Protein Diet in Kidney

Proteins are considered as building blocks of the body. We all require protein in our diets since they are very important. Protein is necessary for muscular growth, the healing process, infection resistance which causes immunity and can improve overall health. Protein requirements differ depending on your age, gender, and overall health which is from individual to individual. Proteins are made up of amino acids. Amino acids are divided into two types, that is essential amino acids and non-essential amino acids.

Essential amino acids are a group of amino acids that should be provided from the diet, whereas non-essential amino acids are not needed in the diet, they can be synthesized from essential amino acids or in the body by other mechanisms themselves. Protein can be from both animal and plant sources in the diet. When you have kidney illness, knowing what to eat is crucial. Kidneys assist to preserve the proper mix of nutrients and minerals in your blood and body by filtering wastes produced by the meals you eat.

Why is an eating plan important related to protein?

You should limit your calorie, sugar, and salt intake in your diet plan while also ensuring that you get adequate protein. It is essential for the formation and maintenance of every cell in our body. It provides energy to our body and feeds our cells. Protein is not stored in our bodies unless for carbohydrates and fats. We should take protein daily. Even though the amount of carbohydrates and fats is important, all the macromolecules are important, particularly proteins.

Macromolecules are molecules that are needed in high amounts to maintain homeostasis. Some of the proteins are glucogenic or ketogenic that can link to other macromolecular pathways.  Protein should be a component of your daily health maintenance strategy. Hence while planning a diet protein makes a major and the most important part. 

Functions of a Protein

  1. Building blocks: Builds bones, muscles, skin, and cartilages
  2. Repair your tissues 
  3. Globulin part in hemoglobin helps in oxygenating the tissues carrying oxygen from lungs to the cells 
  4. Enzymes are made up of proteins that are involved in many biological processes
  5. Maintains homeostasis  

Kidneys are involved in amino acid and protein metabolism, particularly the breakdown and excretion of protein metabolites and their amino acids. Dietary protein consumption has a significant influence on metabolic processes regulated by the kidney, as well as renal function. A high amount of protein diet can harm the kidneys and lead to the build-up of toxic protein metabolites, whereas a low amount of protein diet has several therapeutic advantages for individuals with renal insufficiency. 

A high-protein diet is more than 1.2 g/kg of body weight per day and has been linked to substantial changes in renal function and kidney health. Higher protein intake, in contrast to fat and carbohydrate intake, affects renal hemodynamic functions that are by increasing renal blood flow and intraglomerular pressure, resulting in a higher glomerular filtration rate (GFR) and more efficient excretion of protein derived nitrogenous waste products like urea, as well as an increase in kidney volume. Glomerular hyperfiltration is caused by a high-protein diet. Glomerular hyperfiltration is defined as an increase in GFR. Glomerular hyperfiltration along with the increased urinary albumin excretion might be harmful to the kidneys and other organs. Long-term exposure to high dietary protein intake causes a decrease in renal function and may lead to kidney failure. A low protein diet lowers the intraglomerular pressure, which reduces nitrogen waste products and reduces kidney strain. It protects the kidneys, especially in individuals with reduced nephron capital and renal function. It has beneficial metabolic actions that can help to maintain kidney function and manage uremic symptoms.

Protein Pulses in Kidney Disease

Pulses Related to Protein Content

Pulses are recommended as part of a healthy diet in most national dietary recommendations. People who consume at least 12 cups/day of pulses had greater fiber, protein, calcium, potassium, etc., intakes, as well as reduced-fat intakes. Pulses are a protein source in many diets across the world. Beans, chickpeas, and peas have 2-3 times the protein content of cereal grains. Pulses are a more cheap and sustainable protein source than animals and many other plant-based protein sources.

