Protein Recommendations for People with Kidney Disease and Diabetes

Kidney disease is one of the complications of diabetes. In 2008, 44 percent of the new cases of kidney failure were attributable to diabetes.  Like diabetes alone, diabetic kidney disease requires dietary modifications.

As kidney disease progresses patients usually need to watch their sodium, potassium and phosphorus intake.  In addition, they have often been asked to start to follow a low protein diet. But the use of low protein diets has become controversial with even many nephrologists disagreeing on its importance.

Although still a recommendation of many health care organizations (such as the Academy of Nutrition and Dietetics and National Institute of Digestive and Kidney Diseases), restriction of protein in the diet for preservation of kidney function is felt by many to be unnecessary and perhaps harmful. (Of note: Restriction of protein in the treatment of acute renal failure is still an effective modality of care.)

The origin of this protein-restriction recommendation is two -fold.  First, people with advanced-stage kidney disease prior to dialysis have a buildup of nitrogenous waste in their bodies, a product of the nitrogen molecules leftover from protein breakdown during digestion.  As the kidneys fail they are unable to excrete these waste products.  The excess nitrogen causes symptoms of nausea and vomiting.  Reduction of protein helps to ameliorate these symptoms.

Second, a series of animal studies in the 1970s and 1980s demonstrated that reducing protein was able to decrease the pressure on the filter cells in the kidney, thereby improving filtration rates and attenuating the time to dialysis. The drugs used to prevent and treat kidney disease (angiotensin receptor blockers and angiotensin converting enzyme inhibitors) work on this same principle.

When researchers attempted to reproduce the results of animal studies in humans, they were stumped.  A large-scale study called the Modification of Protein in Renal Disease (MDRD), completed in the 1980s, did not find any improvement in renal function for those following a low protein diet.

There are definite benefits of low protein diets which may be the reason they are still encouraged.  These diets tend to be low in phosphorus and saturated fat. And in addition to often requiring a modification in phosphorus intake, many patients with kidney disease have significant elevations in cholesterol and triglyceride levels.

However, reducing protein in the diet below a certain level can lead to malnutrition.  In addition, low protein diets are difficult to follow for most people.

So what constitutes a low protein diet? That too is not well-defined.  The recommended dietary allowance (RDA) for protein for adults is .8 grams of protein per kilogram of body weight and the estimated average requirement (EAR) is .66g/kg. (The RDA is set at a level of nutrient intake high enough to meet the needs of all healthy people whereas the EAR is the average amount needed to meet the needs of one-half of all healthy people.) Amounts under .8gm/kg are not encouraged for people with diabetes.  This translates into 54 grams of protein per day for a man weighing 150lbs.

This level of protein is significantly under what many Americans eat.  Protein intake for adults 19-30 years of age estimated from National Nutrition and Health Examination Survey 2003-2004 (NHANES) data was 91 grams +/-22 grams.  In general healthy individuals can accommodate a wide range of protein intakes, however, sustained consumption of very high levels of protein may cause alterations in the metabolism of other nutrients

Protein is found in almost all foods in the diet.  Meats, eggs and dairy products contain large amounts of protein; starches and vegetables have small amounts; and fruits and fats have minimal content.  Considering that a 3 oz piece of chicken breast contains over 21 grams of protein, it is easy to see how the protein content of a day’s meals can add up, especially for those who eat meat.

Dr. Robert Stanton, head of the renal division at Joslin Diabetes Center, adds, “There isn’t any evidence to support the use of low protein diets for people with type 2 diabetes.  The studies done were completed on patients with type 1 and they were either small or inconclusive.”

So if you have kidney disease what should you aim for?  If you are a big meat- or dairy-eater, reducing your portions to 3 to 4 oz twice per day is prudent but it may not be necessary to start counting every half cup of rice or green beans you have.

Combining a diet for kidney disease and diabetes is complex and can be frustrating to follow.  Making an appointment with a registered dietitian who is familiar with the needs of patients with kidney impairments can help you stay well-nourished and continue to enjoy your food.

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6 Responses to Protein Recommendations for People with Kidney Disease and Diabetes

  1. Howard says:

    Very informative article. For those who are interested in protein content of foods, there are a few extremely useful online databases. Just Google “protein counter”.

  2. Hey, I really liked the post! I have been interested in this topic and actually really wanted to see what your opinion was on something, given the views stated here on the usage of a low-protein diet. I recently read an article that discussed a paleo diet for type 2 diabetics. As you may know, the paleo diet can easily be considered a high-protein diet. So, I was wondering if this would be a reasonable option for people with type 2 diabetics?

    • Dear Reader,
      In general the Paleo diet is not advocated for those with type 2 diabetes due to its limited food choice repertoire, but the protein content itself is not an issue.

      Nora Saul, MS, RD, CDE
      Manager, Nutrition Services
      Joslin Diabetes Center
      Boston, MA 02155

  3. Jean D Haight says:

    Please see my Facebook site: JeanHaight1@Yahoo.com, I’m trying to have diabetics and their family members get the US Congress to change the wording & The Code Numbers assigned to the Omni Pod! Presently the Omni Pod is classified as a disposable item and cannot be covered by Medicare!
    Please contact the members of the US Congress who represent you and tell them that we want to see the Code Numbers:PodA:9274 & PDME:0784 and the wording changed to allow those of us that are on or about to start on Medicare to be able to continue using the Omni Pod Insulin Pump,the US Congress struck again and we need to let them know that it will be a lot less costly for everybody that uses the Omni Pod to continue controlling their Diabetes and preventing the many complications that can occur! This will in essence allow us to be able to continue using the Omni Pod regardless of age! If someone is particularly good at creating Petitons, please create one to the US Congress (I’ve been in touch with President Obama by E-mail and he likes this idea! It might even be another way to get the Omni Pod covered by Medicare, and the President is open to all ideas about any issues that are important to the Citizens of the United States of America!

  4. Please do whatever you can to have Family & Friends assist you with this Plan!

  5. Contact President Obama, by e-mail,send him a letter or a note! He’s a very reasonable person! He is also very aware that he is in Office to serve the People of the United States of America!

    I personally have found him to be very receptive,and I believe you will also find this to be the case!

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