Kidney Disease & WFPB Part 3

In Parts 1 & 2 we looked at what Dr McDougall 1 and Dr Greger 2 have to say on the subject of CKD (chronic kidney disease) and kidney health in general. Part 3 will consider the thoughts of Dr Dean Ornish’s medical/research team.

Dr Ornish’s Preventive Medicine Research Institute (PMRI) runs a Lifestyle Medicine Program 3 which aims to treat a wide range of chronic diseases by dealing with four areas:

  • diet
  • stress
  • exercise, and
  • social interaction

Dr Ornish is an internationally respected doctor who, along with his team, have published landmark papers 4 on his successes at reversing heart disease and other diseases without the need for medications or invasive surgical procedures but, rather, by simply managing and changing the diets and lifestyles of his patients. But what does the Ornish team have to say about kidney disease?

To answer this, we’ll look at an article 5 written by one of his team of experts, Carra Richling RD 6 .

A comprehensive low-fat, plant-based [diet] can be beneficial in both preserving and improving the function of your kidneys.

What causes kidney disease?

Most common causes:

  • diabetes
  • high blood pressure

other risk factors:

  • family history
  • inherited diseases (e.g. polycystic kidney disease)
  • kidney stones
  • recurrent urinary infections
  • autoimmune disorders
  • inflammatory diseases
  • excess amounts of phosphate (an additive in processed foods)

Plant-based diet and kidney disease

Early detection of CKD is very important in being able to successfully manage the disease most effectively.

Kidney function can be preserved and improved by adopting a low-fat, plant-based approach. A 2015 study 7  considered that: “Plant protein intake is associated with lower production of uremic toxins and lower serum phosphorus levels. Therefore, at a given total protein intake, a higher proportion of dietary protein from plant sources might be associated with lower mortality in chronic kidney disease.”

It’s also important to manage your blood pressure and blood sugars in order to maintain kidney health. [Eating a WFPB diet (with no added salt, oil or sugar) will provide the best dietary means of managing both of these.]

If you have CKD, it’s important to consult your doctor before making any dietary changes, and to work closely with your doctor/medical team by obtaining the necessary biometrics (blood pressure, blood sugar, etc), especially if you have later stages of CKD. [Having said this, there’s a real problem with achieving this when almost all conventional doctors have very little education in nutritional science and, thus, tend to defer to immediate pharmaceutical solutions. The latter often merely treat symptoms rather than the main cause – diet –  and come with their own side-effects8 ]

Phosphorus and Your Kidneys

A phosphate is a salt containing the mineral phosphorus. Phosphorus is found in protein foods (both animal and plant). There’s an important homeostatic balance within the body between calcium and phosphorus 9 . When kidney function declines, phosphorus levels can build up to excess. Calcium deposits can then build up in the kidneys, heart valves, muscles and other parts of the body.  Plant protein does not absorb phosphorus in the same way as animal protein.

A 2011 study 10  confirmed that a vegan diet produced lower phosphorus levels compared with a meat-based diet. Phosphorus in plant foods was shown to be less bioavailable than the phosphorus in animal foods. The positive result of this is that the lower absorption from plant foods limits the phosphorus load on the kidneys, thus reducing the risk of complications caused by excess phosphorus (heart disease, diabetes, and further kidney decline caused by vascular calcification). The researchers concluded that: “…the source of protein has a significant effect on phosphorus homeostasis in patients with CKD. Therefore, dietary counseling of patients with CKD must include information on not only the amount of phosphate but also the source of protein from which the phosphate derives.

A 2010 study 11 revealed that kidney function declines in diets higher in animal protein, animal fat, and cholesterol and kidney function improves with those who followed a plant-based approach.

A 2012 study 12 on the dangers of phosphates in processed foods, came to a rather blunt conclusion: “ In view of the high prevalence of CKD and the potential harm caused by phosphate additives to food, the public should be informed that added phosphate is damaging to health. Furthermore, calls for labeling the content of added phosphate in food are appropriate.

