A diet low in carbs and high in healthy fats helps you lose weight and look fantastic. While a ketogenic diet can have some advantages, it's essential to choose foods carefully to avoid potential adverse effects.
There is no research on the keto diet's effect on kidney health among adults following a low-carb, high-fat diet. However, some food choices within the context of a ketogenic diet could potentially support or detract from a healthy lifestyle when mismanaged.
What are Kidney Stones?
Solid mineral and salt clusters inside the kidneys are kidney stones, also called nephrolithiasis or urolithiasis. Mineral and salt deposits can result from various factors, including poor diet, obesity, and certain medical conditions.
Having an excessive amount of minerals in your urine can cause minerals to stick together and eventually form stones, which can affect any part of your urinary tract––from your kidneys to your bladder.
Once kidney stones pass from your kidneys to your ureters, they can cause blockages in urine flow and swelling in the kidney, which can be very painful.
It is usually possible to pass kidney stones by drinking plenty of water and using over-the-counter pain relievers, but surgery may be necessary in rare cases.
Common symptoms experienced once stones breach the kidneys may include:
- Intense, sharp pain in the side and back, below the ribs
- Pain that pulses in the lower abdomen and groin
- Pain that appears in waves with varying intensity
- Discomfort or a burning sensation while urinating
Other signs and symptoms may include:
- Pink, red, or brown urine
- Cloudy or rank-smelling urine
- An excessive urge to urinate, urinating more frequently than usual, or urinating in minuscule amounts
- Nausea and vomiting
- If you have an infection, you may experience fever and chills
It’s essential to consult your physician immediately if you experience the following:
- When your pain is so severe, you are unable to sit still or find a comfortable position
- Pain coupled with nausea and vomiting
- Pain paired with fever and chills
- Blood in your urine
- A difficult time passing urine
What Causes Kidney Stones?
Various factors can contribute to the development of kidney stones. The following are the most common culprits:
- The food you eat. Eating a ketogenic diet can offer little fiber and significant amounts of animal-based programs, which can both aid in the hardening of stones in the kidneys. So, make an extra effort to craft your keto meal plan with avoiding stone-producing foods in mind.
- Stay hydrated. Drinking ample amounts of water is advisable on a keto diet for several reasons: maintaining fluidity in the body that prevents mineral calcifications that lead to potentially-painful stones.
- Genetics. Inherited genes that result in factors like high calcium urine concentrations increase the risk of developing kidney stones.
- Location: Residents in hot and dry regions of the country may be at a higher risk of developing kidney stones as they may be more prone to dehydration. Sipping on loads of water throughout the day can prevent stones and aid in maintaining stable energy levels throughout the day.
- Gender: Women are more likely than men to develop the struvite variety of kidney stones, which usually form after long-term urinary tract infections, and UTIs are more common among women than men.
- Underlying Health Problems: Kidney stones may indicate other health issues, including, you guessed it, kidney disease. Disorders like Crohn's disease, diabetes, and UTIs may also increase the risk of kidney stones. Plus, people with HIV have an increased risk of developing kidney stones due to the effects of certain anti-HIV medications commonly used in treatment that may crystallize inside the drainage system of the kidneys, causing pesky pebbles.
Eating Too Few Fruits and Veggies: A ketogenic diet encourages consuming ample amounts of healthy fats and premium protein, focusing less on consuming fruits and vegetables to harness carbs as much as possible. However, eating potassium-rich vegetables like Brussel's sprouts, broccoli, and kale reduce calcium loss and prevent kidney stones' formation, so feast on your cruciferous greens daily.
Alkali: Eating fruits and vegetables provides various health benefits, including alkali production during the digestion process. Plus, alkali production is essential. It helps neutralize the acid within the body generated when we eat and metabolize protein in the neats, fish, and animal products that make up the majority of items in your keto meal plan.
Take special care to strategically include mineral-rich, low-glycemic foods in your diet if your meals lean more toward the carnivore protocol to ensure you have the enzymes needed to process and metabolize foods properly to prevent nutrient deficiencies.
Citrate: Properly portioning fruit intake on a keto diet is wise to manage macros. However, fruits contain citrate, a potent kidney stone inhibitor, and low urine citrate can lead to a higher risk of kidney stones.
Therefore, add low-glycemic citrus fruits like lemon and lime into your diet daily––especially if experiencing mild to moderate hypocitraturia; dietary supplementation with citrus-based juices could eliminate a need for medical management, even when consumed in small amounts.
Potassium: The amount of potassium we eat shows up in our urine. The more nutrient-rich foods we eat, the higher the urine potassium concentration, which acts as a potent kidney stone inhibitor.
