Since I only had a bottle of Ensure for dinner last night, and didn’t have any lunch today, my mom said we should go out to eat. My dad had to run an errand for my sister’s family so it was just the two of us. We decided to go to Boiling Point in Irvine. We got there around 6:30 pm and waited about 10 minutes for a table. If you’ve never been to Boiling Point, it’s a personal Taiwanese hot pot restaurant with pre-made soup/ingredient choices, and you can order additional items to put in your pot. It’s not all-you-can-eat but the amount of food is more than adequate.

I ordered a beef hot soup/pot with no spiciness. My mom ordered the seafood & tofu with mild spiciness. I remember ordering something with mild spiciness once and it was really spicy so I chickened out this time. That and I could only eat on one side of my mouth and the food was super hot (temperature). I was a bit worried about the nutritional content of their food because Chinese. I ate all of it anyway and looked up their nutrition info when I got home.

Nutrition Item	Beef Hot Pot	Seafood & Tofu Hot Pot	Spicy Fermented Tofu
Weight	516.4 g	378.3 g	95.8 g
Calories	459 kcal	516 kcal	101 kcal
Total Fat	17 g	23 g	5.8 g
Sat Fat	4.2 g	6.2 g	1 g
Trans Fat	0.3 g	0.1 g	0 g
Cholestrol	86.9 g	142.4 g	0 g
Sodium	516.6 mg	801.1 mg	710.3 mg
Carbs	38.5 g	22.1 g	6.9 g
Fiber	5.7 g	2.7 g	1.3 g
Sugars	6.5 g	0.8 g	4.6 g
Protein	43.1 g	54.8 g	5.4 g

At first glance, it seems there are too many significant digits for sodium. How can you measure something to 0.1 mg precision? But if you look at the nutrition PDF file, it breaks down each menu item into it’s contents and provides nutrition info for each ingredient. So for my beef hot pot, a lot of the sodium comes from the Kamaboko (143.9 mg) and Kakiage tempura (132 mg). We also got the spicy fermented tofu appetizer. It wasn’t what I thought it would be: fried stinky tofu. On paper, it’s saltier than either of the hot pots.

So, 459 calories and 517 mg of sodium is not bad. Both are about one-quarter of allowable daily value (DV). However, it tasted pretty salty and the soup was oily when I was done eating. I highly doubt the provided nutritional values are accurate. That’s the problem with eating at restaurants and eating prepackaged foods. You’re trusting that the ingredient list is what is actually in the food. I’m sure the chef is not measuring out salt to tenths of a milligram. Unless you cooked the meal yourself, you’re never really sure what is in there. At some point though, you have trust the info is accurate enough and make good food decisions.

Reviewing the phosphorus content in nutrition shakes has got me wondering what the actual test result represent other than just high/low versus normal. I’ve received hundreds of pages of test results during the past few years but I don’t fully understand what they all mean. My last lab results for phosphorus was 4.2 mg/dL. I assume that is the concentration of phosphorus in my bloodstream. So if we use the 7% figure for blood/body weight, at 92 kg I have 6.44 liters of blood. Multiply that by 4.2 mg/dL gives me ~270 mg of phosphorus in my blood.

Phosphorus is an essential structural component of cell membranes and nucleic acids but is also involved in several biological processes, including bone mineralization, energy production, cell signaling through phosphorylation reactions, and regulation of acid-base homeostasis.

Linus Pauling Institute

I don’t know how much phosphorus the body uses daily so I’ll use their daily recommendation of 700 mg. If hemodialysis removes 800 mg per session, then that’s an average of 343 mg per day. Add my three Renvela tablets for a bit more (only about 50 mg), my intake allowance is ~1,100 mg per day. DaVita recommends a nutrition goal of 800 to 1,200 mg per day so it’s in the ballpark.

Oops. We have the vanilla flavor Ensure High Protein at home, not the mile chocolate flavor. I like the taste of Ensure more than Nepro. There’s a weird aftertaste to Nepro and it lingers in your mouth for a long time. There’s also more of a milk taste to Ensure whereas Nepro just tastes artificial.

Ensure is also a lot cheaper. I buy Nepro directly from the Abbott store. If you get an order form from the dialysis nutritionist, the cost is $57 for a case of 24, or $2.38 each. Otherwise it’s $92 and prices are similar on Amazon. For Ensure, you can buy almost anywhere (Target, supermarkets) for $9/six-pack, or $1.50 each. On Amazon, it’s even cheaper.

