Written by Shashikant Iyengar, Metabolic Health Coach
Shashikant Iyengar is a Metabolic Health Coach from India, specializing in low-carb/ketogenic diets to help clients worldwide manage chronic health conditions, including the remission of type 2 diabetes, obesity, hypertension, and mental & neurological disorders. He offers personalized, evidence-based guidance to empower lasting health transformations.
Chronic kidney disease (CKD) and polycystic kidney disease (PKD) are major health burdens globally, often leading to deteriorating kidney function and reduced quality of life. Conventional dietary guidelines for managing CKD usually emphasize low-protein intake to avoid kidney stress. However, emerging evidence supports the use of ketogenic diets (KD) and low-carbohydrate diets (LCD) as effective and safe interventions, challenging traditional paradigms.
Ketogenic diet in CKD: Promising evidence
The ketogenic diet, a high-fat, moderate-protein, and very low-carbohydrate regimen, has demonstrated the potential to improve kidney function markers in CKD patients. Studies suggest that ketosis, a metabolic state induced by this diet, provides protective effects against oxidative stress and inflammation, key drivers of CKD progression.
Reduction in oxidative stress and inflammation: Research by Paoli et al. (2019) highlights the ketogenic diet’s anti-inflammatory effects, which may slow CKD progression by mitigating chronic inflammation. Lower carbohydrate intake reduces hyperglycaemia and insulin resistance, critical factors in diabetic kidney disease, a leading cause of CKD.
Improved metabolic parameters: Studies such as those by Hallberg et al. (2018) have shown that ketogenic diets improve glycaemic control and reduce insulin levels, thus decreasing the risk of glomerular hyperfiltration and albuminuria in CKD patients. These benefits extend to improved lipid profiles, weight management, and blood pressure, all critical in CKD management.
Not high in protein: Contrary to common misconceptions, ketogenic diets are moderate in protein, not high. Protein intake typically ranges between 0.8–1.2 g/kg of body weight, and it can be lowered to 0.6 gm or 0.8 gm/kg body weight, which is the recommendation for CKD patients as per KDIGO guidelines.
Protein Intake in CKD: Reassessing the evidence
Traditional guidelines have often cautioned against high protein intake in CKD. However, recent studies challenge this notion, indicating that higher protein intake may not be as detrimental as previously thought:
Moderate protein intake is safe: A meta-analysis by Carrero et al. (2018) found that moderate protein intake does not accelerate CKD progression in non-diabetic kidney disease patients. Instead, poor-quality proteins are more likely to harm kidney function than total protein quantity.
Improved quality of life: Adequate protein intake is essential to prevent muscle wasting and maintain overall health. A well-formulated ketogenic diet, emphasizing high-quality protein sources like eggs, dairy, and plant-based options for vegetarians, can achieve this balance.
Protein intake & mortality: A multi-cohort study in older adults published in JAMA Aug 7th, 2024, showed that a higher intake of total, animal, and plant protein was associated with lower mortality in participants with CKD.
Associations were stronger in those without CKD, suggesting that the benefits of proteins may outweigh the downsides in older adults with mild or moderate CKD
Ketogenic diet in Polycystic Kidney Disease (PKD)
PKD, a genetic disorder characterized by cyst formation in the kidneys, is associated with progressive kidney function decline. Dr Thomas Weimbs, a leading researcher in PKD, has explored the use of ketogenic diets in PKD management.
Reduction in cyst growth: Dr Weimbs’ animal studies demonstrate that a ketogenic diet significantly reduces cyst growth in PKD models. This effect is attributed to metabolic reprogramming, which shifts energy reliance from glucose to ketones, suppressing the mTOR pathway that drives cyst proliferation. (Source: Weimbs et al., 2019)
Improved kidney function: In clinical studies, patients with PKD following a ketogenic or time-restricted feeding protocol experienced stabilization or improvement in kidney function markers. This suggests that metabolic interventions like ketosis can slow PKD progression.
Advantages of ketogenic and low-carb diets for kidney health
Blood sugar and insulin control: Both KD and LCD effectively control blood sugar and insulin levels, reducing kidney hyperfiltration stress, particularly in diabetic CKD.
Reduction in hyperuricemia: Elevated uric acid levels are common in CKD. A low-carb diet has shown efficacy in reducing uric acid levels by improving insulin sensitivity and reducing fructose intake, a significant contributor to hyperuricemia.
Nutrient density: These diets focus on nutrient-dense foods, providing essential vitamins and minerals to support overall health without relying on processed foods or added sugars.
Conclusion
Ketogenic and low-carbohydrate diets offer a novel and effective approach to managing CKD and PKD, focusing on improving metabolic health, reducing inflammation, and mitigating oxidative stress. Contrary to myths, these diets are not high in protein and are compatible with CKD dietary recommendations when well-structured. The groundbreaking work of researchers like Dr Thomas Weimbs underscores the therapeutic potential of ketogenic diets in PKD, offering hope for better management strategies.
These findings warrant further clinical trials to establish standardized protocols, but existing evidence makes a compelling case for integrating these dietary approaches into CKD and PKD management frameworks.
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Shashikant Iyengar, Metabolic Health Coach
Shashikant Iyengar is a prominent advocate for metabolic health in India, known for his expertise in low-carb/ketogenic diets. With multiple certifications in the low carb/ keto space & 35 years of pharma selling in Abbott & Pfizer, he brings a wealth of knowledge to his practice. He has co-organized India's 1st ever low-carb conference along with Anup Singh the pioneer of low carb in India. This conference called as Metabolic Health Conference has significantly influenced the country's approach to managing metabolic disorders. He actively contributes to educating the public & healthcare professionals via social media like Twitter, LinkedIn, Instagram, Facebook & conferences. He is a leading figure in the global metabolic health community.
