Low or very low protein diets. If you've no uremia, will you obtain any benefit?

[Skeptix]

I had uremia at CKD3a/b (uremia =higher levels of urea than there ought to be present in your blood). I was at 13.5 when the normal range is 2.5 to 7.8 (thankfully, I'm now at 6.4 due to diet). Because I had uremia at CKD 3a/b, I assumed everyone else would have some sort of uremia at CKD 3a/b.

When I first read about low protein (or very low protein + keto acid) diets, it made sense that such diets were a "good thing" given that:

- uremia is kidney damaging.

- more protein consumption translates into more serum urea (waste from protein metabolism in your blood) .. and vice versa.

Thus: IF you eat less protein THEN you will produce less urea AND SO your uremia improves AND SO you stave off dialysis.

-

But over this last while I've come across folk with CKD 3/4 who DON'T have uremia. A lady on a Facebook kidney group today for instance: 36 yrs old and just diagnosed with CKD 4. She's a nurse. The only thing "out" in her bloods is creatinine. Nothing else: no uremia, urine fine, nothing. There have been others like her.

It might make sense for her to go on a plant-based diet alright. But would it make any sense for her to go on a low or very low protein diet?

If so, why so? What, or rather, from where, does the benefit of a (very) low protein diet accrue to someone who hasn't got uremia?

(NB: I mean low protein only. Plant based diets tend to be lower protein but I'm not questioning the benefit of plant based diets. Just low protein, whether plant or animal or both)

(A somewhat technical aside occurs to me: the research into (very) low protein diets involves CKDers being recruited for the research. Folk (at stage 3 for example) are recruited, split into groups and subjected to different diets. The results of the groups are analysed and graphed. The trials don't (that I recall) talk of specifically recruiting CKDers with uremia. It's just CKDers

It follows that IF folk without uremia are recruited AND a low protein diet has no beneficial effect on them (because the only benefit of such diets comes from "curing" uremia) THEN the positive result obtained from the group ought to be assigned only to the "uremaics". That is to say, the TOTAL positive result of the group ought to be "credited" only to the uremiacs within that group.

Which means the positive results are even more positive .. but only for the uremiacs. The non-uremiacs obtained no benefit from the (very) low protein diets. They just appeared to do so, being bundled in with those actually getting all the benefit: the uremiacs.

If you catch my drift?)

[userotc]

Like you, mum had higher levels of serum urea (max 13.9) but it has stabilised/slowly reduced over time to ~11.0 albeit a reasonably sudden fall to 8.5 for last reading. Whilst the latter coincided with an increase in serum vitamin D (which she supplements), it may be because of the reduced glucose diet she's on recently or scatter in results - too early to say. Her protein is low-moderate and we plan to reduce further, if possible.

[Skeptix in reply to userotc]

Any correlation between her lowering protein intake and lowering urea numbers? Like, has she been lowering protein intake or has that been stable.

[userotc in reply to Skeptix]

Possibly. Whilst we cant say too precisely, the gradual urea reduction from 13.9, which was 7mths after nephrectomy, to an ave of ~11 (ignoring latest, sudden drop to 8.5) in subsequent 9 tests perhaps matches her gradual reduction in protein. But we cant be too scientific about her protein intake since she applies a "finger in the air" estimate.

We should know at retest in 2-3 mths if the drop to 8.5 is maintained or scatter in results.

[Skeptix in reply to userotc]

I suppose that's the benefit of my abrupt meat-is-murder policy leading to a 13.5 > 6.4 shift in one quarters results. Good correlation between act and result. Hopefully your mums number sticks. Cause for a cheer come the time should it.

[userotc in reply to Skeptix]

New results are in and unfortunately the lower urea did not stick with results yesterday, it increased back to the 12 mmol/L where it has essentially been the past 4+ years since her nephrectomy. That despite continued, encouraging other serum data: eGFR = 76ml/min, creat = 72 umol/L, so effectively both in "normal" range.

Im still getting my head around her urine data. Tot protein back down to 0.08g/l but 24h output almost doubled to 0.44g. Creatinine 1800 umol/l (so just in range; min = 1768)after being generally >5000, hence PCR has increased further to ~3x max of normal range at 44.4.

I dont (yet) understand the massive drop in creatinine but at least initially the low creat doesnt appear to be a concern, at least according to ukidney.com/nephrology-reso....

More research needed but any relevant comments appreciated. Note that besides diet "improvements" (as indicated previously), she has been on cordycepys for ~2m.

