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Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension| Volume 40, ISSUE 2, P265-274, August 01, 2002

Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism

  • Shalini T. Reddy
    Affiliations
    Department of Internal Medicine, Section of General Internal Medicine, The University of Chicago, IL; and the Department of Internal Medicine, Division of General Internal Medicine; and the Center for Mineral Metabolism and Clinical Research, The University of Texas Southwestern Medical Center at Dallas, TX.
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  • Chia-Ying Wang
    Affiliations
    Department of Internal Medicine, Section of General Internal Medicine, The University of Chicago, IL; and the Department of Internal Medicine, Division of General Internal Medicine; and the Center for Mineral Metabolism and Clinical Research, The University of Texas Southwestern Medical Center at Dallas, TX.
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  • Khashayar Sakhaee
    Affiliations
    Department of Internal Medicine, Section of General Internal Medicine, The University of Chicago, IL; and the Department of Internal Medicine, Division of General Internal Medicine; and the Center for Mineral Metabolism and Clinical Research, The University of Texas Southwestern Medical Center at Dallas, TX.
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  • Linda Brinkley
    Affiliations
    Department of Internal Medicine, Section of General Internal Medicine, The University of Chicago, IL; and the Department of Internal Medicine, Division of General Internal Medicine; and the Center for Mineral Metabolism and Clinical Research, The University of Texas Southwestern Medical Center at Dallas, TX.
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  • Charles Y.C. Pak
    Affiliations
    Department of Internal Medicine, Section of General Internal Medicine, The University of Chicago, IL; and the Department of Internal Medicine, Division of General Internal Medicine; and the Center for Mineral Metabolism and Clinical Research, The University of Texas Southwestern Medical Center at Dallas, TX.
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      Abstract

      Background: Low-carbohydrate high-protein (LCHP) diets are used commonly for weight reduction. This study explores the relationship between such diets and acid-base balance, kidney-stone risk, and calcium and bone metabolism. Methods: Ten healthy subjects participated in a metabolic study. Subjects initially consumed their usual non-weight-reducing diet, then a severely carbohydrate-restricted induction diet for 2 weeks, followed by a moderately carbohydrate-restricted maintenance diet for 4 weeks. Results: Urine pH decreased from 6.09 (Usual) to 5.56 (Induction; P < 0.01) to 5.67 (Maintenance;P < 0.05). Net acid excretion increased by 56 mEq/d (Induction; P < 0.001) and 51 mEq/d (Maintenance; P < 0.001) from a baseline of 61 mEq/d. Urinary citrate levels decreased from 763 mg/d (3.98 mmol/d) to 449 mg/d (2.34 mmol/d; P < 0.01) to 581 mg/d (3.03 mmol/d; P < 0.05). Urinary saturation of undissociated uric acid increased more than twofold. Urinary calcium levels increased from 160 mg/d (3.99 mmol/d) to 258 mg/d (6.44 mmol/d; P < 0.001) to 248 mg/d (6.19 mmol/d; P < 0.01). This increase in urinary calcium levels was not compensated by a commensurate increase in fractional intestinal calcium absorption. Therefore, estimated calcium balance decreased by 130 mg/d (3.24 mmol/d; P < 0.001) and 90 mg/d (2.25 mmol/d; P < 0.05). Urinary deoxypyridinoline and N-telopeptide levels trended upward, whereas serum osteocalcin concentrations decreased significantly (P < 0.01). Conclusion: Consumption of an LCHP diet for 6 weeks delivers a marked acid load to the kidney, increases the risk for stone formation, decreases estimated calcium balance, and may increase the risk for bone loss. © 2002 by the National Kidney Foundation, Inc.

