How Not to Die from Kidney Disease

How Not to Die from Kidney Disease
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What are the three significant dietary risk factors for declining kidney function?


Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Kidney failure may be both prevented and treated with a plant-based diet—and no wonder; kidneys are highly vascular organs. Harvard researchers found three significant dietary risk factors for declining kidney function: animal protein, animal fat, and cholesterol. Animal fat can alter the actual structure of our kidneys, based on studies like this, showing plugs of fat literally clogging up the works in autopsied human kidneys.

And, the animal protein can have a profound effect on normal kidney function—inducing what’s called hyperfiltration (increasing the workload of the kidneys); but, not plant protein. Eat a meal of tuna fish, and you can see the increased pressure on the kidneys go up within one, two, three hours after the meal, in both nondiabetics and diabetics. So, we’re not talking adverse effects decades down the road, but literally within hours of it going into our mouth.

Now, if instead of having a tuna salad sandwich, though, you had a tofu salad sandwich, with the exact same amount of protein, what happens? No effect. Dealing with plant protein is no problem.

Why does animal protein cause the overload reaction, but not plant protein? It appears to be due to the inflammation triggered by the consumption of animal products. How do we know that? Because, if you give a powerful, anti-inflammatory drug along with that tuna fish, you can abolish the hyperfiltration protein leakage response to meat ingestion.

Then, there’s the acid load. Animal foods—meat, eggs, and dairy—induce the formation of acid within the kidneys, which may lead to tubular toxicity (damage to the tiny, delicate, urine-making tubes in the kidney). Animal foods tend to be acid-forming—especially fish, which is the worst, then pork and poultry—whereas plant foods tend to be relatively neutral, or actually alkaline (base-forming) to counteract the acid.  So, the key to halting the progression of chronic kidney disease might be in the produce market, rather than the pharmacy.

No wonder plant-based diets have been used to treat kidney disease for decades. Here’s protein leakage on the conventional low sodium diet, which is what physicians would typically put someone with declining kidney function on. Switched to a supplemented vegan diet; then back to conventional; plant-based; conventional; plant-based—turning on and off kidney dysfunction like a light switch, based on what was going into their mouths.

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Videography courtesy of Grant Peacock

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Kidney failure may be both prevented and treated with a plant-based diet—and no wonder; kidneys are highly vascular organs. Harvard researchers found three significant dietary risk factors for declining kidney function: animal protein, animal fat, and cholesterol. Animal fat can alter the actual structure of our kidneys, based on studies like this, showing plugs of fat literally clogging up the works in autopsied human kidneys.

And, the animal protein can have a profound effect on normal kidney function—inducing what’s called hyperfiltration (increasing the workload of the kidneys); but, not plant protein. Eat a meal of tuna fish, and you can see the increased pressure on the kidneys go up within one, two, three hours after the meal, in both nondiabetics and diabetics. So, we’re not talking adverse effects decades down the road, but literally within hours of it going into our mouth.

Now, if instead of having a tuna salad sandwich, though, you had a tofu salad sandwich, with the exact same amount of protein, what happens? No effect. Dealing with plant protein is no problem.

Why does animal protein cause the overload reaction, but not plant protein? It appears to be due to the inflammation triggered by the consumption of animal products. How do we know that? Because, if you give a powerful, anti-inflammatory drug along with that tuna fish, you can abolish the hyperfiltration protein leakage response to meat ingestion.

Then, there’s the acid load. Animal foods—meat, eggs, and dairy—induce the formation of acid within the kidneys, which may lead to tubular toxicity (damage to the tiny, delicate, urine-making tubes in the kidney). Animal foods tend to be acid-forming—especially fish, which is the worst, then pork and poultry—whereas plant foods tend to be relatively neutral, or actually alkaline (base-forming) to counteract the acid.  So, the key to halting the progression of chronic kidney disease might be in the produce market, rather than the pharmacy.

No wonder plant-based diets have been used to treat kidney disease for decades. Here’s protein leakage on the conventional low sodium diet, which is what physicians would typically put someone with declining kidney function on. Switched to a supplemented vegan diet; then back to conventional; plant-based; conventional; plant-based—turning on and off kidney dysfunction like a light switch, based on what was going into their mouths.

Please consider volunteering to help out on the site.

Videography courtesy of Grant Peacock

Doctor's Note

The first time someone visits can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a new series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation HOW NOT TO DIE: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

For the other videos in this overview series, see:

Inspired to learn more about the role diet may play in preventing and treating kidney disease? Check out these other popular videos on the topic:

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.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

241 responses to “How Not to Die from Kidney Disease

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  1. Wow . Here in Ontario Canada the teachers are confiscating snacks from students , like crackers,apple juice and granola bars, I would bet the farm that a ham and cheese sandwich is A OO KK. This has been on the news all week in the Toronto area. This kind of info should be super glued to the forehead of every teacher in the country.

    1. Confiscating a kid’s lunch without giving them a full, healthy meal in return is cruel; in fact, it provides the extreme right with more ammunition, “I’ll give you my Kit-Kat after you pry it from my cold, dead hands!”. Thanks for sharing that story.

  2. I really like these “How not to die from……” videos. A person can watch a few of them and realize that a plant-based diet is the consistent key to preventing and treating many diseases. I think the combination of reference documents, graphics and Dr. Greger’s entertaining delivery is very effective.

  3. Off topic, but I”m not sure where else to post. I’m giving a talk next week refuting a paper that argues against veganism. My question is about of the author’s empirical arguments against veganism. After citing the ADAs statement that well planned vegan and vegetarian diets are suitable for people of all ages, the author then cites another report by W.J. Craig that reports that “eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamin B12 and D, calcium, and long-chain n-3 (omega-3 fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. In some cases, iron and zinc status of vegans may also be of concern because of the limited bioavalability of these materials.” The author (a philosopher) then notes that women are more susceptible to this kind of nutrient deficiency. Is this true? Are vegans, especially female vegans, at special risk of not getting these micronutrients? I was under the impression that vegans needed to get B12 and that all people, no matter their diet, need to make sure to get these micro nutrients.

    1. re: ‘women are more suseptable to this kind of nutrient deficiency. Is this true?’

      Did the author supply their sources for that statement, and did youcheck them out ? Can you post it?

      1. I didn’t read the study. I’m not a nutritionalist, I know that some of these studies are biased and I’m working with little time, so I was hoping someone would know whether the authors interpretation of the data is correct and whether the study is sound. Here’s the reference: W.J. Craig, “Health Effects of Vegan Diets.” American Journal of Clinical Nurtriion 89, no, no. 5 (2009):; 1627S.

        1. ty very much Blanka, you have raised some interesting questions. As a relatively new vegan dealing with anemia, I look forward to the responses you will receive.

          1. A few studies have recently been pubmed indexed, showing the iron absorbed from vegetables is inferior to animal iron from red meat, the human body does not get the heme needed from veggies

          2. red/pink lentils are your friend. very high in iron, very low in tannins (tannins reduce iron bio availability). also be sure you are supplementing with b12

          3. I use one teaspoon blackstrap molasses daily. Doctor tested my iron levels before and after 3 months. She was shocked that it worked.

            1. LeeAnn Flint: That’s super interesting. I’m curious how you ate the molasses. Just off a spoon? Or mixed in something? Sounds like a pretty yummy medicine to take. :-)

        2. I think the study is sound and it pretty clearly implies that a properly planned “vegan” diet, containing fortified foods or supplements, is probably healthier than even other vegetarian diets

          “A vegetarian diet is associated with many health benefits because of its higher content of fiber, folic acid, vitamins C and E, potassium, magnesium, and many phytochemicals and a fat content that is more unsaturated. Compared with other vegetarian diets, vegan diets tend to contain less saturated fat and cholesterol and more dietary fiber. Vegans tend to be thinner, have lower serum cholesterol, and lower blood pressure, reducing their risk of heart disease. However, eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamins B-12 and D, calcium, and long-chain n–3 (omega-3) fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. ”

      1. Hi Mathew – check out my post above about iodine and the supplementation of iodine in the food supply via table salt. Large scale deficiency across the country is why we now have iodized salt. If one is consuming iodized salt then one need not worry about iodine in the diet. But if one has gone to a non-iodized salt . . .like sea salt or another salt where the iodine content isn’t known, then one might want to supplement. Thanks for bringing this up.

        1. I strongly disagree. Iodized salt does not provide enough bioavailable iodine to meet biological needs in people living in a modern industrial society who are inundated with fluorine, chlorine, and bromine continually.

          The soil is so degenerated that terrestrial plant foods alone will not provide sufficient iodine either.

            1. Those elements, in the same vertical line of the table of periodic elements, push out iodine, thereby inducing a lack of iodine in people. Haven’t you read about how many cases there are of iodine deficiency?
              John S

          1. Most importantly, the best dietary source of iodine is sea vegetables. Many vegans (as well as dairy eaters, for other reasons) should probably consume more of them. There are at least two types one should avoid, though – Hijiki, which is likely contaminated with arsenic, and Kelp, which can lead to iodine poisoning, unless you are using only tiny amounts.

            Since I don’t care for the taste of seaweed much, what I do is add a little dried Wakame to my green smoothies after soaking them a couple of minutes. I find the taste of it is completely overpowered by the other ingredients this way.

            1. Not only do sea vegetables concentrate iodine from the ocean, they also concentrate cadmium, mercury, arsenic, lead, and other heavy metals released from coal power plants, not to mention whatever radiation Fukushima is still leaking.

              Considering the Japanese consume 10mg of iodine per day (100x the US RDA) and have some of the best health outcomes in the world please be skeptical of any liberal use of the term “iodine overdose”.

              1. Give some sources, please, instead of just making blanket statements. Sea vegetables are lowest on the food chain. Demonstrate with studies that they are unsafe. Dr. Gregor recommends sea vegetables in moderation. And guess what? The Japenese are getting iodine from sea vegetables. So you admit they have great health outcomes from sea vegetables.

              2. I agree with nc54. Ignoring the inaccuracies in your numbers for a moment, saying that high iodine intake in Japan, which happens to come from sea vegetables, leads to good health, and at the same time implying that we should avoid those same sea vegetables because they are dangerously contaminated with pollutants, doesn’t make much sense, does it?

                By the way, it is only my guess, but it might be that the Japanese high intake of cruciferous vegetables with their goitrogenic compounds helps them to get away with iodine intakes that would otherwise be considered excessive.

                1. I never said to avoid sea vegetables, I simply pointed out they contain heavy metals and radioactive debris. Will the amount of heavy metals and radiation in the sea vegetables cause harm? I don’t know, and I never claimed to know. Due to the recent nature of radiation leaks in the Pacific I doubt there’s much data to go on.

                  1. Soil has only lost 15% of what it had a hundred years ago. That’s not much. More vegans probably eating sea salt and not getting the iodized salt.

    2. 1) Omnivores can also be deficient in B12. Vegans definitely do not get B12 naturally in their diet and should supplement, and so should anyone over age 50.
      2) Vitamin D. Most people are deficient in vitamin D. Omnivores have a few tiny sources in some fatty fish and fortified milk, but not enough to reach sufficient levels. Everyone needs to either supplement with vitamin D or get proper sun exposure.
      3) The Calcium Myth. Just because you don’t drink mild doesn’t guarantee a calcium deficiency. Vegans (and everyone) need to eat greens! Oranges, almonds, fortified non-dairy milks can provide sufficient calcium.
      4) Women are only more likely to be deficient in iron because they have higher requirements than men (18 mg vs 10 mg). They need to concentrate on sources high in iron.
      5) Zinc and iron are more difficult to absorb from vegetable sources. Brenda Davis recommends that vegans get 1.5 times the RDA for zinc.

      A well planned vegan diet can meet all our nutrient requirements. It just takes some effort. I highly recommend “Becoming Vegan” by Brenda Davis to answer all your nutrient questions.

