High-Protein Diets and Kidney Health with Juan Calle, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

High protein diets are all the rage right now, and new FDA guidelines significantly increase protein intake recommendations. But while protein is unquestionably good for your body, can you get too much of that good thing, particularly when it comes to your kidney health?

We're going to explore that question in detail today with the help of nephrologist Juan Calle. He's one of the many experts at Cleveland Clinic who drop into our weekly podcast to talk about health trends and whether they're worth trying. So with that, let's find out whether using a high-protein diet to build your body might also build a few kidney concerns.

Welcome to the podcast, Dr. Calle. Thanks for stopping by to chat.

Dr. Juan Calle:

Well, thank you so much, John, for having me. It's a pleasure to be here, definitely.

John Horton:

We're glad you could make some time for us. So Dr. Calle, at the grocery store these days, we are just blasted with products promising more grams of protein. You can buy yogurt loaded with protein and pancake mix loaded with protein and snack bags of chips with gobs of protein. It is just everywhere. Plus, there's protein powder and protein bars … and I think you kind of get the picture. Given all of that, I wanted to start with a basic question: Can our kidneys handle all the extra demands that come with this protein?

Dr. Juan Calle:

So I'll start by saying, or giving a disclosure about that, and it's the fact that I usually am not the one going to the grocery store in my home. But that aside and all joking aside, yeah, we know that that is happening very frequently. We are bombarded with a bunch of different information and things that we see in stores, in TV, in media, social media, and stuff like that, that is kind of advertising that. For the most part, and for the general population, to be honest with you, a little bit more of protein shouldn't be a problem at all. The issue becomes a little bit more on people who may have certain diseases, especially what pertains to us from the area in the kidney world or kidney medicine, that may pose a little bit more of a risk. But then, I guess, we'll probably can talk about that a little bit more later.

John Horton:

We'll definitely dive into that. But just from what you said then, if you're just your typical healthy individual, you got a workout routine … I know my sons are big into protein with everything. If you're that sort of healthy individual, [inaudible 00:02:49] your body can handle a little more protein in your diet?

Dr. Juan Calle:

So yes, for the most part, for healthy people who don't have any other medical issues at all, that should be OK. I have a philosophy that I apply in my clinics, and when I'm seeing patients and families as well, and giving advice and recommendations, and I usually tell them not to go to an extreme in either way. If you go way, way too much and you just start pounding on a lot of protein, that may be an issue even if you're healthy. But just getting to a balance and trying to be balanced in life, that's probably the best recommendation that I can give on that, too.

John Horton:

Yeah. We talk about that a lot in this podcast, the whole idea of moderation. It seems to be a general theme in a lot of healthcare stuff.

Dr. Juan Calle:

Yes, definitely.

John Horton:

All right. But even with what we've just said, and you are OK, if you're a healthy individual and maybe taking in a little more protein, if you do that, you are putting increased demands on your kidneys. So can you tell me, how does more protein make the kidneys work a little harder?

Dr. Juan Calle:

If we go to what we call an “American-based diet,” compared to some other diets in the world — and there is actually a lot of evidence and very good studies that have shown this — people who have more fruits and vegetable ingestion or in their diet, they tend to do a little bit better in terms of some outcomes from the cardiovascular standpoint. And then, from the kidney standpoint or the kidney health standpoint as well.

When we have a lot of, especially what I call “flesh animal protein,” and when I talk about that, it's even some of the supplements that you were talking about, because most of them are derived or come from animals as opposed to plant-based protein, which is a little bit different, and I think that we're probably going to talk a little bit more about that later, but those diets that have a lot of protein, animal-based protein or flesh animal protein tend to generate a little bit more of acid. That acid that we all generate on a regular basis, it may be increased, and that puts a little bit more of stress on the kidneys and the kidney function as well.

And it may actually increase some of the pro-inflammatory processes that we have. It may also increase something that is called “oxidative stress,” or it makes it more, in general, more difficult for the whole body, and, ultimately, the kidneys, that together with the liver and the kidneys are kind of the waste management products of the whole body, and it makes it a little bit more difficult to handle if it is in an excess.

