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A.
I think the animal
protein dear to nephrologists is based on some fairly sloppy thinking
done in the 60s. Their idea was that since injured kidneys don't
handle protein very well, whatever protein is allowed has to be
of "high biological value" (i.e. meat). The idea that
properly complemented plant protein is of low biological value has
long been overthrown and there is increasing evidence that the amino
acid sequence in animal proteins may be what caused the autoimmune
reaction that damaged the kidneys in the first place. Continuing
dietary animal protein in my opinion is like trying to put out a
fire by throwing gasoline on it.
She
consumes very little dairy in her diet, mostly an ocassional cottage
cheese and butter when at someone's house. As a rule, she eats an
almost vegan diet and is VERY concerned about the requirements the
doctors are placing on her to eat meat and dairy.
Since I'm not
the physician in charge and only have your report to go on I can
make no substantive recommendations. However if she's " VERY
concerned about the requirements the doctors are placing on her
to eat meat and dairy" why is she only on an "almost vegan
diet"?
Being
that she is in kidney failure, has had a three-way heart bypass
three years ago, she needs to be careful what she eats so as not
to bring toxins in to further harm her kidney and heart.
Dr.
Harris, can you advise what she can eat to get good quality protein,
without eating animal products, that would not cause further stress
on her kidney while using the Peritoneal Dialysis; and also foods
that contain low phosphorus and magnesium. She will be getting lab
tests done next week that will show exactly how her body is reacting
to the dialysis and details on where her levels of nutrition are.
The rub here
is that the leafy vegetables that should have always been the source
of her protein and the fruits that should have been the source of
many other nutrients are now the very foods that will get her into
trouble with calcium, potassium, and magnesium.
If
you could help us with the protein question now, that would solve
her immediate urgency in trying to avoid eating the animal products
the doctors are telling her she has to consume.
There is no
trouble getting enough protein from almost any plant food save fruit
and the entire protein question is a very over-ripe red herring.
The problem now is that her electrolytes have to be micro-managed
by her physicians. I can only append for their benefit the few references
that may bear slightly on her problem.
Sincerely,
-William Harris,
M.D.
************
A low-nitrogen
low-phosphorus Vegan diet for patients with chronic renal failure.
Barsotti G,
Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S
Clinica Medica
I, Universita di Pisa, Italia.
The nutritional
treatment of chronic renal failure with a low-protein low-phosphorus
diet (conventional low-protein diet, CLPD) is effective in reducing
uremic intoxication, slowing the progression of renal failure and
preventing secondary hyperparathyroidism. Unfortunately, in some
patients, the poor palatability and the high cost of the protein-free
substitutes, together with difficulties in following the diet away
from home, can make good compliance difficult, possibly causing
low energy intake and malnutrition. Here the results are reported
of an attempt we made to overcome these drawbacks, using a diet
supplying only natural foods of plant origin in definite proportions
to give an essential amino acid supply satisfying the recommended
dietary allowance. This is possible thanks to an appropriate cereal-legume
mixture, supplying proteins complementary for essential amino acids.
Additional positive features of this special vegan diet (SVD) are
the high ratio of unsaturated to saturated fatty acids, the absence
of cholesterol, and the lower net acid production in comparison
with a mixed diet. This study indicates that the results obtained
with the SVD are similar to those obtained with the CLPD. Therefore
the SVD can be a substitute for the CLPD in the management of patients
with mild chronic renal failure. The SVD is the diet of choice when
products made of starch are not available or poorly tolerated.
A special,
supplemented 'vegan' diet for nephrotic patients.
Barsotti G; Morelli E; Cupisti A; Bertoncini P; Giovannetti S Istituto
di Clinica Medica 1, Universita di Pisa, Italy.
Am J Nephrol 1991, 11 (5) p380-5, ISSN 0250-8095 Journal Code: 3MB
Languages: ENGLISH
Document type: JOURNAL ARTICLE
JOURNAL ANNOUNCEMENT: 9207
Subfile: INDEX MEDICUS
High dietary
protein intake, in the past recommended for nephrotic syndrome,
does not improve hypoproteinemia and may accelerate progressive
renal damage. In contrast, low-protein diets reduce proteinuria
and preserve renal function in experimental renal models of nephrotic
syndrome. In this study, 20 steroid-resistant, nephrotic patients
were treated with a pure vegetarian, low-protein diet, supplemented
with essential amino acids and ketoanalogues (supplemented vegan
diet, SVD) for 4.6 +/- 3.1 months. Before the study, these patients
followed an unrestricted protein, low-sodium diet (LSD). Proteinuria,
daily urea nitrogen excretion and creatinine clearance decreased
significantly on SVD. A similar lowering effect of SVD was observed
on serum total cholesterol. Seven of the 20 patients changed from
LSD to SVD and vice-versa on 3 occasions, and in all cases, we found
an increase of proteinuria during the LSD period. Serum albumin,
HDL cholesterol, triglycerides and anthropometric measurements did
not change on SVD. Our data suggest that SVD exerts a favorable
effect on proteinuria and hypercholesterolemia in nephrotic patients,
without inducing clinical or laboratory signs of malnutrition.
Vegan supplemented
diet in nephrotic syndrome.
Barsotti G; Cupisti A; Morelli E; Ciardella F; Giovannetti S Clinica
Medica I, Universita degli Studi, Pisa, Italy.
