I’ve just had blood and urine tests done after 3 months of a vegetarian / almost vegan diet. I wasn’t allowing myself to get too caught up with expectations but have seen some good improvements that I think are worth highlighting and discussing.
Slight edit: this post should also have noted I’ve focussed on drinking more water (approx 1.5 litres per day), reducing stress by meditating (headspace app), exercised fairly regularly and started flirting with gluten free food.
Albumin
Serum albumin which I read is a good overall predictor on how the kidneys and body are doing in general. Mine hasn’t been in range since I found out about my CKD around 8 years ago. I have an auto-immune condition called IGA Nephropathy for info. This is probably the one I am most happy with as I feel like I’ve been putting much less protien into my body but my blood protein numbers have improved a lot. That tells me I’ve reduced inflammation in my kidneys and less is being lost in my urine. It also tells me things are starting to get better overall. The normal range is 36 -44 g/L so just inside the range. Hopefully that keeps improving.
June 21: 31.8 g/L
Sept 21: 36.7 g/L
Creatinine
Can anyone explain to me the general mechanism why creatinine stays in the blood when the kidneys are losing function and is filtered and discharged out in urine when the kidneys are working better?
I’ve just had a result by changing my diet and see my serum creatinine has lowered and urine creatinine increased.
Serum Creatinine
June 21 : 135 umol /L
Sept 21: 115 umol / L
Urine Creatinine
June 21: 2.9 mmol/L
Sept 21: 10.8mmol/L
I can visualise why protein is kept in the blood when the kidneys are working better and lost in the urine when things are not going so well due to inflammation of the glomeruri allowing protein to escape. But how does this work with creatinine?
Protienurea
My urine test results show Albumin Creatinine Ratio 66.6 mg/mmol. This is found by my urine creatinine 10.8 mmol/L and urine albumin 721 mg/L. I am a bit confused as certain online calculators tell me using the ACR number that 24 hour protien loss would be around 0.6g per day (which would be awesome). I believe using ACR to work out 24 hour protien loss is a reasonably accurate method that takes away some of the inaccuracies due to concentration etc from a smaller sample compared to 24 hour collection. I could also use a rough rule of thumb that says i could produce around 2L of urine per day so 721mg /L x 2 = 1.4 ish g in 24 hours. Fairly big difference there. Do others usually go with the ACR or the urine albumin estimation taken from a small sample to estimate 24 hour loss?
Cholesterol is all within range now whereas 3 months ago it was all out of the range.
PTH which I never paid any attention to before is now out of range and increasing so I need to focus on this one
This gives me some hope that we have a chance to at least reduce the severity of our condition and hopefully delay progression for some time and live healthier happier lives.
I am just learning this stuff and would welcome comments from this community.
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Stavrosang
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What drugs are you on? Food is definately the best medicine, for sure. I really credit my mostly vegan lifestyle to slowing the progression of my CDK. But I need medicine now. I"m still exploring the dapaglifloxin route.
As youll note from the end of my reply just now to Stavros, we will have to make a decision similar to yours if/when mum's medics offer an ACE medication to control urinary protein - whether or not its likely to affect kidney function pubmed.ncbi.nlm.nih.gov/406...
They would have to explain the rationale clearly (havent done that thus far!). Either way, it should be an interesting discussion!
That protein needs to be stopped, and the only thing they have for that is either an Ace or ARB. But very draining to have protein leaking because it is not getting into the blood.
Yes I realise that but improving kidney fuction implies its not having a detrimental effect, as my link also indicates. Agree? Hence the necessary discussion with medics.
Again, even if the protein is normal in blood... The protein "leaking" is blowing holes in the filter of the kidneys because those molecules much larger than other molecules,and when they go through the filter, they create holes/scaring and blood in urine hematuria. Once micro becomes macro, then progression to end stage speeds up. Again, your blood surem can show low normal (mine did) but you can be leaking 600 mg/dl (24hrs) PLUS and doing a lot of damage to your kidneys day in and day out.
So what are you proposing? Even her nephro recently refused her ACE or ARB drugs (because her BP normal). We have pestered him constantly about protein but both he and urologist not interested. Meanwhile we are trying diet and cordyceps.
Presume you disagree with report I linked indicating proteinuria with single kidney doesn't affect kidney function? Despite mum's eGFR increase in 4.5y from 36-76.
Strangely shes had haematuria regularly in past but not now.
I doctor at Mayo Clinic in MN...not that they are experts, but this is how I am being treated: . I didnt have high bp and refused to take bp meds for the past 4 years because no one explained to me why it was important regarding the kidney. It wasn't until I saw the nepherologist that was explained to me why I needed to take bp meds. My bp had always been low...and it did rise to 130/90 .which I thought was stress, but not in needing medicine range...BUT that was the protein pounding through the filiter causing this hyperflitration B.S. So with the lisinopril my bp is no really LOW. Like sometimes I don't even think I am breathing...90/60 average, sometimes lower, but no higher than 110/60 that is whith coffee. Anyway. The point is that my Dr. is happy (as am I) that it dropped the protein leaking down. And the second point is, you do not have to have high bp for an ACE or ARB. It says that in basically all the studies, so why your mum's doctor is refusing to take her protein leakage into account baffles me becuase she could end up in the emergency room with probably the worst upper abdomen pain she will ever experience in her life...all that drama was a symptom of the protein leaking and unfortunatly at that time no one tested me for it until I got to Mayo 4 months later. Long story short: It will get worse without treatment, for sure.
I did not have hematuria either. Regarding the study you posted. The sample size was 24 people. That is very small. And it did not say NO risk, it said no increased risk. But obviously, I"m not a doctor. If I had one kidney and I was leaking protein, I would be concerned. I have two kidneysand I'm concerned HAHA. But I hope your mom is going to be OK and I hope your doctors know what they are doing.
"These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect"
The proteinuria reduction through BP is one route. But there appears to be another not related to BP. Haven't read up on it though.
"In addition, ACE inhibitors have renoprotective properties, which may be partially due to the other hemodynamic and nonhemodynamic effects of these drugs. ACE inhibitors reduce the breakdown of bradykinin (an efferent arteriolar vasodilator); restore the size and charge selectivity to the glomerular cell wall; and reduce the production of cytokines, such as transforming growth factor–beta (TGF-beta), that promote glomerulosclerosis and fibrosis"
Dont worry Ive doubted her nephro from the start! But maybe her case is different to yours/others eg due to her sole kidney (explanation would be appreciated, if so!)?
