I’m honestly feeling incredibly lazy (mentally) and tired (physically) tonight, so this post is going to be a “copy and paste” fest. No one really listens to what I’ve got to say anyway, they really want to hear what Robb Wolf and Mark Sisson have to say about life, love and Paleo.
I’ve heard so many…..so-freakin many times “Doesn’t too much protein wreck my Kidneys?!“, that I figured I’d try in vain to clear that old myth up. Let’s face it, if Wolf or Sisson alone haven’t been successful in killing hat good-old conventional wisdom, so little ole’me isn’t going to make a dent in it either….but maybe if I use the combined power of Wolf and Sisson, we can get ‘er done!
So, Mr Wolf…break it down for us in your signature geeky-sarcastic style, would you please?
If I wanted to cut to the chase I could boil this whole thing down to the following:
1-Dietary protein DOES NOT CAUSE KIDNEY DAMAGE.
2-Chronically elevated BLOOD GLUCOSE levels DO cause kidney damage.
3-Dietary fructose REALLY causes kidney damage.
4-Many kidney issues have either a hyperinsulinemic characteristic, an autoimmune characteristic, and or a combination of autoimmunity or hyperinsulinism. A standard, low-ish carb paleo diet can fix most of these issues.
5-For serious kidney damage a low-protein, ketogenic diet can be remarkably therapeutic.
6-If you get kidney stones that are from oxalates, reduce your green veggie intake (spinach for example) and have other types of veggies.
7-If you get kidney stones that are from urate salts, you are likely NOT following a low-ish carb paleo diet, you likely have insulin resistance and your liver is not processing uric acid.
Robb talking about uric acid, actually reminds me that I need to write an article on Gout, or maybe I did already…..I can’t remember.
Hey Robb! What about protein and kidneys?
Hmm…how to tackle this tactfully. In healthy kidneys protein intake has NO EFFECT on kidney health. In sick kidneys, protein can cause problems. Why? Because when the kidneys are not excreting urea bad things happen. Urea itself is not particularly toxic, but other nitrogenous waste products are neurotoxic and can cause death at high enough levels. The bottom line is that in healthy individuals, increased protein intake causes an increase in the kidneys ability to deal with creatinine and BUN. In individuals with kidney disease they will likely benefit from a decrease in protein intake…but they need to address one of the aforementioned factors if they want to REGAIN kidney function, which we will talk about soon.
Putting it all together
Nothing helps cement the learning process better than a practical example. Let’s look at someone who has all the cards stacked against them, then figure out how to pull their heinie from the flames. Here folks is Pete “Proteinuria” Paducka.
Pete is a 30 YO male, 175cm tall, 110kg (I can’t tell you hw depressing and embarrassing it is that the US can’t figure out the metric system) and pretty much a mess. He is sedentary, stressed, has terrible sleep and exists on packaged pastry products and beverages with “DEW, Pepper” and similar monikers. Recently Pete had to get a physical and he had: high blood pressure, elevated: blood glucose, BUN, creatinine. Given that his condition was obviously not good it was recommended that his renal function get checked out. Tests indicated Pete was operating on approximately 10% of normal kidney function. Pete was pretty shaken up by his condition…peri-diabetic, facing dialysis ( his doctor wanted to start dialysis IMMEDIATELY) and all at the ripe old age of 30. Fortunately for Pete, his employer was a member at a wacky little gym called NorCal Strength & Conditioning and the employers offered to not only pick up his gym membership for a few months, but would pay Pete on an incentive basis: $5 for every pound lost. This is a small IT company, and I’m sure this situation violated multiple California state “fair employment” laws…but it’s what happened here. Pete went through an initial assessment at NorCal, and it was recommended that he work with Amy Kubal on his nutrition. The course of action involved a low protein (10-15% protein) low carb ( less than 10%) high fat (mainly from coconut products), ketogenic diet. Pete’s doctor was horrified, but we petitioned for one month of “tinkering” to see how things went. Three weeks later Pete’s GFR was 80% of normal instead of the previous 10% and his BUN was within normal ranges. His doctor was interested…but baffled. Pete has subsequently titrated up his protein intake with no ill effects on kidney function.
