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Table 10 The diets presently employed are identified according to the target protein intake expressed as g/Kg/day (0.6 with protein free food; 0.6 vegan supplemented; 0.6-0.8 vegan non supplemented; 0.3 vegan with protein free- products, supplemented with essential amino acid and keto-acids)

From: “Dietaly”: practical issues for the nutritional management of CKD patients in Italy

0.6 with protein free food 0.6 vegan supplemented 0.6-0.8 vegan not supplemented
Our diet plans to replace bread and pasta-rice-flour with protein free-food; fruits and vegetables can be taken without restriction; meat, fish cheese, etc. can be used as “seasoning” for the pasta, or as part of the “main course” that has to be completed as much as possible with vegetables. Our diet is based upon foods of plant origin only (fruit, vegetables, sugars, starches such as pasta and bread, cous-cous, polenta and legumes) supplemented by tablets of a mixture of amino acids and “ketoacids (Alfa-Kappa® or Ketosteril®).
These tablets allow you choosing the type of plant derived food that you prefer without needing to integrate the different types of vegetable proteins (grains and legumes at each meals). This is a simplified diet, but do not forget the pills…
The supplements are calculated as 1 each 8–10 Kg of body weight; their amount depends on your body weight, on your diet and on your nutritional status. You do not need them only when you eat an unrestricted meal (see below).
The tablets may be taken “in the middle of the meal”, at the beginning or at the end, at your choice.
Our diet employs only foods of plant origin (fruit, vegetables, sugars, starches such as pasta and bread, legumes); they must be combined with each other to allow intake of “complete” proteins, with the sufficient quantity of “essential” amino acids, which are those contained in food of animal origin (meat, fish, cheese and eggs) but not in those of vegetable origin (where the proteins are “incomplete” and must be integrated with each other).
In order to integrate the proteins, it is important to take them during the day, thus if possible every day at least 2 sources of “starches” (bread, rice, pasta (no egg), semolina (cous- cous, polenta) and at least 1–2 kinds of legumes (peas, chickpeas, beans, broad beans, lentils, etc.), making sure to take at each meal at least one type of starch and one of legumes.
Finally, keep a food diary for a few days between each visit, to allow us scoring quality and quantity of food.
If you are asked to bring the 24-h urine collection, please do it in the day preceding the unrestricted meal.
---- (please chose among 1-2-3) UNRESTRICTED MEALS PER WEEK ARE ALLOWED. UNRESTRICTED MEAL IS A MEAL WITHOUT RESTRICTION OF ANY KIND IN QUANTITY AND QUALITY OF THE FOOD.
The intake of a sufficient amount of calories is very important, during the day, starting if possible from a “rich” breakfast. It’s important to take a first course, bread, bread sticks, potatoes or other starches. Fruits and vegetables are allowed without restriction, except for fruit in case of diabetes. The dressing (preferably extra virgin olive oil) is to be used without restrictions.
Examples of meal distribution:
BREAKFAST For example biscuits or bread or croissants (all protein-free), jam, tea or coffee, preferably without milk or with soy milk; small amounts of milk are allowed. A lovely cake is fine (with protein free flour). It is important to eat at least a portion of cake, or a few biscuits, or bread, butter and jam, or, for those who do not love the sweet, protein-free bread with oil and tomatoes or other vegetables … BREAKFAST For example biscuits or bread or croissants, jam, tea or coffee, preferably without milk or with soy milk; in selected cases small amounts of milk are allowed. A lovely cake is fine (a small amount of egg is allowed; however prefer the homemade cakes and egg yolk as compared with egg white). It is important to eat at least a portion of cake, or a few biscuits, or bread, butter and jam, or, for those who do not love the sweet, bread with oil and tomatoes or other vegetables …
Take (1-2-3 according to body weight) tablets of alpha-keto analogues
BREAKFAST For example biscuits or bread or croissants, jam, tea or coffee, preferably without milk or with soy milk; small amounts of milk are allowed. A lovely cake is fine; combine different types of flour if you like, It is important to eat at least a portion of cake, or a few biscuits, or bread, butter and jam, or, for those who do not love the sweet, bread (white or raw) with oil and tomatoes or other vegetables …
LUNCH
At least one large portion of protein-free pasta or rice with a vegetable based sauce (olive oil without restrictions), with fish, meat or cheese to flavor pasta or rice, at least two servings of vegetables (raw or cooked, without restrictions for quantity and for mode of cooking, including frying, if this is done with olive oil) and at least one fruit after a meal.
It also good to associate at least a couple of slices of bread to the vegetables, or breadsticks, rice crackers, etc. Potatoes can be eaten instead of pasta, cooked in any way, but also fried (provided in good olive oil …). Legumes can replace meat, fish, a couple of times per week; better if you use also a little cheese along with legumes (eg pasta and beans with a little parmesan)
LUNCH
At least one portion of pasta or rice with a vegetable based sauce (olive oil without restrictions), at least two servings of vegetables (raw or cooked, without restrictions for quantity and for mode of cooking, including frying, if this is done with olive oil) and at least one fruit after a meal.
It also good to associate at least a couple of slices of bread to the vegetables, or breadsticks, rice crackers, etc. Potatoes can be eaten instead of the main course, or instead of bread.
Take (2-3-4 according to body weight) tablets of alpha-keto analogues
LUNCH
At least one large portion of pasta or rice or beans with sauce made of vegetables (extra virgin olive oil without restrictions), at least two servings of vegetables (raw or cooked, with no restrictions even for cooking modes, including fried); if legumes are not employed in addition to the first course, they have to be consume as second course (ie. peas and pasta, or peas with soy beans); at least one fruit after a meal. With vegetables is good associate bread, breadsticks, rice crackers, etc. Potatoes can be eaten instead of the pasta cooked in any way, but also fried (provided in good olive oil …).
DINNER
Same as lunch, but the portion of protein free pasta may be smaller. A good alternative is a fine vegetable soup, with vegetables, legumes rice or pasta, bread etc. … and with some meat or cheese. Season with olive oil, providing a good amount of calories.
A portion of fish, meat or cheese may be added; else, these aliments may be added to the vegetable portions (spinach with parmesan, egg with spinach, small omelette etc.)
DINNER
Same as lunch.
A good alternative is a fine vegetable soup, with vegetables, legumes rice or pasta, bread etc. … Season with olive oil, providing a good amount of calories.
Take (2-3-4 according to body weight) tablets of alpha-keto analogues
DINNER
Same as lunch; a vegetable soup minestrone), with vegetable, potatoes, legumes, rice or pasta, bread may also be a good choice etc. … always season with olive oil, providing good calories. Vegetables can be associated with bread, bread sticks, crackers, rice, etc.
BEVERAGES
Drink basically water, but you can include wine (if it is good and not too much…) or beer.
Please avoid sodas, since they often have a high amount of added phosphate (not good for the kidney)
THIS DIET IS NOT FOR WEIGHT-LOSS
The distribution of portions during the day reflects the usual Italian habits (more pasta at noon, less at dinner, but there is no fixed rule).
No fear to increase the dose. Careful not to decrease them …
and we will control the results together!
NOTE: for a 0.3 g/Kg/day protein diet:
- double the tablets of supplements (1 for each 5Kg of BW)
- substitute bread and pasta with protein-free foods and use protein-free flour to prepare biscuits or cakes.
  1. This diet is based on a series of very simple assumptions: - the first is that the low-protein diet is not only a mean to slow down the progression of kidney failure, but also a very powerful “metabolic regulator”.
  2. - the second is that the proteins of vegetable origin induce a lesser “workload” for the kidney, and therefore, at equal protein content, they are better suited to stabilize the renal function and the metabolism;
  3. - the third is that diets should be followed to improve the quality of life, and hence they have to be followed with some flexibility, and with a certain degree of freedom, progressively adapting to the preferences of each patient: we need your help to identify problems and to solve them together.
  4. - the fourth is that this is almost an “anti-diet” if diet is intended to lose weight: this is a diet rich in pasta, bread and carbohydrates, even if they are different from the usual ones… Sweets and pastry may also be included…