Eden Approach

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Bill Schuman, Dietitian

Bill Schuman is our Nationally Registered Dietitian and Herbalist.

Jackie Schuman, RN, MH
Jackie Schuman is our Masters Level Nurse and Master Herbalist

Rodrick Washington Personal Trainer

Rodrick Washington is our Certified Personal Trainer

 

 

What We Offer to Help You Stay Healthy

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Nutritional Counseling using the latest knowledge and techniques in the fields of Nutrition, Herbs, and Holistic Medicine.


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We offer daily counseling, coaching, encouragement, guidance and support to ensure that you can meet your goals and achieve your optimum state of health.

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Our Personal Trainer is the best in the business. He meets you at your level and progresses you at your speed to achieve any level of physical fitness you desire.

 


Medical Nutrition Therapy:

A Medicare Covered Benefit

By Marianne Hutton, RD, CSR, CDE 

Twenty million people in the U.S. or one in nine adults in America have chronic kidney disease (CKD). This is a growing public health concern. The number of people needing dialysis or transplant is expected to increase from 406,000 in 2000 to 651,000 in 2010. Total Medicare costs for CKD were $18.6 billion in 2004 ($16.3 billion was spent just providing dialysis). 

Diet is the base of medical management and treatment of chronic kidney disease (CKD), diabetic kidney disease (DKD) and after a kidney transplant. Kidney disease can be prevented or it’s progression slowed by medical and nutritional changes. If you are a dialysis patient you have a renal dietitian at your clinic. But what about people who are not on renal replacement therapy and who would like some nutrition advice? According to the American Dietetic Association, referrals for medical nutrition therapy (MNT) are as easy as 1-2-3! Would you like to work with a nutrition expert to guide you on how to delay the progression of kidney disease but don’t know where to start? Let’s start at the beginning. 

What is Medical Nutrition Therapy? 
Medical nutrition therapy includes evidence based nutrition diagnostic, therapeutic and counseling services. It is designed to help you learn to eat right and take your nutrition related medications correctly. With a doctor’s signed referral, Medicare will cover 80 percent of the cost of MNT. Your diagnosis must be chronic kidney disease (not on dialysis) or diabetes. Medicare also covers for three years after a kidney transplant. (Of course, this coverage is after you pay your Part B deductible.) For MNT, non-dialysis kidney disease is defined as having a glomerular filtration rate (GFR) of 13-50 ml/min/1.73m2. This GFR range includes part of CKD Stage 3, Stage 4 and a small part of CKD Stage 5 (usually before needing dialysis or kidney transplant). Medicare beneficiaries may have from two to four sessions. The total time is three hours during the first year and eights hours total in the years that follow. Medicare will allow more time if your doctor requests so. You may also get MNT services in a group class or an individual treatment setting. 

How Do I Get An Appointment with a Registered Dietitian (RD) for MNT? 
1. Ask your doctor for a referral to a registered dietitian who specializes in kidney disease, diabetes and any other medical issues you may have indicating a need for “medical nutrition therapy” or MNT. 

2. Your doctor will need to: 
• include the covered diagnosis code(s) for your condition, 
• send your most recent medical progress note and medication list, 
• send your recent lab tests (blood and urine), 
• sign a specific order for MNT in your medical chart, and 
• give another MNT order if more services are needed. 

3. You or your nurse can make the appointment with an RD at your local hospital outpatient clinic, an MD clinic if a dietitian is available or at a registered dietitian’s private practice office. Be sure to make a follow-up appointment after your first session. 

What if I’m not covered by Medicare? 
Most dietitians see a mix of Medicare, private insurance and self-pay patients. There are some cases in which a person may qualify for MNT services based on an existing health condition, such as diabetes or obesity. Some insurance carriers allow direct access to MNT services without the need for a physician referral. Many insurance plans cover diabetes education (group and individual). Check with your carrier to find out what your benefits are. 

