Vitamin D Kidney Disease

Vitamin C 

Vitamin C is great for keeping the immune system healthy and is a known antioxidant. It also helps your body absorb iron better and more efficiently, so if you are taking an iron supplement orally, take vitamin C supplement at the same time.
 
In addition, a study suggests that vitamin C may play an important role in our bone health, as well as help in the treatment of anemia in CKD. A lab-based study proposes that high-dose vitamin C may have an antioxidant or protective effect on the kidneys, although a comparative study has not been done in humans.
 

Vitamin D Kidney Disease

Too high of a dose of vitamin C can affect the kidneys, as it can cause oxalate (ox-ul-late) to build up in the kidneys. Oxalate is a byproduct of vitamin C; if too much vitamin C is eaten in the diet, the levels of oxalate can build up and be toxic to the kidneys. In addition, it can increase the risk of kidney stones.
 
As Vitamin C is abundant in fruits and vegetables, there is likely no need to take a vitamin C supplement if you are on a vegetarian diet. If you are taking an iron supplement, as many with anemia and CKD are, then I would take no more than a total of 125 to 250 mg of vitamin C or ascorbic acid daily. Note that vitamin C can also lower zinc levels, and zinc levels can be low in those who have CKD, particularly in the setting of a low-protein diet. If you are not eating a healthy diet, you may need to increase the levels of vitamin C in your diet, but do so only under a doctor's supervision.
 
Vitamin D
 
There are millions of people with low levels of vitamin D in this country - all ages, shapes, and sizes are affected. The combination of a lack of adequate sun exposure and a Western diet low in vitamin D is causing this nationwide deficiency. Vitamin D deficiency is not found only in those with CKD, but also in those with normal kidney function. And there are many whose vitamin D levels are dangerously low.
 
To clarify, there are two different types of vitamin D. The first type of vitamin D concerns vitamin D before it is further processed in the kidneys (the kidney-specific vitamin D). Many people with CKD can be on both forms of vitamin D.
 
In addition to aiding bone health, vitamin D may have beneficial effects on the heart, as well as improve anemia and help the immune system. It may also help lower proteinuria. Vitamin D may potentially do a lot more and it is currently being researched.
 
Your doctor can order blood work to see what your vitamin D levels are. If they are low, two different types of replacement can be used. There is vitamin D2 and vitamin D3. Either form can be used, although the vitamin D3 is better absorbed. In general your doctor may ask you to take one tablet, or 1000 IUs (International Units), of vitamin D3. Your doctor will then obtain follow-up blood work and depending on the test results, may change your dosage.
 
Vitamin E
 
Vitamin E is a very good antioxidant and some laboratory studies have demonstrated that it may help reduce oxidative stress and inflammation in the kidneys. It may also reduce free radical formation and help reduce proteinuria in certain types of nephritis. Additionally, vitamin E may work well with alphalipoic acid for a more significant anti-inflammatory effect.

The optimal dosage of vitamin E is not yet known. Given the oxidative stress and inflammation present in CKD, a dose of 200 to 400 IUs may be beneficial. If you have nephritis, you may benefit from a higher dose. Talk with your doctor before taking any vitamin E, especially if you are on blood thinners. Further study is needed. To find out more, you can check out Vitamin D Kidney Disease.

Vitamins For Kidney Disease

In addition to changing your diet, there are o!her nutritional supplements that you may need to take depending on the cause and stage of CKD. Vitamins, minerals, and nutritional supplements in no way replace a good diet, but are important in maintaining nutrition and total body balance. We will discuss how vitamins and nutritional supplementation can be used in kidney disease.
 

Vitamins For Kidney Disease

THE OPTIMAL DOSAGE 

In many cases, the dosage of a particular supplement may need to be changed because of kidney disease. The dose is often reduced, but in other instances the supplement may have more benefits at higher doses. For example, Thiamine, or Vitamin B1, may reduce proteinuria at a higher-than-normal dose. The "optimal dose" of many supplements still needs to be further studied. This should only be used as a guide. Talk with your physician before making any changes in your current nutritional program.
 
THE VITAMINS
 
The following vitamins are generally safe in kidney disease; however, the dosage and frequency will depend on your stage of CKD, dietary regimen, and other medical problems. I try to have many of my patients on some combination of the vitamins listed below.
 
Natural Versus Synthetic 

Many types of vitamins and supplements are either natural or synthetic. The synthetic vitamins are harder for the body to break down and digest, whereas the more natural vitamins are easier on the stomach and better absorbed in the body. If possible, it pays to get the more natural form.

Vitamins
 
If you have been following a low-protein, vegetarian-based diet, you may need to take a vitamin B12 supplement, as it is commonly found in meat and animal products. On a vegetarian diet, you may be deficient in this vitamin. Low levels can contribute to nerve problems and anemia. As you will read below, B12 may also be important in maintaining bone health. If your doctor feels you may be deficient in this vitamin, she may order a blood test that can measure the level of B12 in the body.
 
