pobres em nutrientes ainda podem ser intoxicantes.

Qual o pH do corpo?

A água é o composto mais abundante no corpo humano, 70% . O corpo contém uma gama enorme de soluções, as quais podem ser mais ácidas ou menos ácidas.

pH (potencial de Hidrogênio) é a medida da acidez ou alcalinidade de uma solução- a relação entre íons positivamente carregados (acidificantes) e íons negativamente carregados (alcalinizantes). O pH de qualquer solução é a medida de sua concentração de íons Hidrogênio.

Quanto maior o índice do pH, mais alcalino e mais rico em Oxigênio o fluido é. Quanto menor o pH, mais ácido e pobre em Oxigênio é o fluído. o pH varia de 0 a 14, sendo 7 o índice de neutralidade. Tudo acima de 7 é alcalino, e abaixo de 7 é considerado ácido.

O sangue humano deveria ser levemente alcalino (7,35 - 7,45). Abaixo ou acima dessa faixa significa sintomas e doença.
Se o pH do sangue se move para baixo de 6,8 ou acima de 7,8 as células param de funcionar e o corpo morre. O corpo portanto se esforça em equilibrar o pH. Quando esse equilíbrio é comprometido, muitos problemas podem ocorrer.

Uma dieta desequilibrada alta em alimentos acidificantes tais como proteínas, açúcar, cafeina e alimentos processados exerce uma pressão no sistemas de regulação do corpo para manter a neutralidade do pH.

A estocagem extra requerida pode debilitar o corpo de substancias minerais alcalinas como sódio, potassio, magnésio e cálcio, fazendo a pessoa tender a ter doencas crônicas e degenerativas.

Os minerais são "emprestados" de órgãos vitais e ossos para compensar (neutralizar) a acidez e remove-la com segurança do organismo.

Por causa desse esforço, o corpo pode sofrer dano severo e prolongado- uma situação que pode ocorrer sem detecção por anos.

Problemas de Saúde causados por acidose

Se vc tem um problema de saúde, muito provavelmente está sofrendo de acidose. As pesquisas mostram que a menos que o pH do corpo esteja levemente alcalino, o corpo não pode auto curar-se. Assim, independente de que método que vc use para cuidar da saúde, ele não será eficaz enquanto seu pH não estiver equilibrado. Se seu pH não estiver equilibrado, voce não pode, por exemplo, assimilar vitaminas, minerais e suplementos nutricionais. O pH de seu corpo afeta TUDO.

A acidose diminuirá a capacidade do corpo de assimilar minerais e outros nutrientes, diminuirá a produção de energia nas células, diminuirá a capacidade do seu organismo de reparar células doentes, diminuirá a capacidade do organismo de livrar-se de minerais pesados, auxliará a reprodução de células de tumores, e fará o corpo mais susceptível de fadiga e doencas.
Um pH ácido pode ocorrer devido a uma dieta acidificante, estresse emocional, sobrecarga de toxinas, e/ou reações so sisteme imunológico ou qualquer processo que dificulte as células de absorver oxigenio ou outros nutrientes. O corpo tentará compensar o pH acídico usando minerais alcalinos. Se a dieta não contiver minerais suficientes para compensar, ocorrerá uma acidificação celular. Acidose pode causar os seguintes problemas:.

Dano cardiovascular.
Ganho de peso, obesidade e diabetes.
Problemas da bexiga.
Pedras nos rins.
Deficiencia imunológica.
Aceleração do dano por radicais livres.
Problemas hormonais.
Envelhecimento prematuro.
Osteoporose e dor nas juntas.
Dores musculares e aumento do ácido lático.
Baixa energia e fadiga crônica. Digestão e eliminação lentas.
Aumento de fermentações e fungos.
Falta de energia, fadiga.
Baixa temperatura corporal.
Tendencia a contrair infecções.
Perda de iniciativa, prazer, e entusiasmo.
Tendencias depressivas.
Exaustão rápida.
Compleição pálida.
Dores de cabeca.
Inflammação da córnea e palpebras. Amolecimento e dolorimento nos dentes.
Gengivas sensíveis, inflamadas.
Úlceras estomacais e da boca.
Fissuras no canto dos lábios.
Excesso de ácidos no estômago.
Gastrite.
Unhas finas e quebradicas.
Cabelos secos, quebradicos e queda.
Pele seca.
Irritação da pele.
Caimbras nas pernas.




Teste a acidez/alcalinidade de seu corpo com as tiras de papel de teste de pH
"É recomendável que você teste seus níveis de pH para determinar se o pH do seu corpo precisa de atenção imediata. Usando tiras de teste de pH (papel Litmus), você pode determinar o seu fator de pH de maneira rápida e fácil na privacidade de sua própria casa.
A melhor hora para testar seu pH é por volta de uma hora antes de uma refeição ou duas horas depois da mesma.

Teste do pH da Saliva:

Simplesmente molhe um pedaço de papel Litmus com a sua saliva. Apesar da saliva geralmente ser mais ácida que o sangue, o pH salivar espelha o do sangue e nos diz o que o corpo retém. É um indicador justo da saúde dos fluídos extracelulares e de suas reservas minerais alcalinas. O pH ótimo para a saliva é de 6.4 a 6.8. Uma leitura abaixo de 6.4 indica insuficiência de
reservas alcalinas. Depois de comer, o pH da saliva deve subir para 7.5 ou mais. Um desvio do pH salivar ideal por um tempo longo é um convite à doença.
Se a sua saliva permanece entre 6.5 e 7.5 o dia todo, seu corpo está funcionando dentro de uma faixa saudável.
Acidose, a permanência por um tempo longo no estado de pH ácido, pode resultar em artrite reumatóide, diabete, lúpus, tuberculose, osteoporose, pressão sanguínea alta, a maior parte dos cânceres e muito mais. Se o pH salivar permanece muito baixo, a dieta deve enfocar em frutas, vegetais e água mineral, bem como procurar remover acidificantes fortes como sodas, trigo integral e
carne vermelha.