Re the study, do you have any more/reputable ones that state there IS an adverse effect of the proteinuria on kidney function for a solitary kidney? If so, please send.
It worries me that even a medic doesnt want to prescribe meds yet - maybe it's something to do with the usual, potential side effects?
I'd tend to side with Roxanne on this one. That report doesn't say a whole lot to my mind. Protein passing might be expected with a single kidney but it's hard for me to imagine that it does less damage in one kidney than it does in two.
Indeed, I'd have thunk that passing X amount of protein through one healthy kidney does far more damage than the same amount of protein passing through two damaged kidneys.
Indeed the amount of protein passing through damaged kidneys is a function of the amount of damage
Damage can't be re-damaged so a certain amount of the protein being passed through damaged kidneys isn't doing any more harm. Seems to my mechanical mind anyhow.
So: unless clear to the contrary, I'd be assuming the negative outcome.
Pressurize? Absolutely not! But I would seek to understand why not and have them answer the kinds of questions I posed.
I'd take the stance that proteinuria is a bad idea unless otherwise proven. If a special case is to be made by the docs that single, healthy kidney owners are different then by all means let it be made.
Me? I'm on ACE. I was on 2.5mg for a few years and noticed (when I woke up to CKD) that my BP wasn't quite within optimal range so "pressurized" (suggested) to my neff that I bump them. Spend 6 months on 7.5mg and suggested again to go to 10mg.
I'd avoid meds where at all possible but I'm not anti-med to the nth degree. I told you, I'm sure, about having highish cholesterol and staving off being put on statins to see how a low protein plant diet would influence things. Cholesterol came down and I don't have to take statins. That to me is a result. But if cholesterol didn't come down I'd certain consider the case for statins.
As you know from past exchanges, we've tried to have meaningful discussions with mum's medics, without success. Hence posing theoretical points is unlikely to change their thinking imo.
But providing scientific evidence from reputable sources (ideally NHS but that's very unlikely!) which shows that protein at mum's level can compromise kidney function might help. The only evidence of the contrary that Ive found to-date was rubbished by you/Roxanne so I'll keep looking for evidence either way, for a single kidney.
Its quite ironic that we are discussing the potential "virtues" of meds in a post started by Stavros illustrating the benefits of a more natural approach!
"Rubbished" is a bit too strong a word for it. I prefer "challenged"
Proteinuria is out and out kidney damaging. That much is sure. So you can see why the onus is on the ones claiming it is not in this particular case (your mum's medics), to show so.
I understand the intransigence you might meet so all you can do is as you say: look for evidence
Re meds. Put it this way: if the vlpd+ keto diet does what it says on the tin and p.u. heads down to within spec I'll tapering off ACE like a rat up an aquaduct. But until then its the lesser of two evils!
Agreed (last point)! Mum has previously managed to come off BP med whilst still controlling her BP. So IF she is put on ARB or similar, it would be seen as a temporary measure until natural resolves - assuming side effects don't stop it earlier!
Meanwhile I'll seek relevant, further evidence for and against protein effects on kidney function.
2 posts below this a response to Roxanne. ACE reduction of proteinuria isn't delivered only through BP reduction. Its one (mechanically obvious) way but There's more to it.
Refusing ACE because BP normal isn't the full story. I haven't gotten to read about the other mechanics but there are these other ways ACE acts
Too soon after ~2 months to know the effect since only 1 re-test in that period.
Her eGFR and serum creatinine have significantly improved (better than the steady improvment previously). But her urea has not improved, her urine creatinine has dropped sharply to just above normal range minimum and her urinary protein continues to increase rapidly. Note she has only 1 kidney.
She takes 2x500mg caps 1-3 times daily as per bottle instructions.
So far she has only taken 2 caps once a day. As you'll note from my previous reply, that's the minimum recommended dose. But she may increase later depending on results.
This is from another site.. YOur site said grams per liter...that is for blood. I was thinking urine::::::::::::::: : )
Normal Protein Level in Blood
When the report is ready, it will give you several numbers. It is important to note what the lab considered normal protein levels. There is a range of what is considered normal. Most labs will consider anything between 6.4 and 8.3 grams per deciliter (64-83 grams per liter) to be normal for a total protein count. However, normal range depends upon the lab, and could include numbers higher or lower than these. Here is a chart that reveals details of total protein test.
Urine Test
This test is extremely simple. It requires a sample of urine in a cup, which is then tested by dipping a special 'stick' or paper tab into the urine. The test results are usually available within minutes and will tell you what your protein levels are. For a more extensive test, your doctor might ask you to collect your urine over a 24-hour period.
Normal values of protein in urine are typically between 0 and 20 mg/dL. For the 24-hour collection, anything below 80 mg/dL is considered normal. Again, remember that the range might vary, depending upon the laboratory used.
Yes serum not urine. My message followed the previous one "Her serum total protein is 69g/l but no normal ranges shown so Ill have to check online". I was responding to your concern about "...protein leaking because it is not getting into the blood".
Re urine; at 0.08 g/l, her tot protein is significantly below the 0.2g/l (or 20mg/dl) you indicated. But her 24h result of 0.44g and rising is a concern albeit currently considered a "low level of proteinuria" at<1g nhs.uk/Livewell/Kidneyhealt....
So I suspect they'll only consider action if/when tot protein reaches the above limit (or more) or maybe if the 24h figure reaches 2-3g i.e. "heavy proteinuria". Hopefully we'll be able to slow it naturally before that.
PS Im unsure of importance/relevance of mg/dL for 24h collection, only g/24h here.
The whole concept regareding diet and serum protein is interesting. Apparently the protein that we eat has little affect on the amount of protein in our blood. My number is at the bottom end of normal. And I have never been a big protein consumer with maybe the exception of nuts. And I have always been an avid weight lifter, so I started looking into this relationship between the eating protein and the serum levels. This is the best article that I found that explains it simply. Which makes me wonder about Dr. Hull's theory for his Albumix supplement. It seems tht the main issue is inflamation. And that might be why the SGLT2 inhibitors work for CDK becasue they have an anti inflamatory agent in them. :::::::::::::::The following is copies from Livestrong.
