A study published in 2012 found that more than 64 million Americans aged 30 or older had periodontal (gum) disease. Gum disease, also known as periodontitis, is a severe infection of the gums caused by an immune response to imbalanced oral bacteria. Inflammation from periodontal disease can damage gums, destroy the jawbone, and lead to tooth loss. Several studies have shown an association between periodontal disease and other systemic diseases such as heart disease, diabetes, cancer, and dementia. But what about the association between dental health and kidney disease? In this blog, I am going to explore that link.
Periodontal disease and systemic inflammation
The oral microbiome produces metabolic by-products in the mouth. Some of these by-products leak into the blood stream and lead to a low-grade systemic inflammation. Studies have shown that patients with severe periodontitis have elevated levels of pro-inflammatory mediators and increased neutrophil numbers in the blood. In fact, successful treatment of gum disease was associated with improvement in inflammatory markers. Many of these inflammatory markers have been linked to heart disease, diabetes, and other diseases. This may explain the link between periodontal disease and systemic diseases.
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CKD is an inflammatory state
Low-grade inflammation has been shown to be an integral aspect of chronic kidney disease (CKD). Here, too, inflammatory markers were found to be elevated. As kidney function worsens, the levels of these markers increase in the body. They also increase with increasing urine protein (albuminuria), which is common in CKD.
On the other hand, an evaluation of the Chronic Renal Insufficiency Cohort (CRIC) study found that elevated inflammatory markers were associated with rapid progression of kidney disease. So, the relationship between inflammation and kidney disease is bidirectional. CKD can lead to inflammation and inflammation can lead to and worsen CKD.
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Can gum disease cause kidney problems?
Periodontitis can increase the risk of CKD by direct and indirect effects. Directly, periodontitis increases systemic inflammatory burden leading to an increased incidence of CKD. In a recent review of 37 studies, researchers found strong evidence that periodontitis is associated with an increased risk for CKD. This association remained strong after adjusting for other risk factors.
Periodontitis can also increase the risk for CKD indirectly by increasing the risk for insulin resistance and diabetes. In this study, diabetes increased the odds of CKD by twofold, and 6.5% of this effect was mediated by periodontitis.
In addition, some of the increased risk of CKD may have to do with genetics. For example, variants in vitamin D receptor gene were associated with CKD during inflammatory conditions caused by periodontal disease.
There is not a lot of data on how treating gum disease affects CKD. However, in this pilot study, researchers found that treating severe chronic periodontitis for 180 days led to improvement of all periodontal clinical parameters. This was associated with statistically significant improvement in kidney function and markers of inflammation.
CKD and periodontitis: Does kidney disease affect oral health?
On the other hand, CKD can affect oral health by inducing gum overgrowth (known as gingival hyperplasia), dry mouth, calcification of root canals, and delayed eruption of teeth in children. These can lead to increased risk of periodontal disease. In addition, severe periodontal disease was found to be more common in patients with more severe CKD.
Kidney disease, gum disease, and nutrition
There is a triangular interaction between nutrients, CKD, and periodontal disease. Protein wasting that is common in kidney disease, for example, can increase the risk of periodontal disease. Omega-3 fatty acids, on the other hand, were found to be beneficial in the management of chronic periodontitis. Many other nutrients and micronutrients that can be altered in CKD were also associated with periodontal disease.
CKD medications may cause gum and teeth problems
Some of the medications that are used for patients with CKD can also increase the risk for periodontitis. Medications such as calcium channel blockers that are used to treat blood pressure can lead to gum swelling and overgrowth. This was also noted in some transplant medications such as cyclosporine. Other medications can be associated with dry mouth, which can promote gum and teeth problems. These include ACE inhibitors, calcium channel blockers, betablockers, and diuretics.
The bottom line on chronic kidney disease and oral health
Both periodontal disease and CKD are associated with low-level systemic inflammation. The association between the two is bidirectional. Periodontal disease can increase the risk for CKD and the rate of its progression. On the other hand, CKD can also worsen periodontal disease. Paying attention to oral health is essential for the prevention of many chronic diseases. It is also crucial for preventing or slowing down the progression of CKD.
