Getting Started on the Very LowProtein Diet

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The best way to get started on a very-low-protein diet is to meet with a dietitian. Dietitians have a R.D. degree, meaning registered dietitian. People with this degree have met certain educational requirements in the field of nutrition. The American Dietetic Association is a good source for finding a dietitian in your area, if your doctor cannot recommend one. The dietitian will explore your eating habits and favorite foods, and will design for you a diet that meets your requirements for calories and your limits for protein and phosphorus. He or she also will advise you on how to get supplemental essential amino acids (either as powder or as tablets), calcium carbonate, ferrous sulfate, zinc sulfate (or zinc gluconate), and multivitamins. (See Appendix 1.) You will be given some low-protein recipes that appeal to you. If, at the next visit, you are losing weight (and don't want to), you will be advised on how to increase your caloric intake. Third and subsequent visits will be provided only if you request them, or if there is evidence that you're having trouble getting or staying on the program.

The most important features of the very-low-protein diet are:

1. Severe restriction of protein intake (to about 21 g per day, in contrast with a usual intake of about 100 g per day). (See Table 1.)

2. Avoidance of high-phosphorus foods. (See Table 2 later in this chapter.)

3. Addition of an essential amino acid supplement as either tablets or powder, taken with meals (about 10 g per day). You must supplement your restricted protein intake with essential amino acids. Eating this diet without taking a supplement of essential amino acids is bound to cause protein deficiency in time.

The dietitian will prescribe how many calories you need. Many patients feel they're not getting enough to eat at first and feel hungry. A second conference with the dietitian usually corrects the problem. A few patients, however, tend to lose weight. Others tend to gain, because they never feel entirely satisfied and regularly consume more than recommended. Usually, but not invariably, these problems can be corrected by further consultation with the dietitian.

Those who want to lose weight can do so on this diet by gradually reducing their caloric intake. It is important to take it slow, because drastically reducing your caloric intake can lead to the loss of lean tissue. When you reduce your caloric intake gradually, your body burns fat stores for energy, and does not consume much lean tissue. However, when you cut back drastically, lean tissue eventually is burned in substantial amounts. Not only does this reduce body protein stores, but it also tends to defeat the goal of protein restriction. Total fasting, for exam ple, exhausts body fat stores at first, with only modest depletion of protein stores, resulting in a fall in urea formation. But eventually fat stores become depleted and urea formation (derived from burning protein stores) rises back to normal or above normal.

The most difficult aspect of this diet is eating out. If there is no low-protein option on the menu, ask the server to omit the meat (or fish or poultry) entrée and to bring everything else. Another option is to utilize the salad bar liberally, avoiding only items like beans, cheese, and bacon bits.

People with diabetes will find that this diet does not compromise any of their goals for controlling blood glucose levels. They can replace the protein calories deleted from the diet with complex carbohydrates such as pastas or starch.

People with high cholesterol may be alarmed at this diet's fat content. Surprisingly, patients' serum cholesterol usually falls on this diet, despite its relatively high fat content.

Let's get specific about the kind of foods you should be eating in a low-protein diet. Table 1 lists common foods (and special low-protein products) in order of their ratio of protein to calories. You're encouraged to eat foods in Category I, which have a low protein content. You should avoid the foods in Category III. They are included for informational purposes. Category II foods are intermediate, and can be consumed in limited amounts. Sticking to the foods in Category I or Category II will optimize caloric intake, thus filling you up more quickly, while minimizing protein intake. As you will note, many appealing foods are in Category I and are okay to consume.

Table 1. Protein Content in Relation to Calories

Category I: Foods with less than 0.6 g protein per 100 cal Fats and oils Fruit juices Sugar, honey, jelly

Low-protein products available from specialized sources: Products Distributed by Cambrooke Foods (www.cambrookefoods.com; 508-601-1640) Artisan Bread

Bagel

Energy Bars

Low Protein Cheddar Cheese Low Protein Jalapeno Singles Low Protein Mozzarella Shreds Munchy Bites

Whitehall LP American Single Whitehall LP Swiss Cheese

Products Distributed by Dietary Specialties (www.dietspec.com; 888-MENU-123) Bread and crackers Cookies

Imitation Macaroni and Cheeses

Imitation Rice

LP Gelled Dessert Mix

LP Plantain Chips

Pasta

Peanut Butter Flavored Spread

Porridge

Sauce Mixes

Vance's Dairifree Beverage Mix Wel-Plan Baking Mixes Wise Onion Rings

Products Distributed by Ener-G-Foods (www.ener-g.com; 800-331-5222) Doughnuts Egg Replacer LP Pizza Crust Potato Mix

Products Distributed by Med Diet Labs (www.med-diet.com; 800-633-5550) Broth, Soups, Gravies Coating Mixes Dessert

Pizza with Cheese Topping

Products Distributed by Scientific Hospital Supplies (www.shsna.com; 888-LOPROGO)

Breakfast Cereal Loops

Broth, Soups, Sauces, Gravies

Crackers

Drink Mix

Loprofin Baking Mix

Pasta

Sweet Biscuits Wafers

Category II: Foods Containing Significant but Acceptable Amounts of Protein

(Consume those near the beginning of this list freely, but those near the end sparingly.)

FOOD gprotein per 100 cal

Apple 0.3

Rhubarb 0.4

Butter 0.5

Pineapple 0.6

Dates 0.7

Apricots 0.7

Grapes 0.9

Tapioca 0.9

Potato chips 0.9

Blueberries 1.0

Grapefruit 1.0

Hash brown potatoes (cooked in oil) 1.0

Pear 1.0

Peach 1.2

Banana 1.2

Figs 1.2

Avocado 1.2

Frosted flakes 1.3

Coconut 1.3

Pecans 1.4

Sweet potato 1.5

Corn flakes 1.5

Strawberries 1.5

French fried potatoes 1.6

Doughnut 1.6

FOOD

Watermelon

Cherries

Orange

Filberts

Rice

Rice Krispies Blackberries Cream cheese Honeydew Flour Brazil nuts

Cream (half and half)

Walnuts

Ice cream

Carrots

Squash

Potato

Noodles

Wheaties

Waffle

Corn

Cashews

Almonds

Turnips

Pistachios

Cream of wheat

White bread

Whole wheat bread

Bran flakes

Beets

Onions

Cheerios

English muffin

Macaroni

Spaghetti

Sausage

Lettuce

Tomato gprotein per 100 cal 1.6

4.0 continued

FOOD gprotein per 100 cal

Frankfurter 4.1

Peanut butter 4.2

Sunflower seeds 4.3

Peanuts 4.4

Peppers 4.5

Eggplant 4.5

Bacon 4.9

Category III: Foods to be Avoided (High-Protein Foods) FOOD gprotein per 100 cal

Celery 5.0

Cabbage 5.0

Artichokes 5.4

Whole milk 5.4

Beans, green 5.5

Lima beans 6.1

American cheese 6.3

Cheddar cheese 6.4

Cream cheese 7.1

Lentils 7.2

Peas 7.3

Swiss cheese 7.5

Brussels sprouts 7.8

Egg 8.1

Yogurt 8.3

Cauliflower 8.3

Broccoli 8.7

Asparagus 8.7

Spinach 8.8

Skim milk 10.0

Mushrooms 10.0

Buttermilk 10.0

Veal 11.7

Pork 11.9

Sardines 12.1

Oysters 13.3

Lamb 13.6

Beef 14.5

FOOD

gprotein per 100 cal

Cottage cheese

Chicken

Fish

Turkey

Lobster

Scallops

21.7

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