Another small study published in the July 2004 "Journal of Renal Nutrition" showed that albumin levels improved in study subjects who received intensive counseling on improving nutritional intake. However, an article in the January 2010 issue of "Journal of the American Society of Nephrology" reviewed 8 studies on people with kidney disease and low albumin levels and concluded that increasing calories or protein is not consistently linked to better albumin levels.
Research published in the April 2014 "Journal of Medical Investigation" indicated that in people receiving treatment for severe burns, albumin was not correlated with diet intake but was related to inflammation. An October 2006 review published in "Practical Gastroenterology" noted that even in severe cases of malnutrition, albumin levels may stay within a normal range. According to an August 2004 article published in the "Journal of the American Dietetic Association," researchers concluded that albumin was not a direct indicator of nutritional health, but rather a marker of the influence of illness on albumin. For instance, inflammation -- present in many diseases -- causes protein to break down in the body, leading to a decreased albumin.
Eating a variety of colorful fruits and vegetables each day along with whole grains, beans, nuts and seeds is a strategy to lower inflammation. According to the "Journal of the American College of Cardiology," including omega-3 fatty acids in the form of fish, walnuts or soy also reduces inflammation.
"Dr" Hull's (he's ex financial services I gather ) position on protein intake and keto acids is that the science says vlpd + keto acid diets lead to better outcomes than the alternatives, commencing early stage CKD. That's the general thrust of the book: the science indicates.
He points out (and its true) that dietary protein will produce urea and that for people with impaired kidney filtering function, urea build up will result in uremia. And uremia causes further problems, including CKD progression. That's one mechanism behind the bottom line indicated by the science.
There is more to lowering protein (as in: the mechanisms whereby a lower protein intake is beneficial to CKDers). But urea (or avoiding uremia) is the key thing, that aided by very low.protein and keto acid analogues.
-
He opens chapter 7 thus. " As you might guess albumin, inflammation and albuminuria are all closely related. Albumin levels are directly correlated to the severity of proteinuria. Proteinuria is correlated to the severity of uninflammation.
The three amigos of kidney disease"
iirc correctly, albumin is produced by the liver and its serum level is influenced by how fast it leaks out of your damaged kidneys.
So there are two separate thing relating to protein: reducing intake to limit urea levels. And retaining serum protein (albumin) by preventing spillage - which Hull ties into inflammation. For that latter he points to a plant based diet with much therein aimed at tackling inflammation. Its not just plant based and that's it.
Definitely all related. Thanks for that. I've also be researching the benefits of fiber/CDK. Very interesting. The renal diet is not high in fiber and in general people do not consume that much.
That would have been me in all likelihood. I ate good food but not varied enough and not a fan of veg. Now I'm plant based and I'm finding going okay. Tasty recipes help and the fibre intake is good.
What's you situation. Proteinuria only? No eGFR drop or other things put of spec?
CVC has gummy fiber supplements that are the bomb. I have never taken supplements. But I do not put fiber in that category. Now I am also taking a probiotic, and I am only doing so because of the research. There was research out that pre/pro biotic harmed the good bacteria by slowing their growth. So I waited. Dr. Pam Popper with the Wellness Forum is researched based, so I tend to rely on her hard work. But the additional fiber, especially with all the water we drink, is great for us, particularly regarding phosphorus levels---considering that the natural fiber in veggies inhibits the accumulation of phosphorus in the system...again, we do not get enough.
Aside from the protein, and being put on the Lisinopril, I do not know what my cause it. The GFR did drop when the protein went up, a good 10 points, but the ACE seems to have that under control for now. I got a recent message from the neph Dr. regarding the value of adding an SGLT2 inhibitor. We are going to wait for a month, retest the the labs, and discuss it. These SGLTs do not stop the protein, but they do have an anti inflamitory agent that would likely be beneficial; however, we shall see. I really do not want to get a biopsy because what the hell can they do for you anyway? Really nothing. Obviously I have something that has done damage and wants to continue to do damage regardless of what it is.
When I look back on my labs, I had micro albumin back in 2015 and I"M PISSED this wasn't addressed. Now macro!! What were they waiting for? SMH.
I just had an appointment with my Neph and although he did seem happy enough with my numbers he didn’t really say too much about the big change since shifting to plant based. I was really expecting a bit more of a reaction especially since he never recommended me to try this diet and now I’ve found something that actually makes a notable difference to my numbers. The ARB I’ve been taking for 8 years which has increased my potassium levels hardly made a noticeable dent in my numbers.
His opinion was the big change was that my blood pressure is better now. It wasn’t crazy high before but is lower now. I suppose that’s something we don’t discuss as often as lowering inflammation etc and a good one to keep in mind.
Not much other support for the many questions I came with and I got a good go out and just enjoy your life. Don’t worry about the PTH going high and out of range or any of the other ones that are out of range.
Going to get a second opinion now anyway and also have some consultations with a dietician to see what else can be done with the ones going in the wrong direction.
The best we can do for ourselves is to do our own research. Last year, I had a friend die from CKD...THis was before I knew I had it. And I feel horrible that I didn't help him because I actually enjoy reading research etc. But damn these doctors, if you can find a good one, keep him/her. I"m happy the plants are changing your numbers. Keep it up. Sunlight is good too.
I wouldn't go so far as damn them. They operate within constraints of their profession and according to paradigms and will be blind and closed to.a degree because if that.
My game is awash with metric and systems based approaches to manufacturing; lean, six sigma, cmms maintenance, GMP, TPM etc. etc. If someone rocked up with some novel (to the mainstream) notion regarding an approach to manufacturing, waving their personal results around like Chamberlain's Peace In Our Time, they'd be given short shrift too.
We're voices calling in the wilderness: make straight the path of dietary interventions.
'Go out and enjoy your life' works until you hit the stage where you're asked 'do you know anyone who can give you a kidney come the time?'
vs
Hull's 'hit every kidney factor you can, as hard as you can, as soon as you can'
Had a somewhat disappointing call with my new RD yesterday myself. Their querying whether I ought not come off the very low + keto and stick with low. My wife (who is a counselling psychologist) was listening in and her take was that the RD is worried about being involved with a supplement bought 'off the internet'. To be fair, she's as much worried about me as a out herself - which is fair enough. A top professional dietician in the public health server mixing it up with a diet reliant on a Web sources supplement??
