| LPD & VLPD Diet Plan — Ketoanalogue Companion |
W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026 |
How Ketoanalogues Work — The Transamination Mechanism
Fig. 1 — On a normal Filipino diet (left), protein breakdown produces excess urea that damaged kidneys cannot excrete. On VLPD + ketoanalogues (right), nitrogen is recycled through transamination to build essential amino acids — without adding new nitrogen. This mechanism only works when dietary protein is simultaneously restricted to 0.3 g/kg/day.
| Reference: Garneata & Mircescu, JASN 2016 · For educational use only · Confirm targets with your nephrologist |
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LPD Meal Plans — Part A 0.6 g protein/kg/day · CKD Stage 3b–4 · eGFR 15–44 mL/min |
Page 2 of 6 · williamriveromd.com |
Who follows LPD? Patients with CKD stage 3b–4 (eGFR 15–44). Rice contributes ~4 g protein per cup — always count this. Take KA tablets with meals, not on empty stomach. Split doses across all 3 main meals.
40 kg Patient — LPD Target: 24 g protein/day · ~1,300 kcal · 8 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 whole egg (scrambled in 1 tsp oil) + ¾ cup rice + sayote sautéed in oil | ~9 g | ~340 | 2 tabs |
| Lunch 12PM | 30 g bangus (steamed) + 1 cup rice + pechay sautéed in oil | ~10 g | ~295 | 3 tabs |
| Snack 3PM | 1 medium kamote (boiled) + ½ cup sago in sugar + 1 saba banana | ~3 g | ~305 | — |
| Dinner 7PM | 50 g firm tofu (fried in oil) + ¾ cup rice + kangkong sautéed in oil | ~9 g | ~330 | 3 tabs |
| Daily Total (approximate) |
≈31 g |
≈1,270 kcal |
8 tabs |
Tip: Add 1–2 tbsp coconut oil to any dish to close the calorie gap. Calorie shortfall is common at 40 kg — use oil liberally.
50 kg Patient — LPD Target: 30 g protein/day · ~1,600 kcal · 10 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 egg (fried in oil) + 1 cup rice + ampalaya sautéed in oil | ~10 g | ~375 | 2 tabs |
| Lunch 12PM | 40 g tilapia (steamed) + 1 cup rice + sayote in oil | ~12 g | ~330 | 4 tabs |
| Snack 3PM | 1 cup boiled gabi + 1 saba banana + sugarcane juice (1 cup) | ~4 g | ~375 | — |
| Dinner 7PM | 75 g tofu (tokwa't gulay style) + 1 cup rice + pechay in oil | ~10 g | ~370 | 4 tabs |
| Daily Total (approximate) |
≈36 g |
≈1,450 kcal |
10 tabs |
Tip: Add an evening snack of 1 cup sago + 1 tbsp sugar or ½ cup sweet corn to reach calorie target (~150–200 kcal extra).
60 kg Patient — LPD Target: 36 g protein/day · ~1,950 kcal · 12 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 2 egg whites + 1 yolk (scrambled) + 1 cup rice + kamote + kangkong + 1 tbsp oil | ~13 g | ~440 | 3 tabs |
| Lunch 12PM | 60 g bangus (baked) + 1½ cups rice + sayote in coconut oil | ~16 g | ~520 | 4 tabs |
| Snack 3PM | 1 cup boiled cassava + 1 banana + coconut water (1 cup, no added sugar) | ~3 g | ~320 | — |
| Dinner 7PM | 50 g tokwa (fried in oil) + 1 cup rice + pechay in oil | ~9 g | ~350 | 5 tabs |
| Daily Total (approximate) |
≈41 g |
≈1,630 kcal |
12 tabs |
Tip: Calorie shortfall is common at 60 kg. Add an extra cup of rice at lunch or increase cooking oil to 1½–2 tbsp per dish to reach the 1,950 kcal target.
