Keto And Kidney Pain: Is There A Link?

The ketogenic diet is a popular, low-carb, high-fat approach to weight loss. While it has been around since the 1920s as a treatment for epilepsy, it has recently gained traction as a weight loss strategy. However, the keto diet has been linked to kidney issues, including kidney stones and even renal failure.

The keto diet's high protein and animal fat content can cause increased acid levels in the blood, which may lead to kidney stones. Additionally, the diet's restriction of fruits and vegetables can result in mineral deficiencies, further contributing to kidney stone formation.

While the keto diet itself has not been conclusively linked to an increase in kidney stone diagnosis rates, some doctors have reported a rise in kidney stone cases among their patients on keto. It is important to note that staying hydrated and monitoring meat intake can help mitigate the risks associated with the keto diet.

Furthermore, individuals with kidney disease or those at risk for kidney disease should consult a healthcare professional before starting the keto diet, as it may negatively impact their kidney function.

Keto and kidney stones

Kidney stones are a well-noted potential side effect of the ketogenic diet. Research has shown that among children following the keto diet as a treatment for epilepsy, 13 out of 195 subjects developed kidney stones.

Causes

The exact mechanism of nephrolithiasis following the ketogenic diet is unclear. However, it is likely related to hypocitraturia and acidosis, common in people consuming a high-protein and low-alkali diet.

Acidosis contributes to significant reabsorption of citrate in the proximal tubule, further contributing to hypocitraturia. A more generous amount of free calcium is available for stone formation in a low-citrate environment. Chronic acidosis also leads to demineralization of the bone and increased calcium excretion.

Hypercalciuria, immobilization, anti-epileptic drugs, and fat malabsorption further precipitate urinary calcium. Moreover, the low urine pH seen in patients with a low-alkali diet contributes to uric acid crystals. Obesity, insulin resistance, and an animal-protein diet are associated with low urine pH. The uric acid stone may act as a nidus for calcium-based nephrolithiasis formation.

Prevention

Potential benefits of urine alkalization with oral potassium citrate in children with a urine calcium to creatinine ratio of >0.20 mg/mg to prevent kidney stone formation are well reported. Genetic polymorphisms in transporters, such as the renal sodium citrate cotransporter, are a known risk factor in recurrent stone formers. Empiric use of oral citrates appears to prevent kidney stones; however, there is mixed opinion on its use.

Other measures to mitigate the risk of renal stones include liberalizing fluid intake and avoiding the initial fasting phase at the start of ketogenic diets. Modification of the diet regimen to allow small, frequent meals might help decrease gastrointestinal side effects and avoid volume depletion.

Risk Factors

The following are risk factors for the development of kidney stones:

• Chronic acidosis
• Dehydration
• Low urine pH
• Fat malabsorption
• Hypercalciuria
• Immobilization
• Anti-epileptic drugs
• Obesity
• Insulin resistance
• Animal-protein diet

Treatment

The treatment for kidney stones is to increase fluid intake and alkalinize the urine to prevent the development of further kidney stones.

Keto diet and kidney pain

The ketogenic diet is a popular, low-carb, high-fat approach to weight loss. While it has been around since the 1920s as a treatment for epilepsy, it has gained traction in recent years as a quick way to shed pounds. However, there are some concerns about its impact on kidney health.

There is no straightforward answer to whether the keto diet directly causes kidney pain. However, it is generally considered safe for individuals with healthy kidneys. On the other hand, if you have any kidney complications or fully developed kidney disease, it is not advisable to follow a ketogenic diet without consulting a nephrologist.

Arguments Against Keto Regarding Kidney Pain

There are two primary arguments or concerns that link the keto diet to kidney pain:

• Ketones and Urine Activity: It is often believed that ketosis can change the pH of urine, making it more acidic and thus increasing stress on the kidneys. However, this only occurs during ketoacidosis, a dangerous complication resulting from extremely high levels of ketones and blood sugar, commonly seen in individuals with diabetes. In typical ketosis, blood ketone levels remain within a safe, normal range, posing no impact on kidney function.
• Kidney Stone Formation: The ketogenic diet has been associated with the development of kidney stones due to its high animal protein content. The belief is that by-products of animal protein digestion may increase urinary acidity, contributing to kidney stone formation. Additionally, a high-protein diet forces the body to excrete excess sodium, calcium, and potassium, which can lead to low blood pressure, another stressor for the kidneys.

