 Let's talk about the best and worst diets for kidney disease. Higher protein ketogenic diets may accelerate kidney failure progression and cause other medical problems in patients with kidney disease. According to the new findings from a review published in Frontiers in Nutrition, is that news to you or do you the chiropractors already brainwash you that the only good diet is keto? Well, if you have doubts about keto diets and want to find out if keto is safe for your kidneys and your overall health, I will tell you a few things the other guys don't want to say to you. Then we will look into scientific facts about keto and kidney disease relationship. We recently published a stop kidney disease video and I think this video will be a good follow up in terms of how to diet correctly when you have diabetes and kidney disease. Some keto diets by the way are more vegetarian predominant but there is little published research on their effects on the kidney health so we are not really talking about this type of keto today. We will be actually talking about keto high in animal protein and we will touch base on the effects of plant based diets. Hi, I am Dr. Ahmet Ergin, I am an endocrinologist and a diabetes and hormone specialist practicing in Florida and helping everyone with diabetes in the universe as long as they watch YouTube. kidney studies point out that the possible long term risks of high protein keto diet including heart disease, cancer, diabetes, kidney stones, Alzheimer's disease, other diseases, even in non-diabetics. The other adverse effects associated with long term high protein or high meat intake are bone and calcium regulation problems and worsening of kidney disease, even kidney stones and liver disorders. Now how true is that? As you all know, keto diets are low in carbohydrates and high in fat with controversy over whether the diets should be high in protein to begin with. The average keto diet consists around 1-2 gram per kilogram per day of protein which is usually a lot of protein, however supporters of keto diet consider this protein intake to be expected or just average possibly because the typical American diet already consists around 1.2 to 1.5 gram per kilogram of protein. Well, here is the deal. By definition keto diets are very high in fat and protein and that is challenging for long term kidney health. What else the keto diets are not good for? It would be especially unsafe for women who are pregnant or may become pregnant with solid data suggesting that the low carb diets are actually linked to a higher risk of neural tube defects in infants even if the mother took a shitload of folic acid. Why does keto diet put a strain on the kidneys? Well, in patients with any reduction in kidney function due to diabetes or high blood pressure, etc., high protein intake accelerates the loss of kidney function and a keto diet can strain the already troubled kidneys. A review published in a reputable journal confirmed that high animal fat consumption was associated with increased risk of albuminuria which is a protein leak in the urine and chronic kidney disease. And because obesity is an independent risk factor for kidney disease, the many nephrologists that I know are looking ways to have their patients lose weight. Many of their patients also have diabetes, high blood pressure, heart disease, etc. As a result, keto diet sometimes is brought up by the patients or the doctors to lose weight. Yet the studies show that the ketogenic diets can lead to further harm in these kidney disease patients. Instead, a healthful diet of vegetables and fruits and legumes, basically a plant-based diet appropriately planned, will lead to a healthier long-term weight control in addition to helping preserve the kidney function to the as much extent as possible. Let's touch base also on the keto diet and its impact on metabolic acidosis which happens in kidney disease. The ketogenic diet has the potential to make the metabolic acidosis that is already present in patients with kidney disease way worse. Well doctors have to treat that metabolic acidosis worsened by the keto diet with sodium bicarbonate which then can have side effects such as worsening of edema which is swelling and elevated blood pressure. Increasing the potential acid load with a high-protein keto diet may exacerbate the situation and require more medication to treat it. How about keto diets in type 1 diabetes? Is that okay for them? Well because keto diets include a lot of saturated fats and the meats and the poultry and the eggs and the cheese, they have been associated with increased cardiovascular risk. These foods often are high in saturated fat and cholesterol and a lot of chemical contaminants and potential other inflammatory compounds. Well when the researchers looked at the adults with type 1 diabetes what they found was that the studies actually suggesting both favorable and unfavorable outcomes for type 1 diabetics. One small study suggested that the keto diet could actually improve the blood glucose control in patients with type 1 diabetes but the big but it caused more frequent and severely low glucose events. As far as I can tell the science indicates that the only well supported use for keto diet is to reduce the seizure frequency in some individuals with drug resistant epilepsy. I can tell you that these recent study reports are not surprising given the well-known problems with excess protein and high acid load in the diet. Well studies in 1998 showed that the Atkins diet which is the predecessor of keto diets worsened the kidney stones by increasing the urinary calcium and lowering protective citrate in the urine. The effect of dietary protein on the worsening of kidney disease progression is pretty much an ancient history for many doctors. What other problems you may encounter with keto diet especially if you are over 50 and have diabetes. A few small studies suggest that the people on the ketogenic diet lose muscle even when they continue resistance training. This may be related to the fact that the protein alone is less effective for muscle building than protein and carbohydrates together after exercise. That's why the guys you see at the gym eat carbs to build muscle except the skinny ones who can't. A study in 2018 in the Journal of Sports showed that the people on keto did lose more leg muscle which can affect your balance especially if you are also dealing with diabetic neuropathy. You may not know but falls are the top cause of death from injury in older population. What else? Well loading your body with meats especially the processed meats will increase your risk of kidney stones and gout. What is gout? Well it is a painful type of arthritis you for sure do not want to have. Eating many animal proteins makes your urine more acidic. It increases the calcium and uric acid levels which is a recipe for kidney stones and the high uric acid is a recipe for gout. A few other annoying problems could be constipation, dehydration, low potassium, low sodium, high blood pressure to name a few. You will also have a bed breath so stay away from me. What about plant based diets for kidney disease? Are they any good? I mean we kind of talked about and bashed the ketogenic diet high in protein. Well plant based foods miss three important things that your kidneys will be super happy for not having to deal with. What are they? Number one the acid load that is created from protein breakdown. Number two is phosphorus very high in animal based foods. Number three cholesterol. When kidneys start to fail they can't deal with the acid load and the phosphorus load as easily. As a result the acid and the phosphorus start accumulating in the body causing further damage to your bones and the arteries. High cholesterol also damages the endothelial lining of your kidney arteries and as a result reduces your glomerular filtration rate, your GFR. Plant based foods that are not highly processed have phytates such as like the fresh vegetables or fruits and all that stuff and then some healthy grains. The phytates binds phosphorus as a result your body don't absorb as much phosphorus as you would otherwise from highly processed foods and dairy foods. Many vegetables also contain something called plant sterols or sterols which prevent the absorption of cholesterol and can actually lower the bad cholesterol which is your LDL by up to 15%. So thanks to the polyphenols in the plant based diet you will also enjoy antioxidant repair which helps lower the risk of heart attacks, the strokes, the cancer and the Alzheimer disease. After hearing all of this I hope you can make a better choice and make better changes to improve your kidney function or at least prevent the deterioration. Please write a comment, like and share and we will see you in the next video guys.