The Ketogenic Antidote to Chronic Renal Disease

It is well know that one of the most profound complications of diabetes is damage to the kidney and the very small arteries within the kidney acting as your body’s filtration system.  The kidney begins to lose the ability to adequately filter and retain microscopic protein progressively over time. As the blood sugar and insulin levels continually rise over time in the patient with diabetes or pre-diabetes, damage to the delicate filtering system of the kidneys occur. This very common and progressively damaging problem is called “nephropathy.”

nephropathy kidney

Chronic elevated blood sugar and insulin cause the filtering system to become more and more “leaky” and ineffective.

We knew in 1972 that patients with diabetes had thickening of the basement membrane or endothelium of the small tubles within the kidneys.  In fact, 98.6% of diabetics tested had thickening of this area of endothelium and tubules also called the renal glomeruli (1).  This allows the glomerulus or filtration system of the kidney to become more “leaky” and microscopic protein loss begins to occur through the kidney.  This loss of important proteins in the blood is called “albuminuria” or “micro-albuminuria.”  It is a flag that further damage of the kidney can and will occur without making significant changes to lower the blood sugar and the insulin. As of today, it is not totally clear how the basement membrane is damaged at the microscopic level, however, there is some evidence that elevated insulin has both a physical and immune type effect that stimulates oxidative stress, atherogenesis, immunoglobulins, as well as the formation advanced glycation end products leading to endothelial wall damage (2).

Recent research reveals that a ketogenic diet effectively repairs and/or completely reverses the albuminuria (3).

Evidence in my office of the significant improvement in micro-albumin can be seen in the one of a number of case studies below:

72 year old male with history of diabetes, diabetic nephropathy already treated with full dose statins, ACE inhibtors, metformin, and Januvia.  (Remember, microalbumin should be <30 mg/g)
Date                 Microalbumin      HbA1c
8/12/2010        2264 mg/g              6.4%   Started carb restriction <30 g per day.
10/01/2010        1274 mg/g               5.2%
1/08/2011            1198                          5.8%   Admits to cheating over holidays
12/26/2013         2434 mg/g            6.8%   Returned from 2 yr travel-off diet
2/27/2014          399 mg/g               6.3%  Restarted carb restriction <20g per day
6/20/2014           190 mg/g              7.0%  Traveling – no carb restriction
10/31/2014          280 mg/g              6.9%  Partial carb restriction <10 g/meal
3/14/2015            97 mg/g                6.8%

The patient began following a ketogenic diet in 2010.  After improvement he moved out of town for two years and “fell of the wagon.” Upon returning h restarted his carbohydrate diet and was only partially following it.  As you can see, he also admitted to some cheating on the carbohydrate restriction over the holidays.  In light of this, carbohydrate restriction decreased his albuminuria from 2400 to 97 mg/g within a period of 18 months.

References:

  1. Siperstein MS, Unger RH, Madison LL. “Further Electron Microscopic Studies of Diabetic Microagniopathy.” Early Diabetes: Advances in Metabolic Disorders, sup 1. New York: Academic Press, 1972, p261-271.
  2. Nasr SH, D’Agati VD.  “Nodular glomerulosclerosis in the nondiabetic smoker.”  J Am Soc Nephrol. 2007;18(7):2032.
  3. Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV (2011) Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 6(4): e18604. doi:10.1371/journal.pone.0018604

3 Comments on “The Ketogenic Antidote to Chronic Renal Disease

  1. Your article is timely for me. That info is so good to know. I have had what appeared to be kidney stone pain but a urine test and ultrasound showed no stones. Could eating ketogenic and not having a gall bladder be the source of the pain? My doctors are stumped. Other symptoms include light-headed ness plus vomiting. Once that happens, the pain is gone until I eat or drink Any ideas? Thank you for your insight.

  2. Joan, without actually seeing you as a patient and having all the data to review, it is not possible or prudent to give adequate insight. I would highly recommend you follow back up with your doctor as soon as possible for further evaluation and testing as the symptoms you describe could be any number of more serious conditions.

    • Joan,

      If your doctors are stumped, I would be happy to see you via a formal Tele-Medicine virtual office visit (where I can become your doctor and see you over you iPad, iPhone or computer video, and order labs, x-rays, prescriptions, and other testing that may be needed for your medical care).

      You can access the registration page here: http://www.sensiblemedicalsolutions.com/TeleMedicine_page.html

      Unfortunately, insurance does not cover this type of service at the present time (maybe in the near future), however, I have tried to make it an affordable cash based service today.

      Sincerely,
      Adam Nally, D.O.

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