By - Craig Mullins

Improve CKD Chronic Kidney Disease With Nephrologist Sean Hashmi & Renal Dietitian Michele Crosmer With Plant Based Nutrition

Not marketing or SEO related but my pops has bad kidneys so I’ve been taking notes on what to do to slow down the progression of his CKD Chronic Kidney Disease . Found a great series of videos on YouTube, still in production, so check back once a week:

I’m not a Dr or health professional. So talk to a professional before trying anything. Just starting to learn about this. So right now the article is just a bunch of random notes not organized in any specific way. Some info may be wrong or may even harm or kill you. If any Dr’s or dietitians want to offer me any corrections or advice it’s gladly accepted.  🙂 These notes are based on my dads current stage 3b disease. My pops is 73. Has high blood pressure, heart disease (stents, heart 2 heart attacks and quad bypass ) & high cholesterol. Not in dialysis or stage 5.

It VERY hard to get proper care in this field. Dr’s basically seem to only want to provide reaction care and not take an active role in keeping kidney function. They are happy to move you along the stages  to finally hit that money milestone of dialysis and kidney transplant. I’ll update this if I find that awesome care team that changes my mind. But right now it’s a huge struggle even know what to eat and not to eat. A lot of providers are still using techniques that are decades old and not using the new guidelines that have been out for years now. Their is also a lot of conflicting info on Dr Google. In the last decade or so a lot has changed in Kidney science, so old articles may be inaccurate. Even your dr may not be giving you the correct info or nutritionist. I just met one, and they gave me all the same advice they were trained to give 30 years ago. That info is no longer correct and may be doing more harm then good.

I just saw a registered dietitian and she was basically no help at all. No explaining anything. Granted she wasn’t a renal dietitian (they don’t offer that option), but the info and advice she gave me I could of done that out of 6th grade. Yep that bad… And this was from Stanford Hospital.

So sit back and enjoy the info I’m about to present… I’ve spent 100’s of hours trolling the internet for the most up to date info on what it take to get back your energy, preserve kidney function and get back to a more normal life.  Notive how I didn’t say we were going to cure anything, we aren’t. Once your kidneys are fried in scar tissue, that’s it. All we can do is keep them from getting worse. At lease that’s what the current research says. Who knows what our amazing bodies are capable of. Maybe one day we can figure out how to completely heal them.

Terms not familiar with / acronyms of dietitians:
RD = registered dietitian
CSR = board-certified in renal nutrition
MS = masters of science
CDE = certified diabetes expert
RDN = registered dietitian
LDN = licensed dietitian (some states require licensure on top of the RD)
PHD = Doctor of Philosophy
MA = masters of arts
MPH = masters of public health
FNP = functional nurse practitioner
CSO = board-certified in oncology nutrition
CD = certified dietitian (some states require certification on top of RD)

Eat right find a dietitian
The National Kidney Foundation directory of dietitians

Most people don’t know they have kidney disease. You can lose 90% of your kidney function and not feel any symptoms at all! One month of dialysis can be $110,000. So ask your dr at a yearly physical to run some kidney tests as part of the blood work. See below for labs to get checked with your yearly physical to keep an eye out for signs your kidneys are failing. If you don’t have a dr. willing to run the tests find one who will. Or get them on your own. So many places online now days will do it. A lot of Dr’s aren’t going to be proactive in treatment. Plan on doing a lot of the legwork. Find a Dr willing to answer a lot of your questions and has an online portal to ask questions. Same goes for a dietitian. You are prob going to have to beg for a referral. Then when you get a standard registered dietitian. They prob won’t tell you much. Just hand you a pamphlet and call it a day. You definitely want a renal dietitian & there aren’t that many of them. I think around 600 in America! Many / most don’t take insurance, and they can be pricey. I’ve seen a minimum charge of $3,500 for one. It’s not easy coming up with that much cash when you are retired and on social security.

