Kidney Disease

It’s easy to take your kidneys for granted, but they work around the clock, like a high-tech, nonstop water filter for your blood. They process up to 150 quarts of blood every twenty- four hours just to make the 1-2 quarts of urine you pee out each day.

If your kidneys do not function properly, metabolic waste products can accumulate in the blood and eventually lead to such symptoms as weakness, shortness of breath, confusion, and abnormal heart rhythms. Most people with deteriorating kidney function, however, don’t experience any symptoms at all. If your kidneys fail completely, you will either need a new one (i.e., need a kidney transplant) or have to go on dialysis, a process by which a machine artificially filters the blood. But kidney donors are in short supply, and the average life expectancy of a person on dialysis is less than three years. It’s better to keep your kidneys healthy in the first place.

Although your kidneys can fail suddenly in response to certain toxins, infections, or urinary blockage, most kidney disease is characterized by a gradual loss of function over time. A national survey found that only 41 percent of Americans tested and normal kidney function, a drop from 52 percent about a decade earlier. Approximately one in three Americans over the age of sixty- four may suffer from chronic kidney disease (CKD), though three- quarters of the millions affected may not even know they have it. More than half of Americans adults currently aged thirty to sixty- four are expected to develop chronic kidney disease during their lifetimes.

Why, then, aren’t millions of people on dialysis? Because kidney malfunction can be so damaging to the rest of the body that most people don’t live long enough to reach that stage. In a study in which more than a thousand Americans over age sixty-four with CKD were followed for a decade, only one in twenty developed end- stage kidney failure. Most of the others had already died, with cardiovascular disease killing more than all other causes combined. That’s because our kidneys are so critical to proper heart function that patients under age forty- five with kidney failure can be a hundred times more likely to die of heart disease than those with working kidneys.

Kidneys are highly vascular organs, meaning they are packed with blood vessels, which is why they look so red. We already know that the standard Indian and American diet can be toxic to blood vessels in the heart and the brain – so what might it be doing to the kidneys?

Putting that question to the test, researchers at Harvard University followed thousands of healthy women, their diets, and their kidney function for more than a decade to look for the presence of protein in the women’s urine. Healthy kidneys work hard to retain protein and other vital nutrients, preferably filtering toxic or useless wastes out of the bloodstream via urine, it’s a sign that they may be starting to fail

The researchers found three specific dietary components associated with this sign of declining kidney function : animal protein, animal fat, and cholesterol. Each of these is found in only one place: animal products. The researchers found no association between kidney function decline and the intake of protein or fat from plant sources.

One hundred and fifty years ago, Rudolf Virchow, the father of modern pathology, first described fatty degeneration of the kidney. This concept of lipid nephrotoxicity, or the idea that fat and cholesterol in the bloodstream could be toxin to the kidneys, has since been formalized, based in part in part on studies that found plugs of fat clogging up the works in autopsied kidneys.

The link between cholesterol and kidney disease has gained such momentum in the medical community that cholesterol- lowering statin drugs have been recommended to slow its progression. But wouldn’t it be better (not to mention safer and cheaper) to treat the underlying causes of the disease by eating healthier.

In two decades between 1990 and 2010, the leading causes of death and disability remained relatively constant. As noted in Heart Disease Blog, heart disease is still the leading cause of loss of health and life. Some diseases, such HIV/ AIDS, have slid down the list, but among the diseases whose incidence has increased the most over the past generation is chronic kidney disease. The number of death has doubled.

Another reason animal protein may be so detrimental to kidney function is that it is generally more acid forming. This is because animal protein tends to have higher levels of sulfur containing amino acids, such as methionine, which produce sulfuric acid when metabolized in the body. Fruits and vegetables, on the other hand, are generally base forming, which helps neutralize acids in our kidneys.

Dietary acid load is determined by the balance of acid- inducing foods (such as meats, egg, and cheese) and base- inducing foods (such as fruits and vegetables). A 2014 analysis of the diets and kidney function of more than twelve thousands Americans across the country found that a higher dietary acid load was associated with significantly higher risk of protein leakage into the urine, an indicator of kidney damage.

Ancient human diets largely consisted of plants, so they likely produced more base than acid in the kidneys of our ancestors. Humans evolved eating these alkaline (base-forming) diets over millions of years. Most contemporary diets, on the other hand, produce acid in excess. This switch epidemic of kidney disease. Acid- inducing diets are believed to impact the kidney disease. Acid – inducing diets are believed to impact the kidney through “tubular toxicity”, damage to the tiny, delicate, urine-making tubes in the kidneys. To buffer the excess acid formed by your diet, kidneys produce ammonia, which is base and can neutralize some of that acid. The decline in kidney function over time may be a consequence of a lifetime of ammonia overproduction. Kidneys may start to deteriorate in your twenties, and by the time you reach your eighties, you may be down to half capacity.

The chronic, low-grade, metabolic acidosis attributed to a meat- rich diet helps explain why people eating plant- based diets appears to have superior kidney function and why various plant- based diets have been so successful in treating chronic kidney failure. Under normal circumstances, a vegetarian diet alkalinizes the kidneys, whereas a non non vegetarian diet carries an acid load. This proved to be true even among vegetarians who consumed processed meat substitute, such as veggie burgers.

If patients are unwilling to reduce their meat consumption, they should be encouraged to eat more fruit and vegetables to balance out that acid load. “However”, kidney doctor editorialized, “many patient find it difficult to follow a diet high in fruits and vegetables and might therefore be more adherent to a supplement”.

So what did researchers try? Giving people baking soda (Sodium Bicarbonate) pills. Instead of treating the primary cause of the excess acid formation (too many animal products and too few fruits and vegetables), they preferred to treat the consequences. Too much acid? Here’s some base to neutralize it. Sodium bicarbonate can effectively contains sodium, which over the long term may itself contribute to kidney damage.

Unfortunately, this type of Band -Aid approach is all too typical of today’s medical model. Cholesterol too high from eating a diet unnaturally high in saturated fat and cholesterol? Take a statin drug to cripple your cholesterol- making enzyme. Diet unnaturally high in acid-forming food? Swallow some baking soda pills to balance that right out.

These same researchers also tried giving people fruits and vegetables instead of baking soda and found that they offered similar protections, with additional advantage of lowering the subject’s blood pressure. The title of the accompanying commentary in the medical journal wad telling “The Key to Halting Progression of CKD Might Be in the Produce Market, Not in the Pharmacy”.

Kidney Stones

Eating a plant- based diet to alkalinize your urine may also help prevent and treat kidney stones- those hard mineral deposits that can form in your kidneys when the concentration of certain stone- forming substances in your urine becomes so high they start to crystallize. Eventually, these crystals can grow into pebble- sized rocks that blocks the flow of urine, causing severe pain that tends to radiate from one side of the lower back towards the groin. Kidney stones can pass naturally (and often painfully), but some become so large that they have to be removed surgically.

The incidence of kidney stones has increased dramatically since World War II and even just in the last fifteen years. Approximately one in eleven Americans are affected today, compared with one in twenty less than two decades ago. What accounts for this rising incidence? The first clue to an answer came in 1979 when scientists reported a striking relationship between the prevalence of kidney stones since the 1950s and increasing consumption of animal protein. As in all observational studies, though, the researchers couldn’t prove cause and effect, so they decided to perform an interventional trial: They asked the subjects to add extra animal protein to their daily diets, the equivalent of about an extra can’s worth of tuna fish. Within two days of eating the extra tuna, the levels of stone- forming compounds- calcium, oxalate, and uric acid- shot up such that the subject’s kidney-stone risk increased 250 percent.

Note the experimental “high” animal protein diet was designed to recreate the animal protein intake of the average American, suggesting that Americans could considerably lower their risk of kidney stones by lowering their meat intake.

By the 1970s, enough evidence had accumulated that researchers to ask whether people suffering from recurrent kidney stones should stop eating meat altogether. A study on the kidney stone risk of vegetarians wasn’t published until 2014, though. Oxford University researchers found that subjects who didn’t eat meat at all had a significantly lower risk of being hospitalized for kidney stones, and for those who did eat meat, the more they ate, the higher their associate risk.

Is some meat worse than others? People who form kidney stones are commonly advised to restrict their intake of red meat, but what about chicken or fish? We didn’t know until another 2014 study compared salmon and cod to chicken breasts and burgers. It found that gram, fish might be slight worse than other meat in terms of the risk of certain kidney stones, but they concluded that overall, “stone former should be counseled to limit the intake of all animal protein”.

Most kidney stones are composed of calcium oxalate, which forms like rock candy when urine becomes supersaturated with calcium and oxalates. For many years, doctors assumed that because stones the stones are made of calcium, they should counsel their patients to simply reduce their calcium intake. As with so much in medicine, clinical practice often flies blind without solid experimental support. This changed with a landmark study, published in the New England Journal Of Medicine, which pitted the traditional, low calcium diet against a diet low in animal protein and sodium. After five years, the study found that eating less meat and salt was about twice as effective as the conventionally prescribed low- calcium diet, cutting kidney- stone risk by half.

What about cutting down on oxalates, which are concentrated in certain vegetables? Reassuringly, recent study found found there was no increased risk of stone formation with higher vegetable intake. In fact, greater intake of fruits and vegetables was associated with a reduced risk independent of other known risk factors, meaning there may be additional benefits to bulking up on plant foods above and beyond restricting animal foods.

Another reason a reduction in animal protein is helpful is that it lowers uric acid build up, which can form crystals that seed calcium stones or form stones all by itself. Indeed, uric acid stones are the second most common type of kidney stones. So it makes sense that to reduce your risk, you should try to reduce excess uric acid production. This can be accomplished either of two ways : by adding drugs or by subtracting meat. Uric acid- blocking medications like allopurinol may be effective, but they can have serious side effects.

On the other hand, removing all meat from a Standard Western diet appears to reduce the risk of uric acid crystallization by more than 90 percent within as few as five days.

Bottom line: When urine is more alkaline, stones are less likely to form. This helps explains why less meat and more fruits and vegetables appears so protective. The standard American diet, however, their urine can be alkalinized up to a near neutral pH in less than a week.

Not all plant foods are alkalinizing, though, and not all animals foods are equally acidifying. The LAKE (Load of Acid to Kidney Evaluation) score takes into account both the acid load of foods and their typical serving sizes in order to help people modify their diets for the prevention of kidney stones and other acid- related diseases, such a gout. The single most acid- producing food was fish, including tuna, followed by pork, poultry, cheese, and beef. Eggs are actually more acid producing than beef, but people tend to eat fewer of them at one sitting. Some grains can be little acid forming, such as bread and rice, but not pasta, interestingly. Beans are significantly acid reducing, but not as much as fruits are, with vegetables crowned the most alkaline forming of foods.

Dietary changes can be so powerful they can not only help prevent kidney stones but also, in some cases, cure them without drugs or surgery. Uric acid stones can apparently be dissolved away completely with a combination of eating more fruits and vegetables, restricting animal protein and salt intake, and drinking at least ten glasses of fluid a day.

Testing Your “Pee-H” with Purple Cabbage

We know that the average Western diet is acid producing, while the average plant- based diet is acid reducing. Eating an acid forming diet can not affect kidney stone risk but may also produce the systemic, chronic, low-grade metabolic acidosis- excess acid in the bloodstream- that is thought to contribute to muscle breakdown as you age. So what’s the best way determine how acid forming your diet really is? Perhaps the easiest ( and most boring) method is to order some pH paper strips to pee on. Alternatively, why not use what you (should) have right now in your now in your refrigerator’s crisper: purple cabbage. Purple, or red, cabbage provides one of the single best nutritional bangs for your buck, and you can even use it to perform kitchen chemistry experiments, or in this case, bathroom chemistry.

Boil some purple cabbage until the water turns deep purple, or blend raw cabbage with some water and then strain out the solids. Pee into your toilet then take your purple- cabbage cocktail and pour it into the toilet bowl. (Low- flow toilets work best, because there is less water in the bowl.) If the liquid in the toilet bowl remains purple or, even worse, turns pink, your urine is too acidic. Blue is the target. If your and cabbage water turns blue, your urine is not acidic but neutral or even basic.

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