The Importance of Patient Education and Best Practices for Managing Renal Health Through Diet
In this podcast episode, Lisa Jones, MA, RDN, LDN, FAND, interviews Kimberly Snodgrass, RDN, LD, FAND, a renal care coordinator at Fresenius Medical Care, on the value of patient education in renal care, real life patient success outcomes where dietary changes improved renal health, what are some best practices for dietitians to follow and more. This episode is part four of a four-part series.
Listen to part one of this four-part series here.
Listen to part two of this four-part series here.
Listen to part three of this four-part series here.
TRANSCRIPTION:
Moderator: Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietician and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.
Lisa Jones, MA, RDN, LDN, FAND: All right, well, we are back again for another segment talking about patient perspectives, real stories of managing renal health through diet. And we are honored again to have Kimberly Snodgrass with us. Welcome again, Kimberly.
Kimberly Snodgrass, RDN, LD, FAND: Thank you so much for having me back. I really appreciate it.
Lisa Jones: Yeah, so we're glad to have you back. And our last episode, we talked about, a lot about beyond the basics, really advanced nutritional strategies for renal care. And I'm just curious, Kim, if you had to sum up that conversation in one or two sentences, what would you say was the key takeaway or takeaways if you wanted to say more than one thing?
Kimberly Snodgrass: Yeah, definitely that dieticians now are actually navigating technology a lot more. Because of COVID, we had to learn to work with the video conferencing, telehealth in order to get that nutritional information out to our patients. So learning how to use all types of digital platforms, and so we find ourselves moving into a space where we're not just dieticians, but we have to work with technology, as well. So I think dieticians made a wonderful transition in that, and it really helped the patients because we're actually touching base with them on non-dialysis days to follow up with them, to make sure they stay on track. And it also helps us to not just tailor the diet, but tailor our care to the patients.
Lisa Jones: Yes, and I love that. I love that too. Also, we talked a little bit about educational handouts and while they still have a place, they're also tailored and customized to that individual, so they feel like, okay, they're not just here taking up a seat. So there's something for everyone.
Kimberly Snodgrass: Absolutely. Everyone has a seat at the table and everyone has a space. You know what I mean?
Lisa Jones: They do. So true.
Kimberly Snodgrass: Yeah.
Lisa Jones: All right. Let's talk a little about, I want to hear more about real stories of managing renal health. So can you share, and I'm sure you have plenty, but can you share any patient success stories where dietary changes significantly improved renal health outcomes?
Kimberly Snodgrass: Yeah, so definitely. So I had this wonderful Latino gentleman, and he was consistently running high potassium and high phosphorus and couldn't get a handle on it. We had that language barrier, so we had to use the interpreter services to talk to him. So we called him in the conference room, I called interpreter services, come to find out he's having a multitude of beans. He's not soaking them. He's not taking his binders properly. So with that education, with the interpreter services, we were able to get a handle on his potassium and his phosphorus by just telling him to make sure he's soaking his beans overnight, pouring that water off, cooking them in fresh water. So that process is called leaching, so we can remove some potassium. And we ended up adding an extra binder for when he had those beans to help control his phosphorus. We didn't really want to take those beans away.
They're a big part of the Latino diet, but we wanted to make sure we controlled his potassium and his phosphorus. So with soaking them properly and taking that additional binder when he has the beans, we got the phosphorus and potassium under control, and that made him so happy. And it's just servicing your patient like that. You want to help them to be able to eat well and to be happy. Because I like to tell patients, say for instance, you have with him a difference between having a processed sandwich from a fast food place versus having those beans or peanut butter sandwich. In the fast food places, they're putting preservatives in those foods. We don't want those. But beans, if you're cooking those, that's healthier. You're cooking those at home and you're having that, and that made 'em happy that I didn't take it away. So just being able to better service that patient, I think, with the language barrier, and then also allowing him to keep a food that's part of his culture was very happy for him. So that's one of my major patient success stories.
Lisa Jones: Oh, that's amazing. Thank you for sharing that. And too, it kind of goes back to you were saying in another segment when we were talking about giving, not saying no to them saying yes, and here's another way you can do it, that you're still maintaining this diet, the diet restrictions that you currently have type of thing.
Kimberly Snodgrass: And when you think about beans or nuts, like phosphorus organically occurs in those foods. So your body only absorbs half of it versus phosphorus as a preservative in a fast food sandwich is inorganically recurrent, and your body absorbs a hundred percent of that. So it's healthier if eat those beans or that peanut butter sandwich, but we just have to make sure we're controlling it with binders and doing the proper things to keep the potassium and the phosphorus together. But we do the workaround so that you can have the better option and still enjoy your food because that's what we want. I mean, dieticians, sometimes we get a bad rep, "Oh, you're there to take all my pleasure away." Well, actually we're not. We're there to help you eat better and lead a healthier life. And so at the end of the day, our patients are healthy and happy that we're there.
Lisa Jones: Yes, we are not the food police. Thank you for saying that.
Kimberly Snodgrass: No, we are not.
Lisa Jones: All right. Well, great. What role do you say patient education plays in managing renal health through diet? And then what are some best practices for dieticians?
