I had a beef burger today, so now what?

[Athena]

After being advised by my Neph to eat red meat at least once or twice a week, I did just that today. I had a juicy beef burger today (grass-fed organically raised beef). It seems like I've never been so satisfied before in the culinary sense like I was after eating this burger. So I guess now my kidneys must be feeling so stressed from this. I feel fine but can anyone just fill me in as to what nastiness must be happening now in the body? I am just so confused.

I am seeing my renal dietician next week just to go over everything with her again. No doubt she will tell me that I should limit or eliminate red meat, etc.

I am so confused about what diet I should follow. Can anyone quote any authoritative experts on this topic? I get the feeling that vegetarian diets may no longer be the gold standard in CKD dietary recommendations but I read contradictory things all the time about this. Would like to hear from others who may also be pondering about the best way to eat in Stage 4 CKD.

[kickingandscreaming]

I know there are some who swear by the vegetarian diet for everything.  I don't think it's that simple.  I think there are better and worst diet for each body.  We are all different in how we process food.  And, there is very little agreement among nephrologists about the protein question.  I was vegetarian for 35 years and my taste buds love eating that way.  But my body does not. I gained tons of weight trying to get adequate protein on the vegetable side of things.  I am convinced that it pushed me to be diabetic-- all that starch, grains and legumes and dairy, etc.  So. for me, I do better eating meat--even though it hurts me ethically and morally.  It is important to get plenty of protein and it becomes absolutely criitical once you're on dialysis.

Everything in moderation, including moderation.

[MooseMom]

A renal dietician can be the very best tool to help you combat the effects of CKD, assuming that s/he knows what s/he is doing.  Mine was extremely helpful.

It is important to remember that a "healthy" diet can be terrible for someone with severe CKD.  Your personal definition of a "healthy" diet will become clearer once you see the dietician.

Your dietary requirements may change as your CKD worsens (if it worsens at all).

A vegetarian diet may sound all well and good, but it is vegetables that contain high amounts of potassium, and legumes and whole grains contain a lot of phosphorus, so a typical vegetarian diet can be harmful to you.  I don't know who in the world told you that a vegetarian diet is the "gold standard" in CKD dietary recommendations, but that person should be drawn and quartered.

You will still need protein, just not so much of it.  I was allowed 3 oz a day, so a daily portion of meat is probably fine.  Leaner protein is better, but that could be said for ALL people, not just renal patients.  The trick is to be well-nourished by foods that won't harm you.  I always found it amusing that a glass of red wine was less harmful to me than a glass of milk which is high in phosphorus!

I was on the "pre-renal" diet for 8 years, so I understand the ins and outs of it.

Good luck to you!

[kickingandscreaming]

Just published. Take with a grain of salt.  What bothers me about all these anti-red meat "proclamations" is that they test people who eat a standard, high-industrialized (CAFO) meat supply.  What seems different about this study is that it postulates that it is the acid-forming nature of the red meat that is at issue, and not something else.  All animal protein is acid-forming, however, so that doesn't explain why poultry and fish are better.  One also has to wonder what a population that is so meat heavy is doing besides eating meat, e.g. drinking alcohol, smoking, eating bad fats, and on and on.

Higher Red Meat Intake Raises Kidney Failure Risk

Substituting 1 serving of red meat with poultry or fish reduced ESRD risk.

Greater red meat consumption is associated with an increased risk of end-stage renal disease (ESRD), new finding suggest.

Individuals in the highest quartile of red meat intake have a 40% increased risk of ESRD compared with those in the lowest quartile, researchers led by Woon-Puay Koh, MBBS, PhD, of Duke-NUS Medical School and Saw Swee Hock School of Public Health at the National University of Singapore reported online ahead of print in the Journal of the American Society of Nephrology. Consumption of poultry, fish, eggs, or dairy products was not associated with ESRD risk.

In addition, the investigators found that substituting 1 serving of red meat with poultry or fish resulted in a 62.4% and 48.6% reduction in ESRD risk, respectively. Replacing 1 serving of red meat with soy and legumes or eggs was associated with a 50.4% and 44.9% reduction in ESRD risk, respectively.

“We embarked on our study to see what advice should be given to CKD patients or to the general population worried about their kidney health regarding types or sources of protein intake,” Dr Koh said in a press release from the American Society of Nephrology. “Our findings suggest that these individuals can still maintain protein intake but consider switching to plant-based sources; however, if they still choose to eat meat, fish/shellfish and poultry are better alternatives to red meat.”

Dr Koh and colleagues studied 60,198 Chinese adults who participated in the prospective Singapore Chinese Health Study. ESRD developed in 951 individuals over a mean follow-up of 15.5 years. The mean age at ESRD diagnosis was 69.3 years.

