A Nutritional Lie or Lifestyle?

When referring to plant-based diets, what comes to mind is the following.

• Vegetarian—someone who refrains from eating all types of meat, including poultry, red meat, and fish, but eats dairy and eggs

• Flexitarian—someone who is a part-time vegetarian but does incorporate meat sparingly into the meal plan

• Pescatarian—someone who follows a similar nutritional plan as a vegetarian except for incorporating fish into the nutritional plan

• Vegan—someone who strictly eats vegetables and fruits

As a person who formerly spent 4.5 years on peritoneal dialysis and is now 23 months into a kidney transplant, the word “diet” is a curse word, such as it is to other battling a chronic illness, especially kidney disease. After reading the article “Plant-based diets and incident CKD and kidney function” (1), I would like to share my perspectives from a person living with this disease.

One of the vital areas in most research studies on nutrition is that the researchers, scientists, clinicians, and medical teams fail to truly understand the socioeconomical challenges that the most affected populations have to endure. Everyone wants to each a healthy, nutritional meal, but affordability, locality, convenience, or access is a hinderance to achieving this goal. Another thing to consider is the accuracy of the data collected and the relevancy of the study. In most urban and rural communities, there is no prediabetic, prehypertension nutritional training, class, or anything that would be perceived as a proactive approach to educating communities on the number 1 and 2 leading causes of kidney failure.

As a 55-year-old black man, my upbringing consisted of my mother cooking everything in lard. Eggs, bacon, sausage, squash, cabbage, and other green vegetables started out in their original coloring, but the finished product as it reached my plate and was sat in front of me was of a different color…brown. I joke with my friends that it took me until my adult years going grocery shopping to realize the actual colors of vegetables. When I saw the many different colors, I was like a little child standing in amazement. If you do not provide an avenue where a person can learn to do better, how can you expect others to know better?

After receiving my kidney transplant, my kidney journey took a turn of its own. It took four surgeries and 33 days of hospitalization for me to get on track, yet my kidney did not wake up until the 47th day. When some form of normalcy came into my life, my post-transplant nurse told me that my laboratory values were improving, which is a good sign that the kidney is working, but now, you need to plan for the longevity of this kidney. When I began dialysis in December 2013, I weighed 378 pounds on a 5-foot, 9-inch frame. I was 278 pounds at the time of transplantation. Being on two different types of insulin and prednisone, which causes spikes in your glucose levels, she felt that I needed to enroll in my hospital’s Weight Loss Clinic. I received my transplant of April 21, 2017. I enrolled in the weight loss program on January 5, 2018. The recommendations of the weight loss physician were to try keto.

The ketogenic lifestyle (cannot say diet; it just does not work for me) is a very low–carbohydrate, high-fat, moderate-protein nutritional lifestyle. These three items (carbohydrates, fats, and protein) are referred to as macronutrients. A macronutrient is defined as a substance required in relatively large amounts by living organisms. The misconception of this diet is that most people call it the “Meat Diet,” and it is far more than that. The ketogenic lifestyle is 75% fats, 25% protein, and 5% carbohydrates. Because of the lower carbohydrates, it causes your body to enter into a natural, biological state of ketosis. This allows your body to burn its own stored fat as energy. Please do not confuse this with ketoacidosis, which is a complication of diabetes. Because I am a type 2 diabetic, my weight loss team felt that this was the best way to go. Every physician and every nurse are currently living this lifestyle. I began this nutritional lifestyle on February 16, 2018. In that time, I was removed from all of my insulins (NovoLog, 8–15 U before each meal and Levemir, 40 U in the morning), and I have lost over 60 pounds. My A1c is between 5.3 and 6.0 compared with when I was diagnosed as a diabetic in 2003 (glucose =758; A1c=11.7), and my overall kidney health is great (2,3).

In my nutritional lifestyle journey, I was on vegetarian, vegan, flexitarian, and Mediterranean diets. What I have found out about a plant-based diet that this article did not disclose is how ineffective the diet is on mental (brain) health.

Plant-based diets tend to be lacking in the following areas.

• Fat-soluble vitamin A: This vitamin is important to the brain function, including memory, vision, and learning.

• Vitamin D3: The vitamin D that the body needs is D3 (cholecalciferol). We can get this from either sunshine or animal foods. The vitamin D that plants make is D2 (ergocalciferol). The body can convert D2 but is does not have the potency of D3.

• Others vitamins: These include K2 (Mk-4), B12, B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), zinc, phytic acid, docosahexaenoic acid, and eicosapentaenoic acid.

Although I am not a certified dietician, I would certainly ask that there be a more comprehensive and collaborative approach to nutritional education and information before pushing these findings on the public. Every diet is not for everyone. We should focus on food as medicine instead of scaring the public with unfounded, inaccurate research. This does not mean that I am disregarding anyone’s choice or findings. However, I do want to assert that, for me, the ketogenic lifestyle worked. I know that it is not a long-term nutritional plan, but out of all of the other dietary options, it enabled me to have normal glucose levels, manage my diabetes, manage my weight, and maintain a healthier and livelier lifestyle.

Disclosures

None.