Renal function in patients following a low carbohydrate diet for type 2 diabetes: a review of the literature and analysis of routine clinical data from a primary care service over 7 years

Abstract

Purpose of review People with T2 Diabetes (T2D) who follow a low carbohydrate diet (LCD) may increase their dietary protein intake. Dietary protein can modulate renal function so there is debate about its role in renal disease. There is concern that higher protein intakes may promote renal damage, and that LCDs themselves may impact on cardiovascular risk. We review the evidence around LCDs, renal and cardiovascular risk factors and compare to results obtained in a real-world, primary care setting. Recent findings Chronic kidney disease (CKD) is a well-recognised microvascular complication of T2D caused in part by; chronically increased glomerular pressure, hyperfiltration, increased blood pressure and advanced glycation end products. Hyperglycemia can be seen as central to all of these factors. A LCD is an effective first step in its correction as we demonstrate in our real-world cohort. Summary We found evidence that LCDs for people with T2D may improve many renal and cardiovascular risk factors. In our own LCD cohort of 143 patients with normal renal function or only mild CKD, over an average of 30 months the serum creatinine improved by a significant mean of 4.7 (14.9) μmol/L. What remains to be shown is the effect of the approach on people with T2D and moderate/severe CKD.

Hypertriglyceridemia and Other Risk Factors of Chronic Kidney Disease in Type 2 Diabetes: A Hospital-Based Clinic Population in Greece

“…In patients with DCKD stages 3 to 5, each 10 mm Hg increase in mean SBP has been associated with a 15% increase in the hazard ratio for the development of both micro- and macroalbuminuria and impaired kidney function [ 28 ]. In a recent study, the mean improvement in SBP of 11,7 mm Hg amongst a cohort of 143 patients with normal function or only mild DCKD significantly improved the serum creatinine over an average of 30 months, suggesting that the improvement could be due, at least in part, to the reduction in BP [ 29 ].…”

Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes with impaired kidney function

“…In a recent practice-based cohort study in the UK including 143 type 2 diabetes patients with normal renal function or mild CKD adhering to a low carb diet it was found that over an average of 30 months serum creatinine improved significantly with a mean of 4.7 (14.9) μmol/L. 18 The effects of Reverse Diabetes2 Now have been investigated in the setting of a pragmatic trial, which inherently has advantages and disadvantages. Data quality and collection can be limiting, since researchers are dependent on the data collection through regular care.…”

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

“…In the general population, it was demonstrated that both high and low percentages of carbohydrate diets were associated with increased mortality, with the lowest risk reported at 50-55% energy from carbohydrate [100]. Moreover, recent studies support that low carbohydrate diets (LCDs) may improve many renal and cardiovascular risk factors in patients with T2DM [101].…”

“…To date, there has been much controversy related to macromineral intake for both CHD and T2DM patients. Many studies have demonstrated that water calcium has a protective role against cardiovascular events [98][99][100][101][102][103][104][105], while others found no relationship between calcium and CVD [106] or T2DM [107]. Other macrominerals, such as phosphorus, potassium, and magnesium, are involved in different components of the metabolic syndrome (e.g., insulin secretion) [108].…”