Tag: WFPB diet and kidney disease

Kidney Disease & WFPB Part 2

In the last blog 1 we looked at Dr McDougall’s views on diet and kidney disease. This blog will look at what Dr Michael Greger 2 has to say on this important subject.

As we look at the advice Dr Greger gives, we will also dig a little deeper into some recent research studies that complement and expand his observations.

Dr Greger – How not to die from kidney disease

In a 2016 video 3 on this specific topic, Dr Greger explains that it’s perfectly rational to expect a plant-based diet can not only prevent but also treat kidney failure. This is because kidneys are highly vascular organs, and we know that blood vessels throughout the body can be clogged up and impaired by eating the wrong diet. But what is the “wrong” diet?

A 2010 Harvard study 4 looked at how diet influences microalbuminuria 5 and estimated GFR (eGFR) 6 decline in people with well-preserved kidney function. They found that there were three significant dietary risk factors for loss of kidney function:

  • animal protein
  • animal fat
  • cholesterol

The researchers conclude: that “Higher dietary intake of animal fat and two or more servings per week of red meat may increase risk for microalbuminuria. Lower sodium and higher beta-carotene intake may reduce risk for eGFR decline.”

Another earlier study 7 explained how animal fat literally clogs up vessels inside the kidney. The following photos of autopsied kidneys show just how badly clogged up they can get,

A 1998 study 8 showed how animal protein can kick the health out of normal kidney function, leading to hyperfiltration, where the kidneys have to work too hard and eventually can fail completely.

But what about plant protein?

A 1989 study 9 showed clearly that animal protein, even good old tuna fish, can increase pressure on the kidneys within a hours of eating your so-called ‘healthy’ tuna sandwich – and this applies to both non-diabetics and diabetics. The researcher concluded: “Plasma concentrations of alanine, glycine, and arginine [amino acids derived from the animal protein], known to induce glomerular hyperfiltration, increased to a greater degree after ingestion of tuna fish meal than after administration of bean curd. These findings suggest that responses of GFR to acute protein loading may differ according to the amino acid composition of the protein ingested and to the stage of diabetic nephropathy.” And as Dr Greger says: “…we’re not talking adverse effects decades down the road, but literally within hours of it going into our mouth.” 3

The following is a chart from the latter study, showing clearly that tuna protein and soy protein have profoundly different effects on the kidneys.

The composition of amino acids within proteins, and the subtle but important differences between amino acids composition in animal vs plant proteins, are fascinating subjects, and nobody is better qualified to talk about them than Dr T Colin Campbell 10 .

Dr Greger raises no concerns about plant protein being a causal factor in declining kidney function. Indeed he states clearly: “Dealing with plant protein is no problem.” 3

What’s mechanism is involved?

Inflammation is triggered when you eat animal products, and this inflammation causes the kidney overload. We’ve already looked at this in some detail in a previous blog 11 , and it’s a phenomenon already demonstrated in earlier studies, one of which 12 demonstrated that the animal protein caused the inflammation. They achieved this by looking at the inflammatory responses in subjects when they consumed animal products alone, and then when they consumed them with a powerful anti-inflammatory drug. In the former case, there was an inflammatory response; in the latter, none.

So, simple choice: eat your animal products in combination with a powerful anti-inflammatory drug, or eat a plant-based diet.

Then there’s the acid load…

Again, we’ve already looked 13 at the issue of acidity in animal-based diets, but it’s worth re-emphasising that animal protein induces acid formation in the kidneys. A 2014 study 14 demonstrated that animal foods (all meat, eggs, and dairy) cause acid to form within the kidneys and this may then lead to an unpleasant condition called tubular toxicity (damage to the tiny, delicate, urine-making tubes in the kidney). This, in turn, may lead to ATN (acute tubular necrosis) where the tubular epithelial cells that form the renal tubules of the kidneys die. The researchers conclude that: “The findings have important implications, in that, if they are corroborated in other studies, altering diets may provide an adjunct approach to other strategies for treatment of CKD [chronic kidney disease].”

And, indeed, other studies 15 16 have corroborated their findings.

Which animal food is most acid-forming?