[Bassetmommer NKF Ambassador]

HI Skeptix,Sometimes your posts confuse me. So I am going to reply with, why not lower protein, even with uremia? The studies show that a lower protein diet, and easily digestible proteins do not tax the already burdened kidney. So why not? For myself, it has lowered my protein output in my urine and my uric acid levels are great for the first time ever.

All studies have bias of some sort and I am sure if you look for them, you can find a study that will say what ever you want it to say.

[orangecity41 NKF Ambassador in reply to Bassetmommer]

Yes agree Bassetmommer. I was put on CKD diet and lowered protein intake. Later test showed that even with diet have hyperuricemia (medicine prescribed) We must rely on our Doctors to prescribe proper diagnosis and prescription medicines if needed. What ifs may not be the answer.

[Skeptix in reply to Bassetmommer]

Sometimes my posts confused me too! Apologies for delay in responding.

The basic question I was asking was "by what means does a low protein diet help?" Less protein = less urea = less kidney damaging toxin is one obvious route.

Is it the same thing for uric acid. Like: is uric acid a waste product (even if indirect) of protein consumption? I don't know the biochemistry but purines, from which uric acid derives, appears to be a nitrogen based thing, which might well mean protein consumption related.

In that event a low protein diet helps kidneys in the same way as with uremia: less intake means less damaging nitrogen based waste floating around (uric acid and urea)

But that wouldn't necessarily help someone who had no protein waste related issues. If no uremia and no elevated uric acid then what benefit a low protein diet.

Could you elaborate on the less taxing nature of less protein? That would be good to understand. Romance refers to it too so I'd better check this out.

[RoxanneKidney]

It all depends on the kind of protein you consume. Plant and Animal protein break down differently in the body...plus the saturated fats with animal proteins have no fiber which to attach, so they wreak even more problems. Low protein means 30-40 grams. Most people just sit in front of computers all day, so the need for more protein likely not necessary. But I have read studies that have found that even if you are spilling protein, you should not restrict it too much. So I get your confussion. Ultimately you have to do what make you feel your best, and for me, low protein, low salt plant based diet, walking every day, seems to work for now. If I were more active, I would eat more carbs, not protein. So far I don't have problems with uremia.

[Skeptix in reply to RoxanneKidney]

Thanks. Something to check out then: this difference in protein.

Agreed on maintaining protein intake. In the US 6gr/kg is considered okay bit Lee Hull /Europe appears to suggest 8gr/kg.

In my case though I'm not low protein even though low dietary protein - since the ketos make up the difference to get to 8gr/kg.

I suspect I'm spilling less (since the bowl isn't as foamy as before) but tests will tell

[RoxanneKidney in reply to Skeptix]

I would rather control everything by diet but that was not working for me regarding this spilling protein BS. I was in denial for awhile but at the same time had NO CLUE how serious it was because I hadn't done my research. Good you are figuring out what is right for you.

[OKShakespeare]

As there was no info given concerning the nurse's diet that lead to her CKD 4 I would wonder if she ate large amounts of animal protein. Without knowing more about her genetic inherited tendencies to kidney disease and what led to her diagnosis-just the creatinine-I would question the presented scenario. Perhaps with high blood pressure as a factor, for instance, lowering that might prevent further kidney failure even without a limitation on protein. We won't know unless that is monitored and proven successful. In any case since her kidneys are struggling she will probably be told to go on a restricted diet of limited plant protein. It would be interesting to know if there are positive changes as a result.

[WildIris]

I too have looked at studies of low protein with Keto acids, and all they study is rate of GFR decline. These people are very smart and knowledgeable about kidneys, I think, because I don't understand half of what they say, and I trust that if Uremia levels mattered they would have noticed and mentioned it and run more studies. (By the way, check out "Angelic Sinensis", a Chinese remedy. that looks good in studies, and its cheap.)I just came from my Dr. My GFR went from 23 to 45, to her it was because of med changes, but I have also been on a Virtuous Vegetarian low protein diet for 10 weeks. Stage 3A. No protein spillover, she said it depends on why you have kidney disease, diabetes, for instance causes more proteinuria. Anyway, she said "there is information on the internet that a low protein diet is helpful at this stage but you DO NOT need to restrict protein." I think I will continue with a low protein diet and some Keto Acids until a few weeks before my next blood test, then try eating more protein in my diet, see how my labs are?

[Skeptix in reply to WildIris]

Thanks for the CHM tip.

Did your doctor say what med change brought about such an improvement in eGFR? eGFR is based on creatinine and I'm wondering what med could cause such a change.