    3. I think the common wisdom is that women are more susceptible to iron deficiency because of menstruation…

      Anyway, some additional points you can make about supplementation are the disingenuous way Craig is portraying the issue.
      First of all, supplementation is fairly easy: the Soymilk I buy is fortified with every single nutrient mentioned by Craig (and a few more)… and its just a store brand. This is not an onerous burden. Many normal products are heavily fortified to ensure people don’t become deficient on their typical crummy diets: especially milk, ‘enriched’ white flour, and salt. If normal diets need a heavy dose of supplements added to the regular food supply, you can’t complain that because a vegan diet also needs some supplementation there is something inherently wrong with it. In fact vegan diets need fewer supplements, so overall it’s a silly argument to make. Standard diets are typically highly fiber deficient, and its very hard to ‘supplement’ your way to a decent fiber intake- a plant based diet does this naturally and easily. Additionally, if you are actually eating a plant based diet, the low bio-availability issue for certain minerals is overcome by the fact that they are present in plants, and your body can and will increase their bioavailablity to extract them if you are deficient.

      This next bit gets technical and mathy, but vegans have much lower calcium requirements than non vegans – there is a 1.75mg calcium loss per gram of animal protein intake, and the average animal protein intake is 70g/130g for women/men respectively. That leads to a loss of 122.5mg/227.5mg of calcium. Combined with the 40% bio-availability of calcium (in milk or supplements), this means non-vegans on average need to consume an extra 306.25/568.75mg of calcium per day.

      And of course, that doesn’t get into any of the empirical evidence that plant based diets are scientifically proved to prevent and reverse disease; or the empirical evidence that animal products (especially in the USA) contain a wide variety of ‘toxins’ that don’t belong there, (e.g., dioxins, hormones, bacteria/viruses, pesticides) many of which are known or probable carcinogens.

    4. Quick note about zinc….It’s in nuts. For example, Brazil nuts are one great source of zinc. Concerning B-12, there is a lot of misinformation out there. B-12 comes from the soil. As we know the soil has become deficient due to toxic chemicals placed on it, industrialized farming, etc…. My educated guess is that maybe everyone is B-12 deficient. Here is more info Iron is found in kale, oatmeal, molasses, raisins and more. Some of us do have to periodically supplement with iron and I’m one of those-have been since I was teenager and all the years I was not vegan due to heavy menstruation. D-get it from the sun. The need to take calcium supplements or drink lots of dairy (wonder which lobby came up with that idea?) is a myth. Your body makes calcium when properly nourished with leafy greens or fresh-pressed vegetable juice, and these are just two of many examples. Fresh-ground flax seeds, about two tablespoons per day, sprinkled on your breakfast, a salad or whirled up in a smoothie provides you with adequate omega-3.

      1. @Weq: Brazil nuts aren’t that great a source of zinc. A cup of them, which also has 88g of fat, has only 36% of the DV for zinc. Since that cup is also 872 calories, to get 100%DV from brazils you’d need to eat 2.7 cups a day, which would come to over 2,400 calories. Since the omega-6 to omega-3 ratio of brazils is very high, this would be a veritable omega-6 bomb, not to mention an astronomic intake of selenium. Chickpeas are a better source of zinc, but even they would need to be eaten in rather large quantities.

        Getting adequate D from the sun is simply not an option for many people who live in latitudes more than 35 or so degrees from the equator. Research indicates that dark-skinned people who live in tropical regions who spend a lot of time outside without a lot of clothing covering their skin have D levels in the 50s. That’s probably optimal for human beings. In the US, even people who spend a lot of time outdoors tend to have much lower D levels, and the ability of skin to produce D from cholesterol declines with age, as skin gets thinner. I was tested last year, and my level was 17, and I spend a lot of time outdoors. It would be impossible for me to get that level up by eating plant foods alone. Supplements or selected animal food sources of pre-formed D are essential. Today my level is 60.

        Low D and low zinc levels are both implicated in prostate cancer, as well as some other cancers, so these are not things to be ignored. It’s definitely true that omnivores are just as likely as vegans to have low D levels. Beef-eating omnivores may still be on the low side but probably not as low as vegans.

          1. You’d still need to eat about 1,000 calories of pumpkin seeds to get the DV amount. It’s possible, of course, that that amount is too high, but until we know that for sure I’d err on the side of supplementing. And pumpkin seeds also have about a 100:1 omega-6 to omega-3 ratio, so I’d be reluctant to eat large amounts of them.

              1. If you sprout beans, the bioavailability goes up and the anti-nutrients go down, so it might even be better. They become vegetables instead of storage legumes.
                JohN S

              2. @disqus_CLxqdPPkNt:disqus According to the USDA database, adzuki beans have 4 mg zinc per cup, which is given as 27% of the DV. An ounce of wheat germ, which is about as much as one would put on one’s oatmeal, provides 3.4 mg. The value you cited for oatmeal is for a cup of dry oatmeal, which is quite a bit to eat but not out of the realm of possibility.

                The impression I’m getting is that it’s possible to get one’s zinc intake up to the desired 15 mg without supplements, by judicious food choices, but it’s also easy to fall short. This is precisely the sort of case where supplementing makes sense.

            1. One thing I’ve noticed about seeds/nuts/avocado that have poor omega ratio’s, it tends not to matter too much because they have low amounts of omega 6. So you would have to have a ton, more then any plant-based doctor would recommend, to upset omega balance if you are also taking in a tablespoon of flax and some chia seeds. Walnuts are the exception with a lot of omega 6 but also a good amount 3.

              1. @disqus_CLxqdPPkNt:disqus I agree with your observation about the omega ratios. If absolute amounts consumed are small, it shouldn’t be a problem. But of course if one were to eat large amounts of, say, pumpkin seeds in an effort to get enough zinc, then the omega-6 load would be quite inflammatory.

                I remain persuaded that these micronutrient shortfalls were not a problem for most of human and history and pre-history because humans were never vegans. That doesn’t mean that they ate vast amounts of meat but it does mean that they routinely took advantage of concentrated sources of vitamins and minerals in things such as eggs, bone marrow, and organ meats.

                I’m not arguing that it follows that the best way to get these nutrients *now* is to consume these things. It may be, or maybe not. It may be, or it may not; I don’t think we really know. By eating 100% WFPB, I believe I’m rolling the dice to some extent, as is the case with just about any diet. I’m willing to do that, but I’m also open to revising my plan in the light of new evidence.

                Paul Jaminet, co-author of The Perfect Health Diet, is every bit as much a research wonk as Dr. G, and engages some of the very same studies, but comes to different conclusions about many things. I know that I personally will never have the time and expertise to conclude with any confidence who makes the better case, so the best I can do is experiment on myself and try to see what works. For now, that means WFPB.

        1. You can get your D levels up with mushrooms. The store bought vitamin D mushrooms are not high in vitamin D because they just flash UV light them because time is money. Plus because the RDA for vitamin D is so low they probably think it’s adequate. You can get your own mushrooms into the 10’s of thousands of units of vitamin per serving if you expose them to sunlight for a few hours or even longer. Dr. Gregor has a video of a case study where a man low in vitamin D raised it to high levels solely with mushrooms.

          1. @disqus_CLxqdPPkNt:disqus That’s very interesting! I’ll have a look at that video. If I’m not mistaken, it’s by UV irradiation of mushrooms that D was first isolated.

        2. @Todd “Supplements or selected animal food sources of pre-formed D are essential” you say. I disgree with that and your entire post for that matter. You’ve provided a lot of disinformation, in fact. Maybe it works for you??? But, definitely not for the people in my life.

          Everything that you say goes against the health that I and my husband experience from eating nuts, and, no, not a cup full of Brazil Nuts. A cup is a lot of Brazil Nuts. Brazil nuts are ONE good source of zinc. I eat Brazil and other nuts. I get as much direct sunshine as I can. I am not vitamin D deficient, and I’m not considered “young” age-wise.

          There is much controversy surrounding vitamin D supplements as mentioned on this site.

          The fat in Brazil nuts is a healthy, plant-based fat, not saturated animal fat. Yes, saturated animal fat will clog your arteries. Counting calories is antiquated. Low-calorie does not equal healthy. Nutrient dense foods that keep you satiated longer are usually higher calorie. Low-calorie foods like “lite” yogurt leave you feeling hungry shortly after you eat them. I am 5’4″, weigh around 110, and eat lots of plant-based nutrient-dense foods, including nuts: Brazil nuts, almonds, walnuts, cashews….. They’ve kept me healthy for a long time.

          The omega 3 to 6 ration you’re talking about is perfectly balanced in God’s food, like nuts. Now, when you’re talking about pastries or breads made with rancid, highly processed oils then, yes, the omega 3 to 6 ratio in those toxic foods is one of the many dangers lurking within them.

          1. @Weq I’m sorry you didn’t appreciate my post. You accuse me of providing a lot of “disinformation.” Can you indicate any specific false statement that I made? That would be the best way to support your accusation. I said “supplements or animal food sources are essential.” Note the word “or”.

            As for “championing” animal food sources, I’m simply pointing out that they are one way to get vitamin D. This site is about nutrition *facts*, is it not? Well, that’s a fact. It’s also a fact that vitamin D deficiency, defined as measured blood levels below 30 ng/ml, is widespread in the temperate zones of the world, even in people who spend a lot of time outdoors. And, as Dr. G points out, it’s also a fact that it’s dangerous for many people, especially those with fair skin, to spend a lot of time in the sun, due to less UVB protection due to ozone depletion. These people face a dilemma: Either accept vitamin D deficiency or use supplements. There are vegan and animal-source (fish oil or lanolin) supplements. The vegan form is D2, which must be converted to D3 in the body. It doesn’t really matter though, because the point isn’t to take a certain amount but to take enough of whatever form to get blood levels to where they should be.

            It is false to claim that the omega-6 to omega-3 ratio is “perfectly balanced” in natural foods, if by “perfectly balanced” you mean optimum for human consumption. In fact, that’s impossible, since natural foods have such wildly different ratios. The 6-3 ratio for brazil nuts is over 1,100 to 1! For walnuts, it’s 4:1. For flax seeds, it’s about 1 to 4 in the other direction. All are natural foods. Can they all possibly be perfectly balanced?

      2. Be very careful about eating Brazil nuts. Eating several a day can lead to selenium toxicity, depending on the soil that they were grown in.

        I think that one of the major problems with meat, fish, cheese, whey protein and/or yogurt is how much is being ingested. protein is very stressful on the kidneys due to the amount of acid byproducts that has to be neutralized as a result of the acid produced by the deaminization process. However, this is also true of nuts and seeds when used as a protein source in a high protein diet. Unfortunately nuts and seeds also have a problem with very high levels of omega-6 fats, which can easily lead to systemic inflammation.You can easily get enough total protein from green vegetables, legumes, mushrooms, potatoes, potatoes, onions, barley, rice, etc.

        I tried veganism but my body can’t seem to get enough iron from vegetable sources, so I have to supplement. I’ve added a little meat, about 0.70 oz. per day of grass fed, organic ground beef about 5 times a week and I’m running a test to see if I can discontinue the iron supplementation. I use supplements, but I don’t fully trust them to be safe, since they’re packaged with added excipients and the capsules aren’t always cellulose based..

        I agree that we overeat on protein when we eat meat, and our bodies don’t need anywhere near the amount of protein that we are eating. On a volume basis, we don’t ingest as much protein when we eat vegetables.

        However, I am comfortable suggesting that most people would protect their health by cutting back on their protein intake, and for most this is more easily done by using vegetables for supplying the majority of their protein.

