Navigating the Challenges of Dietary Management in Patients With Common Renal Conditions
In this podcast episode, Lisa Jones, MA, RDN, LDN, FAND, interviews Kimberly Snodgrass, a renal care coordinator at Fresenius Medical Care, on how dietitians can effectively address some common challenges in managing the diet of patients with renal conditions, such as teaching patients how to incorporate food they like to eat in a healthy way, and what the emerging trends are in renal nutrition and how dietitians can incorporate them in their care. This episode is part two of a three-part series.
Listen to part one of this four-part series here.
Listen to part three of this four-part series here.
Listen to part four 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, welcome back for another segment with Kimberly Snodgrass. Today, we are going to be talking about navigating challenges, the dietary management of common renal conditions. Welcome back, Kimberly.
Kimberly Snodgrass, RDN, LD, FAND: Thank you. I'm happy to be back with you.
Lisa Jones: Yeah. So last time we talked about the basics of renal nutrition. We're talking about understanding kidney health and diet. So what would you say during that episode, we talked about so much, but what is your main key takeaway from that topic that you want to share with our audience of dieticians?
Kimberly Snodgrass: Well, the dieticians are there to help the patient. We don't drive the patient's car. We let the patient take control. We are there to assist them in meeting their nutritional goals and to lead a healthier life. And the way I like to approach a patient is I say, "What is your goal? What can I help you get to? Is it going on a vacation with your family? Because we can help with that. The social worker can help with that. Is it weight loss? I can help with that. Is it a number of things? Is it help it better control your blood sugars?" I let them tell me what they want me to do, and I kind of just take it from there. I want them to feel empowered because I think starting dialysis, they feel like their power has been taken away. And so I want them to feel empowered about their life and their diet, and I just let them know I'm there to assist them. It usually goes really well if you approach the patient that way.
Lisa Jones: Yeah, I love that. I love that. The car analogy that you use.
Kimberly Snodgrass: Yeah, and it works. It works. It really does.
Lisa Jones: Yeah. It reminds me, I just had this flashback when we were talking about cars. There was this one dialysis patient that I've worked with in the past, and he had this really nice sports car, and he would come in and he'd be like, "oh, if you ever want me to take you for a spin in my Corvette, just let me know." He was like.
Kimberly Snodgrass: My goodness.
Lisa Jones: Yeah, I never went in the Corvette, but I'm just saying like cars. And he was his car and I made him happy. So we would talk about cars, but I would also relate it to your point, to nutrition. So it's an excellent, yeah, it's an excellent analogy.
Kimberly Snodgrass: It is. What color was the car? It was probably red.
Lisa Jones: What's that?
Kimberly Snodgrass: What color was the car? Was probably red, right?
Lisa Jones: Yeah, it was red. I mean, he said, I can't control that I'm on dialysis, but I can control what type of car I drive.
Kimberly Snodgrass: Right. Well, that's awesome.
Lisa Jones: That was something he always said. He was great.
Kimberly Snodgrass: Yeah.
Lisa Jones: So how about, let's talk a little bit about what are the primary dietary goals for managing (chronic kidney disease) CKD?
Kimberly Snodgrass: That's a really good question, and what I'd like to say are the primary dietary goals are managing your weight. So if you come in and you're very much overweight, we want to try to get you to a healthy weight. So the dietician in the renal center can actually help you get to your goal weight, a weight that you're healthy and happy with. So we work with a lot of patients on obtaining a healthy weight. So that's important because I at one time had to lose a lot of weight after I had my third daughter, I had to lose about 65 pounds, which is a lot. And so people saw me go through that challenge, and then when they saw me lose the weight, they asked for help more. I felt more empowered to help people lose weight. And I was more patient with people losing weight when I had to go through my journey as well.