Pulses that can be added to the diet are 

  1. Kidney beans
  2. Black beans 
  3. Chickpeas 
  4. Green and black lentils 

Dairy Food for Protein

Whey and casein are the two main forms of protein found in dairy foods and products. Casein accounts for 80% of the protein in dairy products, whereas whey accounts for the remaining 20%. Whey is quickly digested, but casein is digested slowly, allowing amino acids to enter the circulation for a longer period of time. We can say casein releases amino acids sustained. The quantity of protein in dairy meals varies depending on the kind of product. This depends upon the processing steps and procedures needed to create each product. Furthermore, as compared to whole milk, low-fat milk may have a little greater protein level per serving, as the removal of some fat improves the amount of protein per serving. Milk, yogurt, cheese, and other dairy products have a high number of essential proteins. Also, some dairy products may have a high amount of phosphorus and potassium. Dairy products must be limited in the diet of patients with chronic kidney disease (CKD). For example, low-fat milk contains high quantities of phosphorus, potassium, and calcium, which is bad for someone on a renal diet. Alternatives to cow’s milk include soy milk, rice milk, and almond milk. Some of these products, however, do include large quantities of potassium and/or phosphorus, so read labels carefully before choosing to have them as a part of your diet. 

Good and Bad protein

Good Protein

A protein that is rich in omega-3 fatty acids and low in saturated fats is a good protein. It is rich in beneficial elements such as amino acids and vitamins. 

Some of the examples of a good protein include 

  1. Fish: Seafood has a high protein content and is low in saturated fat. Omega-3 fatty acids are abundant in salmon, sardines, etc.,
  2. Poultry: The saturated fat content of chicken and turkey may be significantly reduced by removing the skin.
  3. Dairy goods are dairy products: Skim milk, cheese, and yogurt are all good sources of healthful protein. Sugar added to low-fat yogurts and flavored milk should be avoided.
  4. Beans: Beans and peas are high in protein as well as fiber. No cardiac problems are noted.
  5. Nuts and seeds: They are high in fiber and good fats, in addition to being high in protein.
  6. Avocados, sea vegetables, leafy green vegetables, and potatoes are all vegetable sources of complete protein. Potato protein can give most of the dairy proteins.

Bad proteins

In a bad protein, there will be too much fat, salt, and preservatives. Not all meat is an excellent source of protein. Excess animal protein can leave more residues of uric acid and purines in the tissues which cause over-acidity, nutritional deficiencies, osteoporosis, cardiovascular disease, cancer, and premature aging. Animal proteins are addicting because of the chemicals present in them.

Animal proteins cannot be digested by humans. Within 3 hours animal proteins start to degrade. Humans have a 30-foot-long intestine that they cannot get rid of before it rots and coats the intestines, limiting nutritional absorption. Hydrochloric acid and certain enzymes are required for animal protein digestion, and humans lack some of these enzymes as well as enough hydrochloric acid. The body expends all of its HCl trying to digest this protein, leaving no HCL for minerals or vegetable protein digestion. Calcium and phosphorus are leached from bones to neutralize the acidity of animal protein.

Not only are animal proteins bad, some of the plant proteins like soybeans are a little bit bad. Digestion inhibitors are found in soybeans and isolated soy protein. Phytates included in soybeans induce zinc insufficiency. It also has ten times more aluminum than milk and one hundred times more than raw milk. In laboratory animals, soy diets promoted organ enlargement. Isolated soy protein can harm the pancreas and thyroid, as well as retard brain growth and lead to Alzheimer’s disease, a neurodegenerative disorder.

In conclusion one protein is never said to be 100% good or 100% bad. All proteins have their benefits and disadvantages but the ratio varies. Choice of protein depends upon the individual and his/ her activity range.

Vegetarian and Non-vegetarian Diet for Protein?

There are two major sources of proteins that are the animal source and plant sources. 

Animal source: The quantity of fat in animal protein varies, with the largest levels of saturated fat (less healthy for the heart). Saturated fat is found in the least amount in fish, poultry, and low fat or fat-free dairy products. 

Plant source: One or more necessary amino acids are deficient in plant protein sources. Beans, lentils, nuts, peanut butter, seeds, and whole grains are all good sources of protein from plants. Plant proteins have the advantage of being low in saturated fat and high in fiber. Even though plant sources are deficient in one or two essential amino acids, it does not mean that you have to only eat animal sources to get all the essential amino acids. With careful planning and a variety of plant-based foods, a plant-based diet may fulfill protein demands. 