She was questioning the science saying that in the kidney world, the vlpd+keto recommendation by the NKF is controversial. That said, its got a 1A rating as a recommendation. Tip top guideline according to them.
Having another set of bloods done to follow up the ones in Augusr then a sit down with neff and Rd. I suspect a bit of push to drop the keto element bit we'll see.
RD called out the few bits of results I'd not gotten. Cholesterol was in fact down to 5.2 from 6.6. Less than 5 is the advisory. And LDL down from 4.5 to 2.9 (less than 3 the advisory. Proteinuria down from 665 to 600 it with spot testing I don't suppose that too significant.
One thing I do have to check out (since I've taken the albutrix keto (as in my choosing it) thing on trust is how a 1gr pill becomes the equivalent of 5 gr protein. Does 5 grammes of protein, once metabolised results in 1 gr of amino acid or some such?
{Edit} It looks as if amino acids constitute only between 1% and 10% of protein. So a 1 gr pill is plausibly easily the equivalent of 5gr protein{/Edit}
Aren't you on an ARB? I forgot, but I would not take the protein number lightly. However, I would select proteins that are easier for the proteins to filter. I am not sold ...and have never been sold on a keto diet' but I get Hull's philosophy regarding the blood count in regards to the protein YET the studies I have read regarding diet and protein suggest that the protein you are eating has non significant influence on the blood, unless of course, you are losing it in urine. Therefore, if you want to raise the protein in your blood, you need to stop the spilling of it in your urine. That measurement of 600 mg is probably on a downside of a range which the top number can be over 1000 mg due to the hyper-filtration which the ACE or ARB...as well as the SGLTs are supposed to control, especially if they are working together. Your body has a magical way of adjusting a decrease in a specific nutrition, which makes me skeptical of the supplements as opposed to a well rounded plant based diet. I honestly am reluctant to mess with that until things get really bad; BUT I see what you are saying regarding knowing what is wrong with my kidneys. I do want to know, and so far I have not had an official diagnosis; however, I believe having protein for an extended period of time and downward tread in the GFR is telling enough. Just reading about all the causes, it seems all the treatments are basically the same. The ACE/ARBs are the only thing I have read that stops the protein spilling. Now why my body is producing excess protein (if it is) that is a liver issue etc. etc. The Neph Dr. has had her guesses, non of them good ones, but NOT TODAY DEVIL...My god if I had started worrying about this shit when I was in my late 20s...Now when I worry about it, I think, I could get hit by a bus--then what? Then I would have spent the last years of my life worrying about dying of CKD...Blah. Of course it would have been easier to stop the protein back then for sure, but the underlying issue might not have been found.
ON a side note I did order the Albunix or whatever it is called...But then after reading how dietary protein does not impact the blood protein, I was like WHAT? However, working out does, so I'll stick with that for now. But you have to go by what you feel is right for you regardless of what your doctor says. At least when it comes to diet and nutrition. Which they seem not to know squat about. Even the renal dietician at Mayo who I thought was going to give me a tailored plan based on my blood work had no real advice. SMH. And who am I to doubt Hull. He has obviously done YEARS more research than I have. However, anything over 5 years old is pretty much obsolete. But do check out Popper. Note that she is not talking to CKD patients, and does qualify her statements regarding, for example, bp meds, saying that there are people who do need them, but that is one drug that is overused because so many people are eating and drinking bullshit.
Anyway, right now I am out of the country, so I can only communicate with the Dr. via Zoom. And only have blood and urine work done here...no biopsy yet. But I suspect that will be spring or summer. So only guesses for now.
Just a comment before I switch off for weekend. Ketoacid (,whether albutrix or a.n. other) isn't aimed at proteinuria in the first instance. It's aimed at uremia. At a certain point in ckd, urea goes out of spec. All you have to do is reduce dietary protein and less urea is produced and urea come back into range.
But when you are forced to reduce protein below a certain point, to avoid uremia, you face malnutrition
Enter ketoacidanalogue (kaa). A.K.A protein without any urea baggage alongside. You drop your dietary protein to keep uremia at bay. And if that drop would put you in malnutrition territory, you top up on the resulting protein deficiency with kaa.
Im so glad the conversation appears to have switched back to natural treatment of CKD and away from meds!! And I look forward to reading the Lee Hull book which arrived yesterday (an early birthday present for mum!).
This link includes some of the points you/Dr Hull make such as the reduction in serum albumin with proteinuria epainassist.com/abdominal-p.... Thankfully mum experiences none of the 6 symptoms listed, including that - her serum albumin has been fairly steady at ~35-45% through normal range in the 4+ years since her nephrectomy. Im unsure of the relevance of inflammation markers such as CRP and ESR in this context but mum's are reducing.
PS Im not sure what Dr Hull would make of the remedy in the above link for reducing proteinuria; "Protein rich sources such as beans, lenticels, legumes should be eaten".
Enjoy the book (luck mum to have a child so concerned for her welfare). Lee ain't a doctor (think he's ex-financial services or insurance or some such), he's ploughed a furrow through sheer determination.
You mentioned your mum's urea being well out of spec. I might have missed that, finding it hard to keep track of what folk say re: readings. But in this case, the case is clear.
Serum urea out of spec is the direct result of too much dietary protein for the kidneys to handle.
Ergo: reduce dietary protein to the level required to bring serum urea back into spec.
But: if the reduction is such as to produce malnutrition (i.e. less than 0.6gr protein intake/kg body weight per day, that's the absolute minimum protein requirement) then supplement with a keto acid to achieve that level.
Re: beans and lentils. The issue is max protein allowable + amount of calories required (something like 30kcal / kg body weight per day). If you eat too much by way of high protein foods, you'll find you've spent your protein budget for the day before you hit calories required. What are you going to do if you're budget is 45gr protein and you've spent that but have only 1300 kcals on board?
And so, you've to restrict high protein foods. It's easier the higher function your kidneys have but if urea then protein restriction and so restriction in high protein foods to some degree.
We certainly will consider Lee Hull's approach (when we get around to reading the book) in order to try to reduce her urea from a faily steady 12 mmol/L (N=2.5-7.8) and increasing proteinuria. But unfortunately I have to state some initial reservations as we estimate her protein intake to already be OK - as precise as we can be.