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      References

        • Kuczmarski RJ
        • Carroll MD
        • Flegal KM
        • Troiano RP
        Varying body mass index cutoff points to describe overweight prevalence among US adults: NHANES III (1988 to 1994).
        Obes Res. 1997; 5: 542-548
        • Atkins RC
        Dr Atkins' New Diet Revolution.
        Avon, New York, NY1997
        • Ball D
        • Maughan RJ
        Blood and urine acid-base status of premenopausal omnivorous and vegetarian women.
        Br J Nutr. 1997; 78: 683-693
        • Lemann Jr, J
        Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: A review.
        Nephron. 1999; 81: S18-S25
        • Robertson WG
        • Heyburn PJ
        • Peacock M
        • Hanes FA
        • Swaminathan R
        The effect of high animal protein intake on the risk of calcium stone formation in the urinary tract.
        Clin Sci (Colch). 1979; 57: 285-288
        • Fellstrom B
        • Danielson BG
        • Karlstrom B
        • Lithell H
        • Ljunghall S
        • Vessby B
        The influence of a high dietary intake of purine-rich animal protein on urinary urate excretion and supersaturation in renal stone disease.
        Clin Sci (Colch). 1983; 64: 399-405
        • Fellstrom B
        • Danielson BG
        • Karlstrom B
        • et al.
        Effects of high intake of dietary animal protein on mineral metabolism and urinary supersaturation of calcium oxalate in renal stone formers.
        Br J Urol. 1984; 56: 263-269
        • Anand CR
        • Linkswiler HM
        Effect of protein intake on calcium balance of young men given 500 mg calcium daily.
        J Nutr. 1974; 104: 695-700
        • Linkswiler HM
        • Zemel MB
        • Hegsted M
        • Schuette S
        Protein-induced hypercalciuria.
        Fed Proc. 1981; 40: 2429-2433
        • Johnson NE
        • Alcantara EN
        • Linkswiler H
        Effect of level of protein intake on urinary and fecal calcium and calcium retention of young adult males.
        J Nutr. 1970; 100: 1425-1430
        • Allen LH
        • Oddoye EA
        • Margen S
        Protein-induced hypercalciuria: A longer term study.
        Am J Clin Nutr. 1979; 32: 741-749
        • Abrams SA
        • Esteban NV
        • Vieira NE
        • Sidbury JB
        • Specker BL
        • Yergey AL
        Developmental changes in calcium kinetics in children assessed using stable isotopes.
        J Bone Miner Res. 1992; 7: 287-293
        • Pak CY
        • Hayashi Y
        • Finlayson B
        • Chu S
        Estimation of the state of saturation of brushite and calcium oxalate in urine: A comparison of three methods.
        J Lab Clin Med. 1977; 89: 891-901
        • Werness PG
        • Brown CM
        • Smith LH
        • Finlayson B
        EQUIL2: A basic computer program for the calculation of urinary saturation.
        J Urol. 1985; 134: 1242-1244
        • Pak CY
        • Stewart A
        • Raskin P
        • Galosy RA
        A simple and reliable method for calcium balance using combined period and continuous fecal markers.
        Metabolism. 1980; 29: 793-796
        • US Department of Agriculture
        • Agricultural Research Service
        Composition of Foods.
        Agriculture Handbook No. 8, Series 8-1 to 8-16. Government Printing Office, Washington, DC1976-1987
        • Tschope W
        • Ritz E
        Sulfur-containing amino acids are a major determinant of urinary calcium.
        Miner Electrolyte Metab. 1985; 11: 137-139
        • Bois-Joyeux B
        • Chanez M
        • Azzout B
        • Delhomme B
        • Peret J
        Comparison between starvation and consumption of a high protein diet in rats: Hepatic metabolites and amino acid levels during the first 24 hours.
        Diabetes Metab. 1986; 12: 239-245
        • Greenhaff PL
        • Gleeson M
        • Maughan RJ
        The effects of dietary manipulation on blood acid-base status and the performance of high intensity exercise.
        Eur J Appl Physiol Occup Physiol. 1987; 56: 331-337
        • Kurtz I
        • Maher T
        • Hulter HN
        • Schambelan M
        • Sebastian A
        Effect of diet on plasma acid-base composition in normal humans.
        Kidney Int. 1983; 24: 670-680
        • Coe FL
        • Strauss AL
        • Tembe V
        • Le Dun S
        Uric acid saturation in calcium nephrolithiasis.
        Kidney Int. 1980; 17: 662-668
        • Coe FL
        Uric acid and calcium oxalate nephrolithiasis.
