Written by Jason S. Ewoldt, M.S., RDN, LD. Jason is a registered dietitian for the Division of Endocrinology and the Mayo Clinic Healthy Living Program.
When following a plant-based dietary pattern, the focus is primarily on plants and plant foods. This should include minimally processed whole foods such as fruits, vegetables, beans, nuts, legumes whole grains and oils. It doesn’t necessarily mean animal products are off limits, but that the foundation of the dietary pattern is plants. If you are following a dietary pattern that reduces or removes animal products, such as a vegan or vegetarian diet, a concern might be getting enough protein. Though by eating a well-planned and balanced plant-based diet getting adequate protein does not have to be a barrier.
The recommended daily allowance for protein is about 0.36 grams per pound. This means a 200-pound adult should be aiming for around 70 grams of protein a day. With a little bit of planning, an individual following a plant-based diet should be able meet this recommendation consistently. Below are some of the top plant-based proteins along with their protein content. What are your favorite plant-based protein sources?
Tofu - 1 cup: 20 grams
Lentils - 1 cup: 18 grams
Beans - 1 cup: 15 grams
Peas - 1 cup: 9 grams
Quinoa - 1 cup: 8-9 grams
Soy milk - 1 cup: 7 grams
Nuts and nut butter - 1 ounce: 5-7 grams
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RoxanneKidney
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70gr protein/ 90kg body weight puts the g/kg body protein intake at 0.77g/kg.
That's near enough the 0.8g/kg seen to be the 'right' amount of protein for a healthy adult.
But it's contrary the idea of a low (0.6g/kg) or very low (0.3-0.4gr/kg) protein CKD -focused diet.
The author works in endocrinology. Dunno if that handshakes with renal but there a conflict between this level.of protein and recommendations from the NKF re CKD from 3a into 4.
Certainly cutting down the protein to very low levels (and a bit) dragged my urea from almost twice max range back well into range.
Just as we were getting used to the vlpd for mum to try to reduce urinary protein! Do you have the link for my records? I think I recently sent one to Skeptix which also quoted the higher levels.
We will probably stick with her current level of circa 0.6gr/kg for now, particularly as it correlates with daVita guidance too. But maybe increase later.
Not aiming to sow doubt but I've had this lingering query about daVita.
It's blurb says something like: "A community first, a company second". That's not far away from the kind of thing Facebook would say .. and we take them saying that with a pinch of salt and rolling eyes.
The blurb also says they have 200,000 dialysis patients. That strikes me as closer to the truth. They are, from alpha to omega, a company selling a product called "dialysis".
What possible reason would a company, who makes its money from selling dialysis, have for giving people advice that prevents or slows their descent into dialysis?
Wouldn't they normally be the very last people you would consult in such matters?
Problem with this forum is the difficulty in tracking what conversation you're having with whom and when!
Low protein is a 0.6g/kg diet. Not supplemented with keto acid analogues
Very low protein diet varies, but in the literature it's typically 0.35-0.43gr/kg supplemented with ketoacids to get to an overall target of 0.6g/kg
Lee Hull (whether to allow more wiggle room, since 0.6g/kg overall intake is nutrionally tight OR to sell more of his Albutrix!!) suggests a 0.4gr dietary + 0.4g KAA equivalent = 0.8gr/kg
So you're mum (0.6gr/kg dietary) is running a "classic" low protein diet.
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Just off the phone to my nephr and RD in a group call. It's an interesting phase as the discussion centred around their supporting my being on a very low protein diet + keto, given the unavailability of a pharma-grade keto supplement. You can see the issue: patient get some supplement from some God-only-knows-who on the web (of all places) and they run with it. Potential litigation city if it all goes wrong.
Anyway, they seemed happy enough for me to continue but, from the dietician, on the proviso that I actually aim for the 0.6gr/kg as shown to be effective in the literature. It largely means trimming the keto aspect and moving from 0.46 to 0.43gr/kg on the dietary side.