The Tea Leaves
When you look at the etiology of most kidney diseases the approach we took with Pete addressed every damn variable all at once: autoimmunity, elevated insulin and growth factors, AGE’s…did I miss anything? Interestingly, about a week after Pete got his 80% test results back this article appeared, extolling the virtues of a ketogenic diet for renal failure. As I’m writing this I actually get ANGRY when I realize how much death and suffering occurs because insulin resistant diabetes (and all of it’s complications, like renal failure) is “managed” instead of “cured.” Unfortunately most folks are too addicted to their unhealthy lifeway to change in the way that I’ve descried here…but many will change if given the option, but our government and medical community are still in a metabolic dark ages. Sigh.
Thanks Robb, you’re my hero. Seriously. Ok…..Mr. Super-Sisson, what do you think about the question, “Doesn’t Paleo Protein Wreck My Kidneys?”
I’m reminded of the time I had to take Buddha in for a quick checkup at an unfamiliar vet and the woman examining him mentioned that I’d probably want to switch him to a low-protein diet or risk certain renal failure. Because, you know, the kidneys of dogs, close relative of the carnivorous wolf, are unable to process all that meat and protein. It’s ridiculous on its face, and rather than waste a lot of space debunking what Dr. Eades calls one of the “Vampire Myths” (it just won’t die; get it?), I’ll just link to a few papers that have already done so.
There’s this one from the Journal of the International Society of Sports Nutrition, a massive review of the evidence in favor of and in opposition to the AHA’s weasel warnings about “high protein diets,” namely, that people who engage in such risky behaviors as limiting carbs and increasing protein “are [at] risk for … potential cardiac, renal, bone, and liver abnormalities overall.” Long story short: there’s far more evidence in opposition to the claim than evidence in favor of it. The AHA recommendations are at best incorrect and at worst deliberately misleading, and the sum of the actual evidence points to protein as being protective against heart disease, osteoporosis, kidney disease, and liver problems – all things protein is supposed to initiate or worsen.
Another review, this time focusing strictly on whether or not protein intake can precipitate kidney disease in healthy people, is even better. I mean, that’s the important thing, isn’t it? If we want to exonerate or condemn protein, we must study its effects on healthy kidneys. We have to see if it creates problems rather than potentially worsens them. And, according to the exhaustive analysis of Martin et al, there exists no evidence that protein intake negatively influences renal health in otherwise healthy, active individuals. There is some evidence that already impaired renal function might worsen with increased protein, but the experts, as is their wont, can’t resist applying the same recommendations to everyone, regardless of renal health. The result is a nutrition teacher sowing misinformation across the student body in an introductory course, i.e. one that is intended to establish foundational knowledge that the students will carry on through life as a cornerstone of their thinking.
Simply put, healthy kidneys can handle plenty of protein; heck, they are meant to handle protein. One of their primary functions is to process the metabolic waste that results from protein metabolism. Yeah, protein “works” the kidneys, but that’s what they’re there for!Strength training works the muscles. You might even say it strains them. But is that a problem? Compromised kidneys in patients with renal disease (either full-blown or still in development) may not be able to handle as much protein as healthy kidneys, but even that’s up in the air – and protein is not the cause of the problem.
So what causes kidney disease, if not too many deck of cards-sized pieces of deadly animal protein in the diet?
The top two conditions responsible for chronic kidney disease (CKD) are, respectively, diabetes (45% of CKD cases) and hypertension, or high blood pressure.”Even” the Wikipedia entry on renal failure fails to mention “excess protein in the diet” as a cause (even potentially) of CKD. If you have CKD, chances are fairly high that you’re either diabetic, hypertensive, or both.