Kimberly Snodgrass: So some best practices for dieticians is to always make sure you're staying abreast of everything that's going on in the renal world. And we kind of spoke to this earlier about just being a part of a group, because when you're standing alone, you may not get all the information that you need, but being a part of a group, we can share resources, we can share success stories about patients, or if we have pressing questions that someone in our particular clinic can't answer, we can put that question out. Being a part of these renal practice groups, I get all types of questions that come through an email and say, "Hey, can someone help me manage a patient? For example, this is going on." None of the patient information is given, but they give us an example. How would you manage this? What type of binders would you use? What would you do with the patient that's holding onto a lot of fluid? How would you manage that? Just different scenarios and different things. And some of the things that people come up with, you're like, wow, I never thought about managing it this way, but that could work. So having that resource at your tips, using that technology to bring such a big world together on such a small platform, it helps a lot.
Lisa Jones: Yeah, it definitely does. Definitely does. Thank you for sharing those best practices with us.
Kimberly Snodgrass: Definitely.
Lisa Jones: Yeah. And then the other thing I kind of wanted to talk a little bit about, and you've already given us some resources, but more specifically focusing on the patients. What tools or resources have patients found most helpful in managing their renal diets?
Kimberly Snodgrass: So some of my patients have liked using the apps to track their food intake because some of those food apps, they help you look at your carb intake, especially if it's a diabetic that we're trying to control those blood sugars. Some of the fitness trackers or food apps help monitor their sodium intake because they're on a low sodium diet. So if they put in the food correctly, it can show us how many milligrams of sodium they're taking in. So that's good. It can help tell them how many milligrams of cholesterol they've had in a day where we track all that. And so when they sit down at the chair side and they can pull it up on their phone, we can say, "Okay, hey, you did a really good job here with your sodium. I see that you ate really good, but on this day you kind of went over and let's look at it more specifically about what you had during your snack time that puts you over." So I'm seeing that a lot of patients, at least mine, are starting to embrace technology with the food apps to better service them because they'll say, "Hey, Kim, I can't write down all this stuff on a diet diary." People lose paper, but people always have their phone, so it's easier to track.
Lisa Jones: Yeah, it's definitely easier to track, too. One of the questions I have as I was listening to what you were saying is what specific, I know there's so many different apps, and you probably have patients that come in and do you just let them, do you give them a list of apps they should be following, or if they already have one identifying just to try to help them navigate that?
Kimberly Snodgrass: Yeah, I usually just use whatever they're most comfortable with and just have them navigate with that, because I want them to feel comfortable with the ones that they use, one that I use, some people use and vice versa, but I can use multiple different types of applications when it comes to food trackers. And so I can sit down with them and say, for instance, I saw a patient was eating something that was very high in sodium, like say a type of pretzel. They were eating well, we found some no salt added pretzels. They taste just as good. And so it helped control their sodium so they can do that. And then they had their tuna with that, and they were happy. They were good to go. And they're like, "Oh, I didn't know pretzels had so much salt." Yeah, they do. So it was just able to sit there and pinpoint it and show them how many milligrams of sodium, and if we cut it here, then we'd be on track. And so I love when they take the time to track that, they show that their health is important to them. You can't put a price tag on your health. And then I'm showing that I care because I'm sitting down with them and I'm going through all their numbers, and I'm tailoring their diet specifically to what they like. I didn't take the pretzels away. I found a healthier version.
Lisa Jones: Yeah, I love that you do that. You're not walking in and saying, here's a list of stuff you can't help. Any questions?
Kimberly Snodgrass: Yeah. Yeah. No, I give them options.
Lisa Jones: Which I think is fantastic.
Kimberly Snodgrass: Yeah, you give them options. I mean, I know when my daughter was going to preschool instead of telling the kids no, they would tell them, make a better choice. And I just always thought that that was funny. I'm like, do the preschoolers really understand that? And they're like, yeah, everyone understands that. And I'm like, okay. And honestly, yeah, instead of telling the person, no, you just tell them, make a better choice. It sounds better. And if you can help them do that, they usually get on track. People usually don't like the word "no." So you can rephrase it and really show them that they can make a better choice. They usually go with that.
Lisa Jones: Yeah, I'm a big fan of the "Yes and." Even if they technically can't have it, that's what I like. To your point, you can say "Yes, and you can have it. Here's how we're going to make it work here." And then you give them that alternative.
Kimberly Snodgrass: Absolutely. And all my patients said, when I go see my patients, they smile because they know that Kim is going to figure out a way to work it into their diet. So I like that.
Lisa Jones: Yeah, so true. Well, thank you so much for answering all my questions and giving us such great information. Is there any final parting tips that you want to give to the dieticians out there to try to integrate things that you said into their practice?
Kimberly Snodgrass: Well, I just want to encourage them to keep doing the work. I know sometimes that people say working in dialysis can be redundant or they get burnt out, but just know that you make a big difference to those patients. Try to tailor the diet as much as you can so that patients don't have all their pleasure taken away from them because being on dialysis is hard enough. And then get with a group. A group of people that are like-minded who are in the same area that you're practicing in so that you don't feel alone and that you can bounce ideas off and gain resources. And so those are my parting words.
Lisa Jones: Thank you and such great advice. And I thank you again for being on our show and sharing your insights with us.
Kimberly Snodgrass: You're most welcome. I really enjoyed being with you.
Lisa Jones: Yeah, we enjoyed having you. And to our audience, thanks for listening, and please tune in again and share your comments and feedback on our site. Have a great day, and enjoy a healthier lifestyle with a 411 in mind.
Moderator: For more nutrition content, visit consultant360.com.