Purpose of this thread is to understand the mechanism of how low protein (plant and or meat) diet helps. Uremia is one obvious way and if you have uremia I would disagree with your doctor telling you not to look at low protein / very low + keto).

Not sure what eating low protein + keto 》then higher protein 》then bloods..would achieve.?

[WildIris in reply to Skeptix]

I was taking the diuretic Spirolactone(sp?), beta-blocker Metoprolol 50 mg and ARB inhibitor Losartan 100 mg for high blood pressure. They stopped the spirolactone, doubled the Metoprolol and halved the Losartan. Apparently Spirolactone plus Losartan combination can be bad for the kidneys.Have you talked to Lee Hull? I emailed his company a question and he emailed back and wants me to set up a phone appointment through the website, which anybody can do, and talk to him. I'm a little nervous about it.

[WildIris in reply to WildIris]

Skeptix, I just reread your post. About the low protein diet etc, its just because I don't really know for sure why my GFR went up, so I thought I should just continue this diet, which I feel good on anyway, so that if eating higher protein is harmful I wouldn't have done it for too long but my blood test would still show it. Shaky reasoning? From what I've read, it seems like Nitrogen and Phosphorous are always hard on the kidneys, Potassium and other electrolytes are only unhealthy if your kidney's can't process them so your blood levels are too high. So something about making urea is more harmful to damaged kidneys than the process of filtering Potassium? And filtering Phosphorous is also more harmful? Limited experience here, but I've never heard of a doctor of scientist putting any emphasis on urea in the blood or urine as a major indicator of kidney disease. I don't have it, and my doctor didn't seem to think it was a big deal either way. eGFR was the thing.

[Skeptix in reply to WildIris]

Yours is why I want to stay the hell away from pharma. I remember my dad on that threadmill: one pill to help offset the negative effects of the next one.

Yeah, I talked to Lee. Meant to be twenty.mjns but ended up at 30 or so. I just wanted to sound him out, get a sense of him. The book was enough to tell me he wasn't a huckster but I wanted to be sure (or surer).

Came across nice if busy and aiming to get you onto his diet. You could take that as him wanting to get you onto his supplements (which ain't cheap). But I figured he was genuinely evangelical and cared. It's not some big hard sell, he'll just chat and answer questions.

You can always opt for an alternative supplement to his anyway. That said, the supplement game is problematic re quality assurance so you have, at least, the option of trusting Albutrix if finding you trust Lee.

I ain't done too bad out of him thus far. Bloods have taken a definite turn for the better and more importantly, I'm someway along to being on the warpath. I'm here as a result of him tbh. I really needed to get my finger out on my CKD and he gave it a good tug!

However it all turns out, better to have put up some kind of fight. The palliative nurses regularly say that regret is a big feature in one's dying days.

[RoxanneKidney]

Plant protein is just easier on your kidneys. I think every substance has a sweet spot. Even bp. The kidney needs a certain pressure to funtion normally. I think mine is TOO low.

[Skeptix in reply to RoxanneKidney]

I suppose I'm trying to understand how protein quantity (whether plant or meat or both) loads the kidneys. Uremia - understood. Uric acid (if a by product of protein intake) - understood.

But what other way does protein quantity load the kidneys? Is it, for instance, just workload that damages?

You said this "Plant and Animal protein break down differently in the body...plus the saturated fats with animal proteins have no fiber which to attach, so they wreak even more problems" Could you elaborate in relation to kidneys?

Agreed on BP although most seem to have a too high problem. You'd hope diet would improve proteinuria and allow reduction of the meds (if that's why your taking them)

[Bassetmommer NKF Ambassador in reply to Skeptix]

My only answer as to why low protein for me was because of uric acid. I have psoriatic arthritis and that also causes high uric acid and that ain't going away. I had terrible uric acid kidney stones. So the only thing I could do was to lower uric acid was low protein, low purines if any and take sodium citrate. Got to say it all made a world of difference in how I felt. Did not change much as far as the GFR but my uric acid level dropped to normal and have stayed there and my other levels are much better.

[RoxanneKidney in reply to Skeptix]

Dr. Pamela Popper with the wellness forum.. author of Forks Over Knives explain s this in her videos. She has a website and some if her videos are on YouTube. Not knowing that I even had CKD I was following her channel, and would probably be stage 5 if I hadn't been. She is why I want off this bp med. Or want something less toxic to the kidney. Lisinopril. If you can't find her video on it I'll post a link, but I can't vfrom my cheap phone.

[Blackknight1989]

Skeptic,

Check out this link:

bmcnephrol.biomedcentral.co...

It’s US but should still apply to give you a starting point to answer your question regards plant and animal protein.