Plant-Based Diet for Minimal Change Disease of the Kidney

Michael Greger M.D. FACLM · July 3, 2023 · Volume 62

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What are the three reasons plant protein is preferable to animal protein for kidney protection?

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Transcript

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Chronic kidney disease is one of the top ten leading causes of premature death in the United States, and its incidence is increasing. Chronic kidney disease affects more than 10 percent of the adult population, and each year, more than 100,000 Americans develop end-stage kidney disease and have to go on dialysis. What’s crazy is that a staggering 96 percent of individuals with mild to moderate decreases in kidney function and about half of individuals with severely decreased kidney function go undiagnosed. Meaning the vast majority, like 24 out of 25 people with chronic kidney disease, don’t even know they have it.

What can we do to maintain our kidney function? Well, in a study that followed more than a thousand older women for a decade, those consuming a diet that is richer in plant-based protein had a slower decline in kidney function, extending support for the health benefits of plant-rich diets in the general population to maintain kidney health. Compared with protein from plant sources, animal protein has been associated with an increased risk of end-stage kidney disease in several such studies. We’re not exactly sure why. Kidney damage from animal protein could result from the dietary acid load, excess phosphorus, or gut microbiome bad bacteria and the resultant inflammation.

The dietary acid load in a Standard American Diet is derived mostly from animal sources such as meats, eggs, and cheeses. In contrast, by including a higher proportion of foods with natural alkali, such as fruits and vegetables, a strictly plant-based diet is nearly acid neutral. Even just eating plant-based 2 or 3 days a week can significantly bring down the acid load delivered to the kidneys, and eat plant-based full time, and you can actually flip over into alkaline territory. Even just cutting out meat can yield an alkaline load compared to the acid load in the nonvegetarians. All this is important, since dietary acid may promote kidney injury and a progressive decline in kidney function.

The intake of animal protein can also cause an imbalance in the composition of the gut microbiome by producing more ammonia and the rotten egg gas hydrogen sulfide, and have a proinflammatory effect that may result in reduced kidney function, but it also may be the animal fat. In the Harvard Nurses Study, higher intake of animal fat was directly associated with the loss of protein into the urine, which is a sign of kidney damage, and to protect against that, they suggest diets lower in animal protein, animal fat, and cholesterol.

That may help explain why vegetarians have better kidney function than nonvegetarians matched for sex, age, size, physical activity, alcohol, smoking, etc. So effectively, even a meat eater who is just as slim as a vegetarian, just as healthy cholesterol, blood pressure, and blood sugar control-wise still had inferior kidney function. They think it might be the higher dietary fiber intake on more plant-based diets contributing to the protective effect on kidney function, again through a microbiome mechanism. Whereas the consumption of animal protein may lead to a proliferation of meat-eating bugs, which can result in a leaky gut, uremic toxins, and resulting inflammation, oxidative stress, and chronic kidney disease progression. That can be blocked, with the decreased inflammation and acid load thanks to eating more fiber rich foods.

No wonder an egg-free vegetarian dietary pattern was associated with a 37 percent decreased odds of developing chronic kidney disease. But, what about plant-based diets for not just the prevention but the management of chronic kidney disease? Can comprehensive lifestyle change alter the course of chronic kidney disease? This was the case report of someone diagnosed with minimal change disease. That’s when someone’s kidneys start leaking protein, even though there are minimal changes seen in biopsies under the microscope. You give people steroids and, in a few months, you can knock it down, but a significant fraction may fail to respond to the steroid therapy. He was diagnosed 18 years prior, but only by replacing animal protein with plant-based protein was he able to put his chronic kidney disease into remission.

At age 44, he suddenly developed swelling that crept up throughout his body since he was losing so much protein. He was weak, unable to concentrate, and lethargic. Diagnosed with minimal change disease and treated with a water pill and four different blood pressure lowering agents. Because of unresponsiveness to high-dose steroids, a powerful immunosuppressant was added; yet, severe protein loss continued and his hypertension and kidney function worsened until he started eating plant-based, started exercising, and lost 60 pounds. His kidney disease went away and stayed away.

Let’s hear it in his own words. “I appreciate the recommendations my doctor gave me about making dietary modifications: ‘replace your protein intake with plant-based protein.’ This one change has had a monumental impact on my life. I have gained back a quality of life that I thought was gone forever. My benchmark for normal has been my ability to keep up with my professional work demands and still be able to exercise. For the last 7 months, I now swim over three miles every other day: a distance that surpasses my pre–kidney disease life. I perceived I lived a healthy lifestyle before kidney disease; today, I live a healthier, happier lifestyle, and I have my kidneys to thank for it.