    5. Hi – I think the author of the paper you are refuting is mixing issues perhaps. Whether one is vegan or an omnivore it is difficult to get all of the nutrients that we need in only one way of eating and supplementation is a way to contribute to the foundation of good health overall (which is the way I prefer to look at it). So I would be hard pressed to argue against a vegan diet just because it needs a little help given all the benefits that are so well-documented now. My Mother (a woman :-), who ate an omniverous diet all her life, still needed to supplement her iron (medically) due to low red blood cell counts. This would not be proof of a deficient vegan diet but proof that my Mother did not get enough iron in her diet despite meat eating. In the 1940’s (I may be off on the time period) goiter was a very common thyroid problem in the midwest because people lived far from the ocean which meant being far from a natural iodine source. This is why table salt had iodine added to it which continues today and the midwest goiter problem disappeared. If one chooses not to consume iodized salt then they should be aware of this possible deficiency and this would be true whether one is omniverous or vegan. In general, most people test as deficient in VitD due to lack of sunshine exposure and active protection from the sun using sunscreens. Omniverous diets can also be low/deficient in magnesium which can cause numerous problems systemically throughout the body as magnesium does so much for our health. I knew of a woman who ate lots of meat and never touched a vegetable. At one point she developed very severe heart palpitations. Doctors were at a loss as to the cause so decided the best thing to do was to destroy her thyroid and put her on Synthroid the rest of her life to hopefully regulate her heart rate. They didn’t know, mind you, if this would work or if this was indeed the problem. They just didn’t know what else to do. After a half dozen second opinions all of whom didn’t know what the problem was and what to do about it, a nutritionist was consulted. Magnesium added to the diet and heart troubles resolved. This was not a well-planned omniverous diet of course.
      I think you can see where I’m going with this – My point for your debate with your paper’s author is that all diets have places in them where one needs to be aware of possible deficiencies whether one is vegan or omniverous. This doesn’t make veganism inherently less healthy somehow. And given the well-documented health benefits (Esselstyn, Ornish refersing heart disease in particular), I would be sitting on your side of the debate table. Good luck!

      1. Also, I forgot to add, and to compliment Julie’s comment re: B12 – My own Father, big meat eater, was B12 deficient in his elder years and required B12 shots for his red blood cell support. It is also very common knowledge in the gerontological field that B12 deficiency in the elderly is very common and can be so severe that it mimics Alzheimers. Elders have been institutionalized for B12 deficiencies which were then reversed. If dementia is suspected one of the things doctors look at is the B12 level – for everyone not just vegans.

    6. Vitamin D deficiency is a canard. Unfortified animal products contain very little vitamin D so a standard diet without supplementation represents exactly the same issue with regard to vitamin D deficiency. Dairy is only a source of vitamin D because it has the equivalent of a vitamin D supplement pill ground up and mixed in. Bovine breast milk has very little to none as it comes out of the cow. So carnists and herbivores who can’t get sufficient UVB from the sun are all in the same boat and should take a vitamin D supplement or consume sufficient fortified foods. And since a ground up supplement pill dissolves just as easily in almond or soy milk as it does in bovine breast milk, all represents the exact same path to meeting your vitamin D requirements.

      1. I agree with one reservation – some fish and fish oils can be naturally higher in vitamin D. Of course relying on them for optimal intake would be unhealthy and lead to other problems due to cholesterol content and contaminants. Generally eating a specific food in order to get one nutrient may not be a wise strategy as we need to maximize our nutrition for every calorie we eat, so pills or adequate sun exposure are better. But where these fish are consumed, they may prevent overt deficiencies.

    7. After you refute these bogus charges, go on the attack. Aren’t meat eaters subject to numerous other deficiencies? Where do they get their fiber? What about the excess saturated and trans-fat in their diet, or the cholesterol. How about the bio-accumulation of toxins and pesticides from eating high on the food chain and what about the higher incidence of all manner of chronic diseases? Lots of good stuff in the Health Topics section of this site, alone.

    8. I can’t thank you all enough. This is enormously helpful and confirms my sense that the author was presenting nutritional information out of context in order to make veganism look unappealing. This is an ethics talk, but I find it’s very difficult to be heard unless I debunk some of the nutritional misinformation.

      1. “This is an ethics talk”

        The obvious ethics topics when it comes to a vegan diet is the inhumane treatment of animals and the devastating effects on the environment from livestock production. The former is a tough sell because making people feel guilty is an ineffective way to gain their attention. However, you could broaden your ethics discussion by including topics such as how the food industry and trade associations purposefully deceive the public and cause widespread disability, death, and large unnecessary transfer of wealth from people to the pharmaceutical companies and for profit heath care industries. In addition, medical schools do not properly educate physicians on nutrition, a deliberate choice. The videos here at will provide the facts for you to make the argument. For example, the SAD diet promotes most of the top causes of death and a WFPB diet promotes health. The salt, dairy (including the American Egg Board), and meat industries manipulate data and lie to people just like the tobacco companies did. The bottom line, advocating an unhealthy diet that causes disease, disability and death when you know better is criminal.

        1. Thanks. I do philosophy (specifically ethics) for a living, so I have a firm grasp of the ethics side. It’s getting the nutrition stuff right that worries me.

    9. Another point is that introducing animal foods into the diet increases the risk of a number diseases and health problems (extensively discussed on this website).

      Also, “vegans” are estimated to comprise only 0.5% of the US population

      However, 10.5% of the US population is thought to be B6 deficient, 8.3% are vitamin D deficient, 6.7% iron deficient, 6% are vitamin C deficient and 2% are B12 deficient. All people, whether vegan or not, need to plan their diets to avoid nutritional deficiencies. This is not an issue unique to vegans.

    10. Bianka, I just sat in on a two hour talk on the subject of eating healthy whole food based diet vs eating any other diet by Dr Klaper. Between his website, which has many of his talks and webinars, and Dr Greger’s, you should be able to find plenty of factual information and research papers to fuel your side of the debate. Here’s Dr Klaper’s site:

      He emphasized the fact that there is no way to NOT get sufficient protein, including all the essential amino acids, eating WFPB, as long as you’re getting enough calories. He talked about the fact that calcium supplements don’t just automatically go to your bones, and contribute to calcification of the arteries, kidney stones, etc. It also goes to the blood and through some mechanism I didn’t understand (because I couldn’t hear what he said) that contributes to blood clots. He said we should all eat a good serving of greens daily to get calcium that doesn’t cause these problems. All of this is research-based.

      The largest animals, such as elephants, giraffes, buffalo, hippos, etc get all their minerals by eating plants alone. We do too, as long as we don’t eat processed food and we eat a variety of whole plant foods. Anybody eating according to Dr Greger’s Daily Dozen app will be far better nourished than anyone getting animal proteins with all their fat, cholesterol and calories.

      Dr Greger has videos and blogs on these subjects as well, and next to each one is a link to the research as well as the script for his videos.

    11. All studies are not equally powerful to base national nutrition guidelines. The most relevant are large population studies conducted for long periods such as AHS I and II, and observational studies such as behind the Blue Zones. These give the greatest insight into what diets have a low morbidity and longevity advantage. The most powerful counter argument you can make is that for every “increased risk of certain nutritional deficiencies” on vegan diets, there are dozens more when one eats animal produce. Even small amounts of animal produce have adverse effects on physiology. The only essential vitamin supplement required on a vegan diet is B12, but there are examples of people living over 100 on strict vegan diets for over 50 of those 100 years without supplements. They did grow their own vegetables at home though in rich permacultured soils. There are all sorts of risk humans take in trying to get through life. The best argument would be to compare the risks of nutritional deficiencies on a supplemented vegan diet versus the health risks of including animal produce. In fact, this is where you can catch this guy out. Get him to quantify how much animal produce must be added to a vegan diet to significantly reduce the risk of deficiencies in B12, calcium, Vit.D. He won’t be able to tell you because the literature has not quantified it. Eating animal produce is not positively correlated with less nutrition deficiency in calcium or vitamin D, and the latter evidence is B12 risk is not clearly associated with including animal produce.

      1. As you point out, in the Adventist study to which you linked, the lowest hazard ratio, or HR, of all the groups analyzed was the pesco-vegetarians, not the vegans. In addition, the blue zones are not vegan zones, but they are nearly so. In short, the observational evidence suggests that consumption of very small amounts of animal food (maybe just 2-3%) is at worst not detrimental, but possibly beneficial. It’s possible that a small amount of certain animal foods prevents some nutrient deficiencies that are otherwise more likely to appear, but I don’t think we know that for sure.

        Among the blue zones, the people of Nicoya, Costa Rica eat the most meat and eggs, yet they have the lowest middle-aged mortality rate on Earth ( But if we want to avoid the reductionistic trap of singling out micronutrients, the most we can say is that the nearly vegan diet, perhaps especially if it contains small amounts of fish or seafood (I think “pesco” covers both) is the healthiest *known* diet.

        I’m eating 100% WFPB myself, but I’m not about to claim that this has been proven to be the healthiest way to eat, because it just hasn’t been. The Adventist Study is the best attempt so far to compare vegan to near-vegan and so far near-vegan, in the form of pesco-vegetarian, is the winner. It’s possible, of course, that the vegans fared slightly less well for some reason not related to diet. It’s also possible that the people in the blue zones would live even longer and be even healthier if they were vegans instead of nearly so. But those are hypotheses yet to be confirmed.

        1. The Adventist Study found that the lowest HR for all cause mortality was for vegan males, with pesco-vegetarian males a close second. For women, the lowest HR for all cause mortality was for pesco-vegetarians, with vegan females having the highest all cause mortality. Pretty huge difference between the sexes with vegan males having the LOWEST mortality while vegan females had the HIGHEST mortality–very interesting; I’d love to know why.

          1. Julie: I know you are a fan of Brenda Davis. I recently watched a talk from Brenda Davis where she speculates that the reason for the sex differences is likely that the starting diet of the women in general in the study was better than the men. I may be reporting this theory on a different statistic (so may be misrepresenting what Davis said). I just thought I would share it.

    12. Hello Bianka,

      You got some great responses here, but I must say others are somewhat misleading.

      In order to get all the facts right, I strongly recommend that you read the overview on each of the health topics on this website that the author raised concerns about, and consider watching some related videos or read their transcripts. Dr. Greger provides plenty of evidence and puts everything into context, so you can be sure you are on solid ground. I think doing so doesn’t have to be extremely time consuming and it may save you the embarrassment of making false or unsubstantiated claims. Good luck!

    13. I really wish I could remember off-hand which video the study was in but Dr. Greger has definitely cited research showing that the typical omnivore diet ends up with more nutrient deficiencies than the typical vegetarian or vegan diet

  4. Shouldn’t this (and similar) titles read, “How not to die from…” ? As it stands, one might think, “Oh what IS the correct way to die from kidney disease?”

    1. I think the point of the ‘How Not to Die from…’ series is that there are other factors – some of which are outside of our control – that lead to these diseases. The point is that diet is very much in our control, and therefore we shouldn’t allow it to play any role in the cause or progression of the diseases. A plant-based diet may not make us immune, but what we choose to out into our mouths 3 times a day is certainly the single most important decision we make daily and has the biggest influence on our health.

  5. Soo good. I love this tac, How Not To Die is really what most folk rank right up there…along with Kale, on their favourites list.

    Speaking of Kale…they planted a beautiful display as shown below at my work. I’ve been picking the odd leave at breaktime and I got told in no uncertain terms that this was not eating kale, but decorative kale only. I know I should not eat the decorations but just wondering if there is any down side to eating these super colourful and tasty varieties?

    BTW/ I know for a fact that a certain rabbit has been eating some too so I should not carry all the blame!

    OOPS, cant seem to upload…I’ll try triming down the size

    1. How Not To Die series is great ! I eat a lot of very hot chilies / peppers & salsas . I often wondered if this is hard on the kidney / liver functions ? Some of the so called superhot chilies will blow your head off ! Like the Carolina Reaper , which I understand was developed to fight cancer & to make pain creams etc….? Anyone have any 411 on eating Chile on a regular basis ( like daily ) ???????? Chileman

      1. I think you are doing great with those chile’s. You are lucky you can tolerate them so well since they are a storehouse of nutrition, especially vitamin C and phytonutrients. It can also help to burn what is called “brown fat” in the body, but I am unclear on how much brown fat adults have. Kids have a lot of brown fat. I guess it would be good to get your kid on hot chiles is possible. You would have to start slow. Have you seen these Dr. Gregor videos on hot peppers?

