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Low-carbohydrate diets are perhaps most popular for weight loss, but the strictest form of carbohydrate restriction – a ketogenic diet – has been shown to have therapeutic effects in a number of other areas, such as mental health, type 1 diabetes, and lesser-known conditions, like lipedema and glycogen storage diseases. Previous articles have highlighted the role of keto diets in supporting healthy kidney function, and a paper published earlier this year in Frontiers in Nutrition adds to the body of research showing that keto is not only safe for the kidneys, but it may actually improve kidney function in people with type 2 diabetes. Type 2 diabetes (T2D) is a leading cause of kidney disease and kidney failure. Research shows an association between a slower decline in estimated glomerular filtration rate (eGFR) and reduced risk for end-stage kidney disease (ESKD). The recent paper highlights findings from a post-hoc analysis of the effect of a ketogenic diet (KD) on eGFR slope and select inflammatory markers over two years.
Results showed that among subjects with T2D, adherence to a KD for two years was associated with significant increases in eGFR slope, whereas subjects following the usual standard of care experienced a decline. Subjects reported blood β-hydroxybutyrate (BHB) levels to confirm adherence, and stronger adherence (percentage of days recording BHB ≥ 0.3 mM from baseline to 2 years) was independently associated with greater eGFR improvement that persisted after adjusting for demographics, weight change and baseline medication use. Researchers identified a dose-response relationship between stronger adherence and eGFR improvement, particularly among subjects with a lower baseline eGFR (<90 mL/min/1.73m2). Stronger adherence also correlated with significant reductions in inflammatory markers such high sensitivity C-reactive protein (hs-CRP) and neutrophil-lymphocyte ratio (NLR).
Sodium glucose cotransporter 2 inhibitor drugs (SGLT2is) are effective for slowing eGFR slope and reducing ESKD, but these medications are not without adverse effects. The present research highlights nutritional ketosis as a potential non-pharmacological approach to stabilize or even improve eGFR in T2D. Additional research is needed to assess possible synergistic effects of ketogenic diets combined with pharmacotherapy, but caution should be used when combining KDs with SGLT2is, owing to increased risk for euglycemic ketoacidosis when these two approaches are used together.
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