Food & Dialysis
Aaron McCargo, Jr. is bringing his trademark, the “Flavor of Bold”, into dialysis patients’ kitchens. The winner of the TV casting show “The Next Food Network Star” in 2008 has his own TV show called “Big Daddy’s House”. He has been developing recipes for and cooking with dialysis patients ever since he joined Fresenius Medical Care’s Healthy Lifestyles initiative in North America in January, 2011. Aaron started his career early on working in hospital kitchens, where he learned that “eating is an essential part of patients’ lifestyles and helps them in their fight for their lives”. He also knows a major problem faced by people on dialysis: Because they have to follow a strict diet, many lose their appetite. Aaron’s mission is to create dialysis-friendly recipes that are so easy, affordable and mouthwatering that patients and their families just have to try them.
A passion for food
Aaron’s eyes light up at the sight of a chunk of chicken turning golden brown. The sizzling of the panada is music to his ears, and he loves to inhale the scent of fresh herbs. “I often wake up in the middle of the night with some recipe in my head, so I get up and write down all the ingredients,” he explains. Cooking and enjoying good food mean the world to him. “Many dialysis patients tell me they used to feel he same,” Aaron says. But because they are obliged to avoid some ingredients and to limit others, to use little or no salt and to reduce their fluid intake, they are discouraged from cooking and enjoying meals.
Aaron consulted Fresenius Medical Care’s dietitians and found out which foods patients can eat, and which are a no-go. “I was shocked when I found out that people on dialysis can’t eat bananas, broccoli, oranges, tomatoes, nuts or beans,” the celebrity chef admits. “Things that are generally considered healthy.“ Unlike healthy kidneys, dialysis does not filter patients’ blood around the clock. Nutrients like phosphorus, which together with calcium keeps the bones strong, and potassium, which enables nerves to communicate with muscles, can accumulate within patients’ bodies, resulting in complications such as strokes or heart attacks. To make things even more confusing, foods that are high in phosphorus are often also high in protein. And dialysis patients need about a third more protein than people with healthy kidneys, as they lose some of this vital nutrient during treatment. One of the worst foods for dialysis patients is star fruit (carambola): It contains neurotoxins that are harmless for healthy people, but life-threatening if your kidneys have failed.
When he creates his dialysis-friendly recipes, Aaron McCargo, Jr. leaves out these dangerous ingredients, replacing salt with fresh herbs, lemon zest or pepper, for example. People on dialysis should not ingest more sodium per day than contained in one teaspoon of salt, whereas healthy people usually consume the equivalent of 2.5 teaspoons or more. And while the recommended fluid intake for people with functioning kidneys is about two liters a day, many dialysis patients are advised not to drink more than a quarter the amount. This is because excess fluid is not removed during dialysis and fluid retention can lead to edemas, high blood pressure and other complications. Knowing this, Aaron’s dishes include as little fluid as possible. Whenever a patient tells Aaron what he misses most, the chef feels challenged to create an alternative, “with a distinctive flavor, but following the rules”. Since treatment eats up enough of patients’ time, Aaron makes sure that his meals don’t take long to prepare – some can be pre-made and frozen. Aaron is happy whenever “a patient gets back in the kitchen because of one of my recipes and when it puts a smile on their faces. This makes me want to work even harder.” No wonder he dreams of dialysis-friendly meals at night.
“Not Too Spicy for Your Mama” Chipotle Wings
1 pound fresh jumbo chicken wings cut in pieces,
1½ tablespoons diced chipotle peppers in adobo sauce,
¼ cup honey,
¼ cup unsalted butter (slightly melted),
1 teaspoon black pepper,
1 tablespoon chopped chives
Pre-heat oven to 400° F. Place pre-cut wings on a greased non-stick sheet tray. Bake for 18 – 20 minutes, turning half-way through the cooking time, or until crisp on the outside and reaching an internal temperature of 160° F. In a large bowl, mix remaining ingredients and stir until well mixed. Toss wings in sauce until evenly coated, then remove from bowl and serve.
31 grams protein
237 mg potassium
177 mg phosphorus
107 mg sodium
“New You” Jumbo Shrimp Scampi
1 pound (16/20) peeled shrimp,
2 tablespoons chopped fresh garlic,
1 teaspoon crushed red pepper flakes,
½ teaspoon black pepper,
¼ cup fresh-squeezed lemon juice,
2 tablespoons white wine (or 2 tbsp low-sodium chicken stock),
2 tablespoons unsalted cold butter (cubed small),
1 tablespoon chopped parsley,
¼ cup flour,
¼ cup canola oil
Heat half of the canola oil in large nonstick sauté pan on medium high heat. In a large bowl, mix flour, black pepper, and red pepper flakes. Toss shrimp in flour mixture and coat evenly. Sauté shrimp for approximately 3 – 5 minutes on each side in batches (use leftover oil as needed). Remove from pan and place on a plate or sheet tray to rest. Add to the same pan the garlic, wine, and lemon juice; stir and cook until hot. Turn off heat, stir in cold butter in small amounts until incorporated. Add shrimp back to pan with any drippings along with parsley and toss or stir until coated.
24 grams protein
259 mg potassium
249 mg phosphorus
172 mg sodium
Chef McCargo’s Jalapeño Turkey Burger
“Jalapeño and Lime meets Smoked Mozzarella”
1½ pound ground turkey,
1 jalapeño or 2 tablespoons finely diced jalapeño,
Juice of 2 limes and zest of 1,
1 tablespoon black pepper,
1 tablespoon reduced-sodium Worcestershire sauce,
4 tablespoons extra virgin olive oil,
¾ cup shredded smoked mozzarella cheese,
6 hamburger buns
Pre-heat oven. In a medium size bowl, mix the first 5 ingredients plus 2 tbsp. of olive oil. Make equal size burger patties and lightly brush with remainder 2 tbsp. of oil. Cook for 5 – 7 minutes, flipping once, or waiting until an internal temperature of 165°F is reached. Top each with an equal amount of cheese and melt in a toaster oven or in oven on broil. Serve on a toasted bun.
28 grams protein
382 mg potassium
286 mg phosphorus
344 mg sodium
Crunchy Picking Pumpkin Strudel
12 sheets phyllo dough,
1½ cups canned pumpkin,
¼ cup sugar,
1 tablespoon cinnamon,
⅛ tablespoon nutmeg,
2 tablespoons vanilla extract,
½ stick (4 tablespoons) unsalted butter (melted)
Pre-heat oven to 375°F. In medium-size bowl, mix canned pumpkin, nutmeg, vanilla, half the sugar and half the cinnamon until well mixed. Brush melted butter on bottom of non-stick medium-size sheet tray and in between every other phyllo sheet. (Be sure to save a little melted butter.) Stack the sheets together in one pile and pour mix on one edge of the stacked phyllo sheets, length side, then roll from filled end to unfilled end making sure the seam side ends up facing down. Place on a greased sheet tray seam side down and brush with remaining butter. Mix sugar and cinnamon and sprinkle over the top and sides of the strudel. Bake for 12 – 15 minutes. Remove from oven and let rest for 5 – 10 minutes before cutting.
3 grams protein
126 mg potassium
40 mg phosphorus
141 mg sodium
Dos and Don’ts
The body needs protein for various vital processes such as building muscles, repairing tissues and producing hormones and enzymes. As protein gets lost during dialysis, patients need more protein than people with healthy kidneys. They should therefore choose foods that are rich in high-quality protein such as beef, pork, poultry, lamb, eggs, fish, soy, and dairy products.
Phosphorus and calcium
Phosphorus and calcium are vital for healthy bones, but are often unbalanced in dialysis patients. Therefore patients take phosphate binders whenever necessary to strengthen their bones and consume foods or drinks that are rich in phosphorus, such as roast beef, plain yogurt, cola drinks, nuts, and cheddar cheese, only in moderation.
To function perfectly, the nerves and muscles need potassium, a mineral found in many fruits and vegetables. But while there are no limits to the amount of potassium a healthy person can consume, dialysis patients have to make sure they don’t eat too much as it can have an adverse effect on their hearts. Patients should therefore omit or limit foods that are rich in potassium such as tomatoes, bananas, white beans, potatoes and avocados.
Sodium is a mineral that plays a key role in controlling blood pressure and water balance within the body. Healthy kidneys rid the body of excess sodium, but in dialysis patients, sodium and fluid can build up, resulting in high blood pressure, cardiac arrests or strokes. To avoid complications, dialysis patients should be aware of hidden salt, e.g. in camembert cheese, ready-made sauces, canned soup, smoked salmon, salami, and frozen pizza.
Since dialysis cannot remove fluids from the body as effectively as healthy kidneys do, most patients have to limit their fluid intake. Fortunately, there are some tricks that can help: avoiding food that is too salty or too sweet, for example, sucking on a grape or ice cube whenever thirsty, rinsing your mouth with cold water, or chewing sugar-free chewing gum.