      2. I have stage four kidney failure. Hot spices have no adverse effect on kidney function according to my Nephrologist. One should be cautious tho of packaged spices that contain multiple ingredients as they sometimes contain other things that will adversely effect kidney function, especially salts.

    2. Hi Rhombopterix – I am a professional personal gardener. Puh-leese do not eat the decorative kale. These “decorative vegetables”, including the small decorative peppers, are all loaded with nasty sprayed on and systemic chemicals. They are heavily treated to keep them looking nice in the garden. They, therefore, look perfect and perfectly good for eating but don’t . . .not because you might change the display a little leaf by leaf but because you are eating lots of nasty poisons. And so is that poor bunny. I, for one, think warning signs should be placed with these vegetables when installed. I have seen people steal from public gardens (for various reasons) and not showing this disclaimer that these “vegetables” are poisonous is dangerous to the public. You have helped to get teh word out so thank you for your excellent question!

        1. Hi again – I’m not quite sure what your reply was stating but perhaps you were saying you didn’t feel ill and the rabbit is alive? If that’s the message . . .. yes, that would be the case. Poisons and endocrine disruptors used in systemic and sprayed on insecticides and herbicides don’t make one feel ill. .. they just bioaccumulate and wreak havoc in your body causing things like cancer, eventually, and hormone-related problems.
          I feel for the rabbit (I know you will be ok :-)

      1. Sounds like that applies to all Kale…
        Kale and Pesticide Residues
        According to the Environmental Working Group (EWG) in their 2016 report, Shopper’s Guide to Pesticides in Produce, conventionally grown kale are contaminated with concentrations of organophosphate insecticides, which are considered to be highly toxic to the nervous system. While they were not among the 12 varieties of produce most concentrated in overall pesticide residues (and therefore not part of the EWG’s traditional “Dirty Dozen”), the EWG felt that this organophosphate concentration was relevant enough to bring attention to kale. They actually renamed their produce category of concern from “Dirty Dozen” to “Dirty Dozen Plus” with kale, collard greens, and hot peppers being the “Plus” conventionally grown produce. Therefore, individuals wanting to avoid pesticide-associated health risks may want to avoid consumption of kale unless it is grown organically.

  6. I was looking at a chart of PRAL (potential renal acid load) values for various foods and found that raisins have a PRAL of -21 mEq/100g*. Dried fruit consumption seems to be associated with lowered risk of various diseases and I was wondering if this is the reason (since raisins are probably the most commonly consumed dried fruit), or is it simply that people who eat dried fruit consume more fruit overall?
    (I’m assuming these data are accurate)

    1. The strongly negative PRAL value for raisins is mainly due to their high potassium concentration, and high potassium intake is been associated with lower risk of chronic kidney disease (1), hypertension, stroke, cardiovascular disease (2), and all-cause mortality (3). Raisins have other things going for them, as their darkly purple polyphenols appear to have a wide variety of benefits, including modulating the microbiota, and maybe binding endotoxins in the gut (4), with the absorbed fraction increasing endogenous antioxidant responses, inhibiting inflammatory ones, improving glycemic control, improving endothelial function, and lowering blood pressure (5).

      Dried fruit of course differ in their potassium and polyphenol content. Dried apricots, bananas, peaches, prunes, and raisins have the highest potassium concentrations, and I expect the polyphenol content to be highest in those with higher fresh content: blueberries, cranberries, raisins, and plums.

      1. But raisins are a concentrated source of fructose. Too much can raise your triglycerides or uric acid.Dates are also high and for sure, you shouldn’t eat 30 bananas a day. In one of the few points where I agree with Dr. Mercola, I think we should limit the amount of fruit we eat. He suggests no more than 25 grams of fructose in our diet per day.

        1. Reasonable objections. However, no one has found adverse outcomes for whole or dried fruit consumption, as they have for say, fruit juice consumption. Indeed, some studies have found reduced risks with dried fruit consumption in all-cause mortality (1), prostate cancer (2), and lung, prostate, and pancreatic cancer (3). To me, this suggests that retaining the structure, all the fiber, and much of the polyphenols of the whole fresh fruit counters adverse effects of the fructose content. There are good mechanistic explanations for why fructose in whole and dried fruit wouldn’t have adverse effects from fructose: the microscopic structure of chewed fruit and its fiber content would slow fructose uptake, reducing the chance the liver will be glycogen replete (and not shunt to the triglyceride and uric acid production). The polyphenols in whole and dried are selective antimicrobials, reducing intestinal pathogens that would otherwise ferment fructose, and some beneficial microbes metabolize polyphenols into catabolites that (while the evidence is limited) are well absorbed and appear to have the similar benefits in inducing endogenous antioxidant responses, and inhibiting inflammatory ones. Just last month a paper came out that suggested fruit polyphenols, and especially the ones found in grapes and raisins, bind endotoxins in the gut, reducing systemic exposure to these inflammatory stimuli (4).

          Like any high caloric density food (I’m looking at you, nuts), its really easy to gorge on dried fruit. So perhaps those with weight problems might want to limit exposure. But when all the evidence is positive for whole and dried fruit, any advice to limit intake is sending the wrong message to the public.

          1. I used to be very conservative about the amount of fruit I ate because of its sugar content, usually limiting it to 5 or so servings a day. Then, on April fools day of last year, Dr. Greger did a video that suggested fruit was harmless. I rejoiced and started eating fruit with abandon. Then I got the results of my blood test: my triglyceride level was above normal range. It had been in the low range before going on the fruit binge. Since I’m of normal weight and didn’t change anything else that I can think of, I concluded that it had to be the fruit. I’m sure next year when I get my blood test, it will be in the low normal range again.

              1. Thanks Darryl, I looked at your comments from there. But it seems to me that just because the Tarahumarans and Papuans can get away with high fasting triglycerides, that doesn’t mean that others can. What’s normal for them may not be normal for others. I would think that this is especially true for someone like me who formally had low triglycerides, before eating large amounts of fruit. Besides this, my LDL level and blood sugar are normal and I never eat high fat meals. If you can tell me if there are other factors that can raise triglycerides other than fructose, I’d appreciate it very much. Thanks.

                1. Hi Mike – as someone who enjoys her nightly glass of wine (or two) I am sorry to report that alcohol can increase one’s triglycerides. Beer and wine both do and both can affect and/or contribute to gout. I don’t see much discussion on this site about alcohol but I can’t quite believe that I am the only person who enjoys imbiding.
                  So all of my blood work numbers are normal but my triglycerides run just over the 150 upper limit at around 170. And yes, I am WFPB and do exercise as a matter of course through my day – my job is physical so I don’t worry about hitting the gym (i.e., I don’t have a desk job).
                  Anyway, . .I thought I might just interject the alcohol component as a possibility. I know it’s a part of my picture.

            1. Wow, I had low triglyceride on a fruit based raw diet. But I was also eating plenty of greens and my fat intake was no higher then 10%. Were you eating flour products? That can raise triglycerides because of the very high glycemic index.

        2. I eat probably an average of 5 to 7 fruit each day except maybe in the winter months . my triglycerides are within range .. at most half of my HDL value. Exercise, not eating too much overall, and watching the amount of potatoes/bread seems to keep the trig. down for me

        3. I know that’s false from my own experience. I used to be fruit based raw foodist. I don’t think I ever reached 30 bananas in one day, but I went over 20 bananas a day regularly. And sometimes 20-30 dates per day. Sometimes 10-12 cherimoyas a day when in season. I had my blood tested after many months of very high fruit consumption and I had what was considered a good triglyceride level of 62. I prefer eating a whole food, part cooked, part raw now because I think it’s much healthier. But the Mercola recommendation would only apply to pure fructose separate from the whole fruit… Don’t worry about fruit consumption.

  7. My eGFR, an estimate of how well my kidneys are working came in quite a bit lower than the normal range. Since I’m a white male, my understanding is that this estimate is based on just my creatinin level, which is within normal range, and age (I’m 65). Am I correct in my understanding of this? Is this indicator just an artifact of my age? I’m already fully WFPB, so should I be concerned and do I need to do anything more than what this video suggests? I already had an ultrasound of my kidneys which was indeterminant, so I had a MRI and it showed normal kidney structure, although there was some fat around my kidneys, which is odd since I’m lean and somewhat muscular.

    1. I have stage four kidney failure, my GFR has ranged from 27 to 36. At 65 I would say it would be normal, depends. Some decline in kidney function is to be expected the older you get. What is your level of function?

    2. Gender, age, weight, race and creatinine level all go into the eGFR estimate. Age related kidney decline is normal, but I believe anything below 60 should be followed up on. At the very least, you should continue to monitor GFR at least every 3-6 months. Other factors can affect GFR, just being more muscular can cause a slight elevation in creatinine. It is great that you are on a WFPB diet, as it is kidney protective in so many ways.

  8. B12 is synthesized by bacteria in the herbivore krave.It is not need to kill a cow for B12 because the bacteria in the laboratory may also syntetise B12, so we can take a supplement with B12 instead of meat and milk containing dangerous Matri (saturated fats, cholestrerol, animal proteins for which we have not enzyme uricase ( we even have not gene for uricase ), there’s nothing useful in meat and milk, just harm supstances. All harmful aminoacids and essecntiale ones, fatacids and essentiale ones,monosacharides, all minerals and oligoelements and all vitamins ( except B12) , we have in fruits, vegetables and nuts and other seeds, plus supplement B12 -and it’s our food, it is best if consumed raw …we are frugivores.Maybe we sometimes had each prevotellacea bacteries which are able syntetise B12 ?Sorry for my english, I hope you can understand. Spetial thanks to Dr Greger :-) and thanks to all discutants, discussions are here very usefull.

  9. I was getting constant headaches and daily nausea… And then I heard my diagnosis – stage 3 kidney disease. I tried a lot of different medications that my doctor prescribed to stabilize my kidney function, but got no real results. However, one day I scrolled through facebook and accidenataly found an alternative treatment method. It was an ebook created by former kidney disease sufferer. He claimed that he reversed his impaired kidney function and cured his kidney disease with only natural remedies. Of course, I was skeptical about it, but I had nothing to lose, so I gave it a go (by the way, you can find it here – ). After reading it, I didn’t believe that some changes in my nutrition could help me to stabilize my kidney function, but I started to follow it… My doctor was surprised next time he saw my blood test results – they improved!! my kidney disease decreased to stage 2 and my kidneys are getting better every day :) After all I went through – I wish I tried alternative treatment methods earlier…

      1. Thank you Tom for your smart alert. Looks suspicious to me as well. Anyone normally on this site would have just simply shared the information – no charge ;-)

  10. How can so many people manage to stay oblivious to the undeniable proofs that a WFPB diet is the human ideal, and still insist the “paleo” or low carb type diets based on distorted opinions are preferable? Do they ever bother to search the studies for the bogus claims made by the proponents instead of following like sheep? It boggles me how so many are fooled by the lies and ruled by their taste-buds and preferences instead of their brains!

    1. As somebody said, people love to hear good news about their bad habits. Most people are totally oblivious of the researched facts, and don’t care until they get a serious diagnosis, and often not even then, because they THINK they are healthy!

    2. I am somewhat of a newcomer to NutritionFacts, having arrived here from Dr Mercola, and so your phrase, “following like sheep”, caused me to reflect on the inconceivably numerous times I have seen such words as “sheep”, “sheeple” and “zombies” in the comments section following his articles, being used to describe non-followers of the Mercola cult. They themselves do, of course, follow Dr Mercola, but not at at all like sheep; for they are enlightened, and they know that He is infallible, and that His word is gospel; and that you cannot even dream of good health without regular consumption of grass-fed bone broth, Alaskan wild-caught salmon, and Antarctic krill oil. I hope this helps clarify things for you.