For those with CKD, eating processed foods is not a sensible idea.  Phosphates, which contains phosphorus, are often added to processed foods including dairy, cereals, and soda. Indeed, healthy individuals can quickly end up with CKD by consuming high levels of processed foods.

Phosphates have to be listed on nutrition labels, so it is important to read the ingredients on packaged foods and beverages to look for hidden sources of phosphate (e.g. phosphoric acid and sodium phosphate).  Artificial phosphate is absorbed differently from naturally occurring phosphate (phosphorous) and can contribute to excess amounts in the bloodstream, leading to complications, particularly in people with later stages of CKD.

Limiting Sodium, Potassium, and Phosphorus

It may be that your doctor will recommend that you lower sodium, phosphorus and potassium content in the foods you eat. This will depend, to some extent, on the stage of CKD. Sodium is always going to be less in whole plant foods than in any processed and packaged food. [Cutting out added salt is a good idea for everyone, irrespective of whether or not you have diagnosed CKD. In a previous blog 13 we looked at some great salt alternatives that can be used in your cooking. Ornish Living also provides an article 14 on which spices can be used as effective replacements for salt, as well as providing some healthy and tasty recipes.

It’s useful to become aware of which plant-based foods that are high in phosphorus such as whole grains, bran cereals, wheat germ, beans and dried peas, soy and cocoa. If you have later stage CKD, your doctor or renal dietitian may provide you with specific recommendations for limiting phosphorus, potassium and sodium. You can avoid sodium by cutting out all processed and packaged foods. We looked previously at high 15 and low 16 potassium plant foods.

Some foods low in phosphorus

The USDA Food Composition Databases provide 17  a really comprehensive list of foods by nutrient content. The latter link takes you to a page showing phosphorus, potassium and sodium content in 1000’s of individual foods.

Stage 4 CKD & WFPB diet

Another article 18 worth mentioning is written by one of the Ornish team, Dr Ben Brown, Medical Director of  Ornish Lifestyle Medicine.

The article is entitled “I was Diagnosed with Stage 4 Chronic Kidney Disease. Can Ornish Lifestyle Medicine Help Control CKD?” The answer Dr Brown gives is simple: “yes, most of the time“.

Most chronic diseases, including CKD, have a component to them that can only be treated with changes to your lifestyle.

Most treatments [for CKD] focus on contributing factors (smoking, hypertension, high cholesterol,diabetes, etc). Treating these risk factors with medicines alone, however, does not generally stop the progression of the disease. It just slows it down. There are other factors that lifestyle is more effective at treating than medications. These include systemic inflammation and poor nutritional states.

In all stages of CKD the degree of reversibility with lifestyle changes depends on two factors:

  1. the main cause of the kidney disease
  2. the degree of scarring that’s already occurred

Both of these can be measured by decreased renal function (increased BUN and creatinine) and leaking of protein (albuminuria or proteinuria).

Understanding scarring of the kidneys

If pressure, inflammation and sugar damage on the tiny vessels within the kidneys goes on long enough, the blood supply to the individual kidney cell stops, the cell stops functioning, dies and creates a small scar.

Changes related to scarring are more difficult to reverse than the changes related to inflammation.

What about stage 4 CKD?

Stage 4 kidney disease is a later stage of kidney disease. Patients in this stage are usually referred to a nephrologist and will likely be discussing the probability of dialysis or renal transplantation in the future. Patients with Stage 4 CKD often also have heart disease and other conditions. That is because the same root causes of CKD are lifestyle choices (lack of exercise, poor diets, high stress, smoking) that also contribute to heart disease and other conditions.

If you have a large amount of inflammation, high blood pressure and high blood sugar, and only moderate scarring, when you adopt Ornish Lifestyle Medicine and address the root cause of the problem, your kidneys will get better. There are many reasons why Ornish Lifestyle Medicine works.” He continues to list a few of these:

  • plant protein is easier on the kidneys than animal protein (ideally, this means opting for a WFPB diet)
  • exercise is helpful for people with all stages of CKD
  • social support is important in CKD (for instance, organised group support)
  • stress management helps to improve health

The combined changes in your health can help to heal the kidneys as well as the heart. These include:

  • lowering blood pressure
  • decreasing blood sugar
  • losing weight
  • decreasing inflammation
  • improving symptoms of depression
  • . Together, these changes all help to heal changes to the kidneys as well as the heart.

