 Chronic kidney disease is a major public health problem affecting about one in eight Americans, increasing the risk of disease and death, even among those with only mild decreases in kidney function. So low cost, low risk, preventive strategies that anyone can do or needed to address the epidemic of kidney disease. Diet plays a role in kidney function decline, specifically diets higher in animal protein, animal fat and cholesterol, maybe associated with protein leakage into the urine, which is a sign of kidney damage. And generally, diets high in fruits, vegetables, whole grains, lower in meats and sweets, may be protective against kidney function decline. In comparison to the diet eaten by our ancestors, not only are we eating more saturated fat, sugar and salt, we're now eating an acid-producing diet, as opposed to a base-producing or alkaline diet. Ancestral human diets were largely plant-based and, as such, produced more base than acid. Dietary acid load is determined by the balance of acid-inducing food, which is rich in animal proteins such as meats, eggs, and cheese, offset by base-inducing foods such as fruits and vegetables. In this national survey of 12,000 American adults, dietary acid load was associated with kidney damage among U.S. adults. Acid-inducing diets are believed to impact the kidney via tubular toxicity, damage to the tiny, delicate urine-making tubes in the kidney via increased ammonia production. Ammonia is a base, so the kidney creates ammonia to buffer the acid from the food we eat. This is beneficial in the short term to get rid of the acid, however in the long term all that extra ammonia in our kidneys day in, day out, can exert toxic effects. Our kidney function tends to decline progressively after our 30s, and by our 80s our kidney capacity may be down to half. Perhaps this so-called age-related decline in kidney function is a result of damage induced by a lifetime of ammonia over-production. That's just one theory, though. The acidic pH may increase the production of free radicals and damage the kidney that way, and add to scarring. Not only is protein derived from plant foods accompanied by antioxidants to fight the free radicals, plant protein is less acid-forming in the first place, because it tends to have less sulfur-containing amino acids. One of the reasons plant foods tend to be less acid-forming than animal foods. It's because acid is produced by the sulfur in the protein, and there's less in plant proteins. So, the more important determinant of the effect of dietary protein on kidney disease progression is the quality of the ingested protein. In other words, whether it induces acid production, like most animal protein, or base production, like most fruits and vegetables, rather than the quantity of protein ingested. Since American diets are largely acid-producing, because they're deficient in fruits and vegetables, it could take large amounts of animal products. Changing from a standard American diet to a vegan diet may improve acidosis in patients with chronic kidney disease. Under normal circumstances, a vegetarian diet is alkalinalizing, whereas a non-vegetarian diet leads to an acid load. This is true even of vegetarians that consume like processed meat replacements, like veggie burgers. Plant-based diets have been prescribed for decades for those with chronic kidney failure. No animal fat, no cholesterol, less acid load, and helps lower blood pressure. And indeed, if you compare the kidney function of vegans to vegetarians to omnivores, the most plant-based diet was associated with improved parameters for the prevention of degenerative kidney decline.