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The National Health and Nutrition Examination Survey of 2014 found that adults are over-consuming protein, beyond the recommended guidelines. It’s been fairly apparent for a while in the Western world that protein has a “health halo” around it. The more, the better..right?
Actually, no! Many studies have been showing that a low protein diet can be very beneficial for someone with kidney disease.
While there are several health reasons for starting a low protein diet, we’re going to stick to the reason of having chronic kidney disease in this article.
So what exactly is a low protein diet? How do we define it? Who should be following this? What risks are involved? And how do I know that I’m doing it right? Let’s dive into these questions and more!
What is a low protein diet?
A low protein diet is a diet in which the daily protein allowance is restricted below the general nutrition guidelines.
The general recommendation for adequate protein is 0.8 grams of protein per kilogram of body weight.
A low protein diet is where we start below the general recommendation to anywhere from 0.6-0.8 grams of protein per kilogram of body weight. The amount determined in this range will include factors such as age, activity level, stage of kidney disease and cause of kidney disease.
In restricting protein, the other two macronutrients – fat and carbohydrates- will need to be adjusted.
And while I’m not a fan of the traditional ketogenic diet, I do believe that a modified version can be very beneficial.
What does this mean for fats and carbohydrates in the low protein diet?
Because the amount of protein is generally under 10% of a person’s daily calorie needs, the percentages of fats and carbohydrates will need to be adjusted.
In most cases, I will still aim for 45-65% of the calories coming from carbohydrates. This means the amount of fats will increase to adjust for the 25-45% of remaining calories for the day.
Quality still matters very much here for both fats and carbohydrates. Fats should be from heart-healthy sources such as plant-based, unrefined oils, nuts, seeds, and fatty foods like avocado.
Carbohydrates can come from whole grains to provide enough fiber (something I feel is a must in our meals and snacks) but can also include white carbohydrates from time to time, which can be lower in protein.
Who should follow a low protein diet?
While this type of diet may be helpful for chronic kidney disease, it doesn’t mean this is something everyone should try.
Studies have found a low protein diet (or even very-low protein diet) to be beneficial for those in later stages of kidney disease, like stages 4 and 5.
Who should not follow a low protein diet?
Those at stages 1-3 generally don’t benefit from a low protein diet, but are not always advised to increase protein intake either. It often comes back to focusing on getting adequate amounts of protein without going over and potentially increasing the toxins and workload on the kidneys.
Another part of the equation when it comes to the nutritional intake includes other health concerns. For example, if a person has diabetes a low protein diet may not be the first place to focus on a diet. (I’d look back at that fiber goal.)
Those with kidney failure on dialysis should not follow a low protein diet. The dialysis process includes filtration of the blood, which removes some protein. That protein needs to be replenished. A diet on dialysis generally has a guideline of a high protein diet of 1.2-1.4 grams per kilogram per day. But don’t worry, you can still follow a plant-based diet even on dialysis!
Benefits of a low protein diet
There are a lot of benefits when it comes to following a low protein diet! Some of these benefits include;
- Keep kidney function longer
- Less protein in the urine
- Lower risk of metabolic acidosis
- Less oxidative stress
- Less insulin resistance
- Lower/controlled blood pressure
- Less uremic toxins
- Better control of phosphorus
Risks of a low protein diet
This type of diet does not go without its risks, though. By following a restrictive diet, there is a higher chance of malnutrition. Another name for this is protein-energy wasting, or PEW.
If the diet is not supported with adequate calories from fat and carbohydrates, unintentional weight loss can occur. It is very important that while protein is limited, calories are not.
In fact, it’s recommended that someone on a low protein diet get more calories to prevent undesirable weight loss from lean body mass breakdown.
If done poorly, a low protein diet can lead to inflammation which is really the opposite of what we want. And with inflammation can also come an imbalance of glucose in the body.
Cutting out meat entirely may lead to worsening anemia, one of the first signs and symptoms of kidney disease.
Animal foods are not required in our diet, but it is something to be aware of and make sure you’re doing the right things with your diet and supplements to manage your anemia.
Foods to include on a low protein diet
A low protein diet will include a variety of grains, fruits, vegetables, and healthy fats!
While it’s not a guarantee, many with late stage kidney disease may need to limit potassium. Obviously this will be something to pay attention to when it comes to increasing your fruits and vegetables.
Remember- there are plenty of low-potassium fruits and vegetables available for you to enjoy. You can also likely still include some high potassium foods as well, but it’s best to work with a dietitian to know how to do that safely.
Whole grains are still a go-to source of carbohydrates and fiber. Some whole grains are naturally higher in protein compared to the processed grains.