We routinely see participants with stage 1-3 CKD (And often with stage IV CKD) who are following the four elements of Ornish Lifestyle Medicine, improve their conditions in as short as nine weeks. Though this is common, it is not universal in stage IV. Some cases take longer, and in others, there is just too much scarring to reverse the disease or a different set of root causes for it.

Dr Brown also recommends a low salt diet (which is naturally achieved through eating whole plant foods with no added salt). He also says it’s worth considering probiotics, and anti-inflammatory herbs such as curcumin (in turmeric) and boswellia.

They will also likely recommend a low salt diet. There may be additional benefits of a pure vegan diet, meaning no egg whites or dairy. And other supplements worth considering are probiotics, and anti-inflammatory herbs including curcumin and boswellia 19 .

Joe’s comments

I have no experience of boswellia, but do know that there are huge benefits in taking turmeric on a daily basis, as covered in detail by an earlier blog 20 . If you have certain types of kidney stones, it was recommended in the Part 2 2 that you should consider avoiding turmeric, although, as indicated, there’s some uncertainty about whether this is actually necessary in general cases of CKD.

The consensus from all the medical sources we’ve looked at in Parts 1-3 of this short series is that animal foods and  processed foods should be avoided. The issue of potassium and phosphorus content is something that I think is still somewhat unresolved. There doesn’t appear to be sufficient research data on the effects of consuming naturally-occurring potassium and phosphorus in plant foods when the only foods consumed at whole plant foods  – without the added salt, oils and sugar within the processed or home-prepared foods that we unfortunately see in many vegan diets.

In his book “Whole” 21  Dr T Colin Campbell stresses the incredible complexity of the billions of rapid interactions that take place within the human body. It would, therefore, seem rational to assume that testing the effects of individual foods on a person’s health might produce somewhat different results if the subject was eating the standard Western highly processed, animal-based diet as opposed to a WFPB diet without any added salt, oil or sugar. We’ll have to wait for the research data to appear in order to draw ultimate conclusions on this matter…


References

  1. Kidney Disease & WFPB Part 1 []
  2. Kidney Disease & WFPB Part 2 [] []
  3. Ornish Lifestyle Medicine Program []
  4. Dr Dean Ornish:  Research Highlights []
  5. Ornish Living: Improving Chronic Kidney Disease with a Plant-Based Lifestyle
    by Carra Richling []
  6. Carra Richling and the rest of the Ornish team []
  7. Am J Kidney Dis. 2016 Mar;67(3):423-30. doi: 10.1053/j.ajkd.2015.10.018. Epub 2015 Dec 10. The Associations of Plant Protein Intake With All-Cause Mortality in CKD. Chen X, Wei G, Jalili T, Metos J, Giri A, Cho ME, Boucher R, Greene T, Beddhu S. []
  8. WebMD: What Meds Might Hurt My Kidneys? []
  9. Calcium and Phosphate Homeostasis. Joseph L Shaker, MD and Leonard Deftos, M.D. []
  10. Clin J Am Soc Nephrol. 2011 Feb;6(2):257-64. doi: 10.2215/CJN.05040610. Epub 2010 Dec 23.
    Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease.
    Moe SM1, Zidehsarai MP, Chambers MA, Jackman LA, Radcliffe JS, Trevino LL, Donahue SE, Asplin JR. []
  11. Clin J Am Soc Nephrol. 2010 May; 5(5): 836–843. Associations of Diet with Albuminuria and Kidney Function Decline. Julie Lin, Frank B. Hu, and Gary C. Curhan []
  12. Dtsch Arztebl Int. 2012 Jan;109(4):49-55. doi: 10.3238/arztebl.2012.0049. Epub 2012 Jan 27.
    Phosphate additives in food–a health risk. Ritz E1, Hahn K, Ketteler M, Kuhlmann MK, Mann J. []
  13. How to Get Flavour Without Adding Salt []
  14. Spice It Up: It’s Good For You!
    by Carra Richling []
  15. High Potassium Fruits and Veg []
  16. Low Potassium Fruits and Veg []
  17. United States Department of Agriculture. Agricultural Research Service. USDA Food Composition Databases []
  18. Ornish Living Magazine. I was Diagnosed with Stage 4 Chronic Kidney Disease. Can Ornish Lifestyle Medicine Help Control CKD? by Ben Brown, MD []
  19. Wikipedia: Boswellia. []
  20. Turmeric Proven To Fight Cancer & Diabetes []
  21. Whole: Rethinking the Science of Nutrition by Dr T Colin Campbell and Howard Jacobson []