John Horton:

Well, because the reality is, if you just eat gobs and gobs of protein, you really load up on it, I mean, your body can only really use and process so much of that, right? So if you have this excess, it's basically going to the kidneys and they've got to process it and get rid of it, correct?

Dr. Juan Calle:

Yes, definitely. But again, you brought me in and you're asking me these questions from the kidney standpoint, but it's not only the kidneys, it's the rest of the body. Something that modern medicine, and, I guess, I may be guilty of this, is that we have gotten so specialized, and we, especially at Cleveland Clinic, for example as well, we're being able to do and work on our area of expertise, but we forget that we are a whole. It may affect everything. And when one floor in the building doesn't work well, the whole building doesn't work well. So that goes back to the kidneys, and it's not only there, but it affects the whole body in general.

John Horton:

So that's just something to think about. Even if you are healthy, you don't need to overload on protein because your body can only handle so much.

Dr. Juan Calle:

Yes, definitely. There are certain circumstances, and some people who are like, but that's not part of the norm, it's more of a little bit on the extremes, like bodybuilders and things like that, or people who have certain needs because of medical conditions. But in general, it's trying not to overload the whole system.

John Horton:

Yeah. I get the sense that there's a lot of people who probably take in enough protein where they could be bodybuilders, but they're not doing the bodybuilding part of it. So that's where it kind of gets wasted a bit.

Dr. Juan Calle:

That is actually, I mean, you hit the right point there. And what comes to my mind, even without talking to you before about this or having any information, the first person, and I'm going to do some publicity here, like Michael Phelps, he used to eat an ungodly amount of calories per day, including protein. But again, you think about what the guy was going through, it's completely different than what I go through in my whole year. So it's completely different.

John Horton:

He had the gold medals to show for all the work he put in. So I think we kind of saw the evidence there.

Dr. Juan Calle:

Definitely.

John Horton:

So we've been talking about healthy individuals and how maybe they can take a little more protein in, but you still have to watch at that top end. Let's kind of switch gears a little bit and look at the guidance if you're dealing with some sort of kidney issue, kidney disease. And I got to say, when I looked at the numbers, I was blown away by how large of a group that is. I mean, there's a lot of people who have kidneys that aren't working at 100%.

Dr. Juan Calle:

Yep. So that's one of the biggest issues that we as kidney medicine doctors or nephrologists have to deal with, because, unfortunately, just in the U.S., it is estimated that more than 30 million people have kidney disease.

John Horton:

Wow.

Dr. Juan Calle:

So if you think about just the numbers, the bulk numbers of the amount of people who actually would have to adhere to certain guidances in terms of diet and exercise and medications and things like that, is humongous. It's very, very big.

John Horton:

I'm guessing a lot of people in that group don't even know they have a kidney issue either?

Dr. Juan Calle:

Yeah, I was just going to go there. What is even more striking is the fact that only about 10% of those 30 million people know that they have the disease. And the problem is that many times, I mean, we get many, many patients who, unfortunately, just come to us at the very end of the road when they start manifesting or having symptoms that are associated to the kidney disease. Because you can talk about this unfortunately or fortunately, but unfortunately, many of them, they don't have any symptoms whatsoever, and it is incidentally found because they were getting blood work for something else different or they ended up being sick because of a different circumstance, but then they are found to have a kidney disease.

So yeah, it's a very vast, large amount of the population that may have issues and they may not feel anything.

John Horton:

So if you're in that group and your kidneys aren't working as efficiently as they should, what happens if you take in excess protein?

Dr. Juan Calle:

So remember what I was talking about, about all of these processes of increased oxidative stress, increased inflammation, increased acid buildup, you're actually putting more load into those kidneys that are not working appropriately to begin with. And all of those increase the complications and many, many other issues that we start seeing in blood work, minerals and electrolytes, the acid-based balance of the body, and it starts affecting many other systems or organs in the body, too.

John Horton:

Yeah. And I'd imagine that then it just kind of accelerates. So if you have a little problem, you overload it and you compromise it, all of a sudden, that little problem becomes a much bigger problem.