For example, 

Whole grains are abundant in methionine and cystine, but low in lysine.

Legumes are high in lysine and isoleucine, but not so much in tryptophan, methionine, or cystine.

Tryptophan, methionine, and cystine are abundant in seeds and nuts, whereas lysine is scarce.

Vegetarian diet

It is critical to consume a variety of foods that can fulfill the essential amino acids needed for the body. Some nutrients are present in lesser levels or less easily absorbed by the body in vegetarian foods than in meat or fish. Most vegans consume enough amounts of protein and calcium which are found in dairy products. Dialysis patients having greater protein demands can be met by vegetarian meals. However, if your diet is not carefully planned, you risk missing out on important nutrients. They should include beans, peas, and lentils. They are a low-fat source of protein, fiber, vitamins, and minerals, and they qualify as a vegetable portion. Protein and other nutrients may be found in nuts and seeds. Pulses are especially crucial for those who don’t receive enough protein from meat, fish, or dairy. To acquire the appropriate combination of amino acids, which are required to create and repair the body’s cells, you need to eat a range of different protein sources.

Non-vegetarian diet

The animal sources have all the essential amino acids but it does not mean you should only eat animal sources. If possible, you should include more seafood, compared to red meat and poultry. 

If you do not like seafood but want to eat more of it, there are techniques to make fish more appealing.

  • Fresh fish should always be purchased.
  • Add tasty sauce to mask the taste of fish.
  • To make a delicious sandwich filling, combine canned salmon or tuna with low-fat mayonnaise and minced onion.

High Protein in Urea

Proteins are metabolized in the body and excreted as urea. The nitrogen in the amino acids is excreted out as urea through the urea cycle. Higher amounts of urea and other nitrogenous waste products may result from a high protein diet. Indeed, numerous studies have found that high dietary protein intake is linked to increased blood urea nitrogen (BUN) levels when compared to normal dietary protein intake. Urea has long been thought to be physiologically inert. At concentrations in CKD, urea is hazardous because of higher concentration. Insulin resistance, free radical generation, apoptosis, and breakdown of the protective intestinal mucosal barrier are all triggered by urea. Urea is the precursor of cyanate, ammonia, and carbamylated chemicals, all of which have been related to biological alterations that can lead to urea toxicity. Carbamylation refers to the addition of isocyanic acid and it is an important post-translational modification. Carbamylation is linked to atherogenesis and other functional abnormalities.

Protein take According to different Stages of CKD

CKD stages 1 and 2:  limit dietary protein to not more than 0.8 g/ kg of your ideal body weight. When your GFR begins to diminish, you should consume more plant-based proteins since they produce less urea than animal proteins. 

CKD stage 3 to 5: you will need to reduce your protein intake even more. Limiting protein to 0.55-0.60 g/ kg of body weight to prevent renal function deterioration.

Calculate Protein Intake Per Day

Protein needs are determined by a variety of criteria like height, body weight, medical history, physical activity, etc., Protein requirements for an Indian with a sedentary lifestyle range from 0.8g to 1g/ Kg of ideal body weight. As the amount of exercise increases to moderate or heavy, this demand increases. A gram of protein can give you 4 calories.  There are several protein calculator platforms available online which are useful in fixing your diet. Protein in chronic kidney disease is critical to plan, it depends on the stage of CKD. As described earlier the amount of protein depends upon the stages and the kidney stage.

When to give high Protein Diet in CKD Patients

CKD without Dialysis 

If you don’t want to go on dialysis, limit your protein intake. The more protein waste that must be eliminated, the harder the kidneys must work to eliminate it. This can put a strain on your kidneys, leading them to wear out more quickly. A low-protein diet is suggested for patients with renal disease who are not on dialysis. Many studies show that decreasing protein intake and increasing plant-based items in the diet might help delay renal function decline.

CKD with dialysis 

If you are on dialysis, you should eat more protein. After a person begins dialysis, a higher protein diet is required to assist maintain blood protein levels and enhance health. Dialysis eliminates protein waste from the blood, eliminating the requirement for a low-protein diet. In peritoneal dialysis protein loss is heavy. 

