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    The impact of high protein intake on kidney function.

    Well guys due to forum glitches I cannot include everything I wanted to type out, but at least I have a nice overall summary for myself. So here's a brief version of my thoughts, with conclusions/references in the next post:

    1. We are born with a certain number of nephrons per kidney that filter blood. Initially our glomerular filtration rate (GFR) in young adulthood is ~120 (mL/min/1.73 m^2); after age 30 this declines ~10 per decade. We are born with more than we need; if some nephrons die then others can work harder to make up for this and thus it is possible to incur a significant amount of kidney damage without having a large change in GFR. There are other measures of kidney function than just GFR (primarily the amount of protein that makes it through to the urine), but GFR is what the literature focuses on and a decrease is likely going to be an earlier sign than increased proteinuria of kidney damage from high protein. [1]

    2. It is difficult to measure GFR accurately in larger studies and the estimating formulas typically use creatinine and cystatin c, both of which can be flawed. [2]

    3. It is difficult to determine how much protein people eat. One nice compilation of 5 different validation studies found a correlation coefficient of reported and actual intake for total kcal and grams of protein to be <=0.4 (1 would be the best). [3]

    4. During pregnancy blood volume increases a lot as does GFR and this remains elevated up to 3 months post-partum. This does not seem to lead to any pathology. After having one kidney removed the other one compensates and increases its GFR (hyperfiltration); this also does not seem to lead to pathology for at least 20 years. [4]

    5. Amino acids seem to function as renal vasodilators thus allowing more bloodflow to the kidneys. Protein thus acutely increases GFR.

    6. The question is does this matter in the long term. Unfortunately, pretty much all of the large long term studies compare high and low protein where the high protein group is <1.5 g/kg/d. There are mixed findings in these studies, and questionable methodology in many due to the issues alluded to above. [5]

    7. There are shorter term studies that use higher amounts but the problem is they are shorter term. If we normally lose 10 GFR per decade and we eat a high protein diet and lose say 4 times that amount (hypothetically); we're going to have significant problems after a couple of decades. After a couple of years though there won't be much difference at all. [6] [7]

    8. Jose Antonio has published several studies on really high protein intakes in athletes; all are <=2 years so it's too soon to see significant changes. In the one study he published that was 2 years, it includes 5 people, and while he concludes that there was no change in the average creatinine levels of the 5, looking at the individual data shows the BUN values don't really line up with the reported intakes and 2 of the 5 had significant jumps in reported creatinine from year 1 to 2, which is worrisome. [8] [9]

    9. Animal studies show mixed results. Many studies in rats and dogs don't show scary effects of high protein diets but one study in pigs does. [10] [11]
    Last edited by Heisman2; 11-25-2019 at 04:33 AM.
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    So what conclusions can we draw? Sadly nothing definitive. Bottom line, there is reason to think that the short term elevations in GFR from higher protein ingestion have similarities to the states of pregnancy and nephrectomy, but we cannot conclude this definitively, and even then people are not pregnant forever and people who have a nephrectomy do ok for 20+ years but ultimately many do have worsening kidney function in some respects. Very few studies have looked at protein intakes above the “minimum” of 1.6 g/kg (0.7 g/lb) typically recommended here and none are long term. There is just no way anybody can confidently state that bodybuilding style high protein diets are definitely safe for the kidneys.

    It should be possible to study this though. Rather than check creatinine or cystatin c and estimate GFR, one could quantify the renal functional reserve (amount of renal hyperfiltration possible) before and after a high protein diet, and then again after going back down to a regular protein diet. If high protein diets cause actual kidney damage then the total renal functional reserve should go down after consuming a high protein diet and not recover when going back to a regular protein diet. That’s the study that I feel needs to be done; it has not yet to my knowledge on a >1.7 g/kg diet for 1+ years.

