Low protein diet in CKD

A chain of amino acids bound together by peptide bonds forms a protein. Protein in the blood is filtered by the Malpighian body of the nephron which is present in the kidneys. The malpighian body consists of the glomerulus and bowman’s capsule. Glomerulus filters the protein mechanically as they are smaller in size and it thus becomes a filtrate in the bowman’s capsule. The proteins are further absorbed in proximal convoluted tubules and thus no protein is present in the urine of a normal individual. But in patients with Chronic Kidney disease, all these mechanisms are affected and protein is not well managed leading to the presence of albumin and other proteins in urine. 

Also, protein requires higher energy to get filtered in kidneys. These bean-like organs have to spend more energy to remove the proteins from blood and reabsorb it. Therefore in CKD, consuming less protein leads to fewer energy requirements by the already affected kidney. Diet is the major factor that helps in managing and maintaining adequate kidney functioning. We shall elaborate on how to maintain a low amount of protein in the diet and what to eat instead.

What is the amount of protein to consume in CKD?

• 0.6 to 0.8 g per kilogram of body weight is usually recommended.
• The protein intake depends upon a lot of factors such as age, height, weight, BMI, renal status, metabolism levels, etc.
• Protein content in any food should be known to the individual who cooks for such patients. Lentils, cereals, Dal should be consumed after knowing their protein content.
• For patients not on dialysis but have chronic Kidney disease should follow the above mentioned instructions. But for patients not on dialysis, it is not the same. They can consume a normal amount of protein but should consume less of it preferably.

What food contains high protein levels and should be avoided?

• Egg yolk contains a lot of protein and fat content. It should therefore be avoided by patients with Chronic Kidney disease.
• Animal meat such as chicken, goat, seafood, shellfish, hams, pork has higher protein content in them as animal flesh is a protein in its entirety.
• Milk, cheese, butter, oil, yoghurt, cream, mayonnaise, and other dairy products are rich in protein and high in saturated fats. It should be limited or restricted in CKD cases.
• Cashew, almonds, peanuts, dried figs have a higher level of minerals and protein.
• Horse gram should be avoided as it has more protein.
• Vegetables like potato, sweet potatoes have starch and protein in them. Also, it should be consumed with caution.
• Leafy greens like spinach can approximately give you five to six grams of protein every time you cook it.
• Kidney beans, moong Dal are other frequently used Indian foods that should be avoided in CKD.
• Peanut butter should be avoided as well.

What are Low protein foods which patients with CKD can eat?

• Diet should contain a lot of vegetables and fruits.
• Salads made of cucumber, lettuce, and carrots are preferable.
• Pieces of bread made of wheat can be used. But it contains a medium proportion of protein in it.
• Eat more cabbage, broccoli.
• Eat an apple or have apple juice. It is considered a low protein fruit and is good for a chronic kidney disorder.
• Fruit juices, fruit custard with less milk is a good option to stick to as a low protein food.
• Fibrous foods can be eaten.
• Limited intake of animal protein can be considered as low protein in nature. But it is better to avoid eating meat.
• Making soup, porridge, salad, smoothie of vegetables, ragi, etc, is a good option.
• Having mentioned all the above foods, one should only eat these foods and not eat other foods and include these too. That will be of no help.
• Also, do not consume most of the foods mentioned above in a single day. That will pile up to become a high protein diet. Eat these foods by measuring the level of protein you should consume as mentioned above.

Why a low protein diet for patients not on dialysis?

Every substance has its own metabolic end product. In the same way, the end product of protein metabolism is called urea. As the protein is metabolised, urea levels of blood start rising. When blood passes through the kidneys, urea is filtered out of the blood into the kidneys and is then sent to the urinary bladder in the form of urine. This urine is further expelled out through the process called micturition.

Taking this concept into consideration, when a patient has chronic Kidney disease, but not as bad as to be on dialysis, the kidneys have reduced functioning but have to clear the urea from the blood. There is no help to the kidneys even if it has reduced functioning. So, if the urea amount is high or as before, the pressure on the kidney increases and eventually the patient has to get help in the form of dialysis. 

So, if the protein intake is reduced, urea formation reduces in turn putting lesser pressure on the kidneys. Hence, the need for dialysis is delayed or even eliminated. The workload on kidneys is reduced which gets kidneys some time to recover themselves. 

Along with lesser protein content, other substances have to be restricted too, such as potassium, sodium, unsaturated fatty acids, extremely acidic or basic foods.

How to cook low protein foods?

• Choosing the right ingredients is the key.
• Cook the food completely. Avoid eating a lot of raw food.
• Add more vegetables and a restricted amount of cereals and lentils while preparing salad.
• Do not consume the water in which the food is cooked. It is healthy for a normally functioning kidney, but not for CKD patients.
• Do not add excessive salt while cooking. Rather lower the amount of salt than usual.
• Serve the food fresh. Avoid storing the cooked food for long hours.

Cooking ideas for low protein eaters.

Here, we have some very tasty yet healthy low protein pieces of advice for your tongue and kidneys respectively. A low protein diet can be made delicious. It can include healthy soups, tikkis, paratha, upma, sooji halwa, rice dishes, salad, fruit juices and salad, rolls, kabab, some sweets, etc. 

