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From the Townsend Letter
June 2018

Myth Busting Common Misconceptions of Kidney Disease
by Dr. Jenna C. Henderson
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Treating All Kidney Problems the Same
It is amazing that so many natural kidney support formulas try to be all things to all people. Herbs for treating kidney stones, urinary tract infections, glomerulonephritis, and hypertension are often thrown together in one formula. While kidney stones may lead to chronic kidney disease, these conditions are not interchangeable. Some lay people are under the impression that renal lithiasis is rampant, and all people would benefit from a purification program to push these kidney stones out. This, however, is not the case with a prevalence of kidney stones in the United States at only 8.8% of the population.6
Formulas for kidney stones often contain an agent like Chanca piedra or Hydrangea arborescens to address the issue, as well as a demulcent like slippery elm and a diuretic. Formulas for urinary infections will typically have D-mannose, cranberry and also maybe a diuretic. Formulas to support kidney filtration may have cordyceps or rehmannia included. Hibiscus sabdariffa is an herb with multiple benefits as it may inhibit the formation of kidney stones,7 inhibit urinary tract infections,8 and support kidney function.9 But this is an exception. For most kidney patients, clarifying the problem is important for individualized treatment. A one-size-fits-all formula will have items they don't need and probably won't give an adequate dose of what they do need.

Expecting Water to Cleanse All
Clinical dehydration is certainly bad for the kidneys. Dehydration can also elevate creatinine on a blood draw, making kidney function appear worse than it really is. For many patients not drinking water is just a habit and their sense of thirst may be off. However, going to the opposite extreme brings its own problems.
Chronic Pathologies ConferenceThis was one area where as a kidney patient, the author found agreement working with both a nephrologist and an OMD (Oriental Medical Doctor). The nephrologist was adamant that excess fluids would not help the kidneys get rid of more uremic waste. The same waste is passed but the urine is simply more dilute. The OMD for his part concurred. By the tenants of his practice, all things must be in balance including water.
It was the holistic doctors the author encountered who were of the mindset that if a little is good more must be better. For kidney patients in an early stage, an excess of water can cause an electrolyte disturbance. For patients with kidney failure, fluid overload can lead to congestive heart failure and shortness of breath.
For the holistically minded who have been told over and over that water is cleansing, the situation for those with kidney failure can be shocking. Fluid restrictions would seem counterintuitive when one is full of uremic toxins. However, producing urine is an active process on the part of the kidneys, and this production stops with kidney failure. The patient may be anuric with no urinary output or oliguric with very little output. The author has encountered holistic practitioners who questioned whether they should try to shift the urinary pH to a more acidic or alkaline balance in a patient with kidney failure. The fact that there is no urine and an entire bodily function has shut down did not immediately register.

Inferring Too Much from an Urinalysis
The urinalysis should be a complement to the blood work to provide a more complete picture. Patients often read online that cancer thrives in an acidic body, and therefore they must alkalize their system. The author has encountered many patients who decide that since their urine has an acidic pH, their body is too acidic. They will then set up the goal of a neutral urinary pH to alkaline the body.
It is actually a healthy kidney that is able to expel metabolic acids. A weak kidney unable to filter out uremic wastes will pass mostly water, with a neutral pH. Also, certain bacteria and UTI may be associated with a high pH. In order to achieve a more alkaline urine, the patient usually needs to severely cut back on protein, a diet that will ultimately be unsustainable.

Going to Extremes in Diet
Protein increases the workload of the kidneys and a high protein diet will lead to higher levels of BUN. And when patients are afraid of kidney failure they're willing to go to extremes to cut the protein out of their diet. They may cut protein out or even take up fasting to help their kidneys. But although this self-imposed marasmus or kwashiorkor will improve their BUN, it often comes at a price.
As the body strives for homeostasis, self-correcting mechanisms kick in. Blood albumin must be maintained; and without dietary protein, the body will take protein out of the muscles. Although protein deprivation may temporarily alleviate some kidney stress, the resulting sarcopenia will ultimately be to the patient's detriment.10
Protein deprivation can bring a host of issues for many types of kidney patients. This is especially true with diabetic kidney issues. The patient is careful to avoid carbohydrates but doesn't want to do too much protein either.11 Often the patient feels there are no acceptable options. For the pediatric patient, protein is necessary for growth; and for the kidney patient also fighting infections, protein is necessary for the immune system.
Slightly lower protein may be helpful, but moderation is key. In general, between 0.8 and 1.0 grams of protein per kg of body weight may work. For patients with very low filtration 0.6 grams of protein per kg of body weight may be used for a short time. This calculation may need to be adjusted if the patient has more adipose tissue. Greater body fat would not allow for greater protein consumption. In that case, calculations can be made using ideal weight for height and build rather than the actual weight.

Demonizing All Dairy
Protein puts stress on the kidneys, but is dairy protein really worse than other types of protein? Kidney patients are often under the impression that all milk products are especially detrimental to kidney health, but is that really the case? Kefir has actually been shown to be helpful for diabetic nephropathy,12 and there is evidence that whey and casein decrease kidney inflammation and renal damage.13 While red meat, poultry, and seafood raise uric acid, dairy products will not. Some dairy products are more concentrated in phosphorus than others, but it is not the case that all dairy must be eliminated for every kidney patient.

Going to Extremes Cutting Out Minerals
When patients first learn that they have kidney trouble, the initial response is often to cut way down on sodium intake. Cutting out processed foods, canned soups, and preserved meats and eating in restaurants less often is a good first step. Drastically reducing sodium will also greatly improved edema. However, the body tightly regulates sodium in the blood and there will be diminishing returns if the patient goes to an extreme cutting out sodium. Blood pressure will only decrease a limited amount, as other factors besides sodium are driving the hypertension.14 Depending on the circumstances, foods naturally high in sodium like celery, tomato, or spinach may be beneficial. Whether the patient consumes 1,000 mg of sodium or 1,200 or 1,500 a day is usually not of great consequence. As long as the patient is not well over 2,000 mg of sodium, they do not need to be continually counting the mg of sodium in all of their food.
Kidney patients may also be mindful of potassium consumption. Unlike sodium, there are no hormonal regulators keeping potassium in homeostasis. Under normal circumstances a healthy kidney will expel potassium every time the patient urinates. Problems come with late stage kidney disease when the kidneys no longer pass potassium through the urine, potentially leading to a dangerous state of hyperkalemia. But this danger comes only from late stage kidney disease (or potentially from potassium sparing diuretics). The problem comes when the patient starts a low potassium diet prematurely. If the kidneys are still healthy enough to excrete potassium, there is no benefit to a low potassium diet. It does not reduce stress on the kidneys and cuts the patient off from many healthy fruits and vegetables.

Ignoring Phosphorus
Phosphorus is a mineral that puts more stress on the kidneys, but one can only go so far in eliminating phosphorus from the diet. Some phosphorus in the diet is unavoidable as phosphorus naturally occurs with protein. That is unless the patient completely eliminates protein and takes amino acid supplements, a drastic measure that few patients are able to sustain for an extended period of time. Some dietary measures can minimize the patient's phosphorus intake. Whole grains like quinoa and whole wheat are high in naturally occurring phosphorus. However, naturally occurring phosphorus is usually bound and not fully absorbed. Added phosphorus like phosphoric acid in soft drinks, however, are absorbed at virtually 100%. Many processed foods and fast foods also contain phosphate-based additives.15 This may even be present with food considered healthy like rice milk fortified with tricalcium phosphate.
Often unconsidered are sources of phosphorus from dietary supplements. Sometimes the presence of phosphorus is obvious from the name such as phosphatidylserine or phosphatidyl choline. It may also be added to the supplement as dicalcium phosphate. Krill oil, which is a phospholipid, is also a potential source of phosphorus. With late stage kidney disease, it is often necessary to take a phosphorus binder; but eliminating extra sources of phosphorus will make the situation easier to manage.
Processing natural vitamin D is normally handled by a healthy kidney, and many kidney patients have chronically low levels of vitamin D. But patients and holistic practitioners may be overzealous in correcting low vitamin D, as vitamin D increases the uptake of phosphorus. Some patients unable to manage their phosphorus do well to reduce their intake of vitamin D. If the nephrologist has prescribed calcitriol, additional vitamin D supplementation may be unnecessary. Continual monitoring of blood work will help clarify the patient's needs. It is often good to have a target within normal range but on the lower side of normal.

Being Afraid to Use Magnesium
Many people group electrolytes together and assume that since too much potassium is dangerous, magnesium is also dangerous. But high magnesium does not disrupt the heart the way high potassium does. At worst the patient might experience a loose bowel with too much magnesium.
There are multiple benefits of magnesium for the kidney patient and, like the population at large, magnesium levels may be low. Magnesium is a natural calcium channel blocker, and it also helps balance blood sugar. Even dialysis patients, who don't eliminate magnesium in their urine, benefit from magnesium supplementation as it reduces calcification of the blood vessels.16

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