Daily animal protein is ~26gr and so ~12-13% of total calories based on an assumption of ~1500 calories/dy with maybe up to ~2 % more for other proteins. So this falls within daVita guidance davita.com/diet-nutrition/a....
If we try to reduce protein intake further, it risks increasing:
(i) Carbs which is also damaging (we've reduced for past ~10 months)
(ii) Muscle wastage which has increased anyhow in recent years (current age 66).
My own renal dietician has me energy-aim: 55% carbs / 35% / 10% protein.
I wasn't aware that carbs were bad per se? What's the story there?
Re: protein intake (when my urea was 13.5, a bit above your mum's and I went on the diet). I basically aimed for a 0.8g/kg body weight which would be about 50gr per day for my 65kg frame, all sources. This is above what would be required to avoid wasting due to insufficient protein intake - I gather you can run a 0.6g/kg on a sustainable basis once calories are maintained at sufficient levels.
In practice, I managed to average 30gr dietiary/ 20gr keto split (Lee would have recommended a 25g/25g split) and urea came down to 6.4 in three months of starting the diet. The protein was all plant based (bar for a very occasional egg)
So, if I understand your figs correctly, your protein intake was similar to mum's level. If that's correct, again I can only assume her urea (and urine data) have not improved yet because she has only 1 kidney. Unsure if Lee Hull can help but I reserve judgement on that until we've read it.
We reduced her carbs because hba1c has been at max of 41 for years. A 1-wk keto seemed to significantly reduce blood glucose via capiliiary but no hba1c drop yet.
It doesn't matter whether its meat or plant protein, the cause of high urea is too MUCH protein (in grammes) for the kidney capacity she has.
Once you cut the amount of protein, the urea ought to come into spec. Mine went from almost double the upper range to well in range .. by cutting protein.
My current dietary (i.e
urea producing) protein level is 0.46gr/kg body weight. That brought urea into range.
What's your mum's g/kg dietary protein intake best you can tell?
But that 0.46g/kg is only the dietary protein I take on board. I take another 0.34g/kg on board via keto protein equivalent. Thus 8gr/kg total
I mentioned above:
"I basically aimed for a 0.8g/kg body weight which would be about 50gr per day for my 65kg frame, all sources."
"..all sources" meaning dietary and keto protein
If your mum's total protein intake is 0.46g/kg all in and she weighs the same as me, would she not become malnourished? 0.6gr/kg protein is the very lowest one can sustainably go, as I understand it.
A 0.46g/kg isn't something dealt with in the da Vita guidelines you linked.
Certainly a core guideline (which would trump anything else) is minimum protein intake. And 0.6g/kg is the absolute minimum required to avoid PEW. At least, I've never read anything saying we could do with anything less.
0.6gr/kg would require your mum to have 40 grammes a day from all sources.
(As it happens, I had a 40 gr dietary protein day a couple of days ago. 1500 kcal (too low for me, my target is 2100). 50% carbs (should be 55% 'cording to my RD) and 40% fat (should be 35%), 10% protein)
And so ketos come in frame. Since 40gr (or even less, given you mum's actual protein intake) results in elevated urea, there appears little option but to cut protein and make it up with keto.
0.3g/kg dietary is possible with a keto supplement. That'd be 19.5g per day. Hard achieve though - you're into quality of life there.
But I'm not clear what your mum's protein intake is in total? 26gr animal you say. But inevitably she's getting plant protein as well. Could she be hitting something like 40gr overall?? In that case its much simpler to put a dent in her urea by switching some of her intake to keto.
It typically means you have to trim higher protein foods, like meat and high protein plant (like soya).
Re daVita, I was referring to the protein indication I linked of 12-15% total calories for CKD stages 1-3 (10% stage 4 - are you?). She is in line with that at est 1500 tot cal/dy
I would estimate her total protein intake is nearer 30 than 40 gr and carb/fat/protein ratios ~65/15/20%.
What do you mean by a keto supplement? She managed a low carb/keto diet for a week which reduced her blood glucose (capillary test) significantly. But, like most, she would struggle with a keto diet long term. She loves bread too much!
PS I presume you've seen Roxanne's post/video today which disputes vlpd?
The min protein intake for someone 65kg would be 40gr (0.6g/kg). That seems pretty much a well founded figure. What's your thinking on going lower than that?
I don't really focus on aiming on a precise split carbs, fat, protein (and alcohol :)). Around about 10-12 seems to be where I land.
Ketoacidanalogue (a.k.a. KA, KAA). Nothing to do with keto diets. Rather, its a pill that acts as a urea-less protein if your restricting dietary protein (which has urea) and need to make up for the lack of dietary protein forced upon you by the restriction.
The NKF guideline 2020, when advocating very low protein diets, has you supplement with KAA's. There are only two brands that I know of: Lee Hull's Albutrix and Ketorena.
If you mum's urea is out of spec (high) and she was indeed eating 30gr of protein then:
- 30gr is too much protein (in terms of the amount of urea it contains which her kidneys cannot clear)
- 30gr is too little protein (since less than 40gr means probable protein energy wasting (PEW))
The obvious step are to trim the protein back (to say 20gr) and supplement with KA's to get back to the equivalent of 40gr of protein overall (20gr diet + 20gr KA). That attends to both the above issues
I haven't seen Roxannes vid but will look. What they suggest be done with urea, without cutting protein, will be interesting!
To reiterate, mum's been on circa. 30gr total protein intake for quite a while which fits with daVita re % of total calories for CKD stages 1-3. As I indicated to you 2 days ago, she has no plans to reduce protein intake further at this stage as it risks increasing:
(i) Carbs which is also damaging
(ii) Muscle wastage which has increased anyhow in recent years
In past posts, you seemed to indicate mum should reduce her protein further. But now I think youre suggesting supplementing with a Ketoacidanalogue supplement to make up for her lack of dietary protein at total ~30gr, in accordance with NKF 2020.
If so, I will add to her protocol for near-future consideration - despite the doc in Roxanne's video being very Skepical(!) Maybe I will have had the chance to read and understand more on KAAs in Lee Hull's book by then.