Things to do to preserve and reduce kidney disease:
1. Stop smoking – It raises blood pressure, creates plaque on arteries, makes arteries hard and doesn’t allow them to dilate. A huge cause of erectile dysfunction – who wants that.
2. Lose weight – Get to the lower end of your recommended BMI (25 and under) and lower end of a healthy fat range. I love those new smart scales that can tell you that. Lose a pound a week. My pops is 5′ 7″ So he should be somewhere in the 150 – 170 pound range.
3. Eat for what your body needs today. Eat based on what your labs are showing you.
4. Exercise. Walk at least 30 minutes a day every day. Try to work up to an hour. Get your heart rate up a bit. Don’t do hardcore weight lifting. It’s hard on the kidneys and produces extra creatine (weight lifting might drop your score 10 points for 3 days – so if your doing labs, wait  at least 3 days before weight lifting) ; a bad thing. You should be able to hold a conversation, but def be breathing a lil bit hard. a 15 – 17 minute mile maybe where you want to be at. If you have a heart monitor try to get heart rate to 100 – 120 beats per minute. Maybe have an end goal of 10,000 steps a day. I think about 5,000 steps is 3 miles. Should be able to get that in around an hour. Maybe do it once in the morning and once in the evening. Slowly work up to it. It doesn’t have to be traditional exercise. Shopping counts! Try swimming, do some gardening, volunteer somewhere. For weight loss you may need 60 – 90 minutes a day.
5. Check your blood pressure in the morning when you wake up, before lunch and before dinner every day and put in in an excel sheet. You may want to check it 3 times each time and average the number or use the lowest one. Ask your dr. Try to keep it around & under 120 / 80. No higher. Sit relaxed. arms and legs uncrossed. Back against the chair. Arm at heart level and supported on something. Also pee before the test & sit on the chair for 5 minutes before you take the test. Wait about a minute before the next test.
6. If you have diabetes, get it under control ASAP. It’s another leading cause of kidney disease.
7. Know what macro nutrients you MAY need to limit putting in your body; potassium, phosphors, sugar, protein, sodium, fats and carbs. Stay away form artificial colors, flavors and preservatives. Your gonna have to start looking at labels with an eagle eye.
8. Reduce stress – Go for a walk, meditate, try out one of those new apps, whatever it is you enjoy that relaxes you. I like to go hiking every day.
9. Stick with water for liquids. Limit dairy. Orange juice is high in potassium. NO SODA. Try True Lemon Packets. Walmart has em.  64 oz of water is a good amount of water to get a day. Ask your Dr if you need to limit water. Half your weight in pounds should be ounces to get of water as a rough guide. 200 pounds  = 100 oz water a day.
10. Fiber is great. Try to get in 30 grams a day minimum. Try Benefiber with every glass of water.
11. Sodium – stick with under 2,000 mg a day. 1,500 is better. Sodium is in EVERYTHING. Sodium will raise blood pressure; thus damaging kidneys.
11. a: Monitor your blood pressure and work to lower it. quit smoking. Diet and exercise may be enough. If not get on medication. Uncontrolled blood pressure is a leading cause of continued damage to the kidneys.
12. Read labels. Check how many servings are in a meal. If it has 3 servings on the label and you eat it all. You have to triple all the numbers on the label.
13. Go organic if you can.
14. Watch multivitamins, minerals, herbs and supplements. Ask your DR for an approved one based on your labs. A lot are super high in nutrients you don’t need and can damage your kidneys. Some can interact with prescription drugs (make them not work or make them stronger or less strong. So you may not be able to take them at all or have to time when you take them. Some herbs may even kill you depending on the meds you take.
15. Vitamin d is a popular one prescribed for kidney disease. Try to get at the upper limit. I take 2000 IU of Vitamin D3 daily. Always get your levels checked before starting. Your dr. may put you on a high dose in the beginning to get your levels up then you will get a maintenance dose.
16.  Their are no CHEAT DAYS! Every day you need to be perfect; especially with protein, phosphorous and potassium. One cheat meal might screw you up for weeks or months.
17. No NSAIDS – No ibuprofen, advil, motrin, naproxen, aleve, high dose aspirin.  . So many people have got kidney disease just from taking Advil daily for a year. Even stay away from tylenol (but it’s probably the safest & generally kidney approved) if you can avoid using it.
18. Get enough sleep. 7 – 8 hours. Generally no more no less.
19. Minimize caffeine. Don’t drink those energy drinks; monster, rock star, red bull… Decaf coffee.
20. Minimize alcohol. Less then a drink a day. Ideally none.
21. The FDA has a warning for all deodorants that contain aluminum. Aluminum hydroxide may cause issues with dialysis patients. They have natural ones available. Check the ingredients.
22. Itchy skin could be serious. It may mean you are eating too much
phosphorus and your kidney function is declining. If you have too much phosphorus it will pull calcium out of your bones and make them weak and brittle.   You may need to take phosphorus binders to further reduce the phosphorus you ingest if you have too much phosphorus. That calcium can then be deposited into your heart, organs and blood vessels, leading to a heart attack or stroke or hardening of the arteries. Who wants clogged arteries!
23. Be careful if you drink water from a water softener. They have sodium softeners and potassium softeners. Don’t use either at home for drinking water. It adds either sodium or potassium to your water – both things you don’t want.
24. Optimize cholesterol – Get a fractionalized lipid panel. It will give you much more detailed and useful info then the standard lipid panel. Numbers to aim for. Take a statin if needed or / and an ACE or ARB inhibitor if needed. input recommended levels.
25. Food diet and exercise tips to optimize cholesterol: Need more info. sugar and carbs effect it a lot. Don’t eat as much and the bad numbers will drop like a rock.
26. If getting an RX ask if it’s a renal dose prescription level. Some prescriptions should be halved when you have CKD.
27. Proton pump inhibitors can be bad ask what ones are safer. For example Protonic isn’t as kidney friendly as Pepcid.
28. Ask if the antibiotic is safe for your kidneys or the dose needs reducing.
29. Be careful with contrast dyes and contrast agents when doing imaging like MRI’s or CT’s. It’s VERY bad for your kidneys. Tell the rep you have kidney damage. They may have alternatives to use. They may also be able to do IV sodium bicarbonate to help flush the drugs out of your system.
30. Don’t get a bladder infection. If you do get it taken care of right away.
31. ProRenal+D With Omega 3 is a popular renal vitamin recommended by national kidney foundation.
32. CoQ10 – Can be a good supplement if you are taking a statin or under a lot of stress..
33. I like Himalayan sea salt if I am adding any salt. Not regular iodized table salt in the blue tub.
34. vitamin B6
35. Vitamin B12
36. Omega 3 / Fish Oil – Ideally ask for a prescription for VASCEPA (icosapent ethyl). That way you know it’s super high quality. Most dr’s recommend 2 grams morning and 2 grams evening with fatty food.
37. Minimal potatoes, they have huge amounts of stuff you don’t want.
38. Skip canned food. Why, because most canned foods in the USA are lined with BPA. Or find BPA free canned food. Always jump the fluid out and wash the food before eating it for those you can.
39. See if turmeric is ok to use.