What else does Medicare Cover? 
If you have diabetes, your doctor may say you need diabetes self-management training and education. Medicare will cover up to 10 hours of this training during your first year and two hours every year that follows. If more time for MNT is needed, you need another written referral. The doctor writes in your medical record why more services are important. 

Most people with diabetes have what’s called “Type 2”. More than 50 percent of people on dialysis have some form of diabetes. A qualified dietitian knows how diabetes affects nutrition. With expert help, you can combine nutrition needs for CKD and diabetes. A dietitian knows how diabetes affects your body, knows about your medicines and how they work, as well as problems that can be avoided. They have the time and the expertise to coach you in making lifestyle changes that will make a difference. The diabetic management goals of controlling blood glucose, blood pressure and blood cholesterol and fat levels are even more important when associated with kidney problems. 

In addition to 10 hours of diabetic self management training, Medicare will generally cover three hours of MNT for the first year and two hours every year thereafter. It will cover more hours if your doctor says you need them. Talk to your doctor if you think you qualify for this benefit. 

To find a qualified registered dietitian in your area go to www.eatright.org and click on “Find a Nutrition Professional.” 

If you or someone you know has diabetes, learn how to prevent kidney disease by attending an American Diabetes Association (ADA) Recognized Program. To locate an ADA recognized program near you, call 1-800-342-2383 or visit www.diabetes.org


This article originally appeared in the July 2010 issue of aakpRENALIFE.

 

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Nutrition for Later Chronic Kidney Disease in Adults

On this page:

As kidney disease progresses, nutritional needs change as well. If you have reduced kidney function, your doctor may recommend that you change your diet to protect your kidneys.

You can prevent or delay health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in phosphorus, potassium, and sodium. Eating too much protein can also burden the kidneys and speed the progression of CKD. Protein foods like meat and dairy products break down into nitrogen and creatinine, waste products that healthy kidneys remove from the blood. But diseased kidneys can't stop waste products from building up in the blood and causing health problems.

With reduced kidney function, you may need to start paying attention to the protein, phosphorus, sodium, and potassium content of the foods you eat. Learning about your food will help you understand what changes you need to make.


Calories

Calories are units of energy provided by food. Work with your dietitian to determine how many calories you need each day to maintain a healthy weight.

As CKD progresses, you may find that foods do not taste the same, and you may lose your appetite. Your dietitian can help you find healthy ways to add calories to your diet if you are losing too much weight.

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Protein

Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. But proteins also break down into waste products that must be cleaned from the blood by the kidneys. Eating more protein than your body needs may put an extra burden on the kidneys and cause kidney function to decline faster.

Doctors have long recommended that patients with CKD eat moderate or reduced amounts of protein. Some worried, however, that restricting protein would lead to malnutrition in many patients. In the 1990s, a major clinical trial measured the benefits and dangers of protein restriction for kidney patients. The Modification of Diet in Renal Disease (MDRD) Study assigned groups of CKD patients to diets with different levels of daily protein intake. The study found that patients who succeeded in reducing their daily protein intake by 0.2 grams for each kilogram of body weight for 1 year had healthier levels of bicarbonate, phosphorus, and urea nitrogen in their blood.

For example, a man who weighs 154 pounds (70 kilograms) and who normally eats 56 grams of protein a day would have to reduce his protein intake to 42 grams a day. To cut back on protein, he might eat oatmeal at breakfast (6 grams of protein) instead of a bacon, egg, and cheese sandwich (18 grams of protein).

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Medical Nutrition Therapy

Figuring out what to eat can be tricky at first. You may need to cut down on foods you've always considered healthy, like fruits and vegetables. First, you need to learn how certain foods affect your kidneys and how reduced kidney function changes the way your body uses food. Then learn about the nutritional content of foods so you can recognize foods that are acceptable and foods that contain the substances you need to limit or avoid, like sodium, phosphorus, and potassium.

