Dr. Thomas Campbell, Medical Director of the University of Rochester Weight Management and Lifestyle Center at Highland Hospital, and his team recently published in BMJ Case Reports results from a case study featuring a patient with type 2 diabetes, hypertension, stage 3 chronic kidney disease, hyperphosphataemia, and borderline hyperkalaemia. Below is an excerpt from the published paper, “Plant-based dietary approach to stage 3 chronic kidney disease with hyperphosphataemia.” The full article is open access to the public and can be viewed on PubMed.

Abstract

A 69-year-old man with type 2 diabetes, hypertension and stage 3 chronic kidney disease (CKD), hyperphosphataemia and borderline hyperkalaemia presented to an office visit interested in changing his diet to improve his medical conditions. He adopted a strict whole-foods, plant-based diet, without calorie or portion restriction or mandated exercise, and rapidly reduced his insulin requirements by >50%, and subsequently saw improvements in weight, blood pressure and cholesterol. His estimated glomerular filtration rate (eGFR) increased from 45 to 74 mL/min after 4.5 months on the diet and his microalbumin/creatinine ratio decreased from 414.3 to 26.8 mg/g. His phosphorus level returned to the normal range. For individuals with CKD, especially those with obesity, hypertension, or diabetes, a strict, ad libitum whole-food, plant-based diet may confer significant benefit, although one must consider potential limitations of a creatinine-based GFR equation in the face of significant weight loss.

Patient’s Perspective

At the outset, it seemed like this was going to be a difficult and restrictive way to eat. What I quickly discovered was that I could begin eating foods that I’d been depriving myself of for years because I thought they were unhealthy. By enjoying fresh, ripe fruits, for example, I was suddenly encouraged rather than discouraged. I began feeling different almost immediately and we had to decrease my insulin after ONE day. It seemed like almost overnight I had more energy than I’d had in years. Weight that I had been trying to lose for a decade began dropping off. As the weight came off, I felt lighter, and more able to move my body again. I began walking daily and am now up to 6 miles per day. This lifestyle change has been the greatest gift I’ve ever received. I am off most of my medications, I’ve lost over 70 pounds, and I’ve regained control over my health. I feel empowered by this lifestyle change and I finally feel like I’m in charge of my health, not just an unlucky victim shuffling from one specialist to the next. My only regret was that I didn’t know about this sooner.

Learning Points

• A strict whole-food, plant-based diet, excluding meat, dairy, added fats and processed foods, may offer significant benefit for a motivated patient with chronic kidney disease due to diabetes, hypertension and obesity.
• If a motivated patient makes a major dietary change to a whole-food, plant-based diet and is on high-risk medications like insulin or, to a lesser extent sulfonylureas and antihypertensives, close monitoring is required to decrease medications in advance of potential adverse effects.
• Plant-based diets may offer benefit for patients with hyperphosphataemia, as phosphorus is less readily absorbed than animal-based sources of phosphorus.
• Significant weight loss, which usually involves some degree of lean body mass loss, can reduce serum creatinine independent of its effect on renal function.

To read the rest of this published paper please visit: https://casereports.bmj.com/content/12/12/e232080.full