mayo clinic diet for stage 4 kidney disease mayo clinic diet for stage 4 kidney disease

These include: Not smoking, if you smoke: Smoking damages blood vessels and arteries.It increases the risk of . 10 Foods to Avoid with Kidney Disease and Diabetes, 17 Foods to Avoid or Limit If You Have Bad Kidneys. Major sources of potassium include potatoes, tomatoes, melons, oranges and orange juice, bananas, dairy products and salt substitutes that contain potassium, such as Morton Lite Salt or No Salt. We all need to pay attention to what we eat. Your blood is run through a filter that acts as an artificial kidney. Mayo Clinic. In some conditions, treatment can reverse the cause of the disease. Salt is one of the most commonly used seasonings. @valb68, I want to welcome you to Mayo Connect. Our team thoroughly researches and evaluates the recommendations we make on our site. For example, getting better blood pressure control, improved sugar control and diabetes, and reducing weight are often key interventions. Here are 11 foods to avoid with kidney disease and diabetes. While following a renal diet can feel restrictive at times, there are plenty of delicious foods that fit into a healthy, well-balanced, kidney-friendly meal plan. Mayo Clinic Medical Science Blog an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic. Because your kidneys are able to make up for lost function, you might not develop signs and symptoms until irreversible damage has occurred. Itll take time for you to get used to reducing the salt in your diet. He has said nothing about diet; my gfr is around 21, and he has not even mentioned dialysis or transplant at this point. Dont drink Mountain Dew (any kind), colas, root beers, Dr.Pepper (any kind). Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Its a good source of manganese, vitamin C, and vitamin B6 and contains sulfur compounds that have anti-inflammatory properties. because this population is at highest risk for complications related to Or your doctor could also refer you to a therapist or social worker. I understand that the balancing act can feel overwhelming. Who gets it? Some of the complications of chronic kidney disease include: Low red blood cell count ( anemia ). In particular, these sweet berries contain antioxidants called anthocyanins, which may protect against heart disease, certain cancers, cognitive decline, and diabetes (20). We wish you well. Consuming alcohol in moderation. Chronic kidney disease (CKD). Im not on dialysis. The new kidney's urine tube (ureter) is connected to your bladder. Weak and brittle bones. These items can include boneless chicken and bone-in chicken pieces, turkey breast, whole turkeys, steaks, roasts, burgers, pork tenderloin and pork chops. Once you reach stage three, you've lost half of your kidney. You should aim for less than 2 grams of sodium in your daily diet. Supportive care might include management of symptoms, measures to keep you comfortable and end-of-life planning. However, macadamia nuts are a delicious option for people with kidney problems. Sodium Limiting sodium to 2300 mg or less (about 1 teaspoon of salt) per day: Helps to reduce fluid build up in the body (swelling of the ankles, fingers, eyes) I think that we can connect you with some other members who have also discussed their diabetes diets and/or CKD. Soft drinks contain phosphorus, so only drink clear ones. (Watermelon is OK.). The symptoms, diagnosis and treatment. When you're ready to cook them, pour the soaking water off and use a large amount of water in the pan. The place they are inserted is called the access. Therefore, its necessary for people with kidney disease to follow a special diet. Drain this water before you prepare them to eat. To diagnose end-stage renal disease, your health care provider may ask you about your family's and your medical history. When your kidneys no longer work at a level that's necessary to keep you alive, you have end-stage renal disease. Chronic kidney disease. privacy practices. FIND CLASSES You may need to spend several days to a week in the hospital. Chronic kidney disease. Its a great source of vitamin K, vitamin C, and many B vitamins. Treating the cause is key, leading to reduced complications and slowing progression of kidney disease. But, even controlling the cause might not keep kidney damage from progressing. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This is a chemical imbalance (acid-base) in your blood caused by decrease in kidney function. Examples may be calcium phosphate, phosphoric acid and hexametaphosphate. This is what is working for me but since each person is different find a good dietician that can help you develop a plan that works for you. Learn to read food labels. Chronic kidney disease. A renal diet can help protect you from kidney damage. Accessed April 26, 2021. If you have early-stage kidney disease or you're on dialysis, you may need to limit phosphorus. Last reviewed by a Cleveland Clinic medical professional on 12/06/2021. 26th ed. One of the best ways to reduce potassium buildup is to make dietary changes. A single copy of these materials may be reprinted for noncommercial personal use only. But also heart disease and obesity can contribute to the damage that causes kidneys to fail. Nuts and nut butters Eggs Cheese Fish and seafood Poultry (chicken, turkey and duck) Red meat TIPS Choose plant-based proteins more often such as beans, tofu and other legumes. They can be roasted or boiled and mashed for a healthy side dish that works well for a renal diet. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys with the help of a fluid that washes in and out of the peritoneal space. You may think if you aren't adding salt to your food that your sodium intake is low. What Is Atrophic Kidney and How Is It Treated? Allscripts EPSi. People with kidney disease may need to control these important nutrients: sodium, potassium and phosphorus. A lower-protein diet may also be recommended. Namely quit smoking. Defects in the kidney structure can also cause your kidneys to fail, and you have an increased risk as you get older. If your calcium levels are elevated, avoid calcium-fortified foods. Nutrition Care Manual. In addition, they provide a good amount of plant-based protein and dietary fiber. However, those with end-stage renal disease undergoing dialysis, a treatment that filters and cleans the blood, have greater protein needs (15, 16). not tolerate it for supplements, either.. people who have kidney disease are not aware of it.. A sample diet for stage 4 kidney disease can be found below, described in detail regarding the stage 4 renal failure diet plan. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Here are 20 of the best foods for people with kidney disease. There are various ways in which these vital organs can become damaged. Learn more from kidney doctor Andrew Bentall, M.D. https://www.uptodate.com/contents/search. Delivery, Center for the Science of Health Care Delivery, If you enjoyed this article, you might want to. (https://www.niddk.nih.gov/health-information/community-health-outreach/information-clearinghouses/nkdep?dkrd=lgdmw0002), Visitation, mask requirements and COVID-19 information. There are other lifestyle changes to help prevent further damage to your kidneys. Foods in a kidney diet have lower amounts of sodium, protein, potassium, or phosphorus. Both type 1 and type 2 diabetes. Potential complications include: To reduce your risk of developing kidney disease: Chronic kidney disease care at Mayo Clinic. People with kidney disease and diabetes should monitor their intake of certain nutrients. When your kidneys are not working well, phosphorus can build up in your blood. When shopping for chicken, choose fresh chicken and avoid pre-made roasted chicken, as it contains large amounts of sodium and phosphorus. This site complies with the HONcode standard for trustworthy health information: verify here. https://www.mayoclinic.org/food-and-nutrition/expert-answers/faq-20058408, Let me know what other information might be helpful to you. Mayo Clinic does not endorse companies or products. The Mayo Clinic College of Medicine and Science includes five schools: Tags: Center for the Science of Health Care Delivery, Findings, integrative medicine, kidney disease, News, Rozalina McCoy, Shaheen Kurani, version 3.3.6.2.7.9Page loaded in 0.076 seconds, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Continuing Education for Medical Professionals, Early Research Finds Hope in Stem Cell Therapy for Perianal Fistulas in Patients with Crohns Disease, Mayo Clinic Discovery Leads to Life-Changing Treatment for Young Girl with Ultra-Rare Disease, New Standards and Open Access Can Help Natural Language Processing, Clinical Trials Are Way of Paying It Forward to Your Community, Centers for Disease Control and Prevention, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, National Health and Nutrition Examination Survey, a tablespoon (about 10 grams) of whole flaxseeds, Mayo Our website services, content, and products are for informational purposes only. Unless they are causing complications, your own kidneys are left in place. What is kidney disease? Your dietitian might recommend that you choose lower potassium foods at each meal. The above statements are derived from studies by DaVita, Hindawi, medscape, kidney.org, and the NIH. But there are lots of ways to help you to be more comfortable for longer before more drastic measures are needed. may mean that awareness translates to caution or to greater odds of discussing Chronic kidney disease affects an estimated 37 million people in the U.S., according to the National Kidney Foundation. A single copy of these materials may be reprinted for noncommercial personal use only. Byproducts of protein degradation no longer can be cleared as well by damaged kidneys, so protein is limited to decrease buildup of waste products. The majority of fat in olive oil is a monounsaturated fat called oleic acid, which has anti-inflammatory properties (34). As part of your treatment for kidney disease, your health care provider might recommend that you follow a special diet to help support your kidneys and limit the work they must do. An expert explains, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Effectively managing chronic kidney disease. And as clinicians, we need to do a better job of routinely asking our patients about what non-prescription medications and supplements they may be taking, and doing it without judgement.. Make a donation. Then take note of: Take a family member or friend along, if possible, to help you remember the information you're given. Where possible, the preferred therapy is a kidney transplant. @cehunt57, Thank you for joining this discussion. It's carried out of the body in urine. You also can combine palliative care with kidney transplant or dialysis. High blood pressure (hypertension) that's difficult to control, Shortness of