Whole Foods vs. Processed Foods Part 2

This is Part 2 of a 2-part blog explaining the benefits of a whole foods diet for people with chronic kidney disease.

In part 1 of this 2-part series, we started to discuss the impact of a diet high in ultra-processed foods on chronic kidney disease, and just scratched the surface with sodium and phosphorus intake.

As a review, whole foods are foods that are minimally processed. They are as close to their natural state as possible, and are free from artificial additives, preservatives, and other synthetic substances. 

By contrast, processed foods are those that have been altered in some way from their original form. to enhance shelf life, flavor, or convenience. We are actually not really concerned about processed foods in general, but with ultra-processed foods.  

Ultra-processed foods undergo extensive processing and contain numerous added ingredients, including artificial flavors, colors, emulsifiers, preservatives, and sweeteners. These foods are often engineered to taste very appealing, which can lead to overconsumption. Ultra-processed foods typically have a much lower nutritional value compared to whole or minimally processed foods and can be high in unhealthy fats, sugars, and sodium.

Why is this important for people with CKD?

Consuming a diet high in ultra-processed foods subjects an individual to an increased intake of sodium and phosphorus, potentially thousands of food additives, and can result in excess food consumption leading to overweight or obesity.  Let’s take a look at each of these dietary mishaps and how they relate to CKD.

We discussed sodium and phosphorus in this blog. So let’s discuss food additives and excess food consumption in this one.

Food Additives

Ultra-processed foods typically contain a long list of ingredients, and many of those ingredients are terms that require the reader of the label to have a strong background in phonics to be able to pronounce the word.  These additives have to be on the Food and Drug Administration’s (FDA’s) list of foods Generally Recognized as Safe (GRAS).  

Food additives on the GRAS list are approved through the following steps:

1. Scientific Evaluation: Experts review scientific data or historical use to determine safety.
2. GRAS Notification: Companies submit a notice to the FDA with detailed safety evidence.
3. FDA Review: The FDA evaluates the notice and, if satisfied, issues a “no questions” letter.
4. Public Access: GRAS notices and FDA responses are made publicly available.

Unfortunately, there are some problems with food substances on the GRAS list:

1. The GRAS determination is often made by the manufacturers themselves, which can lead to biased evaluations. There is also a lack of transparency because companies are not required to inform the FDA about their GRAS determinations, resulting in gaps in public knowledge.
2. Some substances may not have undergone rigorous, long-term safety testing. Conflicts of interest can arise since experts who assess GRAS substances may have financial ties to the food industry.
3. The cumulative effects of consuming multiple GRAS substances together are often not evaluated, and regulatory gaps exist, allowing some substances with questionable safety records to remain on the GRAS list due to outdated or incomplete data.
4. Many food additives in the U.S. food supply have been banned in other countries. For example, brominated vegetable oil, potassium bromate, Azodicarbonamide (ADA), rBGH (Recombinant Bovine Growth Hormone), olestra, some artificial food colorings, BHA and BHT, and Ractopamine.  These remain in our food supply in spite of this.

An article published in the American Journal of Kidney Disease in June of 2022 described a study that looked at the impact of ultra-processed foods on the development of chronic kidney disease. Higher ultraprocessed foods consumption was independently associated with a higher risk of incident CKD in a general population.

This is a problem, in my opinion.

And the best way for individuals to solve the problem for themselves is to commit to eating a diet that consists of real, whole foods, avoiding foods that have long lists of ingredients they can’t pronounce.

Excess Food Consumption

As of 2024, the adult obesity rate in the United States is about 42.7%​. This figure highlights a significant public health challenge, reflecting the prevalence of obesity among the U.S. adult population. The global average adult obesity rate is much lower than that of the U.S. According to the World Health Organization (WHO), global obesity rates are rising, but many countries still have rates below 30%​​.

Could this have anything to do with the food additives we allow into our food that other countries do not?  It is doubtful this could ever be answered conclusively, but it certainly stands to reason that making food taste so good with the use of food additives can lead to overconsumption.  And overconsumption leads to obesity.  

Obesity significantly impacts kidney disease by increasing the risk and accelerating the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). Key mechanisms include:

1. Increased Risk: Obesity contributes to the development of hypertension and type 2 diabetes, major risk factors for CKD​​.
2. Disease Progression: Obesity accelerates CKD progression due to proteinuria, inflammation, and oxidative stress, leading to earlier dialysis or transplantation needs​​.
3. Metabolic Complications: Conditions like diabetes, hypertension, and dyslipidemia associated with obesity exacerbate kidney damage.
4. Inflammation and Oxidative Stress: Obesity-induced chronic inflammation and oxidative stress lead to renal tissue damage.
5. Glomerulopathy: Specific changes in kidney structure, such as glomerulomegaly and focal segmental glomerulosclerosis (FSGS), are linked to obesity.

Weight management and treating comorbid conditions are crucial in reducing the risk and slowing CKD progression in obese individuals.

Consuming a diet high in ultra-processed foods subjects an individual to an increased intake of sodium and phosphorus, potentially hundreds of food additives, and can result in excess food consumption leading to overweight or obesity. All of these are factors that contribute to CKD progression.

This is the reason that one of the main focuses of my practice is to guide people with CKD to make the transition from the Standard American Diet (SAD) to a whole foods diet.  

Shutong Du. (2022, June 06). Association Between Ultraprocessed Food Consumption and Risk of Incident CKD: A Prospective Cohort. American Journal of Kidney Disease. https://www.ajkd.org/article/S0272-6386(22)00648-5/abstract

Obesity. National Kidney Foundation. https://www.kidney.org/atoz/content/obesity

Csaba, K. (2017, March 27). Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Pubmed. https://pubmed.ncbi.nlm.nih.gov/28215359/

Obesity Rates by Country 2024. World Population Review. https://worldpopulationreview.com/country-rankings/obesity-rates-by-country