And I think sometimes you have to walk through a person's shoes to really realize just how hard it is to follow a diet. We help them manage their diabetes because that's one of the main reasons why people are on hemodialysis is uncontrolled diabetes. So we have to help them manage their diabetes with their diet, teach them carb counting and things that not just good for their kidneys and their kidney disease process, but what's going to help them control their diabetes, too. So the diet is very specialized. And then we also have to work with them on the manage of blood pressure. So looking at that sodium, like we talked about in the first segment, we want to control their sodium intake. Too much sodium in their diet will make their body hold onto fluid. And then when they get on the machine, we got all this buildup of fluid when they're on the dialysis machine, they can cause cramping. And so we just don't want all of that. Managing weight, diabetes and blood pressure are I think my top three primary dietary goals. When looking at a CKD patient.
Lisa Jones: And that's no easy feat. It's a lot.
Kimberly Snodgrass: It is.
Lisa Jones: It's a lot to have to work through. So I can imagine that there's so many difficulties that dieticians must face in managing these goals with their patients. So with that in mind, how would you say these challenges can be effectively addressed?
Kimberly Snodgrass: Well, I feel like the patients see the dietician and assume that we're there to take all their pleasure away in terms of food. And we have to assure the patients that we're there to teach them how to incorporate what they like to eat, yet making it in an healthier away. For example, instead of having candied yams, which is one of the staples in the African-American diet, especially if it's for the holiday, we teach them how to make candied carrots because carrots are lower in potassium than yams. And so it tastes just as good, same color, but lower in potassium. So you don't take the pleasure away, you find a healthier option of what you like. I've made that before, and the patients love it, can barely tell the difference. Both parties are happy. There you go.
Lisa Jones: Oh, I love that healthier option of what you like. Because a lot of times, you're right, they'll say, "oh, there's nothing for me to eat." Especially the ones that I'm sure you have the patients that are the opposite end of the spectrum. They just stop eating everything because they're afraid to eat anything.
Kimberly Snodgrass: Absolutely. And that's the worst.
Lisa Jones: And then they're losing weight,
Kimberly Snodgrass: And that's not good.
Lisa Jones: No, but your option is really good. We can do something different that you like, but it's a healthier option, and then it fits within these guidelines of your goals. I like that.
Kimberly Snodgrass: Yeah. And it's good. So you just have to show them. I remember working at a larger hospital with kidney patients, and what we did was had a patient support group and the dieticians would do cooking demos. So we would take a recipe that a patient may like, make it healthier and then show them how to do it. So we had three different recipes a month and do those cooking demos. And the patients would love that. They will love, you're showing me how to take something I like and make it healthier. And so people are there to learn, I think. And if we can teach them and make it simple, it's just a win-win situation. And you got to think about it. So many things take place over food. The holidays you gather around the table, there's food. When you have parties, there's food, when there's celebrations, weddings, there's always food. You have to teach people how to make a better choice. You empower them by doing that. So when they know how to make a selection or make what they want in a healthier way, they feel empowered. And that's what we're there for.
Lisa Jones: Yes, empowering them. And also the reframe, I love what you're saying about you're not telling them no, you're telling them yes, and here's how we can make it taste just as good, but with different ingredients.
Kimberly Snodgrass: Absolutely. Absolutely. That's why dieticians are awesome!
Lisa Jones: We are awesome, right?
Kimberly Snodgrass: Yes, we are.
Lisa Jones: Now, what are the stance, you mentioned cooking demos. I know it was in the hospital setting. Are they able to do it in the unit now or is that still a no. I know back when I was doing it, they couldn't, but they weren't allowed.
Kimberly Snodgrass: We weren't doing it in the unit. What we would do there is an area in the hospital where it was conference rooms near the kitchen, and we would set up there. And so we would have chefs and some of the kitchen staff help us prep what we needed to do. And it was simple stuff, but it was fun stuff. We did stuff with the wok and we did healthier desserts, and then we did a healthier type of a drink. Instead of using orange juice, we would do something with a cranberry apple and put a little decoration on it with—what do you call those little umbrellas—and make it fun for them. This is how many ounces you should probably have because they're on a fluid restriction. And so just incorporating all that in. And so they got the smell of the food when they cook, they got to see the different colors, socialize, but like you said, it wasn't in the unit. But since our dialysis was in the hospital, we were at an advantage that we had that space.
