Unfortunately, individuals with PKD are often told that there is nothing they can do to slow the progression of their disease because it is genetic. From what we know today, this is bad advice. In fact, there is a lot that people can do with nutrition and lifestyle changes. The earlier they start the more impact it will have in the long run. You don’t want to wait until kidney damage has become too extensive and you lost the window of opportunity to affect the disease. That’s why we recommend starting the interventions as early as possible.

The standard American diet (aptly abbreviated “SAD”) is absurdly high in carbohydrates which are sugars and starches. Think grains, potatoes, sweets, fruit, starchy vegetables etc. Even the US government guidelines recommend carbohydrate consumption of over 50% of energy. Our species, homo sapiens, did not evolve with such a diet. Humans evolved as hunter-gatherers on a very low-carbohydrate, largely animal-based diet. Thanks to the SAD, we now have epidemics of obesity, diabetes and a host of other metabolic diseases including chronic kidney disease. I understand that it is hard for people to change their nutritional habits. Carbohydrates are addictive. This is exploited by the food industry which creates hyper-palatable ultra-processed foods. Nobody can open a bag of Doritos and only eat one chip, right?! But the question everyone should ask is: “Do I want to keep eating my bad foods or do I want to keep my kidneys?” It’s a choice that everyone can make for themselves. It helps a lot to have good guidance on how to implement nutritional changes in a sustainable way. Unfortunately, most doctors know very little about nutrition and do not even have the time to guide their patients in a typical 10-minute appointment. That’s just enough time to prescribe a few pills. This is the reason why we have created an intensive 12-week nutrition and lifestyle educational program for people with PKD, the Ren-Nu program.

A large portion of diet-centric discussions concerning renal patients often accompany talk of chronic kidney disease (CKD) stages 4 and 5. Why is it critical for patients with CKD, particularly those with polycystic kidney disease (PKD), to prioritize their nutritional health as early as possible in stages 1-3?

Unfortunately, individuals with PKD are often told that there is nothing they can do to slow the progression of their disease because it is genetic. From what we know today, this is bad advice. In fact, there is a lot that people can do with nutrition and lifestyle changes. The earlier they start the more impact it will have in the long run. You don’t want to wait until kidney damage has become too extensive and you lost the window of opportunity to affect the disease. That’s why we recommend starting the interventions as early as possible.

A ketogenic diet largely involves restricting carbohydrate intake, which can be somewhat jarring to patients when considering the typical American diet. Your research shows the benefits outweigh cutting back on some favorite foods…talk about the impact of this diet for polycystic kidney disease patients in the short-and long-term.

The standard American diet (aptly abbreviated “SAD”) is absurdly high in carbohydrates which are sugars and starches. Think grains, potatoes, sweets, fruit, starchy vegetables etc. Even the US government guidelines recommend carbohydrate consumption of over 50% of energy. Our species, homo sapiens, did not evolve with such a diet. Humans evolved as hunter-gatherers on a very low-carbohydrate, largely animal-based diet. Thanks to the SAD, we now have epidemics of obesity, diabetes and a host of other metabolic diseases including chronic kidney disease. I understand that it is hard for people to change their nutritional habits. Carbohydrates are addictive. This is exploited by the food industry which creates hyper-palatable ultra-processed foods. Nobody can open a bag of Doritos and only eat one chip, right?! But the question everyone should ask is: “Do I want to keep eating my bad foods or do I want to keep my kidneys?” It’s a choice that everyone can make for themselves. It helps a lot to have good guidance on how to implement nutritional changes in a sustainable way. Unfortunately, most doctors know very little about nutrition and do not even have the time to guide their patients in a typical 10-minute appointment. That’s just enough time to prescribe a few pills. This is the reason why we have created an intensive 12-week nutrition and lifestyle educational program for people with PKD, the Ren-Nu program.

Some PKD patients want to make a change in their diet but feel intimidated without proper guidance. Can you talk about the SBN’s Ren-Nu program for adult PKD patients, its integration of KetoCitra, and how the program can provide a customized solution?