breath, if fluid builds up in the lungs, Chest pain, if fluid builds up around the lining of the heart, Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli), Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures, Polycystic kidney disease or other inherited kidney diseases, Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers, Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys, Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis), Being Black, Native American or Asian American, Frequent use of medications that can damage the kidneys, Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema), A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's function and can be life-threatening, Weak bones and an increased risk of bone fractures, Decreased sex drive, erectile dysfunction or reduced fertility, Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures, Decreased immune response, which makes you more vulnerable to infection, Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium), Pregnancy complications that carry risks for the mother and the developing fetus, Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival. In the past 3 weeks I had a physica. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. One cup (100 grams) of fresh cranberries contains (56): Shiitake mushrooms are a savory ingredient that can be used as a plant-based meat substitute for those on a renal diet who need to limit protein. Stage 3 Kidney Disease and Diet: What can I eat? Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. They may also refer you to a kidney specialist, a nephrologist like myself. Other supplements may also be harmful for people with kidney disease, the researchers caution, since there is little research in this area and supplements are not regulated in the same way that prescription and over-the-counter medications are in the U.S. Supplements, So seeking medical review is really important. Your GFR increase must make you feel very good! advanced or end-stage kidney disease (stages 4 and 5 chronic kidney disease). Its something thats usually associated with kidney disease, although how, Serotonin-producing 5-HTP supplements have become increasingly popular for their variety of health benefits. One cup (124 grams) of cooked cauliflower contains (18): Blueberries are packed with nutrients and one of the best sources of antioxidants you can eat (19). I'm type 1 diabetic since 1975 (with history of gastroparesis), post pancreas transplant", "@valb68, I want to welcome you to Mayo Connect. You may take a number of medications to help keep your immune system from rejecting your new kidney and to reduce the risk of post-surgery complications, such as infection. Chronic kidney disease. Advertising revenue supports our not-for-profit mission. While an organ transplant can sound daunting, it's actually often the better alternative, and the closest thing to a cure, if you qualify for a kidney transplant. Early detection might help prevent kidney disease from progressing to kidney failure. Our kidneys play many important roles keeping our bodies in balance. Diet Tips for Chronic Kidney Disease Stages Kidney Diet Tips Blog Recipes, tips and news for people on a kidney diet. Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Nearly every food contains some phosphorus, so this can be hard to do. Youll need to avoid certain fruits and vegetables and limit the amount of others. information highlighted below and resubmit the form. Another option is to connect a plastic tube between two blood vessels. Needs are based on height, weight and overall health. By limiting dairy and choosing fruits and vegetables that are lower in potassium, you can control your potassium level. To provide you with the most relevant and helpful information, and understand which GO TO BLOG Learn to manage your kidney health. However, avoiding or limiting certain foods in your diet may help decrease the accumulation of waste products in the blood, improve kidney function and prevent further damage. The solution is left in place for a number of hours while dialysis occurs. https://www.merckmanuals.com/professional/genitourinary-disorders/chronic-kidney-disease/chronic-kidney-disease?query=Chronic kidney disease. Depending on your situation, kidney function and overall health, your dietitian might recommend that you: Choose lower potassium foods. Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Accessed April 26, 2021. Grill, broil, bake, roast, or stir-fry foods, instead of deep frying. Register on Advancing the Science and get updates when we have new content! Mayo Clinic does not endorse any of the third party products and services advertised. It reduces the amount of waste your kidneys need to filter from your blood. One cup (20 grams) of raw arugula contains (45): Most nuts are high in phosphorus and not recommended for those following a renal diet. There are things that are more under our control: Heavy or long-term use of certain medications, even those that are common over-the-counter. survey. Some of them are not things that can be avoided. Dont use kosher or sea salt. But if you do have kidney disease, a renal diet can help slow down the disease before it progresses and worsens. More than one-third of the 15.7 million Americans with moderate or advanced chronic kidney disease use dietary or herbal supplements, reports new research from Mayo Clinic. Anything it doesnt need is carried through the blood to the kidneys. supplement