I ate lunch at work today. Usually I try to go out to for lunch on Fridays, either to a food truck on-site, or to a restaurant. Today, I had too many meetings so there was only time for the cafeteria. I got steak, rice, potatoes, dinner roll, and some peas. Here is the “official” nutritional info for lunch:

Item	Steak	Rice Pilaf	Potatoes	Dinner Roll	Peas	Total
Serving Size	198 g	113 g	113 g	51 g	113 g	588 g
Calories	390	200	120	130	140	980
Total Fat	20 g	9 g	3 g	2.5 g	8 g	42.5 g
Saturated Fat	8 g	0.5 g	0 g	0 g	5 g	13.5 g
Cholesterol	100 mg	0 mg	0 mg	0 mg	20 mg	120 mg
Sodium	550 mg	95 mg	95 mg	260 mg	140 mg	1,140 mg
Total Carbs	9 g	28 g	22 g	21 g	14 g	94 g
Dietary Fiber	3 g	0 g	2 g	NA	5 g	10 g
Total Sugars	4 g	0 g	2 g	0 g	5 g	11 g
Protein	40 g	3 g	3 g	6 g	5 g	57 g
Calcium	100 mg	14 mg	15 mg	26 mg	30 mg	185 mg
Potassium	630 mg	48 mg	601 mg	0 mg	233 mg	1,512 mg

First, it felt much heavier than 588 g so maybe the serving sizes were not accurate. The servers spoon the items from large serving trays so there must be a lot of variability. I also didn’t finished all the potatoes so only count ~50% of the numbers. Anyway, I’m surprised at how much sodium and potassium is in everything. Nothing tasted particularly salty but the meal contained >50% of recommended daily value for sodium. Likewise for potassium. Both beef and potatoes contain a lot of potassium. Also, lots of carbs in rice, potatoes, and bread. Each was ~10% of DV for total carbohydrates.

At least it’s healthier than getting the burger and fries.

When there’s nothing good to eat at work, I used to get a burger and fries as a default option. Since coming back to work post-surgery, I’ve been more focused on nutrition. Here’s the nutrition info; not sure if it’s accurate though:

Nutrition Item	Burger	Fries	Total
Serving size	318 g	198 g
Calories	950	280	1230
Total Fat	63 g	8 g	71 g
Saturated Fat	26 g	2.5 g	28.5 g
Trans Fat	0 g	0 g	0 g
Cholesterol	205 mg	0 mg	205 mg
Sodium	970 mg	35 mg	1,005 mg
Total Carbs	52 g	44 g	96 g
Dietary Fiber	0 g	NA	NA
Total Sugars	9 g	0 g	9 g
Protein	44 g	2 g	46 g
Calcium	347 mg	0 mg	347 mg
Potassium	76 mg	NA	NA

Wow, 28.5 mg of saturated fat. The daily value assuming a 2,000 calorie diet is only 20 mg. Also there was no info for potassium for the fries but potato usually has pretty high potassium content. I think it’s good to avoid the burger and fries combo or I’m going to start clogging my new heart.

Based on experience, I’m pretty sure the sodium number is too low. They sprinkle salt on the fries so there’s no way it’s only 35 mg. I’ve had soup from the cafeteria that were so salty that it burned my throat.

There are a lot more brands of protein shakes than just Ensure. I only compared Nepro and Ensure because Nepro is practically the only product designed specifically for dialysis patients, and we have a lot of Ensure High Protein at home already. I did a search of Amazon for the most popular protein shakes and got this list. The Nepro column is in there for comparison; it’s not that popular:

Brand	Nepro	Premier Protein	Boost High Protein	Orgain Clean	Ensure Max Protein	Core Power	Muscle Milk	Iconic
Flavor	Mixed Berry	Café Latte	Rich Chocolate	Rich Chocolate	Milk Chocolate	Chocolate	Chocolate	Café Latte
Serving Size	8 oz	11 oz	8 oz	11 oz	11 oz	11.5 oz	11 oz	11.5 oz
Calories	425	160	240	140	150	240	160	130
Total Fat	22.7 g	3 g	6 g	2 g	1.5 g	3.5 g	4.5 g	2 g
Sat. Fat	2.0 g	0.5 g	1 g	0.5 g	0.5 g	2 g	1 g	0 g
Cholesterol	6.5 mg	20 mg	10 mg	16 mg	20 mg	15 mg	15 mg	10 mg
Sodium	250 mg	220 mg	230 mg	240 mg	140 mg	160 mg	250 mg	220 mg
Total Carbs	37.9 g	5 g	28 g	10 g	6 g	28 g	7 g	8 g
Protein	19.1 g	30 g	20 g	20 g	30 g	26 g	25 g	20 g
Calcium	250 mg	650 mg (50%)	380 mg (30%)	50%	50%	70%	30%	25%
Potassium	250 mg	360 mg (8%)	470 mg (10%)	300 mg (9%)	10%	600 mg (17%)	770 mg (22%)	380 mg (11%)
Phosphorus	170 mg	620 mg (50%)	25%	NA	40%	NA	40%	40%
Amazon	24/$57.00*	12/$23.99	24/$28.98	12/$20.91	12/$26.16	12/$23.79	12/$9.28	12/$33.99
Price/serving	$2.38	$2.00	$1.21	$1.74	$2.18	$1.98	$0.77	$2.83

