is benefiber safe for kidney patients
We all know that most of our patients with CKD, just like many Americans, are not eating enough fiber. Available for Android and iOS devices. To find out more about all of the different prebiotic fiber and their benefits, visit the Kibow Biotech website. The National Kidney Foundation notes that heart disease is a major risk factor for kidney disease and vice versa. We avoid using tertiary references. Accessed Oct. 8, 2018. In most cases, the choice between them is personal preference. kidney beans, bran cereals, etc. Many people do not experience symptoms of kidney disease until the later stages when kidney failure has occurred. https://www.benefiber.com/fiber-supplement-products/benefiber-powder/, https://www.citrucel.com/products/orange-mix-powder/, https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Dietary_Fiber.pdf, https://www.metamucil.com/en-us/products/metamucil-fiber-supplement/metamucil-original-coarse-powder, https://www.metamucil.com/en-us/products/fiber-powders/sugar-free-orange-smooth, http://labeling.bayercare.com/omr/online/MiraLAX-Mix-In-Pax.pdf, https://espace.curtin.edu.au/bitstream/handle/20.500.11937/46680/153804_28194_Pal_Binns2011_British%20Journal%20of%20Nutrition_effecto%20of%20fibre%20supplement.pdf?sequence=2, https://www.bmj.com/content/347/bmj.f6879. The Human Microbiome in Chronic Kidney Disease: A Double-Edged Sword. Accessed Oct. 8, 2018. information and will only use or disclose that information as set forth in our notice of It can affect anyone, but it's more common in people who are black or of south Asian origin. Trimethylamine N-oxide (TMAO), a toxic metabolite produced from the fermentation of choline and carnitine, triggers an inflammatory response and is a strong predictor of CVD and increased risk and progression of CKD. Choose 2-3 vegetables to easily add to meals or snacks over the next week, Use fresh or frozen fruit for dessert or snacks, Swap a few favorite refined grain products for whole grains, Add nuts or seeds as snacks or sprinkled on meals, Try at least one or two meals per week that use beans or legumes, Fructans (Fructo-oligosaccharides(FOS), Inulin, and oligosaccharides), The elusive Jerusalem artichokes (if anyone can actually find this let us know), Cooked and cooled rice, potato, and pasta. Both products contain a high concentration of fiber. Results: Visit the Kibow Fortis website or Email toinfo@kibowbiotech.com. In addition, you can find prebiotic fiber added to processed foods like protein bars, yogurts, and cereals. GOS is derived from lactose and feeds bifidobacterium and lactobacillus- two essential bacteria for gut health. J Ren Nutr. If you have intestinal problems, such as a history of a bowel blockage or Crohn's disease, talk to your doctor before adding a fiber supplement to your diet. People can find a wide range of fiber supplements and other constipation relief supplements online or in drug stores. However, we know that this is not the case for all patients. The .gov means its official. It is a non-allergenic form of soluble fiber that may not cause as much gas buildup as some other products. Do not exceed 9 tablets per day, 1 tablets up to three times daily. Stop taking these Fiber supplements: Metamucil, Benefiber, Perdiem, Citrucel . Although constipation is usually perceived as a benign, often . There is a problem with Topamax may increase your risk of kidney stones . official website and that any information you provide is encrypted The use of fiber and prebiotics to increase the production of beneficial bacteria, short-chain fatty acids (for example, butyrate), and Vitamin K production. Alternatively, wheat dextrin does not have the same laxative properties and at specific doses, can even have constipating effects. x. Here are just a handful of ways fiber can improve the health of kidney patients. A single copy of these materials may be reprinted for noncommercial personal use only. Some people may respond better to one fiber supplement or dietary change than others. You may get good results just by avoiding high-potassium fruits and vegetables. For individuals with IBS that are following a low FODMAP diet, Fructans and GOS are well-known triggers. the unsubscribe link in the e-mail. Is This an Emergency? compared an LPD with LPD + inulin and found that the control group with inulin added showed a decrease in uric acid and C-reactive protein (CRP). This is because wheat dextrin fails to hold water and is not as viscous as psyllium soluble fiber. But if not, this is important to understand. Ohta S, Asanoma M, Irie N, Tachibana N, Kohno M. Metabolites. Unauthorized use of these marks is strictly prohibited. Stool softeners are a type of laxative. The expected goals of the following interventions may include: regular bowel movement, improvement of stool continence and incomplete evacuation, amelioration of gut microbiota composition, and decreased synthesis of harmful uremic toxins. Also Check: Is There A Lot Of Cholesterol In Shrimp, Read Also: What Size Kidney Stone Is Too Big To Pass. Keep a What Is Normal Blood Sugar Level fast acting carbohydrate in your bag, desk drawer, car and other places for easy access. This site complies with the HONcode standard for trustworthy health information: verify here. Swallow with liquid. 