Teste do pH da Urina:

O pH da urina indica como o corpo está trabalhando para manter o pH apropriado do sangue. A urina revela os ciclos metabólicos alcalinos (construtores-anabólicos) e ácidos (degradativos-catabólicos). O pH da urina indica os esforços do corpo para regular o pH através dos 'buffer salts" e hormônios, via rins, supra-renais, pulmões e gônadas. A urina pode prover um quadro bastante preciso da química do corpo, porque os rins filtram os "buffer salts" da regulação do pH e proporcionam valores baseados naquilo que o corpo
está eliminando. O pH da urina pode variar de 4.5 a 9.0 nos extremos, mas a faixa ideal está entre 6.0 e 7.0. Se o seu pH urinário flutuar ente 6.0 e 6.5 logo de manhã e entre 6.5 e 7.0 à noite após o jantar, seu corpo então está funcionando dentro de uma faixa saudável.
O teste da urina pode indicar quão bem seu corpo está excretando ácidos e assimilando minerais, especialmente cálcio, magnésio, sódio e potássio. Estes minerais funcionam como "buffers". "Buffers" são substâncias que ajudam a manter e equilibrar o corpo contra o excesso de acidez ou alcalinidade. Mesmo com quantidades apropriadas de "buffers", níveis ácidos ou alcalinos podem se
tornar estressantes para os sistemas reguladores do corpo. Quando o corpo produz desta acidez ou alcalinidade, ele deve dispensar o excesso. A urina é o método utilizado pelo corpo para remover qualquer excesso de substâncias ácidas ou alcalinas que não puderem ser "buffered". Se o sistema de "buffering"  do corpo estiver sobrecarregado, um estado de "auto-intoxicação"
ocorre, e deve-se atentar para uma redução deste stress.

Alimentos: são eles alcalinizantes ou acidificantes?

Note que a tendência de um alimento para gerar acidez ou alcalinidade no corpo não tem nada a ver com o real pH da comida em si mesma. Por exemplo, limões são bastante ácidos, entretanto os produtos-finais dos mesmos após a digestão e assimilação são bastante alcalinos, portante limões geram alcalinidade no corpo. Da mesma maneira, a carne possui um pH alcalino antes da digestão mas deixa resíduos ácidos no corpo, então, como quase todos os produtos de origem animal, a carne é classificada como acidificante.
É importante que sua ingestão diária de alimentos aja de maneira a equilibrar naturalmente o pH do corpo. Para manter a saúde, a dieta deve consistir de pelo menos 60% de alimentos alcalinizantes e de no máximo 40% de alimentos acidificantes. Para reconstituir a saúde, a dieta deveria consistir de 80% de alimentos alcalinizantes e 20% de alimentos acidificantes.


Desintoxique com frutas e sucos de vegetais. Todos os sucos de frutas e vegetais crus sao alcalinizantes. (As frutas se tornam mais acidificantes se forem processadas e principalmente se adoçadas com açucar refinado)

A ciência: Porque os ácidos limões sao alcalinizantes?A resposta é simplesmente porque quando o digerimos, ele produz um resíduo alcalino. Porisso o classificamos como alimento alcalino. Quando digerimos um alimento, este é quimicamente oxidado ("queimado") para formar água, dióxido de carbono e um composto inorgânico. A natureza alcalina ou ácida desse composto inorgânico que foi formado é que determina se o alimento é alcalinizante ou acidificante. Se o composto inorgânico contiver mais sódio, potássio ou cálcio, é classificado como alimento alcalino. Se contiver mais enxofre, fosfato ou cloro, é classificado como um alimento acidificante.

Que diferença faz ter sangue ácido (tóxico)?

Para seu corpo se manter vivo e saudável, ele mantem um delicado e preciso equilíbrio do pH do sangue em 7,365, o qual é levemente alcalino (acima de 7 é alcalino). O corpo faz tudo o que for necessário para manter esse equilíbrio. O problema é que as pessoas tem em geral estilos de vida incrivelmente acidificantes. Ácidos sao produzidos no corpo sempre que voce sente estresse, emoções negativas ou quando voce consome alimentos acidificantes.
A dieta típica das pessoas é acidificante. O que ocorre quando seu corpo está mais ácido? Seu corpo armazena excesso de ácidos em células de gordura (por isso é tão difícil, para muita gente, perder peso). Com o tempo, seu corpo retira cálcio e outros recursos alcalinos dos ossos em uma tentativa desesperada de manter o equilíbrio do pH (essa é a razão pela qual as pessoas "encolhem" com a idade).
Seu sangue desempenha um papel importante em sua saúde e energia: ele carrega oxigênio para suas células! Isso lhe dá energia, e é o que o mantem vivo. O sangue também desempenha um papel chave no quão energizante seu sono será.
Abaixo uma gravura de células de sangue saudáveis:


Observe como as células sanguíneas estao separadas umas das outras. Como resultado, seu sangue se move livremente por todo seu corpo, e penetra nos minúsculos vasos capilares, e faz voce sentir que seu corpo está recebendo energia. Durante o sono, o sangue, estando adequado, flui e a hidratacao é importante. Quando seu sangue está como na figura acima, seu sono é realmente energizante e voce precisa de menos horas de sono.
As células sanguíneas tem uma carga negativa na parte externa e positiva na interna. Isso é o que as mantem saudáveis a separadas umas das outras. Entretanto, quando seu corpo está acidificado, as células do sangue perdem sua carga negativa. As células não mais terão aquela forca de repulsão e se agomeram, como na figura abaixo:
Quando as células de seu sangue estao "amontoadas" elas nao mais podem entrar nos minúscuilos vasos capilares  (Nota: as extremidades, as pontas das veias) de seu corpo e levar o oxigênio vital às células. O sangue não mais terá condições de dar à todas as células de seu corpo os efeitos energizantes e rejuvenecedores. Essa é a maior razão pela qual algumas pessoas se sentem horríveis quando acordam, e porque precisam dormir mais. E é também, porque voce tende a acordar sentindo-se desidratado.  .
A maioria de nós, desde a infância, é condicionado por nossos pais a temer as doencas e os "micróbios". Isso ocorre com frases do tipo: "Coloque o suéter ou vai pegar um resfriado!"  ntretanto, a verdade é que a maioria de nós cria um ambiente intoxicado em nosso organismo e é isso que provoca doencas e um estado quase constante de fadiga. Isso nao acontece A VOCÊ, na verdade é VOCÊ que é o responsável pela ocorrência de doencas. 
Aqui está um bom exemplo: imagine que você tem um peixe-dourado em um aquário e que um dia você viu que o peixe estava começando a parecer bastante doente. Você também nota que a água está um pouco suja. O que parece mais sensato?
Tirar o peixe da água e tentar consertá-lo? Ou trocar a sua água? Provavelmente é a água que está deixando o peixe doente, o problema não é o peixe em si mesmo. Quando você trocar a água, o peixe ficará mais saudável. O fato de que o peixe está doente é na verdade um sintoma do ambiente pouco saudável, não um problema em si.

