Jill Rollet; Melanie Betz, MS, RD, CSR, FNKF, FAND , 2025-05-15 15:23:00
Learning about nutrition can empower patients with chronic diseases, according to Melanie Betz, MS, RD, CSR, FNKF, FAND, a dietitian who specializes in kidney stones and chronic kidney disease.
“Many patients can feel there is nothing they can really do to help their kidney disease,” Betz told Healio. “But many times I find patients are empowered to learn that food does matter, food can help them protect their kidneys. Delivering that message, giving patients the autonomy and knowledge to do things to actively protect their kidneys can really help them.”
Betz estimates at least half of her patients also have gout. She spoke with Healio about diet recommendations when the diseases overlap.
Healio: How do you advise patients with kidney disease and gout?
Betz: Luckily, the current nutrition guidelines for CKD are nearly perfectly in line with what we would recommend for someone with gout. There has been a change in how we approach kidney nutrition in the last decade or so. The old way of thinking was a low-potassium, low-phosphorus diet. That resulted in limiting a lot of fruits, vegetables, nuts, beans, seeds and other healthy foods.
Now, our recommendations have switched. We understand much more that those plant-based foods have much less bioavailable potassium and phosphorus than previously thought. Plus, they have a lot more healthful components for general health and for our kidneys.
Historically, the kidney diet would have been difficult to mesh with gout. But now we recommend an even lower protein goal than we did prior to 2020, and I focus on plant proteins in place of animal proteins.
All of that is nearly exactly what we would recommend for gout.
Healio: Would that advice be the same for someone who also has hypertension or diabetes, like many patients with CKD?
Betz: Very much so. That advice addresses hypertension perfectly. With diabetes, there is a slightly higher protein recommendation, because someone with diabetes may need a bit more protein to help control blood glucose, and we want to reduce the proportion of calories from carbohydrates. But still, people with diabetes and gout and kidney disease can still focus on plant proteins and easily get the amount of protein they need.
For gout, the biggest things we think about are limiting red and processed meats, as well as alcohol, and making sure to get in plenty of fluids and plenty of fruits and vegetables. All those things align perfectly for the vast majority of people with CKD.
Healio: Are there common challenges of adhering to this type of eating pattern?
Betz: Diet change is hard, no matter what it is. The two challenges I find people struggle with the most are sodium and eating more plant proteins. Sodium is in so many things we eat. The average American consumes around 1,000 mg more sodium per day than we should. Reducing sodium is just tough.
Plant protein is also challenging. In addition to [the fact that] it’s just hard to make that change, we have to debunk a lot of the marketing from the last many years of plant protein foods. Nothing against [faux beef] — those can be great substitutes if you’re in a pinch or for people who are strictly meat and potatoes types.
But when I say plant protein, that’s not exactly what I’m thinking of. There’s a lot of need for helping people understand what foods have protein in them naturally: beans, nuts, seeds, lentils, whole grains. These are really the plant protein foods we’re after.
And then rethinking how to make a meal can also be difficult. Traditionally, we might think of fish or chicken for dinner, but if we can do more meals that are more bean forward, or lentil forward, that’s going to be good for general health.
Healio: What do you want our nephrologist and rheumatologist readers to know about working with a dietitian?
Betz: Working with a dietitian earlier in CKD can delay the need for dialysis or transplant. Unfortunately, we tend to wait to refer patients to see dietitians until they start or area about to start dialysis. That’s better than nothing, but we can make a much bigger impact if we work with someone who has CKD stage 2 or early stage 3.
Also, Medicare and Medicaid, and therefore many private insurance plans, cover medical nutrition therapy for CKD stage 3b or higher. Physicians should know that payment is not a barrier.
For more information:
Melanie Betz, MS, RD, CSR, FNKF, FAND, is a nationally recognized researcher and educator in kidney nutrition. She is founder and CEO of The Kidney Dietitian. She volunteers for the Renal Practice Group of the Academy of Nutrition and Dietetics and the National Kidney Foundation of Illinois. She can be reached at hello@thekidneydietitian.org or on X @thekidneyrd.
