1

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Are ketogenic diets bad for people with kidney and liver issues?

Answered on August 19, 2014
Created December 10, 2012 at 7:55 PM

i have heard that diseased kidneys have trouble processing ketones and that a damaged liver cannot process the amount of fat required on a ketogenic diet.

is there any truth to these claims?

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2013
at 02:37 PM

Why they heck did you go keto if you were the "healthiest person you've ever met"? Something doesn't add up.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2013
at 02:36 PM

Wow, even zombies use PaleoHacks!

0a6376917fcaee2c65fbf614543f62cb

(438)

on August 21, 2013
at 11:27 AM

Bee, can you elaborate on what your health problems are that were caused by keto? I am very interested in your details, thanks. Bee, can you elaborate on what your health problems are that were caused by keto? I am very interested in the details, thanks.

82166cc32b6cf26de33b69f58fb583b1

on December 15, 2012
at 05:01 PM

People have been down voting this answer. They apparently don't understand that there are about a thousand scientific papers about ketogenic diets in the medical literature. The guidelines that I describe in my answer are based on that science. Science uncovers facts, and facts are what they are. Maybe you don't like the facts, but that doesn't matter. The facts are what they are. For exaple, it happens to be a fact that the rate of kidney stones is much higher in children on ketogenic diets than other children. That's simply a fact. You can't wish it away or down-vote it away.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on December 11, 2012
at 12:46 PM

The take home message from the mice study: ketone bodies are well tolerated.

383127951e2e17f23b584cd3842bb796

(835)

on December 11, 2012
at 03:03 AM

i only eat 4 or 5 eggs at a time and haven't experienced symptoms after eating them

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on December 11, 2012
at 02:34 AM

Have you ever experienced something similar after eating a large amount of eggs?

383127951e2e17f23b584cd3842bb796

(835)

on December 11, 2012
at 01:32 AM

i made a thread addressing symptoms i experience after eating liver. i get nauseated, my face flushes, and my extremities tingle after eating any kind of animal liver. could that be related to liver damage being exacerbated by vitamin a consumption?

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on December 11, 2012
at 12:32 AM

This answer seems to be about the effects of high protein diets on healthy kidneys, not the effects of a high fat diet on damaged kidneys (and liver), which is what the OP seems to be asking.

B3173217a49b5b0116078775a17eb21d

(11488)

on December 10, 2012
at 11:56 PM

of course keto diets are not high protein, but most of the arguments against low-varb diets for kidney health is the misconcrption that they are high protein.

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8 Answers

2
A2c38be4c54c91a15071f82f14cac0b3

(12682)

on December 11, 2012
at 01:23 AM

As to the liver issues, it's possible they could be worsened in specific situations. I elaborated on this idea here:

http://paleohacks.com/questions/150900/hack-this-research-does-mct-cause-fatty-liver-disease#axzz2EhLjO0et

Basically, I believe high fat diets without a good choline supply, whether endogenous or exogenous may worsen certain liver diseases (NAFLD, NASH, etc.).

Thankfully, most people on ketogenic diets generally eat a lot of eggs, liver, animal protein, and leafy greens, so I doubt this should be a concern.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on December 11, 2012
at 02:34 AM

Have you ever experienced something similar after eating a large amount of eggs?

383127951e2e17f23b584cd3842bb796

(835)

on December 11, 2012
at 01:32 AM

i made a thread addressing symptoms i experience after eating liver. i get nauseated, my face flushes, and my extremities tingle after eating any kind of animal liver. could that be related to liver damage being exacerbated by vitamin a consumption?

383127951e2e17f23b584cd3842bb796

(835)

on December 11, 2012
at 03:03 AM

i only eat 4 or 5 eggs at a time and haven't experienced symptoms after eating them

2
E12ead3bf63c94b5b619b03722ef554f

on December 11, 2012
at 01:05 AM

I think ketogenic diets have promising benefits for people dealing with these issues, but it would have to be a real ketogenic diet. Not only very low-carb, but very high-fat and quite low in protein. Blood ketone testing could help make sure nutritional ketosis is achieved.

Here's a study showing that ketogenic diet can not only help but reverse diabetic nephropathy (kidney disease), at least in mice: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018604

2
2c4c08f7b5eeb80bb2e2712c573b6ec2

on December 10, 2012
at 08:29 PM

I don't know how it affects humans, but there was an interesting study that can be found here that shows that a ketogenic diet can reverse kidney failure in diabetic mice.

I would be really interested to see some studies (even n=1) that try this out in humans.

A ketogenic diet may be able to help with fatty liver disease as well. The Effect of a Low-Carbohydrate, Ketogenic Diet on Nonalcoholic Fatty Liver Disease: A Pilot Study

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on December 11, 2012
at 12:46 PM

The take home message from the mice study: ketone bodies are well tolerated.

1
82166cc32b6cf26de33b69f58fb583b1

on December 11, 2012
at 12:39 AM

There is an international organization of doctors and other professionals who have clinical experience with ketogenic diets. It's called the International Ketogenic Diet Study Group. They publish guidelines for safe use of ketogenic diets. The guidelines include a list of medical conditions (contraindications) which would make a ketogenic diet unsafe.

At least one of the conditions on the list (carnitine deficiency) can cause liver dysfunction. You don't say exactly what sort of liver problem you have in mind. If you personally have a disease that affects the liver, maybe you should look at the list of contraindications carefully.

