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THE BEAN:
Kidney Empowerment

Why We Walk for The National Kidney Foundation

3/31/2025

 
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At Jacksonville Nephrology, we are passionate about caring for others and helping when and where we can. This includes participating as ‘The Dream Team’ in the annual Kidney Walk in Jacksonville for the National Kidney Foundation (NKF). We take great pride in our participation each year, representing our patients who have been diagnosed with kidney diseases and helping to bring awareness to the community. Read more below about NKF and from our team to learn why each of us walk with NFK.

About The National Kidney Foundation:
The National Kidney Foundation is a non-profit organization that provides education and resources to people living with kidney diseases. Assistance can include transportation to appointments or treatments, access to personal and healthcare resources, and connection with your community through mentors and other kidney patients. NKF also advocates for equity and equal access to kidney care for all. Their mission is “to revolutionize the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation.” They live their mission in how they care for each patient and the kidney community as a whole. NKF provides educational materials (including kidney-friendly recipes), articles on kidney health, and updates on legislation that promotes kidney care equity. 

Inspiration from the Dream Team
Our team has seen what an impact NKF can make first-hand. From our years of walking with them and listening to patient stories, we have been moved and inspired in our own ways. 
  • Samantha (RPM Care Coordinator): "I walk so that I can be a representative for those that want to walk but are unable to be at the event with us."
  • Kayla (Office Manager): "I walk to help restore hope for those who are living with kidney diseases and other chronic illnesses."
  • Henrietta (Medical Assistant): “I walk to support family members and to support a good cause. This disease can hit any of us at any time.”
  • Chris (Front Desk): “The walk is a fun way for us to show our patients that we are in the moment with them and that we practice what we preach.”
  • Penny (Director of Nursing): “The walk is a way to bring exposure to kidney disease. Many people don’t know about kidney disease until they're in kidney failure.”
  • Brittany (Dialysis Nurse): “I went into nursing because I wanted to be a voice for patients. I never got to build a connection with patients until I came to dialysis. It's bittersweet when you lose a lot more patients than you think. My perspective on dialysis changed when I was able to connect with the patients more.”
  • Cora (Facility Administrator): “Dialysis is a small community. The walk is a chance for patients and providers to connect and share knowledge.”
  • Mary (Home Dialysis Nurse): “I walk to support my patients and for community awareness. A lot of people don’t know what dialysis is and what patients go through. I hope people think about their own choices and healthy kidneys. We just want to educate the community.”
  • Crystal (Patient Care Tech): “NKF can help to provide connections to personal, educational, and financial resources within their community to cope with this disease. A lot of patients wouldn't be able to get the care they need without them.”

In the coming weeks, we are hosting a number of fundraising activities in our offices to raise funds before the walk. We will have an envelope donation wall, a Mother’s Day raffle basket, and a friendly competition between our teams called Penny Wars. Stay tuned for more information to come! All funds from these activities will be donated to NKF. Come stop by our offices and join us this year at Riverside Park on May 18th, 2025 at 8:30am! There will be booths, games, music, and food! We hope to see you there, walking and helping us raise resources and awareness for kidney diseases!

Rebound Hypertension

2/27/2025

 
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Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication, including the use of emergency blood pressure medications. Let’s meet John and Jerry, two patients who are experiencing rebound hypertension.  

John’s Story
     John Smith is finishing out his career as a police officer and is looking forward to retiring with his wife, Jenny. He is passionate about being a police officer and works diligently to maintain his health. John loves to watch football, hike with Jenny, or golf with his buddies when he is not working.
     Despite his efforts to stay healthy, John’s blood pressure continually increased and he was diagnosed with hypertension seven years ago. He was put on medications to lower it and he has since been stable. However, in the past year, he has experienced spikes in the 180s, well outside of his normal range of 120s-130s. With these spikes, he was experiencing headaches and his heart would race. His nephrologist prescribed him an emergency relief drug, Clonidine, a short-acting drug that reduces blood pressure quickly. 
     The Clonidine seemed to work for John when he experienced his blood pressure spikes. His blood pressure would return to its normal range, as intended. Not long after that, John would begin feeling another headache. He would take his blood pressure again and his reading was back into the 170s. “That’s odd,” John thought to himself. “I just took my medication and it was back to normal.” This happened two more times in the coming weeks. He called his nephrologist and explained what he was experiencing.

