How many times have you heard me suggest a vegan diet as the most effective and sensible dietary intervention for a condition….yup…not often but here I am saying it now.   I had a great one-on-one session with a long-term mentee yesterday to discuss a case of advanced Chronic Kidney Disease (CKD).  Her patient, a 60 something male, has had a GFR < 30 for over 5 years, (I know don’t get me started again, right…Goodness Friends Really!), but was only alerted to this being indicative of severe renal impairment (stage 4 of 5 stages, in fact) in the last 6 months. Pause. Everybody who cares about kidneys, take a deep breath. 

So…what’s been his dietary advice and management to date in response to the NEW (!) recognition that his kidneys are not functionally normally, can not clear wastes – whether that’s nitrogenous wastes from protein, or fluid, hence the diminished urinary output & susceptibility to oedema, or even excess potassium and other nutrients, as well as he should?

Cut down on red meat. 

That’s the advice from his renal specialist & there’s not even a referral to a specialist dietitian.

Now this very experienced naturopath says, “Rachel, I know our general rule of thumb is GFR < 30 means not within our scope of practice, but this guy is not getting any more advice than this.  He wants dietary guidance, he’s scared, he wants to do all that he can to improve his health and he wants me to help him, so what’s the best nutritional advice I can give in such an advanced case of CKD, what do I really need to know to be safe and effective?’ Most of us know the cornerstone of CKD diets is protein restriction: restriction suffice to lower the burden on the kidneys in relation to the nitrogen clearance this necessitates and to lessen the toxic uraemia, but not so restricted that the patient starts to lose weight and breakdown their muscles…and this, depending on a number of factors and the particular research you read, equates to between 0.6-0.8g of protein per kg body weight per day.  Because this constitutes a reduction in protein for many patients, they also emphasise the need to ensure that approx. 50% of the protein is what we call, high biological value (all the aminos in the right amounts) aka animal protein.  But is there a better way?

This fantastic review article by Cupisti et al summarises the nutritional makeup & rationale of various dietary models for advanced CKD and vegan diets have never looked so good! Apart from the reduced but still adequate protein intake that comes with a healthy vegan diet, is the much higher fibre (more positively impacting on your kidney health than you would ever believe!), improved vitamin K levels (given people with CKD most typically actually die of CVD and CKD patients commonly have a deficiency of this vitamin), greatly reduced Potential Renal Acid Load (PRAL) etc. This easy-to-read paper, reminds us that the ‘protein restriction approach’ is a very narrow view of CKD and doesn’t make the most of how diet can positively impact in a tremendous way the speed of progression/deterioration in renal health or its partial recovery.

Good for all of us to know, I think.  Could a vegan diet be best practice for some other conditions as well, for sure…just lettuce all digest arguably the biggest no-brainer one first 😉

Acid base balance is intrinsically linked to renal health – both as a prevention and a treatment – want to learn more about this aspect of your patients’ health & disease?  Not ‘uber’ familiar with Acid Base physiology? Need somewhere easy to start? Try this