Low levels of vitamin B9, or folic acid, may play a role in the development of atherosclerosis. If you are on a vegetarian-based diet, you do not need folic acid supplementation, as B9 is found in many leafy greens - though you may be taking a multivitamin, which will usually contain some amount of folic acid anyway. Vitamin B1, or thiamine, may help in reducing proteinuria. In one study, patients with type 2 diabetes and proteinuria were given thiamine at doses of 300 mg daily compared to a placebo group. After three months, the group taking the higher dose of thiamine experienced a decrease in the amount of proteinuria. This needs further research as the optimal dose and duration of therapy with thiamine is still unknown. However, this study suggests that higher doses of thiamine may lower the protein levels even more.
 
In a related study, it was suggested that the combination of high dose thiamine and benfotiamine (ben-fo-tya-mine) - a manufactured form of thiamine - decreased the amount of proteinuria.

The B vitamins are important regulators of homocysteine (homosis-teen), an amino acid that is associated with heart disease at high blood levels, although this connection is still somewhat controversial. There may also be an association with elevated hornocysteine levels and osteoporosis; although again, this needs more research. In one study, blood tests showing high homocysteine levels and low vitamin B12 levels were associated with an increased risk of bone fractures. Homocysteine levels can be elevated in CKD. More research is needed, but taking a B-complex vitamin daily seems reasonable pending further research into this area.

If no proteinuria is present, I would recommend taking one B-complex vitamin a day. If your vitamin B12 level as measured in the blood is low, you may need an additional daily B12 supplement. If you have diabetes and proteinuria, supplementing with thiamine at a dose of 200 or 300 mg a day (two to three tablets at 100 mg each) seems reasonable until more studies are done. If you have any type of cancer, talk to your doctor before either starting thiamine or increasing your thiamine dosage. To find out more, you can check out Vitamins For Kidney Disease.

Kidney Disease Diet Plan

Dinner Examples 

Continuing this theme, reevaluate what you are eating for dinner. Perhaps you can make some healthier selections and discover a few tasty new foods.
 
Pasta
 
Instead of spaghetti, consider trying spaghetti winter squash. 1 cup boiled squash provides 28 mg of sodium, 181 mg of potassium, 22 nag of phosphorus, and 1 g of protein. Summer squash has an even lower amount of potassium.
 

Kidney Disease Diet Plan

If you can't give up actual pasta, at least consider whole wheat or whole grain varieties. 3/4 cup of whole wheat penne pasta from Heartland contains no sodium, no potassium, only 2 g of sugar, and 7 g of protein. Another option is quinoa (keen-wa). 1/2 cup of cooked quinoa contains only 7 mg of sodium, 140 mg of potassium, and 160 mg of phosphorus. It has a very low glycemic index score and provides 4 g protein.
 
Tacos and Burritos
 
Instead of corn tortillas, consider using a brown rice tortilla when making tacos and burritos. One wheat-free, gluten-free tortilla contains only 160 mg of sodium and 95 mg of potassium. It has no sugar, about 100 to 150 mg of phosphorus, and each provides 2 g of protein. Here again, you can add vegetables of your choice depending on your potassium requirements.
 
SPECIAL CIRCUMSTANCES 

One of my reasons for espousing natural and healthy food choices in the face of kidney disease is that food can not only heal it can also hurt. For those with certain forms of nephritis or the nephrotic syndrome, these words ring very true. The following information is useful in the face of special circumstances.

Glomerulonephritis (GN) and the Nephrotic Syndrome (NS)
 
We talked in depth about the role that food allergies may have in getting GN or NS. If you have been diagnosed with one of these syndromes, your diet should be as anti-inflammatory as possible in order to remove any possible exposure to contributing factors in foods. As you read, it can be very hard to pinpoint the exact allergy. Therefore, I would strongly recommend avoiding all dairy and processed food.
 
An interesting medical article suggested that celiac disease may be more common than once thought, and it is my opinion that it may be wise to consider a gluten-free diet.
 
Acidosis 

If you have advanced CKD (stage four or five), or if your doctor says you have acidosis due to kidney disease or diabetes (this can happen here in the early stages), I would ask you to consider the use of alkalized water, plus the consumption of those vegetables that produce more alkalinity in the blood. Again, discuss all changes with your doctor before trying them. If you choose to use a pH booster, be sure you are aware of the potassium content.

There are several important take-away points, and I think they are most clear in list form. You should know a little about each of the following points:

• Blood tests are important in measuring sodium, potassium, magnesium, and protein levels.
• Dietary restrictions may be prescribed to preserve remaining kidney function
• If a fluid restriction is prescribed, you will need to keep track of fluid intake. This includes all foods that are liquid at room temperature, in addition to ice, ice cream, gelatin, gravies, sauces, and soups. Also, many fruits contain large amounts of water. 
• Read nutrition labels and also be aware of hidden sources of salt, potassium, and phosphorus. If you have access to a computer, check nutrient database sites for additional information. 
• Be vigilant with over the counter medications and make sure that your doctor is aware of all medications, herbal preparations, and vitamin and mineral supplements. 
• Be knowledgeable about alternative food choices for optimal well being and preservation of kidney function. 

Food can have the power to change your health, but only you have the power to actually make it happen. In CKD, there are many things you have to pay attention to in terms of restrictions, but you don't have to do it alone. Remember, you have a plethora of resources at your disposal, as well as your doctor and dietitian to fall back on. Talk with your doctor and dietitian about creating an individualized diet plan, as everyone's needs are different. To find out more, you can check out Kidney Disease Diet Plan.