Researchers studied whether a ketogenic diet (a low-carb, high-fat eating plan) could help protect the kidneys of people with diabetes. They looked at data from thousands of patients and found that people following a ketogenic diet had lower rates of severe kidney disease. The study also measured a chemical called beta-hydroxybutyrate that the body makes when following this diet, and found higher levels were linked to better kidney health. While these results are promising, doctors say more research is needed before recommending this diet specifically for kidney protection.

The Quick Take

  • What they studied: Whether eating a ketogenic diet (very low in carbs, high in fat) could help prevent severe kidney disease in people with diabetes
  • Who participated: Thousands of people with diabetes and kidney disease from national health surveys and a hospital in China. The study included people at different stages of kidney disease.
  • Key finding: People who followed a ketogenic diet more closely had lower rates of end-stage kidney disease. A specific chemical produced by this diet (beta-hydroxybutyrate) was linked to better kidney function and lower disease risk.
  • What it means for you: If you have diabetes and kidney disease, a ketogenic diet might help protect your kidneys, but you should talk to your doctor before making major diet changes. This research is promising but not yet strong enough to be a standard recommendation.

The Research Details

This research combined two different types of studies. First, researchers looked at a large snapshot of health data from thousands of Americans to see if people eating more like a ketogenic diet had less severe kidney disease. They measured how closely people’s diets matched a ketogenic pattern using a special score. Second, they followed a group of diabetic patients with kidney disease over time, measuring a chemical in their blood called beta-hydroxybutyrate that increases when you eat a ketogenic diet. They tracked who developed severe kidney disease and compared it to their beta-hydroxybutyrate levels. The researchers also used a special statistical method called Mendelian randomization to try to figure out if the diet actually causes better kidney health, not just that healthier people happen to eat this way.

Using multiple study types and methods helps researchers get a clearer picture. The snapshot study shows what’s happening in the real world, while the follow-up study shows what happens over time. The special statistical method helps rule out other explanations for why people on this diet might have healthier kidneys.

This study is fairly strong because it used real-world data from many people and followed some patients over time. However, the snapshot part of the study can only show connections, not prove cause-and-effect. The researchers tried to account for other health factors that might affect kidneys, which makes the results more reliable. The study would be stronger if it were a controlled experiment where some people were randomly assigned to eat a ketogenic diet.

What the Results Show

The main finding was that people whose diets more closely matched a ketogenic pattern had significantly lower rates of end-stage kidney disease. In the follow-up study of diabetic patients, those with higher levels of beta-hydroxybutyrate (the chemical produced by ketogenic diets) had better kidney survival and lower risk of developing severe kidney disease. The safest level appeared to be around 0.25 millimoles per liter of beta-hydroxybutyrate. The statistical analysis showed these connections were real and not due to chance. The special genetic analysis also supported these findings, suggesting the relationship might be causal rather than just coincidental.

The study found that people without severe kidney disease tended to be older, have higher body weight, and better nutrition markers at the start. There was a weak but measurable connection between how ketogenic someone’s diet was and their kidney function markers. The genetic analysis showed connections between beta-hydroxybutyrate levels and multiple kidney health markers, suggesting the effect might work through several biological pathways.

Previous research has suggested that ketogenic diets might help with weight loss and blood sugar control in diabetic patients, which could indirectly help kidneys. However, there’s been concern that high-protein ketogenic diets might stress the kidneys. This study suggests that if done properly, a ketogenic diet might actually protect kidneys rather than harm them. The findings add to growing evidence that ketogenic diets may have benefits beyond weight loss.

The snapshot study can only show that two things are connected, not that one causes the other. People who choose ketogenic diets might be different in other ways that protect their kidneys. The study didn’t randomly assign people to eat differently, so we can’t be completely sure the diet itself caused the benefit. The research was done in specific populations, so results might not apply to everyone. More research with controlled experiments is needed to prove the diet actually causes kidney protection.

The Bottom Line

Based on this research, a ketogenic diet may help protect kidneys in people with diabetes, but the evidence is not yet strong enough for doctors to routinely recommend it for this purpose. If you have diabetes and kidney disease and are interested in trying a ketogenic diet, discuss it with your doctor or a kidney specialist first. They can monitor your kidney function and adjust your diet if needed. This is especially important because kidney disease patients sometimes need to limit certain nutrients that are high in ketogenic diets.

This research is most relevant to people with diabetes who have early-stage kidney disease. It may be less relevant to people with very advanced kidney disease, who may need different dietary restrictions. People without kidney disease or diabetes probably don’t need to change their diet based on this study. Anyone considering a major diet change should talk to their healthcare provider first.

If you started a ketogenic diet, you wouldn’t see kidney benefits overnight. The study followed people over months to years. You might notice changes in blood sugar control within weeks, but kidney protection would take longer to measure and would require regular blood tests with your doctor.

Want to Apply This Research?

  • Track your daily carbohydrate and fat intake to monitor how closely you’re following a ketogenic pattern. Log meals and calculate your daily carb-to-fat ratio. Aim for a target ratio and track consistency week-to-week.
  • If interested in trying a ketogenic diet for kidney health, use the app to plan meals that are low in carbs and moderate in protein (important for kidney disease). Start by replacing high-carb foods with low-carb vegetables and healthy fats, while keeping protein portions appropriate for your kidney function.
  • Work with your doctor to establish a baseline of kidney function tests. Use the app to log your diet consistently, then compare your dietary adherence to your kidney function test results at regular doctor visits (typically every 3-6 months). Track any changes in energy, blood sugar readings, or symptoms.

This research suggests a potential benefit of ketogenic diets for kidney protection in diabetic patients, but is not yet conclusive proof. People with kidney disease have specific dietary needs and restrictions that may conflict with ketogenic eating. Before starting a ketogenic diet, especially if you have diabetes, kidney disease, or take medications, consult with your doctor or a registered dietitian. They can monitor your kidney function and ensure the diet is safe for your individual situation. This information is for educational purposes and should not replace professional medical advice.