| Protein values are approximate (±3 g/day). Rice protein: ~4 g/cup cooked. Bangus: ~20 g protein/100 g. Tofu: ~8–10 g/100 g. Educational use only. |
williamriveromd.com · Page 2 of 6 |
LPD Meal Plans — Part A (cont.) 0.6 g protein/kg/day · Larger Body Weights 70–80 kg |
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70 kg Patient — LPD Target: 42 g protein/day · ~2,275 kcal · 14 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 2 whole eggs (sinangag-style with garlic + 1 tbsp oil) + 1 cup rice + boiled kamote | ~14 g | ~490 | 4 tabs |
| Lunch 12PM | 70 g tilapia (paksiw) + 1½ cups rice + boiled upo + 1 tbsp canola oil | ~18 g | ~540 | 5 tabs |
| Snack 3PM | 1 cup boiled gabi + 1 ripe mango (medium) + 1 cup pandan sago | ~4 g | ~430 | — |
| Dinner 7PM | 100 g firm tofu (ginisang tofu) + 1 cup rice + kangkong + 1 tbsp oil | ~12 g | ~420 | 5 tabs |
| Daily Total (approximate) |
≈48 g |
≈1,880 kcal |
14 tabs |
Tip: Still ~400 kcal short of target. Add an evening snack of ½ cup cassava + sago. Consider using 4 cups rice total across the day, and 1½ tbsp oil per cooked dish.
80 kg Patient — LPD Target: 48 g protein/day · ~2,600 kcal · 16 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 2 whole eggs (tortang talong style + 1 tbsp oil) + 1½ cups rice + boiled kamote | ~16 g | ~570 | 4 tabs |
| Lunch 12PM | 80 g bangus sinigang (sampalok base, kangkong & okra, no patis) + 1½ cups rice + 1 tbsp oil | ~20 g | ~590 | 5 tabs |
| Snack 3–4PM | 1 cup boiled cassava + 2 tbsp coconut cream + 1 cup sago in sugar | ~3 g | ~490 | — |
| Dinner 7PM | 100 g tokwa (adobo-style, no soy sauce) + 1 cup rice + boiled upo + 1 tbsp oil | ~13 g | ~460 | 7 tabs |
| Daily Total (approximate) |
≈52 g |
≈2,110 kcal |
16 tabs |
Tip: 80 kg patients have the largest calorie gap (~500 kcal). Add a morning snack (1 cup corn + 1 tsp oil = ~200 kcal) and increase cooking oil to 2 tbsp/dish. Consider adding an evening sago or gulaman dessert.
⚠ KA Tablets — Critical Reminders for LPD Patients
- Always take with food, never on an empty stomach. KA tablets are absorbed alongside dietary protein; taking them fasting reduces effectiveness.
- Split doses across all main meals — do not take all tabs at once. Morning, noon, and evening doses are standard.
- Do not miss calorie targets. A calorie-deficient diet forces the body to use KA tablets as fuel, negating their benefit for urea reduction.
- Protein values include rice. Each cup of cooked rice ≈ 4 g protein. At 3 cups/day = 12 g from rice alone — budget the rest for egg/fish/tofu.
| All values approximate. Tilapia: ~18 g protein/100 g. Egg: ~6 g protein each. Tofu (firm): ~8–10 g/100 g. Upo, kangkong, sayote: negligible protein. Educational use only. |
williamriveromd.com · Page 3 of 6 |
VLPD Meal Plans — Part B 0.3 g protein/kg/day · CKD Stage 4–5 · eGFR <30 · Garneata 2016 Protocol |
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Who follows VLPD? CKD stage 4–5 (eGFR <30). This is the protocol proven in the landmark Garneata 2016 trial. VLPD is mostly carbohydrates and fats — about 1 egg or a tiny piece of fish per day. Cassava and kamote are your best calorie friends. A registered renal dietitian is strongly recommended before starting.
40 kg Patient — VLPD Target: 12 g protein/day · ~1,300 kcal · 8 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 egg white only (scrambled in 1 tsp oil) + ¾ cup rice + 1 medium kamote (boiled) | ~7 g | ~315 | 2 tabs |
| Lunch 12PM | ¾ cup rice + 1 cup boiled gabi + sautéed sayote in 1 tbsp oil (no protein food) | ~3 g | ~370 | 3 tabs |
| Snack 3PM | 1 cup sago in sugar syrup + 1 ripe banana | ~1 g | ~280 | — |
| Dinner 7PM | 25 g firm tofu (lightly fried in 1 tsp oil) + ½ cup rice + kangkong | ~4 g | ~245 | 3 tabs |
| Daily Total (approximate) |
≈15 g |
≈1,210 kcal |
8 tabs |
Tip: 12 g/day means almost no visible protein food — just 1 egg white and a tiny cube of tofu. Replace some rice with cassava to reduce background protein (~2 g/cup less).
