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
Low Protein Cheddar Cheese Low Protein Jalapeno Singles Low Protein Mozzarella Shreds Munchy Bites
Whitehall LP American Single Whitehall LP Swiss Cheese
Imitation Macaroni and Cheeses
LP Gelled Dessert Mix
LP Plantain Chips
Peanut Butter Flavored Spread
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
Pizza with Cheese Topping
Products Distributed by Scientific Hospital Supplies (www.shsna.com; 888-LOPROGO)
Breakfast Cereal Loops
Broth, Soups, Sauces, Gravies
Loprofin Baking Mix
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
Potato chips 0.9
Hash brown potatoes (cooked in oil) 1.0
Frosted flakes 1.3
Sweet potato 1.5
Corn flakes 1.5
French fried potatoes 1.6
Rice Krispies Blackberries Cream cheese Honeydew Flour Brazil nuts
Cream (half and half)
Cream of wheat
Whole wheat bread
Tomato gprotein per 100 cal 1.6
FOOD gprotein per 100 cal
Peanut butter 4.2
Sunflower seeds 4.3
Category III: Foods to be Avoided (High-Protein Foods) FOOD gprotein per 100 cal
Whole milk 5.4
Beans, green 5.5
Lima beans 6.1
American cheese 6.3
Cheddar cheese 6.4
Cream cheese 7.1
Swiss cheese 7.5
Brussels sprouts 7.8
Skim milk 10.0
gprotein per 100 cal
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