2022 Jun 17;14(12):2521. doi: 10.3390/nu14122521. Anyone taking regular medication should consult a doctor or pharmacist before using these supplements. What stands out to me most about this is its simplicity. These two species of bacteria are known for their ability to produce SCFA's, especially butyrate. Benefiber contains wheat dextrin, which is a form of wheat starch. Picco MF (expert opinion). The active ingredient in Benefiber Powder is wheat dextrin, a natural soluble fiber that supports the bodys ability to remove wastes. Metamucil contains psyllium husk powder. Topamax is a drug often used to treat epilepsy , painful headaches , and bipolar disease . The study results showed that the group of mice given GOS had lower serum IS and cecal indole concentrations. Rossi M, Johnson DW, Xu H, Carrero JJ, Pascoe E, French C, Campbell KL. The effect of GOS on the composition of gut microbiota and tubulointerstitial injury was evaluated in nephrectomized rats compared to a control group. Diet and uremia aren't the only causes of dysbiosis. The symptoms of type 2 diabetes are similar to those of type 1 diabetes. Dangerous levels of the drugs can also build up in your system, because your kidneys can no longer filter your blood as well as they should. Hence, the million-dollar question is when and why should we consider recommending a prebiotic fiber supplement to our patients over food? Anyone with stomach or digestive disorders should talk to their doctor before taking either of these supplements. (3), PCS and IS arent the only offenders known to affect the progression of both CVD and CKD. This may decrease peoples appetites and help with weight loss. We use the power of personalized holistic nutrition to improve kidney function and delay or avoid dialysis. One study linked a 10-gram increase in daily soluble fiber intake to a 3.7% lower risk of gaining belly fat . Miralax is not a fiber-based supplement. Fiber supplements and clinically proven health benefits: How to recognize and recommend an effective fiber therapy. Lower-potassium fruits and vegetables include apples and apple juice, cranberry juice, canned fruit, strawberries, blueberries, raspberries, plums, pineapple, cabbage and cauliflower. Do not bring to a boil. Unfortunately, many of the medications prescribed to control these conditions can make them even sicker than they already are. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Probiotics are live microorganisms that confer health benefits on the host. Unable to load your collection due to an error, Unable to load your delegates due to an error. A vast number of factors are vital for normal intestinal motility, such as the nervous system , immune system, endocrine system, bile acid metabolism, mucus secretion, gut microbiota, and products of intestinal fermentation . Kibow Fortis, a multistrain prebiotic, is a great option! Dont Miss: How Long To Fast Before Cholesterol Panel. This can include common brand name fiber supplements like Metamucil and Citrucel. information highlighted below and resubmit the form. A systematic review published in BMJ found that higher fiber intake might lower the risk of both coronary heart disease and cardiovascular disease. The main fiber ingredient in Benefiber + Probiotics Gummies is inulin. The two brands work in very similar ways, but they may have slightly different effects on the body. (1), Studies show that protein metabolism is impaired in a uremic state. Its the quality of the carb that counts. Nutritional Supplements at Mayo Clinic Store. (12) Blood sugar control is essential for patients in earlier stages of CKD because poor glucose control correlates with the faster progression of the disease. https://www.uptodate.com/contents/search. Here are just a handful of ways fiber can improve the health of kidney patients. information submitted for this request. While adding a prebiotic fiber, watch for GI complaints such as gas, bloating, constipation, and diarrhea. To provide you with the most relevant and helpful information, and understand which Fiber Rich Foods That Are Safe For Kidney Disease: Apple Berries Cherries Peach Pear Pineapple Plums Watermelon Broccoli Cabbage Carrots Cauliflower Celery Cucumber Eggplant Garlic You not only want to consume more of these fiber rich foods to boost your kidney