    1. Glassock R, Denic A, et al. The conundrums of chronic kidney disease and aging. J Nephrol. 2017.
    2. Jesudason D, Clifton P. Interpreting different measures of glomerular filtration rate in obesity and weight loss: Pitfalls for the clinician. International Journal of Obesity. 2012.
    3. Freedman L, Commins J. Pooled Results From 5 Validation Studies of Dietary Self-Report Instruments Using Recovery Biomarkers for Energy and Protein Intake. American Journal of Epidemiology. 2014.
    4. Helal I, Fick-Brosnahan G. Glomerular hyperfiltration: Definitions, mechanisms and clinical implications. Nature Reviews Nephrology. 2012.
    5. Kamper A, Strandgaard S. Long-Term Effects of High-Protein Diets on Renal Function. Annual Review of Nutrition. 2017.
    6. Elswyk M, Weatherford C et al. A Systematic Review of Renal Health in Healthy Individuals Associated with Protein Intake Above the US Recommended Daily Allowance in Randomized Controlled Trials and Observational Studies. Advanced in Nutrition. 2018.
    7. Devries M, Sithamparapillai A, et al. Changes in Kidney Function Do Not Differ between Health Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Metaanalysis. The Journal of Nutrition. 2018.
    8. Antonio J, Ellerbroek A. Case Reports on Well-Trained Bodybuilders: Two Years on a High Protein Diet. Journal of Exercise Physiologyonline. 2018.
    9. Antonio J. High-protein diets in trained individuals. Res Sports Med. 2019.
    10. Martin W, Armstrong L. Dietary protein intake and renal function. Nutrition & Metabolism. 2005.
    11. Jia Y, Hwang S. Long-Term High Intake of Whole Proteins Results in Renal Damage in Pigs. The Journal of Nutrition. 2010.
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    A high protein diet is NOT unhealthy
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    Originally Posted by armies View Post
    A high protein diet is NOT unhealthy
    Thank you for your wonderful evidence-based rebuttal. Honestly, I legit LOL'ed.

    If anyone has questions/critiques/specific studies they want my comments on, please post them. I was going to go into a lot more detail but the forum glitches were driving me crazy so I decided to keep it short and sweet.
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    Originally Posted by armies View Post
    A high protein diet is NOT unhealthy
    Wow, thanks bro. I would've hated reading all that sciencey stuff and using my own brain to make my own conclusions. That's way too much work.

    In all srsness, how hard would it be to quantify one's renal "functional reserve"? If it's in any way easy, wouldn't it seem that there must be some records somewhere on the reserve levels found in athletes who once followed a high protein diet that we could compare to the gen. pop? Is it something that's rarely if ever tested?
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    Originally Posted by Heisman2 View Post
    Very few studies have looked at protein intakes above the “minimum” of 1.6 g/kg (0.7 g/lb) typically recommended here and none are long term. There is just no way anybody can confidently state that bodybuilding style high protein diets are definitely safe for the kidneys. ... That’s the study that I feel needs to be done; it has not yet to my knowledge on a >1.7 g/kg diet for 1+ years.
    Sorry if I didn't read it carefully enough, but based on what you read, you're saying you consider even 0.7g/lb to be high protein intake that could be unsafe and that should be studied?
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    Han shot first! TolerantLactose's Avatar
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    Originally Posted by air2fakie View Post
    Sorry if I didn't read it carefully enough, but based on what you read, you're saying you consider even 0.7g/lb to be high protein intake that could be unsafe and that should be studied?
    That number is based on general dietary guidelines.

    Imo, fear about high protein diets is overblown. I believe that fear evolved from the basic urinalysis which typically includes detection of protein. High levels of protein in urine indicates kidney dysfunction. It doesn't necessarily follow that protein caused that dysfunction. An analogy would be to find a pool of oil under your car. It indicates you may have a leaky gasket somewhere. It doesn't mean the oil caused the leak. That's my bro take.
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    Awesome post.

    So if it turns out that 1g/lb/day causes long-term damage--what kind of outcomes do you think we could expect down the line? Similar to other renal disorders?

    Originally Posted by Heisman2 View Post
    ... there is reason to think that the short term elevations in GFR from higher protein ingestion ...
    How are you coming to the conclusion that the elevation in GFR is short-lived? Or do you just mean that GFR will eventually nose-dive if high protein intake does indeed damage the kidneys? Would love to read any links you have on whether or not the elevation is transient.

    Originally Posted by Heisman2 View Post
    Very few studies have looked at protein intakes above the “minimum” of 1.6 g/kg (0.7 g/lb) typically recommended here and none are long term. There is just no way anybody can confidently state that bodybuilding style high protein diets are definitely safe for the kidneys.
    I've always found the Korean bodybuilder study compelling in this regard because it can be assumed that they had extremely high protein intake for a long time prior to the study. That study was complete dog****, but what I found interesting was the hypothesis that extreme resistance training offsets the negative effects of extreme protein intake. The whole idea just doesn't fit with the modern theory of exercise-induced acidosis.

    Originally Posted by Heisman2 View Post
    Rather than check creatinine or cystatin c and estimate GFR, one could quantify the renal functional reserve (amount of renal hyperfiltration possible) before and after a high protein diet ...
    I'm a bit out of my depth here, but isn't GFR required to quantify renal functional reserve? Are you saying that we should be focusing on the change to GFR, and not the absolute value of it?
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    Originally Posted by TolerantLactose View Post
    That number is based on general dietary guidelines.