50 kg Patient — VLPD Target: 15 g protein/day · ~1,625 kcal · 10 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 whole egg (poached) + ½ cup rice + 1 medium kamote + ampalaya in 1 tbsp oil | ~9 g | ~415 | 3 tabs |
| Lunch 12PM | ¾ cup rice + 1 cup boiled gabi + boiled okra + 1 tbsp canola oil (no protein food) | ~4 g | ~430 | 3 tabs |
| Snack 3PM | 1 cup cassava (plain boiled) + 1 cup sugarcane juice | ~1 g | ~360 | — |
| Dinner 7PM | 25 g firm tofu (fried in 1 tsp oil) + ½ cup rice + sayote | ~4 g | ~290 | 4 tabs |
| Daily Total (approximate) |
≈18 g |
≈1,495 kcal |
10 tabs |
Tip: Add an evening snack of boiled corn or sweetened sago/gulaman for an extra 150–200 kcal to close the calorie gap.
60 kg Patient — VLPD Target: 18 g protein/day · ~1,950 kcal · 12 KA tablets/day (Reference Weight — Most Clinical Trial Data)
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 whole egg (sunny side up, 1 tbsp oil) + 1 cup rice + 1 medium kamote | ~10 g | ~475 | 3 tabs |
| Lunch 12PM | 1 cup rice + 1 cup cassava + sautéed sayote & kangkong in 1 tbsp oil (no protein food) | ~5 g | ~490 | 4 tabs |
| Snack 3PM | 1 cup boiled gabi + 1 ripe banana + 1 cup sago in buko juice | ~3 g | ~400 | — |
| Dinner 7PM | 25 g tokwa (fried in 1 tsp oil) + ¾ cup rice + pechay | ~5 g | ~310 | 5 tabs |
| Daily Total (approximate) |
≈23 g |
≈1,675 kcal |
12 tabs |
Tip: Add cooking oil generously (2 tbsp/cooked dish) to each vegetable and starch. Include an evening sago snack (+180 kcal) to approach the 1,950 kcal target.
| Reference: Garneata L & Mircescu G, JASN 2016. VLPD supplemented with KA safely delays dialysis initiation. All protein values approximate. Educational use only — VLPD requires physician supervision. |
williamriveromd.com · Page 4 of 6 |
VLPD Meal Plans — Part B (cont.) + Filipino Food Protein Reference 0.3 g protein/kg/day · Larger Body Weights 70–80 kg |
Page 5 of 6 · williamriveromd.com |
70 kg Patient — VLPD Target: 21 g protein/day · ~2,275 kcal · 14 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 whole egg (scrambled in 1 tbsp oil) + 1 cup rice + 1 cup boiled gabi + ampalaya | ~11 g | ~545 | 4 tabs |
| Lunch 12PM | 1 cup rice + 1 cup cassava + 1 cup sayote + 1 tbsp canola oil (no protein food) | ~5 g | ~490 | 4 tabs |
| Snack 3PM | 1 cup sweet corn (nilagang mais) + 1 cup sago in sugar + 1 banana | ~4 g | ~480 | — |
| Dinner 7PM | 50 g firm tofu (tokwa adobo style) + ¾ cup rice + kangkong + 1 tsp oil | ~6 g | ~350 | 6 tabs |
| Daily Total (approximate) |
≈26 g |
≈1,865 kcal |
14 tabs |
Tip: ~400–580 kcal gap remains. Add 2 tbsp oil to every cooked dish, a morning snack (sago/cassava), and an evening gulaman to approach the 2,275 kcal target.
