 Approximately one in seven American adults have chronic kidney disease, and the prevalence is higher in those with metabolic risk factors, such as high blood pressure, diabetes, and obesity. That sounds like a job for plant-based diets, which have demonstrated significant utility for the prevention and treatment of all three of those modern-day scourges of society. Their utility for the treatment of so many diseases has led to a growing interest in their applicability for the prevention and treatment of chronic kidney disease itself. In theory, there are multiple benefits of more plant-based diets in the management of kidney disease. The intake of animal fat is associated with protein loss in the urine, and other components related to meat such as choline and carnitine are converted by bad gut bugs into TMAO, which is associated with scarring of the kidneys. Plant-based diets carry a decreased acid load, whereas ingestion of animal-based foods like meat, eggs, and dairy increases the formation of acid and ammonia, unlike the favorable alkalization from fruits and vegetables. The phosphorus in plant-based protein is less absorbable, which is a good thing if you have alien kidneys, especially compared to the added phosphorus-based preservatives that are often used in meat processing. Indeed, you can successfully lower blood phosphorus levels in kidney disease patients in as short as one week on a vegetarian diet. High dietary fiber intake can also pull advanced glycation and products out of your system, those so-called glycotoxins, and prevent constipation, which can cause potassium overload in kidney patients. A plant-based diet also lessens the likelihood of exposure to potassium-based additives. A lot of the phosphorus additives in meat are also potassium additives. And finally, there may be favorable impacts on the gut microbiome leading to lower generation of uremic toxins. Large putrefaction products are generated by protein putrefying in the gut, but plant-rich dyes may be able to reduce uremic toxins, in part due to increased fiber and lower protein intakes. The lower the dietary protein intake, the slower the progression towards end-stage kidney disease, and the increased risk of progression to end-stage kidney disease associated with dietary protein intake appear to have no threshold, meaning it just seemed the lower the better. But even if you just drop your protein intake by just like 10 grams a day, that modest reduction may decrease the risk of end-stage renal disease in death by greater than 50%. That's incredible. It was a randomized control trial. They were trying to get people down to like 0.6 grams per kilogram a day of protein, which is like 40 grams a day, but could only get people down to about 60 grams a day, which is technically not even a low-protein diet. The recommended protein intake is 0.8 grams per kilogram per day, or like 50 grams a day. But just getting people from the usual protein intake of like 70 grams down to 60, cut their risk of dialysis or death by 77%. Check this out. By the end of four years, more than 25% of those in the usual diet group were either dead or on dialysis from end-stage disease. Between the reduced protein group, it was less than 10%. A randomized control trial proving massive benefit. Yet despite strong scientific evidence, many doctors are still unconvinced that a low-protein diet can help patients with chronic kidney disease. Why? The reasons for this nihilism are unclear, but could be related to insufficient background knowledge, lack of interest in nutrition and dietetics, and limited familiarity with the most recent scientific literature.