How might we cut the risk of dialysis and death in half?
Lower Protein Diet Proven to Help Kidney Disease
5/5 - (95 votes)
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.
Approximately one in seven American adults have chronic kidney disease (CKD), and the prevalence is higher in those with metabolic risk factors such as high blood pressure, diabetes, and obesity. That sounds like a job for plant-based diets, which have demonstrated significant utility for the prevention and treatment of all three of those modern-day scourges of society. Their utility for the treatment of so many diseases has led to a growing interest in their applicability for the prevention and treatment of chronic kidney disease itself.
In theory, there are multiple benefits of more plant-based diets in the management of kidney disease. The intake of animal fat is associated with protein loss in the urine, and other components related to meat, such as choline and carnitine, are converted by bad gut bugs into TMAO, which is associated with scarring of the kidneys. Plant-based diets carry a decreased acid load, whereas ingestion of animal-based foods like meat, eggs, and dairy increases the formation of acid and ammonia––unlike the favorable alkalization from fruits and vegetables. The phosphorus in plant-based protein is less absorbable––which is a good thing if you have ailing kidneys, especially compared to the added phosphorus-based preservatives that are often used in meat processing. Indeed, you can successfully lower blood phosphorus levels in kidney disease patients in as short as one week on a vegetarian diet.
Higher dietary fiber intake can also pull advanced glycation end products out of your system (those so-called glycotoxins), and prevent constipation, which can cause potassium overload in kidney patients. A plant-based diet also lessens the likelihood of exposure to potassium-based additives. A lot of the phosphorus additives in meat are also potassium additives.
And finally, there may be favorable impacts on the gut microbiome, leading to lower generation of uremic toxins. Such “putrefaction” products are generated by protein putrefying in the gut, but plant-rich diets may be able to reduce uremic toxins, in part due to increased fiber and lower protein intakes.
The lower the dietary protein intake, the slower the progression toward end-stage kidney disease. And the increased risk of progression to end-stage kidney disease associated with dietary protein intake appeared to have no threshold––meaning it just seemed the lower the better. But even if you just your drop protein intake by just like 10 grams a day, that modest reduction may decrease the risk of end-stage renal disease and death by greater than 50 percent. That’s incredible. It was a randomized controlled trial. They were trying to get people down to like 0.6 g/kg a day of protein, which is like 40 grams a day, but could only get people down to about 60 grams a day, which is technically not even a low-protein diet. The recommended protein intake is 0.8 g/kg per day, or like 50 grams a day, but just getting people from the usual protein intake of like 70 grams down to 60 cut their risk of dialysis or death by 77 percent. Check this out. By the end of four years, more than 25 percent of those in the usual diet group were either dead or on dialysis from end-stage disease. In the reduced protein group, it was less than 10 percent.
A randomized controlled trial proving massive benefit, yet despite strong scientific evidence, many doctors are still unconvinced that a low-protein diet can help patients with chronic kidney disease. Why? “The reasons for this nihilism are unclear but could be related to insufficient background knowledge, lack of interest in nutrition and dietetics, [and] limited familiarity with the most recent scientific literature.”
Please consider volunteering to help out on the site.
- Campbell TM, Liebman SE. Plant-based dietary approach to stage 3 chronic kidney disease with hyperphosphataemia. BMJ Case Reports CP 2019;12:e232080.
- Joshi S, Hashmi S, Shah S, Kalantar-Zadeh K. Plant-based diets for prevention and management of chronic kidney disease. Curr Opin Nephrol Hypertens. 2020;29(1):16-21.
- Kalantar-Zadeh K, Moore LW. Does kidney longevity mean healthy vegan food and less meat or is any low-protein diet good enough? J Ren Nutr. 2019;29(2):79-81.
- Moe SM, Zidehsarai MP, Chambers MA, et al. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(2):257-264.
- Sherman RA, Mehta O. Potassium in food additives: something else to consider. J Ren Nutr. 2009;19(6):441-442.
- Aronov PA, Luo FJG, Plummer NS, et al. Colonic contribution to uremic solutes. J Am Soc Nephrol. 2011;22(9):1769-1776.
- Nallu A, Sharma S, Ramezani A, Muralidharan J, Raj D. Gut microbiome in chronic kidney disease: challenges and opportunities. Transl Res. 2017;179:24-37.
- Stanford J, Charlton K, Stefoska-Needham A, et al. Associations among plant-based diet quality, uremic toxins, and gut microbiota profile in adults undergoing hemodialysis therapy. J Ren Nutr. 2021;31(2):177-188.
- Metzger M, Yuan WL, Haymann JP, et al. Association of a low-protein diet with slower progression of ckd. Kidney Int Rep. 2018;3(1):105-114.
- Tuttle KR, Sunwold D, Kramer H. Can comprehensive lifestyle change alter the course of chronic kidney disease? Semin Nephrol. 2009;29(5):512-523.
- Carrero JJ, González-Ortiz A, Avesani CM, et al. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol. 2020;16(9):525-542.
- Fouque D, Ikizler TA. Editorial: Implementing low protein diets in clinical practice in patients with chronic kidney disease. Nephrol Dial Transplant. 2020;35(10):1643-1645.
- Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington D.C.: National Academy Press; 2005.
- Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int. 2002;62(1):220-228.
Motion graphics by Avo Media
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.
Approximately one in seven American adults have chronic kidney disease (CKD), and the prevalence is higher in those with metabolic risk factors such as high blood pressure, diabetes, and obesity. That sounds like a job for plant-based diets, which have demonstrated significant utility for the prevention and treatment of all three of those modern-day scourges of society. Their utility for the treatment of so many diseases has led to a growing interest in their applicability for the prevention and treatment of chronic kidney disease itself.
