Type 2 diabetic, kidney damage

[markcunn2]

I am a type 2 diabetic and I think I posted here ages ago, but then had net problems so never came back.

Anyway, I had the results of my latest blood and urine tests last Friday and the HbA1c was up, I had it down to around 8.2 (which is still too high, but compared to the 40 reading when first diagnosed is excellent for me). GP said I realistically had until Christmas this year before I was taken off the Byetta and put on insulin instead.

Weight is coming off slowly, at first it was like a kilo a week now I'm down to losing a kilo over a month period which is a bit disheartening for me as I have always lost the willpower once I hit that plateau however this time I am determined to push on with the weight loss.

He also said that I had the early signs of kidney damage, which threw me into a spin as I had no clue my kidneys were in anyway damaged (no signs of it at all) and when he asked me if I had any questions, I just went no as I was in shock and my brain went funny. Of course, now over the weekend I have thought of loads of questions and can't see a doctor until next week to discuss this with someone.

It was recommended to me by a family member over the weekend that the Atkins Diet might be the best solution for me to help the kidney damage slow down, but as the GP has me on a statin for high (in his opinion anyway, as I am only on 2) cholesterol can I do the Atkins Diet OK, or do I need to see a dietician to get a proper detailed plan tailored for me?

Also, considering I am a fairly chunky man, what other exercise is good cardio wise, as I walk 4 miles a day do 20 situps and some pushups as well. Not really into swimming at my size, or running. Thanks.

 

[Grazer]

Hi Mark and welcome back.
Few queries about your numbers; you say your HbA1c was 40 when diagnosed. Seems unlikely. Are you sure it wasn't your fasting BG you measured there? Although still extremely high.
Also, your cholesterol was 2? Was that your total choleterol?
Seems like I'm nit-picking, but I think it's handy to have these numbers right so you can check future progress.

In terms of Atkins, that would certainly get your BGs down, but you should be aware there is some discussion about high protein being bad for the kidneys. Not sure I'm convinced by that, but if you already have some kidney damage you may wish to check this out, read the fors and againsts, and make your decision. I don't think statins are a bar to Atkins (very low carb). What level of carbs are you on now? Is there an in-between stage you can get down to in the meantime?

 

[viviennem]

Grazer is quie right about high protein diets being considered bad for those who already have kidney problems, so do have a good look round and see what you can find out for yourself.

Do you know how many grams of carb you are presently having each day? You may well be able to reduce them significantly without eating excessive protein. It needs a bit of thought, but you can safely increase your dietary fat a little, to help with the 'full' feeling, if you decrease your carbs. Stick to good quality, unprocessed fats (I don't consider cheese, butter and cold-pressed olive oil to be 'processed' :wink: ).

For a basic list of low-carb foods have a look at Viv's Modified Atkins Diet, which is a sticky thread. I am not suggesting you go this low-carb until you know more about the state of your kidneys, but you can easily use this as a basis to build more Low-GI carbs on to, until you reach the daily number of carbs you are going to allow yourself. Grazer manages very well on between 100g - 150g. I try to eat around 30g per day, 'cos I have a LOT of weight to lose! For me, carbs + fat = weight . Atkins does say decrease the fat a bit as you increase the carbs - keep a balance.

Ask your doctor how much protein he thinks you should be eating each day, so you've got a figure to work from. If you don't have a carb-counter book, get yourself one. You may not be able to do Atkins Induction, but you should be able to go to the next stage - Ongoing Weight Loss- without too much problem. Try starting at 100g carb per day and come down a bit if necessary.

By the way, all a low-carb diet will do to your cholesterol is lower it! Also improve your lipid profile. You could ask for a copy of your latest lipid profile to give you a baseline to work from. You are entitled to have it - part of your medical records.

Don't forget muscle weighs more than fat!

Viv 8)

 

[markcunn2]

Thank you for the replies. I did some calculating yesterday, and without weighing out everything to check what I've eaten over the last week, I think I can safely say that over a week, I am probably eating somewhere around 200+g of carbs a day.

I have made an appointment to see a different GP next week to discuss my diet options, felt it was safer to see him before starting a low carb diet or the Atkins diet.

I'm now determined to get the weight off, my weight on Sunday morning was the lowest I have been in weight since 2004, but in late 2004 and 2005 I had some bad personal issues to deal with which meant dieting went totally out of the window. Got a target weight to aim for, which my GP is trying to encourage me to get to before my birthday this September and I am only 7 kilos short of that so a change in diet can only help me surely.

 

[Sid Bonkers]

H Mark sorry to hear of your news. If kidney damage is evident do not embark on any diet until you have spoken to your doctor and possibly a dietician, Kidney damage is indeed exacerbated by certain diets whether some are convinced of it or not it is a fact and should not be taken lightly.