You know what’s even better? High-protein diets, when compared to the high-carb diet commonly recommended, improve glucose tolerance and blood sugar control in type 2 diabetics without changing kidney function. And, since type 2 diabetes often leads to CKD and is characterized partly by poor glucose tolerance and blood sugar control, you might even say that eating more protein is actually protective against renal failure.
As for hypertension, the latest systematic review concludes that more protein in the diet seems to correlate with lower, or at least normalized, blood pressure in humans. That doesn’t necessarily mean anything definitive, but it’s certainly interesting, and it doesn’t support the standard position.
Of course! Anyway, unless it’ll compromise your grade in the class, I’d speak up about it. Engage your teacher, for without disagreement, especially when warranted, there can be no progress. At the very least, defend your stance, perhaps wielding the aforementioned papers, and by all means: don’t feel the need to limit yourself to 38 grams of protein per day! While that may be adequate – that is, you’ll live – you definitely have room for more.
You need protein for a number of reasons:
It’s required for good skeletal health; contrary to what many vegetarians will scream,animal protein doesn’t leach calcium from the bones, leading to osteoporosis. In fact, inadequate protein intake is a huge risk for the debilitating bone disease.
It provides amino acids, which play multiple roles in the human body. They act as building blocks for most bodily structures, including hair, organs, skin, and muscles. Using amino acids, we build new tissue and repair damaged tissue. Lifting weights “damages” muscle tissue; we repair the damage with amino acids. Amino acids also act as precursors to hormones and neurotransmitters, like serotonin (the amino acid tryptophan) and dopamine (the amino acid tyrosine).
It’s good for quality of life, especially in the later years where folks are more susceptible to skeletal muscle wasting. You try keeping up with your grandkids while experiencing severe systemic muscle atrophy!
It’s good for satiety. Younger and older men eating 1g protein per kg of bodyweight had greater satiation than similarly aged men eating either 0.75g/kg or 0.5g/kg, and they reported a superior ability to stick to an eating plan.
(Animal protein is best, of course. A recent study found that due to reduced bioavailability of plant protein, vegetarians should probably increase their total protein intake to make up for the deficiency.)
Most people don’t need a ton of protein. If asked, I say I eat roughly 1 gram per pound of bodyweight, but it’s not something I’m militant about and I’m no longer hitting the weights like I used to. I just eat to satiety. Since it’s a satiating macronutrient, I find there’s a natural, relatively organic limit to how much pure protein I even want. Lean chicken breasts? I’m lucky if I can get through a whole one. A nice juicy grass-fed ribeye festooned with fat? I’m licking the plate.
Other people will need more protein. Highly active athletes, Crossfitters, powerlifters, folks trying to gain mass and strength, folks trying to lose a bunch of weight – they all can benefit from an increased protein intake, either by increasing satiety (thus improving diet adherence) or providing amino acids for muscle recovery and repair. One gram or protein per pound of lean body mass is a good average number to shoot for over a range of a few days.
Renee, if you’re feeling good with your current level (how much protein are you eating, by the way?), you’re performing well, you’re lean (and you apparently are), and you’re healthy (free of diabetes and hypertension), I don’t see any reason to curtail your protein intake. And certainly not because it’s going to destroy your kidneys. There is some contention that protein restriction (or protein cycling) can extend lifespan, but as I said in the fasting post, I’d rather have a fantastic quality of life (which for me means plenty of lean mass, plenty ofphysical activity, and plenty of meat on my plate) than live a few extra, protein-restricted years.
Phew, you said a mouthful Mark!
Mark Sisson and Robb Wolf actually agree on a lot of things, which I happen to think is rather awesome, because I respect them both very highly. They really are worthy leaders of the ancestral health movement. The bottom line is that when it comes to Paleo Protein (i.e. The large amount of protein Paleo practitioners eat), you don’t need to worry about your Kidneys or overall renal function. You’ll be just fine. Possibly better than fine. Give The Paleo Diet a go, and you’ll see what I mean!
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Barry Cripps is a Paleo-based Nutrition and Wellness Consultant, who operates out of Bowling Green, Kentucky.
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