Working with a dietitian can help you understand how foods affect your health. Ask the dietitian to review your lab reports for problems that you can address by changing your diet. For example, your lab report might show a high level of phosphorus in your blood. Your dietitian can show you how to lower your phosphorus level by avoiding high-phosphate foods like dairy products, nuts and peanut butter, beer, cola, canned iced teas and lemonade, and certain vegetables.

Together, you can plan meals that fit your habits and your preferences but also provide the nutrition you need and avoid or restrict the foods that can cause problems.

Ask your doctor to refer you to a dietitian who specializes in nutrition for people with chronic kidney disease. The dietitian's fee may be covered by your health insurance. Check with your insurance provider. You may need a referral from your doctor. If you qualify for Medicare, you can receive a benefit for medical nutrition therapy (MNT) from a registered dietitian or nutrition professional when your doctor provides a referral indicating that you have diabetes or kidney disease. Medicare covers 80 percent of the Medicare-approved amount for MNT after you have paid the $100 deductible for Part B services.

One way to locate a qualified dietitian is to consult the American Dietetic Association website at www.eatright.org, which features a "Find a Nutrition Professional" page. Users can enter their address or ZIP code and a list of dietitians in that area will appear. Click on "Renal nutrition" in the specialty field.

The typical American diet contains more than enough protein. Most people can get the protein they need by eating two 3-ounce servings of meat or meat substitute each day. Learning about portion sizes can help you limit your protein intake.

What's the Right Size?

A 3-ounce serving of meat is about the size of a deck of cards or the palm of your hand. You can moderate your protein intake by limiting meat in your diet to two 3-ounce servings each day.

Talk with your dietitian about the amount of protein and the sources of protein in your diet. Animal sources such as egg whites, cheese, chicken, fish, and red meats contain more of the essential amino acids your body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your dietitian can suggest ways to make small adjustments in your eating habits that can result in significant protein reduction. For example, you can make sandwiches using thinner slices of meat and filling out the sandwich with lettuce, pickles, cucumber slices, apple slices, and other garnishes.

Protein Content of Foods

High-Protein Foods Lower Protein Alternatives
Ground beef
Halibut
Salmon
Tuna
Chicken breast
Chili con carne
Egg substitutes
Shrimp
Tofu
Imitation crab meat
Chicken drumstick
Beef stew

Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17-1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a203.pdf (PDF, 217 KB)  *; accessed June 2, 2005)

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Fat

Fat provides energy, helps produce hormone-like substances that regulate blood pressure and other heart functions, and carries fat-soluble vitamins. You need fat in your diet, but some fats are healthier than others. Saturated fats and trans-fatty acids can raise your blood cholesterol levels and cause clogging of blood vessels.

Talk with your dietitian about healthy and unhealthy sources of fat. Saturated fats are found in animal products like red meat, poultry, whole milk, and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercial baked goods like cookies and cakes and in fried foods like doughnuts and french fries.

Your dietitian can suggest healthy ways to get fat into your diet, especially if you need more calories. Vegetable oils like corn or safflower oil are healthier than animal fats like butter or lard. Avoid hydrogenated vegetable oils because they are high in trans-fatty acids. Monounsaturated fats-olive, peanut, and canola oils-are healthy alternatives to animal fats.

Sources of Fats

Bad Fats Good Fats
Saturated fats
  • Red meat
  • Poultry
  • Whole milk
  • Butter
  • Lard
Monounsaturated fats
  • Corn oil
  • Safflower oil
  • Olive oil
  • Peanut oil
  • Canola oil
Trans-fatty acids
  • Commercial baked goods
  • French fries
  • Doughnuts
Hydrogenated vegetable oils

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Sodium

Sodium is found in ordinary table salt and many salty seasonings like soy sauce and teriyaki sauce. Canned foods, some frozen foods, and most processed meats have large amounts of table salt. Snack foods like chips and crackers are also high in salt.