Jerry’s Story
     Jerry Williams is a retired accountant. She spends her days watching her 3 grandchildren, reading, and baking. She is diligent about looking after her health and overall wellbeing. Jerry was diagnosed with hypertension three years ago and was put on medication to control it. Along with her medications, she also implemented daily walks and swimming, when the weather allowed and worked to reduce her sodium intake. 
     Jerry’s blood pressure did well on the medication regimen and she saw significant improvements when she added the recommended lifestyle changes. Her blood pressure has begun dropping into the 100s and she experienced dizziness and lightheadedness. At her next appointment, her nephrologist took her off of her blood pressure medication to help bring her blood pressure back up and stop her new symptoms. 
     After her medication reduction, Jerry noticed her blood pressure was elevated, with readings consistently in the 160s.  “We only adjusted one of my medications,” Jerry thought. “Why is my blood pressure acting like this?” She notified her nephrologist and went to be seen for another appointment. 
 
     At their respective appointments, Jerry and John heard this from Dr. Munjal: “It looks like you are experiencing rebound hypertension. Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication. The good news is that this tells me exactly what I need to know.” For Jerry, the current dose is too much and zero is too little. She was put back on her medication and started the weening process. John had one of his other regular medications adjusted to reduce the potential for the spikes and saw a reduction in his emergency medication use. 
     What we can learn from both John and Jerry is that blood pressure is not one size fits all. We expect changes to happen over time which is why rebound hypertension tells us just as much as the initial diagnosis. It helps us make adjustments to keep blood pressure stable as the situation changes. Not everyone needs the same types of changes, so it can take a few tries to get the medication dialed back in to meet each patient's specific needs and circumstances. If you are experiencing rebound hypertension, please contact your doctor to discuss or go to the ER if you experience a hypertensive crisis. As always, stay safe and healthy!

Resources:
https://medlineplus.gov/ency/article/000155.htm#:~:text=Rebound%20hypertension%20occurs%20when%20blood,like%20beta%20blockers%20and%20clonidine.
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417

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Chronic Illness: The Tiring Reality

2/13/2025

 
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According to the CDC, approximately 129 million people in the United States have at least one chronic disease like cancer, hypertension, diabetes, or heart disease. That is almost half of the entire population. Many chronic illnesses are accompanied by a number of comorbidities as well. These illnesses require constant attention, both mentally and physically, to maintain balance in the patient's life. Let’s explore some of what reality may look like for some people. 

Habits
Having a chronic illness often means that patients have to develop healthy habits and routines to ensure they are staying on top of their healthcare between appointments. This can look like:
  • Taking and recording different readings daily (blood pressure, weight, blood sugar, oxygen levels, etc.)
  • Taking multiple sets of medication
  • Regular exercise or physical therapy
  • Tracking fluid and food intake based on dietary needs (low carb, high protein, fluid restrictions, etc.)

Appointments and Labs
Chronic illnesses often mean additional appointments with primary care, a variety of specialists, treatments or infusions, and labs or imaging. We often hear that many of our patients have an appointment a day every week for themselves and their spouses. Can you imagine how limiting that can be on someone’s personal schedule?

Remission and Relapse
As we age, our bodies naturally change over time, whether we want them to or not. Blood pressure, especially, is an ongoing, ever-changing thing. It is only a matter of time. Seeing a decline in lab results or changes in blood pressure can be disheartening, especially when a patient has been “doing all the right things” to keep themselves on track.

Importance of Monitoring
Regular monitoring by patients and doctors together is vital to ensuring that we are able to catch trends and intervene sooner rather than later. Programs like Remote Patient Monitoring help us track changes more closely and identify trends early. Monitoring does not replace regular appointments, but is an incredible tool in assisting your care team in seeing the bigger picture of your health. However, a formal program isn’t always necessary. Tracking daily weight and blood pressure readings at home also help in the decision making process. We want to know what readings look like on average in a normal, day-to-day setting. In an office, there can be multiple other factors contributing to different weight and blood pressure readings, like additional shoes/clothing, eating/drinking, traffic, White Coat Syndrome, etc. This is not to say that these readings are inaccurate, but seeing the home-setting trends are equally important to avoid over- or under-medicating.


