Part 1: How can I slow the progression of my kidney disease by what I eat?
This post is dedicated to all my warrior patients who live the valiant fight against kidney disease! I am continually inspired by them!
When I was a kid, I used to get Smarties from the bank. I’d always offer a couple to my dad, upon which he invariably would reply, “You are what you eat!!” Of course smarties don’t make you smart, but the message of food being very powerful for our health and well-being has never been stated more concisely in my memory. Of course we have some powerful organs that help us compensate for excesses and even some deficiencies. In addition, the human body is incredibly resilient in surviving and functioning in non-ideal circumstances. But eventually, what we eat and how we live does catch-up to us.
So when it comes to our kidneys, does what we eat really make a difference? The answer is a resounding YES! The purpose of dietary changes with chronic kidney disease (CKD) is to slow progression of the disease and prevent complications. Both are equally important for different reasons. Let’s take a look at how to slow progression. When clients come to talk to me about their diet and kidney disease, slowing progression of the disease, and hopefully avoiding dialysis is almost always their number one priority. We’ll learn how to manage complications from kidney failure in my upcoming post
Dietary recommendations to slow progression of kidney disease
Sodium makes a huge difference when it comes to kidney health. Why? Salt impacts your blood pressure and high blood pressure damages your kidneys. Period. On top of this, and to make it even more difficult, kidneys help control blood pressure so as your kidney failure progress it can become more and more difficult to control your blood pressure, especially if you don’t modify the sodium intake in your diet. There are some people who are actually not salt sensitive and salt does not impact their blood pressure. However, if you have kidney disease you are probably not one of these people. It doesn’t matter if your eGFR is 59 or 2, beginning to become aware of sodium in your diet makes a big difference. Managing sodium is more than just taking the salt shaker off the table or refraining from adding it to your food. In fact, according to the American Heart Association, table salt or salt used in home-cooking is actually only 25% of the total sodium intake that Americans intake a daily basis. The rest comes from processed foods and eating out (1). Most Americans get most of their sodium from eating out and processed foods. This entire post could just be about sodium and strategies to cut back, but you’ll have to wait until my post on sodium comes out in the next couple weeks. In a nutshell, if you eat out a lot, then start cooking at home. If you don’t know how to cook or don’t want to cook, then get a few frozen dinners (Healthy Choice or Lean Cuisine) aiming for <600 mg sodium/meal and then add a salad or other vegetable on the side. If you use a lot of canned foods, switch to fresh or frozen alternatives or look for the “no-salt” varieties. Almost all canned vegetables come in no-salt varieties. Replace chips, cookies, crackers, or other processed snacks with lower potassium fruits or vegetables or low sodium alternatives. For the first couple weeks, your food might seem a little bland but the magic of all of this is that your taste buds adjust! Yep, you can train your taste buds. I’ve tried it for myself and seen dozens of patients do it. After a couple of weeks of cutting back salt, if you go back to eat what you ate before, it will be too salty. Your kidneys will thank you if you can cut back on the sodium. You can make food work for you by cutting back on the sodium!
If you are diabetic and have kidney disease, then carbohydrates matter. If you’re not diabetic, then these probably aren’t going to make as big of a difference as sodium. So, if you have diabetes, learn about carbs, count carbs, and get on a good regimen so you don’t have spikes in your blood sugar. High blood sugar damages your kidneys. In fact, people with diabetes and high blood pressure have a much higher risk of developing kidney disease. So, if you have diabetes, get to know carbs. You can have carbohydrates, but the key is knowing how to count them, knowing how to space them throughout your day, and knowing how to balance with your insulin.
If you’re on insulin, you might be lucky enough to have been given a carb-to-insulin ratio by your doctor (meaning they tell you how much insulin you take for the amount of carbs you eat). If not talk with a specialized dietitian to learn how make carbs work for you not against you!
Protein restriction for slowing kidney disease is a very controversial topic among renal professionals. The research is not entirely conclusive on whether or not a low protein diet makes a difference or not. However, it is generally accepted that normalizing protein intake is a good idea. A normal protein intake means that you should consume about 6-8oz/meat per day. If you think in terms of meat, 3 oz is about the size of a deck of cards, so having a small portion of meat, eggs or fish twice a day is plenty. It isn’t a lot compared to what most Americans typically eat (some studies show as much a 12 oz per day!) I advise my patients to make a couple of their meals during the week “mixed meat” meals such as stir fry or salads. Mixed meat meals are meals that look like they have a lot of meat, but they don’t because it is mixed with other vegetables and proteins (Mixed meat meals handout). I also strongly encourage my patients to start including vegetarian meals a couple times a week. This can sometimes be challenging with a potassium restriction but is completely possible. I also encourage my patients to focus more on white meats versus red meats. So, in a nutshell, protein can work for you by 1) eating smaller portions, 2) consuming more mixed meat meals rather than meat-heavy portions 3) focusing more on plant-based proteins rather than animal proteins. If you are diabetic, cutting back on protein but still maintaining good glucose levels can be challenging. In fact, most research does not recommend significant reductions in protein if you’re diabetic with kidney disease, although normalization of protein intake is still important. Talking with a registered dietitian specialized in kidney disease to make a plan specific for you is very helpful.
I mention anti-inflammatory foods somewhat cautiously as the evidence at this point is not conclusive or even well researched on if this makes a difference . Some rare conditions that cause kidney disease such as Systemic lupus erythematosus (SLE), Goodpasture’s Syndrome, and IgA nephropathy can be somewhat helped by incorporating more anti-inflammatory foods. Again, I state this cautiously, since there is not an enormous amount of evidence to support this statement. I will be writing more on this in a future post, but for the sake of this post, it is safe to say that changing your diet towards a more plant-based diet, considering some anti-inflammatory supplements (turmeric, fish oil, etc…) and possibly getting a mediator release testing (MRT) for food sensitivities from a certified LEAP therapist (CLT) could maybe help and definitely wouldn’t hurt. Like I said, the evidence here is more anecdotal than scientific and I want to write more on this later.
If you want your kidneys to stay stronger longer, cut back on sodium, decrease animal protein in your diet or in the very least normalize it, and if you’re diabetic manage carbohydrate intake. This generally means that people begin to eat more fruit and vegetables, eat at home more, and choose more simple foods and a lot less processed foods. This can be a drastic and difficult change for some and having a professional guide them and be their coach and support is of paramount importance. It is possible though, and I’ve seen many patients make a few changes to cut back on sodium or switch to vegetarian meals with great outcomes with their kidney failure. It is always exciting for them (and me and the doctor) to see their kidney function stabilize. Talking with a registered dietitian, specialized in kidney failure, can also be really helpful for a lot of people as they can help you find foods you like and point you toward specific products. Since we have to eat, we might as well make it work for us not against us and our kidneys. Food is powerful, so let it be your slave not your master.
- Processed Foods: Where is all the salt coming from? The American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Processed-Foods-Where-is-all-that-salt-coming-from_UCM_426950_Article.jsp#.VuodAJwrLIU. Published December 8, 2015. Accessed March 1, 2017.