Too much sodium in your diet can be harmful because it causes your blood to hold fluid. The extra fluid raises your blood pressure and puts a strain on your heart and kidneys. Talk with your dietitian about ways to reduce the amount of sodium in your diet. Look for the sodium content on the nutrition labels of the foods you buy. Choose "sodium-free" or "low-sodium" food products. Aim to keep your daily sodium intake less than 1,500 milligrams.

Try alternative seasonings like lemon juice, salt-free seasoning mixes, or hot pepper sauce. But avoid salt substitutes that use potassium.

Sodium Content of Foods

High-Sodium Foods Lower-Sodium Alternatives
Salt
Canned vegetables
Hot dogs
Packaged rice with sauce
Packaged noodles with sauce
Frozen vegetables with sauce
Canned soup
Tomato sauce
Snack foods
Salt-free herb seasonings
Frozen vegetables
Plain rice
Plain noodles
Unsalted pretzels
Unsalted popcorn

Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17-1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a307.pdf (PDF, 211 KB)  *; accessed June 3, 2005)

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Potassium

Potassium is found in many fruits and vegetables, such as bananas, potatoes, avocados, and melons. Check your blood tests to make sure that your potassium level stays in the normal range. If it begins to climb, talk with your dietitian about ways to limit the amount of potassium you eat. You may need to avoid some fruits and vegetables. You can reduce the potassium content of potatoes by soaking them in water for several hours before cooking.

Potassium Content of Foods

High-Potassium Foods Lower-Potassium Alternatives
Oranges and orange juice
Melons
Apricots
Banana
Kiwi
Potatoes
Tomatoes
Sweet potatoes
Cooked spinach
Beans (baked, kidney, lima, pinto)
Apples and apple juice
Cranberry juice
Canned fruit
Strawberries, blueberries, raspberries
Plums
Pineapple
Cabbage
Cauliflower
Mustard greens
Broccoli

Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17-1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a306.pdf (PDF, 211 KB)  *; accessed June 3, 2005)

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Phosphorus

Phosphorus is a mineral found in many foods. Too much phosphorus in your blood pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Too much phosphorus may also make your skin itch. Foods like milk and cheese, dried beans, peas, colas, canned iced teas and lemonade, nuts, and peanut butter are high in phosphorus. Talk with your dietitian about how much phosphorus you should have in your diet.

As your kidney disease progresses, you may need to take a phosphate binder like sevelamer hydrochloride (Renagel), calcium acetate (PhosLo), or calcium carbonate (Tums) to control the phosphorus in your blood. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool.

Phosphorus Content of Foods

High-Phosphorus Foods Lower-Phosphorus Alternatives
Dairy foods (milk, cheese, yogurt)
Beans (baked, kidney, lima, pinto)
Nuts and peanut butter
Processed meats (hot dogs, canned meat)
Cola
Canned iced teas and lemonade
Bran cereals
Egg yolks
Liquid non-dairy creamer
Sherbet
Pasta rice
Rice and corn cereals
Popcorn
Green beans
Lemon-lime soda
Root beer
Powdered iced tea and lemonade mixes

Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17-1 (www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/sr17a305.pdf (PDF, 211 KB)  *; accessed June 3, 2005)

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Fluids

As your kidney disease progresses, you may need to limit how much you drink because your kidneys can't remove the extra fluid, so it builds up in your body and strains the heart. Tell your doctor if you notice you are making either less urine or more urine or if you have any swelling around your eyes or in your legs, arms, or abdomen.

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Keep Track of Test Results

If you have CKD, your doctor will order regular blood tests. Many patients find that keeping track of their test results helps them see how their treatment is working. Ask your doctor for copies of your lab reports and ask to have them explained. Note any results that are out of the normal range. When you learn how to read your reports, you will see how the foods you eat affect your kidneys. Talk with your doctor or your dietitian about what you can do to make healthier food choices. Remember that you are the most important member of your health care team.

