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Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program
Albert, Stephanie L; Massar, Rachel E; Correa, Lilian; Kwok, Lorraine; Joshi, Shivam; Shah, Sapana; Boas, Rebecca; Alcalá, Héctor E; McMacken, Michelle
INTRODUCTION/UNASSIGNED:Interventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs. METHODS/UNASSIGNED:We assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses. FINDINGS/UNASSIGNED:The full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure. CONCLUSION/UNASSIGNED:Our study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.
PMCID:10157493
PMID: 37153909
ISSN: 2296-861x
CID: 5519462
Taking the Kale out of Hyperkalemia: Plant Foods and Serum Potassium in Patients With Kidney Disease
Babich, John S; Kalantar-Zadeh, Kamyar; Joshi, Shivam
Traditionally, diets for kidney disease were low in potassium. This recommendation was based on outdated research and often wrong assumptions that do not reflect current evidence. In fact, studies conducted over the past decades show patients with CKD, including kidney failure, do not benefit from the restriction of plant foods relative to control. Generally, dietary potassium does not correlate with serum potassium, and we posit that this is due to the effects of fiber on colonic potassium absorption, the alkalinizing effect of fruits and vegetables on metabolic acidosis, and the bioavailability of dietary potassium in plant foods. Also, consumption of plant foods may provide pleiotropic benefits to patients with CKD. Emerging dietary recommendations for kidney health should be devoid of dietary potassium restrictions from plant foods so that patient-centered kidney recipes can be encouraged and promoted.
PMID: 35131414
ISSN: 1532-8503
CID: 5176002
Plant-Based Milk Alternatives and Risk Factors for Kidney Stones and Chronic Kidney Disease
Borin, James F; Knight, John; Holmes, Ross P; Joshi, Shivam; Goldfarb, David S; Loeb, Stacy
OBJECTIVE:Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives. DESIGN AND METHODS/METHODS:Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry. RESULTS:The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk. CONCLUSION/CONCLUSIONS:As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry.
PMID: 34045136
ISSN: 1532-8503
CID: 4888282
Plant-Based Diets and Peritoneal Dialysis: A Review
Liebman, Scott E; Joshi, Shivam
Whole food plant-based diets are gaining popularity as a preventative and therapeutic modality for numerous chronic health conditions, including chronic kidney disease, but their role and safety in end-stage kidney disease patients on peritoneal dialysis (PD) is unclear. Given the general public's increased interest in this dietary pattern, it is likely that clinicians will encounter individuals on PD who are either consuming, considering, or interested in learning more about a diet with more plants. This review explores how increasing plant consumption might affect those on PD, encompassing potential benefits, including some specific to the PD population, and potential concerns.
PMCID:8950727
PMID: 35334961
ISSN: 2072-6643
CID: 5191032
Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes
Kalantar-Zadeh, Kamyar; Rhee, Connie M; Joshi, Shivam; Brown-Tortorici, Amanda; Kramer, Holly M
PURPOSE OF REVIEW/OBJECTIVE:Nearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease. RECENT FINDINGS/RESULTS:Low-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources. High-protein diets with greater animal protein lead to glomerular hyperfiltration, especially in patients with T2D, and faster decline in renal function. Guidelines provide differing recommendations regarding the amount (low vs high) and source (plant vs animal) of dietary protein intake (DPI) in CKD/DM. Some such as KDIGO recommend 0.8 g/kg/day based on insufficient evidence for DPI restriction in CKD/DM, whereas KDOQI and ISRNM recommend a DPI of 0.6 to <0.8 g/kg/day. A patient-centered plant-focused LPD for the nutritional management of CKD/DM (PLAFOND), a type of PLADO diet comprising DPI of 0.6 to <0.8 g/kg/day with >50% plant-based sources, high dietary fiber, low glycemic index, and 25-35 Cal/kg/day energy, can be implemented by renal dietitians under Medical Nutrition Therapy. SUMMARY/CONCLUSIONS:Potential risks vs benefits of high vs low protein intake in CKD/DM is unknown, for which expert recommendations remain opinion based. Randomized controlled studies are needed to examine safety, acceptability and efficacy of PLAFOND.
PMID: 34750331
ISSN: 1473-6543
CID: 5050322
Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation
Albert, Stephanie L.; Massar, Rachel E.; Kwok, Lorraine; Correa, Lilian; Polito-Moller, Krisann; Joshi, Shivam; Shah, Sapana; McMacken, Michelle
ISI:000823507200001
ISSN: 1559-8276
CID: 5519472
A call for a better understanding of the role of dietary amino acids and post-translational protein modifications of the microbiome in the progression of CKD [Comment]
Koppe, Laetitia; Beddhu, Srinivasan; Chauveau, Philippe; Kovesdy, Csaba P; Mafra, Denise; Joshi, Shivam; Kalantar-Zadeh, Kamyar; Fouque, Denis
PMID: 33576406
ISSN: 1460-2385
CID: 5073072
A Mini Review of Plant-Based Diets in Hemodialysis
Dupuis, Léonie; Brown-Tortorici, Amanda; Kalantar-Zadeh, Kamyar; Joshi, Shivam
BACKGROUND:Plant-based diets are defined as an eating pattern focused on the consumption of unprocessed fruits, vegetables, nuts, whole grains, oils, and beans. They can include various forms of vegetarian, vegan, DASH, and Mediterranean diets. Plant-based diets have proven useful in the prevention and treatment of several lifestyle diseases like type 2 diabetes, hypertension, and obesity. Recently, a growing body of literature has emerged regarding plant-based diets for patients with kidney failure, including those on dialysis. Although evidence is still limited, preliminary findings are encouraging. SUMMARY/CONCLUSIONS:This article reviews current literature on the use of plant-based diets in the treatment of patients on dialysis.
PMID: 33915550
ISSN: 1421-9735
CID: 4897682
The Future of Nutrition in Kidney Disease: Plant-Based Diets, Gut Microbiome, and Beyond [Editorial]
Joshi, Shivam; Moore, Linda W; Kalantar-Zadeh, Kamyar
PMID: 33741121
ISSN: 1532-8503
CID: 4836142
Nutritional approaches and plant-dominant diets for conservative and preservative management of chronic kidney disease
Chapter by: Joshi, Shivam; Brown-Tortorici, Amanda; Sussman-Dabach, Elizabeth J.; Kalantar-Zadeh, Kamyar
in: Nutritional Management of Renal Disease, Fourth Edition by
[S.l.] : Elsevier, 2021
pp. 515-543
ISBN: 9780128185414
CID: 5369572