Point is, they are distinguising between low and very low in a quite strict way.
PS.
I've seen a 200 point drop from 650 to 450 in proteinuria in the 5 months of this diet. Docs aren't getting excited about it (they didn't either for the urea drop from 13.5 to 6.5) but its better than it going the wrong way. Will let you know know if the shift is sustained come next blood in January.
My urea this blood went back up to 10 from the aforementioned 6.5. That said, I was on hols before the blood and couldn't stick to either very low protein or no meat. I wouldn't say I had a blow out but that may explain the jump up. Hopefully that's what it is: it'd be nice to have something under firm control
Works alright. I ran out of ACE once and my proteinuria shot up. Works with BP too although I don't know precisely how much, maybe 10 points on systolic. 10mg Ramapril, max dose.
Yes we were also dissapointed when mum's urea dropped to 8.5 mmol/L a few months ago but then climbed back to 12 last test. Graphically it shows it's stubbornly high at ~10-12 with scatter.
Not sure which measure youre using for "proteinuria" but, if 24h urine protein output in mg/24h, yours is about the same as mum's at 440 (from 280 a few months ago).
As previously indicated, we will be focusing on reducing carb intake for at least the next couple of weeks then hopefully measuring hba1c. If that means a small increase in protein beyond 0.6g/kg for that period, so be it.
"Not sure which measure youre using for "proteinuria" "
Me neither! My log has the blood test URALB or something and I've annotated 'urine albumin' (having looked the code up. But yesterday my r. dietician decribed it as 'proteinuria'.
Confused.com.
I've to wait until I get the paper copy of blood results in to see.
But the takeaway: I'd a 200 point reduction, whatever the hell is being measured!
I'd say not, if only because it took the NKF 3 years to distill and discuss and decide upon the data as if 2017 so as to issue their 2020 guidelines. That pendulum hasn't even stopped yet (I.e. they are only getting around to starting implementation).
Is this fellow writing about protein and CKD or from some other angle, e.g the endocrine angle?
Ah to be 200 lbs. I'm a small person (4'9" and 92 lbs) and these studies never take into account this. I'd be at 42 kg using the converter. At the 0.6g range I'd eat 25g of protein per day. At the 0.4 range it drops to about 17g. Not sure how healthy that might be. Then there's the limit I have on potassium and sodium.
It isn't that hard to get plenty of protein on a vegetarian diet. My basic diet consists of those things on the list. I have 1-1/2 cups of quinoa, 2tbl. of almond butter on whole grain bread for lunch, and sprinkle Nutritional Yeast over everything, including mixing it into salad dressing for my butter lettuce and raddichio salad for dinner.
The dietician said I need to increase my protein to 50mg. but I'm no where near 200lbs fortunately. On the serum protein electrophoresis (SPEP) test which my hematologist ordered both my protein and gamma globulin levels are low. On my regular metabolic blood panel my albumin is within normal range but on the lower end. A SPEP test can indicate Kidney Disease and in my case autoimmune disease and MGUS. My Neph. didn't order that test and maybe it's not routine except in Hematology.
I know many here are trying to lower their protein level but I've never had protein in my urine nor albumin. I'm kind of the oddball opposite of many here with low protein, low BP, no diabetes but autoimmune disease causing chronic tubulointerstitial nephropathy and calcium oxalate crystalluria.
I totally flooded myself with water the few weeks before my last blood draw for the Neph. The Prednisone he put me on made me so thirsty. I was literally drinking a 5 gallon bottle of water per week. The Neph said my urine was very diluted. He didn't mention it but that could have contributed to my high jump in my eGFR rather than the Prednisone or a combo of the two.
I totally enjoy my plant-based diet. I belong to a Vegetarian forum, and new members seem overwhelmed and afraid they'll starve and their biggest concern is not getting enough protein. It's amazing how much protein is in plants. Mushrooms are a source of protein and are good to put into meals as they have a meaty texture for new Veggies missing meat.