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Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at slowing the progression of chronic kidney disease. For example, the NIDDK is sponsoring the Chronic Renal Insufficiency Cohort study to determine the risk factors for rapid decline in kidney function and development of cardiovascular disease. This study of about 3,000 patients with chronic renal insufficiency, another way of describing CKD, will reflect the racial, ethnic, and gender composition of the people in the United States who have permanent kidney failure. The data collected and specimens obtained from people in this study will serve as a national resource for investigating CKD as well as cardiovascular disease. Establishing this group of patients and following them into the future will also provide an opportunity to examine genetic, environmental, behavioral, nutritional, quality-of-life, and health resource use factors in this population. The main part of the study will consist of monitoring patients and following up at regular clinic visits with kidney function measurements, cardiovascular studies, and laboratory tests. In addition, participants will answer questionnaires to assess various demographic, nutritional, and quality-of-life factors.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.


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Additional Reading

The following fact sheets and brochures, as well as other information, are available on request from the organizations listed. Most of them can also be found online at the web addresses given.

Dining Out With Confidence: A Guide for Patients with Kidney Disease
Nutrition and Chronic Kidney Disease

National Kidney Foundation

30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or 212-889-2210
Email: info@kidney.org
Internet: www.kidney.org click to view disclaimer page

Facts About the DASH Eating Plan
National Heart, Lung, and Blood Institute
Information Center

P.O. Box 30105
Bethesda, MD 20824-0105 
Phone: 301-592-8573 
TTY: 240-629-3255
Fax: 301-592-8563
Email: nhlbiinfo@nhlbi.nih.gov
Internet: www.nhlbi.nih.gov

A Healthy Food Guide for People with Chronic Kidney Disease
American Dietetic Association

120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995
Email: hotline@eatright.org
Internet: www.eatright.org click to view disclaimer page

Kidney Beginnings: A Patient's Guide to Living with Reduced Kidney Function
American Association of Kidney Patients

3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1-800-749-2257 or 813-636-8100
Email: info@aakp.org
Internet: www.aakp.org click to view disclaimer page

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For More Information

American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1-800-638-8299 or 301-881-3052
Email: helpline@kidneyfund.org
Internet: www.kidneyfund.org click to view disclaimer page

Food and Nutrition Information Center
National Agricultural Library/USDA
10301 Baltimore Avenue, Room 304
Beltsville, MD 20705-2351
Phone: 301-504-5719
Email: fnic@nal.usda.gov
Internet: www.nal.usda.gov/fnic

Life Options Rehabilitation Resource Center
c/o Medical Education Institute, Inc.
414 D'Onofrio Drive
Suite 200
Madison, WI 53719
Phone: 1-800-468-7777
Email: lifeoptions@MEIresearch.org
Internet: www.lifeoptions.org click to view disclaimer page

National Kidney Disease Education Program
3 Kidney Information Way
Bethesda, MD 20892 
Phone: 1-866-4-KIDNEY (454-3639)
Email: nkdep@info.niddk.gov
Internet: www.nkdep.nih.gov

The information in this fact sheet should not be used in the nutritional counseling of infants, children, and adolescents with chronic kidney disease. Families of pediatric patients with CKD should seek age-appropriate nutritional counseling from a pediatric renal dietitian.


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About the Nutrition for Chronic Kidney Disease Series

The NIDDK Nutrition for Chronic Kidney Disease Series includes three fact sheets:

  • Nutrition for Early Chronic Kidney Disease in Adults

  • Nutrition for Later Chronic Kidney Disease in Adults

  • Nutrition in Children with Chronic Kidney Disease

For free single printed copies of this series, please contact the National Kidney and Urologic Diseases Information Clearinghouse.

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National Kidney and Urologic Diseases Information Clearinghouse

3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Lisa Murphy-Gutekunst, MSEd, RD, CSR, Cleve-Hill Dialysis, Buffalo, NY; and Marcy Bushman, MPH, RD, LDN, Sigma-Tau Pharmaceuticals.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.


NIH Publication No. 06-5572
January 2006

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