Fato: nossos corpos são mais do que 70% de água! E a maior parte do tempo, por causa de nossas dietas, emoções e estilo de vida, a "água" de nossos corpos está ácida em excesso, e mais claramente: tóxica. No entanto, mesmo sabendo disso, a medicina moderna convencional põe muito mais atenção na luta contra os sintomas, e não reconhece a raiz do problema.
Há algumas outras coisas que podem ser feitas, como complemento à dieta, para ajudar a corrigir este desequilíbrio excessivamente ácido. Entre elas estão a ingestão de enzimas em forma de suplemento, cálcio orgânico e suplemento de
magnésio, minerais coloidais, vitamina A e D, e beber sucos de vegetais alcalinos (cenoura, salsão e beterrada) e uma bebida de limão/xarope de bordo (maple syrup).

Podemos remediar nossos corpos com excesso de acidez em curto prazo com suplementos alcalinizantes, mas além disso, devemos também escolher uma dieta que esteja equilibrada do lado dos alimentos alcalinizantes. Felizmente a maioria destes também tem um indice glicêmico baixo, cuidando do segundo fator essencial na criação de uma dieta saudável. Garanta um nível de Omega 3 
adequado com peixes oleosos na sua dieta, outro fator essencial, e então poderemos ter certeza de que teremos vidas longas e saudáveis.

Se você quiser saber mais a respeito de mudanças em sua dieta para conseguir um máximo de energia, confira o livro de Dr. Robert O. Young, "The pH Miracle". Ele contém infomação a respeito de como as doenças se manifestam, como desentoxicar-se e manter uma saúde equilibrada, juntamente com informações sobre dieta e receitas."

quarta-feira, 19 de outubro de 2016

Nutrition and Renal Disease





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Nutrition and Renal Disease

The kidneys’ job is to keep the body’s fluids, electrolytes, and organic solutes in a healthy balance. Their functional units are the million or so nephrons in the renal cortex which filter most constituents of the blood other than red blood cells and protein, reabsorb needed substances, secrete hydrogen ions to maintain acid-base balance, and secrete wastes.1
renal-disease-treatment
Urine formation consists of three basic processes: glomerular filtration, tubular secretion, and tubular reabsorption. Several disease conditions can interfere with these functions. Inflammatory and degenerative diseases can involve the small blood vessels and membranes in the nephrons. Urinary tract infections and kidney stones can interfere with normal drainage, causing further infection and tissue damage. Circulatory disorders, such as hypertension, can damage the small renal arteries. Other diseases, such as diabetes, gout, and urinary tract abnormalities can lead to impaired function, infection, or obstruction. Toxic agents such as insecticides, solvents, and certain drugs may also harm renal tissue.

Nephrotic Syndrome

In nephrotic syndrome, an injury to the glomerular basement membrane causes an increased glomerular permeability, resulting in the loss of albumin and other plasma proteins in the urine. Urinary protein losses greater than 3-3.5 grams per day usually indicate nephrotic syndrome.
Although albumin synthesis in the liver is increased in nephrotic syndrome, it is not enough to compensate for losses in the urine. The loss of albumin leads to edema.
Low albumin levels also trigger cholesterol and lipoprotein synthesis in the liver, resulting in hyperlipidemia. At the same time, hepatic catabolism of serum lipoproteins is reduced and urinary excretion of HDL is increased. These lipid abnormalities can be exacerbated by medications often used to treat nephrotic syndrome, such as steroids, diuretics, and anti-hypertensive agents.
renal-disease-diet

Diet for Nephrotic Syndrome

A well-planned diet can replace lost protein and ensure efficient utilization of ingested proteins through provision of adequate calories. Dietary changes can also help control hypertension, edema, and hyperlipidemia, and slow the progression of renal disease.
Protein: High-protein diets are not recommended as they may encourage damage to the nephrons, leading to a progression of renal insufficiency. Since albumin losses in nephrotic patients are due to increased catabolism, rather than a reduction in protein synthesis, low-protein diets, which decrease catabolism, may be more beneficial.2
The optimal amount of dietary protein necessary to prevent protein catabolism and progression of renal disease has not been established. A common recommendation is 0.6 grams of protein per kilogram of ideal body weight, adjusted depending on the glomerular filtration rate and nutritional status, plus gram-for-gram replacement of urinary protein losses.
A vegetarian diet, often used for lipid-lowering, also offers a convenient way to provide adequate, but not excessive, protein. In a 1992 study, a group of 20 nephrotic syndrome patients were put on a vegetarian diet for eight weeks. Protein intake averaged 0.7 grams per kilogram per day, which was more appropriate to their needs than the 1.15 grams per kilogram provided in their usual diet.3
Sodium and Fluid: A limit on sodium of 1-3 grams per day is usually recommended to control edema and hypertension. Diuretics may also be used. A fluid restriction is not warranted unless renal failure occurs.
Lipids: A diet low in saturated fat and cholesterol, combined with loss of excess weight, is recommended to reduce the risk of cardiovascular disease. Many clinicians recommend limiting cholesterol to less than 300 milligrams per day and fat intake to 30 percent of calories. However, research has shown that such recommendations lead to only minimal lipid lowering. As noted in detail in Section 1, low-fat vegetarian diets are much more effective for lipid control and usually lead to the reversal of atherosclerotic disease. Cholesterol-lowering drugs can be used adjunctively if needed.
An eight-week trial in 13 men and 7 women with hyperlipidemia and nephrotic syndrome showed that a vegetarian diet significantly reduced cholesterol, triglycerides, and phosphorus.3
Energy: Calorie intake should be adequate to achieve and maintain ideal body weight and maintain protein stores. Foods rich in complex carbohydrates should provide the majority of calories.
Supplements: Patients with nephrotic syndrome are often low in B vitamins and zinc, and can benefit from supplements. In addition, since a significant portion of serum calcium is protein-bound, it tends to be low when serum proteins are reduced. No modification is routinely needed for potassium, but potassium losses due to secondary hyperaldosteronism may require replacement.4
The following clinical values should be monitored:4
  • Serum albumin and total protein
  • Urinary protein
  • Glomerular filtration rate
  • Dietary protein, fat, and cholesterol
  • Daily weights
  • Serum lipids