Considering all these patients have to go through, manage, and keep track of, they deserve an award for handling their lives and continuing to push forward. Share a smile or warm hug and offer assistance to others when you can: you never know who may need it most. 

Resources:
https://www.cdc.gov/pcd/issues/2024/23_0267.htm

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Kidney Korner: Uric Acid

1/29/2025

 
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To understand uric acid, we must first understand where it comes from. Uric acid is a waste product from the body processing purine. Purine is a naturally occurring compound found mainly in meat products like beef, fish, and poultry. If you have a diet that consists of a large quantity of foods that are purine-rich, you are more likely to have high uric acid levels in your blood. With healthy kidneys, this generally is not a problem. However, high uric acid can lead to some painful problems down the line, like gout and kidney stones. 
Common Foods High in Purine:
  • Anchovies
  • Bacon
  • Bouillon
  • Broth
  • Codfish
  • Consomme
  • Haddock
  • Herring
  • Mackerel
  • Meat extracts
  • Mussels
  • Organ Meats
  • Sardines
  • Scallops
  • Shrimp
  • Venison
  • Yeast
  • Yeast Extract
Gout
Gout is a complex form of arthritis caused by the development of uric acid crystals due to high levels of uric acid in the blood. These crystals settle in the joints, commonly the big toe. The settlements can cause gout attacks, or flare-ups, of discomfort, pain, swelling/inflammation, and discoloration of the joint. Gout attacks can last 1-2 weeks, but may last longer depending on treatment and severity.
Kidney Stones
Uric acid kidney stones form when there is too much uric acid present in the urine and/or when the urine is too acidic on a regular basis. Once these kidney stones form, some may pass on their own, but others may require intervention from urology. Symptoms can include: Severe pain in the sides/lowerback, flank or stomach pain, fever, nausea/vomiting, urine that smells or looks cloudy, or blood in the urine. 
Prevention and Treatment
Preventing uric acid build-up can be as simple as being mindful of your consumption of the purine-rich foods listed above. Prevention can also include weight management to reduce the risk of kidney stones. If dietary changes are not sufficient, there are medications that can be prescribed that can help lower the uric acid as well. If you have kidney diseases, please consult a nephrologist for treatment options. 

​As always, life is about balance and enjoying everything in moderation. If you have concerns about your uric acid levels, contact our office today to schedule an appointment with Dr. Munjal. Stay safe and healthy!

References: 
https://www.kidney.org/uric-acid-stones#:~:text=A%20uric%20acid%20stone%20is,smells%20bad%20or%20looks%20cloudy

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Walk This Way: The Benefits of Walking Daily

11/21/2024

 
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Did you know that there are more than 30 unique benefits to walking daily? Sounds too good to be true for this seemingly simple exercise, right? As a team, we embark on a challenge to be healthier through the holidays and we want to challenge you too! We know we will be indulging in sweets, rich meals, traveling, and off of our normal schedules in the coming months, so we are trying to get ahead of the curve. Incorporating more steps into our daily routine is one of the easiest ways to create balance with all the treats this season. Throughout our challenges, our team has seen a number of benefits like weight loss, decreased resting heart rates, improved oxygen levels, increased stamina, and noticeable muscle tone. 
The first few weeks of building a habit are always the hardest, especially with the stress of the holidays upon us. “How can I possibly work something else into my already busy schedule?” I’m glad you asked! Below are 8 ways you can make choices that can increase your step count for the day!
  • Take a brisk walk outside first thing in the morning. Walking can help with insomnia and getting sunshine first thing in the morning can help your sleep and circadian rhythm.
  • Take a short, 10 minute walk after each meal. Walking helps aid in digestion, too! 
  • If you have a pet or children, take them on walks and lengthen it a little more each time.
  • Dance to your favorite song.
  • Challenge a friend or family member to a step challenge! Accountability buddies can be incredibly supportive and beneficial.
  • Do laundry in smaller batches or on the other side of the house/room from your wardrobe. 
  • Shop in-person at stores rather than ordering online. Laps in an air-conditioned store or mall can make it more pleasant.
  • Walk the golf course instead of renting a cart.

