Low protein diet

[MooseMom]

When I saw my renal dietician some years ago, she warned me about the usual things...high potassium and high phos foods and how to keep those levels down through diet.  She never really talked about a specific low protein diet.  She said that I was allowed 3 oz of meat, about the size of a deck of cards, but that was about all the info I got.  How do you all define a "low protein diet"?

[Restorer]

When I was pre-dialysis, my neph told me that he doesn't necessarily advocate a low-protein diet because he wasn't convinced it significantly prolongs the life of failing kidneys. He did tell me stay away from a high-protein diet (Atkins and the like).

Then again, he also glossed over my high phosphorus every time, and I don't think he was a very good doctor.

[MooseMom]

I went for a pretransplant evaluation in Nov 2004, and with it being the day before Thanksgiving, the nephrologist told me in a joking manner not to eat too much turkey, but that's all of the "low protein" type advice I've ever been given.  I have a book called "Coping with Kidney Disease; A 12-Step Treatment Program to Help You Avoid Dialysis" authored by a Dr. Walser of Johns Hopkins, and he does bang on about a low protein diet; that seems to be the focus of his book.  (In saying that, though, it is an invaluable book that discusses the various side effects of CKD and how to make sure your neph is treating those side effects, so the book isn't useless by any means).  I did try to limit my protein and bought special bread flour and all sorts of stuff, but it got really expensive and difficult, so I gave up and just tried to stick to small portions of protein.

[paris]

My problem was getting enough protein.  It tastes terrible and my levels were always low. My neph recommended 40 grams of protein a day.  I consulted our resident diet expert, Zach, to help me understand how much protein 40 grams was.    Diet is definately something I struggle with.     It continues to amaze me how different the advice is from nephs.   Everyone says something different. Very confusing!

[AguynamedKim]

I have been doing a fair amount of research on the level of protein recommended for pre-dialysis diets and have read Dr. Walser's book.  There's only 1 thing I know for sure - there seems to be no consensus with health care professionals on the advocacy of a "normal" (50-90 grams), "low" (40-50 grams) or "very-low" (20 grams) protein diet.  There's a fairly strong consensus on not taking in too much protein (ironic since initial CKD diets advocated large amounts of protein to "make-up" for the protein loss).  After reading Dr. Walser's book, I switched immediately to a vegatarian diet and have been watching my protein.  I was debating between going "low protein" versus "very-low protein" (which is very difficult to do since just about everything has at least a little protein and you need to make sure the little bit you do get is essential amino acids - hence the necessity for the supplements).  Right now I'm probably eating low protein by taking in no major proteins other than 2-3 egg whites a day via my fritatta recipes (at 7 grams each that would be 14-21 grams).  Plus all of the incidental protein of likely another 20 grams.  I haven't started tracking my food as closely as I am planning on doing as just trying to find food I can eat has been difficult (as you all know well).  Do y'all have a daily protein target?

[MooseMom]

I love my fruit and veg and could easily be vegetarian in a normal life, but I have problems with high potassium; I currently take 8 sodium bicarb tablets a day to combat this as restricting my diet alone is not sufficient.  It's hard for me to believe, even after all these years, that there is actually such a thing as eating TOO MANY fruits and vegetables.   I adore beans of every kind, but then there is the phosphorus problem.  My favourite lunch used to be a jacket potato topped with some type of bean or legume, but NOOOOOOOOOO, not any more, no siree.

I don't have a daily protein target, but I don't eat more than 3-4 oz of lean protein a day.  I use the old "palm sized" trick when measuring portions.  I keep very close tabs on my labs and eat (or not) accordingly. It's true that there doesn't seem to be any consensus at all on this issue, which can be frustrating.

[AguynamedKim]

Moosemom - did you (or anyone here) ever try the LoProfin crackers?  I orded some from a diet place that caters to PKU patients (they can only have about 6 grams of protein a day and have to avoid a specific amino acid).  Wow, they were dry.  And basically tasted large a giant cornstarch cracker.  They had this weird rigid yet flexible structure that would eventually break down when you "snapped" it in your teeth and/or kinda gnawed at it for a while.  I've been eating a ton of vegetable soup lately and was looking to add some texture to the mix.  It's a different texture alright - kinda like drywall is a different texture.  All that said, I've grown strangely fond of them...

[ChickenLittle56]

MM i guess there isn;t going to be egg eating contest in your future.

[AguynamedKim]

Funny you should say that, ChickenLittle56.  I work in the energy industry with a bunch of crazy energy traders (those Enron types), and we often have pretty strange "feats of strength/stupidity."  One of these a couple of years back was me versus a triathlete in an 18 egg eating contest.  I was the relatively older, fatter guy versus the young, fit kid in a dual to see who could finish their plate of 18 scrambled eggs first.  Unfortunately I did end up losing, but not by much.  Thinking now at the amount of protein I took in that day...126 grams...makes me kinda want to    (although I did keep everything down that day).

[okarol]

From AAKP: Diet and the Predialysis Patient
Here's the pdf file http://www.aakp.org/userfiles/file/Delicious!%20Final.pdf

[MooseMom]

"LoProfin"...that name sounds familiar.  I think I ordered some of their low protein flour years ago; my husband bought me a breadmaker so that I could make myself low protein bread.  That didn't last long! 

All I can say on the subject is that whenever I speak about my diet to either my neph, his nurse or the dietician, they always put WAY more emphasis on potassium and phos than on protein.

[Sunny]

I am on an extremely low protein diet averaging about 20-30 grams a day and have been doing this for almost ten years.When I went to see my surgeon who is working me up for my potential transplant he told me people on the extremely low protein diets often have higher GFR numbers that don't reflect the way they are feeling. You may have symptoms of someone with a much lower GFR. This can become a problem for people when you're telling your doctor you feel absolutely terrible, but they are saying,"Your GFR is 15%, you shouldn't be feeling this lousy." When you have a potential living donor, like me, they might argue you don't need a transplant just yet, or your nephrologist might argue you don't need dialysis yet. It is a double edged sword.

[AguynamedKim]

Sunny, do you feel it's been good for you these 10 years and do you feel it's slowed the progression?  Would you do it the same way?  I very much appreciate hearing this perspective.  I always wondered if low protein diets treat the disease or just kinda fool the test (or perhaps some of both - it always seems gray).  With such a low protein intake, are you careful about making sure you are taking in your essential amino acids?  I focus on eggs since they seem to be about the best complete protein - the egg whites specifically.  Do you take any complete protein/amino acid supplements?

[Marina]

When I  was  diagnosed  my  Dr   sent me  to  a dietitian  he  wanted  me to  be on a low protein  diet.
The only  difference  back then  he only  mentioned   meat  and  chicken, I  could  have  as  much  cheese  9no phos  problems  then.   But  now,  they  say  low protein  includes  ALL protein.
I  attended a  semminar on this,    here's  what   more  info on  that:

http://www.baakp.org/Newsletters/KidneyKonnections_May_09.pdf
There are things you can do to try and delay the progression
of kidney disease. Keeping your blood pressure under control
is key; especially by using an ACE-inhibitor type of blood pressure
medicine with “pril” as the suffix. Know your lab test results
and try to keep your hemoglobin A1C under 7.0%, your
blood pressure under 130/80, your bad cholesterol less than
100, and eat no more than 0.08 gms/kg body weight of any
type of protein per day. A proper diet is another way to slow
the progression of diabetes and kidney disease. The website
www.nal.usda.gov/fnic/foodcomp/search can help you find out
what the foods you are eating have in them.
Vivek Bhalla, M.D.,
Stanford University Medical Center
Division of Nephrology


 

[Zach]

... and eat no more than 0.08 gms/kg body weight of any
type of protein per day.

Are you sure that is correct?  .08 gms? 
That does not make sense.

At a body weight of 76 kilos, that's only 6 grams of protein a day I would be eating as a pre-dialysis patient.
That's less than one egg!!! That's a prescription for malnutrition!

Please check those numbers ... the newsletter, "Kidney Konnections" must have a typo.

Perhaps the good doctor said 0.8 grams of protein per kilogram of body weight.
Actually, 0.75 grams per kilogram of ideal body weight (IBW) is recommended, along with at least 35 kCal/kg IBW/day:

"Suggestions for Clinical Care

(Suggestions are based on Level III and IV evidence)

 ... For patients with progressive chronic kidney disease (CKD), who receive a protein-restricted diet, the protein content should not be lower than 0.75 g per kg ideal body weight (IBW) per day. The protein should be of at least 50% high biological value. An energy intake of at least 35 kCal/kg IBW/day to minimise protein-energy malnutrition must accompany a low protein diet. (Level II evidence)

 ... CKD patients should not commence a lower protein diet until any plasma acidosis is corrected. (Level III evidence)
It is recommended 15% to 20% of daily energy intake is in the form of protein. Over 50% of this protein should be of high biological value (see the Appendix in the original guideline document).

Low protein diets may increase the risk of zinc, selenium, and some B vitamin (riboflavin, pyridoxine, B12) deficiencies."

"... Between 50% and 66% high biological protein content has been recommended or used (see Table 1 in the Appendix in the original guideline document). This recommendation is to ensure the limited protein taken is maximally utilised for its amino acid composition, and not for energy. It is imperative that adequate energy is consumed with the protein restriction diet to avoid protein-energy malnutrition ..."

http://www.guideline.gov/content.aspx?id=11985#Section420

[AguynamedKim]

I think you're definitely right about the typo, Zach.  I've often seen .8 grams/kg of ideal weight as a target level for protein intake a few different places.  A figure of .08 grams/kg of ideal weight, as you pointed out, would be at a level I haven't seen recommended for anyone except a PKU patient.  Even the Walser book didn't go below 20 grams overall (still quite limited).  The line that resonnated heavily with me is making sure that when you do intake lower amounts of protein, that you do so with adequate calories so that the protein is not used as energy versus broken down into essential amino acids used to help build back up your body.  I'm now making sure I eat enough calories when I do take down my 1 egg white with dinner.  Of course, I'm trying to lose weight was well so it's going to be hard for my body to not use up that protein as energy.  Hmmmm...I'll just add this information to the pile and do my best.

[murphy]

Some dialysis patients need to be on a high protein diet if they are losing a lot in their urine. They had me aim for 120 because my albumin was only 1.5.  This was really hard since I threw up at the smell of meat.  I was very malnourished.

[Sunny]

Yes, my low protein diet for the last 10 years was worth it. I should also mention I was on blood pressure medications and drank plenty of water. I believe I had fewer symptoms over the years, although the last year has been very hard regardless with GFR of 14%. The more protein I ate, the more nauseous I felt and the more amonia breathe I got.I could always tell when I was eating too much meat. It is easier to digest other forms of protein.I never took protein supplements and took B-complex vitamins(renavite).Mind you, this is pre-dialysis.