May Damage Bone Health
The keto diet is also associated with impaired bone health.
Several studies in animals link the keto diet to decreased bone strength, likely due to losses in bone mineral density, which may occur as your body adapts to ketosis .
In fact, a 6-month study in 29 children with epilepsy on the keto diet discovered that 68% had a lower bone mineral density score after going on the diet .
Another study in 30 elite walkers determined that those who followed keto for 3.5 weeks had significantly higher levels of blood markers for bone breakdown, compared with those who ate a diet higher in carbs .
All the same, more extensive research is warranted.
The keto diet may reduce your bone mineral density and trigger bone breakdown over time, though further studies are needed.
Ketones Cause Heightened Stress On The Kidneys Due To Increased Urine Activity
However, this issue only occurs during ketoacidosis, a complication that results from dangerously high levels of ketones and blood sugar , not ketosis.
The dangerously high levels of ketones and blood sugar makes blood too acidic and this is what causes the undue pressure and stress on kidney function and health.
The ketosis achieved following an atypical ketogenic diet will result in levels of blood ketones within a normal range a perfectly safe level that will have no impact on kidney function.
The Ketogenic Diet Can Improve Kidney Function In Diabetics
Diabetic nephropathy is a condition that occurs as a result of damaged kidneys due to diabetes. It is characterized damage to your glomeruli, the small units within the kidney where blood is filtered.
In short, diabetic nephropathy means your kidneys arent able to filter your blood properly.
Studies have shown that a properly formulated ketogenic diet can help reverse diabetic nephropathy.
Keto can improve this condition due to two main reasons:
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Keto May Lead To High Cholesterol And An Increased Risk For Heart Disease
The ketogenic diet doesnt put a cap on saturated fat or even trans fats. The latter are fats you should always avoid. Read ingredient labels and avoid any food with partially hydrogenated oils, aka trans fats. These fats heighten your LDL cholesterol levels and lower your HDL cholesterol levels. They also raise your risk of heart disease and stroke, according to the American Heart Association.
Certainly, the quality of fat counts, says Yawitz. Theres a big difference nutritionally between bacon and almonds. As much as possible, people set on the keto diet should emphasize plant-based, unsaturated fats like nuts, seeds, olive oil, and avocado, which have even been shown to protect the heart. If you have high cholesterol or other risk factors for heart disease, you should speak with your doctor before beginning the keto diet. This is because the diet may but doesn’t have to include large amounts of saturated fat. Some studies have shown increases in cholesterol and triglycerides in people following the diet, while other research reveals that the keto diet may actually decrease heart disease risk as well as saturated fat intake.
Is A Keto Diet Healthy
Except for some rare medical conditions, I do not recommend a keto diet for the vast majority of people. A keto diet is not sustainable lifelong. It also restricts many healthy food groups such as whole grains, fruit, dairy, and some vegetables.
In addition, due to excess fat, a keto diet could also increase risk for heart disease, stroke and fatty liver.
High fat diets also appear to have negative impacts on gut bacteria. The community of bacteria that live in our intestines do more for us than we will probably ever know. Changes to the gut bacteria are linked to high blood pressure, inflammation, altered nutrient metabolism, and even kidney disease.
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Keto Could Cause Your Blood Sodium To Dip
When you start the keto diet, you lose sodium and other electrolytes in the urine due to reductions in insulin, says Yawitz. This is a major contributor to symptoms of keto flu. So its important to replenish sodium through the diet, especially if you exercise or sweat a lot. This can help ward off more serious side effects that are seen with long-term sodium deficiencies, says Yawitz. These include lethargy and confusion and in extreme cases, seizures, coma, and death, according to the Mayo Clinic.
Acid Disassociation Constant Factor
Weak acids like uric acid can occur in two forms:
the ionized or disassociated form , and
the unionized form .
The type of uric acid depends on the pH of its surroundings .
The pH at which an acid occurs as half ionized and half unionized is known as pKa. The pKa for uric acid is normally 5.5. It means that at this pH, 50% of it is like crystal salt, and the other 50% is like dissolved salt.