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Air pollution is linked to kidney disease
PM 2.5 refers to particulate matters that are up to 2.5 microns in size. Because of their small size, they are considered to be the worst of all air pollutants. They reach the alveoli and enter the blood stream. This study looked at the link between PM 2.5 and chronic kidney disease (CKD) in the Twin-cities area of Minnesota. Researchers found that the risk of CKD increases with higher levels of PM 2.5. This remained true after adjusting to all other variable.
It is, therefore, important to think of air pollution as a mediator of CKD and minimize exposure to it.
Block "fundamentals" not found
A Study reaffirms the role of the gut kidney connection in diabetic kidney disease
You know we discussed the role of the gut-kidney connection in the progression of CKD. You can find many of our blogs discussing this here. Dysbiosis can be a predisposing factor or a mediator when it comes to kidney disease. This study looked at the contribution of impairment in the intestinal barrier (leaky gut) to kidney injury in diabetic kidney disease (DKD). In diabetic mice with impaired intestinal integrity intestine-derived Klebsiella oxytoca and elevated IL-17 were detected in the circulation. This was associated with epithelial renal tubular injury and faster progression to kidney failure as compared to control.
So, always think about the gut when it comes to kidney disease. A personalized comprehensive gut restoration protocol is a must to heal the gut.
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A gut-derived uremic toxin is associated with inflammation
Speaking of the gut, we discussed monocyte to HDL ration (MHR) in a previous email. If you missed it, you can read about it on our Instagram page. This study looked at the connection between Indole-3-acetic acid which is a gut-derived uremic toxin and MHR in patients with kidney disease. The study was conducted on 67 patients with CKD. Researchers found that Indole-3-acetic acid levels are directly related to MHR levels. The latter was associated with higher levels of fibrinogen, arterial hypertension, CRP.
So, as they say, when in doubt think about the gut.
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The post March Research and News appeared first on Integrative Kidney.]]>
By Lara Zakaria, PharmD, CNS, CDN, IFMCP
The Gut-Kidney Connection
Recent studies have focused on the significance of a relationship between gastrointestinal (GI) integrity and microbiome diversity with various chronic diseases including kidney disease.
In previous blogs, we discussed the impact of exposure to food and environmental triggers that impact the gut lining (or mucosa)integrity and microbiome balance leading to intestinal permeability (IP or “leaky gut”). The impact of leaky gut on kidney health and progression of chronic kidney disease (CKD) has been referred to as the gut-kidney connection is the result of complex biochemical and immune mechanisms.
A comprehensive approach to CKD includes addressing the health of the GI at the root of it. Furthermore, this means not simply supplementing with probiotics, but instead addressing all the mechanisms that underlie probiotic need. This includes modification of microbiota balance, integrity of the mucosa and epithelium of the GI tract, improving GI motility, absorption and digestion, and modulation of the immune system.
Below we will explore the fifth step, Rebalance. But first, let’s quickly review the first four steps of the comprehensive gut restoration protocol. A reminder that the 5R Protocol addresses leaky gut as a foundational approach to reduce the risk of progression of CKD.
The 5 steps of the 5R protocol for healing leaky gut are:
1) Remove potential triggers, including polypharmacy, pathogenic organisms, food intolerances, sensitivities and allergies, or toxic exposure.
2) Replace digestive aid to support improved nutrient absorption and metabolism, including digestive enzymes, or agents that promote improved motility and regular bowel movements.
3) Reinoculate provide an environment where good bacteria can thrive and where bad ones cannot.
4) Repair support of the cellular repair process through the above, as well as by providing specific nutritional support for the regeneration of the GI protective barrier.
5) Rebalance lifestyle factors that influence the gut bacteria such as stress, sleep, exercise and relationships and assure ongoing gut health.
