Low protein diets were discovered to help CKD and to postpone kidney failure as far back as the 19th century. Now it seems to be touted as a new approach.
I found the article interesting. I was looking up diets to increase my protein since it's below normal on my last bloodwork and came across this article. I guess google cookies put CKD into a lot of my searches whether I want it or not LOL
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Thanks for link. Btw whatever happened to "Ketoanalogs man" Skeptix?
Just back from a break from thinking about kidneys. I actually had turkey & ham for Christmas dinner (and a dinner or two beyond that) such was that break. It was delicious. But back on the grind again and looking at a vegan curry recipe book as I write.
And it's ketoacidanalogs-man to you 
EVERYbody's been asking about you and wondering where you've been. Welcome back!!!!
Cheers bud. I think I OD'd a bit on kidneys to be honest - to the point where I was dreaming of papers I'd read.
A few days ago I was reading an article in the paper about Afghans and the trade in illicit kidney transplant (they get $1,000 for a kidney and awful medical treatment). Pictures of them hoicking their shirts and showing these huge scars from the kidney removal. What a world.
But anyway, it prompted me into re-focusing on my own..
The VLPD sounds all well and good, but I think it's vastly oversimplified. The major concern on these diets is protein-energy (muscle) wasting. If you don't compensate for your desired muscle mass and related activity, you could end up worse than when you started. I don't want to lose muscle mass, and if I work out, I need to increase my protein intake accordingly.
The sVLPD is a pain in the arse. There's protein in just about everything (you find out pretty quick) and keeping levels down really takes a push. I gather the whole point of the ketoacidanalogues is to compensate directly for the reduced protein intake. I gather (and this is simplified) that protein is broken down into useful components (amino acids) and waste produce which the kidneys rid you off. KAA's are simply the useful component minus the waste. So muscle wasting won't happen since you're getting all you need from your dietary protein + KAA supplement.
I was doing Lee Hull's 0.4g/kg plant dietary and 0.4g/kg KAA giving a total of 0.8g/kg body weight - which is considered the normal low end protein intake. My renal dietician (who see's me as something of a guinea pig) pointed out that the science points to a 0.63gr/kg overall intake. And so, I've dropped some KAA's from the budget for the moment. Which saves money.
What the situation is in working out I don't know but I imagine that it's a matter of taking on board more KAA's if wanting to limit dietary protein intake.
Chief question, I suppose, is whether you're body is handling the waste products of your dietary protein intake. Urea for example. My urea was 12.2 (max range 8.6) pre sVLPD diet and it dropped to 6.1 in a few months. It's all too soon to tell as one result doesn't make a summer, but I sure prefer stuff being in range than out of.
Interesting. I thought the purpose of KAA supplementation is to compensate for the lack of certain aminos that you don't get enough of in a vegan diet, especially lysine. But getting back to my original comment, if you're breaking down more muscle as a result of resistance training, and you don't compensate by increasing protein intake, you start catabolizing what your pre-existing muscle mass, thus increasing the waste products that your kidneys have to remove. Perhaps I'm missing something.
The KAA's do give amino acids you don't get from veg. But they also supplement for the overall lower intake of amino acids due to low protein diet. Would they, if all they are, effectively, is protein without the waste, not do just as protein does?
Bear in mind the only muscles I enjoy building up is my typing fingers!
I would think so. I imagine you could live on KAA supplementation and no other protein source. It's the protein "waste" that accompanies regular protein sources that has me a bit confused. If, for instance, a 3.5 oz portion of salmon (about 100 gm) contains 20 gm of protein, is the other 80 gm the "waste" that needs to be removed? If so, does that mean it's better for your kidneys to see only KAA's than animal or dairy-based protein? Is this the basis for ckd patients going vegan and supplementing? As you correctly point out, protein is in everything, including veggies. Should folks be massively upping their fat and sugar intake to compensate for the usual caloric deficit in a vegan diet? 
As opposed to most, I don't need nor want to lose any weight.
That 20gr of protein from the 100gr of salmon is the nitrogen waste-containing element. It (the 20grs of protein) is broken down by your body into amino acids + nitrogen based waste ( e.g. urea, creatinine).
It would be the exact same if you ate 100gr of plant that contained 20gr protein - say something protein-heavy like Quorn. You'd produce nitrogen waste there too (in and around the same amount as with the salmon, let's say).
So, from a nitrogen waste point of view, it doesn't matter whether it's meat or plant based protein. To reduce the waste you have to limit the protein intake, period. And because you have to reduce protein intake (to reduce the quantity of waste that ends up floating around in your blood cos your kidneys can't remove it) you need to get your amino acids from somewhere else than protein.
Enter KAA's: a waste-free amino acid source
Why plant over meat? I've heard folk say that meat protein is "hard" on the kidneys. Even my neff said to avoid red meat. I don't know about the mechanisms of meat protein being harder on your kidneys that plant protein but I do know this...
The prime reason to avoid meat (and high protein plant like Quorn) is that it contains huge amounts of protein for the calories and nutrients you're getting from it.
Consider: if you were on a protein restricted diet (say 0.4gr/kg body weight dietary protein, the rest of your amino acid intake being KAA's) then that snack-like 100gr of salmon/Quornburger is going to use up the bulk of your days protein budget in one sitting! 20gr of dietary protein from my 28gr daily dietary protein budget used up for a few bits of meat/Quorn!!
There would be no way for me to get all the calories and nutrients I need for that day without going over protein budget - since nigh on everything else I eat: coffee, a slice of bread, a biscuit, veg, nuts, fruit .. contains protein.
