Helping Patients and Dispelling Dietary Myths

Melanie Betz, MS, RD, is a nationally recognized kidney stone dietitian and the founder and CEO of The Kidney Dietitian website. In addition to working with patients, she offers online courses, cookbooks, a blog, and a podcast.

Betz served as a planning chair for dietary sessions at the National Kidney Foundation Spring Clinical Meetings 2025 (SCM25), where she also presented on holistic nutrition for stone prevention and updates in nephrolithiasis management. Joel Topf, MD, spoke with her onsite at SCM25.

Dr. Topf: Joel Topf for Nephrology Times. I’m at the National Kidney Foundation Spring Clinical Meetings, and one of the things [that lets] you know you’re at the Spring Clinical Meetings is if you trip over a renal dietitian—they are everywhere. But I don’t just have a renal dietitian; I have The Kidney Dietitian. This is Melanie Betz. She runs a website. She does a lot of work. She’s a very high-profile kidney dietitian. Hey, thanks for joining me.

Betz: Thank you for having me.

Dr. Topf: I take care of a lot of CKD [chronic kidney disease] patients, and every clinical visit ends the same way: “Doc, what should I be eating?” There’s so much inherent desire to know that. How do you answer that question?

Betz: That’s so hard to answer. This is going to be so different for every single person.

Dr. Topf: Hey, take 5 or 10 seconds.

Betz: Focus mostly on plants, low sodium, limit animal protein. It’s so hard to answer that question because it’s going to be so different for each person. As doctors, nephrologists, and dietitians, we understand the differences based on labs, but the piece that is often critically missing is the difference based on patient preferences. Like, that’s the beauty. One of many benefits of working with a dietitian is that you will work with the patient to adjust what they’re eating right now. Dietitians don’t just say, “Eat this.” It’s like you’re taking what patients like, their cultural food preferences, and adjusting them to make them a bit more friendly for their kidneys.

Dr. Topf: I think also that we have gone down the trap of saying, “Oh, their potassium is high, let’s…”

Betz: Oh! [laughs]

Dr. Topf: I touched the nerve, and intentionally so, because I think it’s one of these classics. Before we jump to the meat of this, which is so interesting, what we’ve seen over the last few years is study after study coming out [showing] that making adjustments and putting people on low-potassium diets doesn’t fix the potassium. Yet it’s still the standard first stage of therapy, is always to put them on a low-potassium diet despite it doesn’t work.

Betz: And I would argue there’s a lot of harm in putting someone on a strict low-potassium diet.

Dr. Topf: Thank you! The classic one is, they say, “Oh, look, these fruits and vegetables are high in potassium. I’m going to stop those because they’re a big potassium source.” But they’re also a huge fiber source. They help the bowels keep moving. [They’re an] alkali source. There are a lot of reasons why they’re beneficial in this circumstance. And so, all I say is that the renal dietitians have a lot to answer for.

Betz: Yes. And I think that’s another thing is—I imagine there might be a lot of nephrologists listening to this.

Dr. Topf: Tons! Dozens of nephrologists are listening to this.

Betz: [laughs] What is really important, and one message that I would love to get across to nephrologists, is the way that you frame to your patients working with a dietitian. It’s not like, “Oh, talk to the dietitian about eating less salt.” That’s not fun, right? Instead, it’s like, “Go talk to a dietitian about what you can do to help protect your kidneys. Go talk to your dietitian about what you can do to slow the progression of kidney disease and keep you off dialysis.” That is fun. That’s going to make someone want to talk to a dietitian. And that’s not a lie. That’s what we can do.

Dr. Topf: That’s great. It’s the framing of the interaction. Don’t set it up to be this negative interaction. Set it up to be, “Hey, this is what we’re doing in this clinic. We’re keeping you off dialysis. And part of that is going to be adjusting what you eat.”

