What’s on Your Plate?
Find out the 5 food groups and how they work for you
March is National Kidney Month Be Your Kidneys’ Advocate
The Doctor Is In
What we all should know about kidney health
Living Well Through Awareness By Cathy Nedd Chief Operating Officer Michigan Chronicle
Welcome to LivingWELL. Recognized as the single most credible source of fitness, health and nutrition information for African Americans, each edition is crafted to provide insight into health disparities impacting African Americans and methods on prevention and treatment. There is a growing need for health awareness in our community. The mission of LivingWELL is to provide our readers with a wealth of information that enables them to live healthier and happier lives. In these pages you will find content on health issues, healthy lifestyles and relatable personal stories from people in our community. African Americans are 3 times more likely to experience kidney failure. Major risk factors include diabetes, high blood pressure, a family history of kidney failure and being age 60 or older. Kidney disease often has no symptoms; it can go unnoticed until it is very advanced. In honor of National Kidney month, this March, LivingWELL spoke with members from the National Kidney Foundation to gain insight on the importance of kidney health and ways to prevent kidney disease. There is good news. Taking steps to balance a healthy diet can go a long way towards reducing the risk for diseases such as, type 2 diabetes and hypertension. Healthy nutrition, Along with early detection and treatment can slow or prevent the progression of kidney disease. LivingWELL isn’t just words on a page, it’s a lifestyle and the Michigan Chronicle takes pride in helping lead the way. Be healthy and Live Well.
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| Be Your Kidney’s Advocate | What’s On Your Plate | What We All Should Know About Kidneys | March is National Kidney Month
Publisher | Hiram E. Jackson Managing Editor | Tatiana Jackson Graphic Designer | Juan Sifuentes 2 LivingWELL • Febrauary 2015
Be Your Kidneys’ Advocate Next time you go in for a physical, make sure to be prepared to speak up on behalf of your kidney health
Kidney Checklist for Your Annual Physical What to Share with the Doctor: • Lifestyle — Discuss your lifestyle. Controlling blood pressure and blood sugar, maintaining proper weight, stopping smoking, exercising regularly, and avoiding excessive use of medications that can harm the kidneys can reduce kidney disease risk. •Health history — Be sure to mention if you have a family history of kidney failure.
What Questions to Ask: •Request a simple urine test — If you have diabetes, high blood pressure, have a family history of kidney failure or are over age 60, ask for a simple urine test to screen for albuminuria (protein in your urine), one of the earliest signs of kidney disease. •Obtain a copy of your most recent blood test results. Review your cholesterol, blood pressure and blood glucose. Make sure you’ve had an eGFR calculated. If not, ask. •Ask questions about healthy lifestyle recommendations. Does your healthcare provider have specific suggestions or goals for you? •Find out if you’re taking any medications that could be harming your kidneys.
How To Interpret Results: Albumin-to-Creatinine (A:C) Ratio The A:C ratio estimates the amount of protein in your urine. Excessive protein in urine is one of the earliest signs of kidney disease. In a single urine specimen, less than 30 mg of albumin per gram of creatinine is normal, more than 30 mg is high, and 30-300 mg is very high. Estimated Glomerular Filtration Rate (eGFR) The eGFR measures kidney function by telling you how well your kidneys are filtering the blood. The goal is for this number to be higher than 60. Less than 60 indicates kidney disease. Blood Pressure High blood pressure is a leading cause of kidney disease. Normal blood pressure is less than 120/80 mmHg. High blood pressure is 140/90 mmHg or higher. Prehypertension (120-139/80-89 mmHg) can also damage the kidneys, so take this condition seriously. Blood Glucose (Sugar) Check This test checks for diabetes, the leading cause of kidney failure. A high blood sugar level can cause kidney problems. If fasting, over 125 mg/dL indicates diabetes. After eating, over 200 mg/dL indicates diabetes. Cholesterol If your total cholesterol is over 200 mg/dL, you may be at risk for cardiovascular (heart) disease, a major risk factor for kidney disease. Courtesy of the National Kidney Foundation. For more information visit www.kidney.org.