Acute Renal Failure

Acute renal failure, manifested by oliguria or anuria, usually occurs suddenly and is often reversible. It is marked by a reduction in the glomerular filtration rate and a modification in the kidneys ability to excrete metabolic wastes.
Its causes can be prerenal, intrinsic, and postrenal. Prerenal causes include severe dehydration and circulatory collapse. Causes intrinsic to the kidney include acute tubular necrosis, nephrotoxicity, vascular disorders, and acute glomerulonephritis. Obstructive (postrenal) causes include benign prostatic hypertrophy and bladder or prostate cancer.1
The most common form of intrinsic renal disease is acute tubular necrosis, accounting for about 75 percent of cases. Acute tubular necrosis may be due to posttraumatic or surgical shock or to the toxic effects of drugs, metals, or organic compounds.
Nutrition strategies in acute tubular necrosis vary depending on its stage. During phase one, oliguria, less than 400 milliliters of urine is produced per day. This phase usually lasts one to three weeks. Signs and symptoms include nausea, vomiting, fluid overload, and elevation of BUN, creatinine, phosphorus, and potassium levels. Dialysis may be needed during this stage to reduce acidosis, control hyperkalemia, and correct uremia.
The diuretic phase of acute tubular necrosis lasts one to two weeks, and is characterized by increased urine output and a return of the ability to eliminate wastes. Fluid and electrolyte balance should be monitored and replacements made as necessary. The convalescent phase occurs over the next two to six months.1,2

Diet in Acute Renal Failure

Diet plays a critical role in the care of patients with acute renal failure. Clinicians should plan diets with an eye toward the possibility of uremia, metabolic acidosis, fluid and electrolyte imbalances, infection, and tissue destruction. Nutritional support of dialysis will be discussed below in the section on chronic renal failure.
Protein: A low-protein diet (0.5-0.6 grams per kilogram) is recommended initially. Protein may be increased in the diet as the glomerular filtration rate increases to normal. If dialysis is initiated, the protein level may be increased to 1.0-1.5 grams per kilogram per day if necessary to compensate for protein losses in the dialysate.
Calories: Calorie needs are generally elevated (35-50 kilocalories per kilogram) in order to provide positive nitrogen balance under stressful conditions. As protein is usually quite restricted, calorie needs may be met by providing greater amounts of carbohydrate and fat in the diet.
Sodium and Fluid: Sodium is restricted depending on urinary excretion, edema, serum sodium levels, and dialysis needs. During the oliguric phase, sodium may be restricted to 500-1000 milligrams per day, and fluid requirements are based on replacing losses via urine, vomitus, and diarrhea, plus approximately 500 milliliters per day.
Potassium: Potassium requirements vary depending on hemodynamic status and the degree of hypermetabolism due to stress, infection, or fever. High potassium levels are treated by dialysis or with kayexalate, an exchange resin which substitutes sodium for potassium in the gastrointestinal tract. During the oliguric phase, potassium may be restricted to 1,000 milligrams per day.3

Chronic Renal Failure

Approximately 90 percent of cases of end-stage renal disease are attributable to diabetes mellitus, glomerulonephritis, or hypertension. Kidney failure results in fluid and electrolyte imbalances, the build up of nitrogenous wastes, and reduced ability to produce renal hormones. The two treatment options are transplantation or dialysis.1
Mild renal insufficiency is defined as 40-80 percent of renal function. Moderate insufficiency is defined as 15-40 percent, and severe renal insufficiency is below these figures.2

Diet in Chronic Renal Failure

Low-protein diets may slow the progression of mild and moderate renal insufficiency. Therapeutic diets using plant sources of protein are more effective in delaying the progression of renal insufficiency, compared to those using animal proteins.5
Vegan (pure vegetarian) diets have been shown to provide adequate protein. A study of 22 patients with mild renal failure compared a vegan diet to a conventional low-protein diet. All patients were followed for at least six months. There was no sign of protein insufficiency and inorganic phosphorus levels remained normal.6

Dialysis Patients

Dialysis changes dietary needs. Patients undergoing typical hemodialysis, involving about three treatments per week, follow diets that are restricted in protein, sodium, potassium, phosphorus, and fluid. Patients on continuous ambulatory peritoneal dialysis, involving several dialysate exchanges per day, can be more liberal in protein, sodium, potassium, and fluid intake.
Sodium: Sodium intake must be modified to prevent hypertension, congestive heart failure, and pulmonary edema. Limiting intake will help avoid thirst and maintain acceptable fluid balance. Restrictions range from 1,000-3,000 milligrams per day with hemodialysis and 2,000-4,000 milligrams per day for peritoneal dialysis. Major salt sources are described below.
Fluid: Fluid consumption should be controlled to avoid congestive heart failure, pulmonary edema, hypertension, and swelling of the legs and feet. Fluid allowances are 1,000-1,5000 milliliters per day and are based on urine output and type of dialysis.
Protein: Protein requirements range from 1.1-1.5 grams per kilogram, depending on the type of dialysis used and the patient’s nutritional status. It is important to ensure sufficient protein to maintain visceral protein stores, but to avoid excesses that could lead the accumulation of nitrogenous waste products in the blood (uremia).
Phosphorus: Kidney failure causes high levels of phosphorus to build up in the blood and disrupts calcium/phosphorus balance. Elevated phosphorus levels can lead to metastatic calcification (soft tissue calcification), secondary hyperparathyroidism, and renal osteodystrophy. Recommended intakes usually range from 800-1,000 milligrams per day with hemodialysis and less than 1,200 milligrams per day with periotoneal dialysis.
Potassium: Potassium restrictions depend on serum potassium levels, the type of dialysis, medications, and residual renal function. Patients on hemodialysis are usually restricted to 2,000-3,000 milligrams per day to prevent hyperkalemia between treatments. Patients on peritoneal dialysis may follow a more liberal dietary potassium intake, as potassium is lost in the dialysate solution during daily exchanges.