        Kidney Int. 1983; 24: 392-403
        • Pak CY
        Citrate and renal calculi: An update.
        Miner Electrolyte Metab. 1994; 20: 371-377
        • Kok DJ
        • Iestra JA
        • Doorenbos CJ
        • Papapoulos SE
        The effects of dietary excesses in animal protein and in sodium on the composition and the crystallization kinetics of calcium oxalate monohydrate in urines of healthy men.
        J Clin Endocrinol Metab. 1990; 71: 861-867
        • Schuette SA
        • Zemel MB
        • Linkswiler HM
        Studies on the mechanism of protein-induced hypercalciuria in older men and women.
        J Nutr. 1980; 110: 305-315
        • Robertson WG
        • Peacock M
        • Hodgkinson A
        Dietary changes and the incidence of urinary calculi in the UK between 1958 and 1976.
        J Chronic Dis. 1979; 32: 469-476
        • Lemann Jr, J
        • Pleuss JA
        • Worcester EM
        • Hornick L
        • Schrab D
        • Hoffmann RG
        Urinary oxalate excretion increases with body size and decreases with increasing dietary calcium intake among healthy adults.
        Kidney Int. 1996; 49: 200-208
        • Borghi L
        • Meschi T
        • Amato F
        • Briganti A
        • Novarini A
        • Giannini A
        Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: A 5-year randomized prospective study.
        J Urol. 1996; 155: 839-843
        • Kim Y
        • Linkswiler HM
        Effect of level of protein intake on calcium metabolism and on parathyroid and renal function in the adult human male.
        J Nutr. 1979; 109: 1399-1404
        • Zemel MB
        • Schuette SA
        • Hegsted M
        • Linkswiler HM
        Role of the sulfur-containing amino acids in protein-induced hypercalciuria in men.
        J Nutr. 1981; 111: 545-552
        • King AJ
        • Levey AS
        Dietary protein and renal function.
        J Am Soc Nephrol. 1993; 3: 1723-1737
        • Heaney RP
        Dietary protein and phosphorus do not affect calcium absorption.
        Am J Clin Nutr. 2000; 72: 758-761
        • Bushinsky DA
        • Frick KK
        The effects of acid on bone.
        Curr Opin Nephrol Hypertens. 2000; 9: 369-379
        • Kerstetter JE
        • Mitnick ME
        • Gundberg CM
        • et al.
        Changes in bone turnover in young women consuming different levels of dietary protein.
        J Clin Endocrinol Metab. 1999; 84: 1052-1055
        • Sebastian A
        • Harris ST
        • Ottaway JH
        • Todd KM
        • Morris Jr, RC
        Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate.
        N Engl J Med. 1994; 330: 1776-1781
        • Licata AA
        • Bou E
        • Bartter FC
        • West F
        Acute effects of dietary protein on calcium metabolism in patients with osteoporosis.
        J Gerontol. 1981; 36: 14-19
        • Itoh R
        • Suyama Y
        • Oguma Y
        • Yokota F
        Dietary sodium, an independent determinant for urinary deoxypyridinoline in elderly women. A cross-sectional study on the effect of dietary factors on deoxypyridinoline excretion in 24-h urine specimens from 763 free-living healthy Japanese.
        Eur J Clin Nutr. 1999; 53: 886-890
        • Frassetto LA
        • Todd KM
        • Morris Jr, RC
        • Sebastian A
        Worldwide incidence of hip fracture in elderly women: Relation to consumption of animal and vegetable foods.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M585-M592
        • Munger RG
        • Cerhan JR
        • Chiu BC
        Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women.
        Am J Clin Nutr. 1999; 69: 147-152
        • Hannan MT
        • Tucker KL
        • Dawson-Hughes B
        • Cupples LA
        • Felson DT
        • Kiel DP
        Effect of dietary protein on bone loss in elderly men and women: The Framingham Osteoporosis Study.
        J Bone Miner Res. 2000; 15: 2504-2512
        • Cooper C
        • Atkinson EJ
        • Hensrud DD
        • et al.
        Dietary protein intake and bone mass in women.
        Calcif Tissue Int. 1996; 58: 320-325
        • Sellmeyer DE
        • Stone KL
        • Sebastian A
        • Cummings SR
        A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group.
        Am J Clin Nutr. 2001; 73: 118-122
        • Lutz J
        Calcium balance and acid-base status of women as affected by increased protein intake and by sodium bicarbonate ingestion.
        Am J Clin Nutr. 1984; 39: 281-288