Keto And Kidney Disease: A Safe Combination?

The ketogenic diet, or keto diet, is a low-carb, high-fat diet that has been used to help control seizures in children with epilepsy. In recent years, it has gained popularity as a weight-loss diet and a way to manage diabetes and liver disease. The keto diet aims to induce a state of ketosis, where the body uses fat instead of carbohydrates for energy. While the keto diet has shown some promising results in these areas, there are concerns about its effects on kidney health, especially for those with kidney disease.

The keto diet is restrictive and can lead to nutrient deficiencies, and its long-term effects are still unknown. Some studies suggest that the keto diet may contribute to an increased decline in kidney function for those with kidney disease and a higher risk of developing kidney stones. However, other studies have found that a very low-calorie ketogenic diet (VLCKD) may be safe and effective for weight loss in patients with mild kidney failure when conducted under medical supervision.

So, does keto work with kidney disease? The answer is not yet clear. While some research suggests potential benefits, more high-quality scientific research is needed to fully understand the effects of the keto diet on kidney health, especially in the long term. It is essential to consult with a healthcare professional before starting any restrictive diet, especially for those with kidney disease or other health conditions.

Can keto help with diabetic kidney damage?

The ketogenic (keto) diet has been linked to an increased decline in kidney function for those with kidney disease. The diet is characterized by very low-carbohydrate, modest protein meals, and a heavy focus on fat intake. This means that the body's primary energy source comes from burning fat instead of carbohydrates, which can lead to an increased risk of kidney stones and chronic kidney disease.

However, some research suggests that a keto diet may help reverse impaired kidney function in people with Type 1 and Type 2 diabetes. A study by researchers from Mount Sinai School of Medicine found that a low-carb, high-fat diet reversed diabetic kidney damage in mice. The study, published in the peer-reviewed journal PLoS ONE, also identified a panel of genes associated with diabetes-related kidney damage, whose expression was reversed by the diet.

According to Charles Mobbs, PhD, Professor of Neuroscience and Geriatrics and Palliative Care Medicine at Mount Sinai School of Medicine, the study is the first to show that a dietary intervention alone is enough to reverse this serious complication of diabetes. However, he also notes that the keto diet is not a long-term solution for adults due to its extreme requirements. Instead, exposure to the diet for a limited period may be sufficient to "reset" the gene expression and pathological process leading to kidney failure.

While the keto diet has shown some promising results in reversing diabetic kidney damage, it is important to consult with a physician or nephrologist before making any dietary changes, especially for those with kidney disease. There are alternative diets and lifestyle changes that can help with weight loss and kidney health.

What are the side effects of keto?

The keto diet can have several side effects, and it is not suitable for everyone. Here are some of the potential issues to be aware of:

Keto Flu

When entering ketosis, some people experience what is known as "keto flu", which includes symptoms such as brain fog, headaches, fatigue, muscle aches, nausea, and diarrhea. This is a result of your body transitioning from using carbs to fat as its primary energy source. This side effect is usually temporary and should pass within a week or two.

Constipation

Constipation is a common issue on the keto diet due to the lack of high-fibre foods like whole grains, beans, fruits, and vegetables. It is important to ensure adequate fluid intake and include high-fibre, low-carb foods like avocado, broccoli, and nuts in your diet to prevent constipation.

Diarrhea

The keto diet can also cause loose stools and diarrhea, especially if you consume too much fat or MCT oil. This is because a high-fat diet causes the liver to release more bile, which acts as a natural laxative.

Bad Breath

One of the ketone bodies produced during ketosis is acetone, which can cause bad breath. This side effect should improve as your body adapts to using ketones for energy.

Hair Loss

Hair loss can occur on the keto diet due to calorie restriction, weight loss, vitamin and mineral deficiencies, and unfavourable shifts in the microbiome. Ensuring adequate calorie and protein intake, as well as consulting with a doctor about supplementing with zinc and biotin, may help mitigate this side effect.

Vitamin and Mineral Deficiencies

The keto diet may lead to deficiencies in important nutrients like folate, thiamin, and vitamins A, B6, B12, C, E, and K. These deficiencies can have negative impacts on bone health, gums, metabolism, and red blood cell production.