    Imo, fear about high protein diets is overblown. I believe that fear evolved from the basic urinalysis which typically includes detection of protein. High levels of protein in urine indicates kidney dysfunction. It doesn't necessarily follow that protein caused that dysfunction. An analogy would be to find a pool of oil under your car. It indicates you may have a leaky gasket somewhere. It doesn't mean the oil caused the leak. That's my bro take.
    Heisman2 can probably correct me if I'm wrong, but I think the root issue caused by excessive protein intake is metabolic acidosis (imbalanced pH). Being in an acidic state places a load on the kidneys that eventually "busts the gasket" according to your analogy. So it'd be like the motor oil is too acidic and yeah, that needs to be addressed, but now the kidney gasket is busted too.
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    Pardon my ignorance on the topic but I do have a couple questions from your numbered items:

    1. "We are born with a certain number of nephrons per kidney that filter blood. Initially our glomerular filtration rate (GFR) in young adulthood is ~120 (mL/min/1.73 m^2); after age 30 this declines ~10 per year. We are born with more than we need; if some nephrons die then others can work harder to make up for this and thus it is possible to incur a significant amount of kidney damage without having a large change in GFR... but GFR is what the literature focuses on and a decrease is likely going to be an earlier sign than increased proteinuria of kidney damage from high protein"

    If we have 120, and this drops by ~10/year... then... wouldn't we have 0 in 12 years? I'm confused by this number. Also, why does a kidney working 'harder' necessarily mean it'll be damaged?

    Also, looking at the last sentence where you said that a decrease may be an early sign of kidney damage, doesn't that conflict with the below statement in 4 & 5 where a rise seems to indicate an issue?




    4. "During pregnancy blood volume increases a lot as does GFR and this remains elevated up to 3 months post-partum. This does not seem to lead to any pathology. After having one kidney removed the other one compensates and increases its GFR (hyperfiltration); this also does not seem to lead to pathology for at least 20 years. [4]"

    5. "Amino acids seem to function as renal vasodilators thus allowing more bloodflow to the kidneys. Protein thus acutely increases GFR."

    So from the above, it seems like having a HIGH GFR is actually a negative thing correct?


    8. "Jose Antonio has published several studies on really high protein intakes in athletes; all are <=2 years so it's too soon to see significant changes. In the one study he published that was 2 years, it includes 5 people, and while he concludes that there was no change in the average creatinine levels of the 5, looking at the individual data shows the BUN values don't really line up with the reported intakes and 2 of the 5 had significant jumps in reported creatinine from year 1 to 2, which is worrisome."

    Why is this observation worrisome? What does the BUN not 'lining up' mean?
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    Han shot first! TolerantLactose's Avatar
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    Originally Posted by rtpmarine View Post
    Heisman2 can probably correct me if I'm wrong, but I think the root issue caused by excessive protein intake is metabolic acidosis (imbalanced pH). Being in an acidic state places a load on the kidneys that eventually "busts the gasket" according to your analogy. So it'd be like the motor oil is too acidic and yeah, that needs to be addressed, but now the kidney gasket is busted too.
    It depends. Part of the job of the kidneys (and the lungs) is to maintain blood pH.
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    Originally Posted by Heisman2 View Post
    So what conclusions can we draw? Sadly nothing definitive.
    That about sums it up.

    I would note that many of the higher recommendations of protein consumption are such that the person could not get it all from food without blowing out calories and their toilet bowl, and so must get it from protein powder. And these higher recommendations come from individuals associated with companies selling protein powders. This is probably not a coincidence.

    When my lifters ask if they should get protein powder or not, I say: "You should start by eating good food in line with government health recommendations, if that turns out not to be enough then sure, go for it." I have yet to see anyone completely follow the recommendations. It's actually a lot of food - and gives 80-100g daily protein for most selections, up to 180g if you really want to.
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    Heisman, thanks for the post. The forum glitch is annoying. Can you post your full text in an attachment?
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    Definitely not unhealthy. Look at it subjectively. If you consider what serious lifters are doing to their bodies to achieve their goals, nothing about it is healthy. Considering you're posting on a bodybuilding forum and not a forum made for people trying to live to 140, your argument is near moot.
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    I imagine he meant 10/decade, AdamWW
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    Originally Posted by Strawng View Post
    Wow, thanks bro. I would've hated reading all that sciencey stuff and using my own brain to make my own conclusions. That's way too much work.

    In all srsness, how hard would it be to quantify one's renal "functional reserve"? If it's in any way easy, wouldn't it seem that there must be some records somewhere on the reserve levels found in athletes who once followed a high protein diet that we could compare to the gen. pop? Is it something that's rarely if ever tested?
    Correct, historically rarely tested and not used in clinical practice as far as I know. There's at least one author who's published a bit on this in recent years (see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678605/). There's no doubt in my mind this could be used right now in a research setting for this purpose.

    Originally Posted by air2fakie View Post
    Sorry if I didn't read it carefully enough, but based on what you read, you're saying you consider even 0.7g/lb to be high protein intake that could be unsafe and that should be studied?
    Correct. The RDA is 0.8 g/kg (~0.36 g/lb). Many studies consider anything over this to be "high protein". Most of the studies done thus far either longitudinally for many years or as cohort studies (so also for many ears) do not consider protein intake >1.5 g/kg. The metaanalysis by Stu Phillips above has many studies that go over the recommended minimum here but none of those are longer than 2 years.

    Let's say that hypothetically our GFR goes down 10 in 10 years normally. Now with a high protein diet of 1 g/lb per day, it goes down 20 in 10 years. That can make a significant difference down the road. Over a 2 year timespan though, our GFR may only go down by 4 instead of 2. If we are starting with good kidneys that will make no difference in how we feel physically, no big difference in our health, and regular measures of kidney function such as creatinine and cystatin c are not going to be precise/sensitive enough to pick up a difference. So we may be able to confidently say that for a 2 year time span we don't go from having normal kidneys to clinically damaged kidneys that impacts our health but there is no way to confidently extrapolate that over decades.

    Originally Posted by TolerantLactose View Post
    That number is based on general dietary guidelines.

    Imo, fear about high protein diets is overblown. I believe that fear evolved from the basic urinalysis which typically includes detection of protein. High levels of protein in urine indicates kidney dysfunction. It doesn't necessarily follow that protein caused that dysfunction. An analogy would be to find a pool of oil under your car. It indicates you may have a leaky gasket somewhere. It doesn't mean the oil caused the leak. That's my bro take.
    Actually the general guidelines are at least 0.36 g/lb. The 0.7 number comes from this: https://bjsm.bmj.com/content/52/6/376

    I actually like the car oil analogy for your example. However, the fear in the research/clinical world evolved form an increase in GFR, not an induction of proteinuria. The big question is whether or not the increase in GFR is physiologic (as it seems to be with pregnancy and just a normal adaptive response to increased amino acid intake) or pathologic, or perhaps physiologic to a point but then when protein levels get high enough it becomes pathologic.
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    Originally Posted by rtpmarine View Post
    Awesome post.

    So if it turns out that 1g/lb/day causes long-term damage--what kind of outcomes do you think we could expect down the line? Similar to other renal disorders?
    Yes, depending on the amount of damage. Essentially we may develop chronic kidney disease and all of the associated complications.

    How are you coming to the conclusion that the elevation in GFR is short-lived? Or do you just mean that GFR will eventually nose-dive if high protein intake does indeed damage the kidneys? Would love to read any links you have on whether or not the elevation is transient.
    The elevation is definitely transient with acute protein intake; this has been known for decades. Actually a lot of people state the "Brenner hypothesis" as the first author to really posit that higher protein may be damaging (his paper was published in 1983). People in the "high protein is not bad" camp consider the increase to be physiologic (similar to pregnancy) and thus not worrisome. I linked this above in the last post but this article discussing renal stress testing goes over this some as to test renal function reserve one of the methods to do so would be to give a protein bolus and then see how much higher the GFR gets: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678605/

    I've always found the Korean bodybuilder study compelling in this regard because it can be assumed that they had extremely high protein intake for a long time prior to the study. That study was complete dog****, but what I found interesting was the hypothesis that extreme resistance training offsets the negative effects of extreme protein intake. The whole idea just doesn't fit with the modern theory of exercise-induced acidosis.
    Could you provide a link to the Korean bodybuilder study? Do you mean this one? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142197/ The problem here is the are all young (age 18 to 25) and it'll probably take longer than that to see significant damage.

    I'm a bit out of my depth here, but isn't GFR required to quantify renal functional reserve? Are you saying that we should be focusing on the change to GFR, and not the absolute value of it?
    GFR is required. If you read the above link on renal stress testing I think it will make sense. Let me know if not. Basically you can have substantial kidney damage without a significant change in GFR, however you may have a difference in the maximal possible GFR via hyperfiltration. Point is that testing for hyperfiltration may be more sensitive than an actual change in GFR to indicate kidney damage from loss of functioning nephrons.

