Greetings from the salty gusts of South Padre Island, where sand gets in places protein never will, and the wind howls louder than your average bro-scientist claiming you’ll pee out anything over 30 grams of whey.

Today’s dispatch? A dive deep into the shadowy alleyways of nephrology, muscle tissue, and mortality curves.

But fear not—this ain’t your grandma’s renal diet pamphlet so strap on your propeller helmet as we are going hard down the nerd chute on this one.

The Last Stand Against High Protein Diets?

For decades, the war cry of every anti-protein pearl-clutcher has been,
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“But what about your kidneys, bro?”
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As if slamming a protein shake was akin to snorting drywall and kicking your glomeruli in the nut sack.

Well, pack it up, nephro-nannies. The walls are closing in.

A recent study published in JAMA took that last shaky stronghold of low-protein dogma—older adults with mild to moderate chronic kidney disease (CKD)—and set it ablaze with the flamethrower of large-scale cohort data.

Researchers followed over 3,000 people from Spain and Sweden (and you know the Swedes don’t mess around with their fish or their data sets), tracking protein intake and mortality for up to a decade.

What Did They Find? A Protein Bomb of Truth

The result?

Higher protein intake = lower death risk..

…even in the CKD crowd.

Yes, even in the dusty halls of aging kidneys, protein was linked with survival—not demise.

Let me say that again for the people in the back:

Eating more protein helped older adults with mild to moderate kidney disease live longer.

The magic number?

1.0 grams of protein per kilogram of body weight per day.
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That’s a full 0.2 grams higher than the old-school minimum of 0.8 g/kg/d. For those in the USA that inept at m-a-t-h-s, that is about 0.37 g/lb/d – still below the recommend 0.7 g/lb per day that is the go to in the Flex Diet Cert intervention on Bro-Tein.

And for the stats nerds -the hazard ratio? A cool 0.88. That’s a 12% reduction in risk of death by simply eating more protein.

Let that marinate like a 12oz ribeye in grass-fed butter.

Wait, It Gets Better...

Unlike most politically-charged food wars (cough red meat vs kale), this wasn’t a vegan vs carnivore death match.

Both plant and animal protein showed similar mortality benefits.​
This means your grandma can keep her fish, you can keep your whey, and neither of you has to pretend that lentils are steak, cuz they are not even if they are pressed into the rough shape or a T-bone.

0.20 g/kg/d more plant protein? 20% reduced mortality.
0.20 g/kg/d more animal protein? 12% reduced mortality.

So eat the salmon, toss in some quinoa, and stop asking your tofu if it lifts

Why This Matters

This study gives you permission—not to be reckless—but to break free from the protein-paranoia purgatory that’s haunted older adults for decades.

Sarcopenia is the real monster under the bed, not steak.

Let’s recap what you need to be screaming into the void:

• Muscle = survival. Especially as people age. Losing it means falls, frailty, and early death.
• Protein supports muscle. Period.
• Kidney disease isn’t an automatic protein restriction anymore. At least, not in stages 1–3. The death data says the opposite. Again, check with your doc and this is not medical advice, just reporting to you the latest bleeding edge research based on actual data.

But don’t take my word for it—take the 10-year multicohort study, lace it with Spanish fish and Swedish blood work, and tell your clients to eat like their lives depend on it.

Because they do.

One Last Rant for the Road

Now, of course, don’t start blasting 300g of protein down Nana’s throat without a doctor in the loop.

Get your bloodwork. Talk to your MD. But also, let’s stop treating protein like it’s plutonium.

If your client is 70, frail, pre-diabetic, and on their fourth fall in two years, you know what matters?

Strength

Muscle

Function

Aerobic fitness (VO2 max)

Grip strength

Not whether 1.0 g/kg/d is “too aggressive.”

So go forth.

Push the protein.

Spread the word.

Fight the fear-mongering.

The age of protein caution in CKD might finally be cracking—let’s make sure muscle is there to fill the gap.

Less fear and and more freakin’ protein,
Dr. Mike

PS- for the ulta nerds, here is the claim check

Claim 1: Higher total protein intake was associated with lower mortality in older adults with mild to moderate CKD.​
The study found hazard ratios for mortality improved as protein intake increased (e.g., HR = 0.88 for 1.00 g/kg/day vs. 0.80 g/kg/day; HR = 0.73 for 1.40 g/kg/day vs. 0.80 g/kg/day)​.

Claim 2: Both plant and animal proteins were beneficial, with similar mortality associations.​
The study found comparable associations for plant protein (HR = 0.80 per 0.20 g/kg/day) and animal protein (HR = 0.88 per 0.20 g/kg/day) in people with CKD​.

Claim 3: The benefit was stronger in people without CKD, but still present in those with it.​
HR for non-CKD was 0.85 per 0.20 g/kg/day vs. 0.92 for CKD; difference was statistically significant (P = .02)​.

Claim 4: Fish and cereal protein showed inverse associations with mortality in CKD.​
The HRs were 0.90 for fish protein and 0.84 for cereal protein per 0.2 g/kg/day increment​.

Claim 5: There is no evidence that vegan diets are superior in terms of protein intake benefits.​
The study showed benefit from both plant and animal protein without indicating one was superior within the CKD group​.

Claim 6: Older adults may need more protein due to sarcopenia, anabolic resistance, etc.​
The intro of the paper supports this and mentions evidence-based guidelines recommending 1.0–1.2 g/kg/day or higher in frail or ill older adults

Reference
Carballo-Casla A, Avesani CM, Beridze G, Ortolá R, García-Esquinas E, Lopez-Garcia E, Dai L, Dunk MM, Stenvinkel P, Lindholm B, Carrero JJ, Rodríguez-Artalejo F, Vetrano DL, Calderón-Larrañaga A. Protein Intake and Mortality in Older Adults With Chronic Kidney Disease. JAMA Netw Open. 2024 Aug 1;7(8):e2426577.

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Mike T Nelson CISSN, CSCS, MSME, PhD
Associate Professor, Carrick Institute
Owner, Extreme Human Performance, LLC
Editorial Board Member, STRONG Fitness Mag

Mike T Nelson is a PhD and not a physician or registered dietitian. The contents of this email should not be taken as medical advice. It is not intended to diagnose, treat, cure, or prevent any health problem - nor is it intended to replace the advice of a physician. Always consult your physician or qualified health professional on any matters regarding your health.

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