Speak with your doctor and get a referral to an endocrinologist and a dietician as a mater of urgency, sooner is always better than later

 

[Defren]

Kidney damage is indeed exacerbated by certain diets whether some are convinced of it or not it is a fact and should not be taken lightly.

I wonder Sid, do you have any data on this please? I do a modified version of Atkins, and this is new to me, and also concerning! Yes, I have heard there are 'some concerns' but not that it is actually fact.

I do agree perhaps a word with your GP about diet is the way to go.

 

[borofergie]

I wonder Sid, do you have any data on this please? I do a modified version of Atkins, and this is new to me, and also concerning! Yes, I have heard there are 'some concerns' but not that it is actually fact.

I do agree perhaps a word with your GP about diet is the way to go.

You don't need to eat any more protein on a low-carb diet. In fact I eat only about 90g a day, which is less than one third of the RDA. A good Low-Carb diet is low in carbohydrate, high in fat, with moderate protein.

But that's besides the point, eating more protein doesn't cause increase kidney problems (at least in those that don't already have damaged kidneys).

There are 100,000 kidney donors in the US, all of whom survive on a single functional kidney. None of these people are recommended to eat "less protein" even though their single healthy kidney has to process twice as much protein. Despite this only 65 people have suffered kidney failure in the remaining kidney (requiring a transplant of their own), which is about half the rate of failure in the general population.

If you have existing kidney problems, you need to talk to your Doctor about increasing your protein intake.

 

[Defren]

I wonder Sid, do you have any data on this please? I do a modified version of Atkins, and this is new to me, and also concerning! Yes, I have heard there are 'some concerns' but not that it is actually fact.

I do agree perhaps a word with your GP about diet is the way to go.

You don't need to eat any more protein on a low-carb diet. In fact I eat only about 90g a day, which is less than one third of the RDA. A good Low-Carb diet is low in carbohydrate, high in fat, with moderate protein.

But that's besides the point, eating more protein doesn't cause increase kidney problems (at least in those that don't already have damaged kidneys).

There are 100,000 kidney donors in the US, all of whom survive on a single functional kidney. None of these people are recommended to eat "less protein" even though their single healthy kidney has to process twice as much protein. Despite this only 65 people have suffered kidney failure in the remaining kidney (requiring a transplant of their own), which is about half the rate of failure in the general population.

If you have existing kidney problems, you need to talk to your Doctor about increasing your protein intake.

I would still like Sid to show the 'facts' he has about diets and kidney failure, as I have read quite a lot, and have seen concerns, now I would like to read the factual data. I can't believe I have missed such a vital piece of research!

 

[phoenix]

Defren:
This paper from the journal of N&M society (advocates of low carb diets reviews the evidence )
http://www.nutritionandmetabolism.com/content/2/1/25
There is evidence that excessive protein intake can both cause deterioration of kidney function in those with kidney disease and that a reduction in protein intake may slow the progression in established kidney disease.
There is no evidence that this applies to a healthy person with normally functioning kidneys. (though some late diagnosed people with T2 may already have some damage)

There is some evidence that people with T1 eating diets containing more than 20% protein (particularly animal rather than vegetable) have more protein in their urine.
http://journal.diabetes.org/diabetesspe ... /pg132.htm (bit dated but has the kidney info; you might not like some of the rest)

 

[dawnmc]

How does the doctor know you have kidney damage? Have you had a scan?

 

[Defren]

Defren:
This paper from the journal of N&M society (advocates of low carb diets reviews the evidence )
http://www.nutritionandmetabolism.com/content/2/1/25
There is evidence that excessive protein intake can both cause deterioration of kidney function in those with kidney disease and that a reduction in protein intake may slow the progression in established kidney disease.
There is no evidence that this applies to a healthy person with normally functioning kidneys. (though some late diagnosed people with T2 may already have some damage)

There is some evidence that people with T1 eating diets containing more than 20% protein (particularly animal rather than vegetable) have more protein in their urine.
http://journal.diabetes.org/diabetesspe ... /pg132.htm (bit dated but has the kidney info; you might not like some of the rest)

Phoenix, in link one you provided it states

"Conclusion

Although excessive protein intake remains a health concern in individuals with pre-existing renal disease, the literature lacks significant research demonstrating a link between protein intake and the initiation or progression of renal disease in healthy individuals. More importantly, evidence suggests that protein-induced changes in renal function are likely a normal adaptative mechanism well within the functional limits of a healthy kidney. Without question, long-term studies are needed to clarify the scant evidence currently available regarding this relationship. At present, there is not sufficient proof to warrant public health directives aimed at restricting dietary protein intake in healthy adults for the purpose of preserving renal function. "

So no factual evidence there!!