Dehydration

The keto diet can cause dehydration due to water loss. It is important to drink enough water and increase electrolyte intake to stay hydrated.

Kidney Problems

The keto diet may increase the risk of kidney stones and worsen metabolic acidosis, especially in those with existing kidney disease. This is due to the high protein and animal fat content of the diet, which can increase the acidity of the blood and the formation of kidney stones.

Athletic Performance

The keto diet may negatively impact athletic performance, especially in high-intensity activities. This is likely due to the reduced availability of carbohydrates, the body's primary source of energy during exercise.

Heart Disease Risk

While the keto diet may improve HDL cholesterol, it can also increase LDL cholesterol levels due to the high consumption of saturated fats. This can potentially increase the risk of heart disease and stroke.

Weight Regain

The initial weight loss on the keto diet may be mostly water weight. When resuming a less restrictive diet, it is common to regain the lost weight, as it is challenging to maintain long-term.

It is important to note that the keto diet is not suitable for everyone, especially those with kidney disease or liver problems. Consulting with a healthcare professional before starting any new diet is essential to ensure it is safe and appropriate for your individual needs.

What foods are allowed on keto?

The ketogenic diet is a high-fat, moderate-protein, and very low-carbohydrate diet. Carbohydrates are the body's preferred source of energy, but on a strict ketogenic diet, about 5% to 10% of energy intake is from carbohydrates. The reduction of carbohydrates puts the body into a metabolic state called ketosis, where the body breaks down stored fat into molecules called ketone bodies to use for energy.

Nuts, Seeds, and Healthy Oils

Nuts and seeds are full of healthy polyunsaturated and monounsaturated fats, fiber, and protein. They are also very low in net carbs. Olive oil and coconut oil are the two oils recommended on the keto diet.

Plain Greek Yogurt and Cottage Cheese

Yogurt and cottage cheese are high in protein and calcium. They have also been shown to help decrease appetite and promote feelings of fullness.

Unsweetened Coffee and Tea

Plain coffee and tea contain zero grams of carbohydrates, fat, or protein, so they are allowed on the keto diet.

Dark Chocolate and Cocoa Powder

Dark chocolate and cocoa are delicious sources of antioxidants. Dark chocolate contains flavanols, which may reduce the risk of heart disease by lowering blood pressure and keeping arteries healthy. However, it is important to choose dark chocolate that contains a minimum of 70% cocoa solids and eat it in moderation.

Fish

Fish is rich in B vitamins, potassium, and selenium. It is also protein-rich and carb-free. Salmon, sardines, mackerel, albacore tuna, and other fatty fish have high levels of omega-3 fats, which have been linked to improved hemoglobin A1c levels and decreased risk of chronic disease.

Meat and Poultry

Meat and poultry are considered staple foods on the keto diet. Fresh meat and poultry contain no carbohydrates and are rich in B vitamins and several minerals. They are also a great source of high-quality protein, which may help preserve muscle mass during a very low-carb diet.

Eggs

Eggs are high in protein, B vitamins, minerals, and antioxidants. They also promote feelings of fullness. It is important to eat whole eggs rather than just egg whites since most of an egg's nutrients are found in the yolk.

Non-Starchy Vegetables

Non-starchy vegetables are low in calories and carbohydrates but high in many nutrients, including vitamin C and several minerals. They also contain antioxidants that help protect against cell-damaging free radicals. Broccoli, cauliflower, green beans, bell peppers, zucchini, and spinach are some examples of non-starchy vegetables.

Cheese

Cheese has zero carbohydrates and is high in fat, making it an excellent fit for the ketogenic diet. It is also rich in protein and calcium. However, it is important to note that cheese is high in saturated fat, which has been linked to an increased risk of heart disease.

Avocados

Avocados are high in monounsaturated fat and potassium, a mineral that many Americans lack. They are also low in net carbs.

Berries

Berries are rich in antioxidants that reduce inflammation and protect against disease. They are low in carbohydrates and high in fiber. Blackberries, blueberries, raspberries, and strawberries are some examples of berries that can be included in the ketogenic diet.

It is important to note that the ketogenic diet is a very restrictive diet and may not be suitable for everyone. It is always recommended to consult with a healthcare professional before starting any new diet, especially if you have a medical condition or concerns about your health.

