The Impact of plant-based diet on kidney disease

Senior grocery shopping for vegetables

Is there a specific diet that can help slow down chronic kidney disease (CKD)?

There are several arguments and opinions dictating CKD patients what to eat to manage their conditions. 

Nevertheless, there’s plenty of evidence that suggests that diets consisting of whole ingredients and minimizing processed foods have a positive effect in preserving kidney function. That’s what a plant-based diet does!

A whole-food, plant-based diet primarily focuses on eating plant foods and cutting back on animal-sourced food products. It also minimizes the consumption of processed foods.

What is a Plant-Based Diet? 

Green salad with berries

1. Whole food - It refers to natural and unrefined foods, which means they are not heavily processed and only contain minimally refined ingredients. 

Examples of these foods are: 

  • Whole grains and vegetables
  • Leafy vegetables
  • Beans and other legumes
  • Nuts and seeds

2. Plant-based - Foods that come from plants and don't contain animal ingredients like meat, eggs, dairy, or honey.

A whole-food, plant-based diet avoids the intake of highly processed foods, canned soups, and foods products with artificial sweeteners. 

There are 3 common types of plant-based diets. These include:

1. The DASH diet - DASH stands for Dietary Approaches to Stop Hypertension. It focuses on eating fruits, vegetables, whole grains, nuts, fish, poultry, and low-fat dairy. 

It also consists of foods that help lower blood pressure, specifically foods that are low in sodium and foods high in calcium, magnesium, and potassium. As the term implies, the DASH diet is tailored for people with high blood pressure.  

2. The Mediterranean diet - This diet consists primarily of vegetables, fruits, grains, nuts, cereals, and regulated amounts of fish, red meat, yogurt, and olive oil.

3. The MIND diet - This is a combination of the DASH and Mediterranean diets and is designed to prevent declining cognitive function in elderly individuals. 

The MIND diet emphasizes foods like green leafy vegetables, berries, whole grains, fish, poultry, and olive oil. Cheese, butter, red meat, fried foods, and sweets are cut off in this diet. The MIND diet is often recommended for elderly individuals who have Alzheimer’s disease.

What is a CKD-Friendly Diet?

Green egg grapes salad

Impaired kidneys don’t function as they should. As a result, waste and fluids accumulate in your body. Gradually, waste and fluid buildup can have a negative impact on the heart and bones and can result in different health conditions. 

This is where a kidney-friendly diet is crucial. A meal plan specially designed for preserving kidney function aims to control your intake of specific foods, beverages, and specific minerals (i.e. sodium, protein, potassium, and phosphorus). This is important in preventing excess buildup of waste and fluids in your body, which ultimately increases your kidneys’ workload.

A renal diet plays an important role in maintaining your kidney function and slowing the progression of your kidney disease. It emphasizes the consumption of foods lower in sodium, potassium, and phosphorus. 

Below are the general dietary guidelines for people in different stages of CKD according to the American Kidney Fund:

Stages 1 and 2

  • Eat fresh fruits and vegetables 
  • Drink adequate amounts of water
  • Cook your food at home more often so you can control your salt, oil, and nutrient intake
  • Choose unsalted canned or jarred foods
  • Instead of salting your food to add flavor, use natural herbs and spices
  • Choose whole grains (brown rice) over refined grains (white rice)
  • Get your protein from lean sources like fish, chicken, quinoa, beans, or soy products
  • Make sure to get 0.8g of protein per kilogram of your body weight


Stages 3, 4, and 5 (not on dialysis)

  • Eat smaller portions of protein in every meal
  • Eat lean protein sources like fish, chicken, quinoa, beans, or soy products
  • Avoid red meat (e.g. pork, beef, lamb, and venison)
  • Eat low-potassium vegetables
  • Avoid drinking sports drinks and carbonated drinks, as they have high sodium, potassium, and calorie content
  • Cook your meals at home and limit your salt, oil, and other nutrients that may further damage your kidneys
  • Choose saltless canned and jarred food products
  • Choose whole grains (brown rice) over refined grains (white rice)
  • Eat 0.6-0.8 gram of protein per kilogram of your body weight

Considering the dietary restrictions in every CKD stage, following a plant-based diet becomes a sensible next step for kidney disease patients to better manage their health.

People with early kidney disease can benefit most from a plant-based diet. Studies show that it is effective in helping CKD patients maintain a healthy weight, control their blood pressure, reduce cholesterol, and lower diabetes risk. Over time, these benefits can help prevent your kidney function from declining.

A huge part of following a kidney-friendly plant-based diet is proper food portioning and being mindful of your food choices. You might think that potatoes are healthy for you since they are vegetables. But a plate full of potatoes can increase your potassium levels which is totally harsh for your kidneys. The key is to limit the serving size in every meal based on your recommended nutrient limit for the day.

Every person has unique nutritional requirements. That is why it is important for CKD patients to work with a renal dietitian in designing a meal plan based on their individual CKD stage and lab values.

