Treating Chronic Kidney Disease with Food

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Plant-based diets have been shown to slow or stop the progression of kidney failure, but what about all the phosphorus and potassium in plant foods?

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In the United States, approximately one in three adults aged 65 years and older has chronic kidney disease, but the majority of patients with chronic kidney disease do not progress to the advanced stages because death precedes the progression to end-stage renal disease. Following about a thousand folks 65 years or older with chronic kidney disease for about a decade, only a few had to go on dialysis, because most had to go, underground. The scariest thing for many kidney patients is the fear of dialysis, but they may be 13 times more likely to die than die-alysis. With heart disease killing more than nearly all other causes combined, decreasing kidney function can set one up for heart attacks, strokes, and death.

That’s why it’s critical that any diet chosen to help the kidneys must also help the heart. A plant-based diet fits the bill, providing protection against kidney cancer, kidney stones, kidney inflammation, and acidosis, as well as heart disease. Namely, blood pressure control may be favored by the reduction of sodium intake and by the vegetarian nature of the diet, which is very important also for lowering serum cholesterol, which may not only help the heart but the kidneys themselves.

In 1858, Virchow, the father of modern pathology, was the first to describe the fatty degeneration of the kidney. In 1982, this idea of lipid nephrotoxicity was formalized, the possibility that fat and cholesterol in the bloodstream could be toxic to the kidneys directly, based on data like this, showing plugs of fat literally clogging up the works in autopsied kidneys.

Since the notion was put forth, it has gained momentum. It appears high cholesterol and fat in the bloodstream may accelerate progression of chronic kidney disease through direct toxic effects on the kidney cells themselves.

Given the connection between cholesterol and kidney decline, the use of cholesterol-lowering statin drugs has been recommended to slow the progression of kidney disease. Of course, serious adverse effects on muscles and the liver must be kept in mind. That’s why plant-based diets could offer the best of both worlds, protecting the heart and the kidneys without drug side effects.

The two potential drawbacks are the amount of phosphorus and potassium in plant foods, which ailing kidneys can sometimes have a problem getting rid of, but it turns out that the phosphorus in meat is absorbed at about twice the rate, not to mention the phosphate additives that are injected into meat. So, eating vegetarian can significantly lower phosphorus levels in the blood. The concern about potassium is largely theoretical, since the alkalinizing effects of plants foods help the body excrete potassium, but not theoretically for those on dialysis or with end-stage disease, who need to be closely followed by a dietician kidney specialist.

Special protein-restricted vegan diets have been used successfully to slow or stop the progression of kidney failure. Here is the declining kidney function of eight diabetics for one to two years before switching to the plant-based diet, which appeared to stop the inexorable decline in most of the patients,  leading the researchers to proclaim it as the treatment of choice for diabetic kidney failure.

Vegan diets may help delay dialysis by one to two years, and after kidney transplant may improve the survival of the kidney, and improve the survival of the patient. Most of the papers on this, though, are just pilot feasibility studies; doesn’t matter if it’s effective if we can’t get people to stick to it. But while we’re waiting for more definitive studies, existing data support offering these kinds of plant-based diets as an option to all patients with advanced or progressive chronic kidney disease.

Even if the effects of such diets on the progression of renal failure are still debatable, the unquestionably favorable effects of plant-based diets on some of the most deleterious cardiovascular and metabolic disorders usually associated with renal failure, like hypertension and diabetes, provide a rationale for recommending a predominance of plant proteins for patients with failing kidneys.

Yet, diet is still underutilized, in part because some people find changing their diet is difficult. Yet, we know foods rich in animal protein lead to metabolic acidosis. Our diets are largely acid-producing because they are deficient in fruits and vegetables and contain large amounts of animal products, and so, what do doctors do? They give people baking soda. Instead of treating the cause, the dietary acid load from too many animal products and too few fruits and vegetables, they treat the consequence by saying, “Oh, too much acid? We’ll give you some base, sodium bicarbonate.” And it works. Neutralization of dietary acid with sodium bicarbonate decreases kidney injury and slows kidney function decline, but sodium bicarbonate (baking soda) has sodium; so, doctors may be just adding another problem.

If patients are not going to cut back on animal products, at least they should eat more fruits and vegetables. And they did, and it worked too, and without leading to too much potassium in the blood. And it may even work better, as fruits and vegetables have the additional advantage of helping to lower blood pressure. This study is important because it illustrates a very simple and safe way to treat metabolic acidosis: fruits and vegetables. So, the key to halting the progression of chronic kidney disease might be in the produce market, not in the pharmacy.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Steve Davis via Flickr.

In the United States, approximately one in three adults aged 65 years and older has chronic kidney disease, but the majority of patients with chronic kidney disease do not progress to the advanced stages because death precedes the progression to end-stage renal disease. Following about a thousand folks 65 years or older with chronic kidney disease for about a decade, only a few had to go on dialysis, because most had to go, underground. The scariest thing for many kidney patients is the fear of dialysis, but they may be 13 times more likely to die than die-alysis. With heart disease killing more than nearly all other causes combined, decreasing kidney function can set one up for heart attacks, strokes, and death.

