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Sunday, December 23, 2012

Pros and Cons of Monetary Compensation in Kidney Transplantation

Demand for organs has always exceeded supply. In order to resolve the shortage of donors, some have advocated financial payments being made to donors. Despite being illegal in most countries, the trade appears to be booming in nations such as Turkey, Russia, and South Africa

In 2008, the legislative branch of the Israeli government, approved a law that provides for various benefits to living organ donors, such as:

1. Reimbursement for medical expenses and lost work up to $5,000
2. Priority on the transplant list should they require a future organ donation
3. Waived self-participation fee for any medical service resulting from the donation
4. Attainment of a "chronic patient" status, which entitles the holder to additional medical benefits. 
5. If two patients have the same medical need, priority will now go to the patient who has signed an organ donor card, or whose family members have donated an organ (though medical necessity is still takes precedence).

One of the few countries that has legalised the sale of organs is Iran. A third-party independent association was set up to arrange contact between donors and recipients. This agency is staffed on a voluntary basis by end-stage renal failure patients. Within the first year of the establishment of this system, the number of transplants had almost doubled; nearly four fifths (80%) were from living unrelated sources. Donors receive:

1. A Payment from the government
2. Free health insurance 
3. Often payment from the recipient or a charity

The receiver of the ‘new’ kidney is provided with highly subsidized immunosuppression and charitable organizations allow those unable to pay for the transplant themselves to receive a new organ. Importantly, it is illegal for the medical and surgical teams involved or any ‘middleman’ to receive payment. A potential donor is also not allowed to contact anyone on the waiting list. Despite, this, anecdotal stories of young men touting their ‘spare’ kidney in dialysis clinics are common.

Multiple advertisement for selling kidney in Iran

While still illegal in ‘Western’ nations, could the ‘Iranian model’ of payment for kidney donation be used in Unites States to solve the problems of kidney donor shortages? 

Pros:
1. The advocates for legalization argue that each of us has autonomy over our own body in every aspect of our health and that from this stems the right to donate a kidney to a related or non-related patient. Payment for sperm and eggs is legal in many countries, even though they arguably have greater long-term implications due to the potential to create a whole new individual. Similarly to compensation received for participation in some clinical trials, the individual also gains no immediate benefit from putting themselves at risk.

2. After the initial peri-operative risk, the donor has no long term increased risk of mortality.

3. Most importantly, in the longer term, there is no significant acceleration in decrease in glomerular filtration rate (beyond that expected due to aging) in kidney donors fifteen years after transplantation. 

4. Charitable organizations allow those unable to pay for the transplant themselves to receive a new organ

5. Advocates of the Iranian model insist that where there was once a significant waiting time in excess of the length in ‘Western’ nations, there is now no waiting time. 

6. The Iranian system is known to have ethical and legal loopholes which have been exposed and exploited. 

7. There are “no significant differences” in groups of donors and recipients when compared in terms of socioeconomic background (wealth and education level). Thus significant social exploitation is not occurring. 

8. One of the earliest problems involved patients from abroad travelling to Iran to receive a kidney donation from an Iranian. This practice was outlawed to prevent the development of true ‘transplantation tourism’ and international exploitation of Iranian donors. In addition, refugee groups (such as those from Afghanistan) are offered transplants but are not allowed to donate to people outside of their ethnic groups, further decreasing potential exploitation of vulnerable groups.

9. As ESRD continues to grow in prevalence, the problem of unregulated organ markets and brokers is likely to become more severe. It is argued that the setting up of regulated markets would ‘cut out the middleman’ and reduce the exploitation of individuals and developing nations.

10. Inferior surgical and medical practice, common on the black market, leave both the donor and recipient at greater risk whilst the broker pockets a large cut of the proceeds.

11. The end-stage renal failure population continues to increase in most countries, putting an increasingly heavy load on medical infrastructure. Using economic cost-effectiveness analyses, a figure of approximately $90,000US has been proposed, much less than the estimated cost of dialysis of up to $70,000US per annum per patient. Government intervention would also guarantee adequate post-operative care and follow-up for the donor, something which is currently limited.


Cons:
1. The downside of legalizing Kidney trade is that the majority of those selling kidneys in Iran are disproportionately poor. 
2. Opponents argue that the donation of a kidney is permanent.
3. Iranian system insist that the systemis not as perfect as it seems. 
4. There is evidence to suggest Iran’s system has not cleared its waiting list and that trading between socioeconomic classes is a substantial problem. 
5. Critics of the Iran model would argue that even this well developed system has major flaws and that a ban on payment to kidney donation should be maintained in other parts of the world.