      1. The huge appeal of this site is the fact that it isn’t one “expert’s” opinion about nutrition, it is a compilation of the latest studies from many of them. And Dr Greger walks the talk without preaching, marketing, or dominating, just presenting the consensus instead of claiming he has the definitive answers like far too many diet related websites. The “sheeple” metaphor seems so appropriate applied to a species gifted with a high level of intellect, consciousness and self awareness who forgo them all and allow themselves to be lead around by an “authority figure” who they adulate and mindlessly follow.

  11. Love the video’s Dr. Greger. Thank you! As a RD for 7+ years its refreshing that there are still some “pro nutrition” MD’s ….I have a quick question. Assuming a renal patient does not need dialysis….should I keep telling patients to avoid high potassium fruits/vegetables? Or do the benefits outweigh the risks?

    1. I have stage four kidney failure. One must remember that each kidney failure patient is different, depending on their blood lab work, some are required to have a low potassium diet, while others are given prescription potassium supplements like potassium chloride because they have very low potassium blood levels. Those with very high levels of potassium in their blood work, need to avoid foods with high potassium levels.

    2. Hi Andy. Thanks for re-posting your question on our website. I didn’t initially see this post so I did reply to you on You Tube as well. Here is a copy of my response. The need to avoid high potassium fruits/vegetables would depend on if the patient currently has high serum potassium levels. As you are likely aware, high serum potassium can cause heart failure. On the other hand, there’s no need to restrict potassium rich foods if bloodwork is normal, however, keep an eye on the bloodwork as this can change in people with later stage kidney disease.
      Dr. Greger’s video, Treating Chronic Kidney Disease with Food, does talk about what you might be alluding to, potential benefit to kidney health by including more plant rich foods. Check it out here:

      1. Yes, I understand the guidelines, etc. I was curious what others thought about how much high K fruits/vegetables contribute to that level ….do the risks of eating high K fruits/vegetables outweigh the numerous benefits? That was the question – thanks!

        1. I am an RD and I work with people on dialysis. The recommendations for potassium really depend on what stage they are at. Stage 3, not likely to see much in the way of K+ issues, and eating a WFPB diet can be kidney protective in so many ways. Joan Brookhyser Hogan wrote a book on vegetarian diets for CKD and a great resource. The diciest stage is 4. That is where you might see a rise in serum K+ that has to be treated with reduction in K+ intake. Hope that helps!

  12. I have been vegan for 6 years, vegetarian for 16 years. My blood tests over the last few years have shown higher than normal kidney markers, including high uric acid and higher creatinine than the recommended amount.
    Can you eat too much plant based protein? Would pea and rice protein powders affect this? Or could these simply be due to the fact that I train with weights?
    I’m a 30 year old female natural figure/bodybuilding competitor.

        1. I guess lifting not very heavy weights can be healthy but too heavy is too hard on the joints, muscles, bones and adrenals/nervous system~

          1. I’m interested to see how you came to that conclusion? I’ve only ever read about and experienced benefits – better bone density, stronger joints, better health overall :)

    1. Can you eat too much plant protein? That sounds like it’s hard to do especially if you’re eating whole foods. Processed isolated protein powders, vegan or not, are not whole foods, and yes, they absolutely can be the cause of your test results. Follow your doctor’s advice, continue regular checkups and blood work, be sure and tell him about your diet and all supplements, and cut back, or eleminate the protein powders. You might find they’re unessessary. I don’t mean to be offensive, or scare you, but why risk ingesting protein powders just to be, God forbid, the strongest person on dialysis waiting for a kidney transplant?

      1. Thanks for the reply! I wonder if there is any evidence that shows plant-based protein powders could cause the kidneys to work harder?
        My doctor is not worried – they’re not extremely high and I’m no where near needing to worry. He thinks it’s normal for someone who is training as it indicates protein break down. I just wondered if it could be dietary-protein related, or possibly even just dehydration?

        1. Some good recommendations came in above. Just to share a personal experience: some years ago I also had a high creatinine reading in my blood work. I too am a weight lifter/ body builder. I was using one serving/day of a WPI. My GP said the same thing, athletes normally have higher creatinine levels and not to worry about it. With no changes in diet or supplementation, at my next checkup the same lab raised the spec for “normal” creatinine levels, and my levels without changing are now normal, and haven’t gone up since. So yes, sounds like your MD advised you properly. I had no abnormal uric acid levels though. Still, focus on whole foods, limit the protein supplements, and experiment with both. For me, I found anything more than one serving, about 25 grams, made no difference. Like I said, you may find you don’t need it, and save some money. Your next checkup will tell you more.

          1. Thanks so much! That’s really helpful! Same thing happened to me – although I don’t use whey. But I had a high creatinine and uric acid reading, then 4 weeks later both creatinine and uric acid were in the upper level of normal. I then realised the elevated blood test was taken after a CrossFit workout… lol!
            Sometimes my blood tests come back fine, but the uric is always on the upper end of acceptable, and sometimes goes over.

            1. Generally, you’d like to have blood taken after fasting 8 or more hours the night before, first thing in the am. Of course you can shower, but not post workout. I’m no MD, but I’d search this website for high uric acid, which sounds a little odd for a vegan. Nothing to be afraid of, still worth looking into. BTW, strenuous exercise like CrossFit can cause it as well. Doctors today are so worried about practicing defensive medicane, I’m sure if there was anything to be worried about, he, or she, would’ve told you.
              Good health and good luck to you.

    2. I am not familiar with the literature but I understand that high vegetable protein intake may adversely affect kidney function eg
      “it appears that high intake of animal and vegetable proteins accelerates the underlying disease process not only in physiologic studies but also in short-term interventional trials.”

      You may want to consider dropping the protein powders for a while and see how this affects your kidney function tests.

      As an aside, Michael Bluejay has some interesting things to say on bodybuilding and protein requirements. He briefly refers to a couple of scientific ppers on supplements at th bottom of the page.

      1. I have struggled to find much about plant proteins affecting kidneys, and what makes it harder is a lot of plant based supplements and protein powders claim their protein is “alkalising” and protects against grout, and don’t impact on the kidneys. I want to look into it further because looking at my blood test results, I feel like maybe this is untrue.

      2. In reviewing the abstract from the first article, from the Academy of Nutrition and Dietetics, they unfortunately lumped dairy, egg and soy protein together to contrast with meat protein, calling the former non-animal protein. Without reading the entire article to see if they eventually separate the animal and non-animal proteins since we know eggs and dairy are animal proteins, their conclusion that all sources of protein contribute to kidney failure seems to be a spurious conclusion.

        1. Yes, I saw that. It seems bizarre to describe dairy and egg protein as non-animal protein.

          However, they do specifically state “vegetable protein” rather than non-animal protein when they conclude that it too accelerates the disease process. I find it hard to believe that MD researchers would describe dairy and egg as vegetables. But who knows – you might be right. They may not just be referring to eg soy. That is a frightening thought. It never even occurred to me.

          Unforunately, the abstract is not clear and the full article is behind a paywall

        2. I did find this with a quick Google. It suggests that some vegetable protein may cause adverse effects (although it is only a rat study)
          “Kidneys from diseased rats given diets which contained soy or hemp protein compared with casein-based diets were less enlarged, had lower fluid content, smaller cyst volumes, less fibrosis, lower chemokine receptor 2 (CCR2) levels and normalized serum creatinine levels. Soy and hemp protein diets also normalized heart size, which was enlarged in diseased compared with normal rats consuming casein. Kidneys from diseased rats given pea protein compared with casein were more enlarged and had higher fluid content and cyst volumes, despite growing better and having lower serum creatinine and renal chemokine receptor 2 levels, and similar levels of renal fibrosis.
          Not all plant proteins are equally protective in experimental kidney disease and associated cardiac hypertrophy.”

    3. HI Simone – I grew up a vegan on a limited diet due to a serious childhood illness that began as soon as I was born. I thrived and went on to become an elite athlete – in a strength limited, anaerobic power and aerobic capacity demanding sport (dual Olympian 4th in world type elite). Our training was tough, very heavily strength focused plus long hard aerobic and speed oriented training. During about 10 years of my elite athlete life I did eat some animal foods, but always stayed with my plant based ideals – lots of fruit and veges in particular. I grew up with minimal protein and grew big and strong, all of my muscle was build with a low protein diet. Yes, my vegan/vegetarian diet was questioned, so I bowed to pressure and ate a small amount of red meat (never chicken, yuk) about once a week. I looked like a body builder. Being too lean in my sport is not good (I was around 15% body fat – dropping lower than that impacted on stamina and resilience). You do NOT need protein in excess to build muscle – you need the stimulus – training! Ditch the protein powders – just eat!

    4. Just being more muscular can increase your creatinine levels slightly. As far as eating too much plant protein.. that is an excellent question. DR. Greger did a video on a “plant based atkins diet”, that showed people following a low carb atkins style diet but substituting plant protein for animal protein had lower all cause and cardiovascular mortality. Dr Greger notes the limitation of the study was that it was short. Dr. Greger also answers the question on if vegetarians/vegans get enough protein in this video Hope this helps!

  13. I eat plant based for my kidneys and my doctor has changed my life by making me gluten and grain free for better intestinal health. As I try to follow the daily dozen recommendations, I am worried to miss the nutrients that are in whole grains. Could anyone please advice us how to substitute 3 servings of whole grains for the nutrients? I now eat more fruits for carbs and calories.

    1. When you write that your doctor advised you go “gluten and grain free for better intestinal health”, are you referring to a physician .or an alternative health practitioner such as a naturopath?

      Physicians sometimes advise people with advanced kidney disease to avoid whole grains because they are high in phosphorous and potassium. White rice, pasta, bread and refined cereals are suggested as substitutes.

      However some experts note that the bioavailability of phosphates in grain is low and whole grains can be incorporated in the diet

      1. It is a gastro-enterologidt. Grain consumption caused severe gas and bloating, a Big relief that this is reduced now so I stick to his advice.

            1. Thank you but it was only after excluding all these so-called alternative grains that I got better. I have eaten like this for over 3 years now and just would like to know if I get enough nutrients on a completely grain free diet.

              1. You could always log all the food you eat into a tool like cronometer ( The website uses a food/nutrient database to give you a total nutrient intake for each day. The basic level is free with a paid version offering additional tools and reports. But the information given by the free version should be all that you need to see whether you are getting all the nutrients you need. I suggest getting a digital kitchen scale and weighing the amount of each type of food rather than trying to use volume amounts, or even less accurate using a visual estimate of the amount.

                A couple of words of caution. The web-site includes many commercial packaged foods that look like they would be very convenient to use. However, most of these foods only give the most basic nutritional information that is found on the nutritional labels. The result is that no values are included in the values of most vitamins and minerals even though the food might actually contain them. Thus total daily amounts calculated will under-report what you actually consumed.

                So instead look for a generic equivalent contained in either the USDA or NCCDB databases. For example “Shredded Wheat, original” is for the Kellog’s Shredded Wheat cereal, and gives the bare minimum nutritional information. On the other hand “Shredded wheat cereal, not frosted” in the NCCDB database gives a full nutritional breakdown.

                Also cronometer allows you to create your own recipes from the food items in its database. This allows you to only have to input all the ingredients in your favorite dishes once and then the next time you eat it, it becomes one of the picks that you can add as a single food to your food diary. One lesson I learned is to start the name of the recipe out with the same string, perhaps your last name, to make your recipes easier to find when using the food search feature.

                  1. HiekeRHJ – I didn’t read through every detail of your whole discussion with Tom and Jim, but I did notice that you were asking about adding gluten and also about wanting to make sure you got enough calories (at one point). So just a reminder here that you can purchase seitan which is wheat gluten. It is also known as “wheat meat” and has been eaten for hundreds of years by Monks. My local health food store carries seitan that is made into a “pulled pork” barbeque sort of thingy which makes a great sandwich or roll-up or what have you. So that is a good source for gluten. I also just wanted to say don’t forget to add winter squash to your diet. It has many wonderful phytochemicals and vitamins but also a good source of energy and calories and is satiating. It sits right beside sweet potato in my kitchen. Really yummy; I sometimes have it for breakfast. Good luck to you.