Dr. Juan Calle:

Yes. And I think I might've mentioned something a few seconds ago or a few minutes ago that there is a lot of evidence, medical evidence, that is studies that have been done in a well-designed manner, and they show that people who actually have more fruits and vegetables as opposed to protein, especially animal-based protein, the progression of the disease which we call it chronic kidney disease in those patients eating a lot of protein versus the ones that actually eat a lot more fruits and vegetables, the people who eat a little bit more fruits and vegetables do much better. And they may even slow the progression of the disease and sometimes revert a little bit or improve a little bit the kidney function that they may have damaged for a long time.

John Horton:

That's why they always say eat your fruits and veggies, right?

Dr. Juan Calle:

Yes.

John Horton:

They're good for you.

Dr. Juan Calle:

People joke about an apple a day keeps the doctor away, and they talk about usually the kidney doctor, and that's good.

John Horton:

And I think we're kind of going right into what I wanted to talk about next, and that was whether the type of protein you're eating, how much of a difference that makes. And from what you're saying then, there's a big difference in how your body processes a big steak versus how it's going to handle plant-based protein from legumes and nuts and seeds. How is it different?

Dr. Juan Calle:

So part of it may actually be on the processing of the food as well. Unfortunately, again, and especially for us here in the U.S., we do it a lot more processed and highly processed foods compared to other places in the world, and I think that that plays a big role. And that's probably one of the biggest things that aligns between the previous recommendations from the guidelines from the National Institutes of Health and the current ones, they do hit on the point of trying to avoid highly processed foods. So that's probably one thing.

The other thing as well, or another reason, is that it seems that the protein based from plants versus animals, the composition and everything else and how it's kind of formed, to put it in lay terms, it's different. And the digestion and the processing and the metabolism may make it a little bit easier for the fruits and vegetables because they are kind of more natural than the ones from animals. And especially how the animals have been processed or how the animals have been treated as well, apparently, has a lot to do with it.

John Horton:

Yeah. I mean, to be honest, that makes a lot of sense. Just, I know how you feel after you eat, like I said, a big piece of meat versus, like I said, fruits and vegetables. I mean, your gut feels a little different when it hits. So it kind of makes sense that your body's just handling it in a different way.

Dr. Juan Calle:

Yeah, it's definitely — and trust me, I just came from a conference that we were having in our department half an hour ago and something that we are actually investigating and we are working on, and it seems to hit a very hot topic right now, which is this thing that is called the microbiome or the microbiota. I don't know if you [inaudible 00:14:22].

John Horton:

We talk about that all the time on here. We have gastroenterologist, Dr. Lee, loves talking microbiome.

Dr. Juan Calle:

So we are actually working on that as well. And one of the things that we probably see is that the microbiota, the microbiome, is actually … and it behaves in a completely different way when you are eating fruits and vegetables and protein that is plant-based versus the one that comes actually from animals as well.

John Horton:

So Dr. Calle, we've been talking about foods like meats and vegetables and all of that. What about protein powders and supplements? I mean, because that's a big way that people are adding protein to their diet. How does that fit into how your kidneys handle all this and how they operate?

Dr. Juan Calle:

So going back a little bit more to, or a little in what we were just discussing, it does and it may play a role in the sense that those are still processed. They do go through different chemical … I mean, some functionality and some things like that that are actually changed from their initial presentation. Like we said also, it may be more for people who are actually actively working to gain a lot of muscle mass first, but they must have the other side, which is actually working out and things like that. And then, for some specific people, when they are malnourished or they have certain other conditions, they may need some supplementation of that.

But in general, for the general population and for the vast majority of people, that's probably not necessary. And since we talked about the fact that, like around 90% of the patients who have kidney disease don't know about it, you may actually be in there and you may be adding a little bit more to the mix that you didn't know about.

John Horton:

So if you're going to be hitting the protein powder, do it because you know you're hitting the gym, you're throwing a lot of weights around. You're doing this sort of bodybuilding and exercise where you have those increased demands. Don't just do it because you think you want to get on this train and kind of get as much protein as possible.

