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In the Vegetarian & Vegan News...
   William Harris, M.D. | Kaiser Vegan Lifestyle Clinic

Q&A with Bill Harris MD
Diabetes, renal failure and veganism

Q. Dear Dr. Harris:

My friend, Cynthia, has been a Type 1 diabetic for 26 years. She is now brittle and suffers from such secondary complications as neuropathy, retinopathy (legally blind), hypoglycemic unawareness, and most importantly, nephropathy. Her creatinin clearance is about 47.

Cynthia is an animal lover and a very compassionate individual who wishes more than anything to become vegan. However, all of her doctors and nutritionists advise against it because she must avoid beans as much as possible, as in addition to restricting protein, she must restrict phosphorus.

No one has been able to inform us of how vegan advocates have addressed this dilemma. I am myself a vegan, and would love to have Cynthia accompany me on my mission of humanity. Please help.


 



A. Being vegan is not about eating beans. I myself seldom eat them because of the gastrointestinal symptoms they cause. There's plenty of protein in vegetables (particularly leafy greens).

Renal failure is a very problematic area and one in which the angels fear to tread, mostly because the territory has been staked out by dieticians who believe that since protein intake must be limited, that the small amount that is allowed must be "high quality" protein. In their minds this still means animal protein although there's little evidence that there's any real difference in the quality of diverse plant proteins and animal protein.

In my opinion, animal protein is probably what started your friend's problems in the first place. Type 1 diabetes is an autoimmune disease in which the beta cells of the pancreas are wiped out by the body's own immune system. Recent studies suggest that dairy proteins are one of the triggers (see below). Plant proteins can also jiggle the immune system but since the amino acid sequence of the proteins is so much different from human proteins the result is usually just allergy, a minor annoyance.

I think, but cannot prove, that the continued feeding of animal protein in the face of renal disease is like trying to put out a fire by throwing gasoline on it. The antigen-antibody complexes that destroy the renal architecture, particularly the gossamer membranes of the glomerulus, will continue to accumulate as long as animal foods are consumed. If this is correct then a vegan diet is the proper solution.

However, the complexity of renal failure, which requires that the serum levels of phosphorus, calcium, protein, and many other laboratory values be carefully watched, means that the switch to a vegan diet can only be safely made with the assistance of the patient's health providers. If they can't be persuaded to try it then it's probably not wise to try it on your own.

Below are some references that might be helpful. Good luck.

Sincerely,

-William Harris, M.D.


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.


Disease-associated anti-bovine serum albumin antibodies in type 1 (insulin-dependent) diabetes mellitus are detected by particle concentration fluoroimmunoassay, and not by enzyme linked immunoassay.

Karjalainen J; Saukkonen T; Savilahti E; Dosch HM
Department of Immunology and Cancer, Hospital for Sick Children, Toronto, Ontario, Canada.

Diabetologia (GERMANY) Oct 1992, 35 (10) p985-90, ISSN 0012-186X

Journal Code: E93

Languages: ENGLISH
Document type: JOURNAL ARTICLE
JOURNAL ANNOUNCEMENT: 9303
Subfile: INDEX MEDICUS

We recently developed a particle concentration fluoroimmunoassay for the measurement of serum antibodies to bovine serum albumin in patients with Type 1 (insulin-dependent) diabetes mellitus. We observed elevated IgG-anti-bovine serum albumin antibodies in 100% of newly-diagnosed diabetic children and in 2.5% of matched control children. Here we compare the fluoroimmunoassay and the more commonly available enzyme linked immunoassay technique, exchanging coded serum samples from 40 newly-diagnosed diabetic children and 179 control children between two laboratories. Particle concentration fluoroimmunoassay detected elevated IgG-anti-bovine serum albumin antibodies in all diabetic children, enzyme immunoassay in 25% (p less than 0.0001). Fluoroimmunoassay detected elevated levels in 2.2% and enzyme immunoassay in 10% of control children (p less than 0.002). Elevated IgA-anti-bovine serum albumin antibodies in patients were slightly more often detected by fluoroimmunoassay than by enzyme immunoassay, while in control children enzyme immunoassays detected elevated levels three times more often (p less than 0.01). Values measured in either assay showed overall no correlation in either patient (IgG:rs = 0.28; IgA:rs = 0.11) or control sera (IgG:rs = 0.02; IgA:rs = -0.05). Fluoroimmunoassay for IgG was 100% disease-sensitive (enzyme immunoassay: 25%, p less than 0.0001) and more disease-specific (IgG; p less than 0.02). Our findings demonstrate that these assay techniques detected distinct subsets of anti-bovine serum albumin antibodies with little (IgG) or some (IgA) overlap. In fluoroimmunoassay procedures, antigen:antibody binding occurs within 1-2 min while hours are allowed in an enzyme immunoassay.(ABSTRACT TRUNCATED AT 250 WORDS)


A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus [see comments]

Karjalainen J; Martin JM; Knip M; Ilonen J; Robinson BH; Savilahti E; Akerblom HK; Dosch HM

Hospital for Sick Children, Department of Pediatrics and Immunology, University of Toronto, ON, Canada.

