Tiffany Archibald 00:02
Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. Learn the importance of weight management and how to maintain a healthy kidney friendly lifestyle through meal plans and movement. developing a relationship with your healthcare team and dietitians is key. Welcome, today we are talking with Nadia Lakhani, one of our renal dietitians at Dallas Nephrology Associates. How are you today?
Nadiya Lakhani 00:37
I’m great. How are you?
Tiffany Archibald 00:39
I’m wonderful. So let’s get into it. Today’s topic, I think when people are listening to the podcast, they are going to be tuned in because it’s a topic that is very specific to our CKD patients that will be listening, but also the general population. And we’re talking about weight management. So most people tend to be concerned about their weight. But why is weight management important?
Nadiya Lakhani 01:06
I’ll start off with, you’re right, as this affects every single one of us. And the term weight management is a better way to describe what we’re going to talk about because it is about weight loss that a lot of times people think about, but it is also about weight maintenance. That’s very important. And sometimes there is weight gain that is necessary as well. So thinking about it as a whole, the weight plays an important role for all of us. And what it really comes down to is the fact that it affects our health.
Tiffany Archibald 01:41
All right, so let’s talk about how does weight affect the kidneys. You just talked about weight in general, but let’s tune in and talk about how it affects the kidneys.
Nadiya Lakhani 01:51
Yes, so I’ll start with when there is a lot more weight than the body should be able to handle, it actually increases the demand on the kidneys to hyper filtrate. Having them to work harder. And so eventually, I kind of think of them as any work or you overwork them, they’re going to get weaker. So someone who has been affected by something like obesity, really, in itself independently is at risk for a new onset of chronic kidney disease. So it has a very direct impact, just obesity on its own.
Tiffany Archibald 02:29
And so how is a person, if they’re listening, when they go to their doctor, how do they determine what is their healthy weight?
Nadiya Lakhani 02:40
So a lot of times, there are formulas that are used. But when we think about it, we think about it in two terms. One is what is healthy for that person, right? So we think about their weight history, their musculature, their, where the weight distribution is. So intraabdominal weight being a much higher risk factor for people. We’re also thinking about their gender, their age, body frame. So based on all of that, we have a good idea about where the person could be. But then the other part being that it is a lot to do with where the person wants to be and what is healthy for them. Not thinking about it as a weight because someone could have extra weight on them and really be malnourished. They’re not really eating well. They’re not eating healthier foods too that their body needs. And someone could be sometimes underweight and that does not mean that they’re malnourished. So thinking about it as not just from that number perspective, but how is the person actually doing with their health itself to me is a good determined of what’s a healthy weight for that person.
Tiffany Archibald 03:52
Okay, so in determining healthy weight, I know a lot of individuals that are listening may be familiar with the body mass index. I know that it’s kind of like a baseline that a lot of physicians and dietitians and individuals that are working with patients and weight. Let’s talk about the body mass index.
So, body mass index also, you know, in short, BMI is used as a general population statistic determination of the new risk factors that could happen. It’s a good starting point. So it does not take body composition in account. It does not take again that musculature or weight distribution, but it is a really good way to see where the person is heading and working towards it a little bit opposite. The word I used earlier, the word obesity, it is really a disease. And when people are affected by this, sometimes people think about it as, oh I am obese, but kind of changing that thought process of it as, no, you have obesity, and we need to treat it. And these are some, you know, tools that help us know if we need to treat it.
Tiffany Archibald 05:08
So talking about treatment, what are some interventions that are out there for individuals that need the treatment for weight loss?
Sure. So there’s invariably, you know, of course, there is no jazz up on this, it really is, you know, eating well and moving your body. I personally don’t use the word term exercise a lot. But it is about the movement that the body needs. I think about it as having a car, you have a brand new car, super expensive, but if you don’t use it, it doesn’t work well. Same thing goes with in terms of food wise, what we put in the body. You don’t put bad fuel in the body in the car, right? So similarly, that’s where it starts, the types of foods, the choices, and also being active. So that is the foundation. Then there are also some times when a person may need a little bit more help. And we may need to recommend that they consider being on pharmaceutical interventions. There are some good medications out there that are beneficial, and also safe for patients that have kidney problems. And then there are times when surgical intervention may also be appropriate. A lot of times we think about that, when we think about kidney patients, is when they’re applying for transplant, that BMI is taken into account. And then depending on how much weight may need to be, you know, lost, a surgical intervention may be appropriate for that person.
Tiffany Archibald 06:41
Okay. And so you talked about obesity and how people need to kind of redefine that term. There are individuals out there that are underweight. So what ideas do you have for individuals that are underweight that may need to gain some weight?
