Whole Food Plant Based Diet for Failing Kidneys Dr Ferman

At Central Surgery we recognise the excellent potential health benefits to be gained from following a whole food plant-based diet (WFPBD)

What are the benefits?

Reduced risk of developing many long-term conditions such as type 2 diabetes, heart disease, high blood pressure, obesity and arthritis.
Improved control of long-term health conditions – for those already living with long-term health conditions, a WFPBD can improve your control of these conditions and in many cases reduce the reliance upon medications.
For some people eating this way has reversed the effects of conditions such as diabetes and heart disease
Reduced cancer risk for various types of cancer
Reduced risk of dementia
Long-term improved weight control without the need to restrict portions or count calories

What is a whole food plant-based diet?

There is a very important distinction between a plant-based diet and a whole food plant-based diet. The health benefits already mentioned are linked to those who eat a whole food plant-based diet.

A whole food plant-based diet is a diet based on foods such as whole grains, lentils, beans, vegetables, fruits, nuts and seeds, but also avoids added oils and processed or refined foods.

The foods you eat will generally be foods that you recognise as they grow in nature with little processing and contain few ingredients. The refining and processing of foods generally takes away much of the valuable nutrition naturally available in plant foods and usually involves adding other ingredients which are not associated with health.

Alternatively if you follow a plant-based diet which does not consist of whole foods, this can be very unhealthy – for example if it consists of refined and processed foods and the addition of salt, sugar or oils.

Is a whole food plant-based diet expensive?

It can be a surprise to many people that this diet is very affordable and certainly less expensive than the standard western diet.

The staple foods of this diet such as beans, chickpeas, lentils, whole-wheat, brown rice, oats, barley, corn, potatoes, sweet potatoes etc are all very cheap, particularly if bought in bulk. The additional cost of buying fresh fruit and veg doesn't have to be expensive if bought in season. Buying frozen fruit and veg can also be a cost effective solution and is just as nutritious as buying fresh.

People often think that a plant-based diet is expensive because there are now many vegan or plant-based processed foods such as plant-based burgers and sausages or plant-based ready meals. All of these tend to be expensive and are usually not as healthy as whole plant foods. They tend to be highly processed foods often with the addition of oils, sugar and salt.

A good rule of thumb is that if something is labelled as vegan or plant-based in the supermarket it is likely to be less healthy than the simple whole plant foods which should form the basis of what you eat.

Whole foods usually shouldn't have to be labelled as plant-based or vegan. For example when did you last see an apple, a carrot or a tin of kidney beans advertised as vegan or plant-based?

Should I buy organic?

There is no need to buy organic foods to enjoy the health benefits of a whole food plant-based diet. There may be small additional benefits to eating organic plant foods but the evidence for this is not yet clear. Organic foods are certainly more expensive and for people who can't afford to buy organic foods they can be reassured that they can enjoy the health benefits of eating a WFPBD at a very affordable cost.

How much should I eat?

It's very simple – eat until you are full.

The word diet has some negative connotations to many people and here when we talk about a whole food plant-based diet this just refers to the types of foods eaten.

A whole food plant-based diet is a long-term way of eating, for long-term health

It is not a short-term diet intended to restrict calories for weight loss alone.

However, if you are overweight you will very likely soon loose weight by eating this way and reach a healthy weight without restricting the amount of food you eat or counting calories.

With a whole food plant-based diet, the calorie density of the foods is lower than many foods that make up the standard western diet but the nutritional density is much higher. In other words for every mouthful you eat, you consume fewer calories but take in more valuable nutrition e.g. fibre, vitamins and minerals.

Because of the reduced calorie density when you eat whole foods you will find that you can actually eat a greater volume of food without gaining weight and you are likely to find this way of eating much more filling.

In fact most people who are overweight who switch to this type of diet find that they lose weight. It is generally recommended that, because of the reduced calorie density of the foods eaten when following a WFPBD, regular meals during the day can help to ensure you have enough calories to prevent food cravings.

What about nuts?

Nuts and seeds are very nutritious foods and are highly recommended as part of a whole food plant based diet. They contain the types of fats which are important for health but are not associated with the harmful effects of the regular consumption of processed oils which have been extracted from whole foods. For the greatest benefit nuts and seeds should be eaten raw and unsalted.

What about gluten sensitivity?

Some people are sensitive to gluten which is a protein found in wheat, barley and rye. There is no test for gluten sensitivity. However there are also a small percentage of people who have a condition called coeliac disease which means that they can become unwell if they eat gluten containing foods long-term. There is a blood test to test to screen for coeliac disease if you think that you may be sensitive or intolerant of gluten.

There is no reason why people with coeliac disease or gluten sensitivity cannot follow a whole food plant-based diet. However they need to exclude wheat, barley and rye from their diet.

What about vitamin B12?

If you follow a WFPBD long-term you will need to take a vitamin B12 supplement. This is because vitamin B12 is produced by bacteria and modern agricultural practices mean that most food we buy no longer has the surface bacteria to provide us with the necessary quantities of vitamin B12.

Vitamin B12 (cyanocobalamin) supplements are widely available to buy in pharmacies, health food shops and in supermarkets.

A dose of 50-100 micrograms daily or 2000 micrograms once a week should be sufficient for dietary requirements unless you are known to have a condition which affects your ability to absorb vitamin B12 from your intestines. There is however some evidence to suggest that people over 65 years may need a higher intake of 1000 micrograms daily.

Vitamin D (the sunshine vitamin)

Living as far north as we do, many of us (plant-based or not) have low levels of vitamin D. You may wish to consider taking a vitamin D supplement either over the winter months or all year round if you don't spend much time outdoors or if you have dark skin.

Iodine

For those who don't eat seaweed or use iodized salt, consider a 150 microgram daily supplement (especially important for pregnant women)

An affordable supplement containing both iodine and vitamin B12 is available from The Vegan Society.

Note : Hijiki (hiziki) should not be eaten due to high arsenic levels and kelp
should be avoided as it tends to have too much iodine

I have a long-term condition – can I switch to a whole food plant-based diet?

Absolutely!

For people with long-term health conditions such as diabetes, heart disease or high blood pressure, changing to a WFPBD is very likely to help improve the control of your condition and prevent any worsening of the condition. Some people have even found that they have been able to reverse their Type 2 Diabetes and some people have been shown to have opened up their narrowed blood vessels to their heart by following this way of eating – these are effects that medication alone cannot achieve. There is a video link below explaining how for some people Type 2 Diabetes can be reversed with a WFPBD.

If you take medications for any of these conditions, we recommend you contact us if you plan to change to a WFPBD as over time you may need to stop some of your medications which could be harmful to continue if you no longer need them. However you should contact us to discuss this first as you are likely to need more frequent monitoring of your condition during your transition to your new way eating.

What about athletic performance and people who play sports?

A WFPBD as well as having a wide range of health benefits is also increasingly being recognised as giving performance benefits to a wide range of sportsmen and women including strength athletes and endurance athletes. See link to gamechangers.com website for a look at this topic in further detail and for some of the myths surrounding protein requirements.

What are the common pitfalls?

Buying processed foods

These foods often contain refined foods (such as white flour) which have been stripped of much of their valuable nutrition and often contain oils, sugar and salt which can be harmful to health.

Not eating enough!

Eating whole plant foods means that you may feel full more quickly after only consuming relatively few calories due to the high fibre content (low calorie density). For this reason you are likely to need to eat larger meals than you are used to or eat more regularly during the day . This is to ensure you get enough calories, otherwise you may then start craving sugar or fat just because you aren't getting enough calories to sustain you over the day.

Cooking with oil or adding oil to food

This is the most important pitfall. Although there may be some evidence to suggest that oils may not be quite as harmful to health as animal fats, they have a very low nutritional density – i.e. oils are extremely high in calories compared to whole plant foods and have no fibre and a only a small quantity of vitamins or minerals. Over time oils in the diet also contribute to the formation of plaques in arteries which can lead to heart attacks and strokes. Remember oils are not whole foods, they are extracted from whole foods by crushing and pressing (or chemically processing) whole plant foods. By far the most nutritionally valuable part of the plant food has been left behind separate from the oil.

By adding oil or cooking with oil you will loose much of the benefits of transitioning to an otherwise whole food plant-based diet. Surprisingly most people adapt very quickly to avoiding the use of oil and they don't miss it.

Did you know that plant foods such as onions, garlic and mushrooms can be cooked by sautéing in a pan without any oil or fat. Simply use a small amount of water to stop the food sticking to the pan.

Adding salt and sugar

This can be challenging for many people but there is no need to add salt or sugar to your food.

As an alternative to salt you may find mixed herbs or spices can provide flavour instead.

There are guides to cooking and a vast range of delicious whole food plant-based recipes on the websites listed below. However, you can also keep things very simple and learn to improvise with the food you have available at the time.

Adding a teaspoon of sugar to a bowl of oats in the morning is not going to cause you any significant harm but to benefit most try to keep additional sugar and salt to a minimum.

Perfection!

We all know no one is perfect. The same goes with what we eat, in fact expecting yourself to stick with the plan perfectly all of the time is setting yourself up for failure. Don't be too hard on yourself if you stray from your plan and sometimes you can plan for a treat or decide to satisfy a nagging craving. Doing so can help you get back on track and concentrate better on the rest of your life. However remember a treat is something that you only have occasionally!

Explaining your diet to others

In general those who care about you should encourage you when you are making a positive lifestyle change. However, when you make a big change in your diet people close to you can sometimes feel in some way undermined and even hurt that you are no longer eating the foods they do. This can be one of the most challenging things about changing your diet. Although every situation is different here are a few ideas that may help you: –

Explain the reasons why you have decided to change your diet – e.g. you would like to improve your health, reduce your risks of heart disease, diabetes, cancer etc, or you wish to reduce your impact on the environment etc.
Try not to be critical of the choices of others and try not to persuade them that they should be doing the same as you.

Provide them with more information if they ask for it but don't pressure them or try to convert them.

Try not to come across as an expert to others. You may have read a lot about WFPBD and be very knowledgeable but nutrition is a complicated and emotive field and there will be many people who try to argue with you and tell you that what you are doing is wrong. It is generally best to avoid such arguments and just direct them to the sources of information you are using such as the websites at the end of this page and let them make up their own minds.

Eating out

It is very challenging to eat out and stick to your whole food plant-based diet. Although most restaurants do now serve vegan options, very often they are not whole food options and often consist of processed food or have added sugar and salt and are very often cooked in oil. However if you know where you are going to eat, you can look at the menu online in advance and even phone the restaurant before you go and explain your requirements. Most restaurants will try to accommodate your request.

For a more spontaneous occasion you may have to compromise but you can still chose the 'least worst' options or ask if they can provide something simple for you such as boiled vegetables instead of cooked in oil, or a jacket potato or boiled rice etc. Often there is a salad option and you can ask if they can leave off the dressing if it is oil based as they usually are.

You may have be imaginative when looking at menu options and ask for something that isn't a standard option on the menu. This may be uncomfortable at first but over time it becomes much easier and can actually be a way of finding out how accommodating the restaurant is to it's customers. Fortunately in recent years most restaurants are becoming increasingly flexible to different dietary requirements.

Of course there may be occasions when you deliberately decide you are going to treat yourself and not worry about sticking to your normal diet when you go out. This is absolutely fine for the occasional treat and you should not feel bad about it.

Want to know more?

If a WFPBD interests you and you wish to know more, we have included several links to useful sources of information below.

In addition please click on this link: Evidence-Based Eating Guide for a very useful guide from the non-profit site nutritionfacts.org. The guide includes information on how you might incorporate some of the most healthy foods into your diet.

If you are considering changing to a whole food plant-based diet, Dr Paul Proctor has an interest in this area and he would be very happy to discuss this with you.