The 0.6g/kg absolute min has the appearance of a non-negotiable in the literature. That's the min protein intake to avoid PEW. So 30gr at the moment might very well be the reason for your mums muscle wasting. 40gr (whatever source or combination: plant, meat, keto) would be your mum's absolute min requirement so as to hit 0.6gr/kg.
(did the docs suggest 30gr or is that just what your mum happens to eat? They ask about protein intake in response to the wasting muscle?)
BUT. Given significant urea, that 40gr can't be just dietary. It needs to be at least 40gr alright but made up partially of urea-less protein (I.e. ketoacid).
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That video of Roxannes doesn't stack up from what I can see. The doc in the vid (who has a book himself to sell) stands against the 2020 NKF guidelines on the place of protein (I.e. low and very low recommendations by NKF).
These guidelines are the subject of intensive interrogation of the science (15,000 studies involved iirc) by serious researchers across the globe. Some randomer on the Web cannot compete with that by waving their books in the air
Lee, I think you will find, makes a more compelling, sobrely presented case. A randomer on the Web himself, his thoughts happen to align with the NKF!
- reading Lee's book by way of skimming over most of the papers just to get a sense of the whole and of him. It's 500 odd pages and dense, if you attempting an intensive front to back cover reading. The case for plant based (or very little meat at best) and low or very low is compelling enough
- read the KDOQI guideline pertaining to low and very low protein diets. You'll see that the science is solidly behind low/very low and plant.
- presenting what you learn to your mum's doctors with a view to getting a renal dietician on board who is willing to oversee things. If difficulty getting an RD and you can afford it, KidneyRD will take things up with you/your mum on online face to faces. If your doc says 'not necessary' ask them how else they plan to deal with elevated urea and why they stand contrary to a clear guideline. There might be some reason for a contrary stance taken.
Following this path is complicated amd it's best to have your docs providing cover. As you say, you've competing issues that need balancing.
I am on the max dose of an ARB called Valsartan (Diovan). I’ve been on it for years and don’t remember ever seeing much improvement when I started taking it.
How long have you had CKD? Do you have any thoughts on how much your diet slowed the progression? Is it also an auto-immune condition? Sorry for all the questions, I am just keen to hear about others experience on the direction I am taking.
I’ve been reading a bit about the new treatments including dapaglifloxin and they do look to have promise. That one was initially used for diabetes treatment right so I suppose the safety profile is well known and less than the steroid options.
Have you considered a very low protien diet supplemented by keto analogues? That was my plan before seeing these results with just the diet change. My plan is to continue following the diet to see how far it takes me. If needed the next step would be the very low protein and keto analogues routes. This is recommended as part of the American Kidney Foundation guidelines for medical professionals as a treatment method. See the link below for info. After that then I’ll try one of the new treatments available.
I think a lot of people here have heard but if not and for newbies reading this post the book Stopping Kidney Disease by Lee Hull was my one stop shop for all things kidney disease. I can only go on my own experience and the studies and info in that book are the main reason I started on the diet path. It was a god send to have some hope again in an otherwise fairly depressing outlook using a wait and see approach. Waiting and seeing is a horrendous approach when there’s a chance at intervention before things deteriorate too much. I know that Nephrologists don't get much in the way of nutritional intervention training and this will likely change now but that won’t help people right now.
Bit of a rant there but I feel very passionate about this now. I really hope this post helps others make a decision to try the diet route first and see how it goes and also to start it as early as possible.
Whilst I (and 2 or 3 others on here) find the different parameters interesting, most urologists and/or nephrologists appear to be only really interested in serum data. At least that's the case with my mum. Her serum data have steadily improved in the 4.5y since her nephrectomy eg eGFR now 76ml/min (from 36 post-op), creatinine 72umol/L (131), except her urea remains at ~12 mmol/L.
Meanwhile her urine data have gradually worsened eg PCR 44mg/mmol, 24h protein 0.44g (despite tot protein down to 0.8g/l) and urine creatinine suddenly dropped to 1800umol/l.
In the absence of any rational reason from the medics (!!!), I can only think that it's because she has only 1 kidney where urinary protein is more common - see 1st link below. Albeit without seriously affecting kidney function (hopefully!)- link 2. She does follow a more restrictive diet if only because she had CKD before nephrectomy - link 3.
I think our key problem is what to do if/when the medics offer an ACE medication to control the urinary protein - whether or not its likely to affect kidney function!.
Thanks for your reply, can you explain how the urine protien estimates work? How does total protien = 0.8g/L and 24 hr protein = 0.44g. I am a bit lost on this one
Sorry, typo - the tot protein is 0.08g/l! Still doesnt explain why TP dropped from 0.15g/l previously but both earlier ones were 0-07-0.09 g/l so presume the 0.15g/l was unusual.
Am cook today so on the fly. Question for you. How comprehensive are your bloods. Just asking because I've been spreadsheets all the various bloods I have over years and nearly every one tests for different things. I noticed iron and hemoglobin dropping from previously rock solid and suppose that's to do with the veggie diet (and harder to absorb veg iron)
You notice anything when drilling deeper down into results? Vitamins minerals that kind of thing?
Hi, I've been reading your posts with a great deal of interest. Are you considering supplements for your falling iron? I know some categories of supplements have been described as problematic )no idea if this is amongst) but interested in what you know. I have just in past six weeks implemented a progressive vegetarian to vegan diet. I had a longterm GP I loved (recently retured) but unfortunately was pretty low key/dismissive on my gfr readings for years and suddenly they fell off a proverbial shelf as indicated by bloodwork 3 months ago.
How are you finding the Albutrix ? I am still covering some of your posts and replies so forgive if I have not yet found that.
All the best, thank you for your continued contributions. So appreciated
Glad to throw what I know (or think I know) into the pot. It's by herding together that we be less likely to be picked off by marauding CKD
Re: iron. Nah, haven't considered a supplement yet. Although vegan (+ occasionally egg + low fat milk in coffee), I haven't focused on ensuring I get all the nutrients I need. I was logging all food intake on Cronometer and iron appeared okay. It was only when first blood (post diet start) showed iron down that I checked. And found dietary iron poorly absorbed.
I'll try increase iron intake via food to see how that goes. The supplement industry appears to be problematic so if I can avoid having to navigate that I will.
