Healthy Eating For Life

By Carrie Mukaida
Interviewed by Melissa Moniz
Wednesday - July 29, 2009
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Carrie Mukaida
Renal Nutritionist

Interviewed By Melissa Moniz

What is a renal dietitian?

I specialize in helping people with chronic kidney disease take better care of themselves to slow the progression of their kidney damage. Once kidneys have been severely damaged, people have to start a treatment called dialysis, which is an artificial way of cleaning and filtering the blood. When patients start dialysis, a renal dietitian closely follows them at their dialysis center.

How does nutrition play a role in the formation of chronic kidney disease?

The major causes of chronic kidney disease are diabetes and high blood pressure. So if we can treat and control diabetes and high blood pressure early on, we can slow the damage to the kidney and, perhaps, even prevent kidney failure.

Do you have a set formula as to what people with diabetes and high blood pressure should be eating and not eating?

It varies a lot, depending on the individual. I always say that there’s no such thing as a renal diet because it has to be individualized to fit. And some of the risk factors have to do with metabolism, heredity, diet, lack of exercise and smoking. But I usually say that you inherit a tendency to a disease, and that disease can “come out” if the person does not have a healthy lifestyle. That’s why we tend to see more of these diseases in “developed countries,” because people in “under-developed countries” are still doing a lot of walking and physical labor, and eat more vegetables and less processed foods.

Carrie Mukaida checks out the green leafy veggies at Kaiser Moanalua’s weekly farmers market

Right now one of the concerns in the renal community is the increasing incidence and prevalence of obesity in young people. We are seeing more and more kids who gain a lot of weight very early on and who eventually develop Type II diabetes. When I first began working, Type II diabetes didn’t usually develop until someone was in their 40s or 50s.

With that said, I think one of the messages that we at Kaiser Permanente really feel strongly about is to keep our kids healthy.

Can you talk about medication and diet and how those two treatments work together to help with diabetes and high blood pressure?

When diabetes and hyper-tension are first diagnosed, we can be very successful with lifestyle changes without resorting to medications. For most people, it’s losing a little bit of weight (7 percent to 10 percent of their body weight). Once people start using medications it doesn’t mean that they can stop watching their diet and stop exercising, but a lot of people feel that way. It’s easier to take a pill than to pass up the Big Mac.

What’s your philosophy on food and diet?

I often say that food is a lot like people: Every food has its positives and negatives. So there’s room for everything in the way we eat, but we need to watch the amount. The size of our plates and glasses has gotten bigger, and so have our portions. I think one of the big problems with nutrition is what we drink - we drink a lot of calories. I just had a patient who told me he drinks a six pack of Coke every day: That’s 900 calories of sugar. And that’s not unusual. When I counsel people, the analogy that I use is that the portion they would give you on the airplane is all you need. A lot of it is psychological, and a lot of it is training.

There’s also a possible connection between insulin production and appetite as well. When you eat carbohydrates your body kicks out insulin to help your body absorb and use that carb. Insulin, in turn, causes the production of a neurochemical that affects mood. Without realizing it, some people start to eat more, because they may feel calmer, and get into a vicious cycle of gaining weight, feeling depressed and eating more.

Do you feel that obesity is a disease or is it something that can be controlled?

Obesity is a controllable disease. It is a disease because it damages and affects many body systems. It’s most controllable if you nip it early.

You often hear of people who say that no amount of diet and exercise can allow them to lose weight. Is that possible, where genetics overrides diet and exercise?

Energy balance is pretty much physics, so when you talk about calories, it’s just how we measure energy. So if energy in equals energy out, then your weight should remain stable. If you’re putting more food in and not burning it off, then you’ll gain weight. It’s tricky because a lot of folks who I see with weight problems have a distorted perception of how much they’re eating. They’re telling me that they hardly eat anything and all they have is one little scoop of rice. But their idea of one little scoop of rice is very different than mine. Or they’ll say they had a saimin bowl for dinner, but the size of the bowl may really be equal to three or four servings. And they are not aware of the hidden sodium fats, oils and sugar in the foods they eat.

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