    Originally Posted by rtpmarine View Post
    Heisman2 can probably correct me if I'm wrong, but I think the root issue caused by excessive protein intake is metabolic acidosis (imbalanced pH). Being in an acidic state places a load on the kidneys that eventually "busts the gasket" according to your analogy. So it'd be like the motor oil is too acidic and yeah, that needs to be addressed, but now the kidney gasket is busted too.
    There is definitely some indication that higher acid load (as typically seen with animal protein) may be more damaging than a non-acidic protein load (typically seen from fruits/vegetables), but thus far this seems more consistent in chronic kidney disease than it does in healthy kidneys and there is a good amount of confounding with lifestyles so it's hard to state this confidently. In several but not all studies vegetable protein seems to be less damaging than animal protein, but also keep in mind that most people eat a lot more animal protein than vegetable protein so there could be a threshold effect at play.

    However the concern is actually moreso the increase in GFR induced by protein (as some of the amino acids are vasodilators, thus allowing more blood to flow to the kidneys and thus more filtration to occur) as opposed to the general acid load (when the kidneys are healthy). If you're particularly interested in the acid/base aspects I can post some links for that.
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    Originally Posted by AdamWW View Post
    Pardon my ignorance on the topic but I do have a couple questions from your numbered items:

    1. "We are born with a certain number of nephrons per kidney that filter blood. Initially our glomerular filtration rate (GFR) in young adulthood is ~120 (mL/min/1.73 m^2); after age 30 this declines ~10 per year. We are born with more than we need; if some nephrons die then others can work harder to make up for this and thus it is possible to incur a significant amount of kidney damage without having a large change in GFR... but GFR is what the literature focuses on and a decrease is likely going to be an earlier sign than increased proteinuria of kidney damage from high protein"

    If we have 120, and this drops by ~10/year... then... wouldn't we have 0 in 12 years? I'm confused by this number. Also, why does a kidney working 'harder' necessarily mean it'll be damaged?

    Also, looking at the last sentence where you said that a decrease may be an early sign of kidney damage, doesn't that conflict with the below statement in 4 & 5 where a rise seems to indicate an issue?
    I definitely meant to write 10 per decade and not 10 per year. Thanks for catching that. A kidney working harder does not necessarily mean it will be damaged. That's what the big debate is about; in pregnancy they definitely work harder but don't seem to become damaged. My point with the above though is that if you have 1 million but only need 500,000 to be healthy, then you can develop quite a bit of damage (say 100,000 become damaged) without actually detecting a significant change in how you feel or on laboratory tests. A bit of an oversimplification but we are born with a buffer. That's why GFR can decline 10 per decade or so and us not have any clinical effects until really old age.

    Regarding a decrease or an increase of GFR indicating damage, this is a key concept. Imagine you start with 1 million nephrons and have a GFR of 120. Now you eat a large protein meal and they work harder; thus for the next several hours your GFR goes up to 150-160 or so. Now imagine you do this over and over again for year on end. This may or may not damage the nephrons; if it does then slowly over time they will incur more and more damage and not be able to increase the GFR as much. So slowly over time you lose some of the nephrons and your GFR goes down to say 110, and now in response to the high protein meal your GFR only goes up to the 140-145 range. So protein will still make it go up some acutely (assuming you still have relatively healthy kidneys) but in the long term it will make it go down at baseline (if it actually causes kidney damage)

    4. "During pregnancy blood volume increases a lot as does GFR and this remains elevated up to 3 months post-partum. This does not seem to lead to any pathology. After having one kidney removed the other one compensates and increases its GFR (hyperfiltration); this also does not seem to lead to pathology for at least 20 years. [4]"

    5. "Amino acids seem to function as renal vasodilators thus allowing more bloodflow to the kidneys. Protein thus acutely increases GFR."
    So from the above, it seems like having a HIGH GFR is actually a negative thing correct?

    Possibly; again this is the big question. For pregnancy it doesn't seem to be negative. For a pathologic state such as diabetes and obesity it does seem to be negative. For really high protein diets, we just don't have the data to know for sure.

    8. "Jose Antonio has published several studies on really high protein intakes in athletes; all are <=2 years so it's too soon to see significant changes. In the one study he published that was 2 years, it includes 5 people, and while he concludes that there was no change in the average creatinine levels of the 5, looking at the individual data shows the BUN values don't really line up with the reported intakes and 2 of the 5 had significant jumps in reported creatinine from year 1 to 2, which is worrisome."

