Working toward a evidence based and validated kidney diet

Low protein diets and protein supplements are two sides of the same coin and cannot be separated.  Diets will make or break our success more than the protein supplement.  The reason is that we can negate the benefits of any protein supplement if our diet is flawed or incorrect.

Using a proven diet plan or approach that has some proof and history is key.  Again, guessing is our enemy. One of the criticisms of a low protein diet is malnutrition in some form.

Malnutrition is a risk for any specialized diet or even a normal diet.. Malnutrition can take any number of forms and severity, but is it the reason many healthcare providers  are hesitant to recommend special diets for kidney patients.

Any protein supplements combined with a specialized diet will almost certainly run into some forms of malnutrition when we restrict certain foods.  A good example is the fact that  B vitamins are low in these diets  and protein supplements do not contain vitamins. The same may be true for others like selenium, niacin and others.

To further complicate matters, Kidney patients have trouble managing levels of some vitamins and minerals.  We found patients who were not on dialysis taking dialysis vitamins that contain 500% or more of some B vitamins.

High dose B vitamins are needed by dialysis patients since the dialysis process reduces water soluble vitamins like B vitamins.  However, for those of us not on dialysis, we may not be able to get rid of the excess B vitamin intake. This may lead to increased rates of kidney disease progression.

“Patients with diabetic nephropathy (kidney disease caused by diabetes) who received high dose B-vitamin therapy experienced a more rapid decline in kidney function and had a higher rate of heart attack and stroke than patients who received placebo, according to a study.”

In our case, not getting enough is bad and getting too much is bad as well. For us, it’s always a balancing act.

To solve this problem, the same approach as Albutrix was used. Dietary intake was calculated based on food logs and the “Stopping Kidney Disease Food Guide” diet. Next, any deficiency was solved for using the minimum amounts.

For example, if the average patient is getting 70% of the RDA from diet,  then only 30% is provided in Microtrix.   If 100% is provided by diet, no supplementation is needed.

By combining diet, Albutrix, and Microtrix, we are able to ensure:

• A proven low protein diet 
• 100% nutrition for essential amino acids
• 100% nutrition for vitamins and minerals.

Minerals, vitamins, and essential amino acids are provided with the lowest possible risks and most importantly no guessing. 

This ensures long-term safety for low-protein diets, which has been an issue for kidney patients since the 1970’s.  This issue matters because we have to think about long-term safety and nutrition with any diet or protein supplement.

Compare what is available today for kidney patients to the past.

Past approach (pre 2019)

• High Calcium keto analogues combined with dietary intake exceed all recommendations for calcium intake. Calcium milligrams may not be on the label on older amino/keto acid blends.
• Nitrogen content of protein supplement was not known or calculated or on the label
• No vitamin was used to ensure nutrition
• No specific diet was proven,  everyone is just guessing no matter what they tell you.

The net results are that these diets and or supplements were considered unproven or not reliable.

Now compare to today’s options in 2020

• Choice of magnesium ,calcium or a blend for the appropriate stage of kidney disease
• Calcium/magnesium and nitrogen content are listed on the label 
• RDAs are met with a low-dose time-release vitamin just for kidney patients
• A proven low nitrogen diet is being validated by MD’s.
• Long term safety and nutrition are ensured

While we are working toward the first validated and evidence based diet, we can’t say we are completely validated yet.  However, I can share the blood work from 14 patients who volunteered to share before and after blood work.  This is considered preliminary data and we are working to build a larger more complete database.

Chart from kidneyhood site.

Diet matters and is the most important of all.  The wrong diet will get no or poor results.  The right diet can increase GFR by over 20% and reduce blood urea nitrogen(BUN) levels by 40% or more.

I hope to announce the results from a 15 patient observational study in late 2020.  For now, we hope to announce the first evidence based and validated kidney diet in 2021.

Your diet, protein supplement and vitamin must all be calibrated to work together if you want to get the best results.  Data from dozens of patients tell us this is true.

