Kidney Disease And Your Gut Health…Confusing Questions & Complex Answers

When it comes to managing kidney disease through diet, the answer is not so simple as cutting out this or that food because it contains too much of this or too little of that. It’s certainly one component of a much more multi-layered approach that’s very dependent on a variety of factors unique to one’s own experience with kidney disease.

And those experiences are becoming more and more frequent. Chronic kidney disease (CKD) seems to increase in numbers through the years and throughout the world because of the changes in lifestyle and diets.  CKD patients are told to eat fewer potassium-rich fruits and vegetables and less phosphorus-rich yogurt to avoid hyperkalaemia and hyperphosphatemia.  This leads to very small amounts of dietary fibers and probiotics in their gut lumen. This can also contribute to intestinal microbial composition or dysbiosis, which causes inflammation.

With CKD patients, doctors sometimes focus on medication prescriptions but overlook how important dietary management is for balancing blood pressure and blood sugar.

ANTIBIOTICS, PREBIOTICS AND PROBIOTICS

Prebiotics are beneficial bacteria that promote the growth of probiotics in the gut.

In order to maintain symbiosis of gut microbiome, we should eat healthy foods and avoid the abuse of antibiotics.

MEDITERRANEAN DIET VERSUS WESTERN DIET

Mediterranean diet highlights fruits, vegetables, whole wheat, yogurts, nuts and olive oil which consist of mono-unsaturated fatty acids.  This diet also uses a lot of fish and red wine which are anti-oxidants and red meat is reduced.  It is also rich in dietary fiber and probiotic-rich foods like yoghurt. 

Western diets do not have much fiber and have more red meat, animal fat, sweets and salts which may result in gut microbiome dysbiosis.

INDOXYL SULPHATE, A UREMIC TOXIN ORIGINATED FROM THE HUMAN GUT

The consequence of increased dietary intake of animal protein includes not only urea accumulation but also gut microbiome alteration of the host. In simpler terms, this means a buildup of toxins the kidney can’t filter when it’s impaired and weakened digestive function.

THE EXPENSE OF DIETARY POTASSIUM RESTRICTION IN CKD PATIENTS

Patients with advanced CKD often suffer from hyperkalaemia (high potassium) and are treated with polystyrene sulphonate, which increases the likelihood of constipation and adds physical and psychological burdens to the therapy regimes.

THE EXPENSE OF DIETARY PHOSPHORUS RESTRICTION IN CKD PATIENTS

When renal function gets worse, the urinary excretion of phosphorus is less effective.  CKD patients with poor phosphorus control are at a high risk of impaired bone mineralization.

 

THE EXPENSE OF BASE‐PRODUCING FOOD RESTRICTION IN CKD PATIENTS

Body acid overload not only makes it faster for renal function to deteriorate but also results in musculoskeletal complications leading to frailty, fracture, malnutrition and even long-term bedridden status.

 

CONCLUSIONS

Chronic kidney disease patients are at risks for gut dysbiosis, or an imbalance of gut flora, which partly results from dietary restrictions of potassium and/or phosphorus. The reduction in consumption of prebiotics (vegetables and/or fruits) or probiotics (yogurt) turns gut microbiome towards a pro‐putrefaction flora, and thus increases the production of precursors of protein‐bound uremic toxins in the human gut.

Therefore, to ensure sufficient dietary fiber intake, CKD patients should properly select fruits and pre‐treat vegetables before ingestion, instead of directly avoiding these potassium‐rich, yet fiber‐rich and base‐producing foods. In addition, prebiotic and/or probiotic supplements not containing potassium and phosphorus might be an alternative option to restore gut microbial symbiosis as well as provide constipation relief. However, further randomized controlled trials are warranted to examine whether such beneficial effect of dietary prebiotic/probiotic supplements could have better hard outcomes in CKD population, and thus might develop a new dietary strategy to improve CKD patient health in the future.

In any case, you should always be mindful of maintaining optimal balance of your levels. Controlling your potassium and phosphorous is a wonderful thing and necessary in chronic kidney disease, but this doesn’t always mean maintaining ultra-low levels. Always consult your physician prior to adopting any dietary changes and review your levels with them before deciding on which foods to limit and which ones to eat more of.

For more information on kidney disease diet tips that could help support more normal kidney function, be sure to check out our All-Natural Kidney Restoration Guide complete with diet plans and grocery shopping lists.