Research Findings

Research on the impact of keto diets on kidney function has yielded mixed results:

• A 2016 meta-analysis investigating the effects of low-carbohydrate diets on renal function found that a "low-carbohydrate diet and the corresponding high-protein diet was not harmful for renal function in overweight and obese individuals without renal dysfunction." In fact, it suggested that a low-carb diet may even benefit kidney function through weight loss.
• A study on 68 obese individuals found no decline in renal function after one year on a very low-carbohydrate diet.
• Another meta-analysis of 1,000 individuals revealed an improvement in renal function among those on low-carbohydrate diets.
• A study on 195 children following a ketogenic diet for five years found that only 6.7% developed kidney stones, and there was no statistically significant relationship between the diet and kidney stone incidence.
• Several studies suggest a stronger relationship between strict low-carb diets and kidney stones, and supplementation with potassium citrate was found to reduce the occurrence of kidney stones.

Recommendations

If you are experiencing kidney pain and are on a keto diet, consider the following:

• Consult a Medical Professional: Accurate determination of the underlying cause of kidney pain is crucial. If you are unsure, seek advice from a healthcare provider.
• Dietary Adjustments: A high intake of animal-based proteins may influence kidney stone development. Consider incorporating more vegetarian and vegan-friendly, keto-conducive, high-protein sources into your diet, such as nut and seed butters, and vegan cheese.
• Stay Hydrated: Chronic dehydration is a risk factor for kidney stones. The keto diet can lead to dehydration, so ensure adequate fluid intake. Increasing your consumption of cruciferous and low-net-carbohydrate vegetables can also help.
• Electrolyte Supplementation: The keto diet may cause mineral imbalances due to restricted food sources and the effect of lowered insulin levels on sodium regulation. Consider taking electrolyte supplements, particularly those with positively charged electrolytes like potassium.
• Potassium Supplements: Adequate potassium intake is associated with a reduced risk of kidney stone development. Achieving adequate potassium intake on a ketogenic diet can be challenging, so supplementation may be beneficial.
• Magnesium-Rich Foods: Include foods rich in magnesium, such as kidney beans, as this mineral is associated with a reduced risk of kidney stone development and can help improve symptoms.

While the keto diet has been linked to possible kidney health issues, the evidence suggests little to no direct association between keto and kidney disease in individuals with healthy kidneys. However, those with existing kidney complications should approach the keto diet with caution and under medical supervision. Ensuring adequate hydration and making dietary adjustments to include more plant-based protein sources can help mitigate potential kidney-related risks associated with the keto diet.

The link between keto and kidney disease

The ketogenic diet is a popular, effective weight loss strategy that involves eating very few carbohydrates and instead consuming a high volume of fat. While it has been around for a while, there is still a lack of research on the long-term effects of the diet.

The impact on kidney health

There is no clear answer as to whether keto is bad for your kidneys. However, if your kidneys are functioning normally, you may experience health benefits from following a ketogenic diet, including improved blood sugar control, cardiovascular function, and weight loss.

That said, the keto diet can put stress on the kidneys and may cause kidney stones. This is because the diet is high in animal protein, and the metabolites and by-products of animal protein digestion may increase urinary acidity and contribute to kidney stone formation. The diet can also cause an increased acid load, which can lead to metabolic acidosis and related issues such as weakened bone health.

Who should avoid the keto diet?

If you have any kidney complications or fully developed kidney disease, you should not follow the ketogenic diet without consulting your nephrologist. Those with or at risk of kidney disease can find alternative healthy diets that can help with weight loss.

How to reduce the risk of kidney stones on keto

To reduce the risk of kidney stones, it is recommended to increase your fluid intake and ensure your urine is straw-yellow to clear. You can also drink lemon water, as the citrate in lemons keeps calcium molecules from sticking together. In addition, you can lower your risk of kidney stones by limiting oxalate-rich foods and high-sodium foods.

It is also important to optimize your electrolyte intake, particularly positively charged electrolytes like potassium. Adequate potassium intake has been associated with a reduced risk of kidney stone development.

The effect of keto on kidney function

The ketogenic diet is a high-fat, low-carb approach to weight loss that has become increasingly popular. While it has been around since the 1920s as a treatment for epilepsy, its effectiveness for weight loss and the management of type 2 diabetes and liver disease has brought it into the spotlight in recent years.

