While there are a lot of controversies surrounding the keto diet and the effects that it has on the liver and the kidney, it is not safe for those with kidney damage or liver failure. However, it can be used to reverse a liver condition called non-alcoholic fatty liver disease, and even prevent its onset.
For the kidney, however, you should consider supplementation if you are worried about developing kidney stones while on keto. All in all, run by your health care provider first before attempting keto, especially if you have any underlying medical conditions. Still, the information provided in this article is just but a general overview of my interpretation of the science and the available data on these areas, as the jury is still out.
The keto diet can stress your kidneys and even give you kidney stones. While choosing to do keto, there are two ways to do it- a better and a worse way. This is so as eating lots of processed meats can lead to you developing gout and certain types of kidney stones. When you have a high intake of fatty keto meals such as butter and animal proteins, your urine tends to be more acidic and the uric and calcium levels also increase. This combo makes you more prone to developing kidney stones, as it adds more acid to the kidneys and ends up messing with the body’s calcium balance. The high uric acid levels on the other hand make you more susceptible to having gout, which is a type of arthritis that is very painful.
Moreover, those with kidney diseases should not attempt keto because of the following reasons. First, individuals with kidney illnesses need to follow a diet that is low on proteins, and this does not align with what keto calls for; moderate amounts of protein. For example, in individuals with stages 3 to 5 of chronic kidney disease, the required dietary intake is between 0.6 to 0.8 grams per kilo of body weight per day, as contrasted with the 1.2 to 1.7 grams per kilo of body weight daily for someone on keto. However, if you have a normal functioning kidney minus the risk factors for developing kidney disease, it is not clear whether eating the aforementioned amount of protein can/ will harm the kidneys.
Another interesting point to note is that individuals with kidney diseases are advised to take plant-based proteins as it is better as compared to animal-based proteins. However, with keto, there is no distinction between the two as the most important thing is that you do not exceed the ranges of 1.2 to 1.7 grams per kilo of bodyweight set for each day.
In addition, the keto diet advocates for the consumption of extra amounts of sodium especially when starting out so as not to have a dip in electrolytes. On the other hand, a diet low in sodium is what works for those with chronic kidney disease as it helps in managing high blood pressure and also aids in preventing fluid retention.
Lastly, carbs are restricted or strictly limited in keto, which is used in providing calories minus giving the additional proteins in people with kidney diseases.
HOW DO I PROTECT MY KIDNEYS WHILE ON A KETO DIET?
The following are some of the guidelines that I would recommend when following a keto diet for kidney disease.
Focus on veggies. Some of the vegetables that are friendly to your kidneys include jicama, peppers, cucumbers, kales, green cabbages, and asparagus.
Pick the healthy fats. If you choose to go keto while having chronic kidney disease, then high-quality fat sources are a must in your diet, as they are kidney-friendly. Examples of such sources include avocado oil, olive oil, sesame oil, sunflower oil, canola oil, and safflower oil.
Change your macronutrients intake. You can modify the ratios for the carbs, fats, and proteins so that they align with your kidney health goals as opposed to the initial keto weight loss goal. By doing so, your kidney function is more protected.
Plan your meals and snacks. Have healthy snacks easily available and planned earlier on. Also, be sure to plan out your meals right from grocery shopping to cooking.
Consult with your nephrologist. Be sure to inform your kidney doctor not just about your health, but also about any dietary changes you plan to undertake. This will ensure that they can monitor your progress by ordering lab tests at various intervals, and also be able to make some changes to your medications and dosage as per those lab results. These decisions will be done while having your kidneys in the best interest.
Have a renal dietitian guide you. When you work alongside a renal dietitian, you will have a vast reservoir of information that will help you safely navigate the keto diet as someone having renal impairments. They will not only help you in tracking the lab results and monitoring your progress but also provide you with recipes and meal ideas to make your journey better on keto.
IS THE KETO DIET A GOOD IDEA FOR POLYCYSTIC KIDNEY DISEASE (PKD)?
