The Swedish diet according to Bergström (non-protein selective) | Nutrition in renal insufficiency

The Swedish diet according to Bergström (non-protein selective)

The Swedish diet is a low-protein, non-protein-selective diet, which means that the dietary protein can be freely chosen within the prescribed amount. The required vital amino acids are not contained in sufficient quantities in this strictly low-protein diet and must be replaced. This is done by the administration of amino acid mixtures (10 g/day) or ketoanalogues (precursors) in the form of tablets, pearls or granules.

These preparations are essential amino acids (EAS) are therefore part of the diet and must be prescribed and taken daily. In the Swedish diet, the patients’ eating habits can be taken into account as much as possible and this diet is usually well accepted. Principle of the diet: Reduction of the dietary protein intake to 0.4 g protein/kg body weight (20 to 25 g protein daily) or 0.6 g protein/kg body weight (40 to 45 g protein daily), depending on the severity of the symptoms.

Depending on the clinical symptoms, this diet can be prescribed as a low-sodium, low-potassium, liquid-balanced or diabetes diet. Recipes and daily plans can be found in the book ” Protein balanced diet for chronic kidney patients” by Kotthoff, Haydous, Beiersmann, Riedel. Here you will find an example of the Swedish diet for one day,

• Free choice of protein within the prescribed amount.
• With a total protein quantity of less than 40 g per day, the vital amino acids must be supplied in the form of medication.
• High energy (35 to 37 kcal per kg/body weight)
• Use of high-quality vegetable fats.
• Administration of water-soluble vitamins, minerals and trace elements as prescribed by a doctor.
• 5 to 6 meals per day

Summary

Recommendations for the diet in case of chronic renal insufficiency Low protein diet with biologically high-quality protein. With serum creatinine < 6 mg/dl a lacto-vegetable diet (omit meat and eggs, use dairy products as protein carriers. For serum creatinine > 6mg/dl strictly low protein diet (0.35 – 0.45 g protein per kg body weight.

For example Potato-Egg-Diet (KED) as a high-energy basic diet. Ratio of potato protein to egg protein 3:2 or the Swedish diet with 15 to 20 g of protein from a normal diet supplemented by essential amino acids in drug form. Energy rich with 35 kcal per kg body weight.

As long as a normal urine excretion is possible, a drinking quantity of 2-3 l daily is recommended to excrete the urinary substances. In the case of reduced urine excretion, the drinking quantity is calculated from the urine volume of the previous day plus 500 ml. Limitation to 3 – 5 g of table salt per day.

Do not use any or very little salt for cooking and do not add salt at the table. In the case of sodium depletion, salt must be added with food (e.g. bouillon) or by infusing an isotonic saline solution into the vein. In case of elevated serum potassium levels, a low potassium diet is necessary.

In case of potassium depletion (very rare), potassium may have to be given in the form of effervescent tablets. In cases of advanced renal insufficiency, the intake must be limited to a maximum of 1 g per day and foods rich in phosphates must be avoided. In the case of serum phosphate > 6.5 mgdl, phosphate binders in the form of medication must be added.

As soon as an uncontrollable hyperthyroidism of the parathyroid gland appears despite a low phosphate diet and phosphate binders, vitamin D must be given. In the case of severe protein restriction and when a low potassium diet is prescribed, the intake of water-soluble vitamins such as the B-complex and vitamin in tablet form is recommended. In the case of existing complaints, the supply of iron and zinc in tablet form may also be necessary. The vitamin A level is usually increased with uremia and must not be taken up additionally.