Protein Recommendations for CKD and Diabetes

For people with chronic kidney disease who are not on dialysis, a lower protein diet is typically a common recommendation. In contrast, when people research how to eat for Type 2 diabetes, they often read that they should be eating more protein, or following a high protein diet like Atkins or other popular low carb diets. These are obviously conflicting messages and it can make it really frustrating to try and figure out which one to prioritize.

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Let’s see if we can break this down and figure out what people with CKD and Type 2 Diabetes should be doing.

How much protein should people with diabetes eat?

According to the American Diabetes Association’s 2023 Standards of Care in Diabetes, “evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for people with diabetes”.

What that means is that there is no official recommendation for how much protein to eat with diabetes. The official guidelines don’t recommend a high protein diet, a low protein diet, a moderate protein diet….they don’t have a recommendation at all!

The reason they don’t have a recommendation is because there is not enough good scientific research out there for them to say one way or another.

Will protein help control your blood sugars?

Research shows that people who reduce their carbohydrate intake and increase their protein intake will see a reduction in their blood sugars after meals, however people who eat a high protein diet may not see improvements in their fasting or overnight blood sugar numbers.

This suggests that high protein diets may not improve insulin sensitivity and could possibly worsen insulin resistance, which means that a high protein diet may make it harder for you to control your diabetes in the long term.

Protein stimulates insulin secretion similar to carbohydrates. High levels of insulin in your body can cause insulin resistance, which may explain why people who follow high protein diets continue to have insulin resistance despite eating less carbohydrate.

Protein contributes to metabolic acidosis, and metabolic acidosis can also cause insulin resistance to worsen. People with CKD are at increased risk of developing metabolic acidosis because their kidneys are no longer able to help neutralize acid as efficiently as they could when they were fully functioning. This is another reason that a higher protein diet may not be good for people with CKD and diabetes.

How much protein should someone with CKD and Diabetes eat?

Too much protein can put pressure on your kidneys and contribute to a more rapid decline in kidney functions. Too much protein can also cause metabolic acidosis, which can also cause damage to your kidneys.

The KDOQI guidelines recommend that people with CKD and Diabetes whote are not on dialysis aim for 0.6 – 0.8g of protein per kilogram of body weight per day to help maintain a stable nutrition status and optimize glycemic control.

There are a few things to keep in mind with this recommendation:

  1. This calculation does not typically use your actual body weight to determine protein needs. Most healthcare providers and dietitians will use a standardized weight or adjusted body weight to determine protein needs.
  2. The guidelines recommend that you be closely supervised with following a lower protein diet. Your dietitian can help you determine the right amount of protein is based on your medical history.
  3. The upper range of the recommendation – 0.8g per kg per day – is the same as the Recommended Daily Allowance for protein for the general population, so this is not technically a low protein diet. However, it may be a lower amount of protein compared to what you are currently eating. The upper range of 0.8g per kg is also the amount recommended by the Diabetes Standards of Care in Diabetes.
  4. There are different types of protein and different types will affect your CKD and your diabetes in different ways.

The exact amount of protein that is recommended for individuals with CKD and Diabetes will vary based on the individual.

Don’t confuse grams of protein with grams of food.

Once a healthcare provider has given you a target amount of protein to eat, be sure you understand what that means.

For example, let’s say that your dietitian recommended 60g of protein per day for you. Some people mistakenly thing that this means they can only have 60g of a high protein food, such as chicken.

If the only protein you eat is from 60g of chicken thigh, then you would not be meeting your protein needs. While chicken is considered a very high protein food, it is not 100% protein.

A 60g portion of chicken thigh would contain 40g of water, less than 15g of protein, and around 5g of fat. When adding up your protein intake for the day, be sure to count up the grams of protein in your food and not the total weight of the food item.

Are certain kinds of protein better than others?

More and more research is pointing to plant proteins being more healthful for people with CKD. Protein can be found in many different plant based foods including beans, nuts, seeds, whole grains, and even vegetables.

Getting your protein from plant sources has a number of benefits:

  • Improved blood pressure
  • Improved Phosphorus control
  • Improved gut microbiome
  • Improved control of metabolic acidosis
  • Improved diabetes outcomes
  • Reduced risk of constipation
  • Easier to follow a lower protein diet

Will a lower protein diet make it difficult to lose weight?

One concern that many people with diabetes and CKD have is that a lower protein diet will make it difficult to lose weight.

For people who are significantly overweight and have diabetes, it is often recommended to lose weight to improve insulin sensitivity as well as blood pressure and cholesterol levels.

In my experience, individuals who follow a well balanced kidney friendly diet are still able to lose weight if they want to. The two biggest barriers that I see with weight loss in people who start following a lower protein diet are:

  1. People cut out protein foods and replace the calories with highly processed carbohydrates. Highly processed carbohydrates will not only cause your blood sugars to increase, but they will interfere with your body’s hunger and fullness signals leading you to overeat.
  2. People simultaneously cut out healthy foods like non-starchy vegetables, beans, whole grains, and fruits that they mistakenly believe are not allowed on a kidney friendly diet.

When lowering your protein intake, it is important to add in foods to your diet that will help you reach your diabetes and kidney goals.

Where can I find more information on the CKD + Diabetes diet?

Sign up for our FREE newsletter! We offer tons of helpful nutrition tips specifically for people who have CKD and diabetes, created by a Registered Dietitian that is also a board certified specialist in kidney nutrition. You can sign up by filling out the form at this link.

We also offer in depth online courses, including a full course on CKD + Diabetes Nutrition to help you better understand how to manage your conditions.

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