Control High Phosphorus intake in a high Protein Diet

Extra phosphorus in our blood will be removed by normal functioning kidneys. Your kidneys can’t eliminate phosphorus properly if you have chronic kidney disease (CKD). High phosphorus levels might harm your health. Phosphorus levels in the blood should be between 2.5 and 4.5 mg/dL. As CKD develops, hyperphosphatemia becomes a severe consequence because increased blood phosphate can disturb normal calcium and phosphorus hormonal balance, resulting in cardiovascular disease. Because of their high phosphorus content, high protein foods such as dairy, meat, and some plant items, especially pulses, are restricted in the diet. Because much of the phosphorus in pulses is locked up in the form of phytate, the high phosphorus concentration may not be enough to restrict a high-quality protein source like pulses in renal diets.

Can I take muscle-building protein supplements? How do you choose the protein powder available in the market?

Yes, a patient in dialysis can lose more protein, so he/she can take protein supplements. But for patients without dialysis it is highly risky. These types of patients have a diet that has a decreased amount of protein. We already know good and bad proteins, choose a protein powder wisely based on that. Also, it looks like the protein powders are made up of plant proteins since most of the plant proteins belong to good proteins. The powder is a form of protein supplement. Protein supplements are available in a variety of formats, including powders, ready-to-drink, and bars. These are mostly used by gym professionals to build muscles quicker. Whey, casein, and soy protein are the most frequent forms of protein utilized in these types of protein supplements. As already stated, whey and casein are milk proteins, however, soy is a plant protein which is a preferable option for vegans or those who are allergic to dairy. Protein supplements may not be safe for elderly persons with renal illness or those who have recently had GIT surgery. Some components may interfere with prescription medications, so consult your nephrologist or pharmacist before starting with a protein supplement.

Can These supplements increase creatinine levels? 

Creatinine levels can be increased due to creatine supplements. Creatine is a common supplemental substance taken by athletes and bodybuilders to enhance their muscular performance. Serum creatinine is a common measure for evaluating renal function. Increased creatinine levels indicate renal impairment, necessitating additional research. When taken by healthy individuals at the recommended loading (20 g/day for initial five days) and maintenance doses (3g/day), creatine supplementation appears to be safe. Creatine may be linked to an increased risk of renal failure in persons with a history of renal illness or those using nephrotoxic drugs. Creatine supplementation can raise creatinine levels, which can be a misleading indication of kidney disease.

What are cheap sources of high-quality protein?

In India, protein-rich foods are accessible to meet various dietary choices and budgets. Your body will stay strong if you increase your protein consumption, also making weight loss simpler. If you go to the gym often, eating extra protein will help you recover and increase muscle mass. Overall, you may pick from a variety of sources on the market, ranging from peanut butter to chicken. Choosing protein sources from the list below will allow you to boost your protein consumption healthily. 

Some of the most important and cheap high-quality proteins are 

  1. Pulses
  2. Peanut butter 
  3. Eggs 
  4. Milk
  5. Chicken
  6. Almonds
  7. Soya beans 
  8. Oats 

Albumin protein supplements powder

Albumin is a type of protein that is usually found in eggs. When compared to the muscles of people who do not supplement albumin, albumin-supplemented individuals are quite good for boosting metabolic functioning and are capable of producing healthier muscles. It is healthy and has a high biological content, as it is made from dehydrated egg white. It also has a very low-fat content. It works similarly to eating eggs. Even its high protein content has the same drawbacks as other foods of the same category. Patients undergoing peritoneal dialysis can lead to more protein loss which leads to hypoalbuminemia. For those patients, albumin is needed. 

Advantages of albumin supplementation 

  • Muscle mass reduction is minimal.
  • The composition is devoid of carbohydrates
  • less expensive 
  • Acts on the gut flora’s function.

Disadvantages of albumin supplementation 

  • Slowly digested protein 
  • Increased gas levels and may cause discomfort.
  • To expel gases, you will need to do some walking exercise.

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