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Planting a new seed of health

Planting a new seed of health

Session: Diet and Acid in CKD: Where Do We Stand?

Subsession: Plant-Based Diets: Pros and Cons in CKD

Presenter: Juan Jesus Carrero, MD, PharmD, PhD, Karolinska Institutet

It’s a hot topic. It’s more than hot. And if the SRO turnout to hear Dr. Carrero discuss plant-based diets in terms of CKD is any indication, the subject is red hot.

The session began with a brief review of current dietary recommendations for those with chronic kidney disease (CKD), which traditionally focuses on quantity — from adjusting protein intake to restricting single micronutrients (sodium, phosphorus, potassium, and calcium) to ensuring sufficient energy.

“In the last five years several papers have suggested that moving from a diet of quantity to a diet of quality can have beneficial advantages for those with CKD — especially when there is more emphasis on fruits and vegetables,” Dr. Carrero emphasized during his Thursday afternoon ASN Kidney Week 2019 session.

Starting at square one, the doctor defined what a plant-plant-based diet is. “Any eating pattern where animal-based food is consumed in moderation and proportionately more choices are plant-based.”

Extreme plant-based diets include vegan and vegetarian diets, where there is no meat consumption. Other healthy diets include the DASH diet, Meditation diet, Healthy Eating diet and Okinawa diet.

What’s important when talking about plant-based diets, Dr. Carrero added, is the amount of protein as well as the sources.  CKD guidelines state that at least 50 percent of protein ingested should be of high biological value, equaling complete essential amino acid (AA) profile.  Traditionally, plant protein is considered low biological value and animal protein is considered high biological value.

Recent research discredits this theory. What matters is the ratio of protein to fiber.  If the ratio is incorrect, then the results can lead to:

  • Increased production of uremic toxins in patient with CKD GF.
  • Higher risk of CVD event in men with CKD G-4. 

In people with CKD G3-5 and on dialysis, the right protein to fiver ratio is associated with:

  • Lower inflammation
  • Lower uremic toxins
  • Less myocardial atrophy and injury
  • Lower MACE risk
  • Lower mortality

Another attempt to discredit plant-based diets for those with CKD assumes that plants are the primary determinants of serum K, which can produce diet-induced hyperkalemia. It turns out, Dr. Carrero said, the top sources of K in HD patents int he US include:

  • Beef
  • Chicken
  • Mexican Food
  • Hamburgers
  • Legumes

And yes, there are many meat and dairy products that have K content similar to fruit and vegetables. However, there are also many fruits and vegetables with low K content. In one study, choosing the right plant-based foods had a K recovery of 40 to 60 percent. In a DASH trial, the K recovery was 80 percent.

To wrap up his recommendations, Dr. Carrero concluded that a plant-based diet can potentially deliver little harm and often marked benefits in people with CKD 3-5. In addition, plant-based diets can delay progression of ESRD and reduce uremic toxicity.

Furthermore, indications suggest:

No clear evidence for limiting plant-based food in normokalemic patients with CKD. Plants with lower K content per unit of fiber provide choice for the minority of people with CKD who need to restrict K intake due to their hyperkalemia risk. In one final bow to a plant-based diet, Dr. Carrero reminded his audience that current guidelines are more than 20 years old — and it’s time to get with the times.

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