Kidney Stones

About 12 percent of Americans develop a kidney stone at some point in their lives. Stones usually result from the crystallization of calcium (which originally came in foods or supplements) and oxalate, a part of many plant foods. Some people have a tendency to lose excessive amounts of calcium or oxalate through their kidneys, and they have a greater likelihood of a stone.7-10 Kidney stones can also form from uric acid, which is a breakdown product of protein, or from struvite (ammoniomagnesium phosphate) or cystine.
The prevalence of kidney stones is three times higher in men than women, and is higher among Caucasians than Asians or African Americans, for reasons that are not clear. They are especially likely to strike between the ages of 40 and 60.
Nutritional steps are important in preventing stones and can also help prevent recurrences, which is important given that 30-50 percent of people diagnosed with a renal stone have a recurrence within five years.
Preventing stones is like keeping a salt crystal from forming in a glass of salty water. You can either reduce the concentration of salt or add more water. Epidemiologic studies have shown that certain parts of the diet help reduce the amount of calcium that filters into the urine. It is a simple matter to put these factors to work clinically.

WHAT’S IN A STONE? 7
Calcium oxalate 72%
Uric acid 23%
Ammoniomagnesium phosphate (struvite) 5%
Cystine <1%


Protective Foods

Certain parts of the diet clearly help reduce the risk. The first is no surprise.
Water. Water dilutes the urine and keeps calcium, oxalates, and uric acid in solution. In research studies, those subjects whose total fluid intake (from all sources) over 24 hours was roughly 2.5 liters, the risk of a stone was about one-third less than that of subjects drinking only half that much.7 (They do not need to drink 2.5 liters of water per day; rather this is the total fluid consumption, including juices, soups, etc.) Patients need to understand that their thirst sense can lag behind their hydration status, and they may need to develop a routine for extra water consumption.
High-Potassium Foods. A study of 46,000 men conducted by Harvard University researchers found that a high potassium intake can cut the risk of kidney stones in half. Potassium helps the kidneys retain calcium, rather than sending it out into the urine. Potassium supplements are not generally necessary. Rather, a diet including regular servings of fruits, vegetables, and beans supplies plenty of potassium.
Calcium. Although most stones contain calcium, the calcium in foods does not necessarily contribute to stones. Calcium supplements taken between meals may increase the risk of stones, because about 8 percent of any extra dietary calcium passes into the urine.9,11 On the other hand, calcium consumed with meals has the opposite effect, reducing the risk of stones. The reason, apparently, is that calcium binds to oxalates in foods and holds them in the digestive tract, rather than allowing them to be absorbed.
Caffeine. Caffeinated beverages reduce the risk of stones. Caffeine’s diuretic effect causes the loss of both water and calcium, but the water loss is apparently the predominant effect. Similarly, alcoholic beverages are associated with a reduced risk of kidney stones, again presumably due to a diuretic effect. This is not a compelling reason to drink either coffee or alcohol, but their diuretic actions do present this advantage.

Problem Foods

Animal Protein. Animal proteins cause calcium to be leached from the bones and excreted in the urine where it can form stones. Diets rich in animal proteins also increase uric acid excretion. In a controlled research study, published in the American Journal of Clinical Nutrition, research subjects on a diet eliminating animal protein had less than half the calcium loss that they had on their baseline diet.12
The Harvard study mentioned earlier found that even a modest increase in animal protein, from less than 50 grams to 77 grams per day, was associated with a 33 percent increased risk of stones in men.7 The same is true for women. The Nurses’ Health Study, a long-term study of health factors in a large group of women, revealed an even greater risk of stones from animal protein than was found in previous studies in men.9
The association between animal proteins and stones probably relates both to the amount of protein they contain and to their content of the sulfur-containing amino acids. In particular, the sulfur in cystine and methionine is converted to sulfate, which tends to acidify the blood. As a part of the process of neutralizing this acid, bone is dissolved, and bone calcium ends up in the urine. Meats and eggs contain two to five times more of these sulfur-containing amino acids than are found in grains and beans.11,13
Between 1958 and the late 1960s, there was a sharp increase in the incidence of kidney stones in Great Britain. During that period, there was no substantial change in the amount of calcium or oxalate-containing foods consumed. However, the consumption of vegetables decreased, and the use of poultry, fish, and red meat increased. Statistical analyses showed a strong relationship between the incidence of stones and animal protein consumption.14
Sodium. Sodium increases the passage of calcium through the kidney and increases the risk of stones.9 When people cut their salt (sodium chloride) intake in half, they reduce their daily need for calcium by about 160 milligrams.15
Plants of any kind—grains, vegetables, legumes, and fruits—contain almost no sodium at all unless it is added during canning or other processing. Dairy products and meats contain more salt than plant products, and table salt, frozen meals, and canned and snack foods are the highest-sodium food products. For more information, see the sodium/potassium chart in Section 5.
Sugar. Sugar accelerates calcium losses through the kidney.16 In the Nurses’ Health Study, those who consumed, on average, 60 grams or more of sugar (sucrose) per day had a 50 percent higher risk of stones than those who consumed only about 20 grams.9

SUGAR IN COMMON FOODS (grams)
Candy bar (2 ounces) 22-35
Cookies (3)
11-14
Corn flakes (1 cup, 28 grams) 2
Frosted corn flakes (1 cup, 41 grams) 17
Crackers (5) 1
Fruit cocktail (1/2 cup, 124 grams) 14
Grape jam (1 tablespoon) 13
Ice cream (1/2 cup, 106 grams) 21
Soda (12 ounces)
40
White bread (2 slices) 1
Source: package information
Climate. Kidney stones are also more common in warm climates, presumably because perspiration leads to dehydration and a more concentrated urine, and because sunlight increases the production of vitamin D in the skin which, in turn, increases calcium absorption from the digestive tract.17
Surprisingly, oxalate-rich foods, such as chocolate, nuts, tea, and spinach, are not associated with a higher risk of renal stones,7 nor is vitamin C, even though it can be converted to oxalate. A large study of men taking vitamin C supplements found that they had no more kidney stones than men who do not take them.8

Helping Patients Avoid Kidney Stones

Here are simple steps to help your patients avoid kidney stones.
  1. Encourage patients to drink plenty of water or other fluids, staying ahead of their thirst.
  2. Diets including generous amounts of vegetables, fruits, and beans are rich in potassium and very low in sodium.
  3. If you prescribe calcium supplements, encourage patients to take them with meals, rather than between meals.
  4. Encourage patients to avoid animal products. Their proteins and sodium content increase the risk of stones.
  5. Patients should keep salt and sugar use modest.