Lisa Jones: Definitely. Because I think that's advantageous for them to be able to see it and that, I mean, now you can probably say here, you could probably direct them to a YouTube video or something, or maybe you do little videos and then they can just watch it. I think now that's kind of what we didn't have back then. So I think that's, yeah, there's probably lots of other ways to do it now versus, oh, we can't do a cooking demo. We come up with so many alternatives. So that's good.
Kimberly Snodgrass: Yeah, definitely.
Lisa Jones: So, what about if we want to talk a little bit about emerging trends, if you would say, what emerging trends in renal nutrition should dieticians now be aware of to optimize patient outcomes?
Kimberly Snodgrass: So this was an excellent question, and I really had to dig to find the answer, but one of the emerging trends you already kind of touched on with technology, and it's the mobile and digitally supported nutrition care, being able to virtually care for patients and using digital and mobile devices to better counsel patients in terms of nutrition. So when COVID happened and it happened, we had to find different ways of educating patients. So they use different HIPAA-approved platforms to be able to educate patients on nutrition. The telehealth took off. And so I think the mobile and digital space for nutrition care is one that is going to continue to grow because you're going to need to educate people in the rural population, people who just needs that additional education. If you can do it via telehealth or some HIPAA-approved platform, then that's what's going to take off. And I think that's where we are moving towards the emerging trend in renal nutrition because we have so many people with kidney disease, and so we need to educate them. And so we have to have technology on our side.
Lisa Jones: I think that's exciting for the future, too. I think the possibilities are endless of things that can happen.
Kimberly Snodgrass: Oh, yeah, definitely. And everyone has a cellphone or a tablet or a laptop, so being able to do a telehealth visit or use different apps to communicate with them, that's the wave of the future. And so I think that patients really do good with that. And then that's a way of touching base with them, not just on dialysis days, but non-dialysis days where they sometimes fall off the wagon. And so if I saw you Monday because your treatment is Monday, Wednesday, Friday, I might be sending you a message on Tuesday. How are you doing with your sodium intake today and your fluids, and are you eating the proper fruits and vegetables? Good to have that reminder for them on the days that they don't come, so that they don't forget. Let me remind you and encourage you and patients usually appreciate that little reminder call or touch base.
Lisa Jones: Yeah. They even have those cool, and I'm blanking on the name right now. It's a service that you can get and they just get these little short videos that pop in, and you can probably send them out to all the, I don't know if it's HIPPA compliant, but you can send them out to, it's one of those hello things and you can do a campaign drip. That would be an interesting way to educate too.
Kimberly Snodgrass: Yes, absolutely. And nutrition is key. I always tell people that dieticians, we deal in prevention and I feel like we're underutilized in the health care team, and if we're going to improve health care in our system, we have to utilize dieticians more. We have to get weight under control, diabetes, hypertension, in order to get a handle on this kidney disease problem. If we don't, things are just going to get worse. So I feel like dieticians being able to use in-person platform, telehealth, whichever way we can get this education out is going to be helpful to our patients. And so we have to utilize all avenues.
Lisa Jones: Yes. And that keeps to your point, you were saying earlier, even when you're not seeing them, you see whatever their schedule is, Monday, Wednesday, Friday or Tuesday, Thursday, Saturday, the days you're not seeing them, you can still have that touchpoint if needed. And you already did this work ahead of time, and then they still have the touchpoint of seeing you like it's that day.
Kimberly Snodgrass: Absolutely. Yeah. It is. Technology is winning for us. Right.
Lisa Jones: Yeah. Well, thank you so much for being on this segment with us today, Kim.
Kimberly Snodgrass: Thank you so much for having me.
Moderator: For more nutrition content, visit consultant360.com