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Published on December 1st, 2020 | by Katherine


VLPD – the treatment to STOP CKD stage 4 & 5

Hello, Katherine from 00kidney here, welcome to our journey together to a better kidney health.
In this video: why I think it is actually possible to stop the progression of kidney disease in stage 4 and 5 pre dialysis and – how to do it.
There’s a therapy for advanced stage kidney disease, called VLPD treatment – which is almost never prescribed in the US – and which is showing impressive results in those places where it is actually used.
So, we’re talking about an underutilized therapy in America that could lower your creatinine levels and that’s supported by medical literature.
Incredible, isn’t it? And it’s not even some futuristic or possible new drug, it’s an actual therapy that’s already in use, AT LEAST at some degree, in Europe.
Ok guys, I’ve never made a video like this. This is big. This kind of treatment may be exactly what many of you, especially those in stage 4 and 5 are looking for.

Watch on Youtube

So, really a lot to talk about today, let’s start immediately.
As I was saying, the standard therapy in the US for the treatment of chronic kidney disease is…

Nothing more.
Many doctors in the US, still today, tell patients not to worry when their gfr is you know around 60.
Just wait. No treatments are prescribed, no diet no nothing.
What many doctors tell their patients is to just wait for their kidney health to deteriorate until their kidneys are not working at all.
So all therapy is delayed until the GFR of the patient is much lower, let’s say around 30, or stage 4. And then start the treatment.
Again, the aim here would be to start dialysis as soon as possible.
Ok, if you have been following me here you may already know what I think about this approach.
With all the due respects to all the doctors and nephrologists out there,

Sorry if I’m very blunt here but if there’s a working alternative, a way to stop or at least greatly slow down the progression of kidney disease… well, I’m all for it.
You, as a kidney disease patient should, in my opinion, do all you can to protect the health of your kidneys.
And if anyone tells you otherwise, they just don’t have your health as their priority.
So let’s see this ALTERNATIVE treatment, shall we?

The VLPD treatment.
This treatment is composed by a special diet and a supplementation of ketoanalogues.
Don’t worry, this has nothing to do with the keto diet. Ketoanalogues are a special type of amino acids made for people with kidney disease.
More about this in the next part of this video.
But let’s start with the VLPD, or the VERY LOW PROTEIN DIET.
Now, I’ve already talked about LOW protein diets, very useful for slowing down the progression of kidney disease even in stage 3. But the VLPD is different.
It is more useful for patients in stage 4 and 5 pre dialysis.
We are talking about a VERY low protein diet here. This will make a very very big difference for your kidneys.
So, what is the VLPD and why it works?

They always tell you that up to 60% of the human body is water.
What they don’t tell you, is that excluding water, the human body is made up almost entirely from protein.
Your organs, muscles, skin and tissue… everything is made from protein.
So, protein is obviously an essential part of the human diet.
Protein is composed of “building blocks” called amino acids.
And notice that the human body needs to process protein and break it down into amino acids to use it.
So, basically, this lego wall here is protein, a macromolecule. this is what your body is made from.
The small lego blocks here represent the amino acids.
So, when you eat, the digestive track needs to break down all this protein into smaller amino acids.
This creates waste products. A lot of waste products. actually.
Mainly nitrogen wastes.
Now, the quantity of this nitrogen in the body is a very important indicator of kidney function, so you may be familiar with the term BUN OR blood urea nitrogen.
THIS IS important because the kidney is supposed to clear this waste product, to remove this nitrogen from the blood.
This is literally the hardest task of the human kidney, alright?

IN FACT, the effect of nitrogenous wastes on the kidneys is the exact reason why low protein, plant-based diets are the best way to slow down kidney disease progression.

Does the VLPD diet really work for CKD stage 4 and 5? Is it a proven method?
Well, the only way to answer, is to look at medical literature.
There are two big reviews of studies to support a very low protein diet as a way stop kidney disease in the advanced stages.
To start, let’s talk about the MAIN outcome everyone is concerned about – namely dialysis. In a 2018 Cochrane review, the authors reviewed
17 studies with 2996 people and concluded that, “very low protein diets reduce the number of people with CKD 4 or 5, who progress to end stage kidney disease.
So, on almost 3000 people, those following the VLPD had less chance of having to undergo dialysis.
Now, this is a very important number of test subjects and the results are pretty uniform.
This is clearly a great result.
But there’s more.

In 2017, there was a great review paper written by Dr. Gang Lee Ko on protein intake and chronic kidney disease.

His review concisely identified eight different potential benefits of the VLPD
FIRST, Decreased proteinuria (now, proteinuria is not just the very first symptom of kidney problems, it’s also an indicator of kidney function)
SECOND, Decreased uremic toxins – consider that uremic toxins are the cause of most symptoms of kidney disease
THIRD, Decreased oxidative stress (that’s inflammation, which also cause several serious problems)
4th Decreased metabolic acidosis
5th Decreased phosphorus, very important for bone health, among other things
6th Decreased insulin resistance
7th Decreased blood pressure and, most important,
Ability to slow the decline of GFR.
This means that, basically just by limiting protein intake, dialysis can be delayed very significantly.
Again, this is not me saying this, there are two review of studies signed by medical luminaries and published on peer revied journals.
So guys, I bet that right now you want to know more about the VLPD.

So, let’s take a look at the practical aspect of the VLPD treatment.

How to follow a very limited protein diet.
Low protein diets basically fall into 3 categories:

  1. Very low protein diets (VLPD)
    This means that the patient is going to have around 20 grams of protein/day or 0.3-0.5gm/kg of body weight. Don’t worry if you don’t understand these numbers, I’ll give you a more detailed explanation in a moment. But Notice that this is an extreme diet,
    Which requires supplementation with ketoanalogues. This is important.
  2. Low protein diets – around 40 grams of protein/day or 0.6-0.8gm/kg of body weight. This is a diet that is more doable and that maybe some of you are already following.
  3. Plant-based or vegetarian and vegan regimens.
    There are some combinations of all of the above in the literature.
    Because all of these diets work, at some extent, and following a plant-based diet is a way to limit protein intake.
    Now, this is very important: low protein diets are around 40 grams of protein per day, ok?
    Following a low protein diet means that you can actually have a portion of some high protein food such as meat, eggs or fish on a daily basis.
    On the other hand, VLPD diets are around 20 grams of protein/day.
    And, while numbers are personalized based on someone’s height/weight, having to eat just 20 grams of protein per day means no steak, no eggs, no meat and no fish.
    Now, this slide shows grams of protein, so let’s translate these numbers into serving sizes.

These are some examples of serving sizes and the amount of protein they contain.
Now, if for example we consider 3 ounces of chicken meat, or a portion as big as the palm of your hand, (MOSTRA PALMO MANO) …
it would contain 26 grams of protein.
This tells us if you have to follow a VLPD, just a single serving of meat or chicken is already too much protein for you.
Because you would need to get no more than 20 grams of protein in a day, alright?
And, as we can see here, many foods that are not considered protein sources, such as white bread, oatmeal and rice still have some protein in them.
And this makes the VLPD a very restrictive dietary regimen.
But, patients following it are at severe risk of malnutrition and need the help of ketoanalogues.
More about this in a moment.
Now, very briefly, this is a sample of what someone on a VLPD will eat in a day.

    1 cup apple sauce, 1 tbsp flax meal, low protein toast, cream cheese AND 
    (1 scoop ketoanalogue supplement in water)
    Salad with vinegar & oil, low sodium/low protein crackers 
    AND (1 scoop ketoanalogue supplement in water)
Dinner: Vegetable chili with no salt corn chips, some pineapple.  
     AND (1 scoop ketoanalogue supplement in water)

OK, CLEARLY, There is pretty much no protein in these meals. And, yes, that is exactly right and basically the goal.
And, looking at this slide, you may also understand what the big problem of the VLPD diet is: the diet is really hard to follow.
Switching to a very low protein regimen is not as simple as just cutting out your beloved grilled chicken or Friday night steak.

Now, I know what you’re thinking, “If very low protein diets are so helpful, how come my nephrologist never mentioned it to me or didn’t like the idea when I mentioned it?”
I mean, we have seen that the VLPD may work – and well!
AND that it can be used to slow down and even stop the progression of kidney disease even in stage 4 and 5 pre dialysis.
Then, why very low protein diets and ketoanalogues are not routinely used in America for people with kidney disease?

There are 3 reasons why, mainly:

  1. Not enough nephrology professionals are familiar with how to implement a VLPD + ketoanalogue regimen
    As we have seen, very few doctors in the US believe in this treatment, so they also don’t prescribe it and don’t know how to apply it.

Now guys, I also want to know about the experience you may be having with this kind of diet.
Have you ever tried a low protein diet or even the VLPD? Have you ever talked with your doctor about it?
So let me know how your experience with this diet is, let’s talk about it in comment section.

Ok guys, reason number 2 there’s the need for a team effort with a dietitian, alright? and renal dietitians are hard to find.
To benefit from this treatment, a dietitian should make you a dietary plan accounting for every single gram of protein you eat in a day.
This is clearly a problem, because you need a nephrologist and a dietician to be able to follow this treatment.
But there’s so much evidence to support the potential of the VLPD treatment that I can’t believe that this situation is not going to improve in the next years.
3rd problem, maybe most important, the Fear of malnutrition.
Very low protein diets are not routinely encouraged because there is a real, solid fear of malnutrition. – but this can be solved with ketoanalogues.

So, to sum it up,
protein intake is a double-edged sword.
Your body needs protein, the amino acids that protein is made of especially, but your kidneys are burdened and damaged by the waste of protein metabolism.
THIS makes protein intake really hard to manage correctly, and if you aren’t able to get the exact quantity, your kidneys are going to suffer.
So, you cannot live without protein but your kidneys are damaged by it.

Now, if only there was a way to get the amino acids without the protein.
Is this even possible?

The answer to this question is keto-analogues
What are keto-analogues
Ketoanalogues of amino acids are nitrogen-free analogs of essential amino acids.
Nitrogen free is the key here. As we have seen, nitrogen is actually putting all the burden on the kidneys and making CKD progress.
Keto-analogues of essential amino acids provide potential advantages for CKD patients because they can nourish your body with the amino acids it needs without burdening your kidneys.
So basically you would be getting the lego bricks without the wall and without wastes.
Now, when you see the word, “ketoanalogues” you need to picture a supplement bottle because ketoanalogues are a type of amino acid supplement.
But they are very different from the amino acids sold to bodybuilders, so you won’t be actually able to find them on the supermarket shelves.
There are two main brands selling them, Ketorena and Ketosteril.
While they’re not the same, we are still talking about supplements. One is powder, the other is in tables.
What really matters here is that Ketoanalogues allow someone on a very low protein diet to get all the benefits of adequate amino acids without the nitrogen processing downside.
If you are following a very low protein diet, ketoanalogues are absolutely essential to include as part of your therapy.

In conclusion, there’s evidence to show that Very Low Protein Diets with Ketoanalogues are doable and can be helpful for many people.
I really hope that in the future this treatment will be more widely available to patients that aim to avoid kidney dialysis.
So again guys, let me know if you already know about the option of the VLPD + Ketoanalogues treatment.
Let’s talk about it in comment section.
And, as always, keep taking good care of your kidneys and be good to yourself.
This is all for today, thank you for watching.

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About the Author

Hello, this I Katherine, welcome to 00Kidney! Here you will find how tos and guides for kidney disease patients, how to lower creatinine, how to improve kidney function, the best recipes for you kidney friendly diet and... much more!

One Response to VLPD – the treatment to STOP CKD stage 4 & 5

  1. Genice says:

    Hello Katherine! My name is Genice and I have been following you for about 7 months now when my husband started dialysis last year which his blood pressure shot up! I have been searching for alternatives in helping him get his kidney function back to normal. They said he is in stage 5 with a eGFR of 9 last I remember. I noticed in the video you said this VLPD is good for those especially stage 4 and 5 predialysis? What about while on dialysis? Will is be good for him to do at this time?

    Thank you and I look forward to hearing from you soon! (^_^)

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