Being from a family of doctors, a family that also includes a kidney patient, a specialist in diabetes, and a professor at Harvard Medical School, I have been exposed to more than the layman's usual allotment of medical news. And over the last few years our entire extended family has become intrigued by medical literature on using diet in the control of kidney disease (as well as in the prevention of other illnesses, including cancer and heart disease).

At a meeting of the American Diabetes Association, Dr.G. C. Viberti of Guys Hospital, London, reported that his East Indian patients with renal impairment had a far slower progression of disease and renal failure than did his other patients. Hypothesizing that the Indian vegetarian diet might account for this, Viberti did experiments which, as anticipated, showed that unlike animal protein, vegetable protein did not cause unacceptably high increases in glomerular pressure, and thus tended to preserve kidney function.

Similarly, the work of Dr. Mackenzie Walser at Johns Hopkins has left little doubt that a low-protein diet, with adequate supplementation, is highly effective in preserving renal function, even in patients with advanced kidney disease. The question has been raised by others, however, as to whether patients can be expected to comply with such "severe" and, by implication, unpalatable restrictions.

It was to explore this question that our family decided to experiment with a vegetarian diet.

What we found surprised us. One female member needed iron supplements to prevent anemia, and it was necessary for me, as family cook, to learn basic substitutions. Instead of dairy cheese, for example, I learned to use tofu* cheese, and for sour cream, we used soft, silken tofu with lemon juice and sweetener. But the biggest surprise was that our new diet was anything but "severe." Critics of treating kidney disease with low-protein diet had led us to expect that the sacrifice of meat and dairy produces would be like giving up the luxury of a mansion for a one-room poverty of vegetables. To our amazement and delight, however, quite the opposite proved true.

Unthinking reliance on "meat and potatoes" had led to what, in retrospect, appears as itself a restricted diet, relatively unvaried, comparatively uninteresting. After closing the door to meat, we found that an entire new visit had opened to us. One could imagine a procession of joyous Neapolitan peasant girls displaying their baskets of fresh glistening grapes, olives, fresh green vegetables, fruits, and grains, the rich harvest of the earth that previously we had all but ignored. Italian spices and seasonings soon became favorites, and other ethnic cuisines, with appropriate substitutions where needed, soon filled out a rich variety of fare, more exciting, more delicious, and easier to prepare than the meals we had known before we accepted these vegetarian "restrictions."

A pressure cooker proved to be an amazingly fast (three-minute) means to healthy stews and soups of all kinds--Indian lentil soups and curries, Greek rice and lemon soup, Italian minestrone with any combination of legumes, other vegetables, and pasta, topped with grated tofu cheese, French "cream" (tofu) of broccoli or cauliflower soup, Russian borscht with beets or red cabbage topped with tofu sour cream, Chinese and Japanese soups--the possibilities are endless. Traditional Buddhist dishes, unusually delicious, have for centuries been totally vegetarian, and there are many Middle Eastern dishes, such as falafel and sesami tahini, that are not only entirely vegetarian but robustly flavored. In addition, some vegetarian cookbooks offer a tantalizing variety of recipes for nutmeats to be prepared as roasts, patties, meatloafs, casseroles, stuffing--almost anything imaginable. And for dessert, the wide range of fruits, tofu ice creams, cakes, and vegetable-based pastries make possible hundreds of delightful combinations.

Certainly we do not miss "meat and gravy." It would be inconceivable to us now to give up this splendid new variety. We continue to follow with much interest medical reports on diet in managing renal disease. As new studies are done on specific amino acids and their effects on renal function, it is possible that certain foods, egg whites, for example, as well as certain dairy cheeses, may be reintroduced to the "kidney-friendly" diet, at least in certain stages of renal disease.

Meanwhile, in addition to the health benefits, we continue to enjoy our international culinary adventure.

* Tofu, made from fermented soybeans, is widely used in Japanese and Chinese cooking. It has become popular in vegetarian cooking as a source of protein and

calcium and as a versatile food that can change shape and absorb flavorings well.

[Reprinted from Network News, No. 4 (November 1994)]