The Paleo Diet and Kidney Stones

Kidney Stones….NO THANKS!

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.” –

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, 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
  • Dehydration.

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 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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4 Responses to The Paleo Diet and Kidney Stones

  1. Pingback: Roundup: Great Links & Caption This! | CaveGirlEats

    • Larissa February 28, 2012 at 12:19 pm

      The fact that Smoothies ciutrobnte to healthy bacteria in mouths, I think, is also a factor in having healthy gums and teeth. I worked several years as a Dent. assistant. Soft, sticky foods are very plaque forming. You don’t advocate cheese or other dairy products other than yogurt and kefir. The latter promote healthy bacteria. Acidic foods+refined sugars are the biggest culprits AND milk. (not including breast milk).Also, this is just my opinion, you soak the nuts and seeds you and your family eats, so they aren’t hard like unsoaked nuts and seeds, even once dehydrated. Crunching ice and things like nuts can crack teeth though you might not be aware of it happening. The cracks are food particle traps that can ciutrobnte to decay. By the way, foods like apples, carrots, celery are like nature’s little toothbrushes . Helps keep plaque from forming .good for teeth and gum health.More reasons to promote greensmoothies, salads and healthy whole foods. Drinking water throughout the day is excellent as well.

  2. Dana November 10, 2011 at 5:49 pm

    Oh ffs. Those bullet points from Jaminet:

    1. What is it about lack of carbs that would make someone fail to recycle vitamin C? What does that even mean? Glucose competes with vitamin C for the same receptors (in animals that make vitamin C, they make it from glucose), so why would a lack of excess glucose interfere with the body’s use of vitamin C in any meaningful way? I should think it’d be the exact opposite. (Inuit do not suffer from scurvy on their traditional diet. Ever.)

    I’m kind of talking out my butt on this one so by all means, somebody correct me here if needed.

    2. You always, always, ALWAYS dispose of excess nitrogen products, whether you are in ketosis or not. ALWAYS. And it doesn’t matter whether the protein’s from plants or animals. People need to get over this insane idea that meat is somehow uniquely dangerous to the kidneys. Meat even comes with its own buffering agent (in case anyone would want to go there): the amino acid glutamine.

    3. Eat salt then. FFS.


    4. Drink water.

    None of this stuff necessitates giving up on a ketogenic diet if that is what you want to follow. Good lord.

    And people wonder why I ranted about him on my blog, I bet.

    There’s actually a fair amount of potassium in meat. I was surprised to see how much was available in pork, for instance. And I’m not sure how much potassium we actually need if we are not carbing it up like carbs are going out of style. It could be that our needs are not as great. Kind of like we don’t need as much vitamin C if we’re not always dosing up on glucose. No idea, and I wish researchers would spend more time researching stuff like this and less time trying to convince everybody that phytic acid is important in the fight against cancer. Sigh.

    • Barry Cripps November 10, 2011 at 9:47 pm

      LOL…thanks for the comment (rant) Dana!

      You’re right. Like I touched on in the article, I think that the people who show any detrimental effects from being on a ketogenic diet long term, probably eat a really, really crappy diet. Something not unlike standard Atkins with poor food quality would probably do the job.