Merging Plant-Based and Renal-Friendly Diets

Generally, plant-based diets are a potent source of fiber and various vitamins and minerals. They are instrumental in reducing the risk of chronic diseases, including diabetes, heart disease, and CKD. 

So if you’re wondering if it’s safe for kidney disease patients to be on a plant-based diet, the answer is yes. In fact, there are mounting scientific studies that show the benefits of a plant-based diet in managing CKD and preventing its causes:

Reduced inflammation - People with CKD can experience chronic inflammation. A plant-based diet can lower the risk surrounding this condition. A study published in the online journal Nature Reviews Nephrology cites that inflammation can be prevented by eating a fiber-rich diet of fruits, vegetables, and whole grains. Increasing fiber intake helps produce more anti-inflammatory compounds and reduces uremic toxins (toxic substances excreted by a damaged kidney).

May prevent immediate eGFR decline - A study published in the Clinical Journal of American Society of Nephrology states that plant-based diets were linked to a 12% lower risk of eGFR decline compared with meat-based diets. 

Delays CKD Progression - The same study suggests that plant-based diets in people with eGFR values of 30-59 ml/min per 1.73 m2 may delay progression to end-stage renal disease (ESRD) and dialysis, improving their survival rate. 

Plant-based diets also have low net endogenous acid load, which lowers the acids in the bodily fluids in people with CKD. This can contribute to the slowing down of kidney disease progression.

Better weight management - Plant-based foods contain lesser calories compared to animal-based foods. This makes it easier for you to maintain a healthy weight.

Lower blood pressure and cholesterol levels - Many people with kidney disease are at a high risk of developing heart disease. This is because their impaired kidneys cannot control blood pressure anymore. A constantly high blood pressure can result in heart disease and may further damage the kidneys. 

By eating more fruits, vegetables, whole grains, avoiding saturated fats, and cutting back on your sodium/salt intake, you can lower your blood pressure. Following a plant-based diet also prevents cholesterol buildup in your arteries.

Lower risk of diabetes - Diabetes is the number one cause of kidney failure. Statistics from the National Kidney Foundation shows that about 247,000 cases of kidney failure in the US are attributed to diabetes. Early dietary changes are crucial in preventing diabetic kidney disease. 

Research suggests that people with diabetes can prevent their condition from worsening, bring their blood sugar to a healthy level, and protect their kidneys from damage by embracing a plant-based diet.

A diet that consists mostly of fruits, vegetables, and whole grains may even keep pre-diabetes from progressing to type 2 diabetes by reducing the risk of excess weight gain. Studies also show that eating plant protein can reduce insulin resistance.

These are just a few of the wonderful benefits of following a plant-based diet in staving off CKD and other chronic diseases. Fortunately, anyone can experience these benefits, optimize their kidney function, and improve their quality of life through a renal-friendly plant-based diet.

The first step you can take is to gradually implement small changes to your diet. Read on as we break down the steps for you.

Simple Yet Impactful Ways to Get Started with a Plan-Based Diet

Note that you don’t have to quit cold turkey on animal foods on your first attempt at going plant-based. Replacing animal sources of protein with plant proteins at two or three meals each day is a good start! 

Below are more tips to get a head start with a plant-based diet:

  1. Swap out animal protein sources (e.g. beef, fish, and dairy) with plant proteins (e.g. whole grains, nuts, soy, and tofu) at your meals or snacks.
  2. Swap processed grains with whole grain foods.
  3. Keep a diet journal where you list down your daily calorie and protein intake. Doing this helps you stay on top of your diet and to track your progress.
  4. Develop the habit of reading the nutrition facts label when buying groceries. Take note of the serving sizes, specifically the amount of protein, calories, sodium, potassium, and phosphorus for every food item.

Certain fruits, vegetables, and legumes may have high levels of potassium. Some plant-based meat products like tofu burger patties may contain excess amounts of sodium.

IMPORTANT NOTE: Consult with your nephrologist and renal dietitian before making any dietary adjustments. They will have to evaluate your kidney health, medical history, and nutrient needs first to see if a plant-based diet works for you.

A rigid plant-based diet is not advisable for people who are on dialysis, as they need sufficient amounts of protein to recover the protein they lost during the treatment. Do not create your own meal plan. Always seek the advice of your dietitian. 

Bottomline

A kidney-friendly plant-based diet is rich in fiber and various vitamins and minerals. 

Research shows that eating more whole foods, fruits, and vegetables as well as minimizing the consumption of animal foods and processed foods help lower the risk of chronic kidney disease. A plant-based diet can also keep diabetes and heart disease at bay.

Switching to a plant-based diet is not as easy as changing your clothes. Any lasting change doesn’t happen overnight, especially if it involves long-held habits. 

What’s important is to implement small dietary habits at the onset, and to keep doing it everyday until it becomes a part of your routine. 

In the second part of the plant-based diet series, we’ll debunk the top myths about plant-based diets. Stay tuned!