A possible compromise
1. A non-monetary reward system. For instance, patients who have previously agreed to be on the transplant list could receive priority health care.

2. It has also been suggested that governments should control the monetary aspects of the transactions rather than payment passing directly from individual to individual. The donor would effectively sell their organ to the state which would then allocate it on the basis of clinical need. By making the process more medically transparent, it may placate to some degree those who accuse pro-monetary transplantation advocates of disregarding the exploitation of the poor by the rich. It is also likely that a ‘fair’ standard price could be set to prevent those in desperate financial need from being even further exploited. 

As the pressure of demand for organs continues to increase rapidly, the idea of financial compensation for kidney donation will continue to rise. 

References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/
Griffin A. Kidneys on Demand. BMJ. 2007;334:502–505.
Ghods AJ, Savaj S. Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation. Clin J Am Soc Nephrol. 2006;1:1136–1145.
http://en.wikipedia.org/wiki/Knesset











Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, December 16, 2012

Erectile Dysfunction in Chronic Kidney Disease Patients

http://pinterest.com/amashhadian/erectile-dysfunction/
Sexual dysfunction is very common in patients with chronic kidney disease. Kidney disease can cause chemical changes in the body affecting circulation, nerve function, hormones and energy level. The condition has been found to be significantly more common in men and women with chronic kidney disease (CKD) than in the general population. Approximately 50% of male predialysis CKD patients and 80% of male dialysis patients have erectile dysfunction. Multiple factors contribute to the frequent occurrence of sexual dysfunction in CKD patients, including hormonal disturbances such as hyperprolactinemia, hypogonadism in males.

Causes of erectile dysfunction in chronic kidney disease:
1. Diabetes 
2. High Blood pressure
3. Men with renal disease may find their hormone levels changing
4. Side effect of medicines, particularly those taken to control blood pressure
5. Symptoms such as breath and body odor, weight gain or unusual facial or body hair may be present
6. A man on hemodialysis may feel self conscious about how his vascular access site looks and feels
7. Men on peritoneal dialysis may worry about the size of their abdomens
8. Some men with kidney disease are afraid sexual activity may be harmful to their condition or harmful to their partners. 
9. Anemia due to kidney disease
10. Chronic kidney disease mineral and bone disorder

Treatment must start with determining and treating the underlying causes. Honest evaluation of alcohol, tobacco, and recreational drugs is essential. Assessment of emotional life, i.e. how well the patient gets along with his partner is vital. He may benefit from a referral to a psychotherapist, or the couple may be advised to seek marriage guidance. For men in whom vascular problem appears to predominate: Doppler studies, pharmacocavernosometry, pharmacocavernosography, dynamic infusion studies, and colour Doppler response studies may be helpful. 

Once erectile dysfunction is diagnosed and psychosexual component is ruled out a review of the drugs, haemoglobulin levels and dialysis adequacy should be corrected. They should have hormonal studies, including testosterone, LH, FSH, and prolactin. Correction of these hormones may not necessarily restore libido. The use of testosterone injections have shown only a small and variable response in erectile function. Using clomiphene in uraemic males may correct the androgen deficiency and increase the sense of well‐being, libido, and potency, similarly to testosterone administration; however, its long‐term use in uraemia is inconclusive.  To treat erectile dysfunction, bromocriptine in doses of 2.5–5 mg has been shown to improve libido and potency; the mechanism, however, remains unclear and it is possible that bromocriptine may influence potency directly as a result of its dopaminergic properties.

http://www.aafp.org/afp/2000/0101/p95.html

Treatment of erectile dysfunction in chronic kidney disease:
1. Your doctor can perform blood work to determine if your lack of interest in sex is due to your changing hormone levels. He may prescribe medicine to bring your levels to a normal range.
2. Talk to your doctor about the blood pressure medications you are taking if you are experiencing impotence. 
3. Phosphodiesterase-5 inhibitors (PDE5i) such as viagra compared with placebo significantly increases sexual performance.
4. Oral zinc supplementation results in a significant increase in plasma testosterone concentration along with an increase in the potency and frequency of intercourse. 
5. Only sparse data are available for vitamin E, bromocriptine, and dihydroxycholecalciferol in CKD patients and no trials assessed intracavernous injections, transurethral injections, mechanical devices, or behavioral therapy in CKD. 