Still not convinced? Check out these facts about walking for some extra motivation to lace up those sneakers!
  • Less than 5,000 steps a day is considered a sedentary lifestyle.
  • Walking lowers blood sugars and reduces the overall risk of type 2 diabetes.
  • Walking reduces arthritis-related pain. Walking 5-6 miles per week can even prevent arthritis!
  • Walking reduces the risk of heart diseases and strengthens the heart.
  • Walking regularly can help reduce blood pressure.
  • Walking can stop the loss of bone mass for those with osteoporosis.
  • Walking can reduce the risk of varicose veins.
  • Walking helps to improve the memory, build more neurological connections, and help to prevent dementia later in life.

Moving your body and staying active during this season is so important for your physical and mental health. Once you get up and in the habit of moving, you will find yourself craving the benefits daily. After all, a body at rest stays at rest, while a body in motion, stays in motion. How will you get to stepping this holiday season?

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Healthy Through the Holidays

11/14/2024

 
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The holiday season is such a wonderful time of year to share love and reflect on the events of the year. The holidays often include celebrations, travel, and indulging in lots of rich, decadent foods. These deviations from our routines and normal habits can begin to affect our health, like increased blood pressure and fluid retention, if we are not mindful of our restrictions and doctor recommendations. Listed below are some helpful tips to keep you safe and healthy this holiday season. 

Sodium and Fluid
    Did you know that a single restaurant entree typically contains 50-100% of a full day’s recommended sodium content? If you're eating out at a restaurant, split your entree in two and only have half; save the other half for leftovers on another day to avoid excess sodium. It is equally important to keep the sodium low for your other meals throughout the day when you do go eat out at a restaurant. Additionally, sodium can be hiding in the preservatives of the snacks and fast-food we may be eating outside of our normal routine. If you are cooking, try to use as many whole, fresh foods that you can and replace salt with other dried or fresh herbs, spices, and vegetables (garlic or ginger). Learn more about sodium’s secret identities here. As always, moderation is key! 
Additionally, it is important to be aware of your fluid consumption. We don’t just mean water. Fluids can include tea, coffee, juice, soda, alcohol, broth, and more. For those with fluid restrictions, please adhere to your prescribed diet. For additional information about fluids and fluid intake click the links below:
  • Kidney Korner: We Don’t Just Mean Water
  • Kidney Korner: How Much is Too Much?

Medications and Appointments
Now is the time to check on the status of your medications! We recommend requesting refills of medications at least two weeks in advance to account for holiday pharmacy hours and office closures. Additionally, appointments may be required for refills if you have not seen your physician recently. Be sure to give yourself time to be seen by your prescribing physician. It is important to note that virtual appointments are still covered through the end of the year for those with traditional Medicare coverage and are included in most private insurance plans. 

For more information on how to stay healthy through the holidays, check out the additional posts below! As always, stay healthy!
  • Spooky Sweets (10/03)
  • How to Read a Nutrition Label

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Travel Tips for Your Next Adventure

10/24/2024

 
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Calling all jet-setters, road-trippers, and stay-cationers! Do you know how to stay safe this holiday season while traveling? We’ve laid out some helpful tips and tricks to make traveling this holiday season a breeze. 

Travel
    There are so many things that can go wrong when we travel, like lost luggage, delayed flights, flat tires, and unexpected detours. It is important to be prepared for sudden, unexpected changes in plans. Preparations for these situations can include bringing your entire bottle of emergency relief medication and monitoring devices, like scales and blood pressure monitors, with you. We always encourage monitoring yourself while traveling as you may see changes in readings and symptoms due to changes in eating, drinking, and stress that may require emergency relief medications, like diuretics or antihypertensive drugs. If you are on our Remote Patient Monitoring (RPM) program, our devices are travel friendly and will transmit from all over the world. 