SBN’s Ren-Nu program, which stands for “Renal Nutrition” and rhymes with “renew”, is a way for anyone with PKD to learn how to safely change their nutrition and lifestyle. Anyone who qualifies - based on certain inclusion and exclusion criteria - can sign up and start the program at their convenience. It is 100% remote and can be accessed from anywhere in the world with a mobile device or computer. Participants are guided and monitored by dietitians/nutritionists and health coaches, there is an intensive self-paced curriculum, weekly group meetings, one-on-one meetings with a dietitian, digital tools to track nutrient intake and health outcomes, recipes and meal plans, and many other features. Participants learn all about food ingredients and how to prepare low-carb ketogenic meals. The program includes SBN’s medical food KetoCitra as an integral component to boost effectiveness and avoid potential problems. Being a college professor, I think of the Ren-Nu program like a college class. Our “students” pay tuition to cover the costs, we have an outstanding team of instructors (including a medical director, a scientific director and a director of nutrition), we have office hours, and our students have to do their homework. Nobody can cheat on the “exam” because that would be detectable in the blood labs. In the end, our students graduate and many experience significant improvements in their health such as improved kidney function, decreased pain, decreased blood pressure medication need, and better overall health, well-being and energy. Importantly, the Ren-Nu program is flexible and meets people where they are. It does not matter if someone starts as a vegetarian or carnivore or anything in between. All participants learn to implement the nutritional changes in a sustainable way so that they become a permanent lifestyle habit. Personally, I have been adhering to a ketogenic lifestyle for over 5 years, and I don’t even have kidney disease to motivate me. I just feel so much better on it.

We document participant outcomes and publish clinical studies. Outcomes are also being independently tested in clinical trials in major academic medical centers. One study has been ongoing in Japan for over a year with excellent interim results so far. Another study will soon start at the Cleveland Clinic.

Earlier this year, PKD-Free Alliance provided funding to support an ongoing Santa Barbara Nutrients study in human subjects at Cleveland Clinic (Cleveland, OH), a PKD Center of Excellence. Can you provide a brief overview of this study, its anticipated length, and what you hope to glean from it?

We have been working closely with Dr. Richard Fatica, the deputy chief of nephrology at the Cleveland Clinic to plan this trial. Now everything is set and the trial will start enrolling soon. The focus of the trial is to investigate metabolic and renal outcomes of KetoCitra within the Ren-Nu program in individuals with PKD. Changes of particular interest are blood sugar control, body weight, and kidney function. Of course, safety and feasibility are always tracked. The intervention period is 3 months. Based on our experience with the Ren-Nu program so far - with over 200 graduates – we anticipate to find statistically significant improvements in many health parameters in this trial. The trial is independently run by Dr. Fatica and his amazing team and generously supported by the PKD-Free Alliance. Results will be published in peer-reviewed scientific journals.

Are there any instances or PKD patient scenarios where a keto diet would not be advised (ex. late-stage CKD, pregnancy, or any other comorbidities that may have an adverse effect etc.)?

Currently, KetoCitra and the Ren-Nu program are intended for adults with mild to moderate ADPKD of CKD stage 3 or better. However, with support by their doctor more advanced stage patients may be considered. Unfortunately, once a patient is very advanced, it becomes more difficult to make nutritional changes. However, cutting out carbohydrates is beneficial for every person, no matter their kidney function. Carbs have no benefits for kidneys. Regarding comorbidities, type 1 diabetes requires more careful instruction and monitoring but absolutely benefits from carbohydrate restriction. Some drugs usually need to be deprescribed because of rapid improvements in glucose and blood pressure control when switching to a ketogenic diet. This includes diabetes and blood pressure medications. That’s why it is important to work with a doctor who understands the approach and can monitor and guide their patient.

Do you believe there are potential benefits to following the keto diet post-renal transplant as well?

Absolutely. As the saying goes: “after the kidney transplant is before the kidney transplant”. For anyone with a transplanted kidney, it is critical to keep their new kidney in top shape to make it last as long as possible. Going back on a standard American diet after a transplant is a bad mistake. We already know what happens to kidneys in people on the SAD because chronic kidney disease is extremely common in the US with 14% of the population affected. The SAD causes high blood sugar and insulin levels, obesity, and high blood pressure which are all kidney killers. A ketogenic diets avoids all of these problems.