There are so many great website for vegetarian recipes. You can get on email lists and get inspired with really delicious meals and they give you all the nutrition facts in each meal. Thank goodness for the internet and Google. I remember traipsing to the library and lugging home heavy piles of vegetarian cookbooks in the past : )
I think we each need to get guidance from a renal dietician for our individual protein needs.
As I understand it, the chief aim of lowering protein intake is to tackle elevated urea. Uremic toxins are kidney damaging (and, it seems, contribute to vascular calcification and perhaps more).
I've not dug into the research into low and supplemented very low protein diets to understand by what mechanism they conferred the benefits they did. Lowering serum urea will surely be one mechanism, but there may be other mechanisms.
But IF urea is the only reason for beneficial effects of limiting protein AND someones urea is within range THEN there is no reason to limit protein.
I was only spilling protein. Everything else normal range except elevated bp. but still wanting me on LPD. But hardly ever ate meat, so probably why other work was in normal range.
Okay thanks. That implication is that protein intake affects proteinuria. Which makes 'common' sense: throw more protein at your kidneys and more will leak out.
You any idea what kind of protein level you were on then (even if mostly plant based). I can only guess, since I wasn't measuring, but reckon maybe 1-1.2gr/kg, with the not infrequent protein-fest for breakfast.
There's a good study of studies about keto-acids from 2019 ncbi.nlm.nih.gov/pmc/articl... if you haven't seen it.I discovered that most diet studies do not differentiate between CKD with and without proteinuria. In other studies, CKD without proteinuria progresses more slowly, all else being equal. A few such people on this site say they have been stable at stage 2 or 3 for many years. The diet studies that did mention proteinuria in the introduction if not the results indicate that CKD without proteinuria does do better with the keto acid diet. In one study they tried adding keto acids to a diet with at least .6G/kg and found zero benefit from keto acids. It seems clear to me its the nitrogen proteins that are harmful to all kidney patients though I don't know the mechanism. And less than .6G/kg is clearly even worse for CKD patients, that's old news.
Thanks for that - it occurs to me that we need some kind of receptacle for all this digging we're doing. A kind of sticky were all.paper/info can be assembles rather than being lost in a sea of posts. I'll read with interest.
Proteinuria is a biggie alright and perhaps we don't focus on it enough. It's one thing that my nephr underlined when I suggested reducing my ACE. Horrified at the thought as it's main benefit I'd proteinuria reduction.
When you say add kaa to a 0.6gkg diet do you mean maintain the dietary 0.6 and just add kaa to it. Wouldn't see benefit in that alright
Dunno the precise mechanisms of nitrogen contributing to proteinuria (if any). The nitrogen results in toxins so there will be damage caused (e.g. suppressing the cells that clean the vascular system / reducing build up of deposits on vascular walls) but how directly to proteinuria??
Can it be (per Roxannes experience) that it's not so much the nitrogen as the sheer volume of protein being handled by the kidneys that causes the problem. A low.protein diet = less nitrogen. It also means less protein to filter so naturally less will leak?
And when I read else where that the protein intake has little additive to blood, but protein in blood is mainly produced by the body...that really fascinated me. One could have an overactive liver that is causing this hyper filtration in the kidneys.
Interesting read in that it, amongst other things, expands on the role of elevated urea in the disease. I knew it simplistically (uremic toxins are bad) but this paper outlines the myriad ways by which uremia does damage.
(The conclusion: vlpd+KAs have not being adopted by international bodies as a first line defence .. has been overtaken by the KDOQI 2020 (this paper is from 2019). I must check out the KDIGO as well which I recall have a 2021 update?)
Makes sense but it's a difficult balance - which probably none of us get right tbh! For example, our main concern with mum is her rapidly increasing urinary protein. At least initially, we are trying a v low protein diet (maybe increase later in line with OP here) alongside low carb/keto. That despite her having lost significant muscle already.