There are a lot of studies being carried out currently in the area of polycystic kidney disease and keto. Based on a previous study done on rats with PKD in 2019 to examine how beneficial the keto diet was in impacting cyst growth, it was found that the cyst growth slowed in rats that were put on keto. This slowed cyst growth was a result of the beta-hydroxybutyrate, a type of ketone produced while in ketosis.
However, the studies do not speak the same for human beings with PKD, hence inconclusive results are out there currently. This is why. Individuals with PKD are at an even higher risk for developing heart diseases and other cardiovascular ailments. Therefore, the diet for these people must be heart-friendly. According to the American Heart Association, the recommended daily intake of calories from saturated fats should not exceed 5% to 6% or approximately 13 grams. Furthermore, they advise the addition of whole grains and other foods rich in fiber such as veggies and fruits so as to help in lowering the total cholesterol levels.
Now onto the keto diet, it differs from the nutrition recommended by the American Heart Association for heart health. It is limited in fruit and lots of veggies so as to lower the carb intake. Additionally, it does not give any room for whole-grain foods such as pasta or brown rice. Lastly, the high-fat content aspect of keto inevitably provides a lot of saturated fats, which is bad for heart health and someone with PKD. We do not dispute that heart-healthy fats such as olive and sunflower oil have saturated fats in small quantities but just as too much of something is poisonous, when taken in large amounts it works against heart health.
CAN THE KETO DIET REVERSE KIDNEY DISEASE?
Once the kidneys are damaged, there is no way of repairing them. A transplant will be the only solution at this point. However, before it gets to that point, the keto diet can help in reversing impaired kidney function that has been caused by both type 1and 2 diabetes. This is according to research conducted by a team of scientists from Mount Sinai School of Medicine.
SUMMARY
If you want to start keto, first of all, have a chat with your primary care provider, especially if you have liver problems, pancreatitis, renal impairment, thyroid problems, are pregnant, or are nursing. The doctor(s) can help you stay safe while on keto and monitor your progress if you have the non-alcoholic fatty liver disease already or kidney disease- depending on the stage.
The notion that upping your intake of dietary fat always leads to non-alcoholic fatty liver disease is wrong and has been proven so by many comprehensive studies on that subject. Any diet that aids one to lose excess body weight, such as keto, is also good enough for reversing and managing non-alcoholic fatty liver disease, as long as it is not high in carbs, and for which keto is not.
The keto diet is not for people with kidney diseases as they have an individualized diet plan prescribed by their medical caregivers that they need to stick to. However, it will not hurt if you run this idea by your renal dietitian or kidney doctor as they might be able to provide ways to be on keto while living with this ailment.
WHO SHOULD NOT DO KETO?
As is with everything, there are also exceptions for those who cannot be on the keto diet, however much they would love to. The circumstances surrounding their inability to diet on keto are far beyond their control. These include individuals with kidney damage, people who are predisposed to having heart diseases/ ailments, expectant women, lactating mothers, those with a fat metabolism disorder or pyruvate kinase deficiency, those with pancreatic, thyroid, or pre-existing liver conditions, and anyone who has undergone surgery for the removal of their gallbladder or is having problems with it. Also, individuals with type one diabetes should not be on keto because of the need for tight insulin control.
CAN THE KETO DIET HARM MY LIVER?
There are studies that suggest that the keto diet can cause Non- alcoholic fatty liver disease (NAFLD) and there are those that show that it can actually reverse the condition and even prevent its onset. So which is which? Well, the latter has a body of research that backs it up, and which has been covered in a lot of meta-analyses and study reviews. Non-alcoholic fatty liver disease has been known to affect about 20 % to 30 % of Western individuals. It is a broad spectrum of conditions that are characterized by a build-up of fat in the liver in individuals who are not habitual alcoholic drinkers, hence the ‘non- alcoholic’ bit in the name.
