How does a ketogenic diet affect kidney stones?

By Dr. Stephen Phinney and the Virta Team

Our clinical experience is that kidney stones are rare during a well-formulated ketogenic diet.

Kidney stones have many causes. The most common chemicals found in kidney stones are calcium, oxalate, and uric acid. Significant promoters of kidney stone formation are genetic (aka inherited) factors, dehydration, and low dietary magnesium. Although serum uric acid levels go up in the early adaptation phase of a well-formulated ketogenic diet, this is caused by decreased excretion, not increased production. And after a month or two, the kidneys adapt to maintaining normal uric acid excretion. At Virta, we devote considerable attention to hydration, adequate but not excessive dietary sodium and calcium, and despite plenty of green vegetables, nut, and seeds (dietary sources of magnesium), we supplement magnesium when there are early clinical signs of depletion.

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  1. Jennifer England January 31, 2019 at 5:45 am

    How many people have you monitored for over 6 months to a year? I switched from vegan to keto and ended up with 4 kidney stones (via CAT scan) one of which had to be surgically removed. I had ZERO on a CAT scan done a year ago for another problem.

    Kidney stones form when certain chemicals become concentrated enough in the urine to form crystals so dehydration can contribute but aren’t the cause.

    My urologist said she had seen a dramatic increase in young women with kidney stones on keto and diet not genetics is driving the increase (since our genes haven’t changed in the last 20 years)

    From Harvard Health “Eating too much animal protein, such as red meat, poultry, eggs, and seafood, boosts the level of uric acid and could lead to kidney stones. A high-protein diet also reduces levels of citrate, the chemical in urine that helps prevent stones from forming.” and pointed out that nuts are rich in oxalate (along with Beets, chocolate, spinach, rhubarb, tea) which I ate a lot of.


    1. Virta Health

      We have been following our patients from the clinical trial for over 3 years and we still see kidney stones as a rare occurrence. The reason for that may be due to the fact that a well formulated ketogenic diet is not, in fact, high in protein. It is moderate, meaning that you eat the amount of protein that your body needs. For individuals that are predisposed to calcium oxalate kidney stones, adjustments may be made to increase dietary citrate and reduce dietary oxalate to reduce the risk for more stones.


  2. Jennifer, as stated above, a keto diet is very much not high protein. Also, were you taking ACV or drinking lemon juice while on Keto? I’m truly curious as to if this actually has an affect on kidney stone formation. I was instructed to do this to prevent any stones forming if my protein intake was too high. I was also instructed to go very light on spinach and suplement potassium citrate. I’m curious if this has any affect as I do not want a kidney stone (had one years ago.) Thanks!


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