Nephrol Dial Transplant 1990, 5 Suppl 1 p75-7, ISSN 0931-0509
Journal Code: N7J
Languages: ENGLISH
Document type: JOURNAL ARTICLE
JOURNAL ANNOUNCEMENT: 9112
Subfile: INDEX MEDICUS
Thirteen patients
(7 males, 6 females, aged 17-68 years) affected by primary, steroid-resistant,
nephrotic syndrome and normal renal function were treated with a
vegan, low-protein (0.7 g/kg per day) diet supplemented with essential
amino acids and Ketoanalogues (VSD) for 3.9 +/- 2.9 months. These
patients were studied at the beginning (following an unrestricted
protein diet (UPD) supplying about 1 g/kg per day of mixed proteins)
and at the end of VSD period. Urinary protein excretion decreased
from 8.7 +/- 2.6 to 5.6 +/- 2.4 g/day (P less than 0.01), serum
total cholesterol from 334.6 +/- 97.1 to 275.6 +/- 49.4 mg/dl (P
less than 0.05). Serum albumin, HDL-cholesterol, triglycerides,
and anthropometric measurements (triceps skinfold thickness and
middle arm muscle circumference) did not change. Urinary urea nitrogen
decreased from 7.5 +/- 1.8 to 3.8 +/- 1.2 g/day (P less than 0.005),
according to dietary prescriptions. Creatinine clearance changed
from 104.4 +/- 28.7 to 89.3 +/- 16.7 ml/min (n.s.) and no correlation
was found with the changes in urinary protein excretion. This data
suggest that VSD reduces proteinuria and exerts favourable effects
on hypercholesterolaemia. Protein malnutrition was absent in these
patients, probably because of the essential amino acids and ketoanalogues
supplementation.
Prospective,
randomised, multicentre trial of effect of protein restriction on
progression of chronic renal insufficiency. Northern Italian Cooperative
Study Group [see comments]
Locatelli F; Alberti D; Graziani G; Buccianti G; Redaelli B; Giangrande
A
Division of Nephrology, Ospedale di Lecco, Italy.
Lancet Jun 1 1991, 337 (8753) p1299-304, ISSN 0023-7507
Journal Code: L0S
Comment in Lancet 1991 Aug 17;338(8764):442-4
Languages: ENGLISH
Document type: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
JOURNAL ANNOUNCEMENT: 9108
Subfile: AIM; INDEX MEDICUS
A multicentre,
prospective trial was organised to clarify the role of protein restriction
in the progression of chronic renal insufficiency (CRI). 456 adult
patients were assigned either a low-protein diet (0.6 g/kg body
weight daily; n = 226) or a "normal" controlled-protein
diet (1.0 g/kg daily; n = 230) and were stratified into three groups
(A-C) with increasing baseline plasma creatinine concentrations.
Each patient was followed up for 2 years or until an endpoint (a
doubling of the baseline plasma creatinine or a need for dialysis)
was reached. The difference between the diet groups in cumulative
renal survival defined by these endpoints (27 low-protein, 42 controlled-protein)
was of borderline significance (p less than 0.06). The difference
in renal survival between the low-protein and controlled-protein
diet groups was of borderline significance in group A (0 vs 4 endpoints),
significant in group B (10 vs 21 endpoints; p less than 0.025),
and not significant in group C. There were no differences among
the diet groups or subgroups in mean plasma creatinine concentrations,
creatinine clearance, the slope of the plasma creatinine reciprocal,
or mean blood pressures. Compliance was good in the controlled-protein
group but poor for the low-protein diet: the difference in protein
intake between the groups was substantially less than that required
by the protocol. However, there was no correlation between the progression
of renal failure and protein catabolic rate. These findings offer
little, if any, support to the hypothesis that protein restriction
retards CRI progression: careful medical care and a "normal"
controlled protein intake also allow very slow progression of CRI.
Amino acid
supplemented diet vs. selective low protein diet in chronic renal
failure.
Vujic D; Djukanovic L
Institute for Kidney Diseases and Metabolic Disorders, Zvezdara
University Hospital Centre, Beograd.
Acta Med Iugosl 1990, 44 (4) p377-87, ISSN 0375-8338 Journal Code:
10S
Languages: ENGLISH
Document type: JOURNAL ARTICLE
JOURNAL ANNOUNCEMENT: 9108
Subfile: INDEX MEDICUS
Two groups of
patients with chronic renal failure (creatinine clearance 13 ml/min)
were treated with two different low protein diets: unselected protein
diet with 0.35 g of protein/kg/day supplemented with amino acids
(first group; 10 patients) and selective protein restricted diet
with 0.6 g/kg/day of high biologically valuable proteins (second
group; 9 patients). Both diets showed a good patient compliance.
The serum urea level decreased significantly only in the first group
of patients with a simultaneous disappearance of uremic gastrointestinal
side effects. Progression of renal failure, shown by plotting the
reciprocal of the serum creatinine concentration against the time,
was significantly slower in the first group of patients and therefore
their survival without dialysis was longer than that in the second
group. The nutritional state was well maintained in both groups.
Comparison of two low protein diets showed that the unselected protein
diet supplemented with amino acids is more effective in delaying
the progression of renal failure. The clinical state of patients
is improved and their protein nutrition maintained.
 William
Harris MD received a degree in physics from the University of
California Berkeley, where he earned Phi Beta Kappa honors. He received
his degree in medicine from the University of California at San
Francisco, and received his postgraduate training at San Diego County
Hospital. He holds a Medical License in the State of Hawaii. He
has been an Emergency Department physican since 1963, and the Director
of the Kaiser Permanente Vegan Lifestyle Clinic on Oahu until his
retirement in 1998. Dr. Harris is the author of The Scientific Basis
of Vegetarianism.
In addition, he was the 1950 Big Ten Trampoline Champion, is
an accomplished hangglider and commercial pilot, and at age 70 became
a skydiver with 108 jumps to date. Dr. Harris has been vegetarian
since 1950, and vegan since 1963.
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