Laura Schoenfeld: Okay, so if this man is 70 years old and he’s never dieted before, you have to kind of keep that in mind as being a potential barrier just because once people are that old, usually they are pretty set in their ways as far as what they’re going to eat. It sounds like he’s a lot more open to change than the typical 70-year-old, but … But that’s just something I wanted to mention right off the bat is that there may be some diets that could potentially be helpful. But if it’s too hard for him to do, you have to be somewhat aware of what he’s able to do. Does he have someone who can help him cook, does he have access to certain types of foods? So like I said, that can just play a role in the kind of diet that you would recommend for this person. And if he has diabetes and has trouble … So, I don’t exactly know what you mean by trouble with his kidney, Eliani. I’m not sure if you mean that he’s having some amount of kidney disease or if he is on dialysis or if he is, you know, potentially going to be having a kidney replacement. There are a lot of different stages of chronic kidney disease, and generally the earlier stages of the disease, you don’t necessarily have to restrict protein intake. I’m not exactly sure at which stage they recommend. I can double-check. Let’s see, chronic kidney disease. This is something I haven’t really looked into since my graduate degree because I don’t really work with chronic kidney disease. But let me see. I know that you don’t have to start protein restriction until the person is on a certain level of chronic kidney disease. And I believe that when they’re on dialysis, actually, you don’t need to reduce the protein. Let’s see, just double-checking really quick if they’ll give me information about which stage needs, let’s see. One second, I just want to figure this out before I tell you guys something because I want to make sure it’s the right stage. And like I said, I haven’t done this type of patient really ever in my private practice. I don’t work with people with chronic kidney disease. Let’s see.
Okay, so they say that there’s controversy in the medical literature, but protein restriction is typically recommended for individuals with chronic kidney diseases in stages one through four. So that means the GFR, which is the glomerular, oh my gosh that word, glomerular filtration rate is the GFR, which is basically how fast the kidneys are able to filter proteins out of the urine. That is one, actually I don’t know if this is the right, I’m wondering if this is the right units. Well, anyway, it says 90 to 30 mL per minute per 1.73 m². I’m not exactly sure if that’s the same unit we normally see, but basically if somebody’s been diagnosed with chronic kidney disease, until they’re in kidney failure at stage V they do need to reduce their protein intake a little bit. Now you don’t have to do an extreme protein restriction, but usually I would say no more than 0.8 g per kilogram of body weight is about what the recommendations are for kidney disease. Now, like I said, if the person’s on dialysis, then they don’t have to worry about protein intake because the dialysis is clearing out that extra ammonia and all the other byproducts of protein digestion for them. But if they’re in stage one through four and they’re not on dialysis, then restricting to 0.8 g per kilogram of body weight is usually good enough. You can go a little lower: 0.6 to 0.75 is another recommendation.
I would say, if this man, let’s say he weighs 200 pounds, so that would be, let’s see how many kilograms that is. So 90 kg or 91, I should say, so if you were going to do protein for that man it would be 73 g per day, which is pretty low if you’re just doing meat to get that protein, it would be 10 ounces. But since vegetables also contain protein, I’d say probably closer to 6 to 8 ounces max per day. So it’s pretty low. Somebody’s having three meals per day and they’re trying to get less than 70 g per day, then they’re going to have to restrict protein to like 2 ounces, 2 to 3 ounces per meal at the most, which if you are in another country, an ounce is about 28 g. So average about 30 g of the actual meat. So, you know, 60 to 90 g max of a meat source at a meal. Definitely a much lower protein intake than what you might be recommending for someone who doesn’t have kidney disease.
Now, like I said, I don’t know based on this question if this patient actually has chronic kidney disease or if he’s just having a little bit of kidney issues. Sometimes if you can get someone’s blood sugar improved, you can see improvement in their kidney function because they’re not dealing with quite as much glucose spilling as if they are having high blood sugar as a diabetic. So I would say switching over to the Paleo diet is definitely going to be helpful now because his protein intake is going to be that low if he does have chronic kidney disease. Let’s say his calorie intake is going to be 2,000 calories a day, which is probably about accurate for a man who’s in his 70s, maybe a little lower than that. Let’s just put it at 2,000. So if he’s getting 70 g of protein per day, that would make this diet about 14 percent of his calories from protein. So definitely lower. It’s not so low that it’s dangerous, but definitely a lower percentage of calories.
Now, in his condition, if he’s never been on a diet before and he’s pretty liberal with what he eats, I don’t think you would have to go to that low-carb Paleo to see some improvements in his blood sugar control. Especially if he has type 2 diabetes, which is what I’m assuming here. So you don’t necessarily have to do a low-carb diet, especially with the lower protein intake, you might want to do a more moderate carb. So maybe about like 30 percent of his calories from carbs. So that would be, let’s say, average 15 percent of calories from protein and then 30 percent from carbs. That would be about 55 percent of his calories from fat. So that’s about the macronutrient ratios I would suggest starting with. You could go a little lower in carbs if you want to, but it may not be necessary for this man because again if he’s never been on a diet before and he makes some major changes to more of a whole-foods diet, lower carb than what he’s been doing and most of those carbs coming from things like starchy plants and fruit, that kind of stuff, he’ll probably see some major improvements.
So cutting out sugar and cutting out processed grains and junk food in general, that will make a huge difference. And so I don’t think you need to do much lower carb than that. If he does this approach and he’s still not seeing the blood sugar control that he wants to, you could try dropping the calories, or I’m sorry, the carbs a little bit lower, maybe 15 percent. So that would end up being about 70 percent of his calories coming from fat, which at that point that’s really more of a ketogenic diet. Which again may be a good approach for him, but I wouldn’t jump straight into that if it’s someone who’s never done a diet before. Because it’s just way too much of an extreme change, and honestly, I don’t even think that’s necessary for him. At the age of 70, you don’t necessarily want to be putting someone on a super-restrictive diet if it’s not totally necessary. So just keep that in mind, and like I said, if he hasn’t been on a diet before, you have a lot more wiggle room and you don’t have to go quite as extreme to see the improvements that you’re looking for. Great, so hopefully that helps. Like I said, I don’t know if this man has chronic kidney disease or if he’s just having some kidney issues that are not chronic kidney disease. But if he doesn’t have chronic kidney disease then you could probably go higher, maybe around 20 percent of his calories from protein.