High Quality Protein Versus Low Quality Protein
By Marika Wamback, BSc. R.D.
Protein contains twenty amino acids. When protein is digested, it is broken down into amino acids for the body to absorb and use. Nine of these amino acids are considered essential because the body cannot synthesize them. They must come from the diet and be replenished daily since the body is not able to store them. The body is able to make the remaining eleven amino acids.
Amino acids are responsible for functions such as protein synthesis, immune support, and body tissue repair. Without essential amino acids, these functions may be impaired.
For CKD, the current recommendation is to consume at least 50% of your protein from high quality protein. This is to ensure that you consume adequate amounts of essential amino acids in your diet. Knowing the difference between high and low quality protein can help you achieve a balanced renal diet.
High Quality Protein
High quality protein choices contain all of the essential amino acids to meet your protein needs. Choosing nutritious protein sources is essential to prevent malnutrition and overall good CKD management.
For CKD stages 1-4, the recommendation is .8 gm/kg/day of protein, with at least 50% of your protein needs from high quality protein choices. If you have ESRD and are on dialysis, a protein intake of 1.2-1.5 gm/kg/day is recommended with at least 50% of your protein needs from high quality protein sources.
A common concern with protein intake is that they can be high in cholesterol and fat and its impact on cardiovascular health. By trimming protein of excess fat before cooking, removing skin, selecting less marbled choices, buying unprocessed items, and using healthy cooking methods, this can help reduce your saturated fat and cholesterol intake.
High Quality Protein Sources
- Lean beef
- Lean pork
- Lean lamb
- Poultry such as chicken and turkey (trimmed of fat and skin)
- Fish and Seafood
It is important to buy these items in their original (unprocessed) forms. Processing high quality proteins can result in poorer protein quality and unwanted sodium and inorganic phosphate additives that can negatively impact blood pressure and phosphate levels. Using the proper portion sizes of unprocessed high quality protein foods, as determined by your renal dietitian, will help meet your protein needs.
Low Quality Protein
Low quality protein choices are proteins that do not contain all of the essential amino acids required by the body. These choices are usually from plant-based sources. Even though they are not complete proteins, they are nutritious because they contain antioxidants, fibre, vitamins, minerals and are low in saturated fat and cholesterol. To meet your essential amino acid needs with plant-based proteins, it is important to eat them with carbohydrates such as rice, pasta, bread, etc. Combining plant-based proteins with a whole grain carbohydrate creates a complete protein that contains all of the essential amino acids.
Low Quality Protein Sources
- Nuts and nut butters
- Other vegetarian protein choices such as seitan, Veggie Ground Round
- Protein powders as they can vary in their protein amount and source
Plant-based proteins can be high in phosphorus and may need to be limited if you are on a phosphorus restriction. Although higher in phosphorus, the phosphorus in these food choices is not as readily absorbed as it is organic phosphorus (naturally occurring with the food). They are, however, high in potassium, and may need to be limited if you are on a potassium restriction. If you are on a phosphorus restriction but want to include some or all of these items, consult with your renal dietitian. Your renal dietitian will help you make the best choices for your renal diet.
Poor Quality Protein
Poor quality protein choices are processed proteins that are high in salt, phosphates, and fat. If eaten regularly, poor quality protein choices can complicate CKD management by contributing to high blood pressure which can increase the risk for heart attack, stroke, and further kidney function decline. It is advised to limit these items as much as possible, as you can easily exceed the recommended sodium limit of 1500 mg/day and a phosphorus limit of 800-1000 mg/day.
Poor Quality Protein Sources
- Processed proteins such as deli meats, sausages, and bacon
- Pre-made frozen dinners
- Convenience foods such as frozen pizzas, wraps, and burritos
- Convenience high sodium foods such as ready made soups, stews, and chilis
- Fast foods
Your renal dietitian will help you make the best protein choices for your health needs. A complete assessment of your health history, medical treatment of your CKD, labwork, and personal preferences will be evaluated to create the safest and healthiest renal diet for you.
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