I had a post going about my experience with Crossfit last weekend, but another issue was brought to my attention this week, and I wanted to share and elaborate on this topic.
Keeping with patient confidentiality, I will not divulge the identity of this particular young man to whom this story pertains. In fact, he’s not my patient at all, just a story I was privy to. Let’s call him “AJ.” And if AJ happens to be reading this, pay special attention to the facts. You may want to bring them up at your next check up.
AJ is an 18 year old Caucasian male who presented with pain in his lower right abdomen, pelvis, and testicle. He reported blood in his urine, and dark urine. This has been going on intermittently for the past 4 months or so, but the pain recently has gotten much worse. After going to the ER, the urinalysis and CT scans were both unremarkable, except for the fact that his left kidney sits lower than the right (called an ectopic kidney). I was told it is actually sitting within the pelvic bowl. According to the The National Kidney and Urologic Diseases Information Clearinghouse (1), an ectopic kidney usually has no complications, and is often discovered incidentally, like it was this time. At this point, we would conclude that the ectopic kidney is not an issue as he has lived his whole life without any other complications and without experiencing this before. Also, his pain is on the right side, and the ectopic kidney is on the left, so that would be an unlikely presentation.
AJ has no family history of kidney issues. His own personal history includes bilateral hernia repair when he was an infant, and no other big illnesses or surgeries pertinent. He has always been very active in sports, and weight lifts regularly.
Now, this is where mainstream medicine and “alternative medicine” part ways. After going to the ER, getting antibiotic for the ER doctor’s best guess of a kidney infection, he went to a urologist for a follow up. He was told that he is completely normal and to drink more water. If anything, he may have passed a kidney stone or two, but there’s no way to be sure at this point. When asked by AJ if ingesting too much protein could contribute to this, the urologist shrugged off the suggestion with a quick “no” and in response suggested a few, random mineral supplements to take.
After ruling out major complications (infection, pyelonephritis, kidney damage), my next question is “What does your diet look like? What kind of medications are you on? How often do you work out? How much protein do you consume daily?”
The following paragraph is a little science-y, meaning some technical terms. I’ll break it all down for you in the next paragraph, if you get lost in this one: It is a common conception that high protein metabolism will damage the kidneys. By metabolism, I mean either eating and digesting, or muscle repair following strenuous activity. Though rare, this is documented in endurance athletes that are dehydrated and performing strenuous activity that they may experience acute kidney failure or damage (2). However, in strength training, kidney damage due to exercise and protein ingestion is not totally confirmed. In fact, there has been much dissent on the topic due to conflicting research, some of which showing human subjects consuming upward of 3g per kg of body weight without any adverse effects (3). In animal models fed high protein diets and subjected to weight-resistance activity, adverse renal effects were observed by measuring glomerular filtration rate, urea excretion, and examining histological samples of the kidney itself showing more scarring and fibrosis (4).
What does that all mean? Sports scientists and nutritionists together cannot agree on the effects of consuming a high protein diet combined with strenuous activity. What we do know is this–the kidneys work to balance the protein, water, and minerals in your blood and to make urine. If an unnatural stress is placed on the kidneys, say high levels of protein, the kidneys have to work harder to filter and maintain the right water balance. The kidneys may be able to do this without any issue, especially in a young, healthy, active man. However, let’s say there isn’t enough water to offset the increase in protein, or buffering minerals are in short supply to help bring down the pH generated by metabolizing more protein–then the kidney may falter. It’s like the game Jenga–you can only remove so many pieces before the structure is compromised and it begins to fail. This model is ubiquitous throughout nutritional therapy–your body is the final Jenga tower, its individual blocks are pieces of your nutrition. Each piece your remove compromises the integrity of the tower and makes it less able to withstand stresses, say a gust of air or someone bumping the table. The same is true of your body and general health, and in this case, your kidneys–too much protein, not enough water, not enough minerals to buffer, and your kidney function is compromised.
Now, for AJ, I’m not convinced his kidney function was compromised in a life-threatening way–I just think it was compromised so that it was “suboptimal.” But “suboptimal” is not “normal” just the same as “suboptimal” is not “dysfunctional,” and “suboptimal” will eventually lead to “dysfunctional” if left at “suboptimal” for a period of time. I think it was as the urologist said, likely stone formation and passing. Blood in the urine indicates bleeding somewhere in the urinary tract, which can sometimes happen when kidney stones scrape the epithelial lining of the urinary tract. He is more at risk of developing kidney stones in dehydration, with urine having higher levels of urea (a byproduct of protein breakdown) and calcium (used by the body to buffer urine pH). My recommendation to AJ would be to track his protein consumption–how many grams per day are you eating? Keeping with current recommendations, upward of 3g per kg of bodyweight per day hasn’t been shown to be detrimental (3), however, I may suggest for AJ to back it down to 1.5-1.8g per kg of body weight per day, drinking plenty of water for the time being, watching to see if any of his symptoms abate. But most importantly, to be eating a healthy diet full of fresh fruits and vegetables, legumes, and whole proteins (not just a powdered shake mix or canned tuna fish). This will ensure he is giving his body all the nutrients it needs, from whole food sources, meaning they are more readily absorbed and utilized in the body. After a full diet analysis and history on daily activities, I may recommend nutritional supplements to help his body function optimally with his given lifestyle.
In closing, if your doctor is not giving your concerns the attention they deserve, and if you feel like he’s not paying attention to the Jenga blocks of your health condition, seek someone who will. Along with genetics, nutrition is the foundation for your health. You can only compromise so many pieces until it all tumbles down on you.
1. Ectopic Kidney; The National Kidney and Urologic Diseases Information Clearinghouse. Retrieved from http://kidney.niddk.nih.gov/kudiseases/pubs/ectopicKidney/ Accessed Jul 6, 2012.
2. McCullough PA, Chinnaiyan KM, Gallagher MJ, Colar JM, Geddes T, Gold JM, Trivax JE. Changes in renal markers and acute kidney injury after marathon running. Nephrology. 2011; 16(2): 194-199.
3. Phillips SM, Moore DR, Tang JE. A Critical Examination of Dietary Protein Requirements, Benefits, and Excesses in Athletes. Inter J Sport Nutr & Exerc Metab. 2007; 17: S58-S76.
4. Aparicio VA, Nebot E, Porres JM, Ortega FB, Heredia JM, Lopez-Jurado M, Aranda Ramirez P. Effects of high-whey-protein intake and resistance training on renal, bone, and metabolic parameters in rats. Brit J Nutr. 2011; 105: 836-845.