Dr. Juan Calle:

Yeah, that would definitely be the advice that I would give. And then, on the other hand as well, I mean, we haven't talked that much about those people who are very sick or who are sick and are taking the supplements, it also depends because I have some of my patients in whom I actually, I have to tell them, you need to lay off a little bit more, because it seems that it's actually bringing a little bit more of consequences and benefits versus the risk. And it seems that probably it may be there, too.

John Horton:

And that's where it sounds like if you know you have kidney issues, you should talk to your doctor and really get a good sense as to how much protein you should be taking in.

Dr. Juan Calle:

Yes.

John Horton:

So looking, though, at the overall guidance on how much protein should be in our diet, there have been some changes in that as we've kind of discussed a little bit. Just looking at it, the old guidelines used to be …. looks like 0.8 grams of protein per kilogram of body weight, and that has now changed to 1.2 grams to 1.6 grams per kilogram of body weight. For those who aren't in the kilograms, quick rule of thumb, it looks like if you were weighed 150 pounds, the recommendations change from maybe taking in 54 grams of protein a day to 82 to 108 grams. So it's a big increase.

So that was a lot of math we just threw out there, Dr. Calle. What does that mean for the average person as to what you should be looking to have on your plate, what you should be buying at the store, and how much protein you should be trying to get in?

Dr. Juan Calle:

So I'll tell you that just recently, I had to look into this, and I was actually astonished as to how much that actually means in my daily diet. So for a person who weighs somewhere around 150 pounds, like you were talking about, which is close to the 70 kilograms, that would mean that that person, if we're talking about just protein, would be eating like nine eggs per day.

John Horton:

Yeah. Wow. That's a lot of eggs.

Dr. Juan Calle:

That's a lot of eggs unless you have a very nice egg-bake or quiche or something like that, which, usually, I don't think people eat that much on a daily basis.

When it comes to meats and stuff like that, it's talking about almost 250 grams or 300 grams, that's somewhere a little bit over half a pound per day just in that category. So that's a lot.

I mean, we think and other sources like the National Kidney Foundation and the American Society of Nephrology as well, we believe, and we think that people who have kidney disease should refrain from going there. For anyone who has healthy habits in other ways, who are not prone to have any medical conditions, I think that that should be OK. I mean, again, trying to probably limit a little bit more may be better, based on the studies that I was quoting and mentioning before, too.

John Horton:

Yeah. And you said a lot of this has to do with your activity level. So if you're somebody, you're really active, you're out there running or lifting weights or doing all this stuff, you might be able to safely take in more because your body has more protein demands and you're using it, as opposed to if you're sitting at a desk job all day and not exercising, you live a sedentary life, you might want to stay on the lower end of those guidelines.

Dr. Juan Calle:

Yeah, I think that would be a safe bet.

John Horton:

No, that sounds good. And it sounds like there's been a lot of discussion as to what these guidelines mean. I know we were talking about that ahead of this podcast, just with how it's really sparked a lot of talk and discussion as to where the line should be.

Dr. Juan Calle:

Yeah. I mean, there is a lot of debate. There is a lot of discussion, because for many, many years, we have been following the trend from what the science has shown us. I think that the changes make it a little bit more difficult to understand. And especially sometimes, it's good to have some movement in things so that we are shaken and we know what we're doing, but at the same time, that also may mean that it's creating a disruption with stuff that we may know that has been working in a way or that there is some more evidence to support it.

It's tough. It's very tough because those are the recommendations that we get, that we're getting right now from the NIH. And it makes it a little bit more difficult, especially in my area, for certain patients who have kidney disease, who may have kidney stones, who have high blood pressure, and something different that may happen for people who actually at the point of needing dialysis or stuff like that.

John Horton:

Now, kidneys are one of those things where I don't even know if most people could place them and really kind of know what good kidneys feel like versus bad kidneys. They're kind of in there and they do their job. So if you were having issues with your kidneys, if they are starting to maybe struggle a bit, what are some warning signs that you might see or experience that show that they're a little stressed?