Here is the chemical reaction that shows how urine gets the acid and salt contents:
KHCO3 + R-COOH R-COOK + H2CO3
In simple words,
Potassium bicarbonate + uric acid Mono-potassium urate + Carbonic acid
The bicarbonate buffer reacts with uric acid in the blood to produce mono-potassium and mono-sodium urate .
When potassium bicarbonate reacts with uric acid, it produces mono-potassium urate and carbonic acid , which then undergoes a zinc-catalyzed reaction with the enzyme alpha-carbonic anhydrase to form water.
H2O is removed as urine, while CO2 is exhaled.
The same reaction will take place if the buffer is sodium bicarbonate , and of course, the product would be mono-sodium urate.
Increasing pH will result in a rise of ionized uric acid
Dont forget that the body controls the blood pH and keeps it between 7.3-7.4.
As the environments alkalinity increases, the more ionized the acid to base ratio becomes, and no crystals will form.
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Ketogenic Diets And Chronic Disease: Weighing The Benefits Against The Risks
- 1Physicians Committee for Responsible Medicine, Washington, DC, United States
- 2Brenda Davis Nutrition Consulting, Kelowna, BC, Canada
- 3Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- 4Department of Medicine, New York City Health + Hospitals/Bellevue, New York, NY, United States
- 5College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, United States
- 6School of Public Health, Loma Linda University, Loma Linda, CA, United States
- 7Adjunct Faculty, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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But My Friend Followed An Isolate Diet With Keto And Had Kidney Stones
An increased level of uric acid in the blood is one of the significant consequences of the Metabolic Syndrome. And, during the ketosis state, excessive ketones are excreted mainly via the urine. However, our body also removes them via feces and the breath .
With that said, it is possible for someone on a keto diet despite containing low amounts of purines to develop kidney stones.
Clearly, there must be another contributory factor other than a diet rich in purines.
Such a scenario is especially noticeable in the early weeks of a ketogenic diet protocol which may contribute to gout or kidney stone. At this stage, the body cells dont have all the enzymes needed to use ketones as a source of energy altogether. As a result, some of the unutilized ketones are removed from the body.
Ketones are a little bit acidic and therefore tend to increase the acidity of urine. Leaving this condition unaddressed may lead to a gout attack at the early stage of ketosis, and uric acid stones may form in the kidney.
Now you know the reason why many people attribute a risk factor associated with the keto diet and kidney stones.
What Is A Keto Diet
A true keto diet is very high in fat, has some protein and is very low in carbohydrate. Without carbohydrate, our body doesnt have its preferred source of energy, glucose. The vast majority of the glucose our body uses for energy is derived from dietary carbohydrate. Most of our cells and organs prefer to use glucose for energy.
When we deprive ourselves of carbohydrate, our body makes ketones to use for energy in place of glucose.
The keto diet has been somewhat hijacked by diet culture. The term keto is now used for diets that are lower in carbohydrate and very high in protein and fat. Although the diet culture keto diet is lower in carbohydrate than the average American diet, it is not usually as a true keto diet. A true keto diet only has about 4% of calories from carbohydrate and limits protein.
Diet culture keto diets and recipes are filled with seemingly endless amounts of meat, chicken, fish, seafood, nuts, oils, and other fat sources. It also is not usually low enough in carbohydrate to cause ketone production.
Both a true keto diet and the diet culture keto diet are very different than nutrition recommendations for kidney stones. They are also different than what is recommended for a general healthy diet.
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How To Get Rid Of Kidney Pain On Keto
So if fundamental aspects of the keto diet like eating fat and protein are problematic for our kidney function, then how do we get rid of and prevent kidney pain while remaining in ketosis?
- Stay hydrated
Keeping your hydration levels stable is one of the best ways to prevent kidney pain while on keto. Kidney stones are directly linked to dehydration, so just making sure that you get enough fluids that are rich in electrolytes should help you in a big way.
One of the easiest ways to do this is to just drink water .
