Is there anything left to eat? A lived experience insight of following a restrictive type 1 diabetes and dialysis diet

Chronic kidney disease has a global morbidity burden of >10%, with diabetes being a major cause.  Nutrition therapy is vital in managing both chronic conditions, yet CKD dietary guidelines contradict healthy eating advice, and can result in major psychological and social burdens. Few studies investigate the patient's experience of being placed on such a restrictive diet. This auto/biographical review provides a unique perspective and aims to assist practitioners as they guide patients on 'what is left to eat.'

An auto/biographical approach, supported by a comprehensive literature review using data from MEDLINE, Embase, and PsychoINFO, was used to answer the question: 'What are the diet and lifestyle challenges of following a restrictive Type 1 Diabetes/CKD dialysis diet?'

Restrictive dietary and fluid regimes have a major effect on patients' illness beliefs, anxieties, and independence. This is discussed through five themes: Food is belonging; Normal is a Fallacy; Your numbers define you; A disease disguised as a virtue and Meeting the Elephant: ESKD diagnosis and the burden of dialysis.

Dietary intervention is crucial in the management of T1D and ESKD, but equally important is to consider the implications of strict dietary regimes without sufficient evidence, guidance, and support.