Nutrition Rounds Podcast with the Always Amazing Dr. Danielle Belardo

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I am so thrilled to have been interviewed by Dr. Danielle Belardo for her Nutrition Rounds Podcast, which has been repeatedly featured in the top ten of all podcasts downloaded on iTunes! If you haven’t checked out her podcast, I highly recommend you do ASAP. She’s interviewed many of the greats (including many of the people that I’ve look up to) in plant-based medicine, including Dr. Dean Ornish, Dr. Joel Kahn (twice!), and Dr. Caldwell Esselstyn, and provides a lot of useful information in each episode.

You can find my interview as Episode 14 here.

Here are the links to many of the studies we discussed:

  1. Fast Facts on Kidney Disease
    1. 125,000 new cases of kidney failure each year
    2. 21,000 kidney transplants done each year
    3. 468,000 people on dialysis currently
    4. 5 year survival rate on dialysis is 45%
    5. 3-5 years is the average waiting time to get a deceased donor kidney off the waitlist
  2. Information on live and deceased donor kidney donation
  3. The UCSF Artificial Kidney Project
  4. Overview of how the kidney works
  5. Diabetic Kidney Disease
    1. #1 cause of CKD and kidney failure 
    2. A nice review in the Clinical Journal of the American Society of Nephrology on diabetic kidney disease
      1. Evidence of the importance of glucose control in Type 1 Diabetics
        1. DCCT/EDIC
        2. DCCT/EDIC
      2. Evidence of the importance of glucose control in Type 2 Diabetics
        1. UKPDS
        2. UKPDS
    3. How both protein and hyperglycemia cause hyperfiltration in diabetic kidney disease
    4. Papers on Plant-Based Diets to Prevent, Treat, and Reverse Diabetes
      1. Nice review by McMacken et al. 2017 J. Geriatr Cardiol 
  6. Hypertensive Kidney Disease
    1. #2 cause of CKD and kidney failure
    2. Secondary analysis of DASH-Sodium trial showing a near 21/8 mm Hg reduction in BP for those with a BP > 150/90 mm Hg
    3. Papers on Plant-Based Diets to Prevent, Treat, and Reverse Hypertension
      1. Nice review by Alexander et al. 
      2. Meta-analysis of vegetarians diets and blood pressure by Yokoyama et al.
  7. Listener Questions:
    1. TMAO
      1. Increased TMAO levels are both a product and cause of CKD
    2. Kidney Stones
      1. Evidence that animal protein increases the risk of kidney stones
        1. Borgi study showing a low-protein, low-salt study reduces kidney stone incidence
        2. Another study
        3. “Stone formers should be advised to limit the intake of all animal proteins, including fish.” 
        4. Association of animal protein with kidney stones dating back to WWII
        5. Should recurrent calcium oxalate stone formers become vegetarians?
        6. Fruits and vegetables reduce the risk of kidney stones despite having purines
        7. Potassium citrate, a medication often used to treat kidney stones, has ingredients that are often found in fruits and vegetables
      2. People with documented hyperoxaluria (excess oxalate in the urine determined by a 24 hour urine collection) should consider restricting high-oxalate foods
        1. List of high-oxalate foods
    3. Protein in Chronic Kidney Disease
      1. My paper with Dr. Sanjeev Shah and Dr. Kam Kalantar-Zadeh reviewing the issues of plant protein quantity and quality in CKD
      2. Low-Protein diets in Chronic kidney Disease
        1. Recent review on nutritional considerations in CKD (NEJM review)
          1. Caveat: I disagree with the author’s recommendation for high biologic value protein in CKD. You’ll notice that the same author is a co-author of paper mentioned in the previous point and has since taken on a revised view of plant protein. As we write in that paper, plant-protein is more than adequate in CKD.
        2. Secondary Analyses of MDRD showing a (small, but significant) benefit of low-protein diets
        3. Meta-analysis of low-protein diets on the rate of kidney function decline
    4. What is the evidence that animal protein is harmful for the kidneys for those without chronic kidney disease?
      1. Cross-sectional studies
        1. Nettleton et al. AJCN 2009
        2. Yuzbashian et al. J. of Nephro. 2015
        3. Oosterwijk et al. KI Reports 2019
      2. Prospective observational studies
        1. Haring et al. J Ren N 2017
        2. Lew et al. JASN 2017
        3. Lin et al. CJASN 2010
        4. Lin et al. AJKD 2011
      3. Interventional studies
        1. Kontessis et al. KI 1990 (only study to control for protein QUANTITY – an important confounder in every other study I’ve seen on the subject)
    5. What is the evidence that animal protein is harmful for the kidneys for those with chronic kidney disease?
      1. Observational studies
        1. Knight et al. Annals of IM 2003
      2. Interventional studies
        1. Azadbakht et al. J Ren Nutr 2009
        2. Azadbakht et al. Diabetes Care 2008
        3. Barsotti et al. Nephron 1996
        4. Teixeira et al. J Nutr 2004
    6. What is the best diet for those with CKD?
      1. Although the evidence is generally limited, plant-based diets may be of benefit. Each individual patient is different and monitoring may be required, especially for potassium levels. Here are some recent reviews on the subject of plant-based diets in CKD:
        1. Stewart et al. 2019 JOJ Urology and Nephrology
        2. Chauveau et al. 2018 NDT
        3. Gluba-Brzozka et al. 2017 Nutrients
      2. Plant-based diets have additional (“bonus”) benefits for their ability to treat the following co-morbidities associated with CKD:
        1. Hyperphosphatemia
          1. Moe et al. CJASN 2011
        2. Metabolic Acidosis
          1. Animal protein is acidic
            1. Scialla et al 2013 Adv. Chronic Kidney Dis.
          2. Vegan Diet is nearly acid neutral
            1. Strohle et al. 2011 Ann. Nutr. Metab.
            2. Ausman et al. 2008 J. Ren. Nutr.
          3. Interventional data supporting the use of 2-4 cups of fruits and vegetables for the treatment of metabolic acidosis in CKD. Notice how the fruit and vegetable arms also had lower BPs and weights after the experiment. Also notice the lack of hyperkalemia.
            1. CKD Stages I and II for 30 days
            2. CKD Stage III for 3 years
            3. CKD Stage IV for 1 year
        3. Hypertension
          1. See above section on “Hypertensive Kidney Disease”
        4. Obesity
          1. Turner-McGrievy et al. 2017 J. Geriatr Cardiol
    7. Potassium, Plant-Based Diets, and Kidney Disease
      1. The best (and only) paper on the subject is by St-Jules et al. 2016 J. Ren. Nutr. 
      2. A good editorial on the issue by Moorthi et al. 2019 CJASN
    8. Bellevue’s Plant-Based Lifestyle Clinic

 

Last Updated: April 7, 2019

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