Heart-healthy fats are a must when it comes to a low protein diet. Some of the my favorite fat sources include;
- Olive oil
- Avocado oil
- Sesame oil
- Chia seeds
- Ground flaxseeds or flaxseed oil
- Macadamia nuts
- Hemp hearts
- Low sodium olives
Foods to avoid on a low protein diet
Foods highest in protein tend to come from animal meats. So when we talk about a plant-based diet for kidney disease, this really fits the bill!
By cutting out animal proteins, you are going to eliminate some of the highest protein sources in your diet.
- Game meats
Additionally, high-protein plant foods such as tofu, legumes and beans may need to be limited as well. It’s not just about the source of protein in your diet; it’s the quantity.
By cutting out these significantly high protein sources in the diet, you are giving your kidneys a break from dealing with a huge incoming protein load!
Supplements for a low protein diet
Some studies have shown that adding ketoanalogues (don’t get this confused with the ketogenic diet) to a low protein or very low protein diet may help in delaying dialysis.
Adding ketoanalogues can be a beneficial way to get enough protein without the uremic wastes that come from dietary protein.
Ketoanalogues are the amino acids of proteins but without the uremic toxins the body and kidneys typically deal with.
Ketoanalogues are considered a medical food, meaning they’re regulated by the Food and Drug Administration (FDA). Ketoanalogues have been used for a while now in Asia and Europe and are now only recently becoming more common in the United States.
Your nephrologist may or may not know about ketoanalogues or the low protein diet, but you can learn more about them (and share the information with your nephrologist)! I find Ketorena’s website to be very helpful and informative.
Your dietitian can calculate the correct amount of ketoanalogues you should be taking with your meals. If you take it excessively, it can lead to a nutritional imbalance.
One of the other supplements you may want to look into is a kidney-safe multivitamin. While food should always come first, many people with a restrictive diet can benefit from a multivitamin that can help cover nutritional deficiencies. Some of my top recommendations include ProRenal and Renavite.
What is the difference between ketoanalogues and amino acids?
Ketoanalogues are essentially fragments of amino acids. They do not have the nitrogen piece of the protein, which helps in reducing the stress on the kidney while still providing the necessary nutrients.
The ketoanalogues contain essential amino acids that our bodies need to do a ton of things required for day to day activities and bodily functions.
If you were to purchase amino acids from your local supplement/vitamin store, it is very possible (if not guaranteed) that the amino acids available there will contain the nitrogen piece of the amino acid.
Example of a low protein diet
Breakfast: Cream of wheat with ground flax seeds, chia seeds, berries and maple syrup
Snack: Apple and popcorn
Lunch: Veggie wrap with avocado, lettuce, sprouts, red onion, cucumber, carrots and hummus and a side of chips and corn salsa
Snack: Fruit and veggie smoothie with ground flax seeds
Dinner: Grilled marinated Portobello mushroom with rice and a side salad with olive oil and balsamic vinegar
Snack: Frozen grapes
Tips for switching to a low protein diet
Chickpeas instead of chicken is a great budget-friendly swap! And honestly, you haven’t lived until you’ve tried “pulled pork” jack fruit.
Here are another couple ideas to inspire you!
How to track a low protein diet
Tracking your food can be a great way to give you insight into your nutrition guidelines. A dietitian can help you decode your diet and make sure you’re in the guidelines to keep your kidneys safe and healthy.
One of my favorite trackers is Cronometer. You can use the free tool, but I think the real info is in the paid version. It will tell you so much more and you can set goals when working with your dietitian!
When tracking, you’ll want to be as specific as possible. It can get very tedious, but when you use a system like Cronometer you can set up some of your most common meals and re-use them for quick entries.
Be sure to compare your food journal with your lab test results. The test results can show you more details about your progress.
When to get professional help
To find out if you should or should not be on a low protein diet, it’s important to have a comprehensive nutrition assessment with a renal dietitian. It is highly recommended you work with a dietitian when restricting anything in your diet. Ask your doctor for a referral to a dietitian or find one through resources like the National Kidney Foundation – or me!
A low protein diet comes with risks, so trying it by yourself is not recommended. Work with your healthcare provider to get the support you need and lower risks of not getting enough nutrition.
Always inform your nephrologist about your goals when it comes to your health. And always speak up for yourself and your health!
A low protein or very low protein diet can be a good way to save your kidney function and stay away from dialysis for as long as possible.
With less protein comes more fat in the diet. Make sure that it still comes from healthy sources and not processed foods.
To follow a low protein diet in the safest and most beneficial way possible, work with a dietitian. Find a dietitian that specializes in renal nutrition and knows about a low protein diet and ketoanalogues.