General Health and Safety
    Staying safe is a no-brainer when traveling. Listed below are some general travel and safety tips:
  • Be sure to check the projected weather so you can pack appropriate clothing and footwear.
  • Keep a small notebook or paper with you that details your itinerary, emergency contact information, any medical issues/diagnoses, medications, and other pertinent information. Make copies of your travel documents as well in the event something is lost or stolen.
  • Pack at least two (2) day’s worth of clothing, medications, and toiletries in your carry on bag in case your checked luggage is lost or delayed. Be mindful of any cultural or religious modesty expectations and norms. 
  • Wash and/or sanitize your hands regularly and wear a mask if you have a compromised immune system.
  • Try to incorporate light exercise into your daily routine. This can include walking, stretching, indoor cycling, or water aerobics. For more information on gentle exercises, you can click the link here to be taken to our blog post.


We wish you a happy holiday season and a happy New Year! As always, stay safe and healthy! 

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Kidney Korner: Comorbidities

10/17/2024

 
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A comorbidity is defined as a medical condition that coexists alongside a primary diagnosis. These conditions can develop over time and potentially worsen your pre-existing diagnosis. Properly managing your health conditions can help reduce the risk of developing comorbidities or reduce the impact they may have. Let’s explore a few common comorbidities that impact kidney health.

  1. Diabetes: Diabetes is a disease that affects the body’s ability to control the glucose (sugar) in the bloodstream. Excess sugar in the bloodstream can damage small blood vessels and ultimately lead to hypertension and kidney damage. Diabetes is one of the leading causes of chronic kidney disease.
  2. Hypertension: Hypertension, or high blood pressure, can lead to the hardening of the arteries, which inhibits proper blood flow to the kidneys. Hypertension is also one of  the leading causes of chronic kidney disease.
  3. Heart Diseases: Cardiovascular diseases affect the heart and vascular system. The heart and vascular system play a vital role in blood pressure management and kidney health.
  4. Obesity: Obesity can be defined as a Body Mass Index (BMI) of greater than 30. Obesity can affect the kidney’s ability to function properly in that they are forced to work harder and to filter waste above the normal level. This additional work and strain can lead to an increased risk for kidney disease. Being overweight can also lead to an increased risk for diabetes, hypertension, and cardiovascular disease, which are all kidney disease comorbidities as well. 
  5. Chronic Lung Diseases: Lung and kidney diseases can be a surprising combination for some. Lung conditions can affect the blood flow to the kidneys and the fluid/mineral balance that the kidneys work toward. Additionally, smoking is strongly correlated with both lung and kidney damage. Furthermore, some irritants and treatments for lung disease, like steroids, may irritate and worsen kidney function.
  6. NSAID use: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are part of a medication class that works to reduce inflammation, redness, swelling, pain, and fever. NSAIDs can narrow the blood vessels, thus increasing the blood pressure, which risks damaging the kidneys. You can learn more about NSAIDs and the kidneys here. 
  7. Gout: Gout is a type of arthritis caused by excess buildup of uric acid. When the kidneys are filtering the blood, the excess uric acid can develop into crystals, or kidney stones, that can pass through the kidney and ureter and cause damage, scarring, and lead to reduced kidney function. 
  8. Auto-immune disorders: While it is less common than some of the other listed conditions, some auto-immune disorders can have an effect on the function of your kidneys. One of these conditions is called Lupus. Lupus is a condition that causes your immune system to attack healthy tissues and organs in your body. If Lupus attacks the kidneys, there can be a serious need for intervention by a nephrologist, leading to dialysis and/or transplantation.


This is by no means a comprehensive list of contributing factors and influences on kidney diseases. Each person is unique and requires individualized attention based on their needs and pre-existing conditions. If you have concerns about your kidney function and comorbidities, reach out to our office to schedule an appointment with Dr. Munjal. As always, stay safe and healthy!

Resources:
https://my.clevelandclinic.org/health/articles/comorbidities
https://journals.physiology.org/doi/full/10.1152/ajplung.00152.2021

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Preparing for Open Enrollment

10/9/2024

 
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Health insurance is a vital part of getting the care that you need to stay healthy and happy. Open enrollment for health insurance plans typically starts November 1st and runs into December. However it is important to do your research beforehand so you are prepared when it comes time to choose a new plan. Listed below are our top three points to consider and remember when researching health insurance plans. 