In recognition of Kidney Awareness Month, Living Well spoke with Charles Brown, a father of four and the grandfather of five from the metro Detroit area. He has courageously taken on the initiative to be an advocate for kidney health and help more people understand chronic kidney disease. Brown is a longtime advocate for the legal rights of people who are diagnosed with chronic kidney disease. He is heavily involved with the National Kidney Foundation of Michigan. As peer mentor for the NKFM’s Peer Mentoring Program, he reaches out to those who have questions and concerns and need support while coping with chronic kidney disease. In addition to the gratification from helping others affected by kidney disease, he finds pleasure in reading, traveling, spending time with friends and family, and participating in events where there is a connection of people. Living Well: What was life like before your diagnosis? Charles Brown: Life was normal. I enjoyed traveling and working. I have four children and five grandchildren. I particularly enjoyed being able to live without restrictions. LW: Were you considered at-risk for kidney disease? CB: I didn’t believe that I was. I was in good health at 5’11’, 185 lbs. I never missed time from work because of illness in 18 years. I can say that I haven’t had a cold in almost 20 years. I am not a smoker and I haven’t had alcohol in over a decade. Like many others, I didn’t believe that it could happen to me. I was active and didn’t have any weight concerns. LW: What was your mindset when you were diagnosed?
CB: Six years ago I was diagnosed with diabetes, the number one cause of CKD, especially in the Black community. I didn’t take it seriously as the problems that it caused were subtle. Like many men, I didn’t go to the doctor, just tough it out. LW: How has your life changed since being diagnosed with chronic kidney disease? CB: Monday, Wednesday and Fridays I begin my day at 5:00 a.m. to travel to my dialysis appointment. My session starts at 6:00 a.m. and I’m on the dialysis machine until 9:30 a.m. Once I’m done, I go home for breakfast and a quick rest. About 12:00 p.m., I go to my office if I don’t have an appointment. My day is very flexible as I control my schedule. I’m fortunate, as many in my shoes must work the job schedule they are assigned or make way for a replacement. With the current job market, I didn’t have an option. LW: What restrictions do you have? CB: I have to plan for travel. Planning time is the key and could be as much as 60-90 days. In five years I have only been able to do weekend travel. There are dialysis treatments that can be done at home. That creates additional challenges but allows more mobility. I also must be aware of my limitations and get rest. Charles Brown is a peer mentor for the National Kidney Foundation of Michigan. He can be contacted at (248) 266-0395 or geniyesproject@gmail.com.
LivingWELL • Febraury 2015 3
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ne of the most important components to leading a healthy lifestyle is nutrition. Proper nutrition combined with regular exercise can help prevent disease such as diabetes, hypertension and high cholesterol. There are five food groups — fruits, vegetables, grains, protein foods and dairy. Fruits Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up or pureed. The amount of fruit you need to eat depends on age, sex and level of physical activity. In general, one cup of fruit or 100% fruit juice, or one-half cup of dried fruit can be considered as one cup from the fruit group. Vegetables Any vegetable or 100% vegetable juice counts as a member of the vegetable group. Vegetables may be raw or cooked, fresh, frozen, canned or dried/dehydrated, and may be whole, cut-up, or mashed. Based on their nutrient content, vegetables are organized into five subgroups: dark green vegetables, starchy vegetables, red and orange vegetables beans, peas, and other vegetables. The amount of vegetables you need to eat depends on your age, sex, and level of physical activity. In general, one cup of raw or cooked vegetables or vegetable juice, or two cups of raw leafy greens can be considered as one cup from the Vegetable Group.
Grain Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal, breakfast cereals, tortillas and grits are examples of grain products. Grains are divided into two subgroups, whole grains and refined grains. Whole grains contain the entire grain kernel ― the bran, germ, and endosperm. Examples of whole grains include whole wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal and brown rice. Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron and many B vitamins. Some examples of refined grain products are white flour, de-germed cornmeal, white bread and white rice. At least half of all the grains eaten should be whole grains. Protein All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts and seeds are considered part of the protein foods group. Beans and peas are also part of the vegetable group. Select a variety of protein foods to improve nutrient intake and health benefits, including at least eight ounces of cooked seafood per week. Young children need less, depending on their age and calorie needs. The advice to consume seafood does not apply to vegetarians. Vegetarian options in the protein foods group include beans and peas, processed soy products, and nuts and seeds. Meat and poultry choices should be lean or low fat. • Choose lean or low-fat meat and poultry. If higher fat choices are made, such as regular ground beef or chicken with skin, the fat counts against your maximum limit for empty calories (calories from solid fats or added sugars). • If solid fat is added in cooking, such as frying chicken in shortening or frying eggs in butter or stick margarine, this also counts against your maximum limit for empty calories. Select some seafood that is rich in omega-3 fatty acids, such as salmon, trout, sardines, anchovies, herring, Pacific oysters and Atlantic and Pacific mackerel. Dairy All fluid milk products and many foods made from milk are considered part of this food group. Most dairy group choices should be fat-free or low-fat. Foods made from milk that retain their calcium content are part of the group. Foods made from milk that have little to no calcium, such as cream cheese, cream and butter, are not. Calcium-fortified soymilk (soy beverage) is also part of the Dairy Group. Dairy Tips • Choose fat-free or low-fat milk, yogurt and cheese. If you choose milk or yogurt that is not fat-free or cheese that is not low-fat, the fat in the product counts against your maximum limit for empty calories. • If sweetened milk products are chosen (flavored milk, yogurt, drinkable yogurt, desserts), the added sugars also count against your maximum limit for empty calories.
