Browsing by Author "Asplin, John R."

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    The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease
    (Karger, 2014) Moorthi, Ranjani N.; Armstrong, Cheryl L. H.; Janda, Kevin; Ponsler-Sipes, Kristen; Asplin, John R.; Moe, Sharon M.; Department of Medicine, IU School of Medicine
    BACKGROUND: Chronic Kidney Disease (CKD) is associated with alterations in phosphorus excretion, and increases in fibroblast growth factor (FGF23) and parathyroid hormone (PTH). Plant protein-based phytate-bound phosphorus, is less bioavailable than that from animal sources. Our one-week study that was conducted previously showed that a nearly 100% plant protein-based diet benefits mineral metabolism in CKD; however, this diet may not be acceptable to patients. Here we hypothesize that a diet containing 70% protein from plants has similar efficacy and is tolerated by CKD patients. METHODS: Thirteen subjects with CKD 3-4 received an omnivorous diet containing 70% protein from plants for 4 weeks. The primary outcome was change in 24 h urine phosphorus. Secondary outcomes were changes in serum phosphorus, FGF23, PTH, urine sodium excretion, grip strength and fat free mass. Repeated measures analysis of variance (ANOVA) was used to test differences in parameters over the 4 weeks. RESULTS: Mean age of subjects was 54.8 years. Median eGFR was 26 (IQR 14.7) ml/min/1.73 m(2). Over the 4-week period, urine phosphorus significantly decreased by 215 ± 232 mg/day (p < 0.001). No significant changes in serum FGF23, phosphorus or PTH were noted. Urine sodium and titratable acid decreased significantly on the diet. Hand grip strength and fat-free mass did not change. There were two hyperkalemia events both 5.8 mEq/l, corrected by food substitutions. No other adverse events were observed. CONCLUSIONS: A 70% plant protein diet is safe, tolerated, and efficacious in lowering urine phosphorus excretion and may be an alternative to phosphate binders.
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    Using Low-calorie Orange Juice as a Dietary Alternative to Alkali Therapy
    (Liebert, 2020-05) Large, Tim; Williams, James, Jr.; Asplin, John R.; Krambeck, Amy; Urology, School of Medicine
    Purpose: The pursuit of a dietary source to increase urine pH and citrate in stone formers has been ongoing for more than 30 years. Early evidence showed that orange juice (OJ) contains alkali and citrate but high sugar and ascorbic acid content limited the use of OJ as a viable daily source of alkali. Recently, novel low calorie OJs have emerged and could potentially be a better option. Methods: Beverages with high concentrations of alkali citrate and malate were identified using ion chromatography. Two low calorie OJ beverages, in addition to Crystal Light Lemonade (CLLB) were chosen. Healthy volunteers (5 men, 5 women) drank 1L of OJ or CLLB with 1L water daily for 7 days and then completed a 24-hour urinalysis. A washout week was instituted between trial weeks. The study design is a prospective randomized cross over control trial. A paired analysis using comparison of means was used to evaluate low calorie OJ and CLLB. Volunteers had no prior history of kidney stones and maintained a journal with beverage compliance, side effect, and dietary consumption data. Results: Tropicana 50 (TRP50), Kroger low calorie OJ (KLCO) and CLLB were found to have a total alkali content of 56.60, 47.9, and 17.3 mEq/L, respectively, based on ion chromatography. Consumption of all three beverages raised urinary citrate (116.6 [-118 to 373, 177.9 [-3 to 359], 155.6 [-4 to 237] mg/d 95% CI) and urinary pH (0.25 [0.08-0.53], 0.74 [0.41-1.07 p<0.05], 0.25 [0.25-0.64]) respectively, compared to water phase. Based on volunteer journal entries , TRP50 had the most side effects (90% participants) felt to be a result of the artificial sweetener (Stevia ®). Conclusion: Low-calorie orange juice, and to a lesser extent CLLB, have alkali and citrate based on ion chromatography. Daily consumption, by healthy volunteers of KLCO can raise urinary pH.