N Engl J Med Jul 30 1992, 327 (5) p302-7, ISSN 0028-4793

Journal Code: NOW

Comment in N Engl J Med 1992 Jul 30;327(5):348-9
Languages: ENGLISH
Document type: JOURNAL ARTICLE
JOURNAL ANNOUNCEMENT: 9210
Subfile: AIM; INDEX MEDICUS BACKGROUND.

Cow's milk has been implicated as a possible trigger of the autoimmune response that destroys pancreatic beta cells in genetically susceptible hosts, thus causing diabetes mellitus. Studies in animals have suggested that bovine serum albumin (BSA) is the milk protein responsible, and an albumin peptide containing 17 amino acids (ABBOS) may be the reactive epitope. Antibodies to this peptide react with p69, a beta-cell surface protein that may represent the target antigen for milk-induced beta-cell--specific immunity. METHODS. We used immunoassays and Western blot analysis to analyze anti-BSA antibodies in the serum of 142 children with insulin-dependent diabetes mellitus, 79 healthy children, and 300 adult blood donors. Anti-ABBOS antibodies were measured in 44 diabetic patients at the time of diagnosis, three to four months later, and one to two years later. RESULTS. All the diabetic patients had elevated serum concentrations of IgG anti-BSA antibodies (but not of antibodies to other milk proteins), the bulk of which were specific for ABBOS. The mean (+/- SE) concentration was 8.5 +/- 0.2 kilofluorescence units (kfU) per microliter, as compared with 1.3 +/- 0.1 kfU per microliter in the healthy children. IgA antibodies were elevated as well, but not IgM antibodies. The antibody concentrations declined after diagnosis, reaching normal levels in most patients within one to two years. The initial decline involved anti-ABBOS--specific antibodies almost exclusively. Much lower serum concentrations of anti-BSA antibodies were found in all 379 control subjects, but only 2.5 percent of them had small amounts of ABBOS-specific IgG. CONCLUSIONS. Patients with insulin-dependent diabetes mellitus have immunity to cow's-milk albumin, with antibodies to an albumin peptide that are capable of reacting with a beta-cell--specific surface protein. Such antibodies could participate in the development of islet dysfunction.


Clin Nephrol 1993 Dec;40(6):315-20

Treatment of proteinuric patients with a vegetarian soy diet and fish oil.

Gentile MG, Fellin G, Cofano F, Delle Fave A, Manna G, Ciceri R, Petrini C, Lavarda F, Pozzi F, D'Amico G

Division of Nephrology, San Carlo Hospital, Milano, Italy.

Our aim was to determine whether a longer period of treatment with a vegetarian soy diet with addition of fish oil supplements would accentuate the beneficial effects on hyperlipidemia and proteinuria of nephrotic patients we found in a previous study. After an 8-week baseline period on free diet, patients were randomly allocated either on soy diet alone (SD) or to SD plus 5 g/day of fish oil (SD + FO) orally for two months. Then they crossed over to the other treatment for two additional months. They finally resumed eating the free diet for 3 months. We selected 20 outpatients with chronic glomerulonephritis, proteinuria in the nephrotic range, fasting serum cholesterol > 250 mg/dl, mean serum creatinine concentrations 1.75 +/- 0.23 mg/dl. Serum lipid profile, urinary protein loss and nutritional parameters were monitored. With the soy diet, we obtained a significant decrease both of hyperlipidemia and of proteinuria. The effect of the soy diet on proteinuria increased over the 4 months. The addition of a moderate amount (5 g/day) of fish oil in a randomized cross-over design had no further beneficial effect. Stability of serum albumin, transferrin and the body mass index documented good nutritional status. In conclusion, the dietary manipulation with our vegetarian soy diet confirmed the beneficial effects on hyperlipidemia and proteinuria of nephrotic patients. Such effects persisted and even ameliorated after 4 months of diet. The addition of moderate oral supplements of fish oil did not potentiate the beneficial effect.

Publication Types:

Clinical trial
Randomized controlled trial

PMID: 8299238, UI: 94130407


Nutr Rev 1993 Feb;51(2):44-6

Vegetarian diets for treating nephrotic syndrome.

Dwyer J

Tufts University School of Medicine, New England Medical Center Hospitals, Boston, MA 02111.

Vegetarian diets based on soy-protein appeared to be effective in treating the hyperlipidemia of nephrotic syndrome. Whether there is a unique effect of soy or whether all very low-fat, low-saturated-fat, low-cholesterol, and low-protein diets have similar effects remains unknown.

Publication Types:

Review Review, tutorial

PMID: 8455802, UI: 93205240

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.

Dr. Harris is one of the VegSource experts who will be speaking at the upcoming VegSource e-Vent weekend.

 

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