                    1. Thank you. I need to strictly avoid gluten and all grains so No seitan for me! I do love the easily digestible squash and have it almost every other day. Nice to know that it has good nutritional value!

              2. Thanks. That is interesting because foods like eg buckwheat are not grains and do not contain gluten.

                However, I think that the answer to your question is probably yes. The traditional Okinawan diet, famed for producing large numbers of healthy centenarians, provided almost 70% of its calories from sweet potatoes and other potatoes. It did contain grains but these provided fewer than 20% of total calories. McDougall also notes .potatoes provide excellent nutrition and can provide a sound basis for a healthy diet.

                However, it is hard to be sure. Dr G has commented that excluding gluten from the diet can adversely affect our gut flora and immune function. It would be important to get advice from a registered dietitian and eat a properly planned diet.

                  1. I am not a dietitian or nutritionist so all I can offer is the opinion of an interested layperson.

                    However, healthy eating guidelines from around the world routinely include advice to include more whole grains in our diets. Wheat, barley and rye are regarded as good sources of gluten so eating high quality wholegrain breads is probably a convenient way to incorporate gluten into the diet.

                    There is some discussion about what exactly is gluten. It has been argued that similar prolamins are found in eg maize (AKA sweetcorn or in the US “corn”). They are said to have the same effect and to be a type of gluten. That said, concentrating on wholegrain wheat, barley and rye foods is probably he easiest and most convenient way of ensuring your diet includes gluten.

                1. Thank you Tom and Julie. Plant-based registered dieticians are hard to find! Brenda Davis seems to be an authority and she sounds reassuring. I only reintroduced sweet potatoes and potatoes a few months ago and less than once a week. Fruits are still my main source of carbs but I hope to balance my intestinal flora with daily use of soy yoghurt and occasional fermented veggies.

    2. MiekeRHJ, you may want to follow the advice of Brenda Davis, RD in “Becoming Vegan”. “If you prefer to limit your intake of grains, eat more servings from all of the other groups.” (legumes, vegetables, fruits, nuts & seeds)

    1. In that video, Dr G is careful to say “may” and “could”. The main point of the video is to ask if the carnitine/choline/TMAO link “may help explain plant-based protection from heart disease and prostate cancer.”

      If it doesn’t, then this still does not affect the fact that plant based diets are protective. We just have to look at other mechanisms for an explanation of why this is.

      Thanks for the link though. It is an interesting read. The Life Extension Foundation (LEF) has published a similar critique of these studies. However both life-enhancement and LEF sell supplements so this may be a reason for regarding their arguments with some caution. Nevertheless, the arguments are not unreasonable. There is a balanced discussion of this question in one of the professional journals. It concludes:

      “it would appear premature to think that both L-carnitine metabolism and TMAO production are the major mechanisms via which the gut microbiota can enhance cardiovascular risk.”

  14. Dr Greger! Where can we find link for the studies which you refer to in your videos?
    Why there isn’t a single link anywhere, a single citation??

  15. Dr. Gregger at it again, throwing in cholesterol as cause of kidney disease.
    Our brain has 2-3% of body weight and demands 25% of total cholesterol. You need cholesterol for your brain (hence your intelligence) and fighting virus and bacteria in the blood.

    1. We produce all the cholesterol we need, just like other animals that can subsist on herbivorous diets.

      In CKD, cholesterol appears to be a coincident marker of other adverse dietary factors. It was speculated that low HDL was a risk factor, but we’ve just learned from a Mendelian randomisation study that HDL has no causal effect.

      1. First of all, LDL or HDL is not indicative of any disease because the blood was drawn from the vein. Veins carry the wastes and left-overs.

    2. All true and completely irrelevant. Cholesterol is so important that your body will make all that it needs with ZERO dietary cholesterol. But more is definitely not better. Both clinical and populations studies show that LDL cholesterol levels around 50-70 mg/dl is completely adequate for human health. There is no benefit from having an LDL cholesterol level any higher than this, and in fact quite the reverse is true. It is absolutely clear from study after study that cholesterol levels in excess of biologic need is absolutely necessary for atherosclerotic plaques to form. Populations with total cholesterol values below 150 simply do not have atherosclerosis. Atherosclerotic plaques can happen anywhere in the vascular tree, not just in the heart. The kidneys are highly vascular organs and as such are extremely susceptible to damage due to arterial blockages from plaques.

      1. What you are talking about adequate applies to people under normal condition: no illness, no infection, no inflammation and no stress.
        Under abnormal conditions, the body requires more cholesterol.

        If you adopt vegan/vegetarian for health reasons, you need to have an open mind. For example, in a recent study[1], fish eaters had a significant 20% lower malignant cancer mortality than regular meat eaters. However, vegetarians and vegans had a nonsignificantly lower cancer mortality than regular meat eaters, by about 10%.

        [1] Mortality in vegetarians and comparable nonvegetarians in the United Kingdom, 2016.

        1. And then the body simply makes exactly the additional cholesterol it need for the time that it needs it. You’re grasping at straws here. Cholesterol deficiency simply doesn’t exist. But if you can point to documented case, I would welcome being corrected.

          1. [1] Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly?, J Am Genatr Soc., 2003.
            [2] Cholesterol and all-cause mortality in elderly from the Honolulu Heart Program: a cohort study, Lancet, 2001.
            [3] Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus, CMAJ, 2008.

            1. Jason Huang: I thought I already explained how these studies are just demonstrating reverse causation… I can’t remember if these are the exact studies you showed me before, but one of them looks really familiar. Anyway, a study showing reverse causation does not make your point.

              1. Hi Thea,

                Vegetarians and vegans had less mortality rate of malignant cancer compared with meat eaters. However, fish eaters had a less mortality rate than the vegetarians and vegans.

                I do not doubt that vegetarian diet can reverse some diseases of civilization (DOC). But, what about long term no animal diet in human? It is a challenge to be a vegan. At least, I read somewhere that vegans were deficient in vitamin B12 after about seven years.

                1. Jason Huang: What does any of this have to do with the discussion on cholesterol?
                  re: “challenge” It can be a challenge to eat a healthy diet because there is so much junk out there. However: a) it’s not *that* big of a challenge. There is a learning curve and then after the learning curve, it is pretty easy for most people. b) I would say that it is more of a challenge to die a slow death due to disease than to eat a healthy diet.
                  re: “B12” I am not aware of any pattern of vegans who supplement with B12 and who have a B12 deficiency. I am aware of plenty of meat and dairy eaters who have B12 deficiency, especially as they age. To learn more about B12 and why it is not an argument against a healthy whole plant food diet, check out this NutritionFacts article:
                  I think your mortality figures are off or only looking at one study, but given our previous, long conversation and how unproductive it was, I do not wish to get into another protracted discussion with you. I spoke up this time, because you were repeating the same arguments that I had debunked before, and I wanted to give Jim a head’s up.

                  1. The argument here is the removal cholesterol containing food from diet to avoid kidney disease.

                    Vegans/vegetarians must supplement vitamin B12 and DHA/EPA.
                    As people get old, they have a difficult time in absorbing vitamin B12. There are at least 25% population who cannot convert ALA to DHA/EPA.
                    If human were built to be a vegan like sheep, then we should not have canine teeth, flat molars, larger stomach capacity, much longer small intestine and colon, and non-stop eating, like a sheep.

                    1. Jason Huang: Again, different topics, which I will not get pulled into. For anyone who is interested, all of these issues have been thoroughly addressed on this site either by Dr. Greger and/or in the comments area. For the anatomy arguments, people might want to check out this page: For anyone who thinks that the shape our canines are relevant, I encourage you to look into the mouth of a dog or cat and compare it to your own.

                    2. Jason Huang . . . .argumentative and boring, . . .clearly not interested in any sort of productive conversation. But I would like to thank Jim Felder for his excellent information which he regularly contributes on this site. As well as Thea. The only reason to follow the Huang thread is to glean from Felder.

                  2. Thanks for the heads up on how intractable @disqus_aiBNphpDlU:disqus is on this subject. I am responding for all the folks who read the comments who might be as confused as Jason is, but are more open to other points of view.

                    BTW, if you want to make sure that somebody other than the person you are replying to sees your reply, you can do like I did with the Jason by typing an “@” symbol and start typing in the screen name of that person. After you type the “@” symbol will be presented with a list of names to select from. That list keeps getting smaller as you type more of the persons screen name. Doing this will cause an entry to pop up in that person’s notifications list on Disqus.

            2. These are observational studies which found a correlation, and of course correlation does not equal causality, so they by themselves do not constitute proof that low cholesterol is the causative factor. Subsequent research is needed to find out whether low cholesterol is the root cause of the observed increase in mortality and cancer risk, or it low cholesterol a result of an underlying condition that results in both reduced cholesterol and increase mortality.

              And if reduced cholesterol was actually a causative factor in cancer or mortality in the elderly, then there should be a strong association of statin use and the degree of cholesterol reduction and cancer and increase mortality after removing cardiac deaths (for which cholesterol level has a strong positive correlation along with proven mechanisms that show how increasing cholesterol levels can be the cause of heart disease). I searched and could find no paper showing that statin use increased the risk of developing cancer or dying from non-cardiac diseases.

              Research by Ahn and Yang finds that at least for cancer, the association of low cholesterol and cancer is a case of reverse causation where it is the cancer that directly or through changes in diet and behavior that cause the reduction in cholesterol level, not the other way around.

              As for cholesterol and mortality in the elderly, it is almost certainly a case of reverse causation as well. As the health in the elderly declines most show a marked reduction in appetite. This leads to a significant decrease in dietary cholesterol intake and more importantly saturated fat. As show in any number of dietary feeding trails there is a dose dependent reduction in cholesterol from reducing dietary cholesterol and saturated fat.

              In fact I suspect the association of cholesterol with mortality is likely to be positive if one looked at the initial cholesterol level in the people who died with a low cholesterol level. Give all that we know about how high cholesterol level directly are as a marker for high animal food intake is a causative factor in the development of many chronic disease, it is likely that in a temporal way high cholesterol leads to disease, which leads to reduced appetite, which leads to a low cholesterol level. I have not yet found a study that is able to track the cholesterol level of individual people from before they showed clinical evidence of chronic disease all the way through the progression of their disease until their death. Does anybody know of such a study?

              1. Why did you say high cholesterol level as a causative factor in chronic disease?
                Why not high cholesterol as an indication (not the cause) of abnormal conditions?

                1. I do in the last paragraph, second sentence.

                  Give all that we know about how high cholesterol level directly are as a marker for high animal food intake is a causative factor in the development of many chronic disease

                  where “are as” should read “or is a”

                  1. Jim Felder: I tried your trick to give a notice to you, but I’m not sure it worked. I wonder if disqus only resolves the name if the person already commented on that thread??? Anyway, just in case you didn’t see it, I wanted to point out that I referred someone to your posts about protein and athletes and she was grateful to have that information: My post: The response was a “thanks” with a two exclamation points!! ;-)

  16. Good day. This is a wonderful topic and right on time. My uncle is currently on dialysis, but decided he wants to become vegetarian. Is this possible? He is 83 years old. Doctors say he needs to eat lots of animal based protein and can’t have beans. Is this true? Thank you!

    1. An Italian group used legume containing vegan diets in late stage CKD in the 90s in 1-7 month trials with positive effects in reduced proteinuria and GFR (1, 2). It might be worth printing the papers out, attempting to understand the arguments, and discussing them with the nephrologists. The usual diets for renal failure are low in protein, but perhaps they’re concerned with protein deficiency and frailty given your uncle’s age. I’m not sure why they are concerned with beans, as the few other studies to mention them in renal failure/dialysis don’t mention negative effects. Perhaps they’re concerned with phytate phosphorus, to which a recent review states:

      Even with a lower fractional rate of intestinal absorption with such foods as beans, a large bean intake can still lead to an excessive phosphate burden. There are several important considerations in this regard. First, some seeds and beans have a high content of potassium, which may contribute to worsening hyperkalemia in patients with CKD…In patients with CKD, a mixed composition of dietary animal and plant foods that are rich in phytic acid should be encouraged, whereas the intake of processed foods should be limited.

  17. I’m at a Primary Care Conference in San Francisco hosted by UCSF. Soo many diseases like Hypertension, Headaches, Diabetes, Heart Failure, Osteoporosis, Hyperlipidemia, Stroke, Rheumatology are presented and discussed and Lifestyle changes are mentioned but no details. Treatment is always medications and surgery.
    Nothing has been said about dietary change to a Vegan diet to prevent, stop and even reverse these diseases–only pills, pills, and more pills. It’s disheartening when this is the institution that is home to one of the forefathers of lifestyle change Dean Ornish, MD who has been fundamental in demonstrating we can reverse all these chronic diseases by changing our lifestyle AND dietary habits.
    These conferences are boring and just a financial tool to make money.

    I wish I could post the pic I took of the doc sitting in a recliner chair they brought playing Candy Crush in the back of the lecture hall which is full of 400+ providers. It’s pathetic.

    I would love to get up and share my experiences and your How Not to Die series of videos.

    Enough is enough of the bullshit sickness ‘un’care system. There’s no HealthCare in this system. Medicine is a business and humans are the collateral damage.

    1. HemoDynamic, MD: Good to hear from you! Ya, that conference sure sounds like a waste of everyone’s time. If you feel a mad urge to jump up on a stage and start educating people at the top of your lungs while waving a half-eaten apple, we all here will fully understand the minor breakdown. ;-)

      1. And it isn’t socialism to determine the true root causes of the diseases that are causing increasingly high premature morbidity and mortality rates and institute policies and programs that work to eliminate or at least greatly reduce those root causes. This is still true even if doing so would cause a considerable disruption in those industries which are dependent on the products that are causing the disease.

        After all we don’t call it socialism if it is determined that the untreated discharge into a local river from a heavy metals processing plant is causing death and illness of those downstream and then government agencies force the plant to treat its waste water, even if doing so forces the plant to spend lots of money, lay off workers or even completely shut down. The health of the general public trumps the financial interest of the owners of the plant.

        So given that it is becoming more and more clear that animal foods and highly refined plant foods (at least in the amounts currently consumed) are the root cause of many of our chronic diseases, I don’t think it would be socialism if our federal and state governments would put in place policies and programs to that actively discouraged consumption of these product, even though doing so will strongly disrupt a number of industries and likely will result in a loss of jobs and profits.

        Sadly the focus of current programs and policies of state and federal government is exactly the opposite in that they are focused on increasing the foods that are responsible for the high disease rates because it increases profits and jobs in the animal agriculture sector and refined plant food industries.

        Happily, at least in the area of diet if not health care, we aren’t personally dependent on government policy. But it is distressing to see so many of our fellow countrymen still ignorant or in complete denial of the damage that might be helped of our government was a driving force to improve the health of our nations diet rather than one of the major driving forces in promoting a disease causing one.

  18. O gawd, it’s that same guy who is annoying to listen to. If he would just hire someone to simply read his script, it would be easier to listen to. But this phony presentation style is just too annoying. I understand in advance that I’ll be castigated for giving this particular feedback, and could probably do just as good or better than anyone else at calling myself a pompous jerk or going on about how it’s the message not the delivery, etc. But hey, for those who will feel better about themselves for blasting me for my feedback (that this guy is too annoying to listen to), have at it! Feel good!

    1. “Our investigation discovered that, in resistance-trained men that consumed a high protein diet (~2.51–3.32 g/kg/d) for one year, there were no harmful effects on measures of blood lipids as well as liver and kidney function.” One reason has to be that their normal diet was already extremely high in protein–their starting normal protein intake was a whopping 2.51 g/kg/day, which then was upped to 3.3 g/kg/day! Thus, a subject weighing 150 pounds (68 kg) would be eating 170 grams of protein/day as their normal, then go up to 224 grams protein/day. I bet that if the study had reduced the protein to real normal, .8 to 1 g/kg/day, liver and kidney function may have actually improved.

      1. “Jose Antonio Ph.D. is the CEO of the International Society of Sports Nutrition (ISSN). Dymatize is a sponsor of the ISSN” That doesn’t necessarily void the study or the results. Still, sounds a little like a sponsored study to me.

        Next, they said they were eating 30 grams of fiber/day, which of course is good, or at least above average.

        “One might speculate that a limitation of this investigation is that the subjects were young males who had several years of resistance-training experience and were regularly consuming a high protein diet at baseline. However, the fact that they increased their protein intake by ~32% and still had no deleterious side effects is further evidence that a high protein diet in exercise-trained individuals is indeed safe. The small sample size may also preclude one from applying the results from this study to other populations (i.e., sedentary men or women). Nonetheless, we would posit that the only populations that would consume a high protein diet are athletes (e.g., highly trained endurance and strength-power athletes). Thus, the need to apply our data to other populations may be a moot point.”

        I still strongly believe that athletes, or even those who train regularly, need more protein than otherwise sedentary adults, as every study I’ve ever read concludes this. That said, this was a small study exclusive to young male athletes, or resistance trained individuals, for a very short period of time. If you’re a young male weight lifter, and eat high P for one year, you’re probably going to be fine. Those are some pretty narrow parameters. The other 99% of the population has little to nothing to learn from this study.

        1. The thing is that if you just eat more of the same food in order to get the extra calories required by the higher activity level, the amount of protein increases quite naturally. The calculator says that my basal metabolic rate is 1776 calories per day. Cronometer says my current diet with no focus on high protein foods is about 15% of calories from protein. My lean body weight is 150 lbs or 68 kg (my actual weight is sadly more than this). If I was a sofa spud and just ate at my BMR I would be getting 67 grams of protein a day, or right about 1 g/kg.

          So I am already above the 0.8 g/kg recommended as adequate for 98% of the population. But if I start a moderate workout program and increase my daily calorie needs by 500 calories and just eat more of the same food to get those 500 calories, then I will naturally get an additional 19 grams of protein and my specific protein consumption increases to 1.3 g/kg. But lets say you really amp it up and are working out hours 4 hours a day at around 500 calories an hour. You would need an extra 2000 calories a day, more than double your BMR. So if you just eat twice as much of exactly the same food to get the increased calories, then your total protein intake would be 3776*0.15/4 = 151 grams for a specific protein consumption of 2.2 g/kg. And that works out to the 1 g/POUND recommendation I have seen as the amount that folks looking to build muscle should target. All by just eating more of the same moderate protein whole plant food.

          So you are probably right that folks working out really hard need more protein, but there is no need to add refined protein foods in order to get it. Just eat more of the same healthy whole foods that you would eat if you weren’t an athlete.

        2. baggmann744: I don’t know if you get the ‘PCRM Breaking Medical News’ reports or not. Just in case, I thought I would share one that I *just* got. It’s obviously not about athletes, but it seems at least somewhat relevant? to this conversation:

          “High-Protein Diets Cancel Out Weight-Loss Benefits

          A high-protein diet does not promote healthful weight loss, according to a study published in Cell Reports. Researchers assigned obese postmenopausal women to a calorie-restricted diet with either a high-protein (1.2 g/kg) or normal-protein (0.8 g/kg) diet and monitored insulin sensitivity. Although both diets resulted in a reduction in body weight, the high-protein group did not improve its insulin sensitivity or reduce oxidative stress as observed with the normal-protein diet. Researchers caution that high-protein diets’ failure to improve the primary mechanism for type 2 diabetes raises concern.

          Smith GI, Yoshino J, Kelly SC, et al. High-protein intake during weight loss therapy eliminates the weight-loss-induced improvement in insulin action in obese postmenopausal women. Cell Rep. 2016;17:849-861.”

          I thought you and Julie would be interested.

          1. Interesting. Frankly, in the big picture context of the entire debate, I really don’t know what to make of a single study like this, nor am I qualified to analyze the results. It does however indicate, at least in this study, what the title states.

            In Table 2: Plasma Hormone and Metabolite Concentrations and Glucose Kinetics Before and After the Dietary Intervention, I do see some difference in the before and after glucose levels, but was it significant?

            If i was an obese postmenopausal woman over 60 looking to loose weight and improve insulin sensitivity with diet alone, I’d keep the P @ 0.8g/kg of body weight.

            Thanks for the reply, and as always, comments are welcomed and appreciated.

            BTW, here’s the PDF:


            1. baggman744: You raise an excellent point. I’m always saying that it’s not about one study. It’s about how studies fit into the big picture / the overall body of evidence. Like you, I’m not qualified to analyze the results. I just saw the study, remembered that you and Julie were having some conversation about protein and just thought I would throw it out there just cause. :-O Thanks for supplying the .pdf!

              1. I appreciate the study link. The high protein group ate 50% more P than the other weight loss group, which for that group was too much. So, if there is a conclusion, or recommendation, it would be 0.8g/ kg. of body weight for P would maximize both weight loss and insulin sensitivity improvements.

    2. Like @disqus_Km6QQh7TLV:disqus says, this study is classic example of studying a “sick population”, as defined in the landmark paper by Rose. I like his example of trying to look at the relationship between smoking and cancer if everybody in the study population is a heavy smoker. With only smokers in the study you would conclude whether somebody develops lung cancer or not is completely due to genetics and has nothing to do with smoking. It is only when a significant portion of the study population doesn’t smoke does it become incredibly obvious that smoking is in fact the primary driver of lung cancer risk with genetics playing a secondary role.

  19. Hi,
    this is totally out of context, but I have a question for you all. My son is 8 years old and has ADHD which needs to be treated with MPH at this time. (Belive me, I tried not to) – now he is underweight und failing to thrive. He will eat, if the food is covered in cheese or pure sugar – otherwise he is “not hungry”. I was advised by the ped to do just that, pour cream into everything, cover everything with cheese and let him eat chocolate ad lib. I don’t really feel comfortable with this approach.
    We are trying to eat better, we cut out meat and I am reducing dairy (slowly). I try to increase veggies, fruits work quite well, esp covered in peanut butter :).
    Does anybody have a similar problem and found a solution? I am really getting desperate here … and I don’t want to set him up for an adult life of crap food. :( . Thank you!

    1. That is a very tough situation. I can hardly imagine watching my child fail to thrive despite my efforts.

      It seems like the most important point here is getting him to eat while increasing nutrient density and decreasing the crud like saturated fat and added sugar. If he won’t eat without the cheese and sugar we can at least make it healthier for him. My suggestion is that there are a lot of different vegan cheese recipes out there from aged cashew recipes to nutritional yeast with soy cream and thickeners. They all have different textures and flavors so don’t give up if the first one doesn’t work! If you don’t want to make them yourself, certain stores even carry them these days.

      As for the sugar he likes on his foods, there are healthier alternatives to table sugar that you can try. Black strap molasses and date sugar are both more nutritionally dense and even include a little fiber. Stevia and erythritol are your best bets for artificial sweeteners (erythritol might even be an antioxidant). I would even try unprocessed honey over table sugar since that at least gives you enzymes and can help with allergies.

      I hope you find something that works. Best of luck!

  20. I’m a new blogger but have Dr. G’s book, follow his videos and have seen him in person in New Hampshire. While I understand the title of his book “How Not to Die” is designed to be an attention grabber and aimed at selling books. Fine. However, his continual use on his videos of the title ‘how not to die from …..” is grossly insensitive to those who are actually or potentially dying. We have a friend who is unable to find a match for a kidney and may have to go on dialysis within the next few months. There is a real possibility she may not live. Three kids not yet in college. We read Dr. G’s series on “how not to die from kidney disease” and wanted to forward these to our friend. But we decided that the “how not to die from” was just too frightening for her. We ask that you consider the feelings of people who are in the throws of certain diseases, like cancer, kidney disease, etc. who may well die even after adopting Dr. G’s dietary program.