Chronic Kidney Disease (CKD) – Kidney Disease diet (Renal Diet) – What can I eat?
1. plant-based protein doesn’t put as much stress on your kidneys and can help put less stress on your kidneys and regain some of your GFR.
2. Vegan is great. You may want to limit soy. Some people can be allergic to it.
3. Vegan mayonnaise
4. Don’t ever eat starfruit.
5. Limit protein. As your disease progresses, your doctor WILL lover your kidney disease protein limit. Too much protein, especially animal based protein, will increase your BUN and creatinine levels, lowering you calculated GFR.
6. Be careful with processed foods, microwaved meals and canned goods. It’s usually loaded with crap; especially sodium.
7. limit phosphorus 700 – 1200 mg daily – too much it pulls calcium from bones making them brittle. also leads to deposits it organs and arteries. Makes you itch. Hard to tell if your not getting enough see calcium for better info.
8. limit potassium 1700 – 2700 mg daily – to much symptoms fatigue / shortness of breath – Things to avoid food – portion control is important. read the servings. – avocado, banana , melons, oranges, potato – any, tomatoes, sauce, salsa, tomato juice, you can eat a lil of this but def limit it. brown or wild rice, brussel sprouts, prunes, prune juice, dried apricots,  lentils, raisins, split peas, spinach, milk, bran products, low sodium cheese, whole wheat products including pasta and bread, nuts, beef, chicken, tuna,  3 oz is a serving for the meats. Max to eat at any one meal.  7 oz of meats max per day. – medications can cause body to retain potassium esp blood pressure meds or include potassium in them. exercise – high intensity exercise can increase potassium in blood ( 3 days to go back to normal so delay labs if hard exercise). Remember too much is bad, but too little is just as bad.
9. limit sodium to 1,500 – 2,000 mg daily
10. Limit protein – Need to calculate it based on you.
11. Calcium 1,000 – 2,000 mg a day – symptoms of not enough calcium or phosphorous is pulling calcium out of bones. Muscle cramps or spasms. numbness and tingling around the mouth. Bone and joint pain. weak bones,  rash, itching.