Therapies that have been used to treat sexual dysfunction include phosphodiesterase-5 inhibitors (PDE5i), intracavernosal injections, intraurethral suppositories, hormonal therapy, mechanical devices, and psychotherapy.
Studies have also identified significant associations between sexual dysfunction in chronic kidney disease patients and depression, impaired quality of life, and adverse cardiovascular outcomes. Effective treatment of sexual dysfunction in CKD patients may therefore potentially lead to improvement in these patient-level outcome. There are now many new assessment techniques and treatments. There are encouraging reports in the use of phosphodiestrase 5‐inhibitors use in patients with CKD. A greater awareness of this common problem should be encouraged so that patients and their partners do not feel embarrassed about broaching this subject with their physicians. Although renal transplant may effectively reverse many of the hormonal and psychological changes of chronic renal failure, many patients will remain on a transplant waiting list for a considerable length of time. Patients who develop significant vascular disease may still remain impotent even after a successful transplant.








Resources:
http://cjasn.asnjournals.org/content/5/6/985.abstract
http://ndt.oxfordjournals.org/content/15/10/1525.full
http://www.davita.com/kidney-disease/overview/living-with-ckd/male-sexuality-and-chronic-kidney-disease/e/4900

Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Tuesday, November 27, 2012

Appropriate Initiation of and Withdrawal from Dialysis

http://pinterest.com/amashhadian/appropriate-initiation-of-and-withdrawal-from-dial/
Mortality remains high for seriously ill patients who develop ARF, and dialysis in this population is generally not cost effec- tive. Little is known about the long-term outcome and quality of life of survivors of ARF in ICUs but most patients appear to recover kidney function and enjoy acceptable quality of life. Scoring systems to estimate prognosis in such patients are not perfect but often provide information useful in medical deci- sion-making. The RPA/ASN guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis provides general recommendations to follow when withholding and withdrawing dialysis is considered. Time-limited trials of dialysis with predetermined measures of improvement, reason- able goals and duration of the trial, and ongoing assessment and communication of clinical status with patients, families, and care providers may enhance decision-making, reduce dis- comfort among providers and families, and lead to fewer cases of extended intensive care for seriously ill patients with poor prognoses. Greater awareness and dissemination of the RPA/ ASN guidelines may facilitate decision-making and care of seriously ill patients who develop ARF.


For more information please visit:
http://cjasn.asnjournals.org/content/3/2/587.long
http://jasn.asnjournals.org/content/11/7/1340.full





Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, October 28, 2012

Depression in Patients with Chronic Kidney Disease


One in five patients with chronic kidney disease is depressed, even before beginning long-term dialysis therapy or developing end-stage renal disease. Chronic kidney disease patients with depression have poorer health outcomes than those without depression, even after adjusting for other factors that determine poor outcomes in these patients.

However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients.

When you learn that your kidneys no longer work, it is normal to feel angry, fearful, and sad. Your doctor or nurse can answer medical questions, and a social worker at your unit can help you during this hard time. You have a lot to learn, and many changes to fit into your life. Write down your questions, so you can get them answered and reduce your worrying. You will have ups and downs as you adjust to kidney failure. This is normal. After you get used to your new life and get answers to your questions, you should start to feel better. Even though your dialysis schedule and new eating plan may be hard to get used to, they should start to feel like normal part of who you are and what you do each day.

Here are 9 effective ways to overcome depression with kidney disease:

1. Talk to social worker in your dialysis center.
2. Surround yourself with sights, sounds and smells that give you happiness.
3. Join depression and dialysis support groups
4. Start exercising, even a little.
5. Spend at least 10 minutes every day outside in the fresh air.
6. Reach out past yourself to help someone else.
7. Reach out to your family and friends for support.
8. Seek professional help - ask for a referral to a counselor.
9.  Ask your nephrologist about depression medications that can be used based on your kidney limitations.
Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author
Proposed algorithm for management of depression in patients with CKD and ESRD. Alternative therapies include psychotherapy, counseling, social support, and music therapy. CKD, chronic kidney disease; ESRD, end-stage renal disease; MDE, major depressive episode



http://www.aakp.org/ has great article on this issue. For more information please click here
http://www.nature.com/ also has many good information for providers. please click here
When do you feel more depressed? During dialysis or before dialysis? 

