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Alkaline Diets and Kidney Disease

Many dangerous fad diets exist that purport to treat diseases such as cancer by manipulating the pH of blood with different foods. While there is no good evidence that acidic foods alter the body’s pH and promote disease, the hypothesis that “dietary acid load” relates to disease should not be completely dismissed. The kidney serves to regulate blood pH, but if kidney function declines and other tissues catabolize to maintain pH, then it is very plausible that manipulating the diet to reduce the acid load could spare tissues and improve outcomes in chronic kidney disease (CKD). After all, for example, the metabolism of amino acids yields hydrogen ions, whereas fruits and vegetables contain organic salts that generally reduce acid load when metabolized. Recently, a growing number of human studies that manipulate diet acid load using fruits and vegetables and sodium bicarbonate support this hypothesis. Let’s take a look at some of them.

The first randomized controlled trial on bicarbonate supplementation and CKD progression was published in 2009 by de Brito-Ashurst and colleagues. Bicarbonate is produced by the kidneys and serves to neutralize acid. Supplementation of bicarbonate for 1 year in CKD patients slowed the progression of kidney disease as suggested by creatinine clearance and reduced the need for dialysis. The next year, in 2010, a 5-year trial was published by Donald Wesson’s group that found a slowed kidney decline as measured by estimated glomerular filtration rate (eGFR) with bicarbonate supplementation. Several subsequent studies by his group have used bicarbonate or fruits and vegetables to achieve beneficial outcomes. Goraya et al. gave oral bicarbonate or enough fruits and vegetables that were estimated to reduce dietary acid load by 50% to CKD patients for 30 days and also observed a slowed reduction in eGFR in patients at moderate, but not mild, stages of the disease. In patients with more advanced stages of CKD, one year of bicarbonate or fruits and vegetables did not slow the decrease in eGFR, though several urinary markers of kidney injury were reduced. Their most recent trial tested if kidney function might be preserved through a reduction in angiotensin II in moderate stage CKD patients. Three years of bicarbonate or increased fruits and vegetables lessened the decline in eGFR and resulted in a corresponding decrease in the marker angiotensin II. Other studies using bicarbonate from six months to two years have provided strong evidence that reducing acid load consistently slows the decline of eGFR, and improves markers of bone health and muscle function.

Each of the studies described provided fruits and vegetables to patients free of charge to increase adherence. It will be important to test if adherence can be maintained through education alone. Additionally, it may be that “prescribing” fruits and vegetables is effective at improving outcomes and reducing health care costs more so than bicarbonate since they also reduce blood pressure. While “alkaline diets” in general should be viewed skeptically, there is accumulating evidence that fruits and vegetables as dietary alkali do indeed help in kidney disease.

The French Approach to Nutrition

By Emily Roberts

The United States is able to utilize government assistance to support various programs to help improve the nutritional status of our nation. There is a safety net of several programs to improve public health via nutrition. Prolonged consequences of an unhealthy lifestyle including obesity, heart disease and type II diabetes are being seen in other countries as well. As I am currently residing in the south of France for seven months to teach English, I have the opportunity to discover how another country is tackling the public health problems associated with nutrition.

Chronic Diseases in France

Worldwide we are seeing an increase rate of health disparities. Cardiovascular disease, obesity and type II diabetes are three main common ailments and are often preventable. Cardiovascular disease is the leading cause of death worldwide (1). Now in the 21st century over 30% of the world’s population suffers from heart disease. Interestingly enough in France, heart disease mortality isn’t as high as other 1st world countries (2). Despite a diet rich in saturated fats and cholesterol, the incidence of heart disease remains low (3). While heart disease may not been the main concern, circulatory disease remains an issue, being the second leading cause of death in 2012 after cancer (2). In 2014 25.7% of the French adult population was obese (4). Comparing this to the United States at 35% they aren’t too far behind (5). Type II diabetes is drawing attention as well as a health issue. In 2009 7.0%- 7.5% of the French population had type II diabetes in comparison to about 10.41% of the United States Population (6,7). France is addressing currently addressing these problems and taking on tactics similar to the United States by promoting preventative methods.

Le Programme National Nutrition SantÉ (PNNS)

Manger Bouger translates to Eat and Move. It is supported by Programme National Nutrition SantÉ (PNNS) meaning a national nutrition and health program (8). PNNS began in 2001 with the objective to improve public health and reduce the incidence of chronic diseases by improving nutritional practices. The goals of PNNS assess different social, cultural, cognitive and economic disparities when trying to improve the nutritional status and the level of physical activity of France. Under the umbrella of PNNS there are a few specific programs. In 2010, the French government has implemented un plan obÉsitÉ (PO) (an obesity plan) and also un programme national pour l’alimentation (PNA) (a national food program).

Manger Bouger

Similar to the US’s ChooseMyPlate, the Manger Bouger site offers a plethora of helpful nutritional information to the public (9,10). It stresses to regularly eat a diet mixed in fruits, vegetables, grains and fish; limit salts, sugars and fats and to participate in regular physical activity (10). It explains to the public how these healthy lifestyle choices can reduce your risk for many chronic ailments. The site also briefly mentions to read nutrition facts labels, but there is little assistance on how to understand this information. Furthermore, the format for Nutrition Facts in France is very different and hard to interpret given the main point that there are often no serving size portions and only 100g portion sizes. While, there is no software on the site similar to SuperTracker or any type of diet assessment tool, there is La Fabrique à Menus, which helps to plan out a daily menu of various healthy dishes. Manger Bouger also includes a blog titled “Le Mag” which includes tips on how to enjoy the many rich flavors of France or eating on a budget, while still eating healthy.

My experience

Living in France, I have witnessed how important cuisine is to the French population. A prime example is how each region has traditional dishes tied closely to their culture. In Nice a popular dish is socca, a chickpea pancake, and in SÈte you cannot walk a block without finding tielle, a savory fish tart. Manger Bouger embraces this by providing general nutritional practices like consuming smaller portions, while keeping the tradition of French cuisine alive. Manger Bouger only offers specific meal advice for lunch and dinner (11). This is most likely because a typical French breakfast or petit dÉjeuner is only a slice of bread or a croissant and a coffee. Snacking in France is also less common. While in America five small meals a day can be seen as a healthy eating habit, this would not be ideal for the French as they value their meal time as a time to relax and experience their food. Unfortunately, the French do not seem to draw much attention to the specific nutritional content of their food. Consequently the general public does not seem as well educated on their daily caloric intake and the nutritional makeup. This could be due to the fact that they seem to focus more on reducing portion sizes and over eating rather than changing the composition of their diet.