Individuals in the highest quartile of red meat intake were slightly younger than those in the lowest quartile (55.7 vs. 56.5 years) and less likely to be physically active (31% vs. 39% reporting at least 30 minutes of moderate activity, vigorous activity, or strenuous sports per week). At baseline, individuals in the highest quartile had a lower prevalence of self-reported hypertension than those in the lowest quartile (22% vs. 24%), but a higher prevalence of self-reported diabetes (9% vs. 7%).

Endogenous acid production resulting from red meat consumption is among the possible explanations for the observed association between red meat consumption and ESRD risk, according to the researchers. They cited studies showing that high dietary acid load was associated with an increased incidence of ESRD in a population-based US cohort of adults with chronic kidney disease and that red meat generally yields greater acid production than other animal-sourced protein.

The strengths of the study include its prospective design, large sample size, and long-term and complete follow-up of outcomes, the investigators noted. In addition, dietary intake was assessed using a validated food frequency questionnaire developed specifically for the study population. Limitations include the observational nature of the study, the use of participant self-report, and a single assessment of diet, which could lead to misclassification bias to due measurement error, the investigators stated.

http://www.renalandurologynews.com/end-stage-renal-disease/higher-red-meat-intake-raises-kidney-failure-risk/article/508745/

[MooseMom]

You'll notice that the authors refer to their "CKD" patients.  There is a big difference in the dietary needs for a patient with CKD stage 3 and the needs (nay, RESTRICTIONS) of those in late stage 4/5.  I can't imagine that anyone who is at the point of needing a renal dietician would be told to chose legumes as an alternative protein choice.  What would that do to their phos level?  Why do articles like this completely ignore the dangers that come from eating a lot of fruit and veg?  Gosh, at stage 4, my K went up like a Saturn 5 rocket due to, probably, too many tomatoes (apparently a common summertime problem for CKD stage 4 patients)!
 

[kickingandscreaming]

Legumes are more complicated than that.  The phosphorus is bound by phytates (anti-nutrients) and isn't very assimilable.  Check out this food pyramid by renal dietitions  for CKD in Italy  that I posted a while ago http://ihatedialysis.com/forum/index.php?topic=32929.0

The money quote is that they recommend eating be
http://www.renalandurologynews.com/hyperphosphatemia/phosphorus-pyramid-for-ckd-provides-diet-advice/article/407095/

[Fabkiwi06]

I really like my dietitian. Her and I are in complete agreement that my diet should consist whole/real food. If it's something high in phosphorus, take binders. My dietitian has told me many times that having phosphorus in a natural product (like dairy or a vegetable) is better than a processed product because when it occurs naturally there are often other minerals that are also digested that make it slightly easier to pass through your system.

For me, it means I eat a lot of chicken and seafood (because that's what I like). I also eat beans and peanut butter - even though those are technically no-no foods. I try to load up on fruits and veggies, including the ones that aren't always recommended. I still eat cheese, but have tried to ease up on dairy. I'll eat a steak or a burger if I'm craving it. I do watch my sodium, but I have a lot of luck finding the low sodium swaps when I'm really craving something. For example, I found low-sodium bacon the other day at Publix, so I bought a pack and have it divided in the freezer for future treats. When my family was in town, my sister and I split a small Coke (and I had a side of binders to go with it). I try not to deny myself anything; but I do weigh it against how I'm feeling and what else I've eaten lately.

Basically, if my lab numbers are where they need to be, I don't restrict too much. But if the numbers are too high, I'll follow the "traditional renal diet" until they get back to where they need. It really depends on how your body is reacting and how everything else is.

[KatieV]

My father was a vegetarian when I was growing up, so eating meat was a very rare occurrence.  For a couple of years, we were even on a strict vegan diet that was 85% raw veggies, 15% cooked food (included whole wheat pasta, beans, etc).  Breakfast was carrot juice, and then fresh raw fruit.  I went back on that diet during college for a few weeks and felt SO much better physically.  But it's a hard diet to sustain when the rest of the family is eating other stuff!

This was years before knowing I had kidney disease (my family calls it B.K.D.).  Looking back, I think it may helped prolong my kidney function.  My genetic kidney disease usually is stage 5 at 13 years old (which 2 of my younger siblings hit).  I was diagnosed at 20 with 25% kidney function. 

Regarding phosphorus - my center had it as our "nutrition issue" a couple months ago.  They had figures (which I'm completely forgetting) to show the absorption rate between eating natural foods with phosphorus versus processed food.  It helped me become a little more aware - also a little more loose with the natural products. 

[MooseMom]

Yep, it is absolutely true that phos from legumes is completely different that phos from processed foods.  I should have been clearer on that point!

[kickingandscreaming]

But is phosph from beans different from phosph. from meat, eggs, dairy, etc.?

[Charlie B53]

ALL plants AND animals exist for our use in MODERATION.   Moderation is the key.  Excess consumption of any one item can be detrimental to health.  It is the combination of a wide and varied diet that will contain ALL the essential nutrients our body needs.

Phos in all forms must be limited.  Any consumption of any item, rare or processed, that contains more than a minimum amount may increase the demand to take binders.

