Keto Diet 101: Kidney Stones and Gout “Stones”

Kidney Stones

Kidney stones should be called kidney crystals. That’s what they are: crystals. and the keto diet and kidney stones do sometimes cross paths. Hold on. Don’t run away.  Finish reading about the keto diet and kidney stones.  

• THIS PROBLEM AFFECTS PATIENTS: 2-4 after their first ketone is made
• THIS PROBLEM LASTS UNTIL: the rapid weight loss stops. [The blood ketones along with the blood sugars are stable.]

The formation of these crystals deep inside the kidney starts with a tiny chemical attraction between two elements. Your kidney handles a huge volume of these elements every second.

If you want to begin making a kidney stone, the first step is to get dehydrated. Run low on water (dehydration) and the concentration of urine in your kidneys shoots way up. This concentrated waste flowing through your kidneys puts these crystallizing elements really close together. Voila! Your first crystal is made.  

Next, you add one tiny element to that crystal every time your urine becomes concentrated. As you add one element after another, the crystal grows in size as does its power to attract even more elements. Maybe it takes you five years to build that crystal up to a speck. Maybe it takes you ten years. Unless you ‘melt’ your kidney stones away, you keep adding one tiny element after another.  You can even grow multiple kidney stones at the same time.

Change Over Time

Over time, that crystallized spec turned into a tiny pebble. Then a stone. One awful day, that big crystal breaks away from the place where it grew. The crystal tumbles through your waterworks like a boulder. Each tumbler’s sharp edges cut and scrape through tissue causing one of life’s most excruciatingly painful experiences.  

Making kidney stones is painless. No one can feel those tiny changes inside your kidney as the stone grows. Painlessly your stone collects more and more particles. If you want to grow those stones faster, add insulin to the system. A lot of insulin. A high insulin state leads to several changes that are GREAT for growing kidney stones.

If we use a super advanced imaging system to look into the kidneys of adults, almost every person has tiny little kidney stones. They are growing and shrinking all the time. The stones are either adding crystals or slowly melting away. This is constantly happening.

If your kidney bathes in crystal-growing chemicals, your stones will continue to grow. High sugar levels favor crystal growth. Ketones favor crystal melting. Ketosis shifts the body’s chemistry in the opposite direction of the high sugar state.  

Does this mean ketosis will melt all the stones lurking in your kidneys? Not quite.

The good news: ketosis’ chemistry shift ensures your kidneys’ existing crystals stop growing. Indeed, some of those crystals can disappear over time.

The bad news: Your stone may dislodge before it dissolves.

How come?

When your body produces ketones, kidney stones’ crystals get removed one element at a time. We don’t get to choose which order the elements peel off of that crystal.

If you have a stone that has been there for years, your new keto-centered blood chemistry may whittle away at the base of the stone. This could set the big stone free to roll down the tubes of the kidney and bladder system. When that stone is securely fixed to the wall of the kidney system, you have no symptoms. If the stone breaks free, boy, oh, boy will you feel it! 

That crystallized boulder rolls downstream sending shockwaves of pain through your back and groin.

Question: Can ketosis CAUSE you to pass kidney stones?

That’s a trick question. It certainly disrupts your body’s chemical balance which can lead to your existing stones melting and, in some unlucky situations, passing. Ideally, your body’s chemical shift would melt stones one element at a time without dislodging them from their current position. But this is not guaranteed.

ANTIDOTE: Don’t cheat! The best way to shake loose a bunch of kidney stones is to go in and out of ketosis a lot. The shift from making the stones to melting the stones unsettles your system.  

If you have no stones in your kidney, then you are fine. You won’t make new stones while on ketosis. If you have a crop of growing kidney stones and don’t know it, beware. If you know you have kidney stones because you have had troubles in the past, you need to commit to this shift in chemistry and stay in ketosis. Pray that the stone melts in an orderly and smooth way.