    1. Hi Angela, I understand where your coming from, but I believe your good intentions are very much misplaced. Those who suffer from kidney disease already know and understand that their disease can and does lead to death. Most are not sensitive to these words at all but rather search for any solution to reverse this possibility. Think of this, by being sensitive to the words “How not to Die” you are potentially not allowing her to see this kind of information that could very possibly save her life.

      Let me tell you where I’m coming from. My sister had Type 1 diabetes. She suffered all the debilitating effects of the disease through her short life (she lived to 37). She was blind in one eye (had several laser treatments for her sight), had CVD and a heart attack in her late 20’s, blood sugars always out of control, even taking 3-4 shots of insulin a day, and lost both her kidneys. She spent 5 years on peritaneal dialysis and continued to get worse. She was dying fast. She got put on the kidney wait list. I donated my kidey to her (a process that is far more grueling on the donor than the recipient, but I would do it again in a heart beat). Needless to say the transplant was very successful and gave her another 5 years of a caring, loving life before she finally succumbed to leukemia (most likely caused by all the anti-rejection drugs she had to take everyday. They basically destroyed what little immune system she had left). Nonetheless, the transplant gave her a wonderful last 5 years. If I had known about a WFPD diet and the effects it has on our health back then, you better believe I would have done everything I could to convince her to try it, no matter the words. She new she was dying but the words didnt matter to her, life did.

      Finally, we come to myself. I was extremely unhealthy as well. A lifetime of SAD eating will do that to you. I suffered from Metabolic Syndrome which included type 2 pre-diabetes, CVD, high blood pressure, Chronic Kidney Disease (yes having only one kidney didnt help), morbidly obese, high inflammation levels, bad knees, and virtually every ache and pain you can think of. And I was only 55. I finall decided to do something about it and then put myself on a WFPD (Dr McDougall’s Program) and after a year of doing nothing more that eating properly and doing a little walking I reversed and “cured” myself of every issue I had, includeing my kidney disease. If only I had known what I do now, my sister could possibly still be alive today and continueing to improve.

      Take a look at my testamonial to see what this style of eating can do for a persons health:

  21. Knowing that renal patients need 0.8g/kg protein, to prevent catabolism and more accumilation of toxic waste, this video is encouraging us to give plant based protein sources such as legumes. However, most renal patients have phosphorus restrictions as well, and therefore they cannot have alot of legumes that are very high in phosphorus.I disagree with this conclusion..

    1. Hi Lola, I am a dietitian and I work with kidney patients. Yes, phosphorus restriction historically has kept beans and nuts off the menu for these patients. However, there has been more interest in the absorption of phosphorus from plant sources vs animal sources. The absorption from phosphorus from animal sources is about 40-60% and from plant sources is only 10-30% In addition there is more interest in the possible contribution that the meat heavy diet currently prescribed to dialysis patients may be in part responsible for the worsening of metabolic bone disease in these patients, d/t the acid load it creates. In earlier stages of CKD (chronic kidney disease), plant based diets have been found to be kidney protective and should be recommended. We are not there yet in the latter stages of CKD, but we are beginning to move in that direction.

      1. Thank you Joan for this answer!! So, in your practice your are still not giving alot of legumes until the recommendations have changed.. or are you?

  22. I have a question. Im a 24 yr old dialysis patient.. how can I squeeZE foods like nuts, beans and soy into my diet when they are all high in potassium and phosphorus? My nephros, as always recommend high protein diets as the standard for renal dialysis diets. I dont follow it and I choose the plant based route instead…

    1. Hi, Will. I am Christine, a NF Volunteer Nutrition Moderator. I obviously do not know the cause of your kidney function issues, which are not common in someone as young as you are. Without knowing more about you, it is difficult to give advice. That said, I am surprised that a nephrologist would recommend a high protein diet for someone on dialysis. Have you seen this? You might find it helpful.

  23. i am well aware that this information is based on human biology but my dog of only 4 years old has been diagnosed with Kidney Failure. She has not been given much time left and i am willing to try absolutely anything. in becoming a vegetarian myself earlier this year because of Dr Gregor’s information on this website and his book, I believe in eating this way for myself. just wondering if there is any scientific data that might suggest eating vegetarian/vegan may be beneficial for my dog who is suffering from kidney disease….

    1. katy: I’m so sorry to hear about your dog. Being a dog person myself, I feel your pain. And I can’t imagine a dog getting that problem while so young!
      Some years ago, I researched this issue quite a bit. I found one study done on vegetarian Alaskan sled dogs. It was a short term study and only done on a few dogs. But those strong, working dogs thrived on the diet. No harm was found. Other than that, I’m not aware of any studies on this topic in general, let alone one that specifically addresses kidney disease in dogs. If someone knows of something, please share.
      What I can do is tell you that I’ve had my Great Dane on a vegan kibble since he was 6 years old. He’s about to turn 13. Great Danes typically only live 8 to 10 years. When I switched my dog’s diet from a meat based kibble to the vegan kibble, a few health issues cleared up, including a very serious one (he had been peeing blood for a long time).
      You have a difficult situation. Without good science, we don’t know if such a diet change would likely help or hurt your dog. If you decide you want to give it a try, I like the brand v-dog, which you can order on-line and have it shipped to your house. There are other vegan food options out there for dogs. You just want to do your research to make sure the kibble has the proper nutrients for dogs, including the two amino acids that some vegan dog food brands are short on. If you are interested, I can look up a link to a talk from a vet who helps dogs successfully make the transition to a vegan diet.

    1. It would be wise to bring this up with your physician.
      Foamy uring can be a sign of protein in your urine (proteinuria), which requires further evaluation. Increased amounts of protein in urine may indicate a serious kidney problem. If your urine seems unusually foamy most of the time, your doctor may recommend that your urine be checked for elevated levels of protein.
      To health!

  24. Der Dr. Greger & Team!
    I’ve read your book (German version) and it was very enlightening for me. I have already given the book several times to family and friends. Thank you so much, also for the great website!
    I have a question about the examination of internal organs (MRI) and the use of contrasting for the detection of kidney function: I had to do a MRI screening, because my doctor had only seen one kidney by ultrasound. Because I feared late sequelae, I decided against the prescription of a contrasting. A second kidney should be recognized without contrast. In the physician’s letter they wrote that a second kidney is there, but the function can not be confirmed because of the absence of a contrasting (I was not clarified about that). Does an unnecessary preception of contrasting really harm the brain? Or is it better to see if the kidney is working well?
    Thank you so much for your answer!
    Yours Katharina

    1. Dear Katharina, We are glad you are finding How Not to Die helpful and sharing it with friends. Do check out the website as it has daily tips that are packed with evidence-based insights on the connection between health and our diets.
      As one of the moderators for the website, I appreciate the dilemma you are in try to evaluate the potential harm of a medical procedure your doctor has apparently recommended. Because this website focuses on nutrition a specific answer evaluating personal medical risk/benefits is not possible.
      What I can recommend is closer communication with the doctor/medical team clarifying necessity of 2nd procedure and risks. Are you concerned about the contrast media? the MRI itself? These are valid questions, but certainly knowing if your 2nd kidney is functioning is important too. This may be helpful in evaluating:
      To your good health,

  25. I strongly disagree with this article. As a physician-researcher with expertise in the causes of obesity, metabolic syndrome, insulin resistance and diabetes, hypertriglyceridemia and fatty liver disease, and chronic kidney disease, I know the mechanisms involved and these three things do NOT cause kidney disease. Please post links to your academic journal references, e.g., “Harvard researchers found”, “studies like this”, etc. This transcript doesn’t back up any of its assertions with any evidence. In contrast, I have collected 1700+ articles that back up my knowledge, and my colleague, Dr. Richard Johnson, who is head of kidney medicine at the University of Colorado School of Medicine, has personally authored over 695 journal articles. So, please back up your assertions with references, and post links to the full-text articles so people on here can see for themselves if your statements can be backed up. Thank you. CB King, MD

    1. CB King: re: “…please back up your assertions with references…” Each video has a “Sources Cited” button where you can find links to the research Dr. Greger is talking about.

  26. Hello,

    Is there anyone who has or knows how to stall or cure polycistic kidney disease (PKD) ?? I t would be so helpful for me…


  27. Hi Dr. Antoine,

    I am a volunteer for Dr. Greger. Thank you for your question.

    Unfortunately, little dietary research has been done on PKD. Even much of the dietary research with this disease has been done on rats.

    Because we have no sound evidence for any particular diet, I cannot make any strong recommendations for anything in particular. However, a whole food, plant-based diet has had incredible success for conditions that we thought could not be treated or reversed. Therefore, I would recommend that a strict, whole food, plant-based diet is likely the optimal diet for this condition. At the very worst, even if symptoms from this condition are not relieved, risk of many other ailments will be optimally prevented.

    I wish there was more research on the topic, but hopefully the future will focus more on dietary treatment than pharmaceutical treatments. Best of luck!

  28. Ha ha ha, all this complicated info is hilarious to me. I am a long term vegan who has not eaten meat for 32 years. I could not give a stuff about whether or not I get this, that or the other from supplements or otherwise. I eat lots of fruit, veg, nuts, berries and seeds and feel great, well into my fifties. Most people think I am in my thirties and according to my annual medical ‘MOT’ I am deficient in precisely nothing and have normal everything….while my meat-eating peers are suffering horrific life threatening health problems and take no end of medication. Anyone who thinks that vegans can’t possibly be healthy without supplements are talking utter rubbish.

  29. I have a GFR level that averages 50 – 60. I’m a 67 year old male and have been Vegan for the past 2 years. My BP sometimes spikes to 150 but comes down most of the time to about 125 with normal range diastolic all the time. My BMI is 22, I exercise every day ( for most of my adult life) and I’m in otherwise very good health. I live in Canada and spend a lot of time indoors during the winter and work a lot in my home office ( sitting down at a computer).
    Question: I’ve read a lot of medical journals on the risks and benefits of vitamin D supplementation. I know that having a borderline kidney problem complicates the issue. I also know that causes of vitamin D deficiency can be interrelated to other levels of calcium, vitamin A, vitamin K etc.

    Should I be supplementing Vitamin D and if so at what level? Is their a compromise dose that won’t compromise my kidney health?
    Thank you.

  30. Hello everyone! After watching this video, I’m inspired that there’s another way to treat kidney disease. My question is does this work for nephrotic syndrome too? I’ve been diagnosed by NS for 3 years now and I’d like to know if this works with patients who have NS.

  31. My girlfriend has kidney failure and she is suppose to go to drug she doesn’t and I can’t make her go. In not sure what stage she is in she will just fall right asleep no matter where she is she is swelled up she had puffy eyes she has all the symptoms of kidney failure. What stage is she in and what will happen of she doesn’t get treatment

    1. Hi Matthew, I’m very sorry to hear about your girlfriend’s health. We encourage you to work with her doctors, as our health support team is not able to provide guidance on serious medical situations such as this. We wish you both the best.

  32. Please help me – I was told by my doctor that I have Serious Kidney Function, except for drinking more water I do not know what else I should do. Will this way of eating help me. I am so worried. Thank you for your help. God bless all of you.

  33. As a nurse I’d suggest you sit down with your doctor (& a knowledgeable friend/family member) and ask for clarification of that diagnosis. You have a right to have your diagnosis explained and treatment options reviewed. Your doctor may not know much about nutrition, so do review this summary information:
    https: // and this video as well:
    You’ll learn there are many kidney protective actions you can take.A whole food plant based diet can both prevent kidney problems and help treat them.

    It may take some efforts to adopt new eating habits, but learn what you can(there are tons of resources here and several good books available to help you (How Not to Die by Dr. Greger would be a good start)
    Best of health to you.

  34. Talk about half truths and extreme exaggerations? Can you even read and disect a study? The good doctor is getting worse and worse. Most studies were done on people with end stage kidney disease and on dialySis.

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