That’s why it’s critical that any diet chosen to help the kidneys must also help the heart. A plant-based diet fits the bill, providing protection against kidney cancer, kidney stones, kidney inflammation, and acidosis, as well as heart disease. Namely, blood pressure control may be favored by the reduction of sodium intake and by the vegetarian nature of the diet, which is very important also for lowering serum cholesterol, which may not only help the heart but the kidneys themselves.

In 1858, Virchow, the father of modern pathology, was the first to describe the fatty degeneration of the kidney. In 1982, this idea of lipid nephrotoxicity was formalized, the possibility that fat and cholesterol in the bloodstream could be toxic to the kidneys directly, based on data like this, showing plugs of fat literally clogging up the works in autopsied kidneys.

Since the notion was put forth, it has gained momentum. It appears high cholesterol and fat in the bloodstream may accelerate progression of chronic kidney disease through direct toxic effects on the kidney cells themselves.

Given the connection between cholesterol and kidney decline, the use of cholesterol-lowering statin drugs has been recommended to slow the progression of kidney disease. Of course, serious adverse effects on muscles and the liver must be kept in mind. That’s why plant-based diets could offer the best of both worlds, protecting the heart and the kidneys without drug side effects.

The two potential drawbacks are the amount of phosphorus and potassium in plant foods, which ailing kidneys can sometimes have a problem getting rid of, but it turns out that the phosphorus in meat is absorbed at about twice the rate, not to mention the phosphate additives that are injected into meat. So, eating vegetarian can significantly lower phosphorus levels in the blood. The concern about potassium is largely theoretical, since the alkalinizing effects of plants foods help the body excrete potassium, but not theoretically for those on dialysis or with end-stage disease, who need to be closely followed by a dietician kidney specialist.

Special protein-restricted vegan diets have been used successfully to slow or stop the progression of kidney failure. Here is the declining kidney function of eight diabetics for one to two years before switching to the plant-based diet, which appeared to stop the inexorable decline in most of the patients,  leading the researchers to proclaim it as the treatment of choice for diabetic kidney failure.

Vegan diets may help delay dialysis by one to two years, and after kidney transplant may improve the survival of the kidney, and improve the survival of the patient. Most of the papers on this, though, are just pilot feasibility studies; doesn’t matter if it’s effective if we can’t get people to stick to it. But while we’re waiting for more definitive studies, existing data support offering these kinds of plant-based diets as an option to all patients with advanced or progressive chronic kidney disease.

Even if the effects of such diets on the progression of renal failure are still debatable, the unquestionably favorable effects of plant-based diets on some of the most deleterious cardiovascular and metabolic disorders usually associated with renal failure, like hypertension and diabetes, provide a rationale for recommending a predominance of plant proteins for patients with failing kidneys.

Yet, diet is still underutilized, in part because some people find changing their diet is difficult. Yet, we know foods rich in animal protein lead to metabolic acidosis. Our diets are largely acid-producing because they are deficient in fruits and vegetables and contain large amounts of animal products, and so, what do doctors do? They give people baking soda. Instead of treating the cause, the dietary acid load from too many animal products and too few fruits and vegetables, they treat the consequence by saying, “Oh, too much acid? We’ll give you some base, sodium bicarbonate.” And it works. Neutralization of dietary acid with sodium bicarbonate decreases kidney injury and slows kidney function decline, but sodium bicarbonate (baking soda) has sodium; so, doctors may be just adding another problem.

If patients are not going to cut back on animal products, at least they should eat more fruits and vegetables. And they did, and it worked too, and without leading to too much potassium in the blood. And it may even work better, as fruits and vegetables have the additional advantage of helping to lower blood pressure. This study is important because it illustrates a very simple and safe way to treat metabolic acidosis: fruits and vegetables. So, the key to halting the progression of chronic kidney disease might be in the produce market, not in the pharmacy.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Steve Davis via Flickr.

Doctor's Note

This is the last in an extended six-part video series on the latest science on diet and kidney health. Check out the rest of the series here:

You may also be interested in my video How Not to Die from Kidney Disease.

You have to have functioning kidneys to keep you in balance. The problem for most people is not getting enough potassium, which I discuss in my video 98% of American Diets Potassium-Deficient, but too much phosphorus in the blood can also be a problem. Thus, phosphate additives are something we should try to avoid. For more on this, see:

If you’re wondering about the oxalates in spinach and other greens, and their effect on the kidneys, I have a couple of videos that came out after this one was released: Oxalates in Spinach and Kidney Stones: Should We Be Concerned? and Kidney Stones and Spinach, Chard, & Beet Greens: Don’t Eat Too Much.

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