Keto Diet: Friend Or Foe To Liver And Kidneys?

The ketogenic diet is a popular strategy for rapid weight loss and can help with certain medical conditions like seizures and Type 2 diabetes. However, it is not without its risks. The keto diet is high in fat and extremely low in carbohydrates, which can lead to dehydration, nutrient deficiencies, and kidney stones. The diet may also be harmful to those with liver conditions as the liver has to metabolise large amounts of fat.

Keto can lead to dehydration, which may cause kidney stones

The keto diet is a popular strategy for rapid weight loss and can help with certain medical conditions like seizures and Type 2 diabetes. However, kidney doctors warn that it can also lead to kidney stones and other health issues.

The keto diet is essentially a high-fat, low-sugar weight-loss strategy that forces the body into its natural starvation mode, causing it to rely on fat for fuel instead of sugars and carbohydrates. While this can lead to weight loss, it can also cause dehydration, as the body experiences water loss before fat loss. Dehydration can then lead to kidney stones, as dehydration is a significant promoter of kidney stone formation.

In addition to dehydration, chronic metabolic acidosis, low urine pH, and fat malabsorption can also contribute to the formation of kidney stones. Metabolic acidosis can decrease calcium reabsorption in the renal tubules, increasing urinary calcium excretion and promoting kidney stone formation. Low urine pH facilitates uric acid crystal formation, which can act as a nucleus for calcium stone formation.

To prevent dehydration and the associated risk of kidney stones, it is important to ensure adequate fluid intake while on the keto diet. Staying well-hydrated can help to wash out metabolic products and reduce the risk of kidney stone formation.

While the keto diet has been associated with an increased risk of kidney stones, it is not necessarily the diet itself that is harmful, but rather the way some people approach it. Therefore, it is recommended to consult with a doctor or dietitian before starting the keto diet to ensure it is a suitable choice for your body type and medical history.

The keto diet may overload the kidneys with protein

A high-protein diet can cause an increase in kidney volume and weight, leading to the expansion of the mesangial matrix and tubulointerstitial fibrosis. This can result in intraglomerular hypertension, leading to glomerular hyperfiltration, injury, and proteinuria. In addition, a high-protein diet can cause a decline in kidney function, even in those without prior kidney problems.

A well-formulated ketogenic diet is typically not high in protein. Even low-carb diets that aren't ketogenic do not necessarily equate to eating large amounts of protein. Most people eat moderate or adequate amounts of protein, which is about 1.2 to 2.0 grams of protein for each kilogram of desired body weight.

However, some people on a low-carb diet, such as bodybuilders or athletes doing resistance training, may consume much higher levels of protein. They may eat more than double the amount of protein found in a typical low-carb recipe.

Research shows that when kidneys are healthy, the level of protein in the diet does not impact kidney function. This is true for both higher-carb and low-carb diets. Even at higher protein levels, there is no concern if the kidneys are healthy. Kidney experts reviewed the available scientific literature and concluded that while protein restriction may be appropriate for treating existing kidney disease, there is no significant evidence that high protein intake negatively affects kidney function in healthy individuals.

In addition, a randomized crossover study followed 14 male bodybuilders for a year. For six months, they ate their normal diet, and for the other six months, they ate a high-protein diet. The study found no harmful effects on kidney function from the high-protein diet. Another study looked at five healthy bodybuilders who consumed a high-protein diet for two years without any change in their normal kidney function measurements or other negative effects.

Therefore, while a keto diet may overload the kidneys with protein, research suggests that this is not a concern if the kidneys are healthy.

Keto can worsen liver conditions

The ketogenic diet is not suitable for people with liver failure or other liver conditions. The high-fat content of the keto diet means the liver has to metabolize a large amount of fat, which can worsen existing liver conditions.

Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a condition characterised by a build-up of fat in the liver, affecting 20-30% of adults in developed countries. The exact mechanisms that cause NAFLD are not fully understood, but it is believed that lifestyle, genetics, and gut health issues play a role.

Lifestyle Factors

Insulin resistance, caused by eating too much and exercising too little, is one of the main reasons fat builds up in the liver. This leads to a vicious cycle of insulin resistance and fat accumulation in the liver. Overconsumption of carbohydrates, especially fructose, will lead to the most fat accumulation in the liver. A sedentary lifestyle also contributes to insulin resistance and fat build-up in the liver.

Genetic Factors

NAFLD is polygenic, meaning the interaction of multiple gene variants can make someone more susceptible to the disease. One particular genetic variant, PNPLA3 I148M, is associated with the development of NAFLD without the presence of obesity, diabetes, dyslipidemia, or insulin resistance. However, this gene variant will only lead to disease progression in combination with other factors such as alcohol abuse, an unhealthy diet, or inactivity.