    Why is this observation worrisome? What does the BUN not 'lining up' mean?
    When we at more protein that gets metabolized in the body and one of the byproducts of this is an increase in BUN. Thus for people who are eating more protein their BUN typically goes up. So I would expect under the same study conditions that if someone eats more protein their BUN measurement will go up some. It's just puzzling to me that the BUN did not trend well with the protein intake in some subjects. Maybe that could happen if you stop eating high protein for a couple of days and then test but assuming uniform testing conditions/hydration status/overall lean body mass there shouldn't be a big variability.

    The big increase in the creatinine is worrisome. Numbers from the 5 subjects (the numbers are baseline/year 1/year 2, looking at grams of protein per day, then BUN, then creatinine):

    1. 138/217/255, 33/24/26, 1.44/1.46/1.30 - the BUN is going down despite an increase in protein intake. The creatinine goes down which is good but that doesn't seem physiologic as kidney function doesn't typically improve over time (unless getting over a disease process of some sort or perhaps hopping off special vitamins?)
    2. 193/278/285, 26/12/16, 0.97/0.90/1.02 - again unclear to me why BUN went down
    3. 395/524/562, 25/33/34, 1.26/1.02/1.50 - BUN goes up as expected and the creatinine jumped way up from 1.02 to 1.50 between year 1 and 2; that is worrisome in my opinoin
    4. 184/250/222, 18/12/19, 0.95/0.85/1.30 - unclear why BUN went down year 2, here the creatinine jumped way up from 0.85 to 1.30 between year 1 and 2; that is also worrisome in my opinion
    5. 163/198/200, 18/23/31, 1.25/1.18/1.13 - nothing worrisome here; the creatinine trends downwards but this range is will within measurement variability



    I have to go to work; I'll respond to more later. If there are any other typos in the first post and it gets to a point where I cannot edit it I'll ask a mod to do it.
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    Originally Posted by Heisman2 View Post
    The elevation is definitely transient with acute protein intake; this has been known for decades. Actually a lot of people state the "Brenner hypothesis" as the first author to really posit that higher protein may be damaging (his paper was published in 1983). People in the "high protein is not bad" camp consider the increase to be physiologic (similar to pregnancy) and thus not worrisome. I linked this above in the last post but this article discussing renal stress testing goes over this some as to test renal function reserve one of the methods to do so would be to give a protein bolus and then see how much higher the GFR gets: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678605/
    Gotcha--I misunderstood your first post as saying that the body will respond to chronic, sustained excessive protein with an eventual attenuation of the acute GFR increase (possibly as an adaptive mechanism).

    Originally Posted by Heisman2 View Post
    Could you provide a link to the Korean bodybuilder study? Do you mean this one? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142197/ The problem here is the are all young (age 18 to 25) and it'll probably take longer than that to see significant damage.
    Yeah, that's the one. It's not worth much when it comes to the question at hand, but they did make a reasonable case for the idea that resistance training and calcium/potassium supplementation can minimize the health impacts of high protein intake. I'd categorize this in the "bucket of stuff that would be nice to study more".

    Thanks for the link to PMC5678605. Definitely helps make sense of the dynamics.
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    Originally Posted by TolerantLactose View Post
    It depends. Part of the job of the kidneys (and the lungs) is to maintain blood pH.
    Correct. The kidneys do a lot of things, including help regulate acid/base balance in the body, reabsorb a bunch of nutrients that would otherwise be lost in urine, produce EPO to help stimulate red blood cell production, play a role in vitamin D metabolism, get rid of toxins, help regulate blood pressure, etc. The kidneys are actually pretty complex but also really interesting from a physiology standpoint. For others who are curious, the lungs do help influence acid/base acutely (example: if you blow up a lot of balloons without a break you'll be hyperventilating. This can cause a respiratory alkalosis; you may actually feel this if you get numbness/tingling around your lips as when your blood gets more basic a greater amount of calcium binds to albumin and the hypocalcemia (low blood calcium) can cause numbness/tingling) as well as chronically (patients with COPD are commonly acidotic as they have trouble blowing off all of the CO2 they generate), and one of the jobs of the kidneys is to compensate for these alterations.

    Originally Posted by HanleyTucks View Post
    That about sums it up.

    I would note that many of the higher recommendations of protein consumption are such that the person could not get it all from food without blowing out calories and their toilet bowl, and so must get it from protein powder. And these higher recommendations come from individuals associated with companies selling protein powders. This is probably not a coincidence.

    When my lifters ask if they should get protein powder or not, I say: "You should start by eating good food in line with government health recommendations, if that turns out not to be enough then sure, go for it." I have yet to see anyone completely follow the recommendations. It's actually a lot of food - and gives 80-100g daily protein for most selections, up to 180g if you really want to.
    Agreed most people (without medical conditions/vegans/etc) can get plenty of protein from whole foods. It is also interesting to consider just how much of the consumed protein is utilized; we know that a decent amount does get sequestered in the splanchnic circulation and then oxidized/excreted. I'm not sure any studies look at this at really high intake levels; I'll need to look into this more to figure that one out.

