Q: My 13-year old son is suffering from Nephrotic Syndrome. His blood protein levels are slightly below normal, but his blood cholesterol is very high. He has been prescribed medication. What kind of diet should I give him?
AS, Jamshedpur
In a healthy person, the urine does not contain protein as its large molecules cannot pass through the kidney filtering units. In Nephrotic Syndrome these delicate filtering units which are called glomeruli, get damaged for various reasons, allowing large quantities of protein to leak into the urine. Daily protein loss in the urine results in the fall of blood protein levels, leading to swelling in different parts of the body due to the accumulation of fluid. This is generally associated with an increased blood cholesterol level and an enhanced tendency of the blood to clot. The dietary needs in Nephrotic Syndrome must address these changes in the body. Here are some tips:
Ensure adequate protein intake but not too much. Considering his growing needs and the leaking kidneys, give your son one gram of protein per kilogram ideal body weight. For example, at height five feet one inch (5’1”) he should be taking approximately 50g of protein daily. Half of this should be of animal origin like egg whites, fish, chicken and skimmed milk products. Avoid high-fat animal protein like mutton, beef, pork, egg-yolks, and full cream milk. If his appetite is poor (which often happens in Nephrotic Syndrome), he may require to take protein supplements. Consult a dietician to chalk out the details.
To control body swelling successfully you will need to restrict his salt (sodium) intake. The kidneys generally do not throw out sodium fully in this ailment. The best way to do this is to cut out from his diet, as far as possible, all processed foods which normally contribute to approximately 50 per cent of our sodium intake. So avoid all kinds of ready-to-eat sauces, pickles, butter, cheese, papads, etc. Bakery products like bread and biscuits are rich in sodium and so are the fast foods and most restaurant foods. Restrict their intake. Finally, avoid adding salt to food at the table.
To control elevated blood cholesterol levels, give your son oats and barley regularly as well as nuts like almonds, walnuts and pistachio. For cooking, use only the mono-unsaturated fatty acid (MUFA) — containing oils like olive, canola, rapeseed, mustard and rice-bran. Avoid the omega-6 polyunsaturated fatty acid (PUFA) — rich oils like sunflower, safflower, corn and soybean oils. At the same time, limit his total fat intake by restricting deep fried foods.
Vegetables and fruits of all kinds and colours and pulses, whole-grains and spices (cinnamon, cloves, cumin, coriander) can be consumed freely and should be included daily in the diet. Their fibre, phytonutrients and antioxidants help protect the arteries from getting clogged by atherosclerosis, a process more common in Nephrotic Syndrome.