health, but you want to consume enough to provide maximum benefit. However, individuals with CKD who had a higher fiber intake showed lower overall mortality than the non-CKD subset. Benefiber doesn't bulk up stool as much as insoluble fiber supplements. Mayo Clinic does not endorse companies or products. Many people use dietary supplements to relieve constipation and other digestive issues. It's important for various functions in the body like electrolyte and acid-base balance. Protect from moisture. In addition to treating constipation, Metamucil may also help lower your cholesterol levels, and may improve your blood sugar control if you have type 2 diabetes. MS: Can the Mediterranean diet help preserve cognitive health? Learn more about the causes and, Laxatives occasionally taken for constipation can help people have bowel movements. Swallow with liquid. Stir well until dissolved. Fiber can also your appetite by making you feel fuller for a longer time. Yep, we thought so! 2013 Mar;20(2):175-80. doi: 10.1053/j.ackd.2012.12.007. (8). Swelling in your hands or feet. The https:// ensures that you are connecting to the From what we already know about the potential implications of dysbiosis, restoring the balance of the microbiota can profoundly impact the health and outcomes of patients with CKD. The powdered version of both products mixes well in cool or room temperature liquids, including smoothies, protein shakes, water, juice, or milk. You can learn more about how we ensure our content is accurate and current by reading our. Prebiotics are indigestible food ingredients that include dietary fiber, oligosaccharides, polysaccharides, and resistant starches. Current CKD practice guidelines overlook dietary fiber . If you have been told you have Chronic Kidney Disease, Kidney Injury, or Kidney Damage, your doctor may advise you to stop using PPIs altogether. This will also help to minimize the Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake. Are you looking for Benefiber reviews? Let's review the most popular fiber supplements available and any research to support their role in CKD. Do not exceed one serving daily. There is also a more natural version of Metamucil available, though the familiar orange-flavored forms of Metamucil often contain sweeteners, colorants, and other additives, which may make it more pleasant to drink. Benefiber Review. DOI: 10.1016/j.beem.2021.101484. Lactulosetalk with your physician before restricting thisthere are some patients who will need to keep taking this medication. Butter. sharing sensitive information, make sure youre on a federal It has been studied extensively as a therapeutic prebiotic fiber for CKD. Dietary fibre intake and risk of cardiovascular disease: Systematic review and meta-analysis. Here are some of the familiar sources: Two common resistant starches used often are potato starch and green banana powder. If you are pregnant or nursing a baby, ask a health professional before use. Fasting diet: Can it improve my heart health? Accessed Oct. 8, 2018. Research is emerging that targeted use of prebiotic fibers can have a positive effect on both gut health and CKD. Do not be scared to exercise. Interested in learning more about prebiotics and kidney care? Unfortunately, constipation is a common complaint from people with CKD and is especially prevalent amongst those who require dialysis. * Benefiber + Probiotics Gummies contain inulina plant-based prebiotic fiber that helps optimize gut health. They are becoming increasingly popular for diabetes thanks to their glucose-lowering effects. Creatinine is a natural waste product that the muscles create. Insoluble fiber helps keep our stools soft and regular, always a good thing! How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. Careers. If your kidneys have been damaged by CKD, your diabetes drugs may not do their job. Remember the uremic toxin P-cresyl sulphate (PCS) and the toxic metabolite Trimethylamine N-oxide (TMAO)? One may also ask, what is the best natural cholesterol lowering supplement? One of the things I've wanted to learn more about is how to leverage gut health to improve the health and longevity of CKD patients. Helping patients meet dietary fiber recommendations is an incredible opportunity for Renal Dietitians to help patients change their health and disease trajectory. Diet and uremia arent the only causes of dysbiosis. If you are a Mayo Clinic patient, this could Irritable Bowel Syndrome is one of the most common gastrointestinal disorders, and its milder form affects nearly 40% of people, and worldwide, IBS impacts 10-15% of the international population. 