Sunday, October 14, 2012

Management of Cholesterol in Patients with Chronic Kidney Disease

http://pinterest.com/amashhadian/chronic-kidney-disease/
http://pinterest.com/amashhadian/chronic-kidney-disease/
Chronic kidney disease (CKD) is a common disorder with an increasing prevalence. Cardiovascular disease is the most common cause of premature death in the CKD population. Individuals with CKD have a 10-20 times greater risk of cardiac death than those without CKD. The risk of death, cardiovascular events, and hospitalization increases in a graded fashion as the GFR decreases to less than 60 mL/min/1.73 m2. As a result, the majority of patients with chronic kidney disease die of cardiovascular disease before dialysis becomes necessary.

Lowering cholesterol medications such as statins have the strongest evidencebased association with reduced cardiovascular disease risk. The Study of Heart and Renal Protection (SHARP study) was the first large-scale, long-term, placebo-controlled trial of statins for primary prevention of cardiovascular disease in patients with advanced chronic kidney disease. Treatment with the combination of simvastatin plus ezetimibe was associated with an average reduction in LDL-C of 15.3 mg/dL and a 17% reduction in majoratherosclerotic events. No difference in adverse outcomes was identified (specifically cancer andmyopathy). The clinical implication of the SHARP study is that the combination of low-dose simvastatin (20 mg) and ezetimibe (10 mg) is safe and effective, even in patients with advanced chronic kidney disease. Moreover, if high doses are avoided, statins can be used safely to reduce cardiovascular risk in patients with chronic kidney disease.



What is your current cholesterol level, and are you taking any lowering cholesterol medications?




The American Osteopathic Association, Georgia Osteopathic Medical Society, North
Carolina Osteopathic Medical Association, South Carolina Osteopathic Medical Society, and Impact Education, LLC. has great article about chronic kidney disease and a whole patient approach. For more information, please Click Here

Saturday, September 22, 2012

Kidney Transplant Committee Proposes Changes Aimed at Better Use of Donated Organs


According to the government data, every year, around 2,600 to 2,800 kidneys are recovered from the deceased donor and then they are discarded because the medical staff is unable to transplant them before it gets destroyed. At the same time, it becomes quite shocking to know that hundreds of people are kept on waiting for a kidney transplant in U. S. and among them so many even died waiting only. 

Today, there are 93,000 people on the U. S. kidney transplant list waiting for a surgery to happen. When there are kidneys in stock, then what exactly is the reason that hinders patients to get their treatment on time? Is it a way to keep the kidney transplant rate go higher? Most of the times the organs that are received from the donors are promising but then it all depends upon the age and health of the donors. And this is something that makes the organ unfeasible for transplant. But according to experts, if there is a system of allocating the right organ to the right recipient and during the right amount of time then at least half of these organs would be efficiently used and not discarded.

The main culprit is the outdated computer matching program that has made the entire process inefficient, resulting into a medical rationing system. After nine years of fitful work, the governance committee that oversees kidney transplants in the United States proposed a series of tweaks on Friday aimed at making better use of the country’s desperately inadequate supply of deceased-donor organs. Central to the plan is a new index for better estimating the quality of the more than 14,000 kidneys recovered from dead donors each year. The top 20 percent of kidneys, as measured by the index, would be directed to those candidates expected to live the longest after a transplant — typically younger patients.

Using computer simulations, the plan’s architects estimated the changes would produce an additional 8,380 years of life from one year of transplants. That is about half the number of years generated by a plan previously considered by the committee, which would have matched many kidneys to recipients by age. That plan was abandoned after federal officials warned last year that it would violate age discrimination laws.



New York Times has great article on this issue: Please Click Here

Tuesday, August 21, 2012

Control Blood Pressure by Destroying Nerves Terminating in Kidney


High blood pressure can cause strokes, heart attacks and death. Often, even a combination of pills doesn't work, but a new procedure might. This is a method still under study to control blood pressure by destroying nerves from the kidneys to the brain. Nerve signals in this circuit can push blood pressure very high. Cutting the circuit can make pressure normal again.

For more info, please Click Here

Thursday, August 9, 2012

Knowing the Signs of Chronic Kidney Disease

Knowing the Signs of Chronic kidney disease:

1. Feeling Fatigued
2. Trouble in concentrating
3. Having Poor appetite
4. Trouble in sleeping
5. Muscle cramps at night
6. Swollen feet and ankles
7. Puffiness around eyes, especially in the morning
8. Dry and itchy skin
9. Need to urinate more often especially at night

Foot Care for People with Diabetes


People with diabetes have to take special care of their feet. You should have a comprehensive foot exam every year. This page shows some more things you can do to keep your feet healthy.