Rebalance
The goal of the fifth step is maintenance and prevention of recurrence of IP or leaky gut. There are various factors that lead to IP that involve dietary and lifestyle influences*, including:
· Standard American Diet (SAD) which is low in fiber, high in processed foods, and highly inflammatory
· Poor eating habits (for example, multitasking and not chewing adequately)
· Inadequate hydration and/or electrolyte imbalance
· Motility issues leading to constipation or unfavorable formation/frequency of stool
· Stress and poor sleep
· Not enough exercise
To reduce risk of CKD, we must work towards improving diet and lifestyle habits that support continued GI health.
*Read more about medications that impact gut health and ultimately increase risk for KD progression here.
Where to start?
Address lifestyle factors that impact gut health
Long term dietary goals focus on a plant-based diet that is high in fiber and a wide range of key nutrients. Organic sources of animal protein can beneficial when eaten in moderation. However, the key is to load up on naturally antiinflammatory, low carbohydrate vegetables to maximize vitamins, minerals, phytonutrients and, of course, fiber. Reduce intake of starchy vegetables and eat more**:
· Dark leafy greens (like spinach, arugula, and romaine)
· Cruciferous veggies (like broccoli, cauliflower, and kale)
· Fresh whole fruit (preferably lower sugar berries and avocados, and limit to two servings per day)
· Some colorful starchy veggies can be OK (for example, carrots, sweet potatoes, beets, and squashes)
Those veggies listed above promote a healthy microbiome and improve alkalinity associated with improved kidney health. In addition to those sources of prebiotic fiber, include probiotic sources like fermented vegetables and drinks like raw sauerkraut, kimchi, pickles, apple cider vinegar, and kombucha. It’s recommended these are eaten raw because pasteurization process will destroy the bacterial content of these foods.
In general, reduce processed carbs, like bread, cereals, and high sugar foods, desserts and pastries. These types of foods are usually low in fiber and nutrients and help contribute to starving of beneficial gut bacteria. Furthermore,high carb diets have been associated with increased risk of cardiovascular (CV) disease and diabetes. Instead, moderately consume whole grains like brown rice, quinoa, oatmeal, and legumes**.
Include antiinflammatory fats focusing primarily on omega 3 sources from fish, nuts, seeds, and mono- and polyunsaturated (MUFA and PUFA) like avocados and olive oil. Even though the topic of saturated fats is more controversial, recent evidence suggest that moderate intake of certain saturated fats like that found in beef, organ meat, or ghee (clarified butter) derived from grass-fed cows and virgin coconut oil might have health benefits. Everyone agrees, however, that trans fats(aka hydrogenated oils and artificial products like margarine) or excessive intake of processed and fried fats contributes to inflammation and increased risk of disease.
Ensuring adequate hydration, drinking at least half your body weight (pounds) in ounces of water, not only helps to maintain good kidney health, it also helps support daily regular bowel movements.
It’s well established that regular exercise can be beneficial for many reasons, including improved blood pressure, blood sugar, hypertension, stress relief, and even improved digestion and GI motility. In fact, exercise has been associated with improved microbiome balance as well as beneficial modulation of the immune system.
Poor sleep quality and stress are also deeply tied to many underlying factors impacting of GI health. Reduced sleep duration and quality has been associated with increased inflammatory markers (including TNF, IL-1, and IL-6) associated with GI disease like GERD and Irritable Bowel Disease/Syndrome (IBD/IBS) disrupting digestion and nutrient absorption. Furthermore, sleep has been shown to affect kidney health directly and indirectly, including associated risk of CV disease, diabetes, obesity, and hypertension(read more about the relationship between sleep and kidney health here).
**NOTE: Due to individual variations and progress of disease, work with a nutritionist to assess if you need to maintain any specific restrictions due to your unique case and needs.
The role of supplements
Because of the unique needs of kidney disease patients, many need to rely on supplements to help obtain adequate amounts of key nutrients to maintain GI and kidney health.
This may include GI and motility support including but not limited to digestive enzymes, bitters, probiotics, and magnesium citrate and triphala for motility). Furthermore certain individuals may benefit from supplementation of certain vitamins and important minerals, high potency antioxidants, and/or support of certain key underlying cellular mechanisms impacting mitochondrial health, detoxification and nitric oxide production.
That said, many factors must be taken into consideration when choosing appropriate supplements for each patient. Supplement quality and contamination are a common concern, as are potential interactions with medication or contraindications in certain commonly associated chronic disease. We suggest working under the care and guidance of a practitioner or team of providers who are trained in integrative and functional medicine and understand the unique needs of kidney patients.
Next steps
Unfortunately, addressing gut health is only the beginning. As mentioned above, kidney disease is often associated with multiple chronic diseases including CV disease, diabetes, high blood pressure, and obesity.
The comprehensive approach to kidney care means addressing the underlying causes of this constellation of diseases which is best accomplished by a Functional Medicine approach. The goal is to identify and then rebalance the biochemical and pathophysiological dysfunction at the root of chronic disease, we can stop the progression of kidney damage and preserve kidney function.
Bottom Line
In the final step in the 5R individualized gut restoration protocol, we Rebalance the foundational factors that impact the gut-kidney axis.
Although this might be the last step in the 5R protocol, within the broader context of kidney disease, it might signal the transition to a comprehensive therapeutic protocol that includes management of the underlying dysfunction associated with related conditions such as CV disease, diabetes, obesity, and hypertension.
Working with an integrative or functional medicine provider is essential to help you navigate the comprehensive program successfully, but can help you stabilize blood sugar, lower blood pressure, lose weight, and reduce the risk of CV and ultimately, KD.
More from InKidney on the gut-kidney connection:
· Comprehensive Gut Restoration Protocol https://old.inkidney.com/2019/07/05/comprehensive-gut-restoration-protocol-ckd/
· Feeding Gut Bacteria in Kidney Disease https://old.inkidney.com/2019/02/20/feeding-gut-bacteria-patients-kidney-disease/
· Kidney-Gut Axis: Nutrition can slow the progress of kidney disease https://old.inkidney.com/2018/09/20/kidney-gut-axis-nutrition-slow-kidney-disease/
· Inflammation, Leaky Gut And Kidney Disease https://old.inkidney.com/2018/10/05/inflammation-leaky-gut-kidney-disease/
· Leaky Gut And Kidney Disease: 6 Classes Of Medication That Might Be Contributing https://old.inkidney.com/2018/10/05/leaky-gut-kidney-disease-medications/
The post The 5R Protocol Part 5: Rebalance appeared first on Integrative Kidney.]]>By Lara Zakaria, PharmD, CNS, CDN, IFMCP
The Gut-Kidney Connection
The gut-kidney axis refers to the relationship between gut integrity and microbiome diversity with kidney disease. Excessive intestinal permeability, also known as hyperpermeability or more commonly as “leaky gut,” has been shown to be at the root of this connection. This gut-kidney relationship is the result of complex biochemical and immune mechanisms.
So far we looked at the first three steps of the 5R protocol, Remove , Replace, and Reinoculate. Applied sometimes sequentially and at times simultaneously, these steps are used to address the underlying factors associated with leaky gut. The idea is that comprehensive approach that reveres damage to the gut caused by exposure to food and environmental triggers, addresses the disruption of digestion and nutrient absorption, altered bowel motility, and dysbiosis, improves gut health and ultimately overall kidney health.
Read on below where we will explore step 4, Repair. But first, let’s first review the five steps of the comprehensive gut restoration protocol. A reminder that the 5R Protocol addresses leaky gut as a foundational approach to reduce the risk of progression of CKD and in our upcoming blog on Rebalance, we will explore maintenance and next step in integrative kidney care.
The 5 steps of healing leaky gut are:
1) Remove potential triggers, including polypharmacy, pathogenic organisms, food intolerances, sensitivities and allergies, or toxic exposure.
2) Replace digestive aid to support improved nutrient absorption and metabolism, including digestive enzymes, or agents that promote improved motility and regular bowel movements.
3) Reinoculate provide an environment where good bacteria can thrive and where bad ones cannot.
4) Repair support of the cellular repair process through the above, as well as by providing specific nutritional support for the regeneration of the GI protective barrier.
5) Rebalance lifestyle factors that influence the gut bacteria such as stress, sleep, exercise and relationships and assure ongoing gut health.
Gut Repair
Up until this phase, we’ve focused on removing triggers that contribute to local and systemic inflammation. We’ve even taken steps to rebalance the microbiome. In the repair phase, we work to provide nutritional support that directly impacts the integrity of the gut mucosa and repairs hyperpermeability.
Recall from our previous blog, Part 1: Remove, that exposure to toxins, food sensitivity, and presence of pathogens leads to increased inflammation locally that triggers the immune system and leads to damage to the lining of the gut and mucosa.
The term Intestinal hyperpermeability (aka “leaky gut”) is the result of this inflammatory assault to the gut lining. These breaks in the integrity of the wall (imagine gaps in a fence on your lawn) let undigested food, bacteria, and metabolites “leak” through the holes.
The physiologic changes associated with this leaky state include a combination of factors that reduce your gut’s ability to absorb nutrients. These include hypochlorhydria (insufficient hydrochloric acid in the stomach to digest food), reduced production of digestive enzymes, altered bowel motility (often leading to constipation, but not always), and dysbiosis.
Now that we’ve addressed those aspects in steps 1-3, we can focus our energy on repair. This stage is often several weeks into the comprehensive gut restoration program because initiating it simultaneously may interfere with the efficacy of the prior steps. Working with an integrative or functional medicine practitioner can help guide you through your personalized program.
Where to start?
Address permeability with nutrients and herbs
To support intestinal mucosa regrowth and cell repair we focus on nutrients that have properties that promote rebuilding a healthy mucosal lining. They help improve the integrity of the intestinal wall by supporting building and formation of the intestinal epithelium, villi and cell connective tissue.
This includes a wide spectrum of micronutrients including vitamin A, D, E, and C. L-glutamine, butyric acid, and collagen supplements. These are useful to build collagen that forms the epithelium of the GI tract. Whey, colostrum or serum bovine immunoglobulins may be utilized to balance inflammatory mediators based in the gut. Zinc carnosine, melatonin, cabbage juice, aloe vera, and mucilaginous herbs like marshmallow root and slippery elm are also used therapeutically to support various aspects of the rebuilding process.
This is of course layered in on top of an anti-inflammatory, nutrient-dense, fiber-rich diet that includes healthy fats, moderate intake of animal protein, and a colorful variety of organic fruits and vegetables that provide added antioxidant and phytonutrient repair support.
Bottom Line
The fourth step in an individualized comprehensive gut restoration protocol involves leveraging food and herbs to promote the repair of the gut mucosa. This is often done after Remove, but might be simultaneous to Replace and Repair steps. However, every case is unique, and it’s important to work with an integrative or functional medicine provider trained in the comprehensive gut restoration protocol to help you navigate this safely and successfully. Next, we will tackle the 5th “R” in the gut restoration protocol: Rebalance.
The post The 5R Protocol Part 4: Repair appeared first on Integrative Kidney.]]>
It has been suggested that it could be due to agricultural chemicals, heavy metal exposure, silica inhalation, infectious diseases, genetic predisposition. Many of these workers regularly work in hot conditions for long hours. More recently, they identified repeated heat stress as a cause and a risk factor for kidney disease.
There is no doubt that the prevalence of kidney disease is rising in the United States (US) and throughout the world. In fact, one in seven people in the US has kidney disease. It is one of the fastest growing causes of death throughout the globe. An estimated 5–10 million people die annually from kidney disease worldwide. Unfortunately, due to poor data, lack of awareness, early detection and access to care these numbers could underestimate the exact burden of kidney disease in the world.
Chronic Kidney Disease of Unknown Origin (CKDu)
The type of chronic kidney disease that affected the agricultural workers in Central America is now called chronic kidney disease of unknown origin (or CKDu). Since the nineties, CKDu has been identified in studies of similar etiologies in Siri Lanka, India, Africa, South America and the Middle East. The common thread is the hot and humid climate.
CKDu does not follow the conventional risk factors for kidney disease and, therefore, it’s challenging to detect early and prevent. It disproportionately impacts areas with underprivileged communities and poor infrastructure. However, it would be a mistake to assume that this problem is limited to developing countries. Acute kidney injury has been reported in agricultural workers exposed to hot conditions in California and Florida.
Primary Impact: Global Temperature & Kidney Injury
It has been documented that global temperature have increased by about 1 degree centigrade (1.8 degrees Fahrenheit) in the past 50-100 years. Scientists agree that these changes have contributed with record heat waves, melting ice caps and rising sea levels, and extreme weather patterns. This pattern is posing significant health risks, some directly and some indirectly.
According to a United Nations report, climate change is expected to exacerbate health problems that already pose a major burden to vulnerable populations including children and the elderly. Climate change has been associated with a rise in many infectious diseases, especially water-borne illnesses like cholera, typhoid, and dysentery. It is also expected to contribute to the chronic disease burden and bring on new health epidemics. Not surprisingly, CKDu is one of these health issues.
Secondary Impact: Kidney Disease, Pollution, Water & Food Security
So how does rising temperature affect kidney health? The evidence points to heat stress and dehydration can result in chronic kidney disease as playing an important role in the epidemic of CKD worldwide. In fact, the progression of kidney injury has been found to worsen with rising core body temperature.
The mechanism seems to be linked with a decrease in adenosine triphosphate (ATP) levels and reduced mitochondria. These energy powerhouses are particularly abundant in the kidneys, and with reduced ATP and mitochondria, oxidative stress and cellular damage increases. Combine that with a diet with low nutrient-density and inadequate antioxidant content to neutralize oxidative stress, and risk of CKD significantly elevates. In laboratory studies, the supplementation of antioxidants prevented rats who were exposed to heat stress from developing kidney injury.
Furthermore, heat has been associated with increased risk of kidney stones and kidney stones are known risk factors for kidney disease. Since the kidneys are major site for the metabolism and elimination of toxins, exposure to toxins such as glyphosate contributes to kidney injury due to oxidative damage. Glyphosate in particular also impacts dysbiosis and gut health, which may be a confounding factor in the equation when we consider the gut-kidney connection.
As droughts become a more frequent occurrence as a consequence of climate change, dehydration from heat exposure and inadequate water consumption can lead to concentration of these toxins and, therefore, amplification of their negative effects.
Another factor to consider is the increase of pollution like heavy metal, plastics, and chemicals like pesticides and herbicides. Contamination of air and soil with pollutants increases inhalation and ingestion through food, including rise of mercury contamination in fish and arsenic in rice for example. These toxins have been associated with the rise in incidence of KDas well as other chronic diseases like diabetes and hypertension.
Last but not least, as climate change impacts food security and farming practices, access to fresh food and produce might be compromised. This may shift consumption to processed foods with less nutrient value, including less vitamins, minerals, phytonutrients, and antioxidants needed to promote healthy kidneys. Increased consumption of processed foods also leads to reduced fiber consumption, which impacts gut health and the microbiome which might be the most significant factor as we’ve discussed in our blog on the gut-kidney connection.
Other Considerations
It may sound like a cliché, but hydration is key. For those in labor industries or who work in agriculture or at increased risk of extended heat and chemical exposure, extra effort should be made to adequately hydrate. Broader public health measure and policy should be put in place to improve worker safety.
The risk increases for those taking medications that:
· Increases risk for dehydration, including diuretics (furosemide, hydrochlorothiazide, etc) or SGLT-2 inhibitors (canagliflozin, dapagliflozin, etc), or
· Decreases circulation to the kidneys, including ACE inhibitors (lisinopril, captopril, etc), angiotensin receptor antagonists (ARBS like losartan, Olmesartan, etc). However, as we mentioned earlier, heat lead to energy depletion in the kidneys and supplementing with antioxidants may further decrease the risk of kidney injury due to extreme heat.
Bottom Line
Rising global temperatures are posing increasing risk for kidney disease and contributing to a worldwide rise in chronic kidney disease. Extended exposure to heat and dehydration can lead to kidney injury and kidney stones. Improved hydration, improved nutrient-density diet, and use of antioxidants maybe be preventive. Other confounding factors cannot be ignored, including increased environmental pollution, factors that impact on gut health, and medications. Although individuals can take steps to reduce our carbon footprint, but broad public health measures must advocate for policy changes that reduce contributions to climate change and the resulting global health impacts.
The post Impact of Climate Change on Kidney Health appeared first on Integrative Kidney.]]>You can think of your gut’s bacterial ecosystem (or microbiota) as a society. Just like any society, there are good guys and bad guys, and we can measure such attributes as population and diversity. So, the three questions we ask when evaluating the microbiome are:
- Are there any bad bacteria that need to be evicted?
- What’s the bacterial population? Do you have enough inhabitants living in the gut?
- Is there enough bacterial diversity? Different bacteria have different jobs and contributions, so a broader diversity is an indicator for better health.
There are multiple factors that affect the answers to those questions, and here we’ll focus on diet. Eating the right foods is possibly the most effective way to cultivate a robust microbiome and defend against “bad-guy overgrowth”.
Eating the right foods is possibly the most effective way to cultivate a robust microbiome and defend against “bad-guy overgrowth”
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Probiotics and Prebiotics: What’s the difference?
Prebiotics is a term used to describe “bacteria food” needed to cultivate a healthy microbiome. Bacteria primarily feed on fiber found in vegetables, fruit, and whole grains (not processed grains like bread and pasta). In fact, in people eating the Standard American Diet (SAD), which is high in animal protein and fat and low in dietary fiber, we see microbiome quantity and diversity significantly reduced. This imbalance is thought to be one of the major contributors to the chronic disease epidemic in the US.
Probiotics are live bacteria (and sometimes yeast) that are usually consumed through traditionally fermented foods, like kefir, kombucha, and sauerkraut and other fermented veggies, and are good for optimal gut function. They can also be taken as a supplement, which have grown in popularity as more research has suggested a benefit of supporting healthy gut bacteria.
As it turns out, focusing only on probiotics has yielded mixed results in the research. That’s because bacterial levels in the gut are transient unless supported with long-term dietary changes that incorporate regular intake of prebiotic fiber. Therefore, we need to look at both pre- and probiotic intake to optimize the microbiome.
It turns out, focusing only on probiotics has yielded mixed results in the research. That’s because bacterial levels in the gut are transient unless supported with long-term dietary changes that incorporate regular intake of prebiotic…
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Fiber, Fiber, and More Fiber
There are two kinds of fiber: soluble and insoluble.
Soluble fiber is the kind of food that suck up water and becomes like a gel. This helps to move digested food through the gut. Insoluble fiber does not break down during digestion. It passes through the gut intact, forming a sort of net, binding digested food byproducts together to create firm stool.
Fiber intake of at least 30 g/day is associated with reducing the risk of heart disease, obesity, diabetes, and even certain kinds of cancers like colorectal cancer. These benefits are likely due to improved bowel movements, removal of toxins, and support of a healthy microbiome.
To preserve kidney function, animal protein sources should be reduced or restricted (more about that here). The research suggests, that plant-based protein sources might be ideal for kidney disease patients since they also double as sources of diverse dietary fiber.
Whole grains, legumes, nuts, and seeds make excellent sources of both fiber and protein. In addition, many vegetables and fruits have surprisingly significant amount of protein including avocado*, broccoli, cauliflower, mushrooms (especially Portobello and shitake), and seaweed. Always keep in mind, though these foods may be generally healthy, in some patients with potassium restrictions you need to consult with your renal nutritionist to personalize your diet.
Remember to always choose whole, fresh foods whenever possible and avoid processed foods that claim to have “added fiber”. They are usually packed full of fillers, sugars, grains, cereals and artificial ingredients.
Remember to always choose whole, fresh foods whenever possible and avoid processed foods that claim to have “added fiber”. They are usually packed full of fillers, sugars, grains, cereals and artificial ingredients
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The recommended daily fiber intake is somewhere between 30-40 grams of both soluble and insoluble fiber. The following options allow you to mix and match to achieve your daily fiber. Every kidney patient is different and needs an individualized approach, we’ve highlighted the foods within this list that are high in potassium with this symbol (*) and food high in phosphorus with this symbol (‡) so you can further customize to fit your needs:
- 1 cup of cooked oatmeal = 4 g
- 1/2 cup of raspberries = 4 g
- 1 cup of avocado*= 10 g
- 2 cups of romaine lettuce = 2.4 g
- Medium-sized banana*= 3.1 g
- 1 cup of carrots = 3.6 g
- 1 cup of beets*= 3.8 g
- 1 artichoke*= 10.3 g
- 1 cup of Brussels sprouts = 6.4 g
- 1 cup of kidney beans‡= 11.3 g
- 1 cup of cooked split peas*= 16.3 g
- 1 cup of cooked chickpeas = 12.5 g
- 1 cup of cooked quinoa*= 5.2 g
- 1 ounce of dried chia seeds‡= 10.6 g
- 1 cup of blueberries = 3.5 g
- 1 cup of strawberries = 3.3 g
- 1 cup broccoli = 3 g
- 2 carrots = 6.4 g
- 1 cup of brown rice = 3.5 g
- Half a cup of lentils‡*= 15.6 g
- Medium-sized boiled sweet potato*= 3.8
- 1 oz of almonds = 3.3 g
- 1 apple = 5 g
- 1 pear = 6 g
- 1 ounce of dark chocolate‡= 3.1 g
- 3 cups of popped popcorn = 3 g
The recommended daily fiber intake is somewhere between 30-40 grams of both soluble and insoluble fiber
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Cut out the sugar, You Are Sweet Enough Already
High-sugar diets can be a major disrupter of your gut microbiome, primarily because it feeds bad bacteria and yeast overgrowth. This is one of the proposed mechanisms contributing to metabolic diseases like diabetes and heart disease, two conditions associated with KD.
Should you take probiotics supplement?
Though supplementation may be very useful in some cases, the best long-term strategy is to increase the intake of per- and probiotics naturally through your diet. Traditionally fermented foods are a great source of naturally found probiotics, these include non-pasteurized traditionally-made kefir, sauerkraut, kimchi, miso, and pickled vegetables. However, for various reasons they may be restricted in some patients, so work with a nutritionist to implement the best strategy for gut bacteria balance – which may include a combination of food-based intervention and supplementation.
Other lifestyle factors that affect the microbiome
Interestingly, exercise may change the composition of the microbes in the gut for the better. Aim for at least 20 minutes of exercise daily and make it priority (you and your kidneys are worth it). In addition, stress can deplete the friendly flora and promote the growth bad bacteria. Although stress cannot always be avoided, find way to manage stress like breathing exercises and meditation, and do your best to avoid triggers.
It’s important to work with a physician and nutritionist familiar with integrative approach to kidney disease. He/she can help you design a comprehensive plan that includes personalized dietary recommendations and supplements that promote healthy bacteria balance for optimal gut and kidney health.
The post Feeding Gut Bacteria in Patients with Kidney Disease appeared first on Integrative Kidney.]]>