#protein, #proteinandkidney, #badforkidneys, #meatandkidney

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Sebastião has kidney disease and discovered through tests that his kidneys are working at around 25%. His friends said he had to cut out the proteins in his diet. And proteins are not only meats, they are also eggs, legumes, milk and dairy products.

What now? What am I going to eat?

He then decided to seek a health professional! Sebastião wants to know what science says about it. The word protein is derived from the Greek "protos" which means "first". And that reflects the protein's first-class status in human nutrition.

Proteins have a structural function, that is, they are like bricks that will repair our holes and build our enzymes, antibodies, our skin and hair, our bones and muscles.

As with most things in life, balance is all! There may be a price to pay with exaggeration or restrictions. Health organizations out there have established that the minimum amount of protein you need to meet your basic nutritional needs is 0.8 g of protein / kg / day. The maximum amount is still controversial and will depend on whether you are sedentary or active. But for an average person, maximum consumption of 2.0 g of protein / kg / day seems to be reasonable. And consuming more is not likely to help you build more muscle. In addition to being very difficult for any human being to overdo proteins because they satisfy our hunger and naturally we stop eating when we reach our protein target.

When we eat proteins, they are metabolized by our body and, after proper nutrition, they generate residues (the most known of which are urea and creatinine) which are filtered through the kidneys and eliminated in the urine. So much is discussed about the stress that proteins could cause to the kidneys. After all, you could reason that the less protein you eat, the less waste you generate and the less work your kidneys do to eliminate it. Or would that be a logical fallacy?

It must be recognized that when reducing proteins, dietary arithmetic requires that you eat more of the other macronutrients, such as carbohydrates and fats, to keep your daily calorie goal stable. And consuming more carbohydrates and fats will make you fat and bring you the harm of obesity.

Sebastião, there are randomized studies with people, just like you, with kidney disease in which protein restriction was tested, that is, protein consumption less than 0.8 g / kg / day but above 0.6. The balance of evidence does suggest a benefit. But a proven benefit can vary in relevance because it would be simplistic to claim that protein restriction is proven to be beneficial and that we should implement it. It is necessary to know the degree of relevance of the benefit to make the right decision considering the risks of protein restriction. Therefore, we will analyze the NNT of these studies.

NNT? NNT means the number of patients needed to treat in order to save 01 patient from a certain outcome for a certain time. For example: treatment is protein restriction and the outcome is renal death (which may be the need for dialysis or death itself). The ideal is a NNT of 1, which means that every patient treated with protein restriction is saved from renal death.

But the balance of evidence points to a NNT of around 25. That is, it is necessary to treat 25 patients with protein restriction to save 1 patient from renal death in a year. Therefore, Sebastião, NNT provides us with the notion that an implemented treatment does not guarantee you salvation. It is impossible to predict who will benefit. What we do is treat a large number of patients, in the hope that some will benefit.

How do you perceive the relevance of the benefit, Sebastião? Dr, delaying the start of dialysis by at least 01 month is important for me! I want to try protein restriction! OK! But you will have to do periodic follow-ups so that you are carefully monitored and are not a victim of malnutrition, okay?

Returning to the question at the beginning of the video: protein does NOT harm the kidneys and does NOT cause kidney disease! But restricting proteins in those who already have kidney disease has benefits. But it doesn't mean that restricting proteins will prevent kidney death in ALL patients or that not restricting proteins will cause death in ALL, okay? The NNT is not equal to 1! Health behaviors do not work miracles and professionals must make decisions based on probabilities.

Radicalizing says more about our helplessness or frustration and the need to impose on others to feel powerful. Let us be facilitators to make human life better. One size does not fit all. It is necessary to individualize and consider the patient's values ​​and preferences.