1. Wash your feet in warm water every day.
2. Dry your feet well, especially between the toes.
3. Keep the skin soft with a moisturizing lotion, but do not apply it between the toes.
4. Inspect your feet every day for cuts, bruises, blisters, or swelling. Tell your doctor right away if you find something wrong.
5. Ask your diabetes care team how you should care for your toenails.
6. Wear clean, soft socks that fit you

7. Keep your feet warm and dry. Always wear shoes that fit well.
8. Never walk barefoot indoors or outdoors
9. Examine your shoes every day for cracks, pebbles, nails, or anything that could hurt your feet.



Wednesday, August 8, 2012

Diabetes Target Level




Target Levels from the American Diabetes Association

Blood Glucose
     Before Meals: 80-120 mg/dl
     Two Hours After a Meal: 140-150 mg/dl
     At Bedtime:  100-140 mg/dl
Blood Pressure: Below 130/80
Total Cholesterol: Below 200 mg/dl 
HDL: Above 45 mg/dl LDL: Below 100 mg/dl
Hemoglobin A1c: Below 7%

* These numbers may be modified by your doctor if you are elderly, have vascular disease or cannot tell when your blood sugar is low.



Diabetes Facts In Brief


Approximately 16 million people in the U.S. have diabetes, according to estimates, but only 8 million people are diagnosed. Diabetes can lead to a number of complications, such as heart and kidney disease and foot and eye problems. However, studies have shown that good control of sugar prevented the onset or delayed the progression of eye, kidney and nerve damage by at least
50%.

Type 2 diabetes is a growing problem throughout the country, but it is more common among African-Americans, Hispanics, AsianAmericans, Pacific-Island Americans and Native Americans than Caucasians. African-Americans are 1.7 times as likely to have type 2 diabetes as the general population. On average, Hispanic/Latino-Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age.


Tuesday, August 7, 2012

Diabetes Know the Symptoms


It is well known that diabetes contributes to a number of serious health problems. What is less well understood, but very important, is that these problems can often be prevented or delayed when diabetes is carefully managed. Diabetes management is a team effort involving you, your doctor and your diabetes educators, including a dietitian, nurse and other specialists.


WHAT IS DIABETES?
If you have been diagnosed with diabetes, there is too much glucose in your blood. Glucose is a kind of sugar that the cells in your body use for fuel. Glucose builds up in the blood when your body produces too little insulin or when your body does not use insulin efficiently. Insulin is the hormone made up of protein that helps glucose get into cells throughout the body.  When there is not enough insulin or it is not effective, glucose builds up in the blood instead of going into the cells of the muscles and organs, causing two problems. First, in the short term, your cells may be starved for energy. Second, over time, high glucose levels in the blood may damage your eyes, kidneys, nerves or heart, leading to the long-term complications of diabetes.



Monday, August 6, 2012

10 consejos para disfrutar de sus comidas



Puede disfrutar de sus comidas mientras hace pequeños ajustes a las cantidades de alimentos en su plato. Las comidas saludables empiezan con más vegetales, frutas, y porciones más pequeñas de proteínas y granos. No olvide los lácteos: incluya productos lácteos sin grasa o bajos en grasa en sus comidas, o beba leche con su comida.

10 consejos para empezar se puede obtener un plan personalizado de actividades y nutrición



SuperTracker es una herramienta en internet donde se puede obtener un plan personalizado de actividades
y nutrición. Establezca el recor de lo que come y de sus actividades para ver cómo se integran, y obtenga consejos
y apoyo para ayudar a tomar decisiones saludables. El “SuperTracker está disponible sólo en inglés.

10 consejos para ayudarle a que los dólares para la comida le rindan


¡Haga rendir su presupuesto de comidas! Hay muchas maneras de ahorrar dinero en la comida. Los tres pasos principales son planificar antes de comprar, comprar los artículos al mejor precio y preparar comidas que hagan rendir su presupuesto.

10 consejos para ayudarle a comer más productos marinos


Prepare pescado y mariscos dos veces por semana como el principal alimento fuente de proteínas en su plato. Los productos marinos contienen variedad de nutrientes, incluyendo grasas saludables como omega-3, de acuerdo con la Guía Alimentaria para los estadounidenses del 2010 comer unas 8 onzas por semana (menos para los niños pequeños) puede ayudar a prevenir las enfermedades cardiacas.

10 consejos para ayudarlo a reducirlos



Está claro que a los estadounidenses les gusta la sal, pero la sal infl uye en la presión arterial alta. Todos, incluso los niños, debemos reducir el consumo de sodio a menos de 2,300 miligramos al día. Los adultos de 51 años de edad y mayores, las personas de ascendencia afroamericana de cualquier edad y con presión arterial alta, diabetes o enfermedad renal crónica deben reducir el consumo de sodio a 1,500 mg al día.