Nadiya Lakhani 06:59
Sure. So it starts with first finding out what’s causing the weight loss. So again, if somebody is underweight, but that’s what their normal weight is, it’s not a concern. But if it is someone that is losing weight unintentionally, or out of illness and such, that’s when it’s concerning. And to circle back to that also to relate them to the kidneys is having that unintentional weight loss increases the risk of that person having increased days in hospital. So increased hospitalizations, it increases the risk of infection. You’re losing muscle mass, which is really hard on the kidneys as well. So starting with what’s causing the weight loss. Is it GI related? They’re having, you know, nausea. When I say Gi, it includes both upper and lower symptoms that someone may have. That includes if someone’s having nausea or vomiting. We see a lot of that for patients who are in advanced stages very easily. Sometimes it is they’re not able to tolerate the food that they’re eating, like diarrhea. And so combination of this, of course, can happen. So if that’s the reason, then we address the GI issues that we need to resolve. And then we think about appetite anind two terms. Is it that you have no desire to eat? Versus is it that you’re getting full easily? There’s just no appetite, that’s an issue. You’re getting full easily? That’s a different type of issue. But if you’re talking in general terms, a quick tip, so to speak, is to add some extra calories without having to think like you have to eat a lot. So using some good oils, drizzle on some vegetables or on starch that you might be eating, having an extra serving. And a lot of times people think about, oh, I need to eat it all, when they have a low appetite the idea of eating just makes them feel sick. So eating smaller meals through the day really helps. Colder foods tend to settle a little bit better. And then also, that’s a little interesting thing is that the color red is actually very stimulating for appetite.
Tiffany Archibald 09:08
That is very interesting.
Nadiya Lakhani 09:11
So you know, think about when we go to the Italian restaurant, we tend to overeat over there, right? There’s a lot of color red there. So I suggest for my patients who are struggling with that don’t feel like eating have low appetite to consider like putting their tablecloth to be red or purchase red plates. Something I’ve red color around is really helpful, too. And it actually works really nicely.
Tiffany Archibald 09:35
Yeah, I’m sure the listeners will take note of that because you know, I’ve never heard of that, but you know, obviously makes sense when the way that you explain it.
Thank you. And one more thing to add to it is that sometimes, some carefully selected nutrition supplements are also needed to get them at least to increase their intake and generally when somebody’s not eating well, then that that in itself causes lower appetite. So we try to increase that intake itself, and then that improves the appetite.
Tiffany Archibald 10:08
So I’m the opposite end of teaching individuals that are listening about how to gain weight and you know, different ways to make an association with colors and figuring out what their appetite pattern is. What are some suggestions for individuals that need to lose weight?
Nadiya Lakhani 10:27
Oh, there’s so many…
Tiffany Archibald 10:28
I know. The answer is going to be ongoing, but let’s specifically talk about our CKD patients and their weight loss. Whether it’s for them maintaining or going into dialysis, or preparing for transplantation. Just kind of break that down, if you can.
Nadiya Lakhani 10:52
I really just want to say first is that really, no one needs a dietitian to talk about what’s better apple or an apple pie, right? Most people, if not everyone knows the answer to that. So we really try to think about what’s keeping the person from reaching their goal? What’s keeping them from making that better choice? So attaining, you know, assessing their routines? Is it that someone that is working late nights, or is it someone that tends to skip meals, and then they get stuck in the cycle that they’re really hungry, then it’s hard to make a good choice. So they have good intentions, but they’re not able to meet that goal. So finding little things that will help them to make it all fall in place. So first starts with doing what you already know and then building on it. There is also a lot of times people who do a lot of different changes in their food habits kind of considered that yo-yo dieting, the body loses the ability to realize the hunger cues. So this is where we start teaching about intuitive eating. And we train the brain to recognize those hunger cues and fullness factors. There’s also the concepts that are really important are mindfulness of eating, acknowledging what you’re eating, and not do the instant, I was sad, and I ate this, you know, thinking about the reason why you’re eating first. Is it because you’re sad? Is it emotional eating? So what’s causing those triggers?
Tiffany Archibald 12:26
And so when you talk about hunger cues, for those individuals that are like, what’s that, can you give some examples of what hunger hunger cues are?
Nadiya Lakhani 12:36
Sure, so a popular scale that’s used to train this, and this really would take a longer conversation, so meet with the dietitian to learn more about it. But the scale is you teach the person how to find their keys, so it’s on one to 10. And one is you’re so hungry or dizzy, you’re going to pass out. Of course, you never want to be there. 10 is where you are so stuffed, you feel sick to your stomach, and you never want to think about eating again. Right? So of course, those are extreme levels that you should avoid being in. So the idea is that you start eating when you are thinking about food at three. So you’re not hungry, but you’re starting to get some, you know, your body’s like, Okay, I’m a little hungry, I’m starting to feel that I need to
Tiffany Archibald 13:19
And when you say 3, that’s the scale.