Betz: Yes, and helping them realize that dietitians, we’re not the food police. If you want to eat potato chips, you can eat potato chips. I think so often patients are afraid to see a dietitian because I think they’re never going to be able to eat their favorite foods, and the exact opposite is true. Most dietitians are dietitians because we love food, and we want other people to be able to eat and enjoy food. So, we are going to work with that patient to help them enjoy their favorite foods, potato chips, hamburgers, or whatever it happens to be.

Dr. Topf: We’ve been talking about CKD, but it seems like where you really like to work is with kidney stones.

Betz: Yes, it is.

Dr. Topf: How does that meeting start? What is your framework for dealing with a new patient who has recurrent kidney stones and has been referred to you? What does that interaction look like?

Betz: Similarly, looking at what they want to eat, but most importantly, looking at their urine risk factors. In many ways stone nutrition is decades past even where CKD nutrition is; there’s no one-size-fits-all diet for kidney stones. We need to look at that 24-hour urine test to have any idea what we can do from a medical or nutrition standpoint to prevent those stones.

I find myself—similar to potassium, perhaps, but perhaps even worse—steering people away from focusing on oxalate because that is such standard, general advice given to anyone. Yet there’s really no data that shows a low-oxalate diet prevents stones, and there are so many other things…

Dr. Topf: Wait, do you want to say that one more time for people in the back of the room?

Betz: There’s not a shred of evidence out there that shows that a low-oxalate diet prevents stones.

Dr. Topf: Oh, my God. You’re rocking my world. I had no idea. Let’s extrapolate it from the other unique thing. What about data on increased water intake reducing stones?

Betz: Sure.

Dr. Topf: How about reducing sodium intake to reduce stones?

Betz: Absolutely. More fruits and vegetables, which will come with more oxalate.

Dr. Topf: Oh, my gosh.

Betz: Mind-blowing. [laughs]

Dr. Topf: I’m crawling off the floor here. Let’s switch gears. What other major nutritional myths are you here to dispel?

Betz: Oh, gosh. Oxalate and potassium; those are my things. Those are my two sticking points that I give to group of people after group of people.

Dr. Topf: I love that. Awesome. What’s your final message for the people?

Betz: All kidney patients, whether with CKD or stones, need to have a dietitian or should be offered the opportunity to see a dietitian.

Dr. Topf: I will tell you that my experience is that they all want to. They’re craving it. They have the sense that “This is an important part of my health,” and they go to the doctor, but the doctor doesn’t address it, and the doctor doesn’t know how to address it.

Betz: You don’t have time to. You’re busy. And this is what we do. So, let us do it. All patients need the chance to see a dietitian. There’s this perception that patients don’t want to see a dietitian, and I think that is wrong. It sounds like that’s been your experience as well. I think, especially when you frame it as such, not, “Oh, this dietitian is going to help you eat less salt.” That’s not fun, right? Just framing it as, “This dietitian can help you enjoy your favorite foods, prevent stones, or prevent the progression of chronic kidney disease.”

Another important point is that dietitians for CKD, not stones, unfortunately, but for CKD, are covered by Medicare, which a lot of people don’t realize. This is an underutilized benefit that we need to use more to help our patients.

Dr. Topf: And how can people find the renal dietitian?

Betz: The National Kidney Foundation has a great “Find a Kidney Dietitian” resource. That’s a great way to go about it because you want to try to find someone who specializes in kidney disease, because not all dietitians know about kidneys. So, that’s a great resource. You can also look for a dietitian with a credential, CSR—certified specialist in renal nutrition. That means we’ve had some extra education and passed some extra exams to get that credential.

Dr. Topf: What if they wanted to find Melanie Betz?

Betz: I’m at thekidneydietitian.org. That’s my blog, and I’m also active on social media. I’m on Instagram at the.kidney.dietitian.

Dr. Topf: That’s awesome. Hey, thanks for joining us. Have a good meeting.

Betz: Thank you for having me. Yes, you too.