Plus, the following everyday habits of those on a keto may also cause kidney stones and are worth monitoring strategically to avoid adverse effects:
- Too much salt: Adding salt to a keto diet is wise as our bodies release more sodium, water, minerals, and vitamins, when in ketosis, but overdoing it on salt and increasing urine calcium which can exacerbate the formation of kidney stones.
- Too Much Protein: Most keto dieters aim for a moderate protein intake, but athletes and those following a high-protein modified keto diet should beware of low urine pH and high urine calcium, leading to kidney stones.
- Too Much Fat: A low-carb, high-fat diet, as its name indicates, relies on consuming considerable amounts of healthy fat. However, a ketogenic diet is more reliant on limiting carb intake than the excessive intake of fat calories. Pay particular attention to the inclusion of gut-healthy products like bone broth, sauerkraut, and other fermented foods, to fortify the gut microbiome, which can be offset by consuming large amounts of fat.
- Not Enough Calcium: Adding adequate amounts of calcium to your meal plan is vital for bone health, but your intake may be lacking if you're drastically limiting vegetables.
- Include calcium-rich, low-glycemic foods like chia seeds, sunflower seeds, almonds, and sesame seeds, to your weekly meal plan––along with canned fish with bones, like salmon and sardines.
Also, hard cheese, like Swiss and cheddar cheese, and dark leafy greens, like spinach, kale, and turnip greens––and you'll prevent high urine oxalate, which can lead to or worsen kidney stones.
Although some practices of a standard keto diet may require more mindful planning to avoid nutritional imbalances, setting yourself up for success and fostering kidney health is simple with a few helpful habits:
- Drink plenty of water. Drinking ample amounts of fluid dilute your urine and lessen the chances of a kidney developing.
- While you want to curb fruit intake to minimize carb macros, eat as many veggies as possible. Many delicious low-carbohydrate vegetables can work on keto, review which you prefer, and keep them handy.
- Monitor your sodium intake and cap consumption at 2,300mg per day.
- Consult with your physician about a potassium citrate prescription if your diet isn't sufficient and you're noticing physical effects.
- Limit the intake of animal protein: Consider sourcing protein more heavily from plant-based sources, like seeds and tofu, and reduce the intake of animal proteins if you're prone to developing kidney stones or using a ketogenic diet to relieve symptoms of existing stones.
- Avoid stone-forming food: Although spinach and dark chocolate are generally encouraged on keto, remain mindful if you're concerned about kidney stones. These foods are rich in oxalate, which can contribute to kidney stones.
- Avoid vitamin C supplements: Vitamin C is necessary for the absorption of iron, but large amounts of vitamin C supplements, such as 500 mg or more a day, regularly, can increase the risk of developing kidney stones in some people—especially people who have had calcium oxalate stones before or who have a family history of these issues.
Following a ketogenic diet can create awesome health outcomes, like aiding in rapid weight loss and recalibrating hunger signals and appetite. Still, focusing on the quality of micronutrients is at least as important as monitoring macronutrients on a low-carb, high-fat diet.
While we have no control over factors like gender or genetics, we can eat the highest quality foods, focus on staying hydrated, and exercise regularly to support overall health and prevent breakdowns due to lifestyle choices.
Include significant amounts of dark leafy greens and other high-quality foods in your diet, limit stone-forming varieties, and seek help from your physician if you notice any of the concerning symptoms mentioned above to maintain kidney health and prevent possible setbacks while following a keto diet.
- Haleblian, G. E., Leitao, V. A., Pierre, S. A., Robinson, M. R., Albala, D. M., Ribeiro, A. A., & Preminger, G. M. (2008). Assessment of citrate concentrations in citrus fruit-based juices and beverages: Implications for managing Hypocitraturic nephrolithiasis. Journal of Endourology, 22(6), 1359–1366. https://doi.org/10.1089/end.2008.0069
- Pendick, D. (2020, August 31). Five steps for preventing kidney stones. Harvard Health. Retrieved January 30, 2022, from https://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721
- Izatulina, A. R., & Yelnikov, V. Y. (n.d.). Structure, chemistry, and crystallization conditions of calcium oxalates — the main components of kidney stones. Minerals as Advanced Materials I, 231–239. https://doi.org/10.1007/978-3-540-77123-4_29
- Renata, C. (2003). Citrate and mineral metabolism kidney stones and bone disease. Frontiers in Bioscience, 8(6). https://doi.org/10.2741/1119
- Kidney stones: Preventing recurrence with diet and nutrients. (2012). Advancing Medicine with Food and Nutrients, 476–489. https://doi.org/10.1201/b13694-29