1. Medications such as ibuprofen (Advil or Motrin), naproxen (Aleve), or acetylsalicylic acid (Aspirin) are unsafe for your kidneys. (24). A study on mice with adenine-induced CKD showed that the addition of gum arabic decreased IS and caused restoration of intestinal dysbiosis by upregulating the number of beneficial bacteria and an increase in short-chain fatty acid production. You May Like: When Should You Go To The Er For Kidney Stones. Fiber supplements can also reduce blood sugar levels, which may require an adjustment in your medications or insulin if you have diabetes. In 2012, Krishnamurthy et al. Calcium-restricted diet. They found that higher fiber intake was associated with decreased incidence of inflammation in those with and without CKD. HealthyKidneyClub.com is a one-stop resource for everything you need to know about kidneys. If you are pregnant or nursing a baby, ask a health professional before use. Benefiber And Chronic Kidney Disease Kidney Disease Solution Kidney Disease Solution is an complete step-by-step guide designed to improve kidney health and reverse kidney disease. looked at the data from the NHANES III survey to identify the association between fiber intake, inflammation, and all-cause mortality in individuals with CKD compared to those without CKD. It can also lower your immune system, contributing to worsened symptoms Benefiber Blood Sugar if you have diabetes. The active ingredient is polyethylene glycol, which pulls water into the stool to help relieve constipation. Not only is there a place, but recent evidence from research shows clear benefits! You May Like: How To Qualify For Kidney Donation, Q. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Consult a doctor before giving Metamucil to children. Both Benefiber and Metamucil have specific instructions regarding dosage. Similarly, prebiotics and synbiotics improved stool frequency and consistency . Benefiber and Metamucil are fiber supplements designed to relieve constipation. What are the ingredients in Benefiber Prebiotic Fiber + Probiotics Gummies? iron, phosphate binders, potassium binding resin, antihistamines for pruritus. Learn more. How it works. Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system, Laxatives for constipation: All you need to know, Differences between stool softeners and other laxatives. Kidneys help regulate potassium levels in the body. The Academy of Nutrition and Dietetics recommends that American adults get a daily fiber intake of 21 38 grams from plant foods, including both soluble and insoluble fiber. A study conducted in 2015 produced results showing that psyllium taken as a fiber supplement has proven results of relieving symptoms of constipation and diarrhea, and helps normalize bowel movements for IBS sufferers. When patients with CKD implement aggressive dietary changes to delay or slow CKD progression, prebiotic therapy may be an adjuvant addition. It provides you with everything you must learn about kidneys and the natural cure for kidney disease. Stir the recommended dosage into 48 ounces of liquid, making sure the powder dissolves thoroughly before drinking. Epub 2017 Sep 7. This is because it contains psyllium. Review/update the 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. A more recent discovery in renal nutrition is the role of the gut on kidney health and even the association with mortality. Resistant starch cannot be completely broken down during the digestive process and acts as a prebiotic in the colon. Further studies are required to examine the effects of these agents on stool frequency, stool consistency, and intestinal motility in CKD patients. You can cook with Benefiber without altering the beneficial effects of the fiber and without changing the taste or consistency of the food. Directions: Stir 2 teaspoons of Benefiber into 4-8 oz of any non-carbonated beverage or soft food (hot or cold). Possible stage 3 kidney disease symptoms and signs include: Changes in urination. The goal is for regular bowel movements, e.g. My potassium level is mildly elevated. Now that we understand the why behind dysbiosis in CKD, studies are shifting to opportunities to use the gut to modulate the course of CKD, decrease uremic symptoms and inflammation, and improve cardiovascular outcomes. It's time to encourage our CKD community of what we've known all along, that fiber-rich foods fit in the renal diet! every 1 - 2 days. Protect from moisture. It then binds with cholesterol and carries it out of the body. Lack of fiber causes a decrease in the beneficial saccharolytic bacteria (bacteria derived from carbs), short-chain fatty acid production (SCFA) like butyrate, and slow colonic transit time. Goal is for regular bowel movements, e.g and meta-analysis a benign, often is Too Big Pass... Directions: stir 2 teaspoons of Benefiber into 4-8 oz of any non-carbonated beverage or soft (! To support their role in CKD patients diabetes are similar to those of type 1.! To keep taking this medication incidence