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Sources

Acknowledgements

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Chronic kidney disease is one of the top ten leading causes of premature death in the United States, and its incidence is increasing. Chronic kidney disease affects more than 10 percent of the adult population, and each year, more than 100,000 Americans develop end-stage kidney disease and have to go on dialysis. What’s crazy is that a staggering 96 percent of individuals with mild to moderate decreases in kidney function and about half of individuals with severely decreased kidney function go undiagnosed. Meaning the vast majority, like 24 out of 25 people with chronic kidney disease, don’t even know they have it.

What can we do to maintain our kidney function? Well, in a study that followed more than a thousand older women for a decade, those consuming a diet that is richer in plant-based protein had a slower decline in kidney function, extending support for the health benefits of plant-rich diets in the general population to maintain kidney health. Compared with protein from plant sources, animal protein has been associated with an increased risk of end-stage kidney disease in several such studies. We’re not exactly sure why. Kidney damage from animal protein could result from the dietary acid load, excess phosphorus, or gut microbiome bad bacteria and the resultant inflammation.

The dietary acid load in a Standard American Diet is derived mostly from animal sources such as meats, eggs, and cheeses. In contrast, by including a higher proportion of foods with natural alkali, such as fruits and vegetables, a strictly plant-based diet is nearly acid neutral. Even just eating plant-based 2 or 3 days a week can significantly bring down the acid load delivered to the kidneys, and eat plant-based full time, and you can actually flip over into alkaline territory. Even just cutting out meat can yield an alkaline load compared to the acid load in the nonvegetarians. All this is important, since dietary acid may promote kidney injury and a progressive decline in kidney function.

The intake of animal protein can also cause an imbalance in the composition of the gut microbiome by producing more ammonia and the rotten egg gas hydrogen sulfide, and have a proinflammatory effect that may result in reduced kidney function, but it also may be the animal fat. In the Harvard Nurses Study, higher intake of animal fat was directly associated with the loss of protein into the urine, which is a sign of kidney damage, and to protect against that, they suggest diets lower in animal protein, animal fat, and cholesterol.

That may help explain why vegetarians have better kidney function than nonvegetarians matched for sex, age, size, physical activity, alcohol, smoking, etc. So effectively, even a meat eater who is just as slim as a vegetarian, just as healthy cholesterol, blood pressure, and blood sugar control-wise still had inferior kidney function. They think it might be the higher dietary fiber intake on more plant-based diets contributing to the protective effect on kidney function, again through a microbiome mechanism. Whereas the consumption of animal protein may lead to a proliferation of meat-eating bugs, which can result in a leaky gut, uremic toxins, and resulting inflammation, oxidative stress, and chronic kidney disease progression. That can be blocked, with the decreased inflammation and acid load thanks to eating more fiber rich foods.

No wonder an egg-free vegetarian dietary pattern was associated with a 37 percent decreased odds of developing chronic kidney disease. But, what about plant-based diets for not just the prevention but the management of chronic kidney disease? Can comprehensive lifestyle change alter the course of chronic kidney disease? This was the case report of someone diagnosed with minimal change disease. That’s when someone’s kidneys start leaking protein, even though there are minimal changes seen in biopsies under the microscope. You give people steroids and, in a few months, you can knock it down, but a significant fraction may fail to respond to the steroid therapy. He was diagnosed 18 years prior, but only by replacing animal protein with plant-based protein was he able to put his chronic kidney disease into remission.

At age 44, he suddenly developed swelling that crept up throughout his body since he was losing so much protein. He was weak, unable to concentrate, and lethargic. Diagnosed with minimal change disease and treated with a water pill and four different blood pressure lowering agents. Because of unresponsiveness to high-dose steroids, a powerful immunosuppressant was added; yet, severe protein loss continued and his hypertension and kidney function worsened until he started eating plant-based, started exercising, and lost 60 pounds. His kidney disease went away and stayed away.

Let’s hear it in his own words. “I appreciate the recommendations my doctor gave me about making dietary modifications: ‘replace your protein intake with plant-based protein.’ This one change has had a monumental impact on my life. I have gained back a quality of life that I thought was gone forever. My benchmark for normal has been my ability to keep up with my professional work demands and still be able to exercise. For the last 7 months, I now swim over three miles every other day: a distance that surpasses my pre–kidney disease life. I perceived I lived a healthy lifestyle before kidney disease; today, I live a healthier, happier lifestyle, and I have my kidneys to thank for it.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

For more on kidney health, see my overview videos How Not to Die from Kidney Disease and Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease.

Note, though, that some plants can be overdone. For more on this, see Kidney Stones and Spinach, Chard, and Beet Greens: Don’t Eat Too Much.

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