    Originally Posted by Mrpb View Post
    Heisman, thanks for the post. The forum glitch is annoying. Can you post your full text in an attachment?
    That does seem like a wise idea. When I get home tonight I'll do that.

    Originally Posted by Vampirelol View Post
    Definitely not unhealthy. Look at it subjectively. If you consider what serious lifters are doing to their bodies to achieve their goals, nothing about it is healthy. Considering you're posting on a bodybuilding forum and not a forum made for people trying to live to 140, your argument is near moot.
    I'm fairly confident most of us here are trying to be pretty healthy. Most of us are not competing, are not using special supplements, etc. Now if the point is that for actual competitive bodybuilders who use a lot of special supplements and put their bodies through the stress of competing probably don't need to worry much about the additional negative effect of high protein consumption; I agree that is probably is not going to be the thing that really drives them to poor health down the road. For those of us who want to take a science-based approach to the topic of nutrition and have a decent physiological understanding of how to balance the various variables we can play with to help achieve all of our goals (appearance, performance, health, etc), it's another piece of the puzzle, and may make a difference later in life.

    Originally Posted by Hnbn1 View Post
    I imagine he meant 10/decade, AdamWW
    Correct, thanks for pointing that out.
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    Originally Posted by Heisman2 View Post
    Correct. The RDA is 0.8 g/kg (~0.36 g/lb). Many studies consider anything over this to be "high protein". Most of the studies done thus far either longitudinally for many years or as cohort studies (so also for many ears) do not consider protein intake >1.5 g/kg. The metaanalysis by Stu Phillips above has many studies that go over the recommended minimum here but none of those are longer than 2 years.
    Since there are prob many studies about the effect of higher protein intake on muscle growth - many of which I'm guessing you also read - is there a general consensus on the approximate percentage of improvement in muscle growth between the RDA of ~0.36 g/lb v. goals of 0.7g/lb, 1g/lb, 1.5g/lb, etc.?

    In other words, how much is the benefit of our higher protein diets given the potential risk of renal disorders? Risk v. reward.
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    Protein is alright! Gosh! smh, you all need to relax!
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    Originally Posted by armies View Post
    Protein is alright! Gosh! smh, you all need to relax!
    No one's freaking out or flushing their protein powder down the toilet, we're just discussing the topic. :P
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    Originally Posted by armies View Post
    A high protein diet is NOT unhealthy
    Originally Posted by armies View Post
    Protein is alright! Gosh! smh, you all need to relax!
    Instead of randomly posting your opinion, try posting some references that can shed a different light on the discussion.
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    Originally Posted by Heisman2 View Post

    I have to go to work; I'll respond to more later. If there are any other typos in the first post and it gets to a point where I cannot edit it I'll ask a mod to do it.
    Thanks very much for the info here.

    So on the subject of flags to look for in blood work, what would be the best method of establishing kidney function in terms of what's readily available?

    For example, if we know a higher protein intake can raise BUN, should be then consider a slightly higher level to be 'OK'?

    Or, would it only seem benign if other factors (ie: creatinine) were in normal range?

    From what I recall, my most recent BUN test last year was only slightly high (23 with a ref range of <20 being 'normal'), but my creatinine, etc, is all in range.
    Last edited by AdamWW; 11-25-2019 at 01:39 PM.
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    How many people a year suffer renal failure due to a high protein diet?

    How big was the study?

    What were the ages, sex, race, nationality, income, level of activity of study participants?

    Do any of the people studied have existing co-morbidities? Did they develop new co-morbidities?
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    Well whatever "high" protein does to possibly cause pathology, there is no way I'd eat RDA suggested amount of 58g/day (for my weight) to offset possible future pathology, so I'll guess whatever happens in the future, happens

    C'est la vie

    Thank you Heisman for the excellent write up here
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    Originally Posted by air2fakie View Post
    Since there are prob many studies about the effect of higher protein intake on muscle growth - many of which I'm guessing you also read - is there a general consensus on the approximate percentage of improvement in muscle growth between the RDA of ~0.36 g/lb v. goals of 0.7g/lb, 1g/lb, 1.5g/lb, etc.?

