Keto & Chronic Kidney Disease
Special considerations if your kidneys are compromised but you want to try, or continue with keto
Guest post by Jenny Hart
Chronic kidney disease affects nearly 37 million people across the United States – that’s more than 1 in 7 adults – many of whom aren’t aware that they have the condition until it becomes severe. Combine an aging population with prevalent risk factors such as diabetes and hypertension, and you have a rapidly worsening situation.
As the keto community is well aware, changes in nutrition often help to improve metabolic health and manage the symptoms of chronic disease. But does this hold true for people with compromised kidneys? And if so, how should they adjust their approach to keto? It depends on the stage of the disease.
What is chronic kidney disease
When they are functioning normally, the kidneys clean toxins from our blood and turn that waste into urine. They also help with electrolyte balance, blood pressure control and other important functions. If the kidneys start to fail these jobs – for example, due to inflammation that damages blood vessels in the organs – extra fluid and waste can accumulate in the body, leading to significant health problems over time.
In most patients, chronic kidney disease progresses slowly through five stages. During phase one, which often goes undetected, the rate of filtering remains normal, but proteins appear in a routine urine test. During stages two through four, the rate of filtering becomes compromised, and at stage five, the disease causes renal failure, at which point the kidneys can no longer filter blood and dialysis or a transplant are the only remaining options.
Unfortunately, in late-stage kidney disease, changing to a low-carb diet is not likely to help and should not be considered without prior discussion with a medical kidney specialist. However, in the earlier stages, what you eat (and what you avoid eating) can minimize risk factors like high blood sugar and high blood pressure, which reduces the stress placed on the kidneys. That could be a win-win.
Here are some basics to understand before jumping into (or continuing with) keto after an early-stage chronic kidney disease diagnosis:
Keto works by restricting carbs to initiate the metabolic state of ketosis. In this state, fat becomes the primary source of energy instead of sugar. Senza recommends eating less than 25g of net carbs per day for keto. This amount is low enough that most people can be sure to be in ketosis without having to test for ketones.
Staples of the keto lifestyle include well sourced animal proteins, full-fat dairy, leafy greens and other non-starchy vegetables, as well as limited amounts of nuts and berries. (For a complete list of keto-friendly foods, see this “Keto Food Shopping List.”)
The renal diet
Next, let’s look at the renal diet for the conventional wisdom in managing early-stage kidney dysfunction. Most patients are advised to eat foods that make it easier for the kidneys to do their job (for example, fish, chicken, bell peppers, cabbage, and berries), while limiting minerals like phosphorous, potassium, and sodium, which are more difficult for the kidneys to remove from the blood. (Note, organic sources of phosphorous found in animal foods are absorbed more easily than phosphorous from plant foods, and the inorganic form of this mineral is often added to packaged foods as a preservative, which you want to avoid.)
Early-stage kidney disease patients may be advised to avoid foods like apricots, avocados, bananas, and tomatoes due to their relatively high levels of potassium and phosphorous. For a Renal Diet Food List, see this article provided by UPMC HealthBeat. It’s important to note that these guidelines can vary based on each individual’s journey with the disease.
Which way should you eat?
In the early stages of chronic kidney disease, and under the guidance of a physician, it may be beneficial to follow a nutrient-dense, keto way of eating. Keeping your carbs very low and avoiding ultra-processed foods will help to reduce inflammation, lower blood pressure, and balance blood sugar – all of which will help to support kidney function.
There is a good amount of overlap between the two food lists, with the main difference being that the renal diet includes much higher amounts of carbs with starches, fruits, and even juices and sweets allowed on some lists. However, if one were to ignore the high-carb foods and focus on the kidney-friendly proteins (beef, lamb, pork, shellfish, chicken, turkey, wild game) and fats like butter and sour cream, then in theory, keto could be modified to work within the context of a renal diet.
Some specialists raise concern over protein intake with keto, since excess protein can place added stress on the kidneys. (Note, Senza’s macro calculator sets the protein target at the amount each individual needs to preserve existing muscle, based on age, weight, gender, and body composition. This typically is described as a moderate amount of protein.)
In later stages of kidney disease, it may be better to focus entirely on a standard renal diet. This is especially true if you are undergoing dialysis or are preparing for/recovering from a kidney transplant. In these stages, the top priority is to prevent further damage to the kidneys, and the keto way of eating may not be the best fit at this point.
In short, if introduced early enough, a nutrient-dense keto diet may help to slow the progression of the disease. But remember that changing what you eat can have profound effects on your metabolism and how the body reacts to medications. It’s important to work closely with your medical team as you adjust your approach to nutrition. This is especially critical if you are managing other chronic conditions, such as diabetes or high blood pressure, in addition to chronic kidney disease.
Can Keto (Ketogenic Diet) Reverse Kidney Disease: A perspective from Dr. Eric Berg
What you need to know about a low-carb diet and your kidneys, from the Diet Doctor team
For a medically supervised keto program for Type 2 diabetics, visit Virta Health
About the author:
Jenny Hart is the founder and writer of All Health All Day, a blog dedicated to mental, emotional, and physical wellness. She writes out of Little Rock, Arkansas.
Content provided by Senza is not medical advice. It is intended for informational and educational purposes only