  • Check network status of your current doctors and hospitals
    • Some doctors or practices may be in network with an insurance company as a whole, but out of network with a specific plan within that network. Be sure to write down all of the doctors that you see so you can ensure they are in-network with the new plan. The insurance companies will have the plan-specific information for you.
    • Be sure to know what hospitals near you are in the network of your chosen plan in the event of an emergency or necessity for a procedure. 
  • Your budget and healthcare needs
    • Insurances are providing more plan options to meet the needs of the population. Keep in mind that some lower-cost plans may include restrictions with in-network doctors, authorization requirements, and out-of-pocket expenses. 
    • Be sure to verify coverage and estimated cost for any upcoming procedures and appointments. 
  • Research in advance- know your options
    • By researching in advance, you will be more well informed and prepared when it comes time for open enrollment. Call prospective insurance companies and collect information about each plan you may be interested in. Without the pressure and stress of last-minute split decisions, the already stressful process may go a lot smoother. 

Resources:
Florida Medicaid: https://www.flmedicaidmanagedcare.com/
Medicare: https://www.medicare.gov/
National Insurance Resources: https://www.healthcare.gov/

If you have any questions or concerns about your insurance coverage with our office, please call your insurance provider for plan-specific information. 

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Spooky Sweets: Identifying Tricks from Treats

10/3/2024

 
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Halloween kicks off our season of holiday sweet treats and indulgences. It’s important to know what sweets are tricks and treats, as well as how to satisfy a craving in a more kidney-conscious way. 

Sweet Treats:
When searching for a sweet treat this holiday season, the candies listed below are safer options for those who have kidney diseases. Remember, everything in moderation!
  • Hard Candies: sour balls, Life Savers, lollipops, candy canes, lemon drops, butterscotch, Werther’s Originals, cinnamon balls, Jolly Ranchers, and Starlight mints
  • Gummy Candies: Gummi bears/worms, sour apples, Jujyfruit, jellybeans, and Dots.
  • Marshmallow candies: Halloween pumpkins, Rice Krispies treats, and Peeps
  • Chewy Candies: Candy corn, Tootsie Rolls, chewing gum, Starburst, and Skittles.
  • Chocolate-covered candies: The Three Musketeers, chocolate coffee fondant, York Peppermint Patty, Junior Mints, Skor Toffee bars

Spooky Sweets:
These sweets may give you a spook! The options listed below are not the best choice and should be avoided when possible. For patients with kidney diseases, these candies can pose potential problems as they contain higher levels of phosphorus and potassium due to being made with solid chocolate, nuts, dried fruit, coconut, peanut butter, and caramel. 
  • Chocolate-covered: nuts, cookies, raisins, pretzels, caramels
  • Common Chocolate Bars: Snickers, Baby Ruth, Twix, Butterfinger, Heath Bars, MilkyWay, Almond Joy/Mounds, Kit-Kat, Hershey’s kisses and bars
  • Reese’s Peanut Butter Cups
  • Rolo’s Caramels
  • Cadbury Chocolate
  • All M&M’s
  • Peanut brittle and pralines

DIY: Healthier options
The National Kidney Foundation has some fantastic seasonal recipes that are kidney-friendly to satisfy cravings and keep you on track. 
  • Rice Cereal Treats
  • Pumpkin Maple Custard
  • Pumpkin Cream Cheese Muffins
  • Apple Puffs
  • Apple Caramel Crisp

Moderation is key! The ‘fun size’ portions are approximately 1 ounce which is just right. When you can, opt for sugar-free options or renal-friendly fruits based on recommendations from your nephrologist or dietitian. As always, stay safe and healthy! 

Resources: 
https://www.kidney.org/nutrition/recipes

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    The Bean is a blog on a mission to share valuable information in the world of Nephrology.  We believe in empowering through education and The Bean is a great place to find resources and information on topics related to high blood pressure, kidney disease, dialysis, and topics that enhance the kidney minded lifestyle.    Enjoy and be sure to subscribe!

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