Nourishing Knowledge: Melanie Betz Of The Kidney Dietitian On The Power of Food as Medicine

An Interview With Wanda Malhotra

The Mediterranean Diet, characterized by plenty of fruits, vegetables, whole grains, nuts, seeds, heart healthy fats and fish — while limiting red meat, sweets and added salt has consistently been associated with fewer kidney stones. I consistently see better urine chemistries for people with kidney stones when they start eating more fruits and vegetables, lower sodium intake via fewer processed foods and enjoy sweets in moderation.

In an era dominated by pharmaceutical solutions, there is a rising consciousness about the incredible healing and preventive powers of food. As the age-old saying goes, “Let food be thy medicine, and medicine be thy food.” But how does this translate in today’s world? Can we really use nutrition as a potent tool against sickness and disease? How does one curate a diet that supports health, longevity, and wellness? In this series, we are talking to nutritionists, dietitians, medical professionals, holistic health experts, and anyone with authoritative knowledge on the subject. As a part of this series, we had the pleasure of interviewing Melanie Betz MS, RD, CSR, FAND.

Melanie Betz MS, RD, CSR, FAND is a nationally recognized researcher, speaker and educator in kidney stone nutrition. She is the Founder & CEO of The Kidney Dietitian and has helped thousands of people prevent kidney stones with food. As a leader in the field, she has published and presented numerous research articles and sits on the board or is an advisor for the Renal Practice Group, American Kidney Fund and the National Kidney Foundation of Illinois.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

Sure! I grew up in a small rural town in mid-Michigan, Eaton Rapids. I had a typical Midwest upbringing filled with college football games, lake vacations in the summer, sledding in the winter and casseroles. I graduated with my BS in Dietetics from Michigan State University in 2009 (GO GREEN!), the moved to Chicago, IL for my combined master’s degree in clinical nutrition and dietetic internship program at Rush University. I’ve been in Chicago ever since with a variety of careers, but really found a home in kidney stone nutrition.

What or who inspired you to pursue your career? We’d love to hear the story.

I truly think it was my love of food and desire to help people that drew me to become a Registered Dietitian in the first place. I have fond memories of making cookies with mom. In my mind, each holiday and celebration has at least one specific dish that really makes that day special. The 4th of July isn’t complete without our specific potato salad recipe made with Miracle Whip and hard-boiled eggs.

My love of all things food, cooking and food culture has really stuck with me and informs my approach to nutrition to this day. My favorite part of teaching people about kidney stone prevention is helping them learn that they absolutely can (and must!) incorporate all their favorite foods into their lifestyle. Nutrition should never be an all or nothing approach. If it is, it makes it unsustainable and truly sucks the joy out of life. What is life without chocolate chip cookies?

It has been said that our mistakes can sometimes be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

One of my largest platforms today is my Instagram account. It is painful to look back at how terrible my posts and images were at the beginning — and it would take me hours to create these subpar graphics! As someone who fights extreme perfectionism, this is a valuable lesson for me. If you have an idea or a dream, JUST DO IT, even if it isn’t perfect. If I had waited to really grow my Instagram following or start my website until I get everything “perfect”, I wouldn’t have been able to touch the millions of people I have since starting The Kidney Dietitian almost 4 years ago.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

1. Hardworking. I’ve always been told I have a very strong work ethic. I am most happy when I feel like I’ve accomplished something and/or am working towards a goal. This point was really driven home for me after I had twins in the spring of 2022. Not being able to work as a dietitian on maternity leave was very difficult for me. During that time, I fully realized how important my career and work are to me.
2. Empathy. I think this one is key to anyone who works in healthcare in any capacity. I think a big part of my success is that I really do care deeply for people and want to help them. This certainly helped me when I was working with patients directly at the University of Chicago — and continues to shine through in my blog, social media content and online courses. I think it has also helped as a volunteer leader in various professional organizations. I think you can effectively lead people (especially a group of volunteer positions) when you approach it from a place of understanding and empathy for those fellow leaders.
3. Persistent. I don’t think I would have been as successful as I am without being painfully persistent (and perhaps a little stubborn!). This has and continues to drive me to do better and better and help more and more people. I a constantly driving to tweak and grow!

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I am really excited about publishing the outcomes of my online course, Kidney Stone Nutrition School. This course is the primary way I help people prevent kidney stones on an individual level. Although I know subjectively that I am making a difference, I am planning on collecting data and publishing the outcomes in a medical journal. Although there are many nutrition-related recommendations for kidney stone prevention, there is very little hard data to show that working with a dietitian or making these dietary changes makes a difference in urine chemistry parameters or kidney stone outcomes. I’m hoping to be able to show the healthcare community how big of a difference food can make for kidney stone prevention!

OK, thank you for all of that. Let’s now shift to the core focus of our interview about cultivating wellness through proper nutrition and diet. To begin, can you tell our readers a bit about why you are an authority on the topic of nutrition?

