Hi all! Today I wanted to talk about protein. Protein as most would know is at the heart of much discussion when it comes to treating and managing kidney disease, but for many it still remains a mystery. Questions such as: Does protein cause further kidney damage? How much should I take during each stage of kidney disease? And what are the best sources of protein? Are just a few of the questions I get commonly asked about protein and kidney disease. All of which I want to clarify and answer for you today (and more).
… With any topic it is important to understand the fundamentals, so before I can start saying have X amount of protein at stage 4 kidney disease, you really need to know what the heck protein is! This is important because it gives you a deeper understanding of how your body works and interacts with its environment, and because of this you have far greater chance of following and sticking to the recommendations.
This article is a result of two of my awesome followers (Steven and Mark) asking a question on my facebook fan page; I created my facebook fan page to build a community, for people to “mingle”, chat with each other, pass ideas around, learn, discover, keep up to date with all my latest articles and information, and of course, a place to interact with me and ask questions. You can find me on my facebook fan page here: http://www.facebook.com/kidneycoach
(Remember to click the “LIKE” button near the top of the page to get access to the community.)
So What The Heck Is Protein?
To me proteins are simply amazing. Proteins are literally the building blocks of our body, plus they perform what seems every biological function in our body. To demonstrate this, here are just some of the most important functions performed by proteins:
• Blood Clotting – fibrin is a protein in the blood which causes the blood to coagulate, and therefore stop bleeding.
• Carrier Proteins – haemoglobin is a “carrier” protein that carries oxygen throughout the body.
• Energy – in a nutrient depleted state, the body will switch from carbohydrates and fats, to proteins as its source of fuel (muscle proteins).
• Enzymes – did you know enzymes are actually proteins? Enzymes help make chemical reactions occur in the body.
• Fluid Balance – albumin, a specialised protein, is used by the body to maintain fluid balance within the blood.
• Hormones – hormones, such as insulin, are created from protein.
• Immune system –immunoglobulins and antibodies are protein molecules that help fight infections.
• pH Balance – proteins assist in the management of pH levels in your blood.
• Repair and Growth
• Structural Proteins – the most well known examples of structural proteins are bones and muscles, but also include, hair, nails, skin, eyes, and internal organs (e.g. kidneys).
Simply amazing right? I sure think so.
On a deeper level however, I really need to talk to you about amino acids, because you see, at the very primary level, protein is in actual fact a very large molecule made out of many amino acids. These “amino acids” are in effect “glued” together in varying sequences creating various proteins, for various functions. Proteins maybe termed the “building blocks” of our body, but amino acids are the “building blocks” of protein.
When we are advised to have X amount of protein each day by health experts, what we are really telling you is to have X amount of amino acids each day. This is because when your body takes in (eats) protein, its job of digesting protein in reality is to breakdown these proteins into its most elemental form, amino acids, so you can then go ahead and manufacturer the exact proteins you need for the day.
In total there are 20 naturally occurring amino acids that the body utilises for bodily tissues*, eight of which are termed essential (because the body cannot manufacture these on its own – and therefore is “essential” in the diet), 2 semi-essential amino acids (as they are considered essential only for children), and 10 non-essential amino acids (not because the body does not require these, but rather that the body can manufacture these on its own from protein).
Here is a list of the above amino acid groups:
Essential: Isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine
Semi-Essential: Arginine, histidine
Non-Essential: Alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, proline, serine, tyrosine
* I have stated there are 20 main amino acids required by the body, in some texts however, you may read that there are 19, 20, or 22 “main” amino acids required by the body. Unfortunately amino acid classification has not been formally been agreed upon, and therefore discrepancies do and will exist. Yes there are so many more naturally occurring amino acids, even far surpassing “22”, such as L-Carnitine, Taurine, and Glutathione that the body uses in metabolic functions, but they are not the foundation of human tissue and therefore have been omitted here.
It is important to note that each amino acid has its own action and therapeutic benefit within the body; tryptophan might be the most well known out of the 20 amino acids for its ability to increase serotonin levels (enhance mood and improve sleep quality), but for this article I will leave it at that. That is a topic for a whole other article.
Also important to note, unlike carbohydrates and fat, protein/amino acids are not “stored” within the body for later use. You need to consume protein every day to meet your body’s requirements. Kidney disease, or no kidney disease.
…OK, now you know a little more about protein and the building blocks of protein (amino acids), so let’s get down to business and start answering the real questions that you are here for.