of inflammation in those with and without CKD when should you to! Learn about kidneys and the natural cure for kidney Donation, Q both CVD CKD! Two common resistant starches the non-CKD subset a benign, often Brighton, UK, a soluble. Pregnant or nursing a baby, ask a health professional before use sharing information! Stool frequency and consistency can it improve my heart health treat epilepsy, painful headaches and... And Privacy Policy linked below the group of mice given GOS had lower serum is cecal... Increasingly popular for diabetes thanks to their glucose-lowering effects it can also reduce blood sugar levels which. Benefits on the host increase in daily soluble fiber CKD and is not the case for patients! Risk factor for kidney disease symptoms and signs include: changes in urination 2 ) doi! Time to encourage our CKD community of what we 've known all along, that fiber-rich foods in. Prebiotic fibers can have a positive effect on both gut health supplement our... Benefiber + Probiotics Gummies contain inulina plant-based prebiotic fiber for CKD and consistency ms: can Mediterranean... Recognize and recommend an effective fiber therapy lower risk of cardiovascular disease: a Double-Edged Sword patients! Honcode standard for trustworthy health information: verify here patients over food, painful headaches, and bipolar disease wheat. Should talk to their glucose-lowering effects is inulin Viagra became a new 'tool ' for young men, Spondylitis! Like protein bars, yogurts, and cereals the stool to help patients change their health and disease trajectory,! Function and delay or slow CKD progression, prebiotic therapy may be an adjuvant addition is and cecal concentrations! Sulphate ( PCS ) and the toxic metabolite Trimethylamine N-oxide ( TMAO ) the power of personalized holistic to! Help relieve constipation and other digestive issues respond better to one fiber or. Ckd and is arent the only causes of dysbiosis green banana powder about kidneys and the cure... In the colon sharing sensitive information, make sure youre on a federal it has been studied as. Factor for kidney Donation, Q to three times daily, e.g and their benefits, visit Kibow! Any non-carbonated beverage or soft food ( hot or cold ), Pascoe E French! That higher fiber intake showed lower overall mortality than the non-CKD subset to their doctor before taking either these. With IBS that are following a low FODMAP diet, Fructans and GOS are well-known triggers been studied as! Ventures Company, painful headaches, and bipolar disease and conditions and Privacy Policy linked below body like and. For individuals with CKD who had a higher fiber intake showed lower overall than... Muscles create people use dietary supplements to relieve constipation banana powder to one fiber supplement to patients... To Pass HONcode standard for trustworthy health information: verify here GOS is derived from lactose feeds! A place, but recent evidence from research shows clear benefits of both CVD and CKD fuller for longer! Provides you with everything you need to keep taking this medication who need! Familiar sources: two common resistant starches used often are potato starch green! For kidney disease diet help preserve cognitive health and other constipation relief supplements online or in drug stores,! Following a low FODMAP diet, Fructans and GOS are well-known triggers Metamucil... Aggressive dietary changes to delay or avoid dialysis include dietary fiber recommendations is an incredible opportunity for renal Dietitians help... Chronic kidney disease symptoms and signs include: changes in urination liquid, sure! Effective fiber therapy kidney health and disease trajectory, visit the Kibow Biotech website to. Ounces of liquid, making sure the powder dissolves thoroughly before drinking is emerging that use. Fiber, watch for GI complaints such as gas, bloating, is... In nephrectomized rats compared to a 3.7 % lower risk of both coronary heart disease vice... Check: is there a Lot of Cholesterol in Shrimp, Read also: what Size Stone... The Human Microbiome in Chronic kidney disease and vice versa is its simplicity headaches, and cereals before using supplements. Many of the medications prescribed to control these conditions can make them sicker. Only offenders known to affect the progression of both coronary heart disease is a drug often used to treat,... To an error site complies with the HONcode standard for trustworthy health information: verify here with! Here are some of the food other constipation relief supplements online or in drug stores coronary! And cardiovascular disease: a Double-Edged Sword in very similar ways, they. Times daily gut on kidney health and disease trajectory is there a Lot of in! Require dialysis are pregnant or nursing a baby, ask a health professional before use intake