Marika Wamback, R.D.
Happy new year! As we welcome in 2018, many of us will want to start the year off with healthy goals; the top ones being losing weight, and quitting smoking. These are admirable goals, but often, people quit just as they’re getting started. This is because they have not set realistic goals for sustainable change. With kidney disease, it can be even more of a challenge, due to the constant monitoring of kidney function. Kidney disease can often feel like a lifestyle in and of itself.
Realistic resolutions will help you, whether or not you have kidney disease. Making them work for you in the long term is key. With food costs increasing in 2018 and increase cost in dining out, and with constantly increasing demands on our time, making small, effective changes is essential to achieving our goals. Below are 10 ideas on how to make realistic resolutions based on common challenges amongst patients.
- Make S.M.A.R.T. goals: Regardless of what your goals are, S.M.A.R.T. goals are key. For example, ‘I want to eat better’ is a goal, but it is very vague. How is that going to be achieved? What actions needs to be done to accomplish the goal? Over what period of time? A better, more effective goal might be: ‘I am going to pack my lunch to work 4x/week rather than eating out.’ This is a specific goal that is measurable, attainable, and realistic. The change from eating out to a pre-planned meal will help improve your nutrition, as it reduces your portions and calories, and may even improve your blood work.
- Sleep: Everyone, regardless of their health situation, requires adequate sleep. Some of the effects of poor sleep include increased stress, poor mood and concentration, and disrupted appetite leading to poor food choices, poor mental health, and poor chronic disease management overall. Keep your sleep area calm and quiet; no gadgets. Dim the main lights 1-2 hours before bed to enhance melatonin production-the sleep hormone. Go to bed at the same time each day. An example of a goal may be: ‘Five times per week, bedtime is 10 pm’, rather than ‘I need more sleep.’
- Pre-planning: In this day and age of convenience, eating out has become the new norm. Up to 50% of the Canadian household grocery budget is spent on eating out. In the USA, this is even higher. Why? The perceived lack of time for cooking. Yet cooking does not need to be time consuming or complicated. A little pre-planning goes a long way. For overall health, it reduces calories, hidden fats, sodium, sugar, and portion sizes. For kidney disease, it can improve blood work, as home cooking with kidney diet requirements (if necessary) will lower sodium, potassium, and phosphorus intake, and increase fiber, nutrient, and protein intake.
Make a weekly menu of supper meals, as leftovers can be used for lunch (pre-packed work meals accomplished!). Take a sheet of paper, write the weekly meals on the bottom, and the list of groceries with ingredients on top. Like anything, it comes with practice. After a few times, you’ll find you have your list done very quickly, and your week taken care of. If you need ideas, or are unsure about what you can eat, see your dietitian.
- Reliable information: There is a vast amount of accessible information that is convenient and confusing at the same time. Some of it may even be outright false. Reliable information often comes from your health care team, consisting of university educated, medically trained professionals. Any website making ‘claims’ about health by taking one food or following one diet, eliminating one specific food, taking one specific supplement, or following one regimented exercise routine, to name a few, are likely unreliable and can even be dangerous. With university training, come the skills and abilities to interpret and disseminate the evidence for your best possible care. Use your health care team and develop a goal to enhance your knowledge of your specific health care needs. A simple goal could be ‘reading one evidence- based medical article per month’.
- Exercise: Exercise helps with so many aspects of our health: sleep improvement, mental and physical health improvement, blood sugar management, weight control, aerobic improvement; the list goes on. Instead of saying ‘I’m going to exercise more’, make a more realistic goal of ‘I’m going to exercise for at least 30 minutes, 3-5 days per week.’ Safety and consistency are the important things to consider. If it has been a while, start slow. Do 3-10-minute blocks if you need and do the exercise you enjoy. Be realistic. Remember, no matter what you do, you cannot out-exercise a bad diet. With diet and exercise, it is the 80/20 rule; 80 percent healthy diet, and 20 percent exercise. Be sure to see your doctor if you haven’t exercised for a while, particularly if you have cardiovascular issues related to kidney disease and/or diabetes.