use with their clinical team, she says. Revista da Associao Mdica Brasileira. Allscripts EPSi. All rights reserved. If you have kidney disease, some nutrients can build up and damage your kidney. To help keep fat from building up in your blood vessels, heart, and kidneys. Learning you have chronic kidney disease and learning how to live with it can be a challenge. And even then, there is plenty of hope. Learn more about the center. the unsubscribe link in the e-mail. With polycystic kidney disease (right), fluid-filled sacs called cysts develop in the kidneys. Hepatitis C is an infectious viral disease of the liver that affects around 1% of the U.S. population, or roughly 2.4 million people. That lining is called the peritoneal membrane. Teas have been used as a natural remedy to soothe stomach upset for thousands of years. Whether you are looking for answers for yourself or for someone you love, we're here to give you the best information available. The kidneys are small but powerful bean-shaped organs that perform many important functions. Conditions such as high blood pressure and diabetes take a toll on kidney function by damaging these filtering units and collecting tubules and causing scarring. These can not only slow the damage of kidney disease, but make you feel better as well. Cauliflower is a nutritious vegetable thats a good source of many nutrients, including vitamin C, vitamin K, and the B vitamin folate. 1. There are quite a few things that can cause or put you at higher risk for chronic kidney disease. If we combine this information with your protected Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure. Goldman L, et al., eds. Choose only canned vegetables that say no salt added on the label. Before we get into the disease itself, let's talk a little bit about the kidneys and what they do. Merck Manual Professional Version. I have a list of high fiber foods that I tend to avoid because while high fiber is great for managing cholesterol, blood sugar and weight; it wreaks havoc with my gastroparesis. It does this by preventing certain minerals from building up in your body, which is important because your kidneys do not work as well to remove waste products from your body. A half cup (78 grams) of cooked turnips contains (50): Many tropical fruits like oranges, bananas, and kiwis are very high in potassium. 5 Science-Based Benefits of 5-HTP (Plus Dosage and Side Effects), The 15 Best Vitamin Brands of 2023: A Dietitians Picks. Do you need resources? Start Here. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Blackberry iced tea with cinnamon and ginger, Chicken salad with pineapple and balsamic vinaigrette, Corn tamales with avocado-tomatillo salsa, Fettuccine with clams, basil, tomato, corn and garlic, Pasta with spinach, garbanzos and raisins, Salad greens with pears, fennel and walnuts, Sweet peppers stuffed with scalloped corn, Sweet potato waffles with blueberry syrup, Dilled pasta salad with spring vegetables, English cucumber salad with balsamic vinaigrette, Granola with raisins, apples and cinnamon, Lemon rice with golden raisins and almonds, Savory buckwheat pilaf with toasted spices, Wild rice pilaf with cranberries and apples, Advertising and sponsorship opportunities. The solution draws extra fluid, chemicals, and waste out of those blood vessels and through the lining. Cranberries can be eaten dried, cooked, fresh, or as a juice. We do not endorse non-Cleveland Clinic products or services. Accessed April 27, 2021. However, more than 70% of sodium in the average American's diet already is in the foods we buy, such as grains, meat, soups, sandwiches and restaurant meals. You also may need to limit foods with natural phosphorus, such as dairy, nuts and whole grains. Moderate to severe loss of kidney function. Delivery. Making sure you have a good diet for your health conditions, getting moderate exercise, moderating your stress levels, and following your medical team's suggestions, will go a long way to keeping healthy. The lining acts as a filter. Kidney diet (renal diet) - Mayo Clinic Healthy Recipes Kidney diet (renal diet) Products and services If you have chronic kidney disease or limited kidney function, your health care provider may suggest a kidney diet (renal diet). In the earliest stages, your kidneys are damaged and not working at their full capacity. Canned fruits usually have lower amounts of potassium than fresh ones. I am blessed! And the earlier it's detected, the easier it is to treat. It might be difficult to manage the treatment schedule if you're on dialysis. In the early stages of chronic kidney disease, you might have few signs or symptoms. An expert explains, Science Saturday: Seeking a cellular therapy for chronic kidney disease, Science Saturday: Mayo Clinic researchers integrate genomics into kidney disease diagnosis, care, Mayo Clinic Minute: Understanding chronic kidney disease, Expert Alert: Risk for chronic kidney disease even more critical due to COVID-19 pandemic. Make a donation. Anyone know anything for breakfast, lunch and dinner that does not have any sugar or flour bodies the obvious boring or bland foods good . Complete your request online or contact us by phone. Learning you're in kidney failure can come as a shock, even if you've known about your kidney disease for a while. The dialysis needles are inserted into that vein. Chronic kidney disease has five stages. However, you can still eat numerous healthy vegetables, fruit, proteins, and