Albutrix is going fine afaik. I'm running a 60% diet + 40% Albutrix protein intake regime (0.8gr total protein per kg body weight - I weigh 65kg). No reaction (although one person on here reports negative reaction, feeling sick, etx) and I supposing I'm doing okay and not undernourished protein wise. Due a chat with my renal dietician and that is one of the questions: how to tell I'm not wasting away (a.k.a. is Albutrix doing what it says on the tin).
Certainly I feel fine and have out on a kg (now that I'm hydrating)
What the very low protein diet has done is bring my urea (way out of spec) well in spec. Cholesterol has dropped significantly and will I'm sure drop more.
Creatinine ( the serum measurment which determines eGFR) went UP and so eGFR moved from 30 to 29 (stage 4 wahayy!!). But I wouldn't be too surprised if that went back down next blood (I'd be hopeful given I never drank water and that throws serum creatinine off).
Overall my diet is far better: more mixed and varied and probably better all round not to be eating meat.
Early days yet so we'll see. What's your situation eGFR, what out in your blood etc?
You'll have heard me and others.bamg the drum for folk to buy Lee Hull's book and I'd bang again to you right now.
Just catching up a bit here after giving the mind some time away from kidney stuff. I’ve also spent a bit of time recently consolidating data and making it more visual. Your right that it helps a lot and there’s a lot more to be seen.
I also have differences in the tests that have been performed on my bloods over the years. Will ask if there’s any reason for that today.
I’ve noticed that my potassium levels were actually just out of range until I started this diet and now it’s just inside the range. Need to focus on that one. It slipped under my radar as I am living in Scandinavia and my language skills are still lagging.
I’ve had low vitamin d for a while but this was attributed to not enough sunlight due to the climate here in the autumn and winter. Digging a bit deeper now I also see that calcium levels have been low and now something called PTH (parathyroid hormone) is a high. They all seem to perform a merry dance together so these three need a bit more focus. I’ll talk to the Neph today and see what he can come up with.
The deeper we deep the more there is to learn. Hopefully armed with some focussed questions I can get a bit more direction from the medical professionals today
When charting all my historical results I went down the list to find out what each metric did. Hb, Hct, etc. It goes deeper and wider (which can be enjoyable or tiresome). To infinity and beyond in all likelihood.
The Bible has a verse about us being "fearfully and wonderfully made". I've had my nose pressed up against that window of late, what with all this digging.
Your case underlines how important the medics. Our first task is to query and probe. My new renal dietician had me trim potassium intake even though I'm just in range. She instructed me whilst on the fly and I've to find out next meer 'why trim a metric that is in spec?' Whereas you were out of spec and no action taken.
I think it might be helpful if more of us focused on the protein intake equation. Everybody's needs vary depending on a boatload of factors; height, weight, age, muscle mass, muscle activity level, etc. I think that putting everybody's protein needs into the same box could end up being problematic for some folks. What many should be asking is; What if I don't get enough protein? What happens then? Do I start catabolizing my muscles, and if so, what does that do to my kidneys? What happens when I lift weights? Can I safely increase my protein intake to match my exertion level so that I don't catabolize muscle, and if so, by how much? I think we're starting to ask some good questions in this thread, and I think the Stavrosang will end up being a great contributor to this forum.
Very good points. I've seen urea plummet back into range .. but have no idea whether I'm under nourished. That said, I have got a renal dietician to talk to.
Your post serves to underline that docs needs to be involved in this. We might lead but we need backup - we don't know what we don't know
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If there is one thing that I've learned for sure is that the body is an extremely complex system ... and if doctors struggle to steer then what hope us?
Yet we have little choice. Our efforts are going to blunder along given the nature.of the task. Pity this isn't a proper discussion forum where we could put a sig at the end warning that everything said is 'best understanding by a lay person at this stage in their development'!
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How do we address the protein intake equation? The 0.6gr/kg for example, is given as a sustainable low protein intake but wouldn't work with a weightlifter.
Is there a formula that we can use? What tests do we use to ensure we're consuming enough protein (urea tells us we're consuming too much (for our kidneys at least)).
Me? I'd like to understand precisely what the downside of protein is, aside from the obvious urea elevation. Like, is there any benefit in keeping lower protein than it takes to bring urea under control. Seems there must be since vlpd+ keto is seen as better than low protein diets. But why is that so.
The overarching case is that lowering protein to low or very low + keto is well-indicated as kidney preserving. And so, in an environment of so-many-moves-to-make and so much to know, a move down the protein ladder is perhaps the first one.
I read time and time again that lack of renal dieticians is a bug bear for this low protein paradigm. There simply aren't the resources to man the pumps - meaning folk, if going solo, could well run into the problems you highlight.
How to approach things? You have, in a sense, a fire in the building and lowering protein is a way to start fighting it. Do you wait until you understand everything before moving. Or do you act and then start getting up to speed on fullest consequences?
It's not easy getting answers to all the questions that could be asked.
Like, I'm keen on understanding HOW a very low protein diet is kidney preservative.
At it's most simple less protein = less urea produced = serum urea comes into spec = less damage by a toxin.
If that were it I could just monitor urea and adjust my protein intake to keep it in range.
But I suspect there is more to it than that. But am having a hard time finding out. Time is one problem. Hitting a $31 paywall for a single paper (which MIGHT) illuminate .. is another.
Interesting little diagram here. AA (amino acid I understand) increase the size of the blood vessel leading to the kidneys = more pressure = more damage. And so protein linked to something other than urea. But $31 to find out what's going on precisely? Nah...
Thanks, there’s a lot of great discussions going on in this forum and it’s helped me a lot to feel like I am not alone in this.
Great questions and also things I’ve been thinking about. I’ve started losing a fair bit of weight (around 5kg) since I started eating vegetarian / vegan ish around 4 months ago.
Exercise is a big part of my life and it helps maintain fitness and mental health. I am more focussed on maintaining health than pushing myself but I enjoy heading out for fairly long runs in the mountains now and again. I had concern going into the last bloods as I had been out for long run two weeks before taking them and was worried that this would have negatively effected my results. It doesn’t seem to have had any negative effect this time but it’s hard to know how long term low protein diets will effect people with higher activity levels. It sounds like a risky situation that needs some focus.
Possibly going back to the use of keto- analogues to increase protein in a less urea producing way.
