‘Let food be thy medicine…’: lessons from low-protein diets from around the world

Abstract

In this editorial we present the special issue dedicated to low-protein diets (LPDs) in chronic kidney disease, from a global perspective.The experiences gathered from several countries across all continents have created an issue which we hope you will find insightful, and lead to further discussion on this interesting topic.We discover that LPDs are feasible in both developed and low income countries, in patients where literacy is an issue, and are also safe, including during pregnancy and in old age.Patients prescribed a low protein diet are more inclined to follow and adhere to this change in lifestyle, provided the diet has been adapted to meet their own individual needs. With an increasing list of different menu options and better medical advice being offered we no longer need to identify low protein diets with a specific menu, ingredient or supplement, or with a specific level of protein restriction. Evidence shows how the best diet is often the one chosen by the patients, which doesn’t drastically affect their day-to-day life, and delays the start of dialysis for as long as is safe under careful clinical control. The colourful menus gathered from all over the world remind us that a low protein diet does not necessarily mean that the pleasure of preparing a delicious meal is lost. The final comment is therefore dedicated to our patients: low protein diets can be beautiful.

Low-Protein Diet: History and Use of Processed Low-Protein Rice for the Treatment of Chronic Kidney Disease

“…They concluded that a multiple choice of LPD showed good adherence and promising results in dialysis-free follow-up period [46]. Piccoli and Cupisti edited an issue dedicated to low-protein diets in CKD from a global perspective [47]. They told the patients that LPDs are effective and safe, but further efforts are necessary to make them tasty and easy to follow.…”

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

“…While there is an obvious bias linked to the fact that only the most motivated and best-qualified centres perform these satellite activities, the evidence that is available indicates that this expertise should be maintained and developed when logistically feasible. One example is Italian nephrology’s contributions to the field of renal nutrition: despite the fact that in most settings nephrologists work without the support of a dietician (a specialist that relatively few Italian nephrology wards have), the development of the field at least equals that of other countries in which having a dietician on the staff is standard [ 61 , 62 ].…”

Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project

“…Low literacy is obviously also linked to low health literacy, which has been associated with poorer health related outcomes in CKD patients and families, as well as in patients with other chronic diseases [ 16 , 21 , 22 , 23 , 24 ].…”

“…This was achieved by developing a five-step visual approach to the renal diet, which we called “Eating like a Rainbow”, to try to increase interest and emphasize that following a diet is not necessarily an unpleasant or grim experience. Compliance is ultimately the goal of nutritional intervention in CKD; comprehension is the key for obtaining compliance [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The material whose development is here described was developed using a trial-and-error approach over a 4-year period in the renal unit of a large public facility serving lower socio-economic patients without medical insurance.…”