The Dilemma: Protein and Kidney Disease
By now you can clearly see that protein is not only good, but critical for the survival of the body. Without protein, life ceases. In regard to kidney disease however, there are certain guidelines one must follow to ensure peak kidney function, while maintaining overall body wellness. This is because too much protein can damage the kidneys, yet too little does not provide the building blocks for growth and repair (along with many other functions). So yes, it is true that too much protein will damage the kidneys; but to repeat myself, remember the kidneys need protein to regenerate too.
The mechanism, by which protein can be harmful to the kidneys, is simply from its sheer size. When the kidneys filter blood, small particles pass through with ease, and are then eliminated via the urine. However because proteins are very large molecules, yet just small enough to pass through the kidneys, excess protein in the diet causes wear and tear to the kidneys.
Kind of like if you had a friend with a big head borrow your jumper for the week. Sure you have a head too, but if he or she is continually putting on your jumper, they are going to stretch the neck out on your good jumper (Seinfeld fans maybe remember a similar episode when George Constanza borrowed someone else’s jumper 🙂 ). A high amount of protein also draws extra fluid through the kidneys causing them to swell.
Tricky predicament to be in, right?
A little bit, but with the guidelines I am about to lay out, it should all be a breeze.
How Much Protein Is Needed In Each Stage of Kidney Disease?
Below you will find three stages of protein requirements, related to the stage of kidney disease you are in. You will notice that stages one and two of kidney disease are essentially the same as what a normal healthy individual is recommend to eat, stages three and four protein requirements decrease by about 20%, and stages four to five decrease by about another 40% on top of that. Each of these recommendations is the daily allowance.
Protein For Kidney Disease Stages 1 & 2 (eGFR of 60 to 90+)
Protein – 0.8 to 1 gram per kilo of body weight
(e.g. 48 to 60 grams for a 60 kg (130 lb) individual)
Protein For Kidney Disease Stages 3 & 4 (eGFR of 20 to 60)
Protein – 0.6 to 0.8 gram per kilo of body weight
(e.g. 36 to 48 grams for a 60 kg (130 lb) individual)
Protein For Kidney Disease Stages 4 & 5 (eGFR of 5 to 20)
Protein – Ideal 20 grams, Max 30 grams total*
*Amino acid supplementation is an important therapy to consider at this level of kidney disease and while only taking this much protein per day. Speak to your health professional about your treatment plan.
As you can see a low protein diet in the final stages of kidney disease is the best protein strategy one can apply, of course protein is just one piece of the larger puzzle that makes up the a complete kidney healing program, but nonetheless, it is most certainly a crucial piece of that puzzle.
Best Sources of Protein for Kidney Disease
Interestingly, not all proteins are created equal. As you may have read in an earlier article of mine, there is plenty of research proving that chicken meat for example, is a much better protein source than red meat for kidney disease. Research has proven that switching to chicken, over red meat, is just as effective as using blood pressure lowering medication – blood pressure lowering medication is a common medication in the management of kidney disease. If you missed this article, you can find it here: Kidney Problems: Chickens To The Rescue?
But it is not just chicken that is an excellent source of protein for kidney disease, here are others that are known to be beneficial for kidney damage: chicken, turkey, tofu, tempeh, fish, crustaceans, beans, lentils, buckwheat, brown rice, oats, and nuts and seeds just to name a few (you just want to make sure you avoid ALL red meats).
Complete Vs Incomplete Proteins
If you choose the vegetarian options of tofu, tempeh, beans, lentils, buckwheat, brown rice, oats, and nuts and seeds to supply your body with life giving protein, you will need to make sure that you eat a selection of each to supply all the amino acids that your body needs.
There are two types of dietary proteins available, one is known as Complete Protein, and the other is known as Incomplete Protein. The difference between the two is as follows. Complete proteins are called so because they contain all the essential amino acids your body needs in the appropriate levels to maintain health, whereas incomplete proteins are deficient in one or two of the essential amino acids required by the body. All animal proteins are a source of complete protein, whereas all plant proteins are incomplete proteins. The way around this however, is to make sure you have a combination of the following plants (by doing this you will create a complete protein):
• Combine Grains and Legumes
• Combine Grains and Nuts/Seeds
• Combine Legumes and Nuts/Seeds
Remember, protein is very important for all individuals, with or without kidney disease. The trick is to get your protein consumption matched up with your level of kidney disease, to eat the best sources of protein for kidney disease, and if necessary, during renal failure, take single amino acids to provide the body with the necessary tools to repair, without the concern of placing extra stress on the body. I will reserve a more in depth look at amino acid therapy in kidney disease for a later a blog post, but be sure to know, amino acid therapy is an important consideration for any individual with an eGFR of below 20ml/min.
Once more I hope you found my latest article on protein and kidney disease very beneficial.
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