Tag Archives: sodium

Liver Transplant Houston: Is There a Special Diet to Follow?

A common question I am asked daily is in regard to “what kind of diet do I need to be on while waiting for my liver transplant?”. There is a great deal of misunderstanding surrounding this, that it deserves a few simple comments.

The simple answer is that there is no special diet you have to follow if you have cirrhosis. The central area of concern is dietary sodium or salt. The goal is to have a reduced salt diet, in the neighborhood of 1,500-2,000 mg per day. This is a very restrictive diet compared to the standard American diet (aka SAD). The SAD may include well over 6,000 mg per day. Too much!

The simplest way to achieve such a restricted diet is to eliminate all processes foods, avoid all foods in a can, bag, or box. If it has more than 5 ingredients on the label, keep away.

Salt is the enemy to anyone with chronic liver disease and cirrhosis. The body’s handling of salt and sodium are malfunctioning, resulting in fluid retention, edema, and the development of ascites. In many circumstances, diuretics (water pills) need to be used to remove the excess salt and fluid from the body.

All of our patients need to consume fresh fruits and vegetables, lean fresh meat and fish, and foods found in their natural state. This may be an overwhelming challenge to those accustomed to eating out and or consuming large quantities of processed foods. It is impossible to meet this less than 2,000 mg salt intake by eating out.

I highlight numerous tips from
past entries that will help you with this mission. Read labels, stop eating out, and eat foods found in their natural state.

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January 13: A Low Salt Diet-Simple Step to Improve Health

January 13: A Low Salt Diet-Simple Step to Improve Health

If there is one item to include in your quest for wellness, it is to assume a diet low in sodium. Every day, patients ask for the contents of a low salt diet. They have an idea, but never quite get it right. On questioning, the average adult and their family is consuming well over the recommended amounts that have been put forth by several major medical organizations. The American Heart Association is suggesting between 1500-1800 mg of sodium per day. This is restricted compared to the 4,000 mg/day the average American eats. To get in line with a low salt diet, you must read labels. All commercial food will list the sodium content. My opinion is that it is nearly impossible to maintain a low salt diet if you eat your meals out. The art of home cooked meals is a thing of the past. While I may sound somewhat pessimistic, I interview people for a living, and ask every patient what and where they eat. The answers are not pretty.

Here is a list of sodium in fast foods.

Ill effects of sodium include the following: Too much sodium in the diet can lead to health problems. It is one of the risk factors that contribute towards high blood pressure (hypertension), which substantially increases the risk of developing heart disease or stroke.

So what do you do now? Here are my recommendations:

  1. Read all food labels.
  2. Make sure you know how much is in a “serving” of the food you are looking at.
  3. Don’t eat any canned foods.
  4. Don’t eat anything out of a box, or ready to eat meal.
  5. Avoid ALL fast food, as well as chain restaurants.
  6. Learn to use other spices and herbs in your cooking.
  7. Beware of “salt substitutes” – these contain high levels of potassium and can be dangerous with certain health conditions and medications.
  8. Eat more fresh fruits and vegetables.
  9. Read all of the other blog entries from this month.

Past “salt” entries from our blog:

Salt: Institute of Medicine

Interview with a Dietitian

Educate Yourself on Salt

Start today on the road to reduced sodium.

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Too Much Dietary Sodium: Interview with Jolene Vanderzyl, R.D.

Too Much Dietary Sodium: Interview with Jolene Vanderzyl, R.D.

Jolene Vanderzyl, a Registered  Dietitian with Sugar Lakes Family Practice, will join Dr. Galati tonight to discuss the problem of excessive dietary sodium (salt) in the American diet. For the past five years, we have been discussing the salt problem in our food, and while there have been some strides in changing our behavior, educating the general public is still priority number one.
Salt is everywhere in the food we eat. A day does not pass where I am instructing my own patients, as well as their family, on how to maintain a low sodium diet.  For patients with advanced liver disease and cirrhosis, we strive for a diet with no more than 2000 mg of sodium daily. In some cases, we need to go even lower. There is always great confusion regarding salt and sodium, and the foods to stay away from. Many times, patients will state “I haven’t used salt in years”, yet on a quick scan of their diet history, they are well over 2000 mg. How does this happen, you ask? I do not doubt the patient is telling the truth and retired their salt shaker years ago, yet the sodium content of prepared foods is huge, and this is what throws most everyone over the limit. Eating out regularly, or consuming prepared foods that you nuke, are all loaded with sodium. In addition, both of these activities will lead to obesity.
Links related to dietary sodium are listed here. Let us know what you think on this subject by commenting below.
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Low Salt Diets: More Education Needed

Low Salt Diets: More Education Needed

A delightful new patient was seen in the office today with the diagnosis of non-alcoholic fatty liver disease that unfortunately had progressed to cirrhosis.  She was accompanied by her sister. They we both obese, on the borderline of morbid obesity. The cornerstone of treatment is to get her weight under control, and I estimated that she would have to lose approximately 75 pounds to get anywhere near a reasonable, safe body weight.  We discussed several strategies, but the one point that stood out is that she was consuming massive amounts of dietary sodium (salt). Here diet was a parade of processed, nutrient stripped foods, loaded with enough salt for a week. These were the foods she regularly consumed:

Sodium per serving

Frozen dinners:   800 mg
Commercial vegetable juice:    650 mg
Canned corn: 610 mg
Packaged deli meats:     605 mg
Canned soups:    1025 mg
Chinese food:    3500 mg

Adding it all up, she was consuming well over 7,000 mg of sodium daily. Remember, patients with cirrhosis should shoot for 1800-2000 mg/day. On physical examination, she had well over 30 pounds of fluid hanging on her body.

The lesson once again is to be aware of the foods that are high in sodium.  You must read labels on the food you consume. The public needs to be re-educated on low salt diets. Parents with children equally need to be aware of this fact. It is impossible to maintain a low salt diet if you eat out on a regular basis. If for health reasons (heart failure, liver disease, kidney disease) you must be on a low salt diet, eating out has to be a thing of the past. It will save you money, and the the grief of being scolded by your physician.

Remember: CUT THE SALT!

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More on First Lady Michelle Obama and Let’s Move

More on First Lady Michelle Obama and Let’s Move

Today in the office, it was another hectic day seeing patients. I was struck by how often I had to discuss obesity with patients and their family. The educational need in this area is overwhelming. Basic facts on calorie, salt, sugar, and fat content of foods is lacking.  You can direct patients to web sites all day to seek out information on food, nutrition, and fitness – but in the end my feeling is that they will still fail to really grasp this issue at hand. It is not that these people are not smart-not at all-it is simply the fact they there is a very high level of intensity that is required in getting the real message across. In has to be face to face education.

We have a great staff in our office, Liver Specialists of Texas. I simply don’t have the time to allow the staff to spend any more time with the patients. We could spend all day talking about obesity with them.

Enter Michelle Obama. One family brought up her name, and the Let’s Move effort she has outlined. They seemed to have the basic facts on the program, and the issues at hand. Michelle Obama did seem to connect with them. The First Lady has limits to her time I would imagine. She would need to be pounding the pavement 12 hours a day for the next three years to even make a minor dent in the problem of obesity. So where do we all stand with this?

We have to reach the youth, their parents, educators, school administrators, and corporate leaders. One clear message needs to be in tune. Obesity is killing us. Obesity is killing our children. Obesity is going to bankrupt the economy. If we can fix this problem of obesity, healthcare reform (aka address obesity), and cost savings, would be a true victory.

Do the following starting tomorrow and everyday thereafter:

  1. Reduce your salt (sodium) intake to 2,000 mg per day.
  2. If you go out to eat, order one meal and split in two with you partner.
  3. Weigh yourself daily and record it.
  4. Start a food diary and record everything you put down the trap.
  5. Exercise 5 days per week. Remember 3500 calories burned is a pound lost.
  6. Don’t eat anything out of a can, box, or bag. Fresh fruits and veggies are the only way to go.
  7. Look in the mirror at yourself every morning.

Take responsibility for yourself, and your health.

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