For it to be diagnosed, a doctor has to rule out chronic medication use, some hereditary disorders, or alcohol abuse. There is no definite cause of NAFDL though it often occurs in individuals with a poor diet, those leading a sedentary lifestyle, overweight or obese individuals, and those with high levels of triglycerides, and it can be changed or reversed by healthy eating and regular workouts. Luckily, keto can help with that. This is so as the keto diet works against non-alcoholic fatty liver disease by promoting weight loss, lowering insulin levels, and ensuring that you have a low intake of carbs.
You are probably wondering how keto can cause Non- alcoholic fatty liver disease and not for it yet it is a high-fat diet, on top of medical doctors recommending one to lower their fat intake when dealing with this kind of liver problem. Read on to find out how.
The main driver behind the development of non-alcoholic fatty liver disease is insulin resistance. How do you ask? The fats in the liver can be from the breakdown of fat in fat tissue, the production of fat in the liver itself, and lastly dietary fat. So, the fat buildup in the liver is when the insulin resistance causes carbohydrates from the food to be converted to fat in the liver – insulin resistance leads to high blood sugars, which end up being diverted to the liver.
It might seem logical that consuming dietary fat leads to your body being fat and your liver too, but our bodies are more complex than that. As earlier mentioned, it is too many dietary carbohydrates that are the culprits of non-alcoholic fatty liver disease. However, it is not just the amount but also the type of carbs- fructose and simple glucose- that puts you at risk of developing insulin resistance, leading to a cascade of events. Fructose for example does not spike the blood glucose, instead, it heads straight to the liver and is converted to fat when it is in excess. The same goes for fat. The type of fat that is bad for the liver is saturated fat, while keto advocates for taking unsaturated fats which are healthy as they boost the liver’s health.
IS KETO HARD ON MY KIDNEYS?
The keto diet can stress your kidneys and even give you kidney stones. While choosing to do keto, there are two ways to do it- a better and a worse way. This is so as eating lots of processed meats can lead to you developing gout and certain types of kidney stones. When you have a high intake of fatty keto meals such as butter and animal proteins, your urine tends to be more acidic and the uric and calcium levels also increase. This combo makes you more prone to developing kidney stones, as it adds more acid to the kidneys and ends up messing with the body’s calcium balance. The high uric acid levels on the other hand make you more susceptible to having gout, which is a type of arthritis that is very painful.
Moreover, those with kidney diseases should not attempt keto because of the following reasons. First, individuals with kidney illnesses need to follow a diet that is low on proteins, and this does not align with what keto calls for; moderate amounts of protein. For example, in individuals with stages 3 to 5 of chronic kidney disease, the required dietary intake is between 0.6 to 0.8 grams per kilo of body weight per day, as contrasted with the 1.2 to 1.7 grams per kilo of body weight daily for someone on keto. However, if you have a normal functioning kidney minus the risk factors for developing kidney disease, it is not clear whether eating the aforementioned amount of protein can/ will harm the kidneys.
Another interesting point to note is that individuals with kidney diseases are advised to take plant-based proteins as it is better as compared to animal-based proteins. However, with keto, there is no distinction between the two as the most important thing is that you do not exceed the ranges of 1.2 to 1.7 grams per kilo of bodyweight set for each day.
In addition, the keto diet advocates for the consumption of extra amounts of sodium especially when starting out so as not to have a dip in electrolytes. On the other hand, a diet low in sodium is what works for those with chronic kidney disease as it helps in managing high blood pressure and also aids in preventing fluid retention.
Lastly, carbs are restricted or strictly limited in keto, which is used in providing calories minus giving the additional proteins in people with kidney diseases.
HOW DO I PROTECT MY KIDNEYS WHILE ON A KETO DIET?
The following are some of the guidelines that I would recommend when following a keto diet for kidney disease.
Focus on veggies. Some of the vegetables that are friendly to your kidneys include jicama, peppers, cucumbers, kales, green cabbages, and asparagus.
