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Jeffrey Bland PhD on a Personalized Approach to Kidney Disease

Jeff Bland

Did you know that the average life expectancy for someone on kidney dialysis is five years? If you didn’t, you are not alone. Editor and integrative medicine expert Jeffrey Bland, PhD wrote in a recent opinion column in Integrative Medicine, a Clinician’s Journal he was dismayed to learn this fact from his son Kyle, an executive in the biotechnology sector that focuses on therapeutics for kidney disease 

In the commentary, Bland notes: “According to the National Kidney Foundation, the average life expectancy on dialysis is 5 to 10 years, but the foundation also indicates that many patients can live well for 20 or even 30 years.”  What accounts for the vast discrepancy?

Kyle had a surprising answer for his father:

“Following a decade spent in dialysis centers, Kyle told me he felt that he had developed an instinct for privately forecasting potential life expectancy based on lifestyle habits he took note of among patients. On many, many occasions, he indicated he has observed individuals arrive at a dialysis center with large containers of carbonated beverages and bags of fast food in hand. This tendency has become a marker for him, one that he has come to personally correlate with diminished success of treatment and an increased likelihood that he will see those patients at the centers he visits only a limited number of times in the future.”

In a condition, where the major contributor is related to “lifestyle, diet, and environmental factors,” Bland suggests that “future efforts may focus on the development of a personalized lifestyle medical approach to the prevention and management of this epidemic.”

Could personalized medicine for kidney disease present an opportunity for the mainstreaming of complementary-alternative medicine? The father and son comments prompted Today’s Practitioner to take a closer look at another opinion column by two Italians with the same mindset at Bland.

Giorgini B. Piccoli and Adamasco Cupisti write in Let food be thy medicine … lessons from low-protein diets from around the world (BMC Nephrology (March 2017) that while there is no one single low protein diet (LPD), suitable food choices are abundant regardless of income, literacy, geography and age provided the diet is adapted to their culture.

“Patients prescribed a low protein diet are more inclined to follow and adhere to low protein dietsthis change in lifestyle, provided the diet has been adapted to meet their own individual needs. With an increasing list of different menu options and better medical advice being offered we no longer need to identify low protein diets with a specific menu, ingredient or supplement, or with a specific level of protein restriction. Evidence shows how the best diet is often the one chosen by the patients, which doesn’t drastically affect their day-to-day life, and delays the start of dialysis for as long as is safe under careful clinical control,” the authors note. “Such diets should be adapted to suit local environment, culture, and religious practices, in addition to the single patient’s needs. Adaptation to local habits, and, within them, to the individual patient’s needs, appears to be the key to success.”

Studies show that in Australia and the United States in which normal protein is above 1.2 g of protein per kg of body weight per day, protein intake should be 0.8 g/kg/day. For some individuals, amino acid and ketoacid supplements can help to simplify diet strategies and safely reduce protein intake to 0.3 g/Kg/day.

Above all, Piccoli and Cupisti say that low protein diets should not be about restricted and forbidden foods, but instead foods that are unrestricted and allowable. In conclusion, Bland says, “We cannot solve the kidney disease problem through the building of more dialysis centers or by providing a greater number of kidney transplants. We must find a way to implement effective lifestyle management programs if we truly want to bend the curve and decrease the prevalence of kidney disease. The solution to the chronic kidney disease challenge lies in the skilled application of personalized lifestyle health care. Achieving this goal represents a tremendous opportunity for multidisciplinary collaboration and integration.”

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