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mended daily amount and varies by age, sex vity. Find out your recommend daily amount myplate.gov. LivingWELL • Febraury 2015 5
What we all should know about kidneys LivingWell spoke this month with nephrologist Jerry Yee. We asked important questions to better understand the kidneys and how we can avoid chronic kidney disease. Living Well: What is the function of the kidneys? Dr. Jerry Yee: Healthy kidneys do many important jobs. They keep your whole body in balance. Among Dr. Jerry Yee other things, they remove waste products and extra water from your body. They also help your body make red blood cells, regulate blood pressure and keep your bones healthy and strong. The kidneys filter the blood. The blood cells and major proteins are not filtered, however, and they remain in the blood vessels. The plasma is filtered and wastes are excreted in the urine. On average, in a normal individual, more than 45 gallons of plasma is filtered daily. LW: What is chronic kidney disease? JY: Chronic kidney disease, or CKD, is low filtering capability of one’s kidneys. The normal kidney function declines with age quite slowly, so the majority of persons will not develop CKD. For adults, the glomerular filtration rate (a test used to check how well the kidneys are working) is estimated by a laboratory equation and is normally more than 60 ml per minute per 1.73 square meters of body surface area. If the filtering function becomes less than 60 ml per minute per 1.73 square meters of body surface area for more than three months, then CKD is present. Also, if the kidneys are naturally deformed or develop tissue anomalies, CKD is present, even if the glomerular filtration rate is greater than 60. The same is true if there is persistent albumin or blood that originates from the kidneys in the urine. LW: What causes African Americans to have a higher diagnosis rate that any other ethnic group? JY: We know that African Americans have a higher rate of kidney failure than any other group of people. However, the reasons for this are not fully understood. What we do know is this: African Americans have more diabetes and high blood pressure than other Americans, and having diabetes or high blood pressure can lead to kidney disease and kidney failure. Being overweight is also a factor because it contributes 6 LivingWELL • February 2015
to a higher rate of diabetes in African Americans. Access to healthcare may also play a role. According to a recent study, many African Americans do not even know they have kidney disease until it’s in the latest stages. This means it is not found when treatment can still help slow or stop the damage from getting worse. Finally, heredity may also be involved. According to a recent study by the National Institute of Health, some African Americans are born with a “highrisk” gene. African Americans with kidney disease who have the high-risk gene are twice as likely to progress to kidney failure as African Americans without the high-risk gene or White Americans. LW: When should someone have his or her kidneys checked? JY: Everyone is different, but some people have an increased risk for kidney disease. You should be checked regularly for kidney disease if you ave diabetes or high blood pressure; are 60 years or older; have a family history of kidney disease; are African American, Hispanic, Asian, Pacific Islander, Alaska Native or Native American; have used medications over the course of many years that damage the kidneys (such as NSAIDS); are overweight. The more risk factors your have, the greater your risk for kidney disease. LW: What happens when the kidneys are damaged? JY: The glomerular filtration rate is so low that toxins produced from normal bodily metabolism build up in the blood and the patient becomes ill. Also, the risk of high blood pressure and heart disease increase as well as declines in immune function and other systems occur. You will need to follow a treatment plan that may include taking medicines, limiting salt and certain foods, getting exercise, controlling diabetes and high blood pressure
and more. Finding and treating kidney disease early can help keep it from getting worse. If kidney disease gets worse, it can lead to kidney failure. Once kidneys fail, treatment with dialysis or a kidney transplant is needed to stay alive. LW: Is kidney failure permanent? JY: Yes. Once your kidneys fail, you will need treatment with dialysis or a kidney transplant to stay alive. There is one exception to this rule. Some people with perfectly healthy kidneys may experience a sudden type of kidney problem called acute kidney failure. This type of kidney failure usually gets better after treatment. It can happen if a person becomes critically ill, has complications from surgery or needs treatment in the intensive care unit (ICU). It can also happen after use of certain strong medications or during some diagnostic