You may be surprised to hear that Dr Greger considers fish the worst offender, followed by pork and poultry. Plant foods, of course, are somewhere between neutral and alkaline. A useful chart from his video 3 gives a little more detail:

A 2012 study 17 suggests that the key to slowing or stopping the progression of chronic kidney disease is more likely to be found in a grocery store, than in a pharmacy.

Dr Greger points out that plant-based diets have been used to treat kidney disease for decades. He cites a 1990 study 18 which did an interesting experiment. They took subjects who had declining kidney function and put them on alternating diets – the first, a typical low-sodium diet (LSD) that doctors put CKD patients on and, the second, a standard vegan diet (SVD) to test the protein leakage from the kidneys. The following chart shows that simply changing the diet will turn off or on kidney dysfunction like a light switch:

An additional article 19 on nutritionfacts.org (Dr Greger’s website) makes some other interesting points:

  • to maintain kidney health, avoid the following:
    • toxic metal contamination
    • NeuG5c 20
    • alpha-gal 21
    • advanced glycation end products (AGEs) 22
    • meat (including poultry and processed meat)
    • other animal proteins
    • sugar
    • salt
    • high-fat meals
    • chewing betel nuts 23
    • star fruit 24 25
    • possibly chamomile tea – since nutritionfacts states that its safety for those with CKD has not yet been established. Interestingly, other authorities consider it positively beneficial for those with CKD 26
    • high-temperature cooking may create kidney cancer causing carcinogens 27
    • if you have certain kidney stones, the author on nutritionfacts.org recommends that one should avoid nutritional yeast, turmeric, and beets [I find this one a bit odd since I haven’t yet found research to show that nutritional yeast impairs kidney function; I have found research 28 that actually supports turmeric for improved kidney health; beets, on the other hand, are high in potassium and, as mentioned in Part 1 29 , may well be good to limit in the late stages of CKD.]
  • to maintain kidney health, include the following:
    • stay well hydrated (drink at least ten cups of water per day)
    • consume phytates (found in beans, nuts, seeds, and grains) to reduce kidney stone risk
    • eat a plant-based diet

The article concludes: “Overall, plant-based diets appear to boost kidney health. Plant-based, fiber-rich diets may protect against kidney and other cancers, reduce the risk of childhood prediabetes (which can lead to kidney damage) and diabetes, the top cause of kidney failure. No surprise, then, that plant-based diets can be used to both help prevent and treat kidney failure.” 19

In another more recent 2018 article 30 , Dr Greger expounds on the importance of avoiding an acid-forming diet in order to maintain kidney health:

“Acid-inducing diets are believed to affect the kidney through tubular toxicity, damage to the tiny, delicate, urine-making tubes in the kidney via increased ammonia production. Ammonia is a base, so the kidney creates 31 it to buffer the acid from the food we eat. This is beneficial in the short term to get rid of the acid; however, in the long term, all that extra ammonia in our kidneys day in and day out seems to exert toxic effects.

Our kidney function tends to decline 32 progressively after our 30s, and, by our 80s, our kidney capacity may be down to half. “Perhaps, the so-called age-related decline in renal function is a result of damage induced 33 by ammonia overproduction.” That’s just one theory, though. The acidic pH may increase the production of free radicals and damage the kidney that way, or add to scarring.

Not only is protein derived from plant foods accompanied by antioxidants 34 that can fight the free radicals, but plant protein is 35 also less acid-forming in the first place because it tends to have fewer sulfur-containing amino acids. One of the reasons plant foods tend to be less acid-forming than animal foods is because acid is produced 36 by the sulfur in the protein, and there’s less in plant proteins.”

In Part 3, we’ll look at the thoughts of Dr Dean Ornish’s medical/research team at his Preventive Medicine Research Institute (PMRI).

Joe’s comments

Most of what Dr Greger says is in line with Dr McDougall’s recommendations. Once again, it appears that the take-home message is that a whole food plant-based diet (with no added salt, oil or sugar) is the ideal option for those who want to prevent or do their best to halt the progression of kidney disease.

