Chronic Kidney Disease and Plant-based Diets

Is your goal to slow down the progression of chronic kidney disease (CKD) through diet changes? But are you completely lost when you read through the online search results for CKD and diet? I am a registered dietitian specializing in CKD and dialysis, and even I am overwhelmed by all of the diet options for CKD.

So today, I’m breaking it down with a focus on plant-based diets!  A plant-based diet is gaining in popularity for health and environmental reasons. There is not a specific definition for plant-based eating. For some people it means replacing some of their meat entrees with plant protein sources. For others it means cutting out all animal products.

One of the more well-known types of plant-based diets is a vegetarian diet. Let’s review the role of a vegetarian diet in CKD management. In addition, we will explore the potential advantages of moving from animal-based protein to plant-based protein. This post will focus on CKD, non-dialysis diet tips.

Plant-based and Vegetarian Diet FAQs

The following are frequently asked questions I receive from patients on a regular basis. Hopefully, they help answer a few of your questions, too.  However, please keep in mind that there are different perspectives on the potential benefits of a plant-based diet, so you should continue to consult with your healthcare professional about what is best for you.

Question:  I am currently a vegetarian. Do I have to start eating meat to ensure adequate protein intake?

Answer:  The short answer is, no. Protein is important to stay healthy, so it is important to work with a renal dietitian to ensure you get enough protein from a variety of plant sources. Eggs and dairy products may be included as well. Everyone’s needs are different based on body mass, stage of kidney disease and other individual factors.

According to Dr. Shivan Joshi, clinical assistant professor at New York University, “It’s been shown that patients with CKD who obtain food from plant sources may actually demonstrate improvement in several of the complications of CKD like hypertension, metabolic acidosis and hyperphosphatemia.”(1) 

This means that eating a primarily plant-based diet may help decrease the risk of high blood pressure, high acid levels and high phosphorus levels in the blood. (1)

Question:  How can a plant-based diet help me?

Answer:  A plant-based diet may help to do the following:

1. Maintain a healthy weight. Plant-based foods may have less calories and more fiber to help you feel full, which can help you avoid overeating.
2. Decrease blood pressure. Many processed meat products contain added salt, phosphorus and potassium in preservatives and flavoring. High salt intake may affect your blood pressure, resulting in damage to your kidneys and heart. High potassium levels may result in muscle weakness and changes in heart rhythm. High phosphorus is damaging to bones and may lead to calcification of the blood vessels and heart (4, 5).
3. Reduce risk and symptoms of diabetes. Plant-based foods often take longer to digest. This may decrease the amount of sugar that is absorbed into the blood stream. The less sugar (glucose) in the blood stream, the less insulin required by keep blood sugars within an acceptable range (3, 4).

Question:  Will a plant-based diet slow down the progression of CKD?

Answer:  There are many factors that determine the progression of CKD. Some we can manage and some are outside of our control. Diet is one area that is promising, but it is not a sure thing for every person with CKD.

However, it appears that moving to a more plant-based diet may be beneficial to overall health for some individuals.

According to Dr. Beddhu from the University of Utah, School of Medicine, “Our research indicates that plant-based proteins could play an important role in improving the health outcomes of people with decreased kidney function.”(1)

A recent study from the University of Utah showed that an increase in plant protein (to total protein ratio) was associated with a decrease in death among individuals with CKD.(1) 

Question:  Will a primarily plant-based or vegetarian diet help me manage my phosphorus levels?

Answer: Plants contain fiber and phytates. Phosphorus in plants is bound to phytates so it isn’t as easily absorbed into the blood stream. In addition, foods with fiber take longer to digest, so phosphorus does not move into the blood stream as quickly as it does from animal protein. (1)

Question:  Do I need to decrease the amount of vegetables and minerals I eat to limit potassium and phosphorus?

Answer:  If you are familiar with the typical “kidney diet” you know that limiting fruits and vegetables has been encouraged to ensure a person does not consume too much potassium.

There is evidence supporting the move from a diet that focuses on restricting minerals and protein, to one that focuses on healthy eating. The focus is on increasing fruits, vegetables and whole grains while reducing red meat, refined sugar and processed foods. Some may find this eating plan is easier to follow than counting protein and minerals. According to the article “CKD Patients May Live Longer on a Plant-Based Diet” in Renal & Urology News, this way of eating may lower risk of death in the CKD population. (2)

Question: Which plant-based foods are high in protein?

Answer:  Legumes (lentils, beans, peas), nuts and nut butters (unsalted, of course)Soy beans and soy products; grains (steel-cut oats, millet, spelt, wild rice, high protein pasta and cereals, quinoa)

In addition, some people who choose to eat a mostly vegetarian diet may include animal-based protein like milk, yogurt, cheese and eggs that add to an individual’s overall protein intake.

Summary

In conclusion, there is some evidence that adopting a plant-based diet may: 1) slow down the progression of CKD; 2) decrease many of the complications associated with CKD; and, 3) help a person live longer. However, it is important that you consume adequate amounts of protein for your age, size and sex. Work with a renal dietitian to ensure you are meeting all of your nutritional needs.

References

1. https://www.renalandurologynews.com/home/news/nephrology/chronic-kidney-disease-ckd/greater-plant-protein-intake-may-lower-death-risk-in-ckd-patients/ Renal and Nephrology News; December 11, 2015; accessed February 10, 2020.
2. https://www.renalandurologynews.com/home/news/nephrology/chronic-kidney-disease-ckd/ckd-patients-may-live-longer-on-a-plant-based-diet/ Renal and Nephrology News; December 14, 2016; accessed February 10, 2020.
3. https://www.kidney.org/atoz/content/plant-based; accessed February 10, 2020.
4.  https://kidneyhi.org/dietitian-blog/plant-based-diets-and-kidney-disease; accessed February 10, 2020.
5. https://www.dpcedcenter.org/staying-healthy/nutrition/ Accessed February 10, 2020.

Additional Kidney Diet Resources

Visit DaVita.com and explore these diet and nutrition resources:

DaVita Food Analyzer

DaVita Dining Out Guides

Today’s Kidney Diet Cookbooks

DaVita Kidney-Friendly Recipes

Diet and Nutrition Articles                                                      

Diet and Nutrition Videos

Kidney Smart® Virtual Classes

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.