tests. LW: When is dialysis needed? JY: If kidney function has gotten low enough, usually 10% or less than normal and symptoms are present, dialysis is typically started. You will need dialysis if you develop kidney failure. This happens when you lose about 85 to 90 percent of your kidney function. There are two types of dialysis, hemodialysis and peritoneal dialysis. Both remove waste products and extra fluid from your blood. People should know that they have choices when it comes to dialysis. In fact, some people can choose to do dialysis at home. LW: Are there other methods used besides dialysis for patients experiencing kidney failure? JY: Yes. Besides dialysis, the other treatment for kidney failure is kidney transplant. A kidney transplant is an operation that places a healthy kidney in your body. The healthy kidney will replace the work of the failed kidney. Kidney transplantation offers the greatest survival of all forms of kidney replacement therapy. Donation of a kidney from a live donor works better than one from a deceased donor. Donation from a relative also works better than from an unrelated donor. If you have kidney failure, you should learn everything you can about all your treatment options. The more you know, the better you’ll understand why something is part of your treatment.
March is National Kidney Month and March 12 is World Kidney Day.
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he National Kidney Foundation of Michigan (NKFM) is calling on all Michiganders to take five healthy steps for their kidneys. More than 900,000 Michigan adults have chronic kidney disease and most don’t know it. In most cases, chronic kidney disease can be managed or prevented to delay the onset of other health complications. The kidneys are the body’s chemical factories, filtering waste and performing vital functions that control things like red blood cell production and blood pressure. But over time, the kidneys can become damaged with little or no physical symptoms to warn you that your kidneys are in trouble. “Of the 26 million American adults estimated to have kidney disease, most don’t know they have it. That’s why taking care of your kidneys, especially if you are at risk for kidney disease, is vital,” said Joseph Vassalotti, MD, National Kidney Foundation chief medical officer. “There are a few simple things people can do to keep their kidneys healthy and strong.” Take 5 for Your Kidneys Everyone can do five simple things to protect their kidneys: Get tested — Ask your doctor for an ACR urine test or a GFR blood test annually if you have diabetes, high blood pressure, are over age 60 or have a family history of kidney failure.
Reduce NSAIDs. — Over-the-counter pain medicines, such as NSAIDs (nonsteroidal anti-inflammatory drugs), may alleviate your aches and pains, but they can harm the kidneys, especially if you already have kidney disease. Reduce your regular use of NSAIDs and never go over the recommended dosage. Cut Processed Foods — Processed foods can be significant sources of sodium, nitrates and phosphates and have been linked to cancer, heart disease and kidney disease. Try adopting the DASH diet to guide your healthy eating habits. Exercise regularly — This is beneficial to the kidneys. Regular exercise will keep your bones, muscles, blood vessels, heart and kidneys healthy. Getting active for at least 30 minutes a day can also help you control blood pressure and lower blood sugar, vital to kidney health. Stay Well Hydrated — Doing so helps your kidneys clear sodium, urea and toxins from the body. Drinking plenty of water and avoiding sugary beverages are of the best ways to avoid painful kidney stones. Those with kidney problems or kidney failure may need to restrict their fluid intake, but for most people, drinking 1.5 to 2 liters (three to four pints) of water per day is recommended. Throughout National Kidney Month, the NKFM is
offering resources, community events and more. To find a local program or event near you, or to learn more about the risk factors for kidney disease, visit www.nkfm.org/KidneyMonth. The mission of the National Kidney Foundation of Michigan is to prevent kidney disease and improve the quality of life for those living with it. Since its inception, the NKFM has led the fight against kidney disease and is widely known for providing more programs and services to more people than any other region or state. The NKFM was recently ranked No. 1 in the category of Diseases, Disciplines and Disorders by Charity Navigator, the nation’s largest and most-utilized evaluator of charities. The organization has also been recognized for its success in sound fiscal management by receiving a 4-star rating, seven years in a row from Charity Navigator. In 2014, the NKFM was named in the “11 Top-Rated Charities that Changed the World in 2014” by the Huffington Post. LivingWELL • February 2015 7
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