Gut Health Issues

An unhealthy gut microbiome can also contribute to NAFLD. Studies have found that obese patients tend to have a reduced abundance of a type of bacteria called Bacteroidetes and an increased abundance of another type called Firmicutes. This imbalance leads to an increase in lipopolysaccharide absorption, which triggers a potent inflammatory response in the body and contributes to insulin resistance and obesity.

Treating NAFLD with Keto

The ketogenic diet has been proposed as a possible treatment for NAFLD. By restricting carbohydrates, the keto diet removes one of the main drivers of fatty liver disease. However, the effectiveness of the keto diet for treating NAFLD is still uncertain. While some studies suggest that keto can reduce fat in the liver, others have found that it does not significantly improve liver function tests.

To optimise the potential benefits of the keto diet for NAFLD, it is important to include low-carbohydrate vegetables with every meal. This combination of vegetables and carbohydrate restriction may make the keto diet an ideal treatment for NAFLD.

The high-fat content of keto may lead to increased LDL cholesterol levels, which are linked to heart disease

The ketogenic diet is a high-fat, low-carbohydrate diet that has gained popularity for its ability to induce rapid weight loss. While it may be an effective tool for weight loss, the keto diet has also been associated with negative side effects and potential health risks. One of the main concerns is its impact on cholesterol levels, particularly the increase in low-density lipoprotein (LDL) cholesterol, also known as the "bad" cholesterol.

The high-fat content of the keto diet is primarily comprised of saturated fats, which have been linked to poor heart health. This includes foods such as beef, pork, cheese, butter, oils (palm and coconut), lard, and cocoa butter. The overconsumption of these types of fats can lead to an increase in total cholesterol and LDL cholesterol levels. Higher LDL cholesterol levels are a known risk factor for heart disease and strokes.

Several studies have examined the impact of the keto diet on cholesterol levels, and the results have been mixed. Some studies have shown a modest increase in LDL cholesterol levels, while others have found no significant changes. However, there are also reports of individuals experiencing a dramatic elevation in LDL cholesterol, particularly those who are lean and fit. These individuals, referred to as "Lean Mass Hyper-Responders," may exhibit LDL cholesterol levels greater than 200 mg/dL when following a ketogenic diet.

The impact of the keto diet on LDL cholesterol levels may depend on various factors, including the quality of the diet, the presence of underlying health conditions, and genetic factors. For example, those with insulin resistance, type 2 diabetes, or abdominal obesity may see improvements in their triglyceride levels and a reduction in insulin resistance while on a keto diet. On the other hand, individuals with a genetic mutation that affects LDL regulation may experience a significant increase in LDL levels when following a keto diet.

While the keto diet may be an effective weight-loss strategy for some, it is important to consider the potential risks associated with increased LDL cholesterol levels. Before adopting a keto diet, it is crucial to consult with a healthcare professional to assess individual health needs and risks. Additionally, close monitoring of blood cholesterol and triglyceride levels is recommended to ensure that the diet is not having a detrimental effect on heart health.

Keto may cause vitamin and mineral deficiencies

The keto diet is a low-carb, high-fat eating plan that promises quick weight loss. However, it can also lead to vitamin and mineral deficiencies, which can have negative impacts on overall health.

Folate (Vitamin B9)

Folate, or vitamin B9, is essential for several bodily functions, including energy production, hormone balance, gene expression, and mood control. A folate deficiency can lead to fatigue, mood swings, and increased cravings. The keto diet's restriction of carbohydrates and leafy greens can result in a gradual depletion of folate.

Biotin (Vitamin B7)

Biotin, or vitamin B7, is important for hair, skin, and nail health. It is also involved in the processing of fatty acids, which are consumed in high amounts on the keto diet. A biotin deficiency can lead to hair loss, dry skin, and rashes.

Selenium

Selenium is a trace mineral that acts as an antioxidant, boosts immunity, supports thyroid function, and protects against heart disease. While selenium is found in keto-friendly foods like Brazil nuts, mushrooms, oysters, and meat, a long-term ketogenic diet can lead to selenium deficiency.

Choline

Choline is an essential nutrient for normal metabolism and the transport of fats, neurotransmitters, and homocysteine. It is found in egg yolks, liver, meat, poultry, and fish. A very high-fat keto diet, with extreme restriction of carbohydrates and protein, can lead to a choline deficiency, potentially causing or worsening fatty liver disease.

Other Nutrient Deficiencies

The keto diet may also lead to deficiencies in vitamins A, B6, B12, C, E, and K, as well as minerals like magnesium and iodine. These nutrients are essential for various bodily functions, including bone health, metabolism, and red blood cell production.

Preventing Deficiencies

To prevent vitamin and mineral deficiencies while on the keto diet, it is important to include a variety of nutrient-dense foods. This includes grass-fed meat, pastured poultry, wild-caught fish, leafy greens, nuts, and seeds. Additionally, supplementation with a high-quality multivitamin can help ensure adequate nutrient intake.

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