10 consejos para reducir el azúcar adicional



Limite la cantidad de alimentos y bebidas endulzadas que sus hijos comen y beben. Si no los compra, sus hijos no los beberán muy a menudo. Las golosinas y las bebidas endulzadas tienen muchas calorías pero pocos nutrientes. La mayoría de los azúcares adicionales provienen de gaseosas, bebidas deportivas, bebidas de energía, bebidas a base de jugo, pasteles, galletas dulces, helados, dulces y otros postres.

10 consejos para dar buenos ejemplos de salud a los niños



Usted es la infl uencia más importante para sus hijos. Puede hacer muchas cosas para ayudar a sus hijos a desarrollar hábitos de alimentación sana, para toda la vida. Ofrecer una variedad de comidas ayuda a los niños a obtener los nutrientes que necesitan de cada grupo de alimentos. También tendrán mayores probabilidades de querer probar alimentos nuevos y que estos les gusten. Cuando los niños desarrollan un gusto por muchos tipos distintos de alimentos, es más fácil planifi car las comidas de la familia. ¡Cocinen juntos, coman juntos, hablen y hagan que las comidas sean tiempos dedicados a la familia!

10 consejos para que los alimentos sanos sean más divertidos para los niños



Para animar a los niños a comer vegetales y frutas, hágalas divertidas. Provea ingredientes sanos y permita que los
niños ayuden en su preparación según sus edades y destrezas. Los niños tal vez deseen probar comidas que en el pasado
han rechazado si ayudaron a prepararlas.

10 consejos para mejorar sus comidas con vegetales y frutas



Descubra los muchos benefi cios de agregar vegetales y frutas a sus comidas. Son bajos en contenido de grasas y calorías, también son buenas fuentes de fi bra y otros nutrientes. A la mayoría de los estadounidenses les conviene comer más de 3 tazas y a algunos hasta 6 tazas de vegetales y frutas todos los días. Los vegetales y las frutas no sólo agregan valor nutritivo a las comidas; también les agregan color, sabor y textura. Explore las siguientes maneras de llevar alimentos sanos a la mesa.

10 consejos para economizar en vegetales y frutas



Es posible incluir vegetales y frutas en todo presupuesto. Tomar decisiones nutritivas no tiene que costar demasiado dinero. Comer estos alimentos en cantidades sufi cientes promueve la buena salud y puede ayudarle a reducir el riesgo de contraer ciertas enfermedades. Hay muchas maneras económicas de satisfacer sus necesidades de consumo de frutas y vegetales.

10 consejos para vegetarianos



Una dieta vegetariana puede ser una opción sana. La clave está en consumir alimentos variados y la cantidad correcta
de alimentos para satisfacer sus necesidades de calorías y nutrientes.

10 consejos para platos sanos



Un plato sano comienza con más vegetales y frutas, y porciones más pequeñas de proteínas y granos. Piense en cómo ajustar las porciones en su plato para obtener más de lo que necesita sin demasiadas calorías. Tampoco olvide los productos lácteos; haga de ellos su bebida de acompañamiento o agregue a su plato productos lácteos descremados o con bajo contenido de grasa.

10 consejos para elegir proteínas



La proteína de los alimentos provienen de fuentes tanto animales (carne, aves, mariscos y huevos) como de plantas
(frijoles, guisantes, productos de soja, nueces y semillas). Todos necesitamos proteína; pero la mayoría de los estadounidenses comen cantidades sufi cientes, y algunos de ellos más de lo que necesitan. ¿Cuánto es sufi ciente? La mayoría de las personas de 9 años de edad y mayores deben comer de 5 a 7 onzas* de comidas con proteína cada día.

10 consejos para ayudarle a comer y beber más productos lácteos descremados o bajos en grasa



El grupo de lácteos incluye leche, yogur, queso y leche de soja enriquecida. Estos suministran calcio, vitamina D, potasio, proteína y otros nutrientes necesarios para la buena salud durante toda la vida. Elija productos con bajo contenido de grasa o descremados para reducir las calorías y las grasas saturadas. ¿Cuánto se necesita? Los niños más grandes, adolescentes y adultos necesitan 3 tazas* al día, mientras que los niños de 4 a 8 años de edad necesitan 2½ tazas y los de 2 a 3 años de edad necesitan 2 tazas.