• Soups: everyone likes this form of appetising agent. Soups can be made by boiling cabbage, peas, and beans in water. Add a pinch of salt, pepper, turmeric, mint as per taste. Boil the mixture until the vegetables are completely cooked. Add some lemon juice to the soup. Garnish with some coriander or mint or basil. Serve immediately for best results.
• Salads: lettuce, cucumber, little tomato, broccoli, cherry, strawberry, carrots, beans can be used. Chop Any of the above mentioned veggies and fruits and mix them with salad sauce, dressing, and mayonnaise. Add spoonfuls of vinegar, red chilli sauce, pepper as required. The minimum amount of animal meat can be added sometimes. 
• Sprouts salad: it should be eaten once in a while only. sprouts like moong, Matki should be soaked overnight for them to sprout. Add mayonnaise, red sauce, white salad dressing to it. Or simply add lemon juice and salt to the sprouted grain and have this in limited quantities.
• Vegetable fried rice: in olive oil or a little groundnut oil saute the finely chopped onion, beans, carrot, cabbage, capsicum, etc. Add salt, a bit of sugar, sauces, pepper, and cook it well. Add pre-soaked or half boiled rice. Add some lemon juice as per requirement.
• Jeera rice, masala rice, vegetable pulav, and lemon rice can be made.
• Vegetable tikkis: chop cabbage, carrot, capsicum, onion, and other vegetables. Use corn flour and binding flour to mix all the vegetables and other ingredients like garlic, ginger, spices like turmeric, clove, red chilli powder, and salt. Make the batter well in consistency. Make tikkis of any shape and shallow fry it. You can use boiled vegetables. Avoid the use of potato as it contains starch.
• Millet porridge, oats: cook different varieties of millets in water. It can be eaten with buttermilk, sambar, and other dals. It contains a good amount of fibre for better bowel movements.
• Dal khichadi: this is one of the famous dishes among the Indian population. Cook more rice and less Dal or cereals together in a cooker. Add more water, less salt, and spices. Close the lid and cook for about 30 minutes. Serve fresh.
• Sandwiches: the vegetable sandwich is the healthiest option. Grilled sandwich with less cheese and more lettuce, tomato, cabbage. Make use of some sandwich sauce, white sauce, etc.
• Other dishes like dosa, idli, upma, poha, daliya, puffed rice, vermicelli noodles, macaroni, sandwiches with more vegetables can be cooked for patients with Chronic Kidney disease.

Protein in the diet for patients on dialysis.

Dialysis is the unit that carries out the task of Kidney. Urea is eliminated from the blood when the patient is put on dialysis. So, for such patients protein intake does not make a lot of difference. It is still better to follow a diet that has less protein, potassium, calcium, sodium, phosphorus, magnesium. 

Dietary restrictions are not very strict at this stage. As this stage is the higher one, recovery of kidneys is highly unlikely. Either a transplant works or lifelong dialysis is the option. 

Avoiding spinach, eggs, meat, fish, protein powder or supplement is better. Drink adequate water to ensure hydration. Eat healthy foods like fruits such as apples, berries, chikoo, etc.

The patient develops weakness due to dialysis. Hence, energetic foods like semolina, sprouts, puddings should be given. 

If the patient undergoes kidney transplant surgery the dietary restrictions apply. It then includes a low protein and low potassium diet. But during dialysis patients can eat pretty much anything they want.

Benefits of low protein diet in chronic Kidney disease.

• Prevents the requirement of going on dialysis.
• Keeps the Kidney functioning to a better extent.
• Pressure on the Kidney is reduced.
• Less energy is consumed by the body to digest the food.
• Prolongs the life of the affected kidney.
• Enhances the quality of life of the patient.
• The patient is independent and does not rely on the dialysis unit and family members for day to day activities.
• Dialysis is costly so this method is pocket friendly and saves your money.
• Health does not deteriorate but improves overall.
• The patient can get back to his routine as earlier with this diet.

Key points about the low protein diet and CKD.

• Protein is converted into urea in the body and blood carries urea which is filtered out by the kidney. If kidneys are damaged, reducing the amount of urea by reducing protein intake causes less pressure on kidneys.
• Avoid animal protein, egg, dairy products.
• Eat more vegetables, fruits in your diet.
• Low protein consumption prolongs the initiation of the use of dialysis.
• It may also prevent the need for dialysis.
• Follow the diet as mentioned in the article and keep track of calorie intake.
• Patients on dialysis have to follow the Strict diet to avoid deterioration of kidney health whereas the patient on dialysis can eat protein as before without much concern.
• Consult your nephrologist and dietitian and nutritionist for further tailor made plans exclusively for your health.
• Sufficient water intake is a must.
• Control the secondary issues like hypertension and diabetes to lower the risk of a further worsening of chronic kidney condition.
• Reduce too much of physical work that causes strain to the body as protein is less.
• Keep away from alcohol, tobacco, abusive drugs, protein supplements.

Effects of low protein diet in certain cases.

• the patient may feel lethargic and weak.
• Malnutrition.
• Loss of appetite, reduced muscle mass.
• Loss of enthusiasm, sleep disorders in the patient.
• Incidences of quick and easy fracture of bones.
• Muscle cramps and weakness.
• Anaemia can occur.
• Increased risk and susceptibility to infections.
• Craving from certain food items.
• If a child is affected with CKD, growth can be shunted due to a lack of protein.
• The weight of the patient is seen to get reduced.