80 kg Patient — VLPD Target: 24 g protein/day · ~2,600 kcal · 16 KA tablets/day
| Meal / Time |
Food & Preparation |
Prot |
kcal |
KA |
| Breakfast 7AM | 1 whole egg (poached) + 1 cup rice + 1 large kamote + pechay in 1 tbsp oil | ~12 g | ~570 | 4 tabs |
| Lunch 12PM | 1 cup rice + 1 cup boiled gabi + ½ cup cassava + sayote in 2 tbsp oil (no protein food) | ~6 g | ~560 | 5 tabs |
| Snack 3–4PM | 1 cup sweet corn + 1 cup sago in sugar + 1 ripe mango (medium) | ~5 g | ~510 | — |
| Dinner 7PM | 50 g firm tofu (fried in 1 tbsp oil) + 1 cup rice + kangkong | ~7 g | ~440 | 7 tabs |
| Daily Total (approximate) |
≈30 g |
≈2,080 kcal |
16 tabs |
Tip: 80 kg VLPD requires a dietitian. Add morning snack (cassava + oil) and evening snack (sago) plus 2 tbsp oil per dish daily to approach the 2,600 kcal goal.
📋 Filipino Food Protein & Calorie Reference
| Food |
Serving |
Prot |
kcal |
| Protein Foods |
| Whole egg | 1 large | 6 g | 70–80 |
| Egg white only | 1 white | 3.5 g | 17 |
| Bangus (milkfish) | 100 g cooked | 20 g | 148 |
| Tilapia | 100 g cooked | 18 g | 128 |
| Firm tofu (tokwa) | 100 g | 9 g | 76 |
| Firm tofu (tokwa) | 25 g (small cube) | 2.3 g | 19 |
| Staple Carbohydrates |
| White rice (cooked) | 1 cup (180 g) | 4 g | 200–210 |
| Kamote (boiled) | 1 medium (150 g) | 2 g | 100–110 |
| Gabi / taro (boiled) | 1 cup (132 g) | 2 g | 185 |
| Cassava (boiled) | 1 cup (206 g) | 1 g | 165 |
| Sweet corn (boiled) | 1 cup kernels | 4 g | 130 |
| Sago (cooked in water) | 1 cup | 0 g | 180 |
| Saba banana (boiled) | 1 medium | 1 g | 90 |
| Ripe mango | 1 medium | 1 g | 100 |
|
| Food |
Serving |
Prot |
kcal |
| Vegetables (Low Protein) |
| Kangkong (cooked) | 1 cup | 2 g | 27 |
| Sayote (cooked) | 1 cup | 1 g | 38 |
| Pechay / bok choy | 1 cup cooked | 1.5 g | 20 |
| Ampalaya (bitter melon) | 1 cup cooked | 1 g | 24 |
| Okra (cooked) | 1 cup | 1.5 g | 33 |
| Upo / bottle gourd | 1 cup cooked | 0.5 g | 22 |
| Fats & Oils (Zero to Minimal Protein) |
| Coconut oil | 1 tbsp (14 g) | 0 g | 120 |
| Canola oil | 1 tbsp (14 g) | 0 g | 120 |
| Coconut cream (gata) | 2 tbsp (30 mL) | 0.5 g | 100 |
| Plain white sugar | 1 tsp (4 g) | 0 g | 16 |
| Beverages |
| Sugarcane juice | 1 cup (240 mL) | 0.5 g | 120 |
| Buko (coconut water) | 1 cup (240 mL) | 1 g | 46 |
| Gulaman (plain jelly) | 1 cup | 0 g | 60–80 |
|
| Food composition data: FNRI Philippine Food Composition Tables 2023; USDA FoodData Central 2024. Values are approximate. Educational use only. |
williamriveromd.com · Page 5 of 6 |
| LPD & VLPD Diet Plan — Ketoanalogue Companion |
W.G.M. Rivero MD · FPCP · DPSN · williamriveromd.com · 2026 |
Filipino Protein Portions — LPD vs VLPD on a Real Plate
Fig. 2 — What your daily protein allowance actually looks like on a Filipino plate. LPD (left): roughly 1 egg + 60 g bangus + 50 g tofu across the whole day, plus 3 cups of rice for calories. VLPD (right): only 1 egg or a small cube of tofu — the rest of the plate is rice, kamote, cassava, gabi, vegetables, and cooking oil. Both diets require far more cooking oil than a typical Filipino meal to prevent muscle wasting.