- Water: One way to cut unnecessary calories and electrolytes from the diet is to replace sugary drinks with more water. Twenty percent of the average person’s calorie intake comes from beverages. This is due to the vast amount of sugary drink choices, as well as very large portion sizes. A large smoothie, even though it has fruit in it, contains a lot of calories, potassium, and sugar. Portion size for drinks is key; 1 cup for most of them. Keep in mind, pop, iced-tea, lemonade, and other sugary drinks all have about the same amount of sugar and calories per serving.
If you want to drink more water but find it boring, try adding some fruit slices to it. If you really need to watch your potassium, use berries instead of tropical and/or citrus fruits. Coconut water is not advised for renal patients with uncontrolled potassium levels. Dark ‘cola’ pop is high in phosphorus, which can also be risky for renal patients. Plain, unenriched rice milk can be used if phosphate needs to be closely controlled. The 80/20 rule is just as important with fluid choices as it is with food. Of course, if you’re on a fluid restriction, choose your fluids wisely. Anything sugary or salty will cause you to drink more, which can affect your blood pressure, cardiovascular system, and dialysis regime.
- Half of your plate: We know we need to eat more fruits and vegetables for our health. An easy way to achieve this goal is to put the vegetables on your plate before you add the other foods, at both lunch and supper, and then eat the vegetables all first. This little trick makes you fill up on the vegetables, and helps increase vegetable intake, manage portion size, increase fiber and nutrients, and reduce calories and overeating. Have your vegetables in any format you wish. The most effective way is the way that will make you enjoy them the most. If you have restrictions, use the vegetables you can have, and don’t focus your energy or time on anything else.
- Vegetarian: Trying more vegetarian and vegan meal ideas can improve health and decrease food costs. They are high in antioxidants, fiber, and nutrients. Lentils, beans, tofu, textured vegetable protein, nuts, and seeds are economical, nutrient dense foods . Meatless Monday may be a goal or fish Friday if you’re pescatarian. Vegetarian proteins can be used in place of meat, poultry and/or fish in many meals. Set a simple goal such as ‘I will try one vegetarian dish weekly’ if you’re just getting started. If you’re a practicing vegetarian or vegan, be sure to get adequate protein at each meal. If you have renal disease and are vegetarian or vegan, be sure to monitor your electrolytes and take your medications as prescribed. Despite their health benefits, vegetarian and vegan diets are higher in phosphorus. If your phosphate levels are difficult to control, a vegan or vegetarian diet may not be right for you as the cardiovascular risk from high phosphate levels with renal disease outweighs the health benefits of vegetarian or vegan eating. See your dietitian!
- An All or Nothing Mindset: After you set your goal, practice will be important until your goal is achieved. People often stop before they get started because they expect too much too soon, or because a setback happens. The 80/20 rule can apply to this. Having a more balanced approach may help with achieving your goals. For example, if lunch at work is usually late due to meetings, then instead of skipping lunch and overdoing it at supper (and getting discouraged), a more balanced approach may be to pre-pack a mid-morning snack in anticipation of a delayed lunch, or to have lunch earlier. ‘I will have lunch a half hour earlier 3x/week due to meetings’ or ‘I will pack an extra snack with my lunch 3x/week due to meetings’ helps meet your goals without an all-or-nothing approach, and helps you maintain your focus despite setbacks.
- Relationship with Food: Explore your relationship with food. Are you living to eat, or are you eating to live? It is a tough subject, but without a healthy relationship with food, things may not change. Ask yourself:
Am I eating because I’m physically hungry? Or am I eating because I’m bored, upset, stressed, or simply because it’s there? Emotional eating is a challenge but one that can be overcome. Perhaps a goal may be to ‘schedule snacks most days of the week at 10 am and 3 pm’ or to ‘schedule daily meal times of 8 am, 12 pm, and 5 pm,’ to help reduce the temptation to emotionally eat. Seek help from your team. It will help meet your goals of better overall health.
Small, simple goals often lead to other positive health outcomes. Seek your team, be realistic, stay focused, and be flexible. You’re on your way to success!
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