Understanding Diets: Beverly Hills, Mayo Clinic, and Renal Impairment
Understanding Popular Diets and Renal Health
Beverly Hills Diet
The Beverly Hills Diet derives only 6% of its energy from protein and lacks essential vitamins like B12. It’s based on a sequential intake of fruit, some bread, salad, and very little meat. It is not a recommended diet.
Mayo Clinic Diet
The Mayo Clinic Diet involves a two-week plan that avoids dairy products, meat, and protein sources other than eggs. It provides approximately 1200 kcal/day. This diet can lead to protein deficiency and weight loss (primarily water and lean muscle mass), which is often regained after discontinuing the diet.
High Protein Diets: Risks and Considerations
High protein, low carbohydrate diets are generally not recommended for weight loss. These diets promise quick results by emphasizing meat, eggs, and other protein-rich foods while minimizing carbohydrate-rich foods like cereals, rice, pasta, bread, potatoes, legumes, vegetables, and fruits.
Excessive protein intake with insufficient carbohydrates can cause kidney damage due to excess nitrogen and bone decalcification. It can also lead to fatigue and dizziness due to a lack of glucose. Protein-rich foods often contain significant amounts of saturated fat, increasing cardiovascular risk.
Over time, a lack of carbohydrates can produce an excess of ketones in the body (ketosis) as the body adjusts and uses fat as an energy substrate to preserve muscle protein. These diets can also increase uric acid levels, potentially causing gout attacks in individuals with hyperuricemia. Furthermore, they can cause fluid and electrolyte loss, promoting dehydration, and elevate cholesterol and triglyceride levels.
Diet Therapy in Renal Impairment
Nephrotic Syndrome
Nephrotic syndrome is a heterogeneous group of diseases characterized by the loss of the glomerular barrier to protein, leading to:
- Hypoalbuminemia
- Hyperlipidemia
- Edema
- Proteinuria (> 3 g/day)
The primary objectives of diet therapy are to address nutritional symptoms, reduce the risk of progression to renal insufficiency, and maintain nutritional reserves. Sufficient protein and energy are needed to maintain a positive nitrogen balance, increase serum albumin concentration, and reduce edema. However, a protein-rich diet can increase urinary albumin loss.
Recommendations: A low-fat diet rich in complex carbohydrates and modest sodium restriction (3 g daily) is advised.
Protein Recommendations:
- 0.8 g/kg/day
- 0.6 g/kg/day in patients with renal failure
- 3/4 parts high biological value
Energy:
- 35 kcal/kg/day for adults
- 100-150 kcal/kg/day in children
Acute Renal Failure (ARF)
Acute renal failure (ARF) involves a sudden reduction in the glomerular filtration rate and impaired ability of the kidneys to excrete metabolic waste products. Nutritional care is crucial for managing electrolyte imbalances, uremic acidosis, and metabolic stress.
Balancing protein and energy needs with the treatment of acidosis and excess nitrogenous waste is complex and delicate.
Metabolic Changes in ARF
- Severe protein catabolism with negative nitrogen balance (urinary nitrogen > 15g/day)
- Potential loss or imbalance in plasma amino acid levels
- Altered plasma lipid levels: increased VLDL and LDL, and lower HDL cholesterol
- Reduced ability to metabolize exogenous lipids
Energy Requirements in ARF
ARF itself does not inherently increase energy demand. However, concomitant diseases (sepsis, trauma) can. Provide a moderate amount of energy, approximately 1.3 times the basal metabolic energy, or 25-35 kcal/kg/day (considering individual dry weight).