What is the difference between ketosis and ketoacidosis?

Ketosis and ketoacidosis are two terms that sound similar and are often confused, but they are not the same thing. Both involve chemicals known as ketones, which are produced from the breakdown of fat and can be used as an alternative energy source for the body when glucose levels are low. However, there are some critical differences between the two.

Ketosis is a normal and safe body response to low-carbohydrate diets or fasting. It occurs when ketones accumulate in the blood after the body breaks down fat for energy. Ketosis is a typical metabolic process that is usually harmless. It can be a safe and effective way to help with weight loss for those who don't have diabetes and are in good health. It can also be used to reduce the frequency of epileptic seizures.

On the other hand, ketoacidosis, or diabetic ketoacidosis (DKA), is a dangerous and life-threatening complication that occurs when there is a rapid buildup of too many ketones in the bloodstream, making the blood too acidic. This is a serious complication of type 1 diabetes, and it can also occur in people with type 2 diabetes, albeit more rarely. DKA is triggered by extremely low insulin levels, which can be caused by poor diabetes management, illness, infection, or certain drugs. Symptoms of DKA include fruity-smelling breath, severe abdominal pain, confusion, and extreme fatigue. It requires immediate medical attention and can lead to death if left untreated.

While ketosis is a natural metabolic process, DKA is not. Ketosis can be achieved by limiting carbohydrate intake to fewer than 50 grams per day, which has been shown to result in weight loss. However, more research is needed to determine the long-term safety and sustainability of low-carb diets. It is important to consult a healthcare professional before starting any extreme diet plan.

What are the benefits of keto for kidney disease?

The ketogenic diet, or keto diet, is a low-carb, high-fat, and moderate-protein diet. It was initially developed in the 1920s as a treatment for epilepsy and is now being studied for its potential benefits in managing kidney disease.

Benefits of the Keto Diet for Kidney Disease Patients

Weight Loss:

The keto diet has been shown to be effective for weight loss, especially in obese individuals. This can be beneficial for kidney disease patients as obesity is a risk factor for chronic kidney disease and losing weight can help improve kidney function.

Improved Kidney Function in Diabetic Kidney Disease:

• Research suggests that the keto diet may help reverse impaired kidney function in Type 1 and Type 2 diabetes. A low-carb, high-fat diet administered to mice with diabetic kidney damage showed reversal of molecular and functional indicators of kidney damage.
• The keto diet may help block the toxic effects of glucose, which is thought to cause kidney failure in diabetes.

Potential Improvement in Blood Pressure:

A review in 2017 found that the keto diet showed potential improvement in blood pressure, which may be connected to weight loss from the diet. Managing blood pressure is crucial for kidney disease patients as hypertension is one of the top causes of kidney disease.

Blood Sugar and Insulin Management:

The keto diet can help manage blood sugar and insulin levels, which is beneficial for kidney disease patients with diabetes. The diet shifts the liver's role from insulin regulation to ketone generation, leading to changes in insulin production.

Improved Cholesterol Levels:

The keto diet has been shown to reduce total cholesterol, LDL, and/or triglyceride levels. It may also improve HDL ("good") cholesterol levels. Managing cholesterol is important for kidney disease patients as abnormal cholesterol levels are often observed in kidney disease.

Precautions and Considerations

While the keto diet may offer potential benefits for kidney disease patients, it is important to consider the following:

• Nutritional Deficiencies: The keto diet is restrictive and can lead to nutritional deficiencies, including B vitamins, vitamin C, phytochemicals, fiber, calcium, vitamin D, and electrolytes like potassium. It is important to work with a dietitian to ensure adequate nutrient intake.
• Kidney Stones: The keto diet has been associated with an increased risk of kidney stones due to higher calcium levels and metabolic acidosis.
• Side Effects: The keto diet may cause side effects such as "keto flu," constipation, changes in gut health, abnormal lipid values, and more.
• Individual Variation: The keto diet may not be suitable for everyone, and long-term effects of maintaining ketosis are still unknown. It is important to consult with a healthcare professional before starting any new diet, especially for those with kidney disease.

Frequently asked questions