How to lower your creatinine levels:
1. No heavy weight lifting. No marathons. Nothing vigorous.
2. Don’t take creatinine supplements.
3. Reduce protein
4. Eat more fiber. Benefiver Healthy Shape helps.
5. Drink more water, but not before labs.

Labs to get and check:
1. Put everything in an excel spreadsheet. So you can see trends. Are you getting better or worse or stable. test, date, your result. high range, low range.
2. Get advice from your Dr. Don’t let him push you in and out of the office like a piece of cattle. If he refuses find a new Doc. Go over every item in the lab work. You paid for it. It’s his job to explain it.
3. Glucose
4. A1C
5. Bun – Lower is better. Can be caused by eating too much protein. Not enough fiber.
6. Albumin –
7. Potassium – regular range 3.5 – 5 generally safe. Caution 5.1 – 6.0 – danger zone 6.1 – or higher – This one changes fast like a couple days after making a diet change.
8. phosphorus – regular range  2.5 – 4.5  mg/dl generally safe caution This changes in a couple days in blood work.
9. GFR – It will fluctuate quite a bit like the stock market. High is better. lower BUN and Creatinine will increase GFR
10. Creatinine – lower is better. Caused by eating too much protein. Not enough fiber.
11. Urine ph – Under 6.5 is acidic. Caused by eating too much protein. Not enough fiber.

What allergy medicines are safe to take? anti-allergy medicines, seasonal allergies
1. Most all Eye drops and Nasal Sprays are safe and provide fast relief. Afrin / flosnase
2. Your prob best with Claritin / Loratadine – This one may take a day or 2 to work tho.
3. One to avoid –  Zyrtec / cetirizine  esp if your  kidney function is below 50%; def check with your Kidney doctor first. you may need to reduce the dose or only take it every other day, or avoid it altogether. Just avoid Zyrtec. This one is my fav allergy medicine cause it’s so fast acting. Unfortunately no more.
4. Most of them raise your blood pressure which is hard and damaging to your kidneys.
5. Read all ingredients. Make sure they do not contain any NSAIDs.
6. Benadryl can cause fluid retention & if you have a bladder infection, it could to travel to your kidneys. so be careful on that one as well.

Does the KETO diet work? Is the KETO diet safe? Will a cleaner modified KETO version work with Kidney Disease?

What about intermittent fasting?
1. you can only have water, unsweetened tea, and unsweetened coffee during the intermittent fasting period.
2. the common target is 16 hours of fasting with an 8-hour window for eating

Why is my BUN high? What food raise BUN?

How often should I get my labs done:

At least once a month in the beginning.
Some things can change rather quickly so you may be able to test more. If dr. will allow it. You can always test on your own and pay out of pocket.

Find out the requirements for a kidney transplant now. Different places have different requirements so register with as many as you can find. Maybe if you have a BMI over 30 or 35 your not even eligible. So start losing weight now.  Being a smoker might disqualify you; so stop now. Heart disease may be another. Dementia or poorly controlled mental illness. Active or recent cancer. Advanced age.

Apps to use: – That is great app & I recommend the pro version where you can input everything you eat and it will tell you how much  of each nutrient you are getting for the day. You can also put in a min and max level of key nutrients your Dr has told you that you need to limit that I find really helpful.