Nadiya Lakhani 13:23
Don’t get to that point. Don’t get to that 10. You’re really, really hungry, just really need some quick intervention type. Versus 10, you overate. Now. So the scale being that you are starting to get a little bit of the hunger cues. You’re starting to feel a little hungry. That’s when you start thinking about what you’re going to have. And then about four, you’re not hungry, you’re not full. You start eating about four, five. You want to stop by six or seven. So you’re comfortably satisfied. And you pause every few minutes. So sometimes, you know, you might even have to train the person to learn about the timing, how long they’re taking to eat, and then trying to expand it each time. So you pause a few minutes, and then kind of think about how do I feel? So you’re not overeating and then thinking about later that, oh, I ate too much. So that’s what you’re trying to avoid doing. And so you get satisfied, uncomfortable. Around holidays, you can get to eight and seven or eight, you’re pushing at nine. And that’s okay, too. So, you know, I kind of think about weight management as a journey. You don’t think about the destination, if I’m going to climb 10 flights of stairs, if I go look up, I’m like, oh, that’s too much. But you got to start with that first step and you keep going and say, you know, at the three flights, you’re tired or you want to pause and look at something scenic, you know from the balcony. You do and that’s okay. But you’re not going to turn back yourself because oh you paused right. You just keep going. So thinking about the journey when you’re thinking about weight management. It’s so much about that mental idea about you, really, it’s a mental game, that you’re trying to retrain your brain, and then it actually follows what you want it to do.
Tiffany Archibald 15:15
So this journey that we’re on, can you do me a favor and tie that into how this journey is kidney friendly? How everything you just kind of describe wraps it up for those CKD patients that need to monitor their weight?
Nadiya Lakhani 15:31
So they really do go hand in hand. So when we talk about weight management, and we think about kidney patients. So something to kind of separately think about are the risk factors. The two big factors that cause kidney damage to begin with include diabetes, high blood pressure. So management of that is extremely important. And what do you do in those treatments, is you’re changing food choices. And that, again, if somebody’s watching their sodium, that helps with weight loss. Somebody’s watching their diabetes, avoiding simple sugars, that in itself will help with weight loss. And then weight management will also help with improving the diabetes and high blood pressure and, in turn, protect the kidneys. So right, they’re all kind of working together. So there is not like, oh, here’s a whole different diet and here’s a whole different diet. We’re learning about portions, how much to eat. You’re thinking about the quality of the food as well, right? And so a small piece of chicken that’s fried versus a big piece of chicken that’s baked, right? So thinking about fullness, the volume that it takes to get that fullness happening. So it’s not this all weight loss, we’re really working with the, with the kidneys to take off the burden off of them, and anything that’s affecting them negatively. But truly, you need that guidance to make it all work. It can get overwhelming, right? So not thinking about, oh, this is all I have to do. But again, thinking about it a little bit more positively. And helping the person realize that they have power over this. So there are not a lot of medical issues that we can confidently say this about to change the way you’re eating and will actually help slow down the progression of the disease. And I just love what we do because at Dallas Nephrology, that’s our entire intent, to slow down the progression of kidney disease. And so if we can do that with changes in diet, why not?
Tiffany Archibald 17:33
Nadiya Lakhani 17:34
And how nice that is in something you get to choose? You get to choose what you want to have. And again, you don’t put bad gas in your car. Why would you want to put something bad in bad body intentionally, knowingly?
Tiffany Archibald 17:48
So to wrap this up, can you give me one or two main points of everything you discussed, that you feel are some key takeaways. And it could just be one. But I think you did a great job summarizing just now on how we want to manage the weight not just for aesthetics or any other issues, but to slow that progression of the disease. So what would you say from everything you’ve gave us in this wealth of information?
Nadiya Lakhani 18:17
Come see a dietitian.
Tiffany Archibald 18:18
Nadiya Lakhani 18:20
No really, you know, allowing the experts to help you. It’s you know, we’ve done the research. We’ve looked looked up the food products. We’ve seen what works, what doesn’t work. We individualize the therapy. So you’re treated not as, oh, here’s what’s gonna work for everyone’s so it’s going to work for you. So taking the time with the person. Assessing their lifestyle, their allergies, perhaps, their financial issues. All of that is taken into account, culture. So all of that taken into account. And that’s why seeing somebody that does this day in and out and is wanting to help. Let please, somebody help you in this journey.
Tiffany Archibald 19:01
Yes. And let our dietitians, our fabulous dieticians, who have been with Dallas Nephrology for many years and have seen all types of patients. We have the information. We have the professional so we hope everyone that has listened to this podcast today, whether you had CKD early stages or just a family member, that’s kind of wanting to learn more, I’m sure they got information on weight loss and weight management and things like that. So thank you again for coming as our guest and we appreciate all this information you gave us.
Nadiya Lakhani 19:33
Tiffany Archibald 19:34
Thanks for tuning in today. Learn more about Dallas Nephrology Associates at www.dneph.com. And if you found the information valuable Be sure to share with those who are impacted by chronic kidney disease.