"Treating Chronic Kidney Disease with Food"
In the United States approximately one in three adults aged 65 years and older
has chronic kidney disease. But the majority of patients with
chronic kidney disease do not progress to the advanced stages
because death precedes the progression to end-stage renal disease.
Following about a thousand folks 65 or older
with chronic kidney disease for about a decade,
only a few had to go on dialysis, because most had to go underground.
The scariest thing for many kidney patients is the fear of dialysis,
but they may be 13 times more likely to die than dialysis.
With deaths from heart disease killing more than nearly all other
causes combined, decreasing kidney function can just set one up
for heart attacks, strokes, and death. That's why it's critical that any diet
chosen to help the kidneys must also help the heart.
A plant-based diet fits the bill, providing protection against kidney cancer,
and kidney stones, and kidney inflammation, and acidosis,
as well as heart disease.
Namely, blood pressure control may be favored
by the reduction of sodium intake and the vegetarian nature of the diet,
which is very important also for lowering serum cholesterol,
which may not only help the heart but the kidneys themselves.
All the way back in 1858, Virchow, the father of modern pathology,
was the first to describe the fatty degeneration of the kidney.
In 1982 this idea of lipid nephrotoxicity was formalized,
the possibility that fat and cholesterol in the bloodstream could be toxic
to the kidneys directly, based on data like this showing plugs of fat
literally kind of clogging up the works in autopsied kidneys.
Since the notion was put forth it has gained momentum.
It appears high cholesterol and fat in the blood may accelerate
progression of chronic kidney disease through direct toxic effects
on the kidney cells themselves.
Given the connection between cholesterol and kidney decline,
the use of cholesterol-lowering statin drugs has been recommended
to slow the progression of kidney disease.
Of course, serious adverse effects on muscle and liver must be kept in mind.
That's why plant-based diets could offer the best of both worlds,
protecting the heart and the kidneys without drug side effects.
The two potential drawbacks are the amount of phosphorus
and potassium in plant foods,
which ailing kidneys can sometimes have a problem getting rid of.
But it turns out that the phosphorus in meat is absorbed
at about twice the rate,
not to mention the phosphate additives that are injected into meat.
So eating vegetarian can significantly lower phosphorus levels in the blood.
The concern about potassium is largely theoretical,
since the alkalizing effects of plant foods help the body excrete potassium,
but not theoretical for those on dialysis or with end-stage disease,
who need to be followed closely by a dietitian kidney specialist.
Special protein-restricted vegan diets have been used successfully
to slow or stop the progression of kidney failure.
Here is the declining kidney function of eight diabetics for one to two years
before switching to the plant based diet, which appeared to stop
the inexorable decline in most of the patients, leading the researchers
to proclaim it is the treatment of choice for diabetic kidney failure.
It may help delay dialysis by one to two years,
and after kidney transplant may improve the survival of the kidney,
and improve the survival of the patient.
Most of the papers, though, are just pilot feasibility studies.
Doesn't matter if it's effective if we can't get people to stick to the diet.
But while we're waiting for more definitive studies,
existing data support offering these kinds of plant-based diets as an option
to all patients with advanced or progressive chronic kidney disease.
Even if the effects of such diets on the progression of kidney failure
are still debatable, the unquestionably beneficial favorable effects
of plant-based diets on some of the most deleterious cardiovascular
and metabolic disorders usually associated with renal failure
like hypertension and diabetes provide rationale for recommending
a predominance of plant proteins for patients with failing kidneys.
Yet, diet is still underutilized,
in part because some people find changing their diet is difficult.
Yet we know foods rich in animal protein lead to metabolic acidosis.
Our diets are largely acid-producing because they are deficient
in fruits and vegetables and contain large amounts of animal products.
And so what did doctors do? They gave people baking soda.
Instead of treating the cause, the dietary acid load
from too many animal products and too few fruits and vegetables,
they treated the consequence by saying,
"Oh, too much acid? Well, we'll just give you some base, sodium bicarbonate."
And it works.
Neutralization of dietary acid with sodium bicarb decreases kidney failure
and slows kidney function decline,
but sodium bicarbonate (baking soda) has sodium,
so doctors may be just adding another problem.
Now if patients are not going to cut back on animal products,
at least they should be eating more fruits and vegetables.
And so they tried that, and look, it worked too,
and with it doing so without leading to too much potassium in the blood.
And may even work better, as fruits and vegetables
have the additional advantage of helping to lower blood pressure.
This study is important because it illustrates a very simple and safe way
to treat metabolic acidosis: fruits and vegetables.
So the key to halting the progression of chronic kidney disease
might be in the produce market, not in the pharmacy.