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A Plant-Based Diet Prevents and Treats Chronic Kidney Disease

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A Plant-Based Diet Prevents and Treats Chronic Kidney Disease Review Article JOJ uro & nephron Volume 6 Issue 3 - January 2019 Copyright © All rights are reserved by Stewart D Rose DOI: 10.19080/JOJUN.2019.06.555687 A Plant-Based Diet Prevents and Treats Chronic Kidney Disease Stewart D Rose* and Amanda J Strombom Plant-based diets in Medicine, USA Submission: January 03, 2019; Published: January 23, 2019 *Corresponding author: Stewart D Rose , Plant-Based Diets in Medicine, 12819 SE 38th St, #427, Bellevue, WA 98006, Washington, USA. Abstract (CKD) is now the 8th leading cause of death in the United States and its treatment consumes substantial amounts of medical resources and money. Interest in the dietary treatment of chronic kidney disease has been growing as its incidence has been increasing. Chronic Kidney Disease increased risk among omnivores, especially those who eat red and processed meats. Although the practice started long ago, research on the use Several lines of epidemiological research have shown a lower risk of chronic kidney disease among vegetarians. It also shows a substantially vegetarianof a low-protein diet, oftenplant-based supplemented diet to treat with chronic keto analogues, kidney disease has been diet shownhas intensified to reduce in acidosis,recent years. phosphotemia, This research uremia, has shown proteinuria that a andlow-protein to slow progression.vegetarian diet Research is safe showsand efficacious that this treatmentat both treating does not and result slowing in malnutrition. the progression Research of chronic has also kidney shown disease. that larger Treatment amounts with of aplant low-protein protein preventing and treating common comorbidities such as type 2 diabetes and coronary artery disease. than animal protein can be consumed, without deleterious effects. Treatment with a low protein vegetarian diet also has the advantage of Keywords: Acidosis; Chronic kidney disease; Keto Analogues; Kidney disease; Phosphotemia; Plant-Based diet; Proteinuria; Uremia; Vegetarian; Vegan Abbrevations: AGE: Advanced Glycation End Product; CKD: Chronic Kidney Disease; DAL: Dietary Acid Load; DM: Diabetes Mellitus; ESRD: End Stage Renal Disease; FGF 23: Fibroblast Growth Factor 23; GFR: Glomerular Filtration Rate; HD: Hemodialysis; KD -Keto Diet; LPD: Low Protein Diet; PCB: Polychlorinated Biphenyl; PCDF: Polychlorinated Dibenzofuran; PCDD: Polychlorinated Dibenzo-P-dioxin; POP: Persistent Organic Pollutant RPF: Renal Plasma Flow; SAF: Skin Auto Fluorescence; URM: Uremic Retention Molecule; VLPD: Very Low Protein Diet. Introduction Chronic kidney disease is a major health care problem and slowing its progression to end-stage renal disease (ESRD) has even able to prolong life [10-13]. In the mid-1960s, Giordano and Giovannetti were the first to show that a low-protein diet wasBy able lowering to reduce blood almost urea all uraemic and other signs andnitrogenous symptoms waste [14]. obvious clinical and economic benefits. [1-3] Diet is the largest protein diet (LPD) as a therapeutic measure in chronic kidney products, a low-protein diet has favorable effects on secondary risk factor for CKD patients for death and disability [4,5]. A low- disease (CKD) was suggested by Beale as early as 1869, [6] and hyperparathyroidism [15], peripheral resistance to insulin, [16] the first attempt to experimentally evaluate an LPD in humans hyperlipidaemia, [17] hypertension and acid-base disorders protein diet on CKD progression in diabetic and non-diabetic wasFor done at byleast Smith a century, in 1926 chronic [7]. uraemia has been considered [18]. Four meta-analyses of studies on the effects of a low- patients, have been performed since the early 1990s, all showing renal medicine, low protein diets have been attempted as a an example of “protein intoxication.” Thus, in the history of way to correct the metabolic alterations caused by kidney a beneficial effect [13,19-22]. chronic kidney disease involve the slowing of kidney failure studies on low-protein diets in uraemia patients started with Today, the main nutrition-related goals for people with failure as much as possible [8,9]. Indeed, the first systematic the observation that a protein-restricted diet was effective in disorders of kidney failure, diminishing proteinuria, maintaining progression rate, minimizing uremic toxicity and metabolic good nutritional status, and lowering the risk of complications reducing the symptoms of “uraemic toxicity” and that it was JOJ uro & nephron 6(3): JOJUN.MS.ID.555687 (2019) 0049 JOJ Urology & Nephrology including cardiovascular disease, bone disease, and disturbed clearance than a comparable group of normal subjects ingesting has been shown to help accomplish all of these