Speaker: ‘Fad diets’ may ‘jumpstart’ weight loss in patients with kidney disease
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Along with close monitoring, incorporating “fad diets” into more evidence-based weight loss approaches may improve outcomes for patients with kidney disease, according to a former dialysis dietician who now works in CKD research.
“It’s definitely a crisis,” Laura Byham-Gray, PhD, RDN, FNKF, of the department of clinical and preventive nutrition sciences at Rutgers University in Newark, said at the virtual American Nephrology Nurses Association Nephrology Nursing Practice, Management and Leadership Conference. “Certainly, you are working in the dialysis clinics or working with CKD patients and seeing a much higher proportion of patients that are obese and know this makes their treatment more complicated. It also requires a more integrated approach to weight management.”
In her presentation, Byham-Gray examined a variety of what she termed “fad diets,” including the ketogenic diet, high-protein diet (eg, Atkins), intermittent fasting and the paleolithic diet. All of these, she said, can help patients lose weight but come with associated risks making close monitoring crucial. She also contended that such monitoring, as well as adjusting the dietary pattern as needed, are important components to safe weight loss due to a lack of evidence supporting these diets.
According to Byham-Gray, the keto diet—which increases the amount of fat consumed and is moderate in protein—can have detrimental short-term and long-term effects if followed strictly. In the short-term, she said effects such as upset stomach, fatigue, headache and dizziness; in the long-term, patients may experience nutrient deficiency, kidney stones, liver disease and cardiovascular disease.
“I think the key is allowing patients to try the keto diet in a way that is closely monitored,” she said. “If someone starts on the keto diet and they’re more gentle about it and it helps them to lose some weight and feel successful, along with allowing them to start exercising and maintain overall weight status, that is positive.”
Next, she addressed the high-protein diet which she said is sometimes confused with the ketogenic diet, the important difference being that the keto diet is high in fat whereas high-protein diets supplement protein at a high rate.
“The high-protein diet can be extremely dangerous, especially for someone with stage 3 kidney disease where we are trying to limit the amount of nitrogen because of the increased hypoperfusion that occurs. The excess load can cause diseased kidneys to work even harder.”
Regarding intermittent fasting, Byham-Gray said although the potential nutrient deficiency that occurs can be supplemented with multivitamins, this diet presents problems for patients with diabetes due to their need for glucose management.
“If a patient is very set on following a certain approach, then we start to negotiate a little bit,” she said. “If they want to try intermittent fasting but have diabetes, think about how that might affect blood sugar. Let’s monitor, let’s see how the patient is feeling, let’s try to be safe by consulting with the nephrologist and endocrinologist. Again, monitoring patients closely is the way to be successful.”
Regardless of what “fad diet” the patient chooses, Byham-Gray said portion control and increasing physical activity are other determining factors as to whether they will be successful.
She also touched on three well-studied evidence-based dietary patterns, including the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet and the plant-based diet. All of these, she said, are recommended in KDIGO nutrition guidelines as they have demonstrated a reduction in mortality from cardiovascular disease.
“We do suggest the Mediterranean diet that incorporates higher amounts of fat, fewer carbohydrates, more fish and fresh fruit,” she said. “This is a modified paleolithic type of diet that we recommend across the spectrum of kidney disease: higher fruit and vegetable intake lead to lower blood pressure and lower body weight.”
Byham-Gray emphasized that the evidence for fad diets is still uncertain and further research looking at long-term impacts is required.
“Though we must be mindful of what each individual patient’s health status is like, I think that we can use fad dieting as a way to jumpstart weight loss as long as it’s monitored and done in a careful way.”
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Byham-Gray L. Session 205. Presented at: American Nephrology Nurses Association Nephrology Nursing Practice, Management & Leadership Conference. Nov. 7-8, 2020 (virtual meeting).
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