A Gram Research analysis of 31,761 adults with heart, kidney, and metabolic problems found that those eating diets with a higher ketogenic ratio, more fat and protein relative to carbohydrates, had a 14% lower risk of dying from any cause compared to those with lower ratios. However, this benefit was partly explained by overall diet quality, suggesting the ketogenic ratio works best as part of a broader healthy eating pattern rather than as a standalone strategy.
A large study of over 31,000 American adults found that people with heart, kidney, and metabolic problems who ate diets with a higher ketogenic ratio, meaning more fat and protein relative to carbohydrates, had a lower risk of dying from any cause during the study period. However, Gram Research analysis suggests this benefit may be partly explained by overall diet quality rather than the ketogenic ratio alone. The findings suggest that eating a low-carb diet might help, but it works best as part of a broader healthy eating pattern rather than as a standalone strategy.
Key Statistics
A 2026 cohort study of 31,761 American adults with cardiovascular-kidney-metabolic syndrome found that those with the highest ketogenic ratio had a 14% lower risk of all-cause mortality compared to those with the lowest ratio during follow-up through 2019.
Among 31,761 adults with heart, kidney, and metabolic problems tracked from 2003-2019, each standard deviation increase in ketogenic ratio was associated with a 6% lower risk of death from any cause, according to research published in Nutrition, Metabolism and Cardiovascular Diseases.
In a study of 31,761 American adults with cardiovascular-kidney-metabolic syndrome, 4,481 deaths occurred during follow-up, with higher ketogenic ratio diets showing protective effects that were partly explained by overall diet quality metrics.
The Quick Take
- What they studied: Whether eating a diet with a higher ketogenic ratio (more fat and protein, fewer carbs) helps people with heart, kidney, and metabolic problems live longer
- Who participated: 31,761 American adults with cardiovascular-kidney-metabolic syndrome (a condition combining heart disease risk, kidney problems, and metabolic issues) tracked from 2003 to 2019
- Key finding: People who ate diets with a higher ketogenic ratio had a 14% lower risk of dying from any cause compared to those with lower ratios, though this benefit was partly explained by overall diet quality
- What it means for you: If you have heart, kidney, or metabolic problems, eating fewer carbs and more healthy fats and protein may help you live longer, but only if it’s part of an overall healthy eating pattern. Talk to your doctor before making major diet changes.
The Research Details
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), a large ongoing study that tracks American health. They looked at people with cardiovascular-kidney-metabolic syndrome, a condition where people have multiple health problems affecting their heart, kidneys, and metabolism. The study included people from 2003 to 2018, and researchers followed them to see who died and when, through 2019.
To measure diet, researchers used 24-hour food recalls where people reported everything they ate in one day. From this information, scientists calculated each person’s ketogenic ratio, basically a score showing how much fat and protein they ate compared to carbohydrates. Researchers then used statistical methods to see if people with higher ketogenic ratios lived longer than those with lower ratios.
The study was designed carefully to account for other factors that affect lifespan, like age, smoking, exercise, and overall diet quality. This helps researchers understand whether the ketogenic ratio itself matters, or whether it’s just a marker of eating healthier overall.
This research approach is important because it looks at real-world eating patterns in a large, diverse group of Americans rather than testing a specific diet in a controlled setting. This makes the findings more relevant to everyday life. The researchers also checked whether the benefits came from the ketogenic ratio itself or from eating a generally healthier diet, which helps separate what actually matters.
This study has several strengths: it included a very large number of people (over 31,000), tracked them for many years, and carefully adjusted for other health factors. However, it has limitations: it relied on people remembering what they ate, and it was observational (watching what people naturally ate) rather than an experiment where some people were assigned to eat a specific way. The study also only measured diet on one or two days, which may not represent someone’s typical eating pattern.
What the Results Show
During the study period, 4,481 people died from any cause. People who ate diets with a higher ketogenic ratio had a 6% lower risk of dying for each standard increase in their ratio score. When researchers divided people into four groups based on ketogenic ratio, those in the highest group had a 14% lower risk of dying compared to those in the lowest group.
However, when researchers adjusted their analysis to account for overall diet quality, using a measure called the Healthy Eating Index, the benefit of the ketogenic ratio became smaller. This suggests that the benefit may come partly from eating a generally healthier diet rather than from the ketogenic ratio alone. When researchers looked specifically at low-carbohydrate diet scores, the ketogenic ratio benefit was even more reduced.
For heart disease deaths specifically (1,199 deaths), the association with ketogenic ratio was not statistically strong enough to be confident about. This means we cannot reliably say whether the ketogenic ratio helps prevent heart disease deaths specifically.