What renal diets may work for kidney disease? Many will work; the important thing to do is eat for your labs. Here’s couple options to look into along with your DR”

Dash diet • Diabetic diets • Dialysis diet • Heart Health diets • Ketogenic diet • Low-Protein diet • Mediterranean diet • Vegetarian diet • Vegan diet • Whole-Foods Plant Based diet

Here is the EWG’s Dirty dozen list for 2019 which you should always buy organic as part of your renal diet meal plan for better kidney function:
1. Apples 2. Celery 3. Cherries 4. Grapes 5. Kale/Collard greens 6. Nectarines 7. Peaches 8. Pears 9. Potatoes 10. Spinach 11. Strawberries 12. Tomatoes

The following list of foods are often loaded with pesticides and GMOs – you should always purchase the organic versions as part of your kidney diet:
• Blueberries • Cucumbers • Hot peppers • Raspberries • Snap peas • Sweet bell peppers

Anemia Kidney Disease:
Anemia typically starts to occurs in people with chronic kidney disease (CKD) at stage 3, with the most common anemia symptoms being fatigue and problems concentrating. Anemia usually gets worse as CKD progresses.  It shows up in labs as low RBC (low rbc count) & low Hemoglobin. When it’s low, your red blood cells can’t carry as much oxygen. The heart and brain suffer causing fatigue, confusion and headaches. Your Dr may give you Iron to increase your Hemoglobin. Do not take without labs and Dr advice on dose & type. Your Dr may also check your erythropoietin (EPO) level. It tells your bone marrow to make red blood cells. B12 and folic acid (esp if you take a statin) may also be prescribed to help.

What can you eat to build up your iron:
Kale & Spinach (high in Oxalates – – oxalates limit your body absorbing iron) – Dandelion greens – Broccoli (limit this one) – Asparagus (folic acid) – collard greens – swiss chard – Use an app to make sure your not getting too much of any one nutrient.
All meat & poultry contain iron. 3 oz is a portion on a renal diet. Red meat, lamb, venison, Poultry – chicken
Organ meats – grind it up with some other meat so you don’t notice it as much. Liver – beef tongue, heart, kidney
Seafood: oysters, clams and shrimp most iron. Salmon ok. Seafood not best source of iron.
Fortified foods: Contain iron, B12, Folic acid – white rice, pasta, cornmeal, whitebread, ready to eat cereals
Beans: Generally not recommended – kidney beans, chickpeas, pinta, black beans, peas,
Seeds: Limit seeds not recommended.
Cook with a cast iron skillet – a study showed tomato sauce cooked in a regular pan .6 mg of iron. The sauce cooked in a cast iron skillet had 5.7 mg of iron. Woo hoo.
Do not eat a high iron food when eating the following foods. These foods minimize iron absorption: Coffee, tea, eggs, foods high in oxalate’s, Vitamin c will also help your body absorb iron. Lemon could be good.
Anemia is a high priority item to fix. So if you have to go over on potassium or phosphorous to get anemia under control that may be OK for a short time.

How to lower creatatine levels naturally:
Eat more plant based protein; less animal based protein
Limit sodium / salt
Drink enough fluids – take weight in pounds, divide in half. Thats ounces per day to drink. 200 pounds, 100 oz.
Eat more fiber
Eat less animal protein
Avoid processed foods
Avoid Juice and soda. Water is the way to go.
Get some exercise. Go for a walk. Nothing crazy. a good 30 minutes in the morning. Maybe another 30 in the evening.

High Blood Pressure & Salt

Normal blood pressure is generally less then 120 systolic over 80 diastolic.
dippers = Blood pressure dips in evening. This is more normal.
Non-dipper – Same or higher in the evening. This is a higher risk for heart and kidney disease. You may be in fight or flight mode. sympathetic nervous system may be inflamed.
Salt / sodium will raise it. Stay around 1,500 mg. a day. This is for EVERYONE. A typical person may consume 5,000 mg or more a day.
Being overweight.
Fiber intake can help lower
makes stiffer blood vessels

Here’s a list of foods that have high sodium content:

Smoked, cured, salted or canned meat, fish or poultry including bacon, cold cuts, ham, frankfurters, sausage, sardines, caviar and anchovies
Regular and processed cheese, cheese spreads and sauces
Quick breads, self-rising flour, biscuit, pancake and waffle mixes
Olives, pickles, sauerkraut, and other pickled vegetables
Regular canned and dehydrated soup, broth and bouillon

Dr What are my daily minimums and maximums for the following:
carbs (sugar)
protein (animal proteins super hard on kidneys, plant based better)

How often should you get labs?
First couple visits with your Dr. Maybe once a month. , then to every 3 months or so. But it just depends on what your labs are showing. Say your potassium is high or low. They might test every day or every week till it’s back in range.