Cranberry Juice: An Old Remedy Is Clinically Tested

Cranberry juice has long been used as a folk remedy for urinary infections. A 1994 report in the Journal of the American Medical Association showed that it does indeed have at least a preventive effect. In a test involving 153 elderly women in Boston, half the subjects drank 300 milliliters (about one and one-quarter cups) of cranberry juice cocktail each day, using the same bottled beverage that is commonly sold in grocery stores.18 The other subjects consumed a drink that looked and tasted like cranberry juice, but had no real juice in it.
Over the next six months, urine samples were collected and tested for signs of bacteria. The women consuming cranberry juice had only 42 percent as many urinary infections as the control group. The number of cases that had to be treated by antibiotics was also only about half, which is a real advantage, since antibiotics can sometimes lead to yeast infections and other problems. It takes about four to eight weeks for the preventive effect to be seen.
The explanation for the effect of cranberry juice is probably not an acidification of the urine, because the placebo drink also reduced urinary pH. Rather, cranberries contain a substance that stops bacteria from being able to attach to cells, and this is probably true whether the cranberry juice reaches the bacteria in the digestive tract or the urinary tract. Substances that interfere with bacterial adhesion have also been found in blueberry juice, but not in orange, grapefruit, pineapple, mango, or guava juice.
References
1. Mahan LK, Arlin M. Krause’s Food, Nutrition, and Diet Therapy. W.B. Saunders, Philadelphia, 1992.
2. The American Dietetic Association. Handbook of Clinical Dietetics, second edition. Yale University Press, 1992.
3. D’Amico G, Gentile MG, Manna G, et al. Effect of vegetarian soy diet on hyperlipidemia in nephrotic syndrome. Lancet. 1992;339:1131-1134.
4. The American Dietetic Association. Manual of Clinical Dietetics, fifth edition. American Dietetic Association, Chicago, 1996.
5. Gretz N, Meisinger M, Strauch M. Does a low protein diet really slow down the rate of progression of chronic renal failure? Blood Purif. 1989;7:33:33-38.
6. Barsotti G, Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S. A low-nitrogen, low-phosphorus vegan diet for patients with chronic renal failure. Nephron. 1996;74:390-394.
7. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med. 1993;328:833-838.
8. Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ. Prospective study of beverage use and the risk of kidney stones. Am J Epidemiol. 1996;143:240-247.
9. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Int Med. 1997;126:497-504.
10. Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. Demographic and geographic variability of kidney stones in the United States. Kidney Int. 1994;46:893-899.
11. Lemann J. Composition of the diet and calcium kidney stones. N Engl J Med. 1993;328:880-882.
12. Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr. 1994;59:1356-1361.
13. Breslau NA, Brinkley L, Hill KD, Pak CYC. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol. 1988;66:140-146.
14. Robertson WG, Peacock M, Hodgkinson A. Dietary changes and the incidence of urinary calculi in the U.K. between 1958 and 1976. J Chron Dis. 1979;32:469-476.
15. Nordin BEC, Need AG, Morris HA, Horowitz M. The nature and significance of the relationship between urinary sodium and urinary calcium in women. J Nutr. 1993;123:1615-1622.
16. Lemann J Jr, Adams ND, Gray RW. Urinary calcium excretion in human beings. N Engl J Med. 1979;301:535-541.
17. Soucie JM, Coates RJ, McClellan W, Austin H, Thun MJ. Relation between geographic variability in kidney stones prevalence and risk factors for stones. Am J Epidemiol. 1996;143:487-495.
18. Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271:751-754.




Foodservice Update

Healthy Tips and Recipes for Institutions from The Vegetarian Resource Group

Menu Selection for Vegan Renal Patients

A proper renal diet is extremely important for patients with chronic kidney failure. Many health care professionals have shown that a carefully planned vegetarian diet is adequate in managing chronic kidney failure.
It is vital that a renal patient's food and fluid intake be overseen by a nephrologist and a registered dietitian familiar with vegan diets. These professionals can help manage kidney disease with appropriate vegan food and fluid choices. The information in this article is not designed to replace consultation with medical doctors and registered dietitians. This article provides general guidelines and information about vegan diets that can be used in menu planning for people with chronic kidney disease, stage 2 or 3, in conjunction with consultation with health care professionals who treat people with kidney disease.
In kidney disease, nutrition management focuses on decreasing waste products built up from digested foods. The goals for planning a vegan renal diet, as for any other renal diet, are to:
  • Obtain the appropriate amount of protein to meet protein needs while minimizing waste products in the blood
  • Maintain sodium, potassium, and phosphorus balance
  • Avoid excessive fluid intake to prevent overload
  • Ensure adequate nutrition
The information provided in this article is meant as a very general guideline for patients that have at least 40-50 percent normal kidney function (chronic kidney disease, stage 2 or 3) and who are not currently receiving dialysis. For patients with lower kidney function or who are receiving dialysis, very individual diet planning must be done. All renal patients need to be closely monitored, with regular blood and urine testing.

