"Low protein diet" prescription - A Myth
In Western societies, individuals typically ingest 1 to 2 grammes of protein per kg of body weight per day, an intake well above the daily protein requirement. The recommended "safe level of protein intake" is between 0.8 to 1.0 gm/kg/day, an amount that is adequate for more than 95% of the population.
If we take the middle socio-economic class adult Inadian population, the majority is vegetarian and simple dietary recall will reveal disturbingly low calorie consumption with protein intake amounting to 28.5 grammes/day (toned milk-250 ml, 1 katori curd, 2 katori dal, 32 grammes paneer and no soyabean).
The non-vegetarian middle-class adult fares marginally better with an additional 4 eggs/week and 2 pieces of chicken or fish/week amounting to an average of 38.5 grammes/day of protein intake.
"Low protein diets" of 0.6 gm/kg/day have been propagated for patients with chronic kidney diseases in an attempt to reduce nitrogenous waste accumulation and hence maintain normal nitrogen balance, studies having been conducted in western subjects. Yet, on the other hand, the prototype nitrogenous waste (i.e. urea) has not been proven to be the "uremic toxin" responsible for our patient's symptomatology.
Can we put into practice such information before assessing what our patient is actually consuming? Hypoalbuminemia and malnutrition are rampant in the Indian population, let alone the implications of super-added appetite loss, income loss and the physician's advice to restrict "so many foods" given co-morbid conditions such as diabetes, dyslipidemia and high potassium levels. Hypoalbuminemia is, in turn, a pro-inflammatory state associated with high positive predictive value for mortality.
So, let physicians and dieticians like US think again before prescribing the "low protein diet" to our CKD patients. Rather, we should encourage generous consumption of soyabean, paneer, curd and milk amongst our majority vegetarian population and provide more formal dietary counselling.
(The writer is consultant, Nephrology and Hypertension at Max Healthcare Centre, New Delhi)