In theory, there are multiple benefits of more plant-based diets in the management of kidney disease. The intake of animal fat is associated with protein loss in the urine, and other components related to meat, such as choline and carnitine, are converted by bad gut bugs into TMAO, which is associated with scarring of the kidneys. Plant-based diets carry a decreased acid load, whereas ingestion of animal-based foods like meat, eggs, and dairy increases the formation of acid and ammonia––unlike the favorable alkalization from fruits and vegetables. The phosphorus in plant-based protein is less absorbable––which is a good thing if you have ailing kidneys, especially compared to the added phosphorus-based preservatives that are often used in meat processing. Indeed, you can successfully lower blood phosphorus levels in kidney disease patients in as short as one week on a vegetarian diet.
Higher dietary fiber intake can also pull advanced glycation end products out of your system (those so-called glycotoxins), and prevent constipation, which can cause potassium overload in kidney patients. A plant-based diet also lessens the likelihood of exposure to potassium-based additives. A lot of the phosphorus additives in meat are also potassium additives.
And finally, there may be favorable impacts on the gut microbiome, leading to lower generation of uremic toxins. Such “putrefaction” products are generated by protein putrefying in the gut, but plant-rich diets may be able to reduce uremic toxins, in part due to increased fiber and lower protein intakes.
The lower the dietary protein intake, the slower the progression toward end-stage kidney disease. And the increased risk of progression to end-stage kidney disease associated with dietary protein intake appeared to have no threshold––meaning it just seemed the lower the better. But even if you just your drop protein intake by just like 10 grams a day, that modest reduction may decrease the risk of end-stage renal disease and death by greater than 50 percent. That’s incredible. It was a randomized controlled trial. They were trying to get people down to like 0.6 g/kg a day of protein, which is like 40 grams a day, but could only get people down to about 60 grams a day, which is technically not even a low-protein diet. The recommended protein intake is 0.8 g/kg per day, or like 50 grams a day, but just getting people from the usual protein intake of like 70 grams down to 60 cut their risk of dialysis or death by 77 percent. Check this out. By the end of four years, more than 25 percent of those in the usual diet group were either dead or on dialysis from end-stage disease. In the reduced protein group, it was less than 10 percent.
A randomized controlled trial proving massive benefit, yet despite strong scientific evidence, many doctors are still unconvinced that a low-protein diet can help patients with chronic kidney disease. Why? “The reasons for this nihilism are unclear but could be related to insufficient background knowledge, lack of interest in nutrition and dietetics, [and] limited familiarity with the most recent scientific literature.”
Please consider volunteering to help out on the site.
- Campbell TM, Liebman SE. Plant-based dietary approach to stage 3 chronic kidney disease with hyperphosphataemia. BMJ Case Reports CP 2019;12:e232080.
- Joshi S, Hashmi S, Shah S, Kalantar-Zadeh K. Plant-based diets for prevention and management of chronic kidney disease. Curr Opin Nephrol Hypertens. 2020;29(1):16-21.
- Kalantar-Zadeh K, Moore LW. Does kidney longevity mean healthy vegan food and less meat or is any low-protein diet good enough? J Ren Nutr. 2019;29(2):79-81.
- Moe SM, Zidehsarai MP, Chambers MA, et al. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(2):257-264.
- Sherman RA, Mehta O. Potassium in food additives: something else to consider. J Ren Nutr. 2009;19(6):441-442.
- Aronov PA, Luo FJG, Plummer NS, et al. Colonic contribution to uremic solutes. J Am Soc Nephrol. 2011;22(9):1769-1776.
- Nallu A, Sharma S, Ramezani A, Muralidharan J, Raj D. Gut microbiome in chronic kidney disease: challenges and opportunities. Transl Res. 2017;179:24-37.
- Stanford J, Charlton K, Stefoska-Needham A, et al. Associations among plant-based diet quality, uremic toxins, and gut microbiota profile in adults undergoing hemodialysis therapy. J Ren Nutr. 2021;31(2):177-188.
- Metzger M, Yuan WL, Haymann JP, et al. Association of a low-protein diet with slower progression of ckd. Kidney Int Rep. 2018;3(1):105-114.
- Tuttle KR, Sunwold D, Kramer H. Can comprehensive lifestyle change alter the course of chronic kidney disease? Semin Nephrol. 2009;29(5):512-523.
- Carrero JJ, González-Ortiz A, Avesani CM, et al. Plant-based diets to manage the risks and complications of chronic kidney disease. Nat Rev Nephrol. 2020;16(9):525-542.
- Fouque D, Ikizler TA. Editorial: Implementing low protein diets in clinical practice in patients with chronic kidney disease. Nephrol Dial Transplant. 2020;35(10):1643-1645.
- Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington D.C.: National Academy Press; 2005.
- Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int. 2002;62(1):220-228.
Motion graphics by Avo Media
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Lower Protein Diet Proven to Help Kidney Disease
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
What about lower protein diets for everyone else? That’s actually one of my Anti-Aging Eight recommendations in my upcoming book How Not to Age, for a longer, healthier life. (As always, all proceeds go to charity.) Stay tuned!
Here are some more videos on kidney health:
- How Not to Die from Kidney Disease
- Preventing Kidney Failure Through Diet
- Treating Kidney Failure Through Diet
- Which Type of Protein Is Better for Our Kidneys?
- Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease
- Plant-Based Diet for Minimal Change Disease of the Kidney
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