What supplements should I take? Ask your Dr
ProRenal®+D with Omega 3

What foods or supplements lower my blood pressure?
Coco or preferably cocoa 2 points
folate 5 points
Higher potassium (talk to your dr for sure on this!)
Fiber (10 additional grams) 2 points
diet under 2300 mg sodium 5 points

Fiber – A good 40 grams or so is ideal. Fruits, nuts, vegetables, beans & whole grains all great sources of dietary fiber. Never do a huge increase in fiber. Add more slowly over time or you could get severe constipation or even get backup up so bad you may need a trip to the emergency room for a dr to remove the impacted poop. After you eat go for a walk. It will get things moving and make you poop.
Soluble Fiber – dissolves in water, helps lower cholesterol and lower glucose, apples beans blueberries, lentils, nuts oatmeal. This also helps feed the probiotics.
Insoluble Fiber  – Good to make your food move. Helps ya poop, have a bowel movement. Does not dissolve in water. Part of the bulk of stool. brown rice, carrots, cucumbers, tomatoes, whole grains and wheat, legumes.

Probiotics – live cultures of beneficial bacteria in our gut. Great to take. Good for IBS – irritable bowel syndrome. When you take antibiotics take a probiotic to get them repopulated as antibiotics kill some of them off. Some bacteria will eat some of the excess nutrients in our stomach, small and large intestine and actually lower excessive toxic levels in our blood and urine labs; a good thing.  Gut health seems to be the new thing that helps many problems. Natto may be good. almond or coconut based based yogurts may be good. yogurt, kefir, kimchi, miso, tempeh, sauerkraut, sourdough bread, kombucha. Look for 3 or more live cultures in the ingredient list.

prebiotics – onion, chicory, garlic, leeks, banana, artichoke, oatmeal, asparagus, jicama

Postbiotics – Still very new and being studied.

Spices cinnamon – blood sugar, garlic – blood pressure, ginger – anti inflammatory, turmeric – anti inflammatory, cayenne – anti inflammatory, black pepper – helps turmeric get absorbed, rosemary – anti inflammatory

What were my first symptoms when I had early kidney Disease CKD
Foamy urine

What to do about chronic constipation or IBS?
Fiber is always good. Start slow. Drink more water. Dulcolax, MiraLAX Polyethylene glycol as a short term solution.

Can you cure CKD, repair kidney damage, reverse kidney failure, or heal kidneys:
No once you’ve fried them the damage is done; the scar tissue will forever be there. But you can keep them working longer or slow down the progression. You can also raise what stage you are in. Make your GFR better & creatine levels. Some people have went from stage 5 to stage 3. Be careful With Dr Google. There is a lot of old school info that isn’t up to date. Even some dr’s are giving outdated advice. Some things people recommend might even make it worse or kill you.

Eat to your Labs
See whats wrong in your labs and ask your dr what you need to change.

If you take excess calcium. Generally over 1,000 mg a day it can leach into organs, tissues and actually plug blood vessels. So make sure it’s something you really need. Exercise helps to move the calcium you did take into your bones.

Some bread brands that might be good & not have excess nutrients we shouldn’t eat.

dave’s killer bread
ezekiel bread
siete tortillas
Trader Joes tortillas

Best water to drink:
Orange county has some of the purest water in the USA. Move their! 🙂 Who knew. – Get info on your local tap-water. Just input zip code.

Natto Fermented Beans – Great source of Vitamin K2.
Proteins can have up to 22 different amino acids. 9 of which are essential & we need to get from food. Animal protein is a complete protein meaning it has at least the 9 essential amino acids. Plants are generally an incomplete protein with the exception of two; quinoa & buckwheat. So you would need several different items to get a complete protein.

