Optimize Your Kidney Health With a Low-Acid Diet
In this interview, Dr. Lynda Frassetto, a nephrologist and professor emeritus in the department of medicine at University of California San Francisco (UCSF), shares important information about how acid in your diet affects your kidney health and longevity.
“When I was in internal medicine training, I happened to have a really super mentor, Dr. Eli Friedman, at the State University of New York (SUNY) in Brooklyn,” Frassetto says. “He made nephrology sound really interesting.
And so, after I finished my residency and was a hospitalist for a couple of years, I decided to go back and do nephrology, because people who did nephrology just have a better understanding of physiology than most internists do.
I thought that would help make me a better doctor. After I finished my fellowship, I started working with Anthony Sebastian here at UCSF. He was interested in diet acid load in people who were relatively healthy.
The kidneys do a lot of things. One of the things they do is they get rid of acid. We know that as kidney failure progresses, you have trouble getting rid of the acid. It accumulates in your system and has a lot of bad side effects.
We also know that, as you get older, your kidneys tend not to work as well. What Tony was looking at was, in otherwise healthy, older people — whose kidneys just aren’t working as well as they did, let’s say, 40 or 50 years earlier — does eating a high-acid diet have any potential side effects?”
Low-Acid Diets as a Means to Protect Kidney Function
In the initial stages of their work, Frassetto and Sebastian worked on neutralizing acid in the diet using bicarbonate. Then, just over a decade ago, they started looking at low-acid diets. While all foods contain precursors that can be metabolized into acids, fruits and vegetables contain a lot of alkali precursors that are metabolized into bicarbonate, like citrate or malate.
Frassetto’s interest in low-acid diets began with the paleo diet, promoted by Loren Cordain, Ph.D. According to Cordain, many foods in our modern diet were unavailable to our ancestors, such as processed grains and sugars.
He believed a diet closer to our ancestral diet would be healthier, and one of the reasons for this is because any diet high in fruits and vegetables (and devoid of processed food) will be lower in acid. As explained by Frassetto:
“If you look at any large population, and you just look at the average kidney function over time, on average, everybody’s kidney function declines. But if you look at specific individuals, kidney function either declines much more slowly or may even level out.
The question is, ‘How related is that to eating a low-acid diet or doing things that wouldn’t bother your kidneys?’ This has actually been looked at by Dr. Donald Wesson, a nephrologist at University of Texas (UT) Southwestern.
He’s looked at both alkalized supplements and fruits and vegetable diets in people with Stage 2 kidney disease, with an estimated glomerular filtration rate (GFR) between 60 and 90, and Stage 3 chronic kidney disease (CKD), which has an estimated GFR from 30 to 60.
[GFR is] an estimate of kidney function. So, if you’re 50 years old, your GFR is about 90. If you’re 80 years old, your GFR is about 60. On average, people who are older are going to have … Stage 2 or Stage 3 CKD.
Wesson showed that in these people, if you either give them alkalized supplements like baking soda, or put them on a diet with more fruits and vegetables, that you could slow the rate of decline …
If you extrapolate that from people with kidney failure to just older people, the idea would be that, maybe, you can slow the rate of decline of your kidney function, even if you’re otherwise healthy and just getting older. That’s the idea.
Everything that you do, everything, is related to kidney function in some degree. Because the kidneys get rid of a lot of things. The worse the kidneys work, the worse everything works.”
Fasting Also Protects Kidney Function
According to Frassetto, most kidney disease in weste
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