Kidney Disease & WFPB Part 1

One of the principal reasons why kidneys start to lose their functionality and can eventually start to fail is because of the consumption of excessive protein – animal protein. So, you’d think that a whole food plant-based diet would be the ideal assumption. But does the research back this up? And what are the opinions of the renowned medical experts in this field? Best find out…

We’ll look at some of the research in this area as we hear the opinions (some quotes and some summaries) of some eminent physicians who emphasise the importance of diet in the prevention and treatment of disease. In Part 1, we’ll take a look at what Dr John McDougall 1 has to say on the matter.

Dr McDougall – starch-based diets for kidney health

The kidneys are vital organs that filter the blood. One of the primary wastes is dietary protein. Excess protein increases the wear and tear on the kidneys’ filtering units. By following the high-protein Western diet over seventy years, people lose on average a third of their kidney function, although this is usually inconsequential due to the organ’s reserve capacity (people can function normally after removal of one entire kidney, after all). The damage from excess protein becomes critical when kidney tissues have been previously lost for other reasons, such as injury, donation, diabetes, atherosclerosis, and nephritis. With reduced kidney function, the amount of protein commonly consumed on the Western diet can result in progressive kidney failure, dialysis, and transplant. A simple, highly effective way to preserve kidney function is to reduce the workload on them by eating a diet with a minimal amount of excess protein, and this is best accomplished with a starch-based diet. Medications commonly recommended to “protect” the kidneys are of limited benefit with serious side effects and costs. They should only be prescribed as a medical treatment of last resort…”

Typically a patient discovers his or her kidneys are failing by a routine laboratory blood test called a serum creatinine, which indirectly measures kidney function. (Normal creatinine depends on a person’s age and in older adults is 1.2 mg/dL or less.) Once a problem is discovered, the doctor will try to slow the progression of this disease with medications intended to treat high blood pressure, diabetes, high cholesterol, and/or the use of anti-angiotensin medications.  Little or no attention is given to what the patient eats, because primary and ongoing medical training never covers profit-free diet therapy

Diet becomes a topic for discussion only after the kidneys have been almost completely lost, a condition called end-stage kidney disease —a stage of pre-dialysis.  Now the powerful kidney-saving benefits from a healthy diet are of very limited value. At this time a referral is made to a kidney specialist, a nephrologist, and a renal dietitian.  They will mention a low protein diet.  But, because most of these professionals do not believe patients will follow such a diet, and because they themselves do not have real training and experience with this simple approach, no meaningful change is accomplished.  After this cursory discussion of diet, the very sick patient is shuffled off on a tour of the dialysis ward – where he will soon be attached to machines for several hours a day, three or more days a week.” 2

Dr McDougall refers to a 1997 study 3 which found that patients with failing kidneys who opt for a low-protein diet would reduce the progression of their kidney disease and death on average by 33% to 50%. The researchers concluded that there is: “…a persuasive argument to restrict dietary protein intake in order to minimize complications of renal failure while preserving nutritional status.” And their research indicates that many individuals will thereby be saved having to ever go on dialysis. Additionally, this same diet will improve their overall health and feelings of well-being, eliminating uremic symptoms 4 as well as allow patients with kidney disease who are on multiple medications (e.g. for high blood pressure, diabetes) to reduce the number of medications they take.