Vegan Protein

Renal patients need to limit the amount of protein in their daily diets. For this reason, the protein in the diet needs to be high-quality protein. Very generally, depending on individual ability and needs, 0.8 gram of protein per kilogram of body weight is recommended per day. This translates to approximately 2 ounces of pure protein per day for a 140-pound person.
High-quality vegan protein for renal patients includes tofu, peanut butter (no more than two Tablespoons

Vegan Foods That Provide Approximately
7 Grams of Protein Per Serving

Protein Source Serving Size
Seitan (wheat gluten)
Beans, dried/cooked
Tofu, firm
Tofu, regular
Tempeh
Nut Butters
1 oz.
½ cup
1/3 cup
⅔ cup
¼ cup
2 Tablespoons

per day), tempeh, and beans. Soy meats, such as textured vegetable protein (TVP) or vegan ground round, are high in quality protein but are also high in sodium, phosphorous, and potassium, which need to be limited. Soy protein has been found to assist in minimizing some complications from kidney disease. Patients should have at least one serving of soy a day, such as soymilk, tofu, or tempeh. Again, it is a balancing act for renal menus - a small amount of soy each day may be beneficial, but too much can be harmful.
Here are some tips for including soy products on your vegan renal menu:
  • Mash a few Tablespoons of regular tofu with croutons and seasonings to 'extend' the tofu and decrease the amount of protein served.
  • Add small chunks of regular tofu-rather than animal protein-to soups, stews, and stir-fries.
  • Use silken tofu instead of vegan mayonnaise in salad dressings, sandwich fillings, and sauces.
  • Crumble up regular tofu, add a spicy seasoning (without salt), and quickly sauté to top rice or pasta, or use as a filling for a taco or burrito or to top a pizza crust.
Beans and nuts are good sources of high-quality protein. However, they can be high in phosphorus and potassium, so the amounts served need to be carefully calculated. Try to use dried beans or beans frozen without salt. Canned beans, even lower sodium beans, are usually high in sodium. A way to balance potassium intake is to include needed protein (which may be high in potassium) and then to select fruits and vegetables that are lower in potassium.

Sodium

Some vegetarian foods can be very high in sodium. Here are suggestions for avoiding excess sodium on the menu:
  • Avoid using ready-to-eat foods, such as frozen meals, canned soup, dried soups, or packaged vegetable broths.
  • Use miso very sparingly.
  • Use lower-sodium soy sauces very sparingly, as there is still a lot of sodium in these soy sauces.
  • Limit soy- and rice-based cheeses.
  • Amino acid preparations, such as Bragg's Liquid Aminos, can be very concentrated in protein, potassium, and phosphorus; if the patient wants to include these types of products, they will need to be calculated into the daily intake.
  • Read the labels for vegan meats (such foods as tofu hot dogs and veggie burgers) or other canned or frozen soy products.
  • Read the labels for seasoning mixtures to avoid excess sodium.

Potassium

Potassium may not need to be strictly restricted unless the function of the kidney decreases to less than 20 percent. Routine blood testing is the best way to know a patient's potassium requirements. Approximately two-thirds of dietary potassium comes from fruits, vegetables, and juices. The easiest way to limit potassium would be to limit fruit and vegetable selections based on the level of potassium in the patient's blood.

Higher Potassium Foods

Textured vegetable protein (TVP)
Soy flour
Nuts and Seeds
Cooked dried beans or lentils
Cooked dried soybeans
Tomato products (sauce, pureé)
Potatoes
Raisins
Oranges, bananas, cantaloupe, or honeydew melon
¼ cup
2 Tbsp
¼ cup
1/3 cup
1 cup
¼ cup
½ cup
¼ cup
½ cup

A common limitation is five servings of fruits and vegetables per day. A potassium serving size is generally:
  • 1/2 cup fresh fruit, canned fruit, or juice
  • 1 cup fresh vegetables
  • ½ cup cooked vegetables
If a patient would like several servings of protein, alternative protein selections may be needed to keep potassium levels from going too high. This will mean using more tofu and seitan, rather than beans or textured vegetable protein (TVP), at every meal. Blackstrap molasses, spinach, Swiss chard, beet greens, and prunes are very high in potassium and may need to be limited or avoided.

Phosphorus

Depending on the extent of an individua's kidney disease, phosphorus may need to be restricted. Foods high in phosphorus include bran cereals, wheat germ, whole grains, dried beans and peas, colas, beer, cocoa, and chocolate drinks. For more information about high phosphorus foods, see www.kidney.org/atoz/ atozitem.cfm?id=101. Dried beans and peas and whole grains are high in phosphorus, but because of their high phytate content, they may not cause phosphorus in the blood to be elevated as much as would be expected. Individual monitoring by the health care provider is necessary to determine the appropriate level of dietary phosphorus.

Adequate Nutrition

A vegan diet can be lower in calories and higher in fiber than an animal-based diet. This is great news for healthy patients. However, for vegan renal patients, we need to ensure that there is no weight loss or loss in nutritional status. Here are some tips for adding more calories to a vegan renal diet:
  • Make shakes with soymilk, tofu, rice milk, and non-dairy frozen dessert. Some patients, especially those with very limited kidney function, may need to use unfortified soymilk or rice milk and unfortified soy yogurt.
  • Use more oils, such as olive oil in cooking. Drizzle flaxseed oil on food after it is cooked, or mix with salad dressing and serve over lettuce.
  • Provide frequent small meals if patients feel full very quickly.
  • Even though sugar is not the best selection in a diet, for a renal patient who needs extra calories, sorbet, vegan hard candy, and jellies may be added.

Additional Ideas When Planning Vegan Renal Menus

  • Avoid using salt or salt substitutes. Use herb mixtures, such as Mrs. Dash, or mixtures you create yourself with fresh or dried herbs.
  • If you need to use canned broths, purchase the lowest-sodium version possible.
  • Use fresh or frozen (without salt) fruits or vegetables when possible.
  • Lower potassium fruits and veggies include wax beans, green beans, kiwi, watermelon, onions, head lettuce and Romaine lettuce, bell peppers, pears, and raspberries.
  • Lower phosphorus foods include sorbet, unsalted popcorn, white bread and white rice, hot and cold rice cereals, pasta, cold corn-based cereal (such as Corn Flakes and Corn Chex), Cream of Wheat hot cereal, and grits.