Looking at the nutritional labels again, Ensure has 250 mg of phosphorus vs. 170 mg for Nepro. I take 800 mg of Renvela (Sevelamer Carbonate) each meal. This paper states that the phosphorus binding capacity for Renvela is only ~21 mg/g. That means it will take four of the huge tablets to absorb the excess phosphorus in Ensure. Another paper says dialysis only removes 800 mg of phosphorus per session so an extra 80 mg is not trivial. However, my phosphorus results from the last set of labs is in the middle of the normal range so maybe I have some room to indulge in Ensure instead of Nepro.

Today was a very long day. I had dialysis in the morning and found out I needed to extend my dialysis time. That was followed by a three hour dentist appointment that turned out to be very painful, and ended with an acupuncturist appointment that lasted until 7:00 pm. I had several temporary crowns put in at the dentist and was told not to eat on that side of the mouth. I was tired, half my face was on fire, so I ended up napping from ~9:00 pm to ~11:00 pm, skipping dinner.

Typically when I skip a meal, I drink a container of Nepro. It’s a protein shake specifically made for dialysis patients by Abbott, the same company that makes Ensure. It also costs more than Ensure, even when I order directly from Abbott, and only has three flavors. Ensure has a lot more varieties and flavors. Since I also have bottles of Ensure High Protein at home, let’s comparison the nutrition labels. I’m going to use Nepro’s label as the base since it has more rows. Both come in 8 oz. containers.

Nutrients	Nepro	Ensure High Protein
Protein	19.1 g	16 g
Total Fat	22.7 g	2 g
Saturated Fat	2.0 g	0.5 g
Transfat	0 g
Polyunsat Fat	4.1 g
Monounsat Fat	16 g
Cholesterol	6.5 mg	20 mg
Carbohydrates	37.9 g	19 g
Dietary Fiber	3.0 g	< 1 g
Sugars	8.4 g	4 g
Glycerine	2.6 g
L-Carnitine	63 mg
Taurine	38 mg
Water	172 g
Calories	425	160

Vitamins	DV*	Nepro	Ensure High Protein
Vitamin A	5,000 IU	750 IU	30% (1,500 IU)
Vitamin D	400 IU	20 IU	120% (480 IU)
Vitamin E	30 IU	23 IU	90% (27 IU)
Vitamin K	80 mcg	20 mcg	30% (24 mcg)
Vitamin C	60 mg	25 mg	100% (60 mg)
Folate/Folic Acid	400 mcg	250 mcg	60% (240 mcg)
Vitamin B1	1.5 mg	0.56 mg	30% (0.45 mg)
Vitamin B2	1.7 mg	0.64 mg	30% (0.51 mg)
Vitamin B6	2 mg	2.0 mg	30% (0.6 mg)
Vitamin B12	6 mcg	2.3 mcg	30% (1.8 mcg)
Niacin	20 mg	7.5 mg	30% (6 mg)
Choline		150 mcg
Biotin	300 mcg	120 mcg	30% (90 mcg)
Pantothenic Acid	10 mg	3.8 mg	30% (3 mcg)

Minerals	DV*	Nepro	Ensure High Protein
Sodium	2,400 mg	250 mg	135 mg
Potassium	3,500 mg	250 mg	170 mg
Chloride	3,400 mg	200 mg
Calcium	1,000 mg	250 mg	30% (300 mg)
Phosphorus	1,000 mg	170 mg	25% (250 mg)
Magnesium	400 mg	50 mg	15% (60 mg)
Iodine	150 mcg	38 mcg	25% (38 mcg)
Manganese	2 mg	0.5 mg	20% (0.4 mg)
Copper	2 mg	0.5 mg
Zinc	15 mg	6.4 mg	35% (5.3 mg)
Iron	18 mg	4.5 mg	40% (7.2 mg)
Selenium	70 mcg	18 mcg	30% (21 mcg)
Chromium	120 mcg	30 mcg	40% (48 mcg)
Molybdenum	75 mcg	19 mcg	40% (30 mcg)

I always wanted to do this comparison since Ensure’s nutrition label has a lot of items listed with %DV instead of the actual amount. If you look at the lab result scorecard from dialysis, it only lists three minerals: potassium, phosphorus, and calcium. Ensure has slightly lower potassium and slightly higher phosphorus and calcium. The other major differences seems to be Nepro has a lot more calories/fat/carbs vs. Ensure, and slightly less cholesterol. All the other nutrition items seem to be similar between the two drinks. I also noticed that I take a 2,000 IU capsule of Vitamin D3 each day when DV is only 400 IU, and my Vitamin D lab results are still low.

I’m tired of “Mixed Berry” since it’s the only Nepro flavor I have; the other two flavors are even more gross. After an hour of typing and calculating DV, I think I’m going to drink a chocolate vanilla Ensure High Protein instead of Nepro.