Research even further back in time, namely Thomas Addis‘s landmark treatise in 1948 5 , argued that protein-restriction (which happens pretty naturally in a wholefood plant-based diet) was effective in minimising further loss of kidney function in patients suffering from chronic kidney insufficiency.

But can kidney disease be reversed in some cases? A 2006 study6 is not only useful to read for those who wish to understand more about the mechanisms involved in the progression of kidney disease, but they refer to evidence that kidney disease (specifically glomerular sclerosis 7 can indeed be reversed, partly through the adoption of a low-protein and low-sodium diet.

Taking just the above research into account, Dr McDougall states: “… for the past sixty years doctors and patients should have known that the primary focus of attention for the preservation of the kidneys should be diet.” 2

We’ve already seen 8 that if we eat enough plant food, we will get enough protein – easily between 10% and 12% of calories. The human body actually needs no more than 5% 9  of the calories consumed to be from protein in order to build all cell structures, enzymes and hormones; once these needs are met then the excess must be excreted from the body, and that’s a problem for the kidneys. The typical Western diet, focused as it is on meat, poultry, eggs, dairy and highly processed foods is packed full of protein: 35% or even more protein content within the total calories consumed.

When all this excess protein is eliminated, the blood flow and filtration rates of the kidney tissues (called nephrons) increase, which in turn, causes a condition known as “intra-glomerular hypertension.” 10 . The progressive damage sustained hypertension in the glomeruli causes is most important and apparent in those people who have pre-existing kidney loss from conditions such as donation of a kidney, physical injury, diabetes, atherosclerosis, hypertension, and polycystic kidneys.  The excess protein accelerates the loss of kidney tissue to the point of end stage kidney disease..

Even in individuals who have not been diagnosed with kidney disease, the kidneys are “overworked” by the burden of excess protein in the typical Western diet. Studies 11 12 have shown that as much as 25-50% of functional kidney capacity is destroyed after 7 to 8 decades of eating the typical protein-rich diet.

A 1998 analysis 13 of multiple studies using a low-protein diet for people with kidney disease has found that glomerular filtration rate (GFR) 14 , which will tend to decrease as time passes, decreases by 0.53 mL/min less each year for those on a low protein diet compared with those who follow the usual diet.

A 1989 study 15 looked at people with chronic glomerulonephritis16 and concluded that: “…a vegetarian diet seems to be superior to a meat-containing diet. Thus we conclude that there are sufficient data from the literature to suggest that a low protein diet delays the progression of chronic renal failure.”

People with other forms of kidney disease, including those with polycystic kidney disease 17 , have shown remarkable benefits from being on a low-protein diet. 15 The amount of protein in the urine (proteinuria), which is considered an important sign of kidney health, has also been shown 13 to be greatly reduced by this side-effect-free form of natural dietary “therapy”.

Animal vs plant protein for kidney health

For many years, studies 18 19 20 have clearly shown that proteins from plants are much healthier for the kidneys and can slow down the progression of kidney disease more effectively than animal proteins. Consuming wholefood plants provides the perfect balance of macro- and micro-nutrients. However, eating processed plant foods that contain unnaturally high levels of protein can still be damaging to anyone’s kidneys. The authors of the latter 2007 study 20 concluded: “…long-term consumption of high protein diets composed of either predominately animal or vegetable protein, by persons with normal kidney function may cause kidney injury and both animal and vegetable protein accelerates the progression of chronic kidney disease.” But, to repeat, there’s no worry at all about eating too much protein if you eat a diet consisting of whole plant foods – not extracted protein in such things as protein powders or processed ready meals.

When Dr McDougall wrote the article (July 2007) on which the information thus far is largely based, there was already plenty of research 21 22 23 24 25  showing the benefits of a vegan diet (which, by merely removing all animal  foods, can generally be far from the optimal WFPB diet) for preventing and treating failing kidneys.