When researchers repeated the analysis using two days of dietary data instead of one day, the results were similar, suggesting the findings were fairly consistent. The pattern held across different ways of measuring and adjusting the data, which increases confidence in the main finding. However, the fact that the benefit was reduced when accounting for overall diet quality suggests that the ketogenic ratio may be less important than eating a healthy diet in general.
Previous research has suggested that low-carbohydrate diets might help with weight loss and blood sugar control, but less is known about whether they help people with multiple health problems live longer. This study adds to that evidence by showing a potential survival benefit, but it also suggests that this benefit may be part of a broader pattern of healthy eating rather than something unique to low-carb diets. The findings align with growing evidence that diet quality matters more than any single dietary component.
The study relied on people remembering what they ate, which can be inaccurate. Diet was measured on only one or two days, which may not represent someone’s typical eating pattern over months or years. The study was observational, meaning researchers watched what people naturally ate rather than assigning them to eat a specific way, so we cannot prove that the ketogenic ratio caused the lower death risk, other factors could explain the connection. The study also did not have detailed information about how strictly people followed their diets or whether they changed their eating over time.
The Bottom Line
If you have heart, kidney, or metabolic problems, eating a diet with more healthy fats and protein and fewer carbohydrates may be associated with living longer. However, this should be done as part of an overall healthy eating pattern that includes plenty of vegetables, fruits, whole grains, and lean proteins. The evidence is moderate, the study shows an association but cannot prove cause and effect. Always consult your doctor or a registered dietitian before making major diet changes, especially if you take medications or have kidney problems.
This research is most relevant to people who have been diagnosed with cardiovascular-kidney-metabolic syndrome or who have multiple conditions affecting their heart, kidneys, and metabolism. It may also be relevant to people with individual conditions like heart disease, high blood pressure, or type 2 diabetes. People without these conditions should focus on general healthy eating guidelines. Pregnant women, people with severe kidney disease, and those taking certain medications should talk to their doctor before trying a low-carb diet.
If you make dietary changes, you may notice improvements in blood sugar control and weight within weeks to months. However, the mortality benefits shown in this study developed over years of follow-up, so don’t expect to see major health improvements immediately. Consistency over months and years is what matters most.
Frequently Asked Questions
Does eating a ketogenic diet help people with heart and kidney problems live longer?
A study of 31,761 adults found those eating diets with higher ketogenic ratios had 14% lower mortality risk. However, this benefit was partly due to overall diet quality, suggesting it works best combined with healthy eating patterns rather than alone.
What is a ketogenic ratio and how do I calculate mine?
The ketogenic ratio measures the proportion of fat and protein you eat relative to carbohydrates. It’s calculated from your daily food intake. Most nutrition apps can track this automatically when you log your meals.
Is a low-carb diet safe for people with kidney disease?
People with kidney disease should consult their doctor before trying low-carb diets, as high protein intake may stress damaged kidneys. Your healthcare provider can recommend a safe approach based on your specific kidney function.
How long does it take to see health benefits from eating a higher ketogenic ratio?
You may notice changes in energy and weight within weeks to months. However, the mortality benefits in this study developed over years, so consistency over time is most important for long-term health improvements.
Can I follow a ketogenic diet if I take heart or blood pressure medications?
Talk to your doctor before starting a ketogenic diet if you take medications. Diet changes can affect how medications work, and your doctor may need to adjust dosages or monitor you more closely.
Want to Apply This Research?
- Track your daily macronutrient ratio (percentage of calories from fat, protein, and carbohydrates) using your app’s nutrition tracker. Aim to monitor whether you’re maintaining a higher proportion of fat and protein relative to carbs, and note any changes in energy levels, weight, or how you feel.
- Set a daily goal to include one additional source of healthy fat (like avocado, nuts, or olive oil) and one additional protein source (like fish, eggs, or legumes) while reducing refined carbohydrates. Use your app to log these foods and track your progress toward your ketogenic ratio target.
- Review your weekly macronutrient averages in the app to see if you’re consistently maintaining a higher ketogenic ratio. Also track related health markers like weight, energy levels, and any symptoms. Share this data with your doctor during regular check-ups to ensure the diet is working well for your specific health conditions.
This research shows an association between higher ketogenic ratios and lower mortality in people with cardiovascular-kidney-metabolic syndrome, but cannot prove that the diet causes longer life. Individual results vary based on genetics, overall health, medications, and other factors. People with heart disease, kidney problems, diabetes, or those taking medications should consult their doctor or registered dietitian before making significant dietary changes. This article is for educational purposes and should not replace professional medical advice. Always work with your healthcare provider to develop a safe, personalized nutrition plan.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.