Sample Menu to Get You Started

Breakfast
  • Cream of Wheat or cream of rice cereal with a small serving of fresh or thawed frozen peaches and cinnamon
  • White toast with a choice of two fruit jellies
  • Pear cocktail
Mid-Morning Snack
  • Popcorn tossed with a very small amount of nutritional yeast
  • Sparkling water with lemon and lime
  • Raspberry popsicle
Lunch
  • Angel hair pasta topped with chopped mushrooms, broccoli, and nutritional yeast
  • Tossed green salad with chopped bell peppers (red, yellow, and green for color) and silken tofu salad dressing
  • Garlic bread made with fresh chopped garlic and olive oil
  • Sorbet served with cookies
Mid-Afternoon Snack
  • 1 small tofu taco on flour tortilla
  • Sparkling water with a kiwi slice
Dinner
  • Stir-fried seitan or tempeh tossed with onions and cauliflower, served on a bed of herbed rice
  • Onion dinner roll served with nonhydrogenated vegan margarine
  • Chilled watermelon slices
Evening Snack
  • Small soymilk shake

Icy Smoothie

(Serves 4)
  • 2 cups soft silken tofu
  • 3 cups ice
  • 2 Tablespoons coffee powder or green tea powder
  • 2 teaspoons vanilla extract
  • 2 Tablespoons rice syrup
Place all ingredients in a blender and process until smooth and thick. Serve immediately.
Total calories per serving: 109 Fat: 3 grams
Carbohydrates: 13 grams Protein: 6 grams
Sodium: 24 milligrams Fiber: <1 gram
Potassium: 255 milligrams Phosphorus: 75 mg

Hot Spiced Cereal

(Makes approximately 1 quart or four 1-cup servings)
  • 4 cups water
  • 2 cups cream of rice or other hot rice
  • cereal, grits, or Cream of Wheat
  • 1 teaspoon vanilla extract
  • ¼ cup maple syrup
  • 1 teaspoon powdered ginger
Bring water to a boil in a medium pot. Whisk in cereal and lower heat. Continue to stir until mixture is smooth. Reduce to a simmer. Stir in remaining ingredients. Allow to cook, stirring, until desired texture is attained.
Total calories per serving: 376 Fat: <1 gram
Carbohydrates: 85 grams Protein: 5 grams
Sodium: 7 milligrams Fiber: <1 gram
Potassium: 166 milligrams Phosphorus: 108 mg

Lemon Hummus

(Makes approximately 1 pint)
This spread is higher in phosphorus and potassium than other spreads, but it is a good source of protein.
  • 2 cups cooked garbanzo beans
  • 1/3 cup tahini
  • ¼ cup lemon juice
  • 2 minced garlic cloves
  • 1 Tablespoon olive oil
  • ½ teaspoon paprika
  • 1 teaspoon parsley flakes
Place garbanzo beans, tahini, lemon juice, and garlic in a blender or food processor. Blend until smooth. Transfer mixture to a serving bowl. Drizzle olive oil over the mixture. Sprinkle with paprika and parsley. Serve with pita triangles or unsalted crackers.
Total calories per serving: 72 Fat: 4 grams
Carbohydrates: 7 grams Protein: 3 grams
Sodium: 4 milligrams Fiber: 2 grams
Potassium: 88 milligrams Phosphorus: 75 mg

Corn and Cilantro Salsa

(Serves 6-8)
This is an unusual twist on the usual salsa recipe.
  • 3 cups fresh white or yellow corn cut from the cob
  • ½ cup chopped cilantro
  • 1 cup chopped sweet onions (such as Vidalia or Maui)
  • ½ cup chopped fresh tomato
  • 4 Tablespoons lemon or lime juice
  • ¼ teaspoon dried oregano
  • 2 teaspoons chili powder or red pepper flakes
Place corn in a medium-sized bowl. Add remaining ingredients and mix well. Cover and refrigerate for at least one hour prior to serving.
Total calories per serving: 89 Fat: 1 gram
Carbohydrates: 21 grams Protein: 3 grams
Sodium: 9 milligrams Fiber: 3 grams
Potassium: 270 milligrams Phosphorus: 72 mg

Mushroom Pockets

(Serves 6)
Here's a tasty vegetarian version of soft tacos.
  • 2 Tablespoons water
  • 2 Tablespoons lemon or lime juice
  • 1 Tablespoon vegetable oil
  • 2 minced garlic cloves
  • 1 teaspoon ground cumin
  • 1 teaspoon crushed dried oregano
  • 3 cups thinly sliced fresh mushrooms, such as portobello caps, white button, or brown crimini
  • 1 cup thinly sliced bell pepper
  • ½ cup chopped scallions (white parts only)
  • 3 Tablespoons shredded vegan soy cheese
  • Six 7-inch flour tortillas
In a large bowl, mix water, juice, oil, garlic, cumin, and oregano. Add mushrooms, peppers, and scallions. Stir to coat. Allow to marinate for at least 30 minutes. If desired, this can be done the day before.
Heat a large saut&3acute; pan. Sauté vegetable mixture with marinade until the peppers and scallions are soft, approximately 5-7 minutes. Allow to continue cooking until most of the liquid has evaporated.
While veggies are cooking, wrap tortillas in a paper towel and heat in a microwave, or wrap in foil and heat in a 350-degree oven.
Place each tortilla on a plate. Spoon on vegetable mixture and top with cheese.
Total calories per serving: 147 Fat: 5 grams
Carbohydrates: 23 grams Protein: 4 grams
Sodium: 262 milligrams Fiber: 1 gram
Potassium: 267 milligrams Phosphorus: 64 mg

Fruit Cobbler

(Serves 8)
  • 3 Tablespoons melted nonhydrogenated vegan margarine
  • 1 cup all-purpose unbleached flour
  • ¼ teaspoon salt
  • 1 teaspoon baking powder
  • ½ cup rice milk
  • 3½ cups pitted fresh cherries*
  • 1¾ cups white vegan sugar, divided
  • 1 Tablespoon cornstarch
  • 1 cup boiling water
Preheat oven to 350 degrees.
In a medium-sized bowl, combine margarine, flour, salt, baking powder, and rice milk and mix just to combine.
In a separate bowl, toss cherries with ¾ cup sugar and place cherries in the bottom of an 8-inch square pan. Place dough in small pieces over cherries to cover cherries in an even pattern.
In a small bowl, combine remaining sugar and cornstarch. Whisk in boiling water. Pour cornstarch mixture over the dough. Bake for 35-45 minutes or until bubbly. Serve warm or cold.
Note: You can use thawed frozen pitted cherries; peeled and cored fresh pears; or fresh or thawed frozen raspberries to replace a part of or all of the fresh cherries.
Total calories per serving: 315 Fat: 5 grams
Carbohydrates: 68 grams Protein: 2 grams
Sodium: 170 milligrams Fiber: 2 grams
Potassium: 159 milligrams Phosphorus: 87 mg