Patients with CKD debate value of meat, plant-based meals
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For patients with chronic kidney disease or on dialysis, plant-based diets have been viewed as second rate to animal protein. It was believed that plant-based diets would cause phosphorus and potassium levels to rise and plant proteins could not meet the needs of the patient with kidney disease.
Studies support an increase of fruits and vegetables and plant-based proteins in the CKD and dialysis populations. Lower overall protein intake associated with vegetarians can help slow the progression of kidney disease without sacrificing nutritional status in CKD. A recent study by Bernier-Jean and colleagues revealed a slower decline in kidney function in a 10-year longitudinal study for older women with a plant-based protein diet. Potassium and phosphorus levels are better controlled on whole food plant-based diets, secondary to less exposure to phosphorus and potassium additives. There are several other benefits, such as anti-inflammatory factors, improvements in gut health and a decrease in acid load.
Check the ingredients
Not all plant-based diets are created equal in times in which convenience is king. The Impossible Burger and Beyond Meat options are two plant-based imitation meat products that have taken off in the restaurant industry. However, when you compare the nutrition profile of a beef burger and that of the processed plant-based burger, you will find only a few differences. Plant-based burgers have higher fiber yet almost double the amount of potassium and sodium, while other nutrients are comparative. The processed plant foods that offer a “meat-like” taste tend to use additives and preservatives; therefore, the nutritional benefit these boast is often lost. For patients with CKD, this could be a complicated way to include plant-based foods in the kidney diet.
For those with CKD, food choices can be confusing and frustrating; what once was considered acceptable is only allowed in certain amounts or taken out of the daily diet. Trying to decide what is the best option between the arguments over plant-based vs. animal-based proteins is difficult, too. Registered dietitian nutritionists (RDNs) work feverishly to ensure diet changes that both provide good nutrition and also meet patients’ personal needs. That means having a hamburger from time to time at their favorite restaurant is fine.
If you crave meat, make it meat
In general, those with CKD and those on dialysis have to keep in mind several things when deciding between meat and vegetarian options, including ingredients like sodium, potassium, phosphorus and protein (lower protein recommended for patients with nondialysis CKD). As previously mentioned, and noted in the table, the nutrient content of the plant-based Impossible Whopper is comparable to the traditional Whopper. The traditional Whopper has less sodium and less potassium, but comparable protein and calories. Information on phosphorus content is not available but is likely high in both, secondary to the additives in the ingredients. Therefore, encouragement of taking phosphorus binders with the meal is recommended.
The overall recommendation is moderation for either the plant-based or the meat choice. Also, take prescribed binders with the meal, and have only the sandwich instead of an entire fast food meal. For someone truly wanting to eat a plant-based burger, the recommendation would be to purchase the plain plant-based burgers at the local grocery and prepare at home where you can control the seasonings using low/non-salt based options such as garlic and onion powder, pepper and other seasonings.
To reap the benefits of a plant-based diet, you should consume whole plant-based foods. Meal planning and preparation can make this an easy process. Simply adding a “Meatless Monday” each week can add some whole food plant-based options too, such as a tofu scramble for breakfast, homemade black bean burger and veggies at lunch, and a high-protein chickpea pasta for dinner.
Those who are on more frequent hemodialysis or PD and those with transplants often have increased options when it comes to diet, but all can benefit from a whole food plant-based diet.
References:
Anjos JS, et al. J Ren Nutr. 2018;doi:10.1053/j.jrn.2017.11.005.
Bernier-Jean A, et al. Nephrology Dialysis Transplantation. 2020;doi.org/10.1093/ndt/gfaa081
Haring B, et al. J Ren Nutr. 2017;doi:10.1053/j.jrn.2016.11.004.
Joshi S, et al. J Ren Nutr. 2019;doi:10.1053/j.jrn.2018.06.006.
Kalantar-Zadeh K, et al. N Engl J Med. 2017;doi:10.1056/NEJMra1700312.
Malhotra R, et al. J Ren Nutr. 2018;doi:10.1053/j.jrn.2017.11.008.
Moore LW, et al. Kidney Int. 2013;doi:10.1038/ki.2012.420.
Rhee CM, et al. J Cachexia Sarcopenia Muscle. 2018;doi:10.1002/jcsm.12264.
Perspective
Back to TopWilliam Craig, MS, RD, CDN
In some cases, the information being addressed and the conclusions are questionable but deserve consideration.
One such article is the one concerning plant-based foods, in particular, plant-based meats. Ms. Hannahs touches upon the many facets of a meal plan that might very well be considered vegetarian. And at the same time speaks to both classes of patients — the one receiving dialysis and the one that is pre-hemodialysis. Further, she acknowledges while there is a vague/slight similarity between the two, in truth they are diametrically opposed. One minimizes the consumption of protein, while the other stresses its need. Here is where there might be a major difference of opinion. Fifteen grams of plant-based protein is not equivalent to fifteen grams of animal protein. Without going through all the differences, naming only one, the absence of vitamin B12 is significant, and how that absence impacts an individual’s metabolic physiology in ways we have yet to fully understand.
If we acknowledge again the extraordinary impact that renal disease has upon human physiology, we find that the ability to even consume (adequate amounts of) protein is at best difficult. And to consume any meal that is of lesser quality places the patient at risk for poor nutritional outcome. Add to this the (necessary) adulteration of foods to be consumed to enhance their palatability engenders other issues, which might very well be more significant, i.e., more detrimental to the patient than hypoalbuminemia.
There is so much to be considered. The condition of CKD and its vast issues — physiologically, metabolically, and psychologically — necessitate a subjective approach that is individualized if there is to be any degree of success at our attempts in supporting the patient’s wellness.
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