Once again, Nepro seems to be the fat bomb with the most fat, carbs, and calories per serving. What I’m most worried about however, is the levels of potassium (K) and phosphorus (P). Since Nepro was designed for dialysis patients, it makes sense that it would have low levels of both. Most of the other protein shakes listed have lots of both, assuming NA for P means at least 40% DV. If I wanted to keep both K and P low, then I’m stuck with Nepro or Ensure Original/Plus/High Protein. If I had to get something else, I guess Boost is a viable option, except it’s made by Nestlé, the evil food corporation.

I wish Orgain would detail how much P there is per serving since everything else looks okay. The ingredients for the Clean Protein Shake includes sodium phosphate, magnesium phosphate, and tricalcium phosphate. Usually if there are several ingredients with something phosphate, there’s probably a lot of P in the product. There also seems to be a sale on Muscle Milk since it’s only $0.77 per carton. Maybe I can buy it for my mom since her kidneys are fine so the high levels of P and K is okay.

The best option is probably to eat well balanced meals so I don’t need to drink protein shakes. That’s not that easy now that I’m working again. Often, none of the food choices look appetizing to me. Also, it’s hard to figure out nutritional information for my parent’s home Chinese cooking.

After drinking a couple bottles of vanilla Ensure High Protein, I wanted to try some other flavors. There are lots of varieties of Ensure so I compared some nutrition values:

Nutritional Item	Original	Plus	High Protein	Max Protein
Serving Size	8 oz	8 oz	8 oz	11 oz
Calories	220	350	160	150
Total Fat	6 g	11 g	2 g	1.5 g
Saturated Fat	1 g	1 g	0.5 g	0.5 g
Cholesterol	<5 mg	10 mg	20 mg	20 mg
Sodium	210 mg	210 mg	210 mg	140 mg
Total Carbohydrate	32 g	50 g	19 g	6 g
Protein	9 g	13 g	16 g	30 g
Calcium	25%	25%	40%	50%
Potassium	10%	10%	10%	10%
Phosphorus	15%	15%	25%	40%

Looking at cholesterol and phosphorus levels, the original shake is probably best, though there is only 9 g of protein. After all, these are protein shakes. I wonder how Abbot decides on the nutritional content of each Ensure product. Do scientists or nutritionists come up with the recipe or does marketing?

Amazon seems to have the best prices: you can get a 24 packs for ~$26, or a 16 pack for $20. Target sells six packs for $8, which is more expensive but you don’t have to buy a lot at once. I think I want to try out the chocolate and the strawberry flavors. Abbott’s website lists a lot more flavors but they’re hard to find in stores.

My parents and I were planning to eat dinner at Souplantation last night. I’ve been trying to track my food intake with both Fitbit and MyFitnessPal apps on my phone. Since Souplantation has extensive nutritional information on their menu online, it’s easy to track. However, my dad ended up eating too much junk food in the afternoon so only my mom and I went to dinner in the end. Instead of Souplantation, we ate at a Japanese izakaya next door.

We ended up sitting at the sushi bar since there were no more tables, but neither one of us ate raw fish. It was weird sitting right in front of the sushi chefs and not ordering anything from them. My mom got a chicken teriyaki bento 照り焼きチキン, and I got some hot soba with shrimp tempura 天麩羅蕎麦 plus some fried tofu 揚げ出し豆腐. The food was pretty good; my mom wants to go back to eat already. However, there’s no nutritional information on their menu so I have to guess at my food intake. The soba didn’t taste that salty but I’m sure there’s quite a bit of sodium in the broth. Likewise, how much fat and phosphorus is there in the fried tofu? Do people who need to track their food intake closely just not eat out at small restaurants?

My friend and I are planning to meet for lunch today near my work. Usually we go to a hole-in-the-wall Vietnamese place. Obviously, they don’t post any nutritional information anywhere. I usually get their pho or egg noodles. The only nutritional information is salty.

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.