If you are worried about a kidney stone as you transition to a ketogenic diet, consider adding ketone supplements to MAKE SURE you stay in ketosis as you figure out the rules.  Ketone supplements, also called exogenous ketones, keep your chemistry on the side of melting kidney stones while you work on the habits of keeping those carbohydrates less than 20 per day.  Be sure to add exogenous ketones every 4 hours if you choose this plan.  These supplements are a solid bridge to temporary ketosis, but they only last 4 hours.  My favorite way to take them is to mix them with cream and ice in a small glass and sip it over several hours.  It tastes good as I add a steady stream of ketones.

Finally, stay hydrated. A dry kidney is a painful kidney. Never is this truer than when dealing with kidney stones.  

GOUT

• THIS PROBLEM AFFECTS PATIENTS: 2-4 after their first ketone is made
• THIS PROBLEM LASTS UNTIL: the rapid weight loss stops

If you’ve ever had a gout attack, pay attention to this section. Gout happens when waste products crystallize within the body’s joints and produce pain when those crystals start to move.

Ketosis significantly reduces your body’s inflammation. It causes your body to adjust. One of those adjustments can involve gout crystals getting dislodged from inside your joints-a gout attack.

Don’t let a history of gout stop you from a keto diet. Gout crystals formed because of the food you ate years ago. Diets high in carbohydrates combined with fatty meat sparked the problem in your joints. When you switch to a high-fat-low-carb diet, the inflammation drops and the process begins to reverse.  As the crystals dissolve, the burden on your joints lessens. But the moment too many crystals move at once, you may spark a gout attack.

Not everybody with a history of gout suffers a flare on this keto diet. If you’ve had attacks in your past, you need this lifestyle change more than others. Those crystals hiding in your joints are just a barometer, an indicator, of all the things that have slowly gone wrong deep inside your system. Your high-carb, high-insulin lifestyle has led to gout. Believe it or not, gout crystals are produced by the body as a quick fix. The body stuffs joints full of these extra crystals for storage to prevent your blood from becoming toxic with excess uric acid.

Your body will store these crystals into every joint possible unless somehow you tip the scales back the other direction. Bathing your system in ketones will reduce insulin and inflammation. This process also dissolves gout crystals. The process of melting such buildup can result in a painful gout flare.

Antidote: Keep your probenecid or your colchicine around. And of course, stay hydrated.

Want to learn more? Check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

RESOURCES:

1. Mehmood A. Khan MD  John V. St. Peter Gail A. Breen  Guilford G. Hartley John T. Vessey; Diabetes Disease Stage Predicts Weight Loss Outcomes with Long‐Term Appetite Suppressants; 06 September 2012
2. Stubbs, James, et al. “Macronutrients, Feeding Behavior, and Weight Control in Humans.” Appetite and Food Intake, 2008, pp. 295–322., doi:10.1201/9781420047844.
3. E. Cersosimo, M. Ajmal, R. J. Naukam, P. E. Molina, and N. N. Abumrad; Role of the kidney in plasma glucose regulation during hyperglycemia; American Journal of Physiology-Endocrinology and Metabolism, Volume 272, Issue 5; 1997 May 01; https://doi.org/10.1152/ajpendo.1997.272.5.E756
4. I. Alexandru Bobulescu, Naim M. Maalouf, Giovanna Capolongo, Beverley Adams-Huet, Tara R. Rosenthal, Orson W. Moe, and Khashayar Sakhaee; Renal ammonium excretion after an acute acid load: blunted response in uric acid stone formers but not in patients with type 2 diabetes; American Journal of Physiology-Renal PhysiologyVolume 305, Issue 10; 2013 Nov 15; https://doi.org/10.1152/ajprenal.00374.2013
5. Goldberg, Emily L., et al. “β-Hydroxybutyrate Deactivates Neutrophil NLRP3 Inflammasome to Relieve Gout Flares.” Cell Reports, vol. 18, no. 9, 2017, pp. 2077–2087., doi:10.1016/j.celrep.2017.02.004