I am of the opinion that humans are omnivore, eating everything that grows, walks flies or swims.  But again, moderation is essential.

[Athena]

I am of the opinion that humans are omnivore, eating everything that grows, walks flies or swims.  But again, moderation is essential.

That's a fact, not just an opinion. Humans eat both animal and plant food & have done so since the beginning of time.

I've tried eating a vegan gluten-free burger recently and the veggie pattie was simply awful! The burger place people seemed to understand though, they said that it's what a lot of their customers seem to say. It's dry (because it's low-fat) and just unsatisfying to the palate. Quinoa, chickpeas, beetroot and similar such things - sounds nice but just not in practice.

I'm sorry to say but one of the worst experiments I ever did in the past was eating a mostly raw food diet. The enormous weight loss and the constant cold raw taste of food is still something I shudder about when it pops up in my mind. Man needs to eat cooked foods, particularly in the colder seasons! And man needs to have enough fats and proteins in his diet as well (the man quote is my attempt at some humour here).

[MooseMom]

But is phosph from beans different from phosph. from meat, eggs, dairy, etc.?

I don't think so.  I think dietary phosphorus is the same whatever the source.  This is where someone will post a link to some study showing I'm wrong!     I suspect that a bigger danger lies in PHOSPHATES which are so prevalent in processed foods because they are used as preservatives, particularly in meats like bacon and sausages.

[Charlie B53]

I would venture that there is some difference between plant and animal based phos.

I know foe a fact that .... qwap, just lost the word.  The element that is the primary cause of my gout.  Higher in crustacean seafood yet found in vegetation also.  That in veggies does NOT contribute to gout.  Same stuff, only different.

I HATE it when I knkow something, think of it, then the next second it's gone. like a wisp of smoke.  And I know I've posted this word before in posts related to my experience with gout.  Another one of those 'Senior Moments"?

Whatever.  The comparison that there IS some elemental difference, not in the laboratories yet there IS a difference how that element is used within the body dependent upon what the source is.   This could be true of a number of things.  We just haven't learned enough,yet.

PURINES,   that's it!   Animal based contributes to gout, but veggy based does not.   How strange.

[Athena]

Thanks for that Charlie - Purines, got it.

Coming back to the original beef burger question - there's also NITRATES in meat that's supposed to be really bad for us with kidney disease.

[kickingandscreaming]

AFAIK nitrates and nitrites are found mainly in processed meats, e.g. bacon, sausage, deli meats, etc.   And there are many brands which do not contain them (read your labels). 

the vast majority of nitrate/nitrite exposure comes not from food, but from endogenous sources within the body. (1) In fact, nitrites are produced by your own body in greater amounts than can be obtained from food, and salivary nitrite accounts for 70-90% of our total nitrite exposure. In other words, your spit contains far more nitrites than anything you could ever eat.

When it comes to food, vegetables are the primary source of nitrites. On average, about 93% of nitrites we get from food come from vegetables. It may shock you to learn that one serving of arugula, two servings of butter lettuce, and four servings of celery or beets all have more nitrite than 467 hot dogs. (2) And your own saliva has more nitrites than all of them! So before you eliminate cured meats from your diet, you might want to address your celery intake. And try not to swallow so frequently.

https://chriskresser.com/the-nitrate-and-nitrite-myth-another-reason-not-to-fear-bacon/

[Charlie B53]

I've opened the link in another tab but haven't read it yet.

Nitrates are one of my gout triggers.  I can get by eating some, not much, but I can't layer a big sandwich or I can't turn a doorknob with my right hand for a few days.

Niece, nitrates are a trigger for migraines.  Don't know how that works.  But it shows that the element does not always do the same thing in all people.  Some of us are more sensitive in some ways than most others.

We are all very similar, just not exactly the same.

ANY food additive should be approached with caution.  Most every one is POISON, just not so bad in the very small quantities that we ingest.

The question should be,  "Why are we eating poison at all?"

[Charlie B53]

OK, I read the article.

I do NOT agree.   One day science will prove me right, again.  As there is a known difference in how the body processes purines from plant sources differently that those same purines found in animal sources, so it will be proven with many other elements.  Science has not yet learned to identify the differences in those elements found in the different sources.  Notice the 'Yet', as there must be a difference since it is already documented and repeatedly proven that for those elements such as the purines, there is an observable difference in how a human body uses them.

It has already been proven how different sources of vitamins and minerals are not processed and utilized.  These are simply further examples that science is still looking, studiing why, we simply do not know enough.

Naturally occurring nitrates from preserving process like smoking meats will be one day proven to be far different than those nitrates corporations use to process foods.  Natural vs chemical, way different.

Take your reading glasses to the store, READ the labels.  If the ingredients contain words you cannot pronounce, you probably should NOT eat it.    My reading glasses are not enough, that fine print is so fine I also need my magnifying glass.