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Is it possible to ameliorate chronic kidney disease using a whole food, plant-based diet? In my last video on kidney disease, I talked about how randomizing people to cut just around 10 grams of protein from their daily diet could cut their risk of dialysis and death by a whopping 77 percent. That was cutting protein across the board. But while animal-based protein ingestion—meat, dairy, and egg white protein ingestion—promotes an acidic environment in the kidneys, inflammation, and stresses the kidneys into what’s called hyperfiltration mode, plant-based protein can be alkaline-producing and anti-inflammatory, and contain kidney-protective properties. So, what if you gave kidney patients a plant-dominant low-protein diet, abbreviated adorably as PLADO, I guess for plant-dominant.
If you fashion up a plant-based diet index score, where you get points for healthy plant foods and get points deducted for eating animal foods, those with serious kidney disease with higher scores were found to have lower systemic inflammation. But does that actually translate into living a longer life?
Apparently so. Even a 10 percent increase in the proportion of plant-based protein was associated with a significant reduction in all-cause mortality. Even just eating more servings of fruits and vegetables, like two a day compared to two a week, is linked to living longer.
Without fully functioning kidneys, there are concerns about phosphorus and potassium overload, though, on plant-based diets. But the phosphorus in plant-based foods is not as much of a problem as the phosphorus additives in processed and animal foods. And the risk of potassium overload from plant-based diets appears overstated, and is not supported by the evidence. But you don’t know about ameliorating chronic kidney disease using a whole food plant-based diet, until you put it to the test.
Here’s a case report of a 69-year-old man with type 2 diabetes, high blood pressure, and stage 3 chronic kidney disease, resulting in elevated phosphorus and potassium in the blood. He was interested in changing his diet to improve his medical condition. That’s my kind of patient! He was on 12 different medications, eating a diet that may actually be slightly better than the average American’s. Some whole grains and beans, but then his doctor advised him to try eating whole food, plant-based. So, oatmeal with fruit and flax, beans and greens, whole-wheat spaghetti and veggies, fruit as snacks. He was counseled to eat as much as he wanted from whole healthy foods—no carb counting, no calorie counting, no portion size restriction—improving the quality of food rather than restricting the quantity of food.
He adopted the whole food, plant-based diet, packed with carbs, yet rapidly reduced his insulin requirements by more than 50 percent, and subsequently saw improvements in weight, blood pressure, and cholesterol. Because eating healthy can have such a rapid effect on improving your body’s insulin sensitivity, immediate adjustments in insulin dosing were made. Within four days, his insulin dose was able to be reduced from roughly 210 units of insulin a day down to 70 units daily, and an oral blood-sugar lowering medication had to be stopped due to rapidly improving blood sugar.
He also was able to stop his carvedilol, hydrochlorothiazide, amlodipine, and sitagliptin within the first two months, due to improving blood pressure and blood sugars. His insulin dose was steadily titrated downward. His pravastatin dose was cut in half, and he lost about 50 pounds. Okay, so what happened to his stage 3 kidney failure? He was no longer in stage 3 kidney failure! Doctors watching this will understand what all these numbers mean. Here’s a graph of his GFR, which is a measure of kidney function, declining for years before shooting up after he started eating healthy.
He experienced an increase in estimated GFR of 73 percent, suggesting that the improvement in estimated kidney function was greater than what would be expected from weight loss alone. For example, lose about 60 pounds with bariatric surgery, and you only get about a 12 to 15 percent boost. Bottom line: for individuals with chronic kidney disease, especially those with obesity, hypertension, or diabetes, a strict, all-you-care-to-eat whole food, plant-based diet may confer significant benefit. I mean, apart from the kidney-specific outcomes, overall mortality is significantly lower among kidney patients who eat more plants. And that’s critical, because most kidney patients don’t even make it to dialysis because they die first, most often from cardiovascular disease.
Let’s hear from the patient: “At the outset, it seemed like this was going to be a difficult and restrictive way to eat,” but “I began feeling different almost immediately and we had to decrease my insulin after ONE day. It seemed like almost overnight I had more energy than I’d had in years. Weight that I had been trying to lose for a decade began dropping off. As the weight came off, I felt lighter, and more able to move my body again.”
“This lifestyle change has been the greatest gift I’ve ever received. I am off most of my medications, I’ve lost over 70 pounds, and I’ve regained control over my health. I feel empowered by this lifestyle change, and I finally feel like I’m in charge of my health, not just an unlucky victim shuffling from one specialist to the next. My only regret was that I didn’t know about this sooner.”
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