oils. While dietary restrictions vary, its commonly recommended that all people with kidney disease restrict the following nutrients: Protein is another nutrient that people with kidney disease may need to limit, as damaged kidneys cant clear out waste products from protein metabolism. It can also be helpful to find a support group and connect with people going through the same thing. Mayo Clinic; April 21, 2021. My Bday was Wednesday 2/7/1957. Without either dialysis or a transplant, kidney failure progresses, eventually leading to death. Ive been on a low carb, sodium and fat diet for a long time and do carb counting to calculate insulin bolus dosages. Please discuss your specific and individual diet needs with your healthcare provider or the registered dietitian at your dialysis center. I look after patients with kidney disease, either in the early stages, or with more advanced kidney disease considering dialysis and transplantation as treatment options. Limit these to 1 cup per week: Certain cereals should be limited to 1 serving per week. Sauting onions with garlic and olive oil adds flavor to dishes without compromising your kidney health. And as kidney disease progresses, you may notice the following symptoms. The biopsy needle is inserted through your skin and is often directed using the guidance of an imaging device, such as ultrasound. health information, we will treat all of that information as protected health Work with your dietitian to make a meal plan that meets your individual needs. If you can share a little bit about yourself, I think we can better assist you. Sometimes, other common medical conditions can increase your risk. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. For end-stage renal disease, you'll likely continue to see the same health care provider and care team you've been seeing for treatment of chronic kidney disease. When the kidneys filtering ability is impaired, supplements may accumulate and lead to toxicity. Chronic kidney disease. Furthermore, it provides insoluble fiber, a type of fiber that keeps your digestive system healthy by promoting regular bowel movements and adding bulk to stool (37). You then have surgery to place the new kidney in your lower abdomen and attach the blood vessels and ureter the tube that links the kidney to the bladder that will allow the new kidney to function. whether supplements are safe because for most supplements and herbs, we just After a successful kidney transplant, your new kidney filters your blood, and you no longer need dialysis. All Rights Reserved. Chronic kidney disease (CKD) is a persistent kidney disease that reduces the rate at which kidneys filter waste and fluids (as measured by the glomerular filtration rate, or GFR) accompanied by an increase in the amount of protein passed in urine (referred to as albuminuria ). Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Kidney Health. They helped to make hormones to produce red blood cells, and they turn vitamin D into its active form, so it's usable in the body. What is it? Its also full of anti-inflammatory compounds like indoles and is an excellent source of fiber (17). Mayo Clinic is a not-for-profit organization. If you are a Mayo Clinic patient, this could information and will only use or disclose that information as set forth in our notice of If you'd like to learn even more about chronic kidney disease, watch our other related videos or visit mayoclinic.org. I dont have fluid restrictions and Im supposed to stay well hydrated. Go to the Kidney & Bladder Support Group. I too have diabetes and esrd 2020; doi:10.1590/1806-9282.66.S1.3. To determine what stage you have, your health care provider performs a blood test to check your glomerular filtration rate (GFR). One ounce (28 grams) of macadamia nuts contains (46): Radishes are crunchy vegetables that make a healthy addition to a renal diet. @valb68, Hi valb68, I am happy that you found some helpful information in the New and Confused Diabetic Discussion where I tagged you. A coordinator will follow up to see if Mayo Clinic is right for you. Supplements can also interact with other medications, either amplifying or diminishing their effects. If you have kidney disease, your health care provider will determine the best diet for your needs. In addition, 1.3 percent of patients who were unaware they had moderate kidney impairment took flaxseed oil, which translates to 167,500 Americans. All rights reserved. Thank you, @cehunt57, for telling me your story. If you buy through links on this page, we may earn a small commission Heres our process. Advertising revenue supports our not-for-profit mission. Mayo Clinic Explains Kidney Disease From an accredited hospital Watch on Show transcript Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Maybe they will help prepare you for a meaningful conversation with the nutritionist. Merck Manual Professional Version. include protected health information. You are so right: we are each different in what we need to do to maintain our own level of success. Whats more, onions are high in vitamin C, manganese, and B vitamins and contain prebiotic fibers that help keep your digestive system healthy by feeding beneficial gut bacteria (42). To get ready for your appointment, ask if there's anything you need to do ahead of time, such as make changes to your diet. Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Accessed April 26, 2021. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes.