Do the high‐protein recommendations for athletes set some on a path to kidney injury and dialysis?

Abstract

Athletes and fitness enthusiasts are often encouraged to follow high‐protein diets to optimize muscle protein synthesis, modify body composition, and enhance performance, yet the safety of these higher protein intakes has been debated. Many people with kidney dysfunction are unaware of their condition, and the potential harm of excess protein intake on the kidneys may not be adequately reported in the sports nutrition literature. Studies suggesting that high‐protein intake may be associated with incident kidney disease have led the nephrology community to make conservative recommendations. In contrast, the fitness community suggests that high dietary protein intake is safe and poses no risk of kidney injury. These claims often fail to acknowledge limitations in the internal validity and generalizability of the study results, despite many studies not being adequately powered to support such claims. It is essential to make dietary recommendations that consider the totality of the data and follow the ethical norm of “do no harm.” Studies that evaluate the use of high‐protein diets among athletes must consider the balance of efficacy with safety. While an intervention may be safe in one population, it does not mean that safety can be assumed for all groups.

Current Controversies in Kidney Nutrition

“…Meade et al. [5] discuss the potential value of clinicians adopting a more positive, health benefits–oriented approach to care in people with kidney disease that focuses on optimizing physical function rather than avoiding negative health outcomes. Their article examines common dietary strategies and nutritional supplements aimed at improving athletic performance, and achieving the benefits of exercise, and explores how they might be adopted or adapted for people with kidney disease.…”

“…However, excess protein intake could present a problem for people with kidney disease. In this issue, Marinaro et al [6] highlight important gaps and limitations in the research supporting the purported kidney safety and benefits of high-protein diets. As many competitive and recreational athletes with kidney disease may be unaware of their condition, or the potential harms of excess protein intake, authors urge against the universal promotion of high protein intakes within the fitness community and underscore the need for medical professionals to recognize and address their potential for interest and uptake by patients.…”