HI Fatbuddy, You would be amazed to see how many have diabetes and CKD and now, heart issues.
As far as losing muscle mass, I was concerned with that because of how low my protein intake is. Solution: work out! Changed the whole picture in a matter of months. Now what was flab is going and the muscles issue is getting fixed AND it helps with the whole body. I do water workouts and it is easy to transition into a doable workout. I now do an hour long workout with barbells and other resistant equipment and water walk in a current channel. Easy peasy. For those who don't have pool access, resistance bands are great. I use them on the days I am not in the pool. Any age can use them.
I gather so. I find myself ball watching my kidneys and forgetting about the device that pumps the blood my kidneys aren't capable of filtering properly...
No pump and there'll be nothing to filter, badly or otherwise.
I started a vegetarian diet about a year ago. My dietician suggested that I take a protein supplement made especially for persons with ckd. My dietician recommended Ketorena, Nutramine, or AMinoBytes. I make a smoothie using one scoop of Ketorena, which I drink twice a day.
Does anybody know how many mg of ketoacids it takes to make a Gram of protein equivalent? This is what you'd need to know to compare these products. It seems like Albutrix has more protein equivalents per "serving" than the other two, 5 G per pill it says, 30G per "serving". If you're getting around .4G per Kg from diet, you'd need at least .2G of protein equivalents in Keto acids to have minimal protein for health. I'm confused by the mg of ketoacids that the other 2 advertise, also suspicious that they aren't being upfront about protein equivalents, and about it being enough. Also, shouldn't the servings needs vary more by the user's weight?
Don't know. I remember doing a cost / per equivalent gramme of protein on both ketorena and albutrix and they came out about the same. But that was using the manufacturers claims.
I also looked up the amount of ketoacid (final form your body uses) that you'd get from an amount of dietary protein like meat .. and it was miniscule. Which is why a pill weighing maybe a gramme can give you the equivalent of 5grammes of dietary protein
Your right on serving size, of course weight matters. There isn't even a serving size panel on Albutrix which is really sloppy - its standard practice to put instructions on packs of any food.
The only way to compare I to dig around (e.g. do you accept Hull's "magnesium better than calcium based ketoacid" argument? If I recall it was about calcium based keto acids (like Ketorena) giving you your daily calcium intake and we need to ve careful with calcium for vasclar reasons. But aI didn't dig much since I wanted to get going.
He put a lot of rigorous research into his book, which was kind of a service, plus he has CKD himself, so I basically trust him, though I don't like the Albutrix 180 pills every 25 days business model. Don't know the stories behind the other businesses. My lupus doc had me on a gram and a half of calcium for about 20 years for bone health, so personally I'm happy to take a break from it, maybe a mistake.
Just kidding. At the end of the day You have to use your judgement and whilst some here focused on his having a pill to sell, my sense was that that development was borne out of his previous hard effort.
If you've ever been doorstepped by an earnest Christian beseeching you to turn to the Lord then you'll recognise the same thing in Hull!
I imagine the price is a function of low production volumes. I do recall the researchers using ketos (ketosteril) remarking on the high cost too, so it might be they'll never be nickel and dime.
Besides, you can do as my RD suggested and go true very low protein per the literature. O.43gr/kg dietary and only 0.17g/kg to make up with KAs. That'll save a few pills!
"In 25- to 34-year-old patients with end-stage kidney disease, annual mortality is increased 500- to 1000-fold and corresponds to that of the ≈85-year-old general population. Adapted from Foley et al.5"
It's pretty much drumbeat. I constantly come across that statement: cardio gets us before anything else.
And vascular calcifcation is apparently the biggest of the KardioKillerz in the CKD population. So at least its a large target to try to make a dent in (if you'll excuse the mix of methaphor)
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Do I need another opinion?
Do I need to see a specialist?
Do I need a new nephrologist?
Very low protein diet + keto analogues
How do I convince my husband?
