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Ketosis Kidney Stones

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Clearing Up Kidney Confusion: Part Deux

It’s funny how our mental state really affects how we write and what we are interested in. When I wrote the introduction to this piece I was just getting settled into our new place in Santa Fe, NM and was looking at over a month at home to work and write. Then a number of wacky events happened and I’ve been home about 7 days out of the last month and I’ve only made it about 70 pages into Kon-Tiki. Ouch. Now I’m home for 8 days and will then be gone for a project that will take me completely off the grid for nearly 3 weeks. No phone, email…nada. When I sat down to do this kidney piece it was with a mindset that I had a ton of time and could really sink my teeth into it. Now I’m time crunched and anxious that I will get it done at all! Up front here I’d like to thank Mat “The Kraken” Lalonde with his help on some literature for this piece. Any inaccuracies however are my own tomfoolery. If I wanted to cut to the chase I could boil this whole thing down to the following: 1-Dietary protein DOES NOT CAUSE KIDNEY DAMAGE. 2-Chronically elevated BLOOD GLUCOSE levels DO cause kidney damage. 3-Dietary fructose REALLY causes kidney damage. 4-Many kidney issues have either a Continue reading >>

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  1. Deranged_hypnotist

    Hey all, So I began this Keto diet over 1 month ago and the results have been FANTASTIC! I have lost 35 pounds! (M/6'1 Sw: 245 CW: 210 GW: 180) I have been extremely happy with myself now and its all thanks to you guys. Sadly though yesterday while checking my ketosticks i saw blood in my urine and after a 7 hour ER visit I was told by the doctor that I had passed a kidney stone and gotten a UTI from it as well. I have never had a kidney stone in my life or any major health problems (aside from being overweight). The doctor told me to get off my diet until I can see an urologist to find out why I have a kidney stone. The thing is the next available appointment is not for a long time since I work 2 jobs. So I have done a bit of research and a side effect of being in ketosis is kidney stones (from random online website).
    So my questions to r/keto is 1. How often does this happen? 2. Is this Research Valid Online? 3. Where do I go from here?
    I still want to continue keto for the next 30 more pounds.
    P.S. I do not want this post to discourage anyone from trying keto, EVERYONE'S body is different.

  2. gogge

    Higher protein intake increases the calcium absorption in the gut, and consequently increases the calcium excreted in the urine. Ketosis increases the need to balance blood pH as ketones are acidifying, one way the body likely does this i by increasing calcium leaching from the bones, this also increases urine calcium excretion.
    Increased calcium levels in the urine increases the risk of calcium-oxalate stone formation.
    Excretion of ketones in the urine increases urine acidity, as does the increased excretion of uric acid (can lead to supersaturation, the uric acid can't dissolve and form crystals).
    Increased urine acidity increases the risk of kidney stone formation, lower levels of citrate in the urine also increases the risk of stone formation.
    Paul over at perfecthealthdiet.com has an article on kidney stones and carb restriction, "Dangers of Zero-Carb Diets, IV: Kidney Stones".
    Generally the best way to counter this is to eat more vegetables, most have a negative potential renal acid load (PRAL), which means they'll reduce the acidity of urine (here's a list of foods and their PRAL score). Even calcium rich foods can help as the calcium will bind to oxalate (chelation) in the gut and prevent absoption.
    Increased water intake also helps as it balances the urine pH and prevents supersaturation (through dilution) as you pee more, in general dehydration is a common risk factor for stone formation.
    Another more drastic way to reduce calcium excretion, reduce urine acidity, and increase urine excretion of citrates, is to supplement with potassium citrate. It's been tested in epilepsy studies and resulted in a very high reduction in stone formation incidents (0.9% of patients compared to the 25% Paul mentions in his article):
    Successful empiric administration of Polycitra K at KD onset resulted in a kidney-stone incidence of 0.9% (1 of 106) compared with administration only because of hypercalciuria, 6.7% (13 of 195; P = .02).
    McNally MA, et al. "Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet." Pediatrics. 2009 Aug;124(2):e300-4. Epub 2009 Jul 13.
    You probably need to talk to your doctor about that as potassium is usually limited to ~99 mg for OTC tablets.
    Anecdotaly another thing sometimes used is sodium (or potassium) bicarbonate, as it also reduces urine acidity. I haven't seen any studies on it, but WebMD has some articles on it, "Sodium Bicarbonate (Baking Soda) for Kidney Stones". It's probably a good idea to discuss this with your doctor before starting taking any.

  3. [deleted]

    I had kidney stones about 3 years ago and from what I understand is that there are two different types. Calcium stones and uric acid stones.
    Calcium stones are more often than not a result of not enough fluid intake or an over abundance of calcium in your diet. Were talking multiple Tums a day, a wheel of cheese, gallons of cream - for most people. Others can just be an increase in calcium intake that the body is not used to. Such as going from little to no calcium intake, to hitting well over the suggested daily amount. This could very well be the case with you.
    From what I understand as well, uric acid stones are likely hereditary.
    At the end of the day, no, your keto diet is not the cause of your Kidney stones.
    Personally, I would never wish the pain of a kidney stone onto my worst enemy. So your best course of action is to be sure you're drinking plenty of water. Make sure your pee is always crystal clear. Increase your magnesium intake, either via supplements or more easily, eat an avocado every day. You also have to make sure you supplement your magnesium with calcium. This sounds counterintuitive to what I just stated, but the two work in conjunction with each other ( i dont know the exact science of it). I would suggest chewing on 1 or 2 Tums a day (depending on how much cheese and other dairy products you're already eating).
    Hope this helps!

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