Could the Ketogenic Diet Cause Kidney Stones?

The ketogenic diet has become incredibly popular in recent years as a way to lose weight, improve health, and treat certain medical conditions. However, some people worry that following a high-fat, low-carb ketogenic diet may increase the risk of developing kidney stones. In this article, we’ll examine the evidence on whether keto actually causes kidney stones, discuss the real causes to watch out for, and provide tips on how to prevent kidney stones on any diet.

The Purported Link Between Keto and Kidney Stones

Over the past decade, the ketogenic diet has grown from an obscure medical therapy to a mainstream weight loss approach adopted by millions. As keto has gained popularity, some critics have theorized that eating high amounts of animal protein and fat on the diet could increase the risk of kidney stones.

The reasoning is that high-protein diets increase calcium and uric acid excretion, which could potentially lead to crystal formation in the kidneys. Additionally, on keto, the production of ketones leads to a slightly acidic environment in the body which, again, could theoretically promote kidney stones.

However, these hypothetical mechanisms are not backed up by research or clinical evidence. In fact, the epidemic of kidney stones began long before keto became trendy.

The Kidney Stone Epidemic Predates Keto

Between 2001 and 2010, hospitalizations for kidney stones increased by around 50% in the United States. During this time period, low-fat diets dominated nutritional guidelines, and the ketogenic diet was relatively unheard of.

Clearly, the rise in kidney stones was not caused by high-fat meat and dairy consumption, as keto did not become popular until much more recently. The timeline simply does not add up to blame keto for the kidney stone epidemic.

Obesity and Inflammation Are More Likely Culprits

Instead of dietary fat, the main drivers of the kidney stone epidemic appear to be obesity, inflammation, and insulin resistance—all related phenomena. Multiple studies have found a significant association between higher BMI and increased risk of kidney stones.

Chronically elevated insulin levels and inflammation—both consequences of excessive refined carbohydrate intake—are likely contributors. High fructose intake from sugar and high fructose corn syrup has also been implicated in kidney stone risk.

Overall, the Western junk food diet, not the meat and dairy consumed on keto, seem to be at the root of kidney stone formation.

Preventing Kidney Stones on Keto

While keto itself does not cause kidney stones, certain adjustments can minimize your risk even further on a low-carb, high-fat diet:

Get plenty of magnesium and potassium. Low magnesium and potassium levels are linked to increased kidney stone risk. Make sure to get adequate minerals by consuming foods like spinach, avocado, nuts, seeds and mushrooms. Supplementing may also be beneficial.

Moderate protein intake. Excessively high protein intake could potentially increase kidney stone risk. Moderate your protein on keto and focus more on fat sources like olive oil, coconut, avocado and fatty fish.

Stay well hydrated. Chronic dehydration is a major risk factor for kidney stones. Focus on drinking plenty of water and herbal tea each day. Urine color is a good indicator—aim for light lemonade color.

Reduce high-oxalate foods. For individuals prone to calcium oxalate stones, try restricting spinach, almonds, peanuts, soy, beet greens, rhubarb and chocolate.

Maintain a healthy weight. Obesity seems to be the #1 controllable risk factor for kidney stones. Sticking to keto can help get your weight under control.

Limit added sugars. Added fructose from sugar, high fructose corn syrup, honey and fruit juice may increase kidney stone risk—another reason to avoid on keto.

Tips for Preventing Recurrent Kidney Stones

For those who have already experienced a painful kidney stone, the goal is preventing recurrence. Here are some tips:

• Drink enough water to dilute your urine. Aim for at least 2.5 liters per day, and avoid dark yellow urine.
• Limit sodium intake, as higher sodium excretion increases calcium in urine.
• Restrict oxalates from foods like spinach, nuts and chocolate if you form calcium oxalate stones.
• Follow a low-purine diet if you have a history of uric acid stones. Limit high-purine foods like red meat, organ meats and certain fish.
• Take magnesium, potassium and vitamin B6 if deficient – ask your doctor to test levels.
• Consider medication if stones are recurring frequently despite diet changes. Potassium citrate or thiazide diuretics can help.
• Follow up regularly with your urologist or nephrologist. Identifying the stone type is key for prevention.

The Bottom Line: Keto Does Not Cause Kidney Stones

In summary, substantial evidence shows the rise in kidney stones is linked to the obesity epidemic and Western diet – not dietary fat or protein. The ketogenic diet itself does not appear to increase risk if basic preventive steps are taken.

For optimal kidney health, focus on weight control, adequate hydration, avoiding added sugars, and getting sufficient minerals. Keto, when formulated thoughtfully, can be an appropriate and beneficial dietary approach even if you are prone to kidney stones. Just be sure to consult your healthcare provider and get regular follow up if you have a history of renal stones.