Published on November 8, 2023, 12:37 am
A low carbohydrate diet combined with a sodium glucose contransporter-2 (SGLT2) inhibitor has been found to be a safe and effective approach for weight loss and glycemic control in patients with diabetes and chronic kidney disease, according to recent research. The ketogenic diet, which is a low carbohydrate diet that aims to induce ketosis, was the most searched diet on Google in 2020, with over 25 million unique searches.
At the American Society of Nephrology’s Kidney Week Annual Meeting, Johannes Kovarik of the Medical University of Vienna presented findings that suggest a low carbohydrate or very low carbohydrate diet could be an effective intervention for patients with diabetes and chronic kidney disease. The findings challenge the notion that drugs are the only way to address this problem and highlight the potential role of dietary changes.
The Kidney Disease Improving Global Outcomes (KDIGO) organization updated its dietary recommendations for patients with CKD and diabetes in 2020. The new recommendations emphasize individualizing the diet to include plenty of vegetables, fiber, legumes, whole grains, plant-based proteins, nuts, and unsaturated fats while limiting processed meats, refined carbohydrates, and sweetened drinks.
The ketogenic diet specifically restricts carbohydrate consumption to less than 50 to 60 grams per day while maintaining adequate protein intake. This approach aims to achieve stable blood insulin and glucose levels by entering ketosis. Keeping insulin levels low is crucial as it helps reduce inflammation and improve insulin resistance—the common denominator in hypertension and diabetes.
Hypertension is closely linked to both diabetes and CKD, with insulin resistance being a factor in all three conditions as well as obesity and pre-diabetes. Without intervention, these conditions can lead to cardiovascular disease. To combat this epidemic of kidney disease along with obesity, pre-diabetes, diabetes, and hypertension, dietary changes such as adopting a low carbohydrate or very low carbohydrate diet may offer significant benefits.
Several studies have shown the effectiveness of the ketogenic diet in patients with type 2 diabetes and hypertension. These studies found that the diet decreased hemoglobin A1c levels, fasting glucose levels, weight, blood pressure, and visceral fat. In addition, combining a low carbohydrate diet with a weight loss medication, such as an SGLT2 inhibitor, has been shown to be safe and effective for weight loss in patients with CKD and type 2 diabetes.
Patients participating in these studies received psychological support and nutritional counseling alongside their dietary intervention—a multidisciplinary approach that could be a successful lifestyle intervention when combined with current medications. The low carbohydrate diet also proved effective for glycemic control and had positive effects on kidney function.
By reducing obesity and improving overall health outcomes, this dietary approach has the potential to benefit patients with various economic or racial backgrounds at different stages of CKD. However, concerns about diabetic ketoacidosis—a condition caused by excess ketones in the blood—have been raised regarding low carbohydrate diets. Encouragingly, advanced CKD appears to protect against ketoacidosis based on promising studies.
The potential uses of this dietary intervention extend beyond diabetes and CKD. Researchers are exploring its impact on mental disorders, polycystic ovarian syndrome, epilepsy, autoimmune diseases, and more. While some healthcare professionals remain hesitant about recommending low carbohydrate diets, further research will provide better insights into their full impact on diabetes and CKD management.
Patient safety is paramount in any healthcare intervention. Future research should continue exploring the risks associated with low carbohydrate diets to ensure their effectiveness against worsening conditions and negative cardiovascular outcomes. By investing in our patients’ well-being through evidence-based approaches like the low carbohydrate diet, we can make significant strides towards improving their health outcomes.
In conclusion,the combination of a low carbohydrate diet with an SGLT2 inhibitor shows promise for weight loss and improved glycemic control in patients with diabetes and chronic kidney disease. The ketogenic diet, in particular, has gained popularity and has been shown to be effective in managing type 2 diabetes and hypertension. While more research is needed to fully understand the benefits and risks of low carbohydrate diets, they offer a potential intervention for patients with these conditions. By focusing on patient safety and continuing to study the effects of these diets, we can better support individuals with diabetes and CKD.