It is well know that one of the most profound complications of diabetes is damage to the kidney and the very small arteries within the kidney acting as your body’s filtration system.  The kidney begins to lose the ability to adequately filter and retain microscopic protein progressively over time. As the blood sugar and insulin levels continually rise over time in the patient with diabetes or pre-diabetes, damage to the delicate filtering system of the kidneys occur. This very common and progressively damaging problem is called “nephropathy.”

We knew in 1972 that patients with diabetes had thickening of the basement membrane or endothelium of the small tubles within the kidneys.  In fact, 98.6% of diabetics tested had thickening of this area of endothelium and tubules also called the renal glomeruli (1).  This allows the glomerulus or filtration system of the kidney to become more “leaky” and microscopic protein loss begins to occur through the kidney.  This loss of important proteins in the blood is called “albuminuria” or “micro-albuminuria.”  It is a flag that further damage of the kidney can and will occur without making significant changes to lower the blood sugar and the insulin. As of today, it is not totally clear how the basement membrane is damaged at the microscopic level, however, there is some evidence that elevated insulin has both a physical and immune type effect that stimulates oxidative stress, atherogenesis, immunoglobulins, as well as the formation advanced glycation end products leading to endothelial wall damage (2).

Recent research reveals that a ketogenic diet effectively repairs and/or completely reverses the albuminuria (3).

Evidence in my office of the significant improvement in micro-albumin can be seen in the one of a number of case studies below:

72 year old male with history of diabetes, diabetic nephropathy already treated with full dose statins, ACE inhibtors, metformin, and Januvia.  (Remember, microalbumin should be <30 mg/g)

Date                 Microalbumin      HbA1c

8/12/2010        2264 mg/g              6.4%   Started carb restriction <30 g per day.

10/01/2010        1274 mg/g               5.2%

1/08/2011            1198                          5.8%   Admits to cheating over holidays

12/26/2013         2434 mg/g            6.8%   Returned from 2 yr travel-off diet

2/27/2014          399 mg/g               6.3%  Restarted carb restriction <20g per day

6/20/2014           190 mg/g              7.0%  Traveling – no carb restriction

10/31/2014          280 mg/g              6.9%  Partial carb restriction <10 g/meal

3/14/2015            97 mg/g                6.8%

The patient began following a ketogenic diet in 2010.  After improvement he moved out of town for two years and “fell of the wagon.” Upon returning h restarted his carbohydrate diet and was only partially following it.  As you can see, he also admitted to some cheating on the carbohydrate restriction over the holidays.  In light of this, carbohydrate restriction decreased his albuminuria from 2400 to 97 mg/g within a period of 18 months.

References:

1. Siperstein MS, Unger RH, Madison LL. “Further Electron Microscopic Studies of Diabetic Microagniopathy.” Early Diabetes: Advances in Metabolic Disorders, sup 1. New York: Academic Press, 1972, p261-271.
2. Nasr SH, D’Agati VD.  “Nodular glomerulosclerosis in the nondiabetic smoker.”  J Am Soc Nephrol. 2007;18(7):2032.
3. Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV (2011) Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 6(4): e18604. doi:10.1371/journal.pone.0018604

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