Another condition on the list, beta-oxidation defects, can cause the liver to lack the ability to oxidize fatty acids. Regarding this condition the guidelines say, "An inborn metabolic error at any point along this pathway can lead to a devastating catabolic crisis (i.e., coma, death) in a patient fasted or placed on a [ketogenic diet]."

Ketogenic diets increase the risk of kidney stones. Doctors often prescribe potassium citrate to people on medical ketogenic diets as a prophylactic measure against kidney stones.

Here is a link to the full text of the guidelines. Contradindications are in Table 2. The title says "children" because virtually all clinical experience with ketogenic diets has been with kids.

Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group

If you want to read more about the risks of ketogenic diets, click here to see a bibliography on my website (with many links to full text) of articles about risks and prevention.

Some people seem to believe that ketogenic diets are harmless, risk-free, totally wonderful things. This isn't true. Ketogenic diets are like medications. They bring benefits but they also bring risks and harmful side effects. They involve tradeoffs.

I'm not against ketogenic diets. I've been on a ketogenic diet for years to treat my migraines. For months at a time I've eaten 90% of my calories as fat. But I think it's important to weigh the tradeoffs carefully. Ketogenic diets can be beneficial, but they can also cause harm.

If you (or anybody) is considering a ketogenic diet, it might be a good idea to look at the papers on risk and prevention in the link above.

References:

  1. Kossoff EH et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304-17. doi: 10.1111/j.1528-1167.2008.01765.x. Epub 2008 Sep 23. PMID: 18823325

  2. wwww.KetoCure.com. Scientific papers about risks and prevention

82166cc32b6cf26de33b69f58fb583b1

on December 15, 2012
at 05:01 PM

People have been down voting this answer. They apparently don't understand that there are about a thousand scientific papers about ketogenic diets in the medical literature. The guidelines that I describe in my answer are based on that science. Science uncovers facts, and facts are what they are. Maybe you don't like the facts, but that doesn't matter. The facts are what they are. For exaple, it happens to be a fact that the rate of kidney stones is much higher in children on ketogenic diets than other children. That's simply a fact. You can't wish it away or down-vote it away.

1
3089dd0b9a8f1d24f1b08d6cc3ca84e3

(363)

on December 10, 2012
at 08:23 PM

This is a question dats often asked i think emailing Robb Wolf on this would bring some great advice . Theirs doctors that have actually said theh seen ketogenic diets reverse kidney dysfunction as odd as dat might sound .

0
0a6376917fcaee2c65fbf614543f62cb

on August 21, 2013
at 11:26 AM

Bee, can you elaborate on what your health problems are that were caused by keto? I am very interested in your details, thanks.

0
F236230bcaedcb6f70e1750122fcf6f1

on August 21, 2013
at 06:19 AM

I am current (still) living proof that ketogenic diets can terribly injure people and even lead to death. Thomas Cowan put me on a medical keto diet in January 2013, and I continued it until my body gave out at the end of May 2013. He ignore my symptoms and complaints, and I trusted him as the "Dr" he supposedly is. Keto almost killed me, and possibly still might. I am 29, female, and (formerly) was always complimented being told I'm the healthiest person you've ever met. Now I can barely walk. Keto can be dangerous to some people, and a blessing to others. Don't ever speak as though you are the total authority on the topic. I'll come back to haunt whoever says keto is the answer to everything.

** and it's blogs and posts like these ones that have kept me digging for help and answers to this madness.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2013
at 02:36 PM

Wow, even zombies use PaleoHacks!

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on August 21, 2013
at 02:37 PM

Why they heck did you go keto if you were the "healthiest person you've ever met"? Something doesn't add up.

0a6376917fcaee2c65fbf614543f62cb

(438)

on August 21, 2013
at 11:27 AM

Bee, can you elaborate on what your health problems are that were caused by keto? I am very interested in your details, thanks. Bee, can you elaborate on what your health problems are that were caused by keto? I am very interested in the details, thanks.

0
B3173217a49b5b0116078775a17eb21d

(11488)

on December 10, 2012
at 11:52 PM

From http://www.kriskris.com/how-to-win-an-argument-with-a-nutritionist/

There is NO evidence that increased protein is harmful for people with healthy kidneys.

In fact, the studies show that increased protein can lower blood pressure:

http://jama.jamanetwork.com/article.aspx?articleid=201882 http://hyper.ahajournals.org/content/38/4/821.short http://www.ncbi.nlm.nih.gov/pubmed/20711407

…and improve blood sugar control in type II diabetics:

http://www.ajcn.org/content/78/4/734.short http://care.diabetesjournals.org/content/25/3/425.short http://diabetes.diabetesjournals.org/content/53/9/2375.short

High blood pressure and diabetes are the key risk factors for kidney failure. Consequently, eating more protein, not less, should be good for the kidneys.

The advice to restrict protein intake for the bones and kidneys is likely to have the exact opposite effect.

Here are two review articles that show no harmful effect of protein consumption on kidney health:

http://www.jissn.com/content/1/1/45

http://www.nutritionandmetabolism.com/content/2/1/25

B3173217a49b5b0116078775a17eb21d

(11488)

on December 10, 2012
at 11:56 PM

of course keto diets are not high protein, but most of the arguments against low-varb diets for kidney health is the misconcrption that they are high protein.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on December 11, 2012
at 12:32 AM

This answer seems to be about the effects of high protein diets on healthy kidneys, not the effects of a high fat diet on damaged kidneys (and liver), which is what the OP seems to be asking.

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