    In other words, how much is the benefit of our higher protein diets given the potential risk of renal disorders? Risk v. reward.
    The 0.7 number comes from here: https://bjsm.bmj.com/content/52/6/376 . Scroll down to figure 5. You'll see there is a lot of variability. Because of that it's really hard to say. While maintaining/bulking you may get faster results with higher intake but you should be able to make steady progress with well under 0.7 if I had to guess. While cutting I'd be cautious of cutting the protein too low if the goal is to maintain as much muscle as possible and you plan to cut to a low bodyfat percentage. A reasonable strategy would be to keep protein high while cutting (as you shouldn't be cutting for a large percentage of your life) to aid lean body mass retention/satiety and then to lower it while maintaining/bulking.

    Originally Posted by AdamWW View Post
    Thanks very much for the info here.

    So on the subject of flags to look for in blood work, what would be the best method of establishing kidney function in terms of what's readily available?

    For example, if we know a higher protein intake can raise BUN, should be then consider a slightly higher level to be 'OK'?

    Or, would it only seem benign if other factors (ie: creatinine) were in normal range?

    From what I recall, my most recent BUN test last year was only slightly high (23 with a ref range of <20 being 'normal'), but my creatinine, etc, is all in range.
    I definitely would not worry about BUN if creatinine is fine. If your creatinine is fine then you should be good. If you're worried about kidneys a urinalysis is also helpful to determine if there is protein in the urine. For people with a decent amount of muscle mass if the creatinine is high it will be worth checking a cystatin c as muscle mass should not affect this.

    Originally Posted by AutistTrigger View Post
    How many people a year suffer renal failure due to a high protein diet?

    How big was the study?

    What were the ages, sex, race, nationality, income, level of activity of study participants?

    Do any of the people studied have existing co-morbidities? Did they develop new co-morbidities?
    There's no good way to answer those questions. There is a fairly large consensus that high protein diets for people with chronic kidney disease can accelerate damage to renal failure. There have been several studies that show this; I didn't get into this above as I was mostly focusing above on people with healthy kidneys, not with chronic kidney disease. If you are actually interested I can link several other things to read.

    Originally Posted by boo99 View Post
    Well whatever "high" protein does to possibly cause pathology, there is no way I'd eat RDA suggested amount of 58g/day (for my weight) to offset possible future pathology, so I'll guess whatever happens in the future, happens

    C'est la vie

    Thank you Heisman for the excellent write up here
    "RDA" is tricky. It comes primarily from nitrogen balance studies that show the 0.8g/kg number should be good for ~97.5% of people. A lot of people think RDA means maximum but really it should be considered a minimum in this case. How high about that minimum is safe is unclear. A lot of people think the RDA should be higher for elderly people (closer to 1.0-1.2 g/kg), and most of the studies looking at "high protein" intakes of 1.0-1.5 g/kg longitudinally don't find that much damage, so I think you can safely go quite a bit above the RDA without any concerns. I just don't know about the 2.0+ g/kg intakes that a lot of the sports world uses for an extended period of time.


    I've attached a more expanded version of the above that I would have put here had it not been for the glitches. This expanded version still doesn't include everything I read but it should be comprehensive enough to get the points across without being too much.
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    Originally Posted by Heisman2 View Post


    I definitely would not worry about BUN if creatinine is fine. If your creatinine is fine then you should be good. If you're worried about kidneys a urinalysis is also helpful to determine if there is protein in the urine. For people with a decent amount of muscle mass if the creatinine is high it will be worth checking a cystatin c as muscle mass should not affect this.

    Yeah my urinalysis showed no detectable protein, so no worries there.
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    Originally Posted by boo99 View Post
    Well whatever "high" protein does to possibly cause pathology, there is no way I'd eat RDA suggested amount of 58g/day (for my weight) to offset possible future pathology, so I'll guess whatever happens in the future, happens
    RDAs generally represent minimums to avoid nutrient deficiencies, not maximums to avoid ill effects.

    Unless the person is vegan or elderly, it's rare to find a Westerner who is protein deficient. Deficient in various micronutrients like vitamin C or D, or things like fibre, sure. But not in protein.

    Only 4% of Western adults get the recommended 3 cups of vegies a day. Almost nobody follows the official government guidelines, and if they did they certainly would not have deficiencies, absent chronic disease. And indeed they can follow those guidelines and get nutrition sufficient to gain muscle mass while lifting, etc. Even if high levels of protein are damaging in some way, people will only get that high either by eating absurd amounts of meat, or creating expensive urine with supplements. If they just have their 3 cups of vegies, 3 serves of meat/fish, etc daily, they won't get stupidly high intakes.

    Of course, if people just eat good food then there are a lot of supplement companies which would go under. Thus the advertising and convincing people they need this stuff.
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