The keto diet is not without its risks, however, and one of the most well-noted potential side effects is kidney stones. Kidney stones are hard deposits of minerals and salts that form in the urinary tract and can cause intense pain. The diet's association with kidney stones is thought to be due to the high consumption of animal proteins, which increase the acidity of urine and contribute to stone formation.

Arguments against keto

There are two primary arguments against the ketogenic diet when it comes to kidney health:

• Ketones cause heightened stress on the kidneys due to increased urine activity: This is a common misconception. The urine pH is only affected during ketoacidosis, a dangerous complication resulting from high levels of ketones and blood sugar, most often seen in diabetics. In typical ketosis, blood ketone levels remain within a safe, normal range that does not impact kidney function.
• A ketogenic diet causes an increased frequency of kidney stone formation: While the diet is associated with a higher risk of kidney stones, research does not appear to support a direct causal link. A 2016 meta-analysis found that a low-carbohydrate diet was not harmful to renal function in overweight and obese individuals without renal dysfunction and may even be beneficial due to its contribution to weight loss.

Other causes of kidney pain

While kidney stones are a possible cause of kidney pain, there are other factors to consider:

• Blood clots in the kidney, often caused by Nephrotic Syndrome, a condition where large amounts of protein are lost in the urine.
• Blunt force trauma to the lower back, where the kidneys are located, can cause serious damage to their structure.
• Urinary Tract Infection (UTI) – A UTI can cause pain that radiates up to the kidney along the urinary tract.
• Kidney infection – Bacteria from an associated bladder infection can spread to the kidneys, causing inflammation and pain.

Precautions for those on a keto diet

While kidney pain is not necessarily caused by the keto diet, there are some precautions that those on a keto diet can take to reduce the risk of kidney-related issues:

• Ensure adequate fluid intake to stay well hydrated.
• Limit animal-based proteins, which are associated with kidney stone development, and consider a more vegetarian approach.
• Take potassium supplements, as adequate potassium intake is associated with a reduced risk of kidney stones.
• Consume kidney bean broth to increase your magnesium intake, which is associated with a reduced risk of kidney stone development.
• Ensure adequate electrolyte intake, particularly positively charged electrolytes like potassium.

In conclusion, while there may be some risks associated with the keto diet and kidney function, there appears to be little to no direct association between the two. However, those with kidney disease or at risk of developing kidney disease should consult a medical professional before starting a ketogenic diet.

How to prevent kidney pain on keto

The ketogenic diet is a popular approach to weight loss, but it is not without its risks. While the keto diet is not directly linked to kidney issues, it can cause complications for those who already have kidney disease. If you are considering the keto diet, it is important to understand the potential impact on your kidneys and take steps to prevent any problems. Here are some ways to help prevent kidney pain while on the keto diet:

Consult a medical professional

Before starting the keto diet, it is essential to consult a doctor or a nephrologist, especially if you have any kidney complications or risk factors for kidney disease. They can advise you on whether the keto diet is suitable for you and provide guidance on how to follow it safely.

Stay hydrated

Dehydration is a common issue on the keto diet and can increase the risk of kidney stone formation. Make sure you drink plenty of water throughout the day and aim for a urine colour that is straw-yellow to clear. Adding lemon to your water can also help prevent the formation of kidney stones by keeping calcium molecules from sticking together.

Optimise electrolyte intake

The keto diet can affect the balance of electrolytes in your body, so it is important to ensure adequate intake. Include plenty of electrolytes in your diet, especially positively charged ones like potassium. Fruits and vegetables are good sources of electrolytes, but you may also consider taking a high-quality electrolyte supplement.

Limit oxalate-rich and high-sodium foods

Oxalate-rich foods such as spinach, beets, rhubarb, miso, and sweet potatoes, as well as high-sodium foods, can increase the risk of kidney stone formation. Limiting your intake of these foods can help reduce that risk.

Choose your protein sources wisely

The keto diet is often associated with a high intake of animal-based proteins, which can increase the risk of kidney stones and put additional stress on the kidneys. Consider incorporating more plant-based protein sources into your diet, such as nut and seed butters, and vegan high-protein cheese.

Monitor your kidney function

While on the keto diet, it is important to monitor your kidney function through regular check-ups and renal function tests. This is especially important if you have any existing kidney issues or risk factors for kidney disease. Early detection of any problems can help prevent more serious complications.

Frequently asked questions