A long time ago…well, it was actually only about 3 years ago, but it certainly feels like a long time ago…when I first began my Nutritional Odyssey, one of the first stops on my quest, was the Ketogenic diet.
I read Lyle McDonald’s book “The Ketogenic Diet”, and promptly lost 24lbs of pure body-fat over the next two months. I wasn’t interested in the Ketogenic Diet as it pertains to the form of the diet that some progressive doctors are prescribing to children with Epilepsy, I was more concerned about the weight-loss and body-building applications as they pertained to me. It was obvious to me at the time, that the general consensus was that there is a high risk of Kidney stones while on a Ketogenic diet, and that Potassium supplementation was highly recommended to combat this heightened risk.
Why is there a higher risk of Kidney Stones while on a Ketogenic Diet?
Kidney stones are a frequent occurrence on the ketogenic diet for epilepsy. [1, 2, 3] About 1 in 20 children on the ketogenic diet develop kidney stones per year, compared with one in several thousand among the general population.  On children who follow the ketogenic diet for six years, the incidence of kidney stones is about 25% .
A 100-fold odds ratio is hardly ever seen in medicine. There must be some fundamental cause of kidney stones that is dramatically promoted by clinical ketogenic diets.
Just over half of ketogenic diet kidney stones are composed of uric acid and just under half of calcium oxalate mixed with calcium phosphate or uric acid. Among the general public, about 85% of stones are calcium oxalate mixes and about 10% are uric acid. So, roughly speaking, uric acid kidney stones are 500-fold more frequent on the ketogenic diet and calcium oxalate stones are 50-fold more frequent.” – perfecthealthdiet.com
An important distinction here, is that even though pretty much any diet that encourages Ketosis by maintaining an extremely low level of dietary carbohydrate intake, could potentially be called “Ketogenic”, the Ketogenic diet is also the name of a specific dietary protocol that is given to children with Epilepsy. This Ketogenic Diet typically consists of no more than 5% of calories per day from carbohydrate, and usually not more than 30% from protein (often much less). This makes the Epilepsy Ketogenic diet a high-fat, moderate protein, very-low carbohydrate diet. The reason that even protein is heavily restricted on a Keto diet, is that a very deep level of Ketosis is required for optimal Epileptic seizure control, and too much protein would encourage the body to create glucose from excess protein, via gluconeogenesis. This creation of additional glucose would lower the depth of Ketosis, providing less protection from seizures, and therefore lowering the efficacy of the protocol.
Aside from the effective seizure control that stems from adherence to such a diet, it has also been shown to be very effective for fat-loss. A Ketogenic diet puts a practitioner on the fast track to converting their body from burning carbohydrate, to fat for fuel. Even though Ketosis itself isn’t necessary for fat-loss, it is an interesting side effect, and comes with some great benefits. Deep Ketosis encourages an amazingly clear frame of mind, heightened senses, blunted appetite and hunger pangs, and many people claim that it offers relief from depression and anxiety, which of course ties it in with the added benefit of Epileptic Seizure control.
According to perfecthealthdiet.com, there are several reasons that no-one should attempt to follow a “zero-carb” or epilepsy Ketogenic diet:
Zero-carb dieters are at risk for
- Excess renal oxalate from failure to recycle vitamin C;
- Excess renal uric acid from disposal of nitrogen products of gluconeogenesis and ketogenesis;
- Salt and other electrolyte deficiencies from excretion of oxalate, urea and uric acid; and
These four conditions dramatically elevate the risk of kidney stones.
To remedy these deficiencies, we recommend that everyone who fasts or who follows a zero-carb diet obtain dietary and supplemental antioxidants, eat salt and other electrolytes, and drink lots of water.
Also, unless there is a therapeutic reason to restrict carbohydrates, it is best to obtain about 20% of calories from carbs in order to relieve the need to manufacture glucose and ketones from protein. This will substantially reduce uric acid excretion. If it also reduces vitamin C degradation rates, as we argued in our last post, then it will substantially reduce oxalate excretion as well.”
Given the amount of muddy data and questionable studies, I’m not sold on the idea that a Ketogenic diet encourages or causes the growth of Kidney stones at all. The main reason that I don’t buy-it, is the same reason that many people became Paleo in the first place. The whole movement is built upon learning from our ancestors, and eating what they ate….but there were times when our Paleolithic ancestors would have been in a Ketogenic state, due to not eating, possibly for long stretches of time. Even if meat was abundant during particular times of the year, carbohydrate sources may not have been. Why would something that seems so natural and beneficial to our brains, be so detrimental to our Kidneys?
Do we just assume that man evolved to be stricken with Kidney stones if carbohydrate sources were not available to be eaten on a regular basis? Do we believe that the Inuit Eskimos, and the Masai of Africa suffer significant cases of Kidney stones, throughout their population? Or do we believe that maybe there is some factor that we are missing here?
I have a really difficult time believing that any of the children (or adults for that matter), that are included in these studies, actually ate real, whole foods. I wouldn’t be surprised if, even though the Ketogenic diet was being utilized for therapeutic reasons, the majority of the participants steered away from eating lots of red-meat and saturated fats, because of the supposed risk of heart disease and all of the other myths that we now know to be complete lies. I wonder what would have happened if the participants made sure to eat copious amount of REAL FOOD, while avoiding industrial oils, fats, and processed meats etc?
Check out this article entitled “Interim Report: The Risk of Kidney Stone With Carbohydrate Restriction“ from low-carb advocate Dr. Su of carbohydratescankill.com. Here’s his conclusion from the article:
Interim Conclusion: At this time, there is no evidence in supporting the assertion that carbohydrate restriction increases the risk of kidney stone formation. Interestingly, the adoption of carbohydrate restriction may help prevent and alleviate kidney stone formation. Further follow-up with the participants of this polling will provide more information about the prevalence of kidney stone formation with carbohydrate restriction.” – Dr. Su.
The Paleo Diet and Kidney Stones
Ok, so maybe, if a person wants to follow a very-low-carb Ketogenic style diet, they should either do so while supplementing with some Potassium or sea salt to hopefully minimize the possibility of developing Kidney stones…..
Or, maybe a good Paleo template diet that contains lots of red meat, organ meats, and tons of great saturated fat from grass-fed or pastured animals….maybe throwing some green vegetables, and some nuts and berries in the mix, would supply all of the vitamins and minerals necessary to keep those pesky Kidney stones at bay?
I don’t know, what do you guys think?
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Barry Cripps is a Paleo-based Nutrition and Wellness Consultant, who operates out of Bowling Green, Kentucky.
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