References

  1. Kidney Disease & WFPB Part 1 [↩]
  2. Dr Michael Greger’s website [↩]
  3. How Not to Die from Kidney Disease. Michael Greger M.D. FACLM October 12th, 2016 Volume 32 [↩] [↩] [↩] [↩]
  4. Lin J, Hu FB, Curhan GC. Associations of diet with albuminuria and kidney function decline. Clin J Am Soc Nephrol. 2010 May;5(5):836-43. [↩]
  5. Definition of microalbuminuria: a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine, in other words, when there is an abnormally high permeability for albumin in the glomerulus of the kidney. [↩]
  6. Definition of eGFR: an abbreviation for estimated glomerular filtration rate. Your eGFR is a number based on your blood test for creatinine, a waste product in your blood. It tells how well your kidneys are working. [↩]
  7. Hartroft WS. Fat emboli in glomerular capillaries of choline-deficient rats and of patients with diabetic glomerulosclerosis. Am J Pathol. 1955 May-Jun;31(3):381-97. [↩]
  8. Soroka N, Silverberg DS, Greemland M, Birk Y, Blum M, Peer G, Iaina A. Comparison of a vegetable-based (soya) and an animal-based low-protein diet in predialysis chronic renal failure patients. Nephron. 1998;79(2):173-80. [↩]
  9. Nakamura H, Takasawa M, Kashara S, Tsuda A, Momotsu T, Ito S, Shibata A. Effects of acute protein loads of different sources on renal function of patients with diabetic nephropathy. Tohoku J Exp Med. 1989 Oct;159(2):153-62. [↩]
  10. Animal vs. Plant Protein. October 29, 2013. By T. Colin Campbell, PhD [↩]
  11. Animal Foods Are The Smoking Gun [↩]
  12. Trevisan R, Valerio A, Avogaro A, Borsato M, Doria A, Semplicini A, Sacerdoti D, Jones S, Bognetti E, et al. Impaired renal response to a meat meal in insulin-dependent diabetes: role of glucagon and prostaglandins. Am J Physiol. 1990 Mar;258(3 Pt 2):F675-83. [↩]
  13. Alkaline Diet – So What?! [↩]
  14. Banerjee T, Crews DC, Wesson DE, Tilea A, Saran R, Rios Burrows N, Williams DE, Powe NR; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team. Dietary acid load and chronic kidney disease among adults in the United States. BMC Nephrol. 2014 Aug 24;15:137. [↩]
  15. Nutrients. 2017 Apr; 9(4): 374. Published online 2017 Apr 10. Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe. Anna Gluba-Brzózka, Beata Franczyk, and Jacek Rysz. [↩]
  16. National Kidney Association: Plant Protein Reduces Mortality in Chronic Kidney Disease Patients [↩]
  17. Uribarri J, Oh MS. The key to halting progression of CKD might be in the produce market, not in the pharmacy. Kidney Int. 2012 Jan;81(1):7-9. [↩]
  18. Barsotti G, Cupisti A, Morelli E, Ciardella F, Giovannetti S. Vegan supplemented diet in nephrotic syndrome. Nephrol Dial Transplant. 1990;5 Suppl 1:75-7. [↩]
  19. Kidney Disease: nutritionfacts.org article [↩] [↩]
  20. Definition of NeuG5c: N-Glycolylneuraminic acid is a sialic acid molecule found in most non-human mammals. Humans cannot synthesize Neu5Gc because the human gene CMAH is irreversibly mutated, though it is found in apes. [↩]
  21. Definition of alpha-gal: Galactose-alpha-1,3-galactose (alpha-gal) is a carbohydrate found in the cells of many mammals that humans eat, such as cows, sheep, and pigs. … People with this allergy may experience mild discomfort after eating meat, or they may have a dangerous reaction that leaves them unable to breathe. Alpha-gal syndrome is a recently identified type of food allergy to red meat. [↩]
  22. Definition of AGEs: Advanced glycation end products (AGEs) are proteins or lipids that become glycated as a result of exposure to sugars. They can be a factor in aging and in the development or worsening of many degenerative diseases, such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s disease. [↩]