treatment blood pressure control [23]. A low-protein plant-based diet a vegetarianAn epidemiological diet [31]. study with a 23-year follow up period goals. Plant-based diets lend themselves well to low-protein showed that diets with different dietary protein sources have treatment and still supply adequate protein while helping to diets suitable for CKD patients. They are a safe and efficacious adversely associated with CKD risk, while nuts and legumes are different risks of incident CKD: red and processed meat are protective against the development of CKD. Red and processed Epidemiologicalprevent and treat common Studies comorbidities [24,25]. Several epidemiological studies consistently show that meat increased the risk of CKD by 23% (Q5:Q1) whereas a vegans (those who follow a plant-based diet) have a decidedly higher dietary intake (Q5:Q1) of nuts and legumes resulted in of adults aged 45-74 years old, red meat intake was strongly lower risk of chronic kidney disease than those who consume a 19% and 17% decreased risk respectively [32]. In a study associated with an increased risk of the eventual development of End Stage Renal Disease (ESRD) in previously healthy people group those following a plant-based diet have better renal animal derived foods. These studies also indicate that as a in a dose-dependent manner, with the highest quartile having function than those following an omnivorous diet. Furthermore, epidemiological studies show that vegans also have much lower replacing one serving of red meat with other food sources of levels of risk factors for chronic kidney disease such as type 2 a 40% increased risk over the lowest. In substitution analysis, diabetes and hypertension. protein was associated with a maximum relative risk reduction Epidemiological studies have been able to show which foods the risk of ESRD in the general population, and that substituting of 62.4%. This study shows that red meat intake may increase raise and which foods lower the risk of chronic kidney disease. alternative sources of protein may reduce the incidence of ESRD sources of saturated fat raise the risk of chronic kidney disease, These studies show that while eating red meat and other consuming tree nuts, legumes, fruits and vegetables lowers it. [33]. followed a western dietary pattern (higher intake of red and Studies comparing those who consume animal protein with Female participants in the Nurses’ Health Study who had processed meats, saturated fats, and sweets) had 2.17 times those who consume equal amounts of plant protein show that the risk of microalbuminuria, and a 77% greater risk of rapid those who consume plant protein have a lower risk of chronic with those following a prudent diet high in fruits, vegetables, estimated Glomerular Filtration Rate (eGFR) decline, compared kidney disease, indicating a significant advantage for those glomerular and systemic hemodynamic changes which may be following a plant-based diet. The vegan diet is associated with in animal fat with high levels of saturated fats. A cross-sectional legumes and whole grains [34]. The Western-style diet is high beneficial in the prevention of glomerular sclerotic changes in study (Reasons for Geographic and Racial Differences in Stroke healthOne and study disease. showed Details that of thesevegans studies had area lower provided glomerular below: Study; REGARDS), including more than 19,000 adults over 45 years of age, found a significant association between saturated that the use of animal proteins compared to plant proteins filtration rate (GFR). Early elevation of the GFR plays a central fat intake and hyperalbuminuria [35,36]. Several studies showed induced a worsening of hard outcomes such as mortality and CKD role in the pathogenesis and progression of renal disease [26]. are at reduced risk of incipient or early stage kidney disease. Since those following a plant-based diet have a lower GFR they healthy dietary patterns high in fruits, vegetables, legumes and progression [37,38]. In a meta-study that included six studies, min/1.73 m2, the vegetarians 105 ml/min/1.73 m2 and the whole grains were consistently associated with lower mortality In this study omnivores were found to have a GFR of 113 ml/ or ESRD among adults with CKD, with a risk reduction of 30%. (39) Substituting soy and other legumes for red meat resulted in vegans 100 ml/min/1.73 m2 [27]. Omnivores also had a vegans, and higher mean diastolic blood pressure than both significantly higher mean urinary albumin excretion rate than vegans and lactovegetarians. a reduced risk for ESRD by about 50%-62% [39]. Vegans have been found to have a 75% decreased risk of that independent of the quantity of protein, soy protein has Looking at soy protein specifically, one study showed Since type 2 diabetes and hypertension are both risk factors hypertension and a 78% reduced risk
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