Pick the healthy fats. If you choose to go keto while having chronic kidney disease, then high-quality fat sources are a must in your diet, as they are kidney-friendly. Examples of such sources include avocado oil, olive oil, sesame oil, sunflower oil, canola oil, and safflower oil.
Change your macronutrients intake. You can modify the ratios for the carbs, fats, and proteins so that they align with your kidney health goals as opposed to the initial keto weight loss goal. By doing so, your kidney function is more protected.
Plan your meals and snacks. Have healthy snacks easily available and planned earlier on. Also, be sure to plan out your meals right from grocery shopping to cooking.
Consult with your nephrologist. Be sure to inform your kidney doctor not just about your health, but also about any dietary changes you plan to undertake. This will ensure that they can monitor your progress by ordering lab tests at various intervals, and also be able to make some changes to your medications and dosage as per those lab results. These decisions will be done while having your kidneys in the best interest.
Have a renal dietitian guide you. When you work alongside a renal dietitian, you will have a vast reservoir of information that will help you safely navigate the keto diet as someone having renal impairments. They will not only help you in tracking the lab results and monitoring your progress but also provide you with recipes and meal ideas to make your journey better on keto.
IS THE KETO DIET A GOOD IDEA FOR POLYCYSTIC KIDNEY DISEASE (PKD)?
There are a lot of studies being carried out currently in the area of polycystic kidney disease and keto. Based on a previous study done on rats with PKD in 2019 to examine how beneficial the keto diet was in impacting cyst growth, it was found that the cyst growth slowed in rats that were put on keto. This slowed cyst growth was a result of the beta-hydroxybutyrate, a type of ketone produced while in ketosis.
However, the studies do not speak the same for human beings with PKD, hence inconclusive results are out there currently. This is why. Individuals with PKD are at an even higher risk for developing heart diseases and other cardiovascular ailments. Therefore, the diet for these people must be heart-friendly. According to the American Heart Association, the recommended daily intake of calories from saturated fats should not exceed 5% to 6% or approximately 13 grams. Furthermore, they advise the addition of whole grains and other foods rich in fiber such as veggies and fruits so as to help in lowering the total cholesterol levels.
Now onto the keto diet, it differs from the nutrition recommended by the American Heart Association for heart health. It is limited in fruit and lots of veggies so as to lower the carb intake. Additionally, it does not give any room for whole-grain foods such as pasta or brown rice. Lastly, the high-fat content aspect of keto inevitably provides a lot of saturated fats, which is bad for heart health and someone with PKD. We do not dispute that heart-healthy fats such as olive and sunflower oil have saturated fats in small quantities but just as too much of something is poisonous, when taken in large amounts it works against heart health.
CAN THE KETO DIET REVERSE KIDNEY DISEASE?
Once the kidneys are damaged, there is no way of repairing them. A transplant will be the only solution at this point. However, before it gets to that point, the keto diet can help in reversing impaired kidney function that has been caused by both type 1and 2 diabetes. This is according to research conducted by a team of scientists from Mount Sinai School of Medicine.
SUMMARY
If you want to start keto, first of all, have a chat with your primary care provider, especially if you have liver problems, pancreatitis, renal impairment, thyroid problems, are pregnant, or are nursing. The doctor(s) can help you stay safe while on keto and monitor your progress if you have the non-alcoholic fatty liver disease already or kidney disease- depending on the stage.
The notion that upping your intake of dietary fat always leads to non-alcoholic fatty liver disease is wrong and has been proven so by many comprehensive studies on that subject. Any diet that aids one to lose excess body weight, such as keto, is also good enough for reversing and managing non-alcoholic fatty liver disease, as long as it is not high in carbs, and for which keto is not.
The keto diet is not for people with kidney diseases as they have an individualized diet plan prescribed by their medical caregivers that they need to stick to. However, it will not hurt if you run this idea by your renal dietitian or kidney doctor as they might be able to provide ways to be on keto while living with this ailment.