How to read protein supplement labels for kidney patients

This is a summary of some of the data in the previous articles condensed to make it a little easier to read.  Please see the related articles to get the background of each article.

What to look for and what each item means to you as a kidney patient.

1. Supplemental calcium content (if not listed, call or email the manufacturer)
   If calcium content is greater than 500 mg per day, then we know this formulation is for stage 5 patients only based on data from over 20 countries and all modern dietary guidelines. Calcium content above 500 milligrams equals an incredibly restricted diet that may not be possible in real life.  Stage 3 and 4 patients need to look elsewhere.  Calcium content under 200 mg per day is best to allow for the least amount of dietary restrictions is suitable for Stage 3 and 4 patients.
   
   
2. Read the label to see if high glycemic sugars and starches are at the top or the bottom of the ingredient list.  
   If ingredients like Maltodetrin or other sugar is listed as the top three ingredients, then the product is likely not for patients who are diabetyeic or predibetic.  Again, no one in the world recommends high glycemic products for any kidney patients regardless of diabetic status. This subject is not up for debate.
   
   
3. Check the amount of magnesium and the recommendation for your stage of kidney disease.
   General guidelines are magnesium up to the RDA of 420 mg mg per day for Stage 3 patients.   100 to 300 mg per day for Stage 4 and no magnesium for stage 5 patients. If you are stage 5, then look for the one with the lowest calcium content. These are broad guidelines and your blood test and doctors advice are the best guide. 
   
   
4. Read the label for nitrogen content  if not listed, call or email the manufacturer and ask for a copy of the lab tests.
   This one is the simplest rule to understand:  the lowest nitrogen product will allow you the least restricted diet and will give you the fastest gains in your  bloodwork and GFR.  From our work, we think supplemental nitrogen needs to be below 400 mg per at the highest to get the best results.  Nitrogen above 500 mg  in a day’s serving and results start to get less predictable, above 700 mg+  random results are more likely than not.   
   
   
5. How are you going to meet the RDA for essential amino acids, vitamins, and minerals to ensure safety?  Do you have a proven approach to the diet and protein supplements?
   This is where a prescribed or evidence based diet crashes into protein supplement and vitamins.  It is easier than you think for all of these variables to work against each other.  We see this everyday.  Random choices will get random results in most cases.   We need a calibrated and coordinated approach to low nitrogen load and complete nutrition to ensure fast results and long term safety. I refer to kidney disease management as s three legged stool.   If you remove one leg everything starts to fall apart.  Know what approach and plan you are going to us before you start.
   
   
6. What diet will you follow  and what is the data that supports the dietary approach?
   The vast majority of kidney diets are based on limiting potassium, phosphorus and sodium.  However, these diets do nothing to slow kidney disease progression, reduce your blood urea nitrogen or creatinine levels.
   
   If there is any one secret to getting good results is it the best diet.  Diet matters more than any other factor in my opinion. 
   
   If you are trying to make your kidneys last longer, you need to be on a diet that has the potential to do this and not just be a pretty cookbook or free internet article.
   
   I explain it this way: Diet does the work for us, Albutrix and Microtrix make the diet safe.   All three are attached at the hip and can’t be separated in my mind. 
   
   Diet is the number one factor in my mind.  Ignore this advice at your own peril. Go with the most proven diet you can find and demand proof before you make a decision.
   
   
7. Always be under a physician care and supervision
   I thought I should mention this as I don’t want to imply you should go it alone. Every kidney patient should always be under the care and guidance of a qualified physician. Your doctor can help you interpret your blood and urine tests to see what kind of progress you are marking or keep you from pursuing something risky

These are all questions we should be asking.  No product or solution will ever be perfect.  However,  long-term intake or long-term diets need to be safe if we are going to try and slow kidney disease progression.

I often refer to kidney disease as a three legged stool. If you remove one leg, the stool falls over.  Low nitrogen diet is one leg,  protein supplement is another and ensuring RDA’s are met is another.  You need all three legs to work together to give you the highest odds of success. 

I hope this report reduces any confusion about what is recommended for kidney patients and what should be avoided if possible.