More about vegetarian diets for renal patients

OK, I have a confession. The one thing I miss the most is a really nice lentil soup. I haven’t had my lovely lentil soup in 7 years, so anything I read that I perceive gives me permission to eat legumes gets me all excited. So, I’m posting this link to an article posted on RenalWeb, and I’d love to hear your thoughts.

I would happily be vegetarian, but being CKD5 and still pre-dialysis, I don’t dare.

This is more of the animal phosphorus vs plant phosphorus debate…

Hello MooseMom,

Thank you for checking in and posting your link on plant-based diets and CKD. This subject has been an ongoing debate in the dialysis center where I work. The medical director believes that patients, especially those with good labs, should be able to eat some beans and legumes. As this study and others point out, the phosphorus in plant foods is less absorbed than it is in meat and other phosphorus-containing foods. I think a potential problem I see with my patients is when beans are consumed as an additional protein source along with meat at a meal instead of as a substitute to meat. This results in more total phosphorus consumed, which can result in high blood phosphorus levels. I think that lab tests are a great tool to helping us understand if patients are eating enough, too much, or inadequate amounts of protein, potassium and phosphorus.

Yes, I agree with all of your points, and that’s why I wanted to add yet another study regarding this ongoing debate. I understand how a patient, if allowed to consume some legumes, might team them with meat, resulting in an even higher level of PO, but I’m sure that a competent renal dietician would make sure that patient understood that legumes are meant to be a substitute for meat. It seems to me that if eating a more plant based diet might be healthier from a cardiovascular point of view, and since CKD/ESRD patients are so much more vulnerable than the general population to heart problems, it might be an idea to further investigate a renal diet that focusses less on meat and more on plants, always being guided by labs, of course.

Every day there seems to be new advice and information about nutrition…a new study, a new concept. It must be difficult to keep up with it all!

Thank you so much for your comments. Yes, you make very good points. I think one of the primary jobs of the renal dietitian is to individualize recommendations for each patient in order to promote optimal nutrition status. Many of my patients are able to eat plant-based proteins and maintain labs in normal range. I find that patients who eat whole foods, including vegetarian items, and avoid or limit processed and fast foods do the best. Again, thanks so much for sharing your thoughts.