- Consider cutting back on meat
I know it seems counterintuitive because youre already cutting back on carbohydrates, but we really dont need meat to survive on the keto diet. Its extremely helpful for those that do eat meat to stay in ketosis, and I have nothing against it , but cutting back and favoring alternative types of proteins within dairy products, nuts, and leafy greens is a great way to prevent the build up of uric acid.
- Try potassium supplements
Potassium is one of the primary electrolytes that help to contribute to general hydration and regulate bodily functions. Potassium has been proven to help regulate your overall body fluid balance, as well as assist with the health of your entire nervous system. Foods rich in potassium include: bananas, salmon, baked beans, yams, avocado, peas, and spinach.
- Introduce healthy fats
- Try magnesium supplements
Some of the most common sources for magnesium include: sunflower seeds, almonds, shrimp, and spinach.
The Role Of Fructose In Kidney Stone Formation
It has only been in the last few years that we have discovered that a far greater cause of the formation of uric acid is excess consumption of fructose. Diets that are low in fructose and other sugars like the ketogenic diet have been shown to be far more capable of reducing uric acid levels below the 6.0 mM mark that prevents the formation of the crystals that cause gout and kidney stones. In fact Dr Adam Nally has said that one of the first medications he is able to take his patients off is their anti-uric acid medications as he sees a rapid drop in uric acid levels once his patients stop eating sugar, even if the patient also raises the amount of purine containing foods the consume like pork , liver and certain fish.
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It’s Not One And Done
Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, it’s not always a one-time event. Studies have shown that having even one stone greatly increases your chances of having another. “Most people will want to do anything they can to ensure it doesn’t happen again,” said Dr. Jhagroo. “Unfortunately, it doesn’t seem to be the case that people make the changes they need to after their first stone event.”
Research conducted by Dr. Jhagroo shows that those with kidney stones do not always heed the advice of their nephrologists and urinary specialists. About 15% of kidney stone patients didn’t take prescribed medications and 41% did not follow the nutritional advice that would keep stones from recurring. Without the right medications and diet adjustments, stones can come back, and recurring kidney stones also could be an indicator of other problems, including kidney disease.
Adverse Effects Of Ketogentic Diets
The most restrictive ketogenic diets used for epilepsy can cause fatigue, headache, nausea, constipation, hypoglycemia, and acidosis, especially within the first few days to weeks of following the diet . Dehydration, hepatitis, pancreatitis, hypertriglyceridemia, hyperuricemia, hypercholesterolemia, hypomagnesemia, and hyponatremia can also occur .
A study of 300 users of online forums found that self-administered ketogenic diets may be accompanied by a temporary cluster of symptoms frequently termed keto flu, which includes headache, fatigue, nausea, dizziness, brain fog, gastrointestinal discomfort, decreased energy, feeling faint, and heartbeat alterations . In endurance athletes, 3.5 weeks on a ketogenic diet led to unfavorable effects on markers of bone modeling and remodeling .
Longer-term effects can include decreased bone mineral density, nephrolithiasis, cardiomyopathy, anemia, and neuropathy of the optic nerve . Ketogenic diets have low long-term tolerability, and are not sustainable for many individuals . Diets low in carbohydrate have also been associated with an increased risk of all-cause mortality , although recent data suggest that lower-carbohydrate diets can be linked to either higher or lower mortality risk, depending on the quality of the carbohydrate they contain and whether they rely more on animal protein and saturated fat or plant protein and unsaturated fat, respectively .
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Not Enough Calcium On Keto Diets
Although cheese is typically allowed on a keto diet, milk and yogurt are not. Eating calcium rich foods is key to kidney stone prevention and bone health. One study found a 50% reduced risk of kidney stones with adequate calcium intake in people with a history of kidney stones.
Calcium reduces the amount of oxalate absorbed from your food. It is difficult to get enough calcium on a keto diet. This may be another reason for the keto kidney stone connection.
Note: Calcium supplements are not ideal and can increase the risk of kidney stones, whereas calcium rich foods reduce risk.