I’ll add this to my list of research topics and see if I find anything morw
Re: my post above your own. I'm interested in the mechanisms of proteins affect on kidney. Urea, okay. But what else. See this:
"Effects of Amino Acids and Proteins on Renal Hemodynamics
Excess nutritional load of AAs dilates the “afferent” arteriole, increasing intraglomerular pressure and resulting in “glomerular hyperfiltration” and increased renal plasma flow (39). Glomerular hyperfiltration may contribute to progression of CKD (40–43). Conversely, a lower protein intake leads to greater constriction of the afferent arteriole, resulting in a reduction in GFR (Figure 1). In addition to hemodynamic-mediated mechanisms, protein restriction may protect against CKD progression by changes in cytokine expression and matrix synthesis (5)."
If you look at the diagram in the above you'll see the 'afferent arteriole' is basically the blood tap leading to the kidneys. High AA intake opens the tap and increases blood pressure in the kidneys (thus hyperfiltration thus damage).
The thing I note is their use of the term AA. Amino acid. If AA's 'open the tap' then switching to ketoacid won't help in this particular mechanistic way, since ketoacids are AA's
But the second bolded bit switches units, as it were. It refers to proteins, not AA's.
So which is it that opens the tap? AA's or proteins. And if the latter what component of the protein if not AA's
Unfortunately the paper referred to sits behind a paywall.
Point is: we need to understand the mechanism more completely so as to make good decisions.
A quote from the article that should answer the question:
In the Modification of Diet in Renal Disease (MDRD) Study, dietary protein restriction (0.58 g/kg/day, versus a usual-protein diet of 1.3 g/kg/day) did not significantly affect the mean change in glomerular filtration rate (GFR) over 3 years. Secondary analyses, however, suggested that a low-protein diet may slow the GFR decline in patients with the most rapidly declining GFR and reduce proteinuria. [67]
Quote is under the title “Management of Protein.”
The article is from MedScape and written for GPs. The entire article is extremely interesting if you have time for a long read.
So basically accoridng to this study to prevent ESRF with an ACE or ARB in those of us with proteinuria: only approx 10 out of 100 people will actually be helped if they are udner 70 years old...and if they are older than 70 ..then only 1 in 100 will be helped with the ACE or ARB. Did I read this correctly?
"A retrospective simulation study found that in older patients with CKD, ACEIs and ARBs provided only marginal benefit in preventing progression to end-stage renal disease (ESRD). Among over 370,000 CKD patients aged 70 years and older, the number needed to treat (NNT) to prevent 1 case of ESRD was more than 100 for most patients (even with an exposure time of > 10 y). In younger patients, the the NNT ranged from 9-25. The investigators suggested that the reduced benefits in older patients may reflect differences in baseline risk and life expectancy between older and younger patients. [56]"
Them's two different types - CKD not necessarily producing proteinuria. If they were including folk with CKD but without proteinuria in their trialing, then perhaps it's to be expected that the benefit in all groups will be less that otherwise expected..
" prevalence of patients with a eGFR of less than 60 ml/min/1.73 m2 and a negative proteinuria by dipstick urinary test was about 10%;"
So 10% of people with (let's say) CKD don't have proteinuria (so ACE aimed at reducing proteinuria obviously isn't going to help this 10%.)
Of the 90% remaining, we might suppose that proteinuria is going to be a distribution: some will have minor amounts and others significant amounts. ACE isn't going to help those with minor amounts all that much - they are naturally going to be progressing more slowly in their disease anyway.
So it may be (I would expect it to be) that ACE is much more helpful to those that have a more serious problem. It's just that a generalist shotgunning of the CKD population is to coarse a way to determine efficacy.
Presumably this is realised and there are trials that focus on ACE performance for a high proteinuria population.
I guess I just need a crystal ball. But what I am really worried about is if this low blood preassure is actually damaging my heart and kidneys by reducing the oxygen. I feel like just eating low protein and skipping the meds. I feel like a damn zombie.
Is there nothing you can do to raise your BP whilst taking the med? Happily coffee and beer do! But understand being pissed off. No sooner do you think you've got a handle on some aspect of things and something else comes along to piss on your parade...
Protein Restriction, CKD Patients Not on Dialysis and Without Diabetes
3.0.1 In adults with CKD 3-5 who are metabolically stable, we recommend, under close clinical supervision, protein restriction with or without keto acid analogs, to reduce risk for end-stage kidney disease (ESKD)/death (1A) and improve quality of life (QoL) (2C):
a low-protein diet providing 0.55–0.60 g dietary protein/kg body weight/day, or
a very low-protein diet providing 0.28–0.43 g dietary protein/kg body weight/day with additional keto acid/amino acid analogs to meet protein requirements (0.55–0.60 g/kg body weight/
In case you're not aware, one of the common side effects of ckd is muscle wasting. And muscle wasting makes for a poorer prognosis. It has been determined that aerobic and weight training is good to prevent this muscle wasting in ckd patients. The problem is how to reconcile the protein needs of ckd patients who wish to retain muscle mass vs the need to reduce protein intake in order to protect the kidneys. One of the more prolific posters here would frequently suggest working out with very light weights and lots of reps, but there is absolutely no research to back any of that up. I'll have to ask my nephrologist at my next visit. If you come across any decent research, please post a link here.
I wasn't that aware tbh. Another one to add to the list. Is it something that affects stage 3 - given I haven't crossed paths with the notion much (and tend not to focus on stages further down the slippery slope.
It would be strange for the likes of the NKF to promote low/very low protein diets for early stage if muscle wasting was such a significant factor at those stages. They surely wouldn't be ignoring the one for the other?
I imagine keto analogues is one way to go about it: get the amino acids on board without the downsides of "full fat" protein.
I'm running a 0.8gr/kg as you know - which is 33% more than what is reckoned to be a safe/minimum amount (protein wastage issues notwithstanding)
Another one to tag onto the growing questions for my renal dietician.
Okay going more vegan is good but if you want to do everything you can then you need to go fruit based high raw diet. This is literally the best thing you can do for kidneys, lowest strain on them and creates the least inflammation. Damage comes from foods that cause inflammation n high salt ect.
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Not Sure What All the Lab Results Mean???
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Diagnosed with Stage 2 Chronic Kidney Disease!
High serum creatinine with High Creatinine clearance. Thoughts or experience on this