Dr. Juan Calle:

So it's very interesting that you framed it like that, because when I met my wife, she didn't even know what a nephrologist was or she had to look it up a little bit more, because people are usually not that attuned to kidney disease. So unfortunately, again, or fortunately, whichever way you want to look at it, people only start showing and having very severe symptoms that they can tell at the point where they are very close to needing dialysis if they haven't seen a physician in the past or a primary care provider or something like that.

The symptoms that they may have … so one of the things that we see fairly commonly is not a symptom per se, but they notice that their blood pressure goes up. They may start having swelling or edema, especially they notice it more in the lower extremities or the legs. When they wake up, sometimes they may even see a little bit of more rounded, full face because that's kind of fluid accumulating. Depending on their disease, they may end up seeing some bubbles that remain in the toilet when you're actually urinating or voiding. The appetite may go away, but once again, at very advanced stages.

The kidneys — and when the kidneys fail or you get to that point — any organ pretty much any system in the body can be affected. They become more lethargic or their thinking is not as clear and as straight as it used to be. They may be having some more tremors, twitches here and there. They don't feel well. They really don't feel well and their energy goes away.

John Horton:

That is pretty stark, what you just laid out. And you hate thinking that you're not going to find something out until it's way down that path to a problem, but it sounds like that's kind of when those obvious symptoms kind of show up.

Dr. Juan Calle:

Yes. It's at the very, very late stages of kidney disease that people may end up noticing that.

John Horton:

Are some of these problems found a little bit earlier through just routine check-ups or blood tests or things like that?

Dr. Juan Calle:

Yep. So the recommendation would be, probably as we grow and get older, obviously, having the regular screenings and visits to your primary care provider as well. Usually, they check for blood work, at least once a year or twice or every other year or so to check on the blood work. And that shows how your kidneys are doing and how your minerals and electrolytes are looking. And something as simple as just a urine analysis, a urine analysis test, can give us a lot of information, and that's when they may get referred to us as well.

John Horton:

Yeah. Well, it just drives home the point about how important it is to keep up with your medical care and those precautionary kinds of check-ups, or just to make sure everything's working the way it should be.

Dr. Juan Calle:

Yeah, definitely.

John Horton:

Well, Dr. Calle, we've covered so much here today. And, I guess, just looking to sum everything up, what's the best way that people can go about striking a healthy balance to meet their body's protein needs, but keep their kidneys happy at the same time?

Dr. Juan Calle:

So I think, just like I mentioned at the beginning, trying to keep a balance and not going into the extremes. I think that trying to follow the guidelines that have come out even recently and the previous ones, again, trying to make a balance of all of those, just to keep in the middle of the road and push through there. Trying to avoid some of the medications and things that may cause a little bit more of harm to the kidneys, which we may talk about this at a later time, but medications like anti-inflammatories that are over the counter and are very prominent, that can cause a lot of damage to the kidneys as well.

And just keeping yourself healthy, having more fruits and vegetables, I think, is the regular advice. The whole thing about drinking a lot more, yeah, go ahead and drink, but don't — and I mean fluid like water and stuff like that — don't go overboard. Giving or taking a lot more extra doesn't necessarily push the kidneys to work much better. It's a matter of not being literally "dehydrated."

John Horton:

Well, Dr. Calle, I love that you threw in that last little bit about the medications because we did not touch on that, but that is such an important point. Sometimes, I think we have all those over-the-counter meds that we take for aches and pains, whatever, and we don't really think about what they're doing to various body parts. But it sounds like they can really have an effect on your kidneys if you're overdoing it.

Dr. Juan Calle:

Yes, they do.

John Horton:

All right. Well, we just got information from the first second right up to the last one. So I appreciate just everything you shared, and I'm really looking forward to having you back on again.

Dr. Juan Calle:

Well, thank you so much for having me. It was a complete pleasure.

John Horton:

Your body needs protein, but there's also only so much it can handle and use. Overdoing it on the protein front can put extra stress on your kidneys. Something to consider before pushing up your protein intake.

If you like what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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