As all Registered Dietitians (RD) do, I completed an undergraduate program in dietetics, an accredited dietetic internship program, passed a credentialling exam and continually maintain continuing education credits. In addition, I have a masters degree in Clinical Nutrition, a specialty certification in kidney nutrition and over 10 years experience as a RD. I have published over 10 research articles in medical journals, have given numerous kidney nutrition presentations at the local, state and national professional organizations. Lastly, I am on the board or advisory group for the Renal Practice Group (a group within the Academy of Nutrition & Dietetics), the American Kidney Fund and the National Kidney Foundation of Illinois.

We all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

This is a massively complicated question! But, for many of us I think it boils down to an “all or nothing” mindset. We expect ourselves to be “perfect” when it comes to eating. When we think this way, we really set ourselves up for failure. Nobody can (or should!) follow nutrition recommendations “perfectly”. When we “fail”, it throws us off and we tend to eat whatever we want until we decide to “get back on the wagon”. This feeling of failure doesn’t feel very good and makes us less likely to try to make healthful changes again.

All foods are good food, and food doesn’t have a moral value. You are not “good” for eating a certain way — just as you aren’t “bad” for eating a certain food. Placing these moral implications on health and food puts undue pressure and stress on the situation. Instead, I recommend setting small, realistic and behavior-focused goals. For example, being sure to eat 1 fruit or vegetable with all meals, or increasing water intake by 1 more glass per day.

From your professional perspective, do you believe that nutrition plays a pivotal role in supporting the body’s natural healing processes and overall well-being, particularly in cases of chronic diseases? We’re interested in hearing your insights on the connection between a holistic approach to diet and its benefits for individuals facing health challenges.

Absolutely! As a Registered Dietitian, I learned about how nutrition can help improve the lives of people living with nearly every chronic disease. Nutrition is imperative for everything from diabetes and heart disease to kidney stones and inflammatory bowel disease. What you eat is fuel for every single cell in your body. How could it NOT matter?

Based on your research or experience could you share with us five examples of foods or dietary patterns that have demonstrated remarkable potential in preventing, reducing, or managing specific health conditions? If you can, it would be insightful if you could provide real-life examples of their curative properties.

1 . The Mediterranean Diet, characterized by plenty of fruits, vegetables, whole grains, nuts, seeds, heart healthy fats and fish — while limiting red meat, sweets and added salt has consistently been associated with fewer kidney stones. I consistently see better urine chemistries for people with kidney stones when they start eating more fruits and vegetables, lower sodium intake via fewer processed foods and enjoy sweets in moderation.

2 . Similarly, the DASH (aka Dietary Approaches to Stop Hypertension) diet is also associated with fewer kidney stones. The DASH diet is similar to the Mediterranean diet in that it focuses on whole grains, lean animal and plant proteins, but it has an even bigger focus on fruits and vegetables (9–10 servings per day!) and 2–3 servings of low-fat or fat-free dairy per day. This focus on tons of produce, whole grains, more whole food plant proteins and dairy tends to be a really good approach for most people with kidney stones.

3 . Despite popular belief, eating enough calcium is crucial for people with calcium oxalate kidney stones (by far, the most common type of kidney stone). If tolerated, dairy is a wonderful source of calcium as calcium from dairy tends to be more bioavailable. People who consume dairy consistently have fewer kidney stones. Calcium is so important because it reduces intestinal absorption of oxalate, thereby reducing urine oxalate and reducing risk of kidney stones. People with calcium stones are also at higher risk of bone fractures and osteopenia — making it extra important they are eating enough calcium.

4 . Sounds simple, but it wouldn’t be right to give a kidney stone nutrition interview without mentioning the importance of water. Drinking plenty of fluid is the one thing that holds true for every single person with kidney stones — no matter what type of kidney stone they have, or the results of their 24-hour urine test. The more fluid you drink, the less concentrated your urine will be with stone making minerals like calcium, oxalate or phosphate. This lower concentration makes kidney stones much less likely! The American Urological Association guidelines recommend people with kidney stones drink enough to produce at least 2 ½ liters of urine each day.

5 . Lastly, I must mention how important it is that people with kidney stones focus on eating plenty of fruits and vegetables every day. Unfortunately, these foods often get limited because people are told to go on a low oxalate diet for kidney stones. However, it is imperative that most people with kidney stones eat plenty of produce. Although some are higher in oxalate, fruits and vegetables are also packed with potassium, magnesium, alkali, fiber and many other nutrients that are beneficial to kidney stones. I recommend aiming for at least 5 servings of fruits and vegetables each day.

Do experts generally agree that merely choosing healthy foods isn’t sufficient, but that understanding how to consume them is key to unlocking their full health benefits? (For example, skins on/off, or cooked/raw, or whole grain/refined grain) Could you provide advice on how to approach this and sidestep common errors or misconceptions?

I think the key here is variety. There are benefits to eating raw produce, and benefits to eating it cooked. Some nutrients are more available in the cooked form — for example, the antioxidant lycopene is more bioavailable in cooked tomatoes vs. raw tomatoes.

On the kidney stone front, one recommendation often given is to boil higher oxalate foods to reduce their oxalate content for kidney stones. Although boiling foods does reduce the oxalate content by about 50%, I DO NOT recommend this for most people. Boiling food also reduces the content of ALL water-soluble vitamins in that food, making the food overall less nutritious. It is a much better approach to manage oxalate by getting in enough calcium, rather than try to boil all your vegetables.

With the recent prominence of nutrition’s integration into healthcare, what’s your perspective on the collaborative approach between medical professionals, health coaches, and nutrition experts when it comes to delivering holistic patient care? Can you please explain?

I think it is wonderful that nutrition is getting a more prominent seat at the table in mainstream healthcare. However, I think we still have a LOT of work to do. Medicare still only covers Registered Dietitian services for people with a diagnosis of chronic kidney disease or diabetes. Really, everyone would probably benefit from seeing a dietitian and we really need to work to expand this coverage.

In general, I think an interdisciplinary and collaborative approach to healthcare is imperative. Medical science has grown and diversified so much in the past century. We simply cannot expect one person to be an expert in everything. This is why specialists exist! And this is exactly why it is so important that more people get their nutrition advice from a Registered Dietitian — who is the true nutrition expert. No other healthcare provider has any required nutrition training.

It’s been suggested that using ‘food as medicine’ has the potential to reduce healthcare costs by preventing disease severity. However, there’s concern about the affordability of healthier food options. What solutions do you believe could make nutritious choices accessible to everyone, ensuring that food truly becomes a form of medicine for all?

I completely agree that prevention could be huge in reducing healthcare spending. I think expanding the Supplemental Nutrition Assistance Program (SNAP) could do wonders to help make nutritious food accessible to more people. On a cultural level, I also think we need to stop demonizing perfectly healthy and affordable food options. The rhetoric around GMOs, organic and “natural” products can cause families with lesser means to either feel like they aren’t promoting health by purchasing more affordable options — or choose the more expensive “better” option and end up being able to buy less food. For example, frozen, canned and conventionally grown fruits and vegetables are all fantastic, more affordable health promoting foods.

Everyone’s body is unique, and what works for one might not work for another. How does one navigate the vast array of nutritional advice available today to curate a diet tailored to individual needs, ensuring health and longevity?

For kidney stones, this question couldn’t be more on point. There is NO single “kidney stone diet” — and even no single “kidney stone diet” based on the type of kidney stone you have. It is crucial to get something called a 24-hour urine test to understand what is “off” in your urine chemistry that is causing kidney stones. From there, we can create a personalized kidney stone prevention plan for you!

In general, working with a Registered Dietitian is also important. Good advice for one person might be harmful to another — depending on your medical history, labs, lifestyle, and current eating habits. Registered Dietitians are trained to look at your entire medical history and lifestyle and make recommendations tailored to your situation.

As our understanding of the intricate link between food and health continues to evolve, we’re curious to know which emerging trends or breakthroughs in nutritional science excite you the most. How do you envision these advancements shaping the future of healthcare?

As we continue to learn more about how food interacts with your genes and body, I think we will be able to personalize nutrition recommendations even more! One aspect of this that is most interesting to me is the gut microbiome. We are continuing to learn how important gut bacteria are for all sorts of health conditions. Most importantly, we are learning what we can do with that information. For kidney stones, we know that kidney stone formers tend to have a different bacterial profile compared to non-stone formers. It is yet to be seen if we can change that profile and if that change results in fewer kidney stones. But I see lots of promise in this area!

How can we better educate the public about the medicinal properties of food, and what role do professionals like you play in this educational journey?

I think persistence is most important here. Education is key! Me and other dietitians have to continue to put ourselves out there online and in front of other healthcare professionals to help educate them. I try to do as many professional and public presentations as I can to get the word out that food does matter for kidney stone prevention!

How can our readers further follow your work online?

You can check out my website: www.thekidneydietitian.org or follow me on Instagram @the.kidney.dietitian or on Facebook at facebook.com/thekidneyrd. You can also subscribe to my email list at: www.kidneystonefreebie.com

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success and good health!

About the Interviewer: Wanda Malhotra is a wellness entrepreneur, lifestyle journalist, and the CEO of Crunchy Mama Box, a mission-driven platform promoting conscious living. CMB empowers individuals with educational resources and vetted products to help them make informed choices. Passionate about social causes like environmental preservation and animal welfare, Wanda writes about clean beauty, wellness, nutrition, social impact and sustainability, simplifying wellness with curated resources. Join Wanda and the Crunchy Mama Box community in embracing a healthier, more sustainable lifestyle at CrunchyMamaBox.com.