Bread is another bogey: huge amounts of protein in it for virtually nothing by way of nutrients or calories. One thin slice of supermarket brown bread contains 5 grammes of protein!! That's 1/3th of my daily dietary protein budget gone if I make a 2 slice sandwich!! And so I eat this "cardboard" bread from the "free from" aisle in the supermarket that only has a gramme of protein per a slice. It does okay toasted. Cardboard, but toasted cardboard.
Eating meat/bread/Quorn is spending your money on an iphone 13 when you haven't yet paid your rent.
Great explanation. What's your approximate daily caloric intake if I may ask? Is it enough? Are you trying to maintain, gain, or lose weight?
B.K. (before kidneys), I paid no attention to diet, other than eat reasonably good food. I tended not to eat enough (I'd skip breakfast or have a slice of toast) and maybe even skip lunch. So weight wasn't an issue.
Since attending to diet I read up what I ought to be eating and it's 2100 calories a day. In a few months I've put on a kg (up to 65 from 64) and that's about the size of it. Its hard to get those calories on board though - my protein budget gets typically maxed out at about 1900 calories. I get sick of eating an apple or a few spoonfuls of honey to get some low-protein calories in..
There's probably more I could do to check out the foods that will give the optimal result but I spend enough time on this little pair of organs.
Roll on pig-transplants I say!
Thanks for sharing this good article. Its amazing how some of the old remedies become the latest treatment ideas. Warm regards
Interesting that the new tech (dialysis) caused the old tech to be dropped off. Also interesting that there was money to be made in the new tech and none in the old tech (a.k.a. diet)
This is significant ... and somewhat concerning . From your linked paper
"The residual nephrons in the attempt to maintain neutral body balances increase the solutes excretion by activating some compensative mechanisms (i.e. the so called “Trade-off hypothesis”) which, however, are detrimental for the kidney and the whole body. Hence, during the progressive CKD the renal adaptations allow maintaining the balance of major body solutes, but also contribute to the negative progression of renal damage toward the end-stage renal disease."
In other words (if I'm reading this right): Just because a particular "solute" is in range in your bloods doesn't mean that all is well with that aspect of your kidneys which deals with that solute.
For example: all of us CKD-ers will have elevated creatinine - but are we holding that creatinine level at a falsely low level (even if that elevated) because of these renal (mal)adaptions??
What about those of us (indeed, a good few of us) that haven't got elevated urea or phosphate (I had elevated urea but phosphate was okay.)? Is my phosphate in range only because my kidneys are maladaptively maintaining phosphate levels in check - all the while damaging themselves in their maintaining things so?
The (my) solution to elevated urea was to alter diet (cut protein). But do I now need to control other dietary intakes even though serum readings are okay? Feck!
(NB: I asked kidneyRD.com (when I had my free phone consultation) whether there was a need to diet for things which were in range in the blood (e.g. potassium) and they said no. Lee Hull, when asked the same thing, was equivocal and merely said to "follow my diet suggestion"
It would seem, from this paper, that there is something needing clarification here. Are my kidneys acting maladaptively and if so, how do I stop that via diet?
I have not read the whole article yet but a couple of observations you may find interesting. When I was at stage 4 with about 18% egfr I asked my nephrologist about diet changes including low protein and he said it would not make any difference at all. But as I got close to the point of starting dialysis and my egfr reached about 8% I decided to go vegan as a last ditch attempt to delay dialysis. After a couple of weeks my BUN fell by over 50% from 19 mmol/l to 9 mmol/l which was actually lower than when I was first diagnosed with CKD four years earlier. Phosphate also dropped by a similar percentage as did potassium. Nearly all my bloods were better than when I was fist diagnosed. Even my PTH was down by 20%. So yes I am pretty convinced that starting a low protein diet earlier would have delayed dialysis at least for me. Now how long such a diet could be maintained is a different story. My remaining kidney function was too low to risk carrying on delaying dialysis so I started it and resumed my previous meat eating lifestyle.
Logical question (although by the sounds of your nephrologist, not one worth asking them, except for sport maybe).
"IF dialysis is a mechanical way to remove toxic waste from my blood
AND diet is a way in which I can prevent toxic waste being dumped into my blood
THEN it would seem to make sense to remain on the toxic waste limited diet
AND SO reduce the level of dialysis I need"
As far as I can gather, dialysis isn't exactly a bed of roses and it tends to detract from your lifespan. Would it not be the case that you'd be better off reducing the amount of dialysis you need. Even at the cost of delicious meat!
Thanks for posting. I'm on a low protein and a low fat diet most of the time. I think it's the way to go. The need for so much protein in meat is overblown.
I should have added interesting article
I Had to go on a low protein diet because of my kidney disease and I am prone to getgout. I have been off any meat for 10 years and the last five years I stop eating veggies
and beans that are high in purine. veggies like PEAS, AND ASPARAGUS and also legumes like lentils.
So, what do you eat to get protein? thx.
Hello Everyone, I was eating only beans, nut butter, rice, millet bread, fruits, vegetables mainly and I really wasn't feeling good. I had really low energy and was fatigued. I added back about 2 oz of chicken or fish a day and I'm feeling a lot better. Maybe I just wasn't getting enough plant protein. But, has anyone else felt low energy on plant based?
Also I think I saw a study somewhere that end stage renal disease patients who went plant based low protein were able to delay dialysis for 1 year. I wonder how many years it gives us when we start earlier? It may not have been studied yet...
Protein in urine
Liquid amino acids
amount of protein allowed daily?
Daily requirement of Protein
Successful diet to manage CKD