Link 2 is very dated, infact well over a decade dated. So not much use as I am sure more recent studies have been done.

So is there factual evidence to say a high protein diet can present problems to a patient with a pre-existing kidney condition or not? Not seems to be the answer.

 

[Sid Bonkers]

@ borofergie and dawnmc the OP has stated quite clearly that they have kidney damage.

@ Defron there is considerable data relating to kidney damage and diets whether you chose to ignore it is up to you but do you feel it is a good idea to post your left field beliefs to one who is suffering with kidney damage? Lets not turn another thread into a high fat high protein high carbs or high anything else debarcle cant you just reserve your attacks on me to less serious threads please.

@ Mark, talk to your doctor mate there are far to many barrack room lawyers here to get any sensible answers, seek professional advice about diet from an endo or a dietician

 

[viviennem]

How does the doctor know you have kidney damage? Have you had a scan?

Through your regular blood and urine tests. I don't really understand which ones 'cos mine have always been bang on target so I haven't gone into the subject much, but it's to do with protein in the urine and something in the blood - serum ferritin levels?

Dr Atkins, and Dr Mary Vernon in Atkins Diabetes Revolution, both recommend patients with known kidney disease to check with their doctor before starting a low carb diet. She quotes 2 papers, one that suggests that restricting carbs is good for kidneys and seems to concentrate on the level of iron intake related to protein - but I haven't read it.

Facchini, F.S., Saylor, K.L., "A Low-Iron-Available, Polyphenol-Enriched, Carbohydrate-Restricted Diet to Slow Progression of Diabetic Nephropathy" Diabetes, 52(5), 2003, pp 1204-1209; and:

Jameel, N., Pugh, J.A., Mitchell, B.D., et al., "Dietary Protein Intake Is Not Correlated with Clinical Proteinuria in NIDDM", Diabetes Care, 15(2), pp 178-183.

Both of these are quite old; there may be more recent research.

Viv 8)

 

[Defren]

@ borofergie and dawnmc the OP has stated quite clearly that they have kidney damage.

@ Defron there is considerable data relating to kidney damage and diets whether you chose to ignore it is up to you but do you feel it is a good idea to post your left field beliefs to one who is suffering with kidney damage? Lets not turn another thread into a high fat high protein high carbs or high anything else debarcle cant you just reserve your attacks on me to less serious threads please.

@ Mark, talk to your doctor mate there are far to many barrack room lawyers here to get any sensible answers, seek professional advice about diet from an endo or a dietician

I am promoting nothing Sid, simply asking for data to back up what you are claiming. I am not even denying what you say, but I do like a bit of proof before I jump one way or the other. As for attacking you Sid, I have done no such thing, but I have and I will continue to question anything that I feel is pertinent. Could you now supply the data please - thank you!

 

[noblehead]

H Mark sorry to hear of your news. If kidney damage is evident do not embark on any diet until you have spoken to your doctor and possibly a dietician, Kidney damage is indeed exacerbated by certain diets whether some are convinced of it or not it is a fact and should not be taken lightly.

Speak with your doctor and get a referral to an endocrinologist and a dietician as a mater of urgency, sooner is always better than later

Not a type 2 Mark but as Sid has said it's best to get this cleared by your Endo or GP first before embarking on a high protein diet.

 

[Sid Bonkers]

Defron this is a serious post from someone who is worried about kidney damage, if you have a problem with me take it to the Admin or one of the mods but please stop stalking my every post.

 

[phoenix]

Defren:
....
Phoenix, in link one you provided it states

"Conclusion

Although excessive protein intake remains a health concern in individuals with pre-existing renal disease, the literature lacks significant research demonstrating a link between protein intake and the initiation or progression of renal disease in healthy individuals. More importantly, evidence suggests that protein-induced changes in renal function are likely a normal adaptative mechanism well within the functional limits of a healthy kidney. Without question, long-term studies are needed to clarify the scant evidence currently available regarding this relationship. At present, there is not sufficient proof to warrant public health directives aimed at restricting dietary protein intake in healthy adults for the purpose of preserving renal function. "

So no factual evidence there!!

Link 2 is very dated, infact well over a decade dated. So not much use as I am sure more recent studies have been done.

So is there factual evidence to say a high protein diet can present problems to a patient with a pre-existing kidney condition or not? Not seems to be the answer.

Sorry Defren I can't accept that the first paper provides no evidence: it provides no evidence in healthy individuals which is what I said but also says excessive protein intake remains a health concern in those with pre-existing disease.
I accept the second is an older review but it doesn't invalidate the findings .

The ADA says:

Studies in patients with varying stages of nephropathy have shown that protein restriction of dietary protein helps slow the progression of albuminuria, GFR decline, and occurrence of ESRD (312–315). Dietary protein restriction should be considered particularly in patients whose nephropathy seems to be progressing despite optimal glucose and blood pressure control and use of ACE inhibitor and/or ARBs (315)

I assume they did a full literature search when devising their guidelines but only the Hansen et al is more recent than the review I gave you.

312.↵ Pijls LT, de Vries H, Donker AJ, van Eijk JT. The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Nephrol Dial Transplant 1999;14:1445–1453 Abstract/FREE Full Text
313. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med 1996;124:627–632 Abstract/FREE Full Text
314. Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int 2002;62:220–228 CrossRefMedline
315.↵ Kasiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis 1998;31:954–961

 

[borofergie]

I would still like Sid to show the 'facts' he has about diets and kidney failure, as I have read quite a lot, and have seen concerns, now I would like to read the factual data. I can't believe I have missed such a vital piece of research!

It's kind of irrelevant though, based on the misconception that Atkins and other low-carb diets are high-protein. If you're eating high-protein on Atkins , then you're doing it wrong. Excess protein turns to glucose and knocks you out of ketosis. I can see that for sure on my new blood ketone meter.

Stephen

 

[hanadr]

Don't panic!
I was told a few years ago that my kidneys showed signs of deterioration, but that Ididn't need treatment.Last ttime I had my MOT done the new doctor told me that although there were some numbers below optimum, there's a ratio which in my case is normal. Sorry Ididn't take note of these details.
Ask to speak to the doctor about it all again.
AND Atkins works well for diabetes
Hana
PS my kidney number are improving with my LOW bg [pretty much always between 4.4 and 5.5

 

[Defren]

Defren:
This paper from the journal of N&M society (advocates of low carb diets reviews the evidence )
http://www.nutritionandmetabolism.com/content/2/1/25
There is evidence that excessive protein intake can both cause deterioration of kidney function in those with kidney disease and that a reduction in protein intake may slow the progression in established kidney disease.
There is no evidence that this applies to a healthy person with normally functioning kidneys. (though some late diagnosed people with T2 may already have some damage)

There is some evidence that people with T1 eating diets containing more than 20% protein (particularly animal rather than vegetable) have more protein in their urine.
http://journal.diabetes.org/diabetesspe ... /pg132.htm (bit dated but has the kidney info; you might not like some of the rest)

Phoenix, in link one you provided it states

"Conclusion

Although excessive protein intake remains a health concern in individuals with pre-existing renal disease, the literature lacks significant research demonstrating a link between protein intake and the initiation or progression of renal disease in healthy individuals. More importantly, evidence suggests that protein-induced changes in renal function are likely a normal adaptative mechanism well within the functional limits of a healthy kidney. Without question, long-term studies are needed to clarify the scant evidence currently available regarding this relationship. At present, there is not sufficient proof to warrant public health directives aimed at restricting dietary protein intake in healthy adults for the purpose of preserving renal function. "

So no factual evidence there!!

Link 2 is very dated, infact well over a decade dated. So not much use as I am sure more recent studies have been done.

So is there factual evidence to say a high protein diet can present problems to a patient with a pre-existing kidney condition or not? Not seems to be the answer.

Sorry Defren I can't accept that the first paper provides no evidence: it provides no evidence in healthy individuals which is what I said but also says excessive protein intake remains a health concern in those with pre-existing disease.
I accept the second is an older review but it doesn't invalidate the findings .
The ADA says:

Studies in patients with varying stages of nephropathy have shown that protein restriction of dietary protein helps slow the progression of albuminuria, GFR decline, and occurrence of ESRD (312–315). Dietary protein restriction should be considered particularly in patients whose nephropathy seems to be progressing despite optimal glucose and blood pressure control and use of ACE inhibitor and/or ARBs (315)

I assume they did a full literature search when devising their guidelines but only the Hansen et al is more recent than the review I gave you.

312.↵ Pijls LT, de Vries H, Donker AJ, van Eijk JT. The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial. Nephrol Dial Transplant 1999;14:1445–1453 Abstract/FREE Full Text
313. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med 1996;124:627–632 Abstract/FREE Full Text
314. Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int 2002;62:220–228 CrossRefMedline
315.↵ Kasiske BL, Lakatua JD, Ma JZ, Louis TA. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis 1998;31:954–961

I quoted the conclusion of the article you posted Phoenix. The paper suggests a link, but then in conclusion states there is no conclusive proof. It states more research needs to be done. That is not scientific proof.

"Dietary protein restriction should be considered particularly in patients whose nephropathy seems to be progressing despite optimal glucose and blood pressure control and use of ACE inhibitor and/or ARBs (315) Phoenix this is NOT proof!

Sid, I refuse to dignify your post with a reply.