10 consejos para ayudarlo a consumir granos integrales


Los alimentos hechos con trigo, arroz, avena, maíz, cebada o cualquier otro grano de cereal son productos de granos.
El pan, los fi deos y tallarines, la avena, los cereales para el desayuno, las tortillas de harina y la sémola son ejemplos de estos productos. Los granos se dividen en 2 subgrupos: granos integrales y granos refi nados. Los granos integrales contienen el grano completo; es decir, la cáscara, el germen y el saco embrional. Las personas que consumen granos integrales como parte de una dieta saludable tienen menos riesgo de presentar algunas enfermedades crónicas

10 consejos para ayudarlo a comer más frutas



El consumo de frutas brinda benefi cios de salud. Las personas que comen más frutas y vegetales como parte de una
dieta saludable integral tienen menos riesgos de presentar algunas enfermedades crónicas. Las frutas proveen nutrientes
importantes para la salud, como el potasio, la fi bra, la vitamina C y el ácido fólico. La mayoría de las frutas son naturalmente
bajas en grasa, sodio y calorías. Ninguna de ellas contiene colesterol. Todas las frutas o los jugos de fruta 100% naturales
forman parte del grupo de frutas. Las frutas pueden ser frescas, enlatadas, congeladas o secas, y pueden consumirse
enteras, cortadas o en puré.

10 consejos para ayudarlo a comer más vegetales


¡Comer más vegetales es fácil! Comer vegetales es importante porque contienen vitaminas y minerales y no contienen muchas calorías. Para incluir más vegetales en sus comidas, siga estos sencillos consejos. Es más fácil de lo que piensa.

10 consejos para crear un buen plato


Elegir alimentos para llevar un estilo de vida sano es muy sencillo si sigue estos 10 consejos. Use las ideas de esta lista para balancear las calorías, elegir los alimentos que le conviene comer con mayor frecuencia y reducir la cantidad de alimentos que le conviene comer con menos frecuencia.

10 Tips to Creating Healthy, Active Events


Eating healthy and being physically active can be a fun part of parties and events. Great gatherings are easy to do when tasty, healthy foods from all the food groups are offered in a fun, active environment. Above all, focus on enjoying friends and family.

10 Tips to Make Better Beverage Choices


What you drink is as important as what you eat. Many beverages contain added sugars and offer little or no nutrients, while others may provide nutrients but too much fat and too many calories. Here are some tips to help you make better beverage choices.

10 Tips to Enjoying Your Meal


You can enjoy your meals while making small adjustments to the amounts of food on your plate. Healthy meals start with more vegetables and fruits and smaller portions of protein and grains. And don’t forget dairy—include fat-free or low-fat dairy products on your plate, or drink milk with your meal.

Track What You Eat and Your Activities to Make Healthy Choices


SuperTracker is an online tool where you can get a personalized nutrition and activity plan. Track what you  eat and your activities to see how they stack up, and get tips and support to help you make healthy choices.

10 Tips to Help You Stretch Your Food Dollars


Get the most for your food budget! There are many ways to save money on the foods that you eat. The
three main steps are planning before you shop, purchasing the items at the best price, and preparing meals that
stretch your food dollars.

10 Tips to Help You Eat More Seafood


Twice a week, make seafood—fish and shellfish—the main protein food on your plate. Seafood contains a range of nutrients, including healthy omega-3 fats. According to the 2010 Dietary Guidelines for Americans, eating about 8 ounces per week (less for young children) of a variety of seafood can help prevent heart disease.

10 Tips to Help You Cut Back on Salt and Sodium


It’s clear that Americans have a taste for salt, but salt plays a role in high blood pressure. Everyone, including kids, should reduce their sodium intake to less than 2,300 milligrams of sodium a day (about 1 teaspoon of salt). Adults age 51 and older, African Americans of any age, and individuals with high blood pressure, diabetes, or chronic kidney disease should further reduce their sodium intake to 1,500 mg a day.

10 Tips to Decrease Added Sugars


Limit the amount of foods and beverages with added sugars your kids eat and drink. If you don’t buy them, your kids won’t get them very often. Sweet treats and sugary drinks have a lot of calories but few nutrients. Most added sugars come from sodas, sports drinks, energy drinks, juice drinks, cakes, cookies, ice cream, candy, and other desserts.

10 tips for setting good examples


You are the most important influence on your child. You can do many things to help your children develop healthy eating habits for life. Offering a variety of foods helps children get the nutrients they need from every food group. They will also be more likely to try new foods and to like more foods. When children develop a taste for many types of foods, it’s easier to plan family meals. Cook together, eat together, talk together, and make mealtime a family time!

