Considering a plant-based ketogenic diet for PKD

by KNI

Table of Contents

    It’s week 3 of PKD awareness month! This week we’re uncovering how a ketogenic plant-based diet can inhibit cyst growth and slow the progression of ADPKD.

    We’re also introducing the importance of protein. Why it matters and how limiting protein can help keep your kidneys stronger for longer!

    Overhead view of ketogenic diet foods in grey bowls on a grey table

    Considering Keto

    What is ketosis?

    Normal metabolic state

    Before we dive into the nitty-gritty of ketosis, let’s look at the carbohydrate-based metabolic process.

    Most of our cells use glucose (blood sugar) as their primary energy source in a well-fed state. Why? Because it is really easy for the body to use for energy. Glucose mainly comes from the carbohydrates (carbs) that we eat.

    If we eat more carbs than we need for energy, the extra glucose gets converted to fat and stored in fat tissue. Stored fat is used for energy when glucose is not available.

    Most people in modern societies eat too many calories and carbohydrates. Unfortunately, excess calories and carbs can lead to obesity and chronic medical problems such as type 2 diabetes.

    The metabolic state of ketosis

    The regular metabolic state changes during periods of fasting or with a lower carbohydrate intake. As blood glucose levels decrease and glucose stores become depleted, the body’s fat reserves become the primary energy source.

    Our fat tissues release fatty acids into circulation. Some of the fatty acids are converted into “ketones” by the liver. Fatty acids and ketones are both used as an energy source for cells in the body instead of glucose.

    It is essential to understand that ketosis is a normal physiological state and should not be confused with ketoacidosis.

    Our bodies have adapted to switch to ketosis without any adverse effects to ensure that the body has energy when needed. However, ketosis may not be safe for individuals with underlying medical conditions like Type 2 Diabetes or rare genetic disorders.

    In today’s industrialized societies, most people have constant access to food, from breakfast to lunch, dinner, a late-night snack, and many snacks in between. As a result, most people rarely experience the switch to ketosis because they are in what is considered an “overfed” state.

    Benefits of Ketosis

    Being in a metabolic state of Ketosis has several beneficial effects:

    1. Because ketosis allows our body to use up its fat stores, it may help spur weight loss.
    2. Ketosis leads to high levels of ketones in the blood, especially beta-hydroxybutyrate (BHB). BHB has numerous beneficial effects on cells in the body. (1)
    3. Ketosis has potent anti-inflammatory effects. This is important because many chronic diseases involve chronic inflammation.

    You can switch your body’s metabolism to ketosis by fasting or eating specially designed diets called a ketogenic diet. But not just any ketogenic diet. Many popular ketogenic-based diets are too heavy in protein for people with kidney disease.

    What is a ketogenic diet?

    The goal of a Ketogenic diet is to put the body into ketosis without fasting. The ketogenic diet significantly reduces the number of carbohydrates while increasing fat in the diet.

    If a person is on a ketogenic diet, their metabolism should quickly switch to ketosis as their blood glucose concentration decreases and the blood levels of ketones (BHB) increases. Ketosis can take, on average, 2-3 days depending on the individual. Being in “ketosis” means you have ketones in your blood at a level of 0.5 mmol/L.

    Ketogenic diets have been around since biblical times as a nutrition treatment for many medical conditions. One example is epilepsy that isn’t responsive to medication.

    There is increasing evidence that the ketogenic diet may benefit other diseases, including certain cancers, diabetes, non-alcoholic fatty liver disease (NAFLD), and several other conditions, including PKD!

    How can ketosis benefit people with PKD?

    Close up view of man conducting research with a mask, lab coat, and hair net on examining a slide.

    Research from several laboratories has discovered that kidney cells with the ADPKD mutation have a metabolic defect that drives disease progression. This defect includes impairment of fatty acid metabolism and dependence on glycolysis. (2)

    These cells become dependent on glucose (blood sugar) as their energy source. They also appear unable to efficiently use other energy sources such as fatty acids and ketone bodies. We like to refer to PKD cells as “sugar addicts.”

    These changes in cellular metabolism are similar to the “Warburg Effect” that has been known in cancer cells for a long time.

    The Weimbs Lab at UCSB, in collaboration with many other experts, has shown that nutritional ketosis induced by fasting, time-restricted feeding, or ketogenic diet therapy strongly inhibits renal cyst growth, fibrosis and prevents loss of renal function in several different animal models with PKD. (3)

    The same researchers also found that glucose levels in the blood were higher in human subjects with ADPKD, even for individuals without a history of Diabetes. (3)

    Consistent with these findings, individuals with ADPKD and type 2 diabetes have larger total kidney volume (TKV) than those with ADPKD alone. (4) In addition, studies show that overweight and obesity can lead to faster progression of ADPKD. (5)

    Altogether, these findings support the conclusion that renal cysts in PKD depend on glucose as their primary energy source and cannot adapt well to the metabolic switch in ketosis.

    What is the role of the ketone beta-hydroxybutyrate(BHB) in PKD?

    BHB is one of the “ketones” produced by the liver during ketosis. Blood levels of BHB are typically low but rise to high levels during fasting. BHB is an energy carrier that cells take up and “burn” for energy.

    In addition, BHB has other functions and can regulate cell behavior by affecting numerous signaling pathways.
    The researchers at Weimbs Lab discovered that administering BHB in the drinking water of animal models produced the same beneficial effects as nutritional ketosis on PKD progression. (3)

    These findings suggest that elevated BHB levels contribute to the beneficial effects of ketosis on renal cyst growth. Researchers are currently investigating the exact mechanisms that are involved in these beneficial effects.

    BHB levels in the blood can be increased by taking a BHB supplement (exogenous form) or by inducing “nutritional ketosis,” which can be achieved by fasting or following a ketogenic diet.

    BHB is widely available as a dietary supplement and is Generally Recognized As Safe (GRAS). For example, athletes often take high doses of BHB as an “energy booster.”

    The Ren.Nu program utilizes a plant-focused ketogenic diet and an exogenous BHB supplied by the medical food KetoCitra. KetoCitra and the plant-focused ketogenic diet were designed specifically for people with PKD.

    Plan for Protein with PKD

    Man in a white short-sleeved button up and black tuxedo  tie with a fork and knife and large plate of raw steak on a white plate

    The discovery that ketosis can inhibit cyst growth and delay the progression of ADPKD is so exciting! But don’t get started just yet! Not all ketogenic diets are created equal and could be harmful to people with kidney disease. Understanding protein and how it can impact the kidneys is one of the foundations of kidney care!

    What is protein?

    Protein is one of the macronutrients, along with carbohydrates and fat. Macronutrients are the source of energy for our bodies. Protein comes from animal products like meat, eggs, dairy, fish and is found in smaller amounts in grains, beans, nuts, and even vegetables.

    How much protein and WHAT TYPE of protein are two critical considerations when it comes to kidney health.

    Why does the type and amount of protein matter?

    When looking for ketogenic diet recipes online, you’re likely to find recipes that include large amounts of meat and dairy. As a result, many people believe that a ketogenic diet is a high protein diet. However, the original ketogenic diet used therapeutically is low in carbs, high in fat, and contains only moderate amounts of protein.

    TOO MUCH protein can be problematic for people with kidney disease for several reasons:

    Hyperfiltration

    High protein diets cause an extra filtration burden on the kidneys. That’s because the kidneys have to remove waste products from the amino acids found in protein.

    Hyperfiltration is ESPECIALLY problematic for compromised kidneys and can lead to faster decline. (6) We have seen people with low eGFR in beautiful ketosis headed toward dialysis until the amount and type of protein were adjusted.

    Dietary Acid Load

    The TYPE of protein is also essential. Diets high in animal protein are more acidic. The kidneys are a key player in the regulation of acid and base balance in the body. Too much acid from the diet can lead to metabolic acidosis.

    Metabolic acidosis can cause the urine to become more acidic, and acidic urine is the perfect environment for kidney stones to develop. Kidney stones are not only painful; they can cause damage to the kidneys and trigger cyst growth. (7)

    Limiting animal protein can help the diet become more alkaline, decreasing the burden of acid removal from the kidneys and the risk of metabolic acidosis. Studies show that a more alkaline diet can slow the progression of kidney disease. (8)

    Purines

    But that’s not all! Diets high in animal protein often have a higher purine load. Purines can break down into uric acid, which is considered a uremic toxin. (9) High uric acid levels can lead to uric acid crystals that cause gout or uric acid stones in the kidneys.

    Protein can impact ketosis

    And finally, too much protein can prevent the body from switching to ketosis. When blood glucose levels are low, the body can convert some amino acids from proteins into glucose.

    The moral of the story is that protein matters!

    What does a plant-based ketogenic diet look like?

    Many keto diet plans are very high in protein and not as high in fat. The Ren.Nu program limits animal proteins and teaches a plant-based TRUE high fat (not just low carb) ketogenic approach.

    We focus on vegetables first! We also use a limited amount of some nuts (like macadamia and pecan), seeds, eggs, fish, and some full-fat dairy. Notice the emphasis on a limited amount!

    The animal protein we include is rich in omega-3 fatty acids and nutrient-dense in positive ways for PKD and the kidneys.  

    There is no one size fits all amount of protein because each person has unique protein needs. A Renal Dietitian familiar with ketogenic therapy can help you determine how much protein is suitable for you!

    Diet Matters for PKD!

    For individuals with PKD, considering ketosis and being mindful of protein intake are two essential ways to care for your kidneys!

    A recent discovery in ADPKD research found that cyst growth is glucose-dependent. Therefore, ketogenic diet therapy, time-restricted feeding, and BHB supplementation are all promising strategies to delay the progression of PKD and not just in animal studies!

    Breaking news!! A retrospective case study series in 131 humans with ADPK showed that time-restricted feeding and a ketogenic diet improved blood pressure, weight, and overall health. (10)

    Many modern ketogenic diets are very high in protein and can wind up causing more harm to the kidneys. Protein matters in kidney disease; that’s why we developed the plant-focused ketogenic diet that is high in fat, limits protein and is absolutely delicious! Check out our recipe for salmon with avocado salsa and try for yourself!

    If you want to learn more about the science-based nutrition approach designed for people with PKD, visit the Ren.Nu PKD Nutrition program. Ready to get started? Join the waitlist for the next available program, or schedule your free discovery call today!

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