| Reference: Garneata & Mircescu, JASN 2016 · For educational use only · Confirm targets with your nephrologist |
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Diet Adherence Guide — Part D, E, F Calorie Boosters · Foods to Avoid · Adherence Tips · Safety Warnings |
Page 6 of 6 · williamriveromd.com |
🔋 Calorie Booster Foods — High Energy, Low Protein
🛢️
Cooking Oils
120 kcal/tbsp · 0 g protein
Add to every dish. Coconut oil or canola oil. The single easiest calorie booster — mandatory on LPD/VLPD.
|
🍠
Kamote (Sweet Potato)
~100 kcal/medium · 2 g protein
Boil and eat with oil. Very low protein. Good mid-morning or afternoon snack with oil or coconut cream.
|
🥔
Cassava
165 kcal/cup · 1 g protein
Best low-protein starch. Lower protein than rice. Boil and eat plain or with gata. Good rice substitute.
|
🌿
Gabi (Taro)
185 kcal/cup · 2 g protein
High calorie starch with very low protein. Good in soups or with oil. Boil until soft.
|
🫙
Sago
180 kcal/cup · 0 g protein
Perfect calorie booster — pure carbohydrate, zero protein. Sweeten with sugar. Use as snack or dessert.
|
🍌
Ripe Banana
~90 kcal · 1 g protein
Good snack. Watch potassium if your nephrologist says your K+ is elevated. Limit to 1 per day if unsure.
|
🥥
Coconut Cream (Gata)
~100 kcal/2 tbsp · <1 g protein
Add to cassava, kamote, or sago desserts. Very low protein. Rich in saturated fat — use in moderation.
|
🍬
Plain Sugar / Syrup
16 kcal/tsp · 0 g protein
Add to sago, gulaman, or beverages. Zero protein. For diabetics — discuss blood sugar targets with your doctor first.
|
|
🚫 Foods to Avoid → Safer Alternatives
| ❌ Avoid |
✅ Replace With |
| Red meat, pork, beef (large portions) | Bangus, tilapia, or tofu (small measured portions) |
| Processed meats (tocino, longganisa, hotdog) | 1 egg or small piece of white fish |
| Dairy (milk, cheese, condensed milk) | Kamote, cassava, sago with oil |
| Fast food, instant noodles (high Na + P) | Home-cooked rice + vegetables + measured protein |
| Dried fish (tuyo, daing) — very high Na | Fresh fish steamed without salt |
| Bagoong, patis (fish sauce) | Calamansi + garlic for flavor |
⚠ Calcium Warning — KA Tablets
Never take calcium-containing antacids (Tums, Kremil-S) without checking with your nephrologist. Each Ketosteril tablet already contains calcium — adding antacids raises the risk of hypercalcemia.
|
✅ Adherence Tips
1Take KA tablets WITH meals — never on empty stomach. Split across all 3 main meals.
2Cook your protein portion separately from the family's — use a small kitchen scale.
3Replace 1 cup rice with cassava or kamote daily (saves 3–4 g protein).
4Add 1–2 tbsp cooking oil to every dish — this is mandatory, not optional, for hitting calorie targets.
5Weigh yourself every morning. Act if you lose >1 kg in one week.
6Plan your "protein moment" the night before — decide which meal gets the egg or fish.
7At social events: eat rice and vegetables only; decline the ulam politely. Say "kidney diet."
8Track your BUN (blood urea nitrogen) — a falling BUN is the sign your diet is working.
9Weekly family diet audit with the person who cooks — they must understand the rules too.
10If you slip on a meal, restart at the NEXT MEAL — not next Monday. One slip does not ruin the diet.
|
🚨 Seek Medical Attention Immediately If You Experience:
- Nausea, vomiting, or excessive thirst — may indicate hypercalcemia (too much calcium from KA tablets)
- Confusion, drowsiness, or muscle weakness — possible electrolyte imbalance
- >2 kg unintentional weight loss in 1 month — protein-calorie malnutrition
- Bone or joint pain, or eye redness — signs of calcium-phosphate deposition (metastatic calcification)
- BUN rising despite correct KA use and protein restriction — may need diet reassessment or dialysis evaluation
| Reference: Garneata & Mircescu, JASN 2016; KDIGO 2024 CKD Nutrition Guideline Update. All protein values are approximate (±3 g/day). Confirm targets with your nephrologist. A registered renal dietitian consultation is strongly recommended before starting VLPD. For educational use only. |
williamriveromd.com
Page 6 of 6 · 2026 |