Some plant based foods rich in protein: Beans, certain fruits (avocados, guava, jack-fruit, kiwi, blackberries), Grains, hemp / hemp seeds, legumes, nuts, rice, vegetables (alfalfa sprouts, asparagus, broccoli, Brussels sprouts, cauliflower, Chinese cabbage, bok choy, collard greens, mustard greens, peas, spinach, watercress).

Have an egg a day, eat lean and low fat cuts of meat. drain off the fats, don’t eat poultry skin, Don’t buy typical processed lunch meats in the store that are full of additives like sodium & phosphate additives that are easy to get into your blood.

1 oz of protein(what the food weighs) is generally 7 grams of protein.
3 oz might be a recommendation per meal if you have 3 meals & you are 180 pounds and eating protein based on this formula from the table below –  0.8 g/kg/day CKD stage 3- 5
1 egg counts as one ounce of protein.
1 oz of almost counts as 2 oz of protein – about 25 almonds / palm full
Meat 3 oz serving size of palm / thickness of deck of cards
Salmon 3 oz serving about size of smartphone.
peanut butter serving is 2 tablespoons – size of a ping pong ball
1/2 cup of cooked beans is 2 oz of protein. About size of light-bulb or half baseball

What are ketoanalogues? Albutrix tablet / Ketorena powder – a supplment that contains all amino acids. Offers protein with less nitrogen.

Blood testing Tips:
As soon as the needle goes in make sure they release the tourniquet.
Don’t clench or pump your fist
Don’t exercise before your test
Doing any of these can cause your labs to be off. Hyper, Hypo , pseudo hyper, pseudo hypo


How Much Protein Do I Need
CKD Stages 1 – 2CKD Stages 3 – 5End Stage – On Dialysis
0.8 – 1.0 g/kg/day0.28* – 0.8 g/kg/day1.0 – 1.2 g/kg/day
* – Low protein diets below 0.6 g/kg/day – Amino Acid / keto-analog supplementation may be required

1. Protein needs – Take your weight in pounds and divide it by 2.2 to get your kilogram number. We will use 180 pound male in this example.  = 81.81 kg
2. Multiply the kilograms weight 81.81 (180 pounds male) by protein needed in the table above. This person is stage 3b so he needs 0.28 – 0.8 g/kg/day = low end  22.9 grams protein per day / high end 65.45 grams protein per day.
3. Divide this number by 7 (grams of protein in an ounce of meat/beans/etc.) to get protein needed in ounces. 3.2 ounces – 9.35 ounces of plant or animal protein per day.
Notes: The grams of protein is how many grams of protein is in an item, for example a steak.  The ounces of plant or animal protein is the actual weight of the food.

How Much I Weigh In Pounds150180220
CKD Stages 1 – 2 – 0.8 – 1.0 g/kd/day7.79 ounces –  9.74 ounces protein day9.3 ounces – 11.7 ounces protein day 11.43 ounces –  14.29 ounces protein day
CKD Stages 3 – 5 – 0.28* – 0.8 g/kg/day2.71 ounces –  7.79 ounces protein day3.2 ounces – 9.3 ounces protein day4 ounces –  11.43 ounces protein day
End Stage – On Dialysis – 1.0 – 1.2 g/kg/day9.74 ounces –  11.68 ounces protein day11.7 ounces – 14 ounces protein day 14.29 ounces –  17.14 ounces protein day

Renal Acid load – Plant protein tend to produce a lot of acid in the body. Plant sources are more alkaline. So ideally eat less animal protein. If your naughty and eat too much meat your Dr more prescribe baking soda or sodium bicarbonate tabs to counteract the effects. Just know your screwing up your kidneys if that’s the case. Do not ever take this unless directed to by your physician.

BUN blood urea nitrogen –  normally 7 – 20 – Urea nitrogen is the byproduct of your body breaking down the protein you eat. Urea isn’t being properly filtered by our kidneys & liver and excess is circulating in our blood. Other things that can make bun higher are taking antibiotics, stomach or intestinal bleeding or too much protein in your diet.

Here’s a great video series from a kidney Dr and Renal Dietitian:

Plant Based Kidney Health With Nephrologist Sean Hashmi, MD, MS, FASN & Renal Dietitian Michele Crosmer, RD CSR

Connect with us: Sean Hashmi, MD, MS, FASN

Michele Crosmer, RD CSR


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