10 Tips for Making Healthy Foods More Fun for Children


Encourage children to eat vegetables and fruits by making it fun. Provide healthy ingredients and let kids help with preparation, based on their age and skills. Kids may try foods they avoided in the past if they helped make them.

10 Tips to Improve Your Meals with Vegetables and Fruits


Discover the many benefits of adding vegetables and fruits to your meals. They are low in fat and calories, while providing fiber and other key nutrients. Most Americans should eat more than 3 cups—and for some, up to 6 cups—of vegetables and fruits each day. Vegetables and fruits don’t just add nutrition to meals. They can also add color, flavor, and texture. Explore these creative ways to bring healthy foods to your table.

10 tips for affordable vegetables and fruits


It is possible to fit vegetables and fruits into any budget. Making nutritious choices does not have to hurt your wallet. Getting enough of these foods promotes health and can reduce your risk of certain diseases. There are many low-cost ways to meet your fruit and vegetable needs.

10 tips for vegetarians


A vegetarian eating pattern can be a healthy option. The key is to consume a variety of foods and the right amount of foods to meet your calorie and nutrient needs.

10 tips for healthy meals

A healthy meal starts with more vegetables and fruits and smaller portions of protein and grains. Think about how you can adjust the portions on your plate to get more of what you need without too many calories. And don’t forget dairy—make it the beverage with your meal or add fat-free or low-fat dairy products to your plate.

10 Tips for Choosing Protein


Protein foods include both animal (meat, poultry, seafood, and eggs) and plant (beans, peas, soy products, nuts, and seeds) sources. We all need protein—but most Americans eat enough, and some eat more than they need. How much is enough? Most people, ages 9 and older, should eat 5 to 7 ounces of protein foods each day.

10 Tips to Help You Eat and Drink More Fat-free or low-fat Dairy Foods

The Dairy Group includes milk, yogurt, cheese, and fortified soymilk. They provide calcium, vitamin D, potassium, protein, and other nutrients needed for good health throughout life. Choices should be lowfat or fat-free—to cut calories and saturated fat. How much is needed? Older children, teens, and adults need 3 cups a day, while children 4 to 8 years old need 2½ cups, and children 2 to 3 years old need 2 cups.
Here is 10 tips to help you eat and drink more fat-free dairy foods:

1. Drink Fat-free or low-fat milk.
2. Choose mild or yogurt more often than cheese.
3. Use fat-free or low-fat mild on cereal and oatmeal. Top fruit salads and baked potatoes with low-fat yogurt instead of sour cream.
4. Try different brands of reduced-fat or low-fat cheese
5. Regular cream cheese, cream, and butter are not part of the dairy food group. They are high in saturated fat and have little or no calcium.
6. When recipes such as dips call for sour cream, substitute plain yogurt.
7. Choose sweet dairy foods with care. They can contain a lot of added sugars which are empty calories.
8. Get you calcium along with your morning caffeine boost. Make coffee with fat-free or low-fat milk.
9. If you can not drink milk, try lactose-free milk, drink smaller amount of milk at a time and try soymilk
10. Try to set an example for your kids

How often do you try to get a low-fat or fat-free dairy products?

10 Tips to Help You Eat Whole Grains


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. Grains are divided into two
subgroups, whole grains and refined grains. Whole grains contain the entire grain kernel, the bran, germ, and endosperm. People who eat whole grains as part of a healthy diet have a reduced risk of some chronic diseases.

Here is 10 tips to help you eat whole grains
1. Substitute a whole-grain product for a refined-grain product. For example, eat 100% whole-wheat bread or bagels instead of white bread or bagels, or brown rice instead of white rice.
2. Popcorn, a whole grain, can be a healthy snack. Make it with little or no added salt or butter.
3. Cook extra bulgur or barley when you have time. Freeze half to heat and serve later as a quick side dish.
4. Use whole grains in mixed dishes, such as barley in vegetables soups or stews and bulgur wheat in casseroles or stir-fries. Try a quinoa salad or pilaf.
5. Try brown rice or whole-wheat pasta.
6. Bake up some whole-grain goodness
7. Be a good role model and set a good example for children by serving and eating whole grains.
8. Use the Nutrition Facts label to check the fiber content of whole-grain foods.
9. Read the ingredients list and choose products that name a whole-grain ingredients first on the list.
10. Be a smart shopper

How much do you pay attention to Nutrition Facts?