  23. Public Health Nutr. 2009 May;12(5):723-7. doi: 10.1017/S1368980008003339. Epub 2008 Jul 23. Association between betel-nut chewing and chronic kidney disease in men. Chou CY, Cheng SY, Liu JH, Cheng WC, Kang IM, Tseng YH, Shih CM, Chen W. [↩]
  24. BMC Res Notes. 2015; 8: 796. Star fruit toxicity: a cause of both acute kidney injury and chronic kidney disease: a report of two cases. R. A. Abeysekera,corresponding author S. Wijetunge, N. Nanayakkara, A. W. M. Wazil, N. V. I. Ratnatunga, T. Jayalath, and A. Medagama. [↩]
  25. National Kidney Foundation: A TO Z HEALTH GUIDE. Why You Should Avoid Eating Starfruit. [↩]
  26. CKD Website: Can You Drink Chamomile Tea If You Have Renal Failure [↩]
  27. Science Daily: Increased meat consumption, especially when cooked at high temperatures, linked to elevated kidney cancer risk [↩]
  28. Molecules. 2014 Dec 2;19(12):20139-56. doi: 10.3390/molecules191220139. Curcumin and chronic kidney disease (CKD): major mode of action through stimulating endogenous intestinal alkaline phosphatase. Ghosh SS1, Gehr TW2, Ghosh S3. [↩]
  29. High potassium vegetables [↩]
  30. Reduce Acid-Forming Proteins to Protect Kidney Function. Written By Michael Greger M.D. FACLM on July 24th, 2018 [↩]
  31. J Nephrol. 2011 Jan-Feb;24(1):11-7. Dietary acid load and rapid progression to end-stage renal disease of diabetic nephropathy in Westernized South Asian people. van den Berg E1, Hospers FA, Navis G, Engberink MF, Brink EJ, Geleijnse JM, van Baak MA, Gans RO, Bakker SJ. [↩]
  32. N Engl J Med. 1982 Sep 9;307(11):652-9. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. Brenner BM, Meyer TW, Hostetter TH. [↩]
  33. Am J Nephrol. 2014;39(2):142-4. doi: 10.1159/000358602. Epub 2014 Feb 7. Is dietary Acid a modifiable risk factor for nephropathy progression? Goraya N1, Wesson DE. [↩]
  34. Am J Kidney Dis. Author manuscript; Am J Kidney Dis. 2013 Aug; 62(2): 267–275. Lifestyle-Related Factors, Obesity, and Incident Microalbuminuria: The CARDIA (Coronary Artery Risk Development in Young Adults) Study. Alex Chang, Linda Van Horn, David R. Jacobs, Jr., Kiang Liu, Paul Muntner, Britt Newsome, David Shoham, Ramon Durazo-Arvizu, Kirsten Bibbins-Domingo, Jared Reis, and Holly Kramer. [↩]
  35. Clin J Am Soc Nephrol. 2011 Jul; 6(7): 1526–1532. Estimated Net Endogenous Acid Production and Serum Bicarbonate in African Americans with Chronic Kidney Disease. Julia J. Scialla, Lawrence J. Appel,Brad C. Astor, Edgar R. Miller, III, Srinivasan Beddhu,§Mark Woodward, Rulan S. Parekh, and Cheryl A.M. Anderson [↩]
  36. Am J Nephrol. 2014;39(2):145-52. doi: 10.1159/000358262. Epub 2014 Feb 11. Dietary acid intake and kidney disease progression in the elderly. Kanda E, Ai M, Kuriyama R, Yoshida M, Shiigai T. [↩]

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?

  1. Dr John McDougall website [↩]
  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. [↩]
  5. Addis T. Glomerular nephritis: diagnosis and treatment. New York: Macmillan, 1948. [↩]
  6. Remuzzi G, Benigni A, Remuzzi A. Mechanisms of progression and regression of renal lesions of chronic nephropathies and diabetes. J Clin Invest. 2006 Feb;116(2):288-96. [↩]
  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 [↩]
  10. Brenner B. Dietary protein intake and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation and intrinsic renal disease. N Engl J Med 307:652, 1982. [↩]
  11. Kennedy G. Effects of old age and over-nutrition on the kidney. Br Med Bull 13:67, 1957. [↩]
  12. Baldwin D. Chronic glomerulonephritis: nonimmunologic mechanisms of progressive
    glomerular damage. Kidney Int 21:109, 1982. [↩]
  13. Kasiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis. 1998 Jun;31(6):954-61. [↩] [↩]
  14. Definition of Glomerular filtration rate: GFR is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute [↩]
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