Few proteins (and vegetables), lots of vegetables: kidney health begins at the table
2 years ago
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More than the drugs we take, maintaining good kidney health depends on what we eat. Food and beverages are involved both in the prevention of kidney disease and especially in the conservative therapy of chronic kidney failure. “Not a disease, like pneumonia or hepatitis – he clarifies Piergiorgio Messa, former director of the complex operational unit of nephrology, dialysis and kidney transplantation at the Milan Polyclinic -. But a large container which includes all kidney diseases which, if not resolved in the acute phase, are destined to accompany us throughout our life. ”For these reasons, diet occupies a leading place in the management of these conditions.
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Kidney disease prevention starts from the table
On the prevention front, the rules to be followed at the table to protect the kidneys are those that are applied in practice against all chronic diseases. The diet – as repeated by the specialists during the congress of the Italian Society of Nephrology, which has just ended in Rimini – must be varied and balanced. The risks – regardless of the consequences: from kidney stones to the most severe forms of chronic renal failure – can be contained by reducing the intake of animal proteins, simple sugars and salt. And drinking at least two liters of water a day (to avoid carbonated and sugary drinks). “The best diet to prevent the formation of stones is the Mediterranean one, which provides an abundant intake of fresh fruit and vegetables, legumes, whole grains and an adequate intake of foods containing calcium”, adds Messa.
The habits of three groups
The latest confirmation, in this sense, came from a study published in 2020 in the American Journal of Clinical Nutrition. On that occasion, researchers from the Gemelli Polyclinic in Rome and the universities of Verona and Harvard checked what had been the dietary habits of three large groups of people involved in as many American studies for over three decades. Counting also on the incidence data of kidney stones, the authors concluded that the risk of developing new stones was lower (-28 percent, on average) in people more accustomed to following a diet in which the consumption of fruit was frequent. vegetables, legumes, complex carbohydrates, fish and extra virgin olive oil.
The link between obesity and chronic kidney disease
To this it should be added that adherence to the Mediterranean diet facilitates the control of body weight which, if excessive, can favor the onset of kidney stones. For the same reason, exercising regularly is another piece of advice that is given both as a preventive measure and to those who have already received a diagnosis of kidney stones. “Obesity also implies an overload of work for the kidneys which over time can lead to a progressive reduction of the overall renal function – the specialist points out -. Furthermore, the obese patient is more at risk of developing diabetes and hypertension, among the first causes of chronic kidney disease “. The link between obesity and poor kidney health is very close. “Diabetes, which is almost always associated with excess weight, is one of the leading causes of chronic kidney disease. This is because diabetics most frequently develop cardiovascular and infectious diseases which contribute to the development of kidney disease.”
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A low-protein diet for those who already have kidney disease
More than prevention, however, nutrition plays an important role in the management of chronic kidney disease. Together with the use of some drugs, the diet is in fact considered a real therapy in the approach that aims at the conservation of the kidney. That is, in all those patients with overt insufficiency, but not yet severe to the point of requiring dialysis or organ transplantation. Replacement procedures that can be postponed for several years or made less frequent – in the case of dialysis – thanks to an appropriate correction of eating habits. “The diet must be tailored to the patient suffering from a kidney disease and adapted over time”, explains Stefano Bianchi, former director of the complex operating unit of nephrology and dialysis of the Asl Toscana Nordovest and just elected at the helm of the Italian Society of Nephrology.
Almost vegetarian diet
“In conservative therapy, it is necessary to follow a diet tending towards vegetarianism, low protein (with an intake of 0.3-0.7 grams of protein per kilo of body weight, ed) and low in sodium and phosphorus “. Foods of animal origin, the experts recall, should be consumed in moderation. Fish and white meats are possibly preferable to red meats. More space should be left instead to the macronutrient of vegetable origin: a starting with legumes, with soy at the top of the list for the high biological value of its proteins. To reduce its overall intake, carbohydrate sources must also be changed. Via biscuits, bread, pasta, crackers and traditional flours to the advantage protein-free products, which can be purchased in pharmacies (although with different reimbursement mechanisms from one Region to another).
Give vegetables more benefits than risks to kidney health
If there is unanimity in the management of protein sources, diet management in these patients is more difficult as regards the consumption of fruit and vegetables. On the one hand, to be encouraged, since the pattern to be followed is the Mediterranean one: more pushed towards vegetarianism. On the other hand, it is necessary to take into account the need to minimize the intake of some minerals – phosphorus and potassium – which are abundant especially in plant products.
We are talking about food and not poisons
How then to reconcile the two needs? “I like to repeat to patients that we always talk about food and never about poisons – he says Adamasco Cupisti, in charge of the diagnosis and treatment program of metabolic-nutritional alterations in chronic kidney disease of the hospital-university of Pisa -. This means that even the riskiest food, as in this case could be red meat and Parmesan, can be consumed occasionally without particular consequences. Considering the need to limit the intake of food of animal origin, over the years we have found the formula to guarantee an adequate consumption of vegetables: able to guarantee an adequate state of nutrition, without putting the kidneys at risk “.
To reduce potassium intake – which are rich in both fruit (kiwi, avocado, banana, currants), as well as vegetables (spinach, Brussels sprouts, fennel, artichokes, endive) and dried legumes (especially beans, lentils and chickpeas) – just wash these foods (especially those you want to eat raw), cut them into small pieces and leave them to soak for a few tens of minutes. Among vegetables, however, phosphorus is abundant in dried fruit and legumes. “But in the latter case we find phosphorus in the form of phytate: so it is much less absorbable than that found in meat”, adds the expert. The preservation and cooking of food are also very important, thanks to which it is possible to reduce the intake of sodium, phosphorus and potassium by 30-40 percent. “These patients are recommended to consume mostly boiled legumes and vegetables, in order to reduce the intake of sodium, potassium and phosphorus from the dish”, concludes Cupisti. Without, of course, recovering the cooking water.