Concentrated soy protein products and kidney disease

Following on from a gentle warning above about extracted plant proteins also being potentially harmful for the kidneys, Dr McDougall has very strong views on the “kidney toxic protein” contained in isolated soy proteins such as “Vegetarian” burgers, hot dogs, luncheon meats, sausages, candy bars, shakes, and cheeses. He calls these “fake foods“, partly because they are an “unbalanced hodge-podge of ingredients” and are usually deficient in natural dietary fibres, carbohydrates, vitamins, minerals and other phytochemicals.  Isolated soy protein can cause large quantities of calcium to be lost from the body. The result of this has been shown 26 27 to be potential bone loss and kidney stones. In addition, and rather worryingly for those who think that eating these “fake foods” are doing them good, these isolated proteins also appear to dramatically increase the production of the growth hormone IGF-1 28 , something which is proven 29 to promote cancer growth.

As is usual, the picture is not black and white in relation to soy protein, since studies have shown that soy proteins have some positive effects on kidney function. However, eaten regularly in relatively large amounts, they also provide this huge excess of protein which contributes to uremia and, therefore, has to be eliminated by the kidneys.  Dr McDougall’s conclusion on this topic is that these isolated soy protein foods “…should be strictly avoided by anyone with failing kidneys.

Dr McDougall on “How to Save the Kidneys”

A low-protein, starch-based diet, such as the McDougall Diet 30 “…should be vigorously followed to reverse conditions of hypertension, type-2 diabetes, and atherosclerosis, all of which, in their own right, lead to kidney damage. Even people who believe they are in good health need to heed this advice.”

His advice for those with clear evidence of failing kidneys is that they should should restrict their diet even further: “…the avoidance of high protein vegetable foods, especially the legumes (beans, peas, and lentils).  Green and yellow vegetables and mushrooms are also high in protein, but the absolute amount consumed is usually small, so their consequences are few. Fruits and fruit juices are low in protein and can be used more liberally, as plentiful sources of calories…The dietary protein intake can be further reduced by adding simple sugars like table sugars, honey and molasses—which are essentially protein-free.

When a person is heading towards the final stages of kidney disease, he suggests that “…caution must be taken to avoid the buildup of potassium in the body, which can be fatal.  Fruits and vegetables are high in potassium and contribute to this problem, especially when less than 10% of the kidney function remains.  Careful monitoring and changes in diet to include lower potassium fruits and grain products (avoiding green and yellow vegetables and potatoes, for example) will be necessary.  Effective dialysis also corrects potassium build-up.

High Potassium Fruits and vegetables

High-potassium fruits:

  • apricots
  • bananas
  • cantaloupe
  • dried fruit
  • honeydew melon
  • kiwi
  • mango
  • nectarines
  • oranges and orange juice
  • papaya
  • pomegranate and pomegranate juice
  • prunes and prune juices
  • pumpkin
  • raisins

High Potassium vegetables:

  • acorn squash, butternut squash, Hubbard squash
  • avocado
  • artichoke
  • beets
  • baked beans, black beans, refried beans
  • broccoli (cooked)
  • Brussels sprouts
  • kohlrabi
  • lentils
  • okra
  • onions (fried)
  • parsnips
  • potatoes (white and sweet)
  • swede (rutabaga)
  • spinach (cooked)
  • tomatoes, tomato sauce, and tomato paste
  • vegetable juice
Low potassium fruits and vegetables

Low-potassium fruits:

  • apples (plus apple juice and apple sauce)
  • blackberries
  • blueberries
  • cranberries
  • fruit cocktail
  • grapes and grape juice
  • grapefruit
  • mandarin oranges
  • peaches
  • pears
  • pineapple and pineapple juice
  • plums
  • raspberries
  • strawberries
  • tangerine
  • watermelon

Low-potassium vegetables:

  • alfalfa sprouts
  • asparagus (6 raw spears)
  • broccoli (raw or cooked from frozen)
  • cabbage
  • carrots (cooked)
  • cauliflower
  • celery (1 stalk)
  • corn (half an ear if it’s on the cob)
  • cucumber
  • aubergine/eggplant
  • green beans or wax beans
  • kale
  • lettuce
  • white mushrooms (raw)
  • onions
  • parsley
  • peas (green)
  • peppers
  • radish
  • water chestnuts
  • watercress
  • yellow squash and zucchini 31

Joe’s comments

The foregoing seems to suggest that it’s a good idea for all of us to cut out all animal foods in the first instance. Then, we would do well to cut out all the processed “fake foods”, like the soy burgers and tofu sausages. Next, eat a balanced wholefood plant-based diet. If, however, an individual is already diagnosed with kidney disease, Dr McDougall makes it clear that there are groups of plant foods that are best avoided or, perhaps at least, reduced in proportion compared with others (see lists above).

As with all diseases, there’s rarely just one system or organ within the body affected by poor diet. It’s often the case that those who succumb to chronic kidney disease  (and it’s now reported 32 that one in three Americans is at at risk of CKD) have already experienced one or several other diseases – such as obesity, diabetes, atherosclerosis, CVD, hypertension, hypercholesterolemia, etc. But the great news is that a WFPB diet can benefit all these conditions at the same time – preventing, slowing and even reversing in many cases. And this would be dealing with the causes of the disease/s and not just the symptoms as is mostly the case with pharmaceutical or surgical alternatives.

In Part 2, we will look at Dr Greger’s views on the causes and treatments for kidney disease.

When is the best time to look after your kidneys?

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  2. Dr John McDougall: Kidney Disease article [] []
  3. Annu Rev Nutr. 1997;17:435-55. Role of nutrition in prevention of the progression of renal disease. Maroni BJ1, Mitch WE. []
  4. Uremic symptoms: Uremia is a condition resulting from advanced stages of kidney failure in which urea and other wastes build up in the body. Early signs of uremia are lethargy, mental depression, loss of appetite, and oedema; later, diarrhoea, anemia, convulsions, and coma. []
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  7. Definition of glomerular sclerosis (GS) : GS is hardening of the glomeruli in the kidney. It is a general term to describe scarring of the kidneys’ tiny blood vessels, the glomeruli, the functional units in the kidney that filter urine from the blood. []
  8. Eat Enough Food & You Eat Enough Protein []
  9. Dr. Campbell’s recommendations for Dietary Guidelines. May 4, 2015. By T. Colin Campbell, PhD []
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  24. Wiseman MJ, Hunt R, Goodwin A, Gross JL, Keen H, Viberti GC. Dietary composition and renal function in healthy subjects. Nephron. 1987;46(1):37-42. []
  25. Barsotti G, Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S. A low-nitrogen low-phosphorus Vegan diet for patients with chronic renal failure. Nephron. 1996;74(2):390-4. []
  26. Spence LA, Lipscomb ER, Cadogan J, Martin B, Wastney ME, Peacock M, Weaver CM. The effect of soy protein and soy isoflavones on calcium metabolism in postmenopausal women: a randomized crossover study. Am J Clin Nutr. 2005 Apr;81(4):916-22. []
  27. Roughead ZK, Hunt JR, Johnson LK, Badger TM, Lykken GI. Controlled substitution of soy protein for meat protein: effects on calcium retention, bone, and cardiovascular health indices in postmenopausal women. J Clin Endocrinol Metab. 2005 Jan;90(1):181-9. []
  28. Definition of IGF1 []
  29. Arjmandi BH, Khalil DA, Smith BJ, Lucas EA, Juma S, Payton ME, Wild RA. Soy protein has a greater effect on bone in postmenopausal women not on hormone replacement therapy, as evidenced by reducing bone resorption and urinary calcium excretion. J Clin Endocrinol Metab. 2003 Mar;88(3):1048-54. []
  30. The McDougall Diet []
  31. Low-Potassium Diet: What to Know. WebMD []
  32. National Kidney Foundation: KIDNEY DISEASE: THE BASICS. []