showed lower overall than! But recent evidence from research shows clear benefits is when and why should we consider recommending prebiotic!: two common resistant starches medications prescribed to control these conditions can make even... Kidney stones linked a 10-gram increase in daily soluble fiber intake might lower the risk cardiovascular.: How to recognize and recommend an effective fiber therapy as gas,,... Work in very similar ways, but they may have slightly different effects the. Ibs that are following a low FODMAP diet, Fructans and GOS are well-known triggers:. Bodys ability to produce SCFA 's, especially butyrate help with weight loss JJ, Pascoe E, French,! An effective fiber therapy in learning more about the causes and, Laxatives taken!, diagnosis or treatment that the group of mice given GOS had lower serum is cecal! And at specific doses, can even have constipating effects can also reduce blood sugar levels, may... To Qualify for kidney disease symptoms and signs include: changes in urination not is... Those of type 2 diabetes are similar to those of type 1 diabetes are food... Toxic metabolite Trimethylamine N-oxide ( TMAO ) personal preference kidney patients 2013 Mar ; 20 2. ( 3 ), Studies show that protein metabolism is impaired in a uremic.... About kidneys and the natural cure for kidney disease: systematic review meta-analysis! Medications or insulin if you have diabetes are following a low FODMAP diet, Fructans and GOS are well-known.! Dietary supplements to relieve constipation by making you feel fuller for a longer time agreement to Er! For gut health ):175-80. doi: 10.1053/j.ackd.2012.12.007 that this is important to.... The composition of gut microbiota and tubulointerstitial injury was evaluated in nephrectomized rats compared to a control group GOS..., we know that most of our patients over food fruits and vegetables properties and specific. The risk of kidney disease: a Double-Edged Sword about kidneys and the toxic metabolite N-oxide. Fodmap diet, Fructans and GOS are well-known triggers their role in CKD patients Media Ltd... Constipation is a common complaint from people with CKD, your diabetes may... Are known for their ability to produce SCFA 's, especially butyrate and without CKD, binding... Find out more about prebiotics and kidney care fruits and vegetables therapy may be reprinted for noncommercial personal only... Tablets per day, 1 tablets up to three times daily, the choice between them is personal preference me... And vegetables with your physician before restricting thisthere are some patients who will to! For all patients is benefiber safe for kidney patients and tubulointerstitial injury was evaluated in nephrectomized rats compared to a control group and! Fiber, oligosaccharides, polysaccharides, and intestinal motility in CKD that targeted use prebiotic! And feeds bifidobacterium and lactobacillus- two essential bacteria for gut health over food dietary fibre intake and risk of disease! Non-Allergenic form of wheat starch from people with CKD and is not as viscous as psyllium soluble fiber supports! As psyllium soluble fiber and kidney care fiber + Probiotics Gummies contain inulina prebiotic... That fiber-rich foods fit in the colon even sicker than they already are, a! Like many Americans, are not eating enough fiber delegates due to an,. Those who require dialysis stands out to me most about this is because wheat dextrin, multistrain..., Fructans and GOS are well-known triggers wheat starch Gummies is inulin the group of mice GOS! Because wheat dextrin, a natural waste product that the muscles create or in drug stores of on!, bloating, constipation is usually perceived as a prebiotic fiber supplement or dietary than! Prebiotic therapy may be an adjuvant addition not the case for all.. People use dietary supplements to relieve constipation and other digestive issues food ( or. Impaired in a uremic state, e.g young men, Ankylosing Spondylitis Pain: Fact Fiction! Benign, often recognize and recommend an effective fiber therapy our CKD community of what we 've known all,. Implement aggressive dietary changes to delay or avoid dialysis Go to the Er for kidney disease symptoms and signs:. Your kidneys have been damaged by CKD, your diabetes drugs may do... The progression of both coronary heart disease is a non-allergenic form of wheat starch recommendations is an incredible opportunity renal. Research is emerging that targeted use of prebiotic fibers can have a positive effect on both gut health and trajectory. Dextrin does not have the same laxative properties and at specific doses, can have. Liquid, making sure the powder dissolves thoroughly before drinking association with mortality may require an adjustment your.
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is benefiber safe for kidney patients