How do you prevent kidney stones on a keto diet?

This week, Jill answers a listener question about preventing kidney stones with a keto diet.

Jeff Sarris: Welcome back to the Kidney Stone Diet podcast, the show about reducing your kidney stone risk and living your best life. I’m your host and fellow student, Jeff Sarris.

Jill Harris: And I’m Jill Harris, your kidney stone prevention nurse. So, we’ve been shooting a few shows right now, but I was looking at your face and I’m like, “Oh, I love you.” That’s what I was thinking. And, you know, folks, Jeff gets so embarrassed. It’s like, “Stop being embarrassed.” I do. We all do. And I know my mom’s watching right now. And she’s like, “Yeah, we all do.” She loves you. “That Jeff! He’s so handsome, Jill!” Oh, God, mom. But he is.

Jeff Sarris: You’re just too sweet. I just don’t know how to respond to that. No, I appreciate it. I just don’t know how to respond. You get me all flustered.

Jill Harris: I know. We like seeing you flustered. It’s fun.

Jeff Sarris: But, yeah, so as you mentioned, we’ve been filming a few today, a few episodes. And we were thinking one more FAQ and we’ll get back to the listener questions, which we always appreciate. But we were thinking, specifically, to talk about the Keto diet and how do you prevent kidney stones on a Keto diet being a pretty common question, because there’s, well, why don’t you just take it from here?

Jill Harris: Yeah, but I mean, say whatever you want. Nobody ever wants to hear my cacklin’ voice all day long. So, what do you think about the Keto diet?

Jeff Sarris: Oh, yeah, just from a health and just just an all-around perspective, like I come from the Paleo diet space, which is a lower carb–it’s not the depths of low carb as Keto is because that, as I understand, came more from a clinical standpoint, initially, but I do participate in a low carb diet. Like that’s basically what I’ve done now for a while. I mean, maybe since 2012, 2011 or so. And yeah, I feel great. It feels so much better than when I have a lot more carbs and things. So I do have an affinity for it, but I know there’s also a connection here that ties into kidney stones, which is something to definitely note and be aware of.

Can I do the Keto diet alongside the Kidney Stone Diet?

Jill Harris: Yes, so this is what people say, “Jill says ‘no Keto.’ That’s what Jill says.” That is not what Jill says. Jill does not say ‘no Keto.’ That is not what I say. Here’s what I say: you could do any lifestyle that works for you. You just got to fit them into the KSD goals, Kidney Stone Diet goals. We have, if you go to kidneystonediet.com, the start page, you’re gonna see a little handout and it just puts the goals right there for you. The salt: 1500 milligrams a day. The added sugar: 25 grams of added sugar a day for women, 38 grams of added sugar a day for men. It’s 37.5, but we just give you the half. Calcium: 1000 for men and 1000 for women who still get their periods. Postmenopausal women, 1200 milligrams of calcium. Get your fluids. We want you to pee out 2 1/2 liters to three liters of urine a day. Oxalate, 100 milligrams a day you get and then there’s a protein part, meat protein.

“Jill, I don’t eat red meat!” Well, chicken’s meat, too, people. All meat, plus some seafood. You don’t want to overeat it and this is where we go into Keto and Paleo. You don’t want to overeat it because it can increase your risk for uric acid stones and calcium oxalate stones. So, Keto. Here’s what I officially think of Keto. Most people can’t stay on it a long time. It’s very difficult to not eat–that’s a very low carb diet. Wow, is it a low carb diet! If you can do it, and you’re happy on it, and this is your lifestyle for the rest of your life, then you can continue doing it. You just got to fit into my Kidney Stone Diet goals and the way that Keto people overeat spinach and almonds, they’re going to break that oxalate. They’re going to be withdrawn on that oxalate bank account with one spinach salad, just because there’s over 600 milligrams of spinach for a cup of oxalate for a cup of spinach.

So, if you want to do keto, you can do it you just can’t overeat all that meat. It’s not a high protein diet, it’s a high fat diet. People also do Keto wrong. So let’s just say this, I, like Jeff, also do a very low-carb diet. So, I’m not opposed to low-carb diets if that diet works for you. Now, if you’re somebody that’s like, “I need to lose 50 pounds and I’m gonna go on Keto or Paleo, and I’m going to give up bread.” But every day all you think about is bread and/or you lose that 50 pounds and you go back to eating all those carbs, you’re gonna gain your weight right back. So what I’m saying is, if Paleo or Keto–and in this case, we’re talking about Keto–is not something you can sustain long-term, you shouldn’t be doing it. What I’m trying to teach you is long-term dietary changes. Figuring out a lifestyle that works for you. And it can be any lifestyle you want, as long as you fit in those KSD goals.

Why do Keto patients make kidney stones?

So, for Keto, what happens? Why do Keto patients make kidney stones? Because they overeat all the almonds, almond flour because they’re baking now because they can’t have their carbs. So, they’re gonna bake with almond flour and a lot of it, and milk and flour. And just a handful of almonds is what I’m told every day. Spinach, spinach, spinach. So, what they’re doing is they’re overeating the highest oxalate foods in any and all amounts they want. Because, remember, when you’ve discluded a whole food group, you won’t be overeating the ones you can have, which in this case–people, even though it’s a high fat diet, they will overeat things like they’ll still overeat meat. They’re overeating avocados. Avocados, as a kidney stone patient, there’s a video on it, you can certainly have an avocado. You just can’t have four of them a day. And, believe me, I’ve dealt with keto patients that were like, “Well, I was eating four of them a day because it’s high fat and fiber.” So, that’s what they’re doing.

So it’s not necessarily Keto that caused your stone. The Keto people are going to be like, “Oh, okay. It’s how you interpreted keto? And did it? So if you want to eat a higher fat diet, because that works for all your things, your cholesterol, your heart disease, if that’s working for you, is it. But if it is, is it, all that saturated fat, is it but if it is, then continue doing it. If all your numbers look good, and you feel great, and most of all, you’re happy with it, you feel satisfied, and it’s something you’re enjoying, then you should do it. You just can’t overeat meat. And, again, I know Keto was high fat, but people overeat meat because they’re not eating any carbs. And they overeat the highest oxalate foods. So I work with people that stay on Keto, I just tell them, “You’re gonna have to have other nuts. There’s other nuts you can have, but you can’t have handfuls and bushels of anything all day long, and you must get your calcium needs met.”

So Jeff and I both do a low-carb diet, but we’re not overeating foods we are allowed to have. We’re not doing that. We eat all food within normal portion sizes. That’s what a healthy diet is, no matter what lifestyle you’re trying to lead. So, if you want to do Keto, you certainly can. You just have to fit in the Kidney Stone Diet goals. Also, a lot of Keto patients are eating so much salt because they’re sucking down cheese all day long. Cheese because it’s higher fat. They’re eating cheese and a lot of the meats they’re eating are too high in salt. So, it’s a very high-salt diet. And, listen, you can’t blame people. I’m not mad about that. Unless we have high blood pressure issues, or we have too much calcium in our urine, or we have heart disease, nobody’s talking to us about a high-salt diet.

So if you Keto patients say, “Well, I didn’t realize anything about salt. My blood pressure’s fine, so I didn’t think anything about it.” It’s not until things go wrong with us that we’re told to change something. But everybody should be paying attention to sodium. And, so, Keto can be a very high-salt diet even though you didn’t even think that matters until you got a kidney stone. And we overeat the highest oxalate foods on Keto. That’s what we do. So, Keto, if you want to do it just fit into the Kidney Stone Diet goals. I don’t necessarily have a problem with it. It’s not something I would enjoy, but if it’s what you enjoy, and you’re doing it that fits into the goals, God bless, go for it. That’s what I say. You just cannot eat as much as you want of those high oxalate foods anymore. You can eat some of them. Not spinach products, or not spinach stuff, or almond products, but everything else can–you can eat an avocado, just not four anymore. Get your calcium needs met and not just through salty cheese.

Jeff Sarris: Oh yeah, the salt is a great point because people hear like, “Oh, I can eat all the bacon I want.” And that sounds phenomenal and then you have a bunch of bacon. “Oh, I’ll throw some spinach in my smoothie.” It’ll be “Oh, almond milk or almond butter in this smoothie,” like all these things that it’s like, “Oh, this is healthy.” And sure, there are parts of these things that are healthy, but when it comes to kidney stones, there are very specific red flags that go up right away.

Eat your veggies (just not spinach)!

Jill Harris: Absolutely. Absolutely! And so people will say Keto caused my stones. Keto didn’t cause your stones. It’s the way you did it. And I’m also not blaming you guys because you don’t know what you don’t know. So, I’m not blaming you. We, as human beings, tend to find something that works for us and, again, especially if it’s a healthy food, we’re just like it’s a free food. There is no free food. I know Weight Watchers will say, “There’s zero points. Eat as much spinach as you want! Ah, Weight Watchers gave me a stone.” No, it’s the way you did it. We should not eat any food. There’s no one superfood that we should be eating all day. All foods, all fruits and vegetables, in this case, no spinach because of kidney stones, but all fruits and vegetables, normal portion sizes, a varying amount of fruits and vegetables.

“I don’t like fruits and vegetables.” Well, could you try? Could you just eat one vegetable? And you might find it–don’t pick corn. Just pick a vegetable and try it. I can’t tell you how many patients are like, “I don’t eat vegetables.” “Well, how long have you been saying that Henry?” “Well, since I’m seven.” “Well, you might want to pick up your pen and write a different story because now you’re just a 70 year old man that doesn’t eat vegetables.” How about just try a vegetable. Email me in a couple of weeks and tell me what you’re trying. Tell me how you feel. “Dear old lady, it’s been two weeks I hated you the first week and a half. And then, finally, after the 12th day I said, “Oh, let me try some zucchini. I tried it. I have to tell you. I liked it. I’m gonna keep on trying.” That’s all I’m asking. That’s all I’m asking.

No matter what it is, whether it’s food, or, you know, “I’m not somebody who swims, I’m not somebody who does this.” Sometimes we need to revisit our stories and think to ourselves, “Holy bragioli! I’ve been saying this for decades. Maybe that’s not-” and then you become that character! Maybe it’s time to pick up a pen and write a different story. Just like I was the kind of person that said, “I just don’t cook.” Well, when I got divorced, I had to learn how to cook and my friends said to me if you can read, you can cook. It changed my life. I got a meal plan now. Who would think? I might friggin’ do a cooking show! One never knows, but we gotta write. We gotta write a different character for ourselves sometimes. So that’s all I’m saying.

A keto diