Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Normally, wastes are filtered out of the blood through thousands of tiny nephrons in the kidneys which filter the blood and channel the waste products into small tubes leading to the urinary bladder, while the cleansed blood is turned back into the general circulation. But when the kidneys fail and waste products back up into the bloodstream, we call the condition uremia.

There are common substances which we eat, or to which we are exposed, which can act as irritants to the nephrons. These include such things as coffee, tea, colas, chocolate, pepper, mustard, ginger, vinegar, alcohol, tobacco, many drugs, industrial chemicals, and others.

Little by little, the filtering cells deteriorate; but since no pain is involved, the damage does not appear until many years have gone by, often when the condition is irreversible. We were created with four times as much kidney capacity as is necessary to maintain normal cleansing of the blood. With abuse of the kidneys, day by day, the margin of safety is reduced until one day a serious overload is placed on the kidneys by an illness, or by accumulated degeneracy of the kidneys. Wastes cannot be removed and backs up in the bloodstream.

Symptoms may include swelling of the body, nerves becoming extremely hypersensitive so that a loud noise, jolting the bed, or slamming a door, may greatly startle or irritate the nerves of the patient. Perspiration, nature's second excretory pathway, develops the odor of urine. There may be nausea, loss of appetite, and vision may be impaired.

Uremia is one of the most costly diseases in America today. A vegetarian diet can slow down, or even stop all together, the build-up of toxic wastes that mark patients with renal failure. Restricting protein intake reduces the work load of the surviving kidney nephrons, which minimizes further loss of renal tissue. Our modern high protein diet has a great causative influence on the production of various forms of kidney disease both in humans and animals. The so-called normal aging of kidneys need not occur in those who are careful to avoid excessive intake of protein. The higher the intake of protein the higher the blood flow and filtration work load on the kidneys. Striking increases in kidney size have been reported in patients receiving large quantities of amino acids intravenously during hyperalimentation.

Usually, we can survive on about one fourth of our total kidney mass, or one half of one kidney, although overuse damage to the remaining glomeruli is evidenced by increasing protein in the urine. If a patient who has lost three fourths of his renal mass is given a protein restricted diet, the subsequent progression of glomerular sclerosis will be reduced significantly.

After a person reaches his 30s, there is a very slow progression of glomerular sclerosis as a part of normal aging. We can thus see why we have been endowed by our Creator with far more nephrons than is required to maintain the balance of various blood chemicals. We can also see why renal disease is invariably progressive. There is a natural aging of the kidneys associated with loss of nephrons, and when disease strikes the kidneys, this progression intensifies. There is a burden imposed on the kidneys by our modern ad libitum eating habits. Sustained excesses of protein in the diet impose a strain on the nephrons with an increase in the internal blood pressure in the kidneys.‍

Diet in renal failure‍

All nutrients the body requires can be obtained either from plant food sources or from the manufacturing plants the body itself maintains - liver, skin, brain, etc. Since some patients with kidney failure have a problem in retaining certain nutrients and others a different set, it is essential to know the type of problem the patient has so that the specific elements retained by the kidneys of that person can be minimized in the diet by eating foods low in those particular substances. The vegetarian routine is the most favorable for kidney patients, giving the best opportunity both to work with the kidneys, and to avoid diseases of other kinds than kidney disease that will put an even greater burden on the kidneys.

The quantity of protein used should be just barely enough to maintain a degree of strength and low normal blood proteins. Some 20 to 40 grams of protein daily should be quite adequate. (Ref. MEDICAL WORLD NEWS, November 3, 1967) That would figure to be about 120 to 200 calories in the form of protein. The balance of the 1500 to 1700 calories which the kidney patients should be taking can be obtained from the carbohydrates and fats found in fruits, vegetables, whole grains, nuts, and seeds. Probably no more than 150 to 200 calories per day should be taken in the form of fats, unless weight loss is excessive. Some weight loss can be expected because of the nature of kidney disease. This is loss of actual fat and some muscle mass, which is offset somewhat by fluid retention which accounts for some weight gain - 5 to 20 pounds.

Since potassium is high in many fruits and phosphorus is high in many grains, those who need to pay attention to these features of blood chemistry will need to be guided accordingly. Sometimes a uremic patient may be able to stay off dialysis by a rigidly low protein diet. Even those who are on hemodialysis, if they adopt a spartan dietary regimen, can reduce the time spent on dialysis. The uremia patient must learn to eat to live, not live to eat. Perfect discipline is required and the eyes should not be allowed to even rest on foods which you may not have, nor should the imagination be allowed to picture them. Why make yourself miserable. There is a balance between having so much protein that you poison yourself with nitrogenous wastes, or so little protein that you become undernourished and vulnerable to infection.

Hemodialysis itself causes some loss of amino acids and peptides, and this lack can be supplied by the dialysis machine. Low protein spaghetti is good for uremic patients with a tomato sauce thickened with starch such as arrowroot, cornstarch, or tapioca. Those who maintain a very strict diet will feel better and be spared from certain agonizing symptoms.

Good psychological support from the patient's family and the patient's doctor can be very helpful in the patient's continuing to maintain a good dietary regimen. If the food is made attractive and served cheerfully, it can be tolerated quite nicely even though it may tend to be somewhat monotonous. If the dialysate in the machine cannot compensate for the losses of protein which occur during dialysis, the dietary allotment of protein may need to be increased to 30 to 50 grams per day to prevent muscle wasting and peripheral neuropathy (strange and distressing symptoms from nerves) which plague many dialysis patients. Those who manage to stay on the diet will have approximately half the BUN (blood urea nitrogen) of those who eat a more regular diet. The hours spent on dialysis may need to be from six to ten hours more per week for those not adhering to a strict diet.

For many decades the low protein diet has been promoted as a method of causing the majority of patients to ''show no further progression of the disease, or a much slower rate.'' Sixty-one percent will achieve a stabilization of kidney function regardless of age, sex, or general health of the patient. Early intervention is the key, preferably when serum creatinine levels are still down around 2-2.5 mg/dL. If the creatinine reaches 4-5 mg/dL, it is much more difficult to get the disease under control. At 2 mg/dL the renal patient has already lost roughly 70% of renal function. It is at this point that protein and phosphate restrictive diets are the most useful.

Patients having polycystic kidney disease with renal failure respond less well to a low protein diet than do those with chronic glomerulonephritis, hypertension, or diabetes, but even in polycystic disease there is some help from diet. (Ref. THE NEW ENGLAND JOURNAL OF MEDICINE May 31. 1990, 322(22):1610.

As protein intake goes up, urinary urea excretion also goes up. A formula can be used to calculate the protein intake judged by the urinary urea excretion. (Ref. KIDNEY INT. 27:58-65;1985 "A Method for Estimating Nitrogen Intake of Patients with Chronic Renal Failure," by Maroni, B.J.) Your doctor can make the appropriate laboratory tests and calculations.Strict compliance to the diet does not greatly interfere with patient's lifestyle: "in fact many feel better which provides positive reinforcement for continuing the diet." (Ref. THE NEW ENGLAND JOURNAL OF MEDICINE May 31, 1990, 322(22):1610)

Death from unassisted kidney failure will usually occur at serum creatinine levels of 10. Even without dialysis, 70-75% of patients will survive more than six years on a protein-restricted diet, survival times being 91 months on the restricted diet, and only 16 months on a free diet. Creatinine is an end product of protein metabolism in skeletal muscle. Creatinine is excreted by the kidneys, and represents a good marker for the progression of kidney disease. Close follow-up by the physician is an important point. (Ref. MEDICAL TRIBUNE, January 22, 1986:l and THE NEW ENGLAND JOURNAL OF MEDICINE 322(22);1609-1611)

‍Treatment

• The eight natural laws of health assume a greater importance to the kidney patient; they are the lifeline. Fresh air, proper sunshine, a good diet, exercise even when you don't feel like it, pure water, strict temperance in all things, rest in the form of short stops or even naps during the day and seven to eight hours sleep at night, with trust in divine power - these are the natural laws of health.
• Become informed in a library about your disease. Work with it.
• Wear a large (one foot square or more) charcoal compress over the back each night. Change it in the morning or take a fresh shower. The skin will rid the body of many urinary wastes if encouraged to do so by charcoal, frequent showers, and warm skin.
• Take one tablespoon of charcoal powder in water four times a day to get rid of internal toxins.
• Take ginkgo as tea if you can drink four extra glasses of water a day, or as the slightly less beneficial capsules if you need to use them. Ginkgo improves circulation to many internal organs.
• Keep up your muscle strength by exercise. Expect to feel some weakness. That is natural in kidney failure.
• If there are complicating diseases such as diabetes or hypertension, these diseases should be rigidly controlled to prevent additional stresses on the kidneys. With progressive deterioration comes increasing incidence of hypertension, urinary tract infection, secondary hyperparathyroidism, muscle loss and weakness, and increased incidence of infections including pneumonia. (Ref. THE NEW ENGLAND JOURNAL OF MEDICINE 307(11) 652-659, 1982)
• The presence in the diet of a lot of vegetable fiber influences the digestive degradation and disposal of blood urea. Urea passed from the blood to the colon in approximately 50% greater quantities in those fed an oat fiber diet, and 120% greater in those fed gum arabic and oligosaccharide diets, than in those fed a wheat starch diet. Fecal nitrogen was 10% in fiber free controls, 20% in oat fiber groups, and 30% in the gum arabic and oligosaccharide groups. We can expect then that the simple addition of a large quantity of fiber to the diet will induce a 20-30% decrease in blood urea and renal nitrogen excretion relative to those not taking such an increase in fiber. (Ref. JOURNAL OF NUTRITION 125:1010-1016:1995) These studies indicate the benefits of a vegetarian diet for persons with kidney failure.
• Since patients with uremia are likely to get itching all over the body, or in certain areas, one study showed that ultra violet phototherapy decreased the itching remarkably. The use of sunlight to the point of sub-sunburn would be acceptable instead of the use of artificial ultraviolet lights. (Ref. THE NEW ENGLAND JOURNAL OF MEDICINE 297:136-138;1977)
• A good treatment consists of a mild steam bath or soak in a very warm tub at 101 or 102° water temperature. If water is not being retained, copious quantities of water can be taken during the bath. After the sweating bath a full body whirlpool, or a full body massage, can be very helpful to stimulate the skin. Finish with a brisk toweling with a coarse dry towel.
• Take echinacea capsules or tincture to boost the immune system. Be involved in something creative every day. There are several million persons with weakened immune systems in the United States, including one million with HIV positivity. Other systemic diseases producing weak immune systems are chronic renal failure, alcoholism, cirrhosis, diabetes, cancers, leukemia, chronic fatigue syndrome, and those having bone marrow transplants, splenectomy, radiation, chemotherapy, and those taking corticosteroids.

LAB VALUES AND DIETARY ADJUSTMENTS

TEST ...... NORMAL VALUE FOR YOU ..... DIETARY SOURCE ........................ HOW TO CORRECT ABNORMAL VALUE

B.U.N. .............. 60-100 ............................. Beans, nuts, rice, tofu .................... Too High: Decrease protein intake. Too Low: Increase protein intake.

Potassium* ..... 3.5-5.5 ............................. (separate list) .................................. Too High: Omit high potassium food; limit fruits, vegetables; meat and milk can be omitted. ................................................................................................................................. Too Low: Increase intake of high potassium foods.

Phosphorus .... 3.5-5.5 ............................. Most foods, especially milk, milk products, beans, nuts, chocolate. Also, check Diet Guide. ................................................................................................................................. Too High: Take phosphate binders as directed with meals; decrease intake of milk,
................................................................................................................................. milk products, beans, nuts, chocolate.
................................................................................................................................. Too Low: Increase high phosphorous foods & omit any phosphorus binding drugs.

Calcium ........... 9.5-11.2 ............................ Beans, greens, tahini ...................... Too High: Study your diet and make adjustments.
................................................................................................................................. Too Low: Get some sunshine, more rest, and more exercise.

Albumin ........... 3.8-5.0 ............................. Protein: beans, tofu, nuts, rice ...... Too High: Not a problem.
................................................................................................................................. Too Low: Eat more protein-high foods.

‍POTASSIUM‍

CONTENT RANGE IN EDIBLE FOODS - FROM THE HIGHEST DOWN
(Measured in milligrams per 100 gram portion)

Molasses ("Blackstrap") 2,927
Yeast (Torula) 2,046
Yeast (Bakers, dry, active) 1,998
Soya Grits ("low fat") 1,942
Yeast (Brewers) 1,894
Soya Flour ("full fat") 1,730
Soya Beans (dry, raw) 1,677
Soya Milk (dry) 1,640
Apricots (dried) 1,561
Lima Beans (dry, raw) 1,499
Rice Bran (dry, raw) 1,495
Bananas (dehydrated) 1,477
Haricot Beans (dry, raw) 1,194
Peaches (dried) 1,191
Mung Beans (dry, raw) 1,028
Wheat Germ (dry, raw) 1,020
Wheat Bran (dry, raw) 1,050
Pistachios (kernels, raw) 972
Sunflower Seed (kernels, raw) 903
Parsley (raw) 903
Figs (dried) 900
Chestnuts (dried) 875
Raisins (dried) 840
Olives (green, fresh) 809
Chickpeas / Garbanzos (dry, raw) 797
Almond Kernels (natural, raw) 773
Lentils, Brown (dry, raw) 757
Sesame Seeds (whole, raw) 725
Peanuts (roasted, skins) 720
Currants (dried) 719
Brazil nuts (kernels, raw) 715
Hazelnuts (kernels, raw) 704
Peanuts (raw, w/o skins) 700
Spinach (raw) 700
Prunes (dried) 694
Cream Cheese 686
Dates (Calif., natural, dry) 648
Spinach (boiled) 637
Avocados (average) 604
Pecans (kernels, raw) 603
Lima Beans (boiled) 602
Yams (raw) 600
Custard apples (raw) 578
Pears (dried) 573
Beet Greens (raw) 570
Apples (dried) 569
Parsnips (raw) 541
Soy Beans (boiled) 540
Garlic Cloves (raw) 529
Swiss chard (raw) 526
Parsnips (boiled) 505
Potatoes (baked) 503
Walnuts (kernels, raw) 491
Yeast (Bakers, compressed) 482
Coconut (fresh) 480
Swiss chard (boiled) 480
Broad beans (fresh, raw) 471
Rye (whole grain) 467
Cashews (kernels, raw) 464
Avocados (small) 455
Chestnuts (fresh) 454
Buckwheat (raw) 448
Breadfruit (raw) 439
Artichokes (Globe, raw) 430
Millet (whole grain) 430
Artichokes (Jerusalem, raw) 420
Brussels sprouts (raw) 420
Coconut (dry, shredded) 420
Chocolate (plain, milk) 413
Potatoes (raw, broiled) 410
Broccoli (raw) 388
Kohlrabi (raw) 382
Wheat (soft, whole, raw) 380
Bananas (ripe, raw) 377
Wheat (hard, red, whole, raw) 370
Flour (wheat, whole meal) 370
Pasta (whole meal) 370
Squash (winter, raw) 369
Currants (black, raw) 360
Squash (winter, boiled) 360
Rolled oats (dry) 354
Sugar Cane (Crystals) 350
Loquats (raw) 348
Passion fruit (raw) 348
Pumpkins (raw) 340
Peas (fresh, raw) 338
Miso 334
Shallot bulbs (raw) 334
Beet Greens (boiled) 332
Celery (raw) 332
Leeks (raw) 330
Radishes (raw) 322
Beets (raw) 320
Haricot Beans (boiled) 320
Nectarines (raw) 307
Carrots (raw) 305
Artichokes (Globe, boiled) 301
Brussels sprouts (boiled) 200
Watercress (raw) 298
Guavas (fresh) 289
Tomatoes (raw) 287
Corn Meal (dry) 284
Chocolate (plain, dark) 382
Rhubarb (raw) 282
Kohlrabi (boiled) 278
Beans (long, green, raw) 272
Butternut Squash (baked) 271
Cabbage (red, raw) 268
Broccoli (boiled) 267
Beans (long, green, boiled) 258
Cabbage (Chinese, raw) 253
Cabbage (white, raw) 250
Chives (raw) 250
Turnips (raw) 245
Tomatoes (boiled) 244
Sweet Potatoes (raw/boiled) 243
Maple Sugar (pure) 242
Persimmons (raw) 242
Lentils (brown, boiled) 240
Pumpkins (boiled) 240
Turnips (boiled) 240
Celery (boiled) 238
Honeydew melons (raw) 235
Prune juice (canned) 235
Currants (red, raw) 234
Papayas (raw) 234‍‍


‍

THESE FOODS ARE KNOWN TO CONTAIN MORE THAN 230 MILLIGRAMS PER 100 GRAM PORTION:

• Broad beans (dry, raw)
• Buckwheat flour
• Carob powder (dry)
• Pepitas / Pumpkin Seeds (raw, shelled)
• Pinon / Pignolia / Pine Nut (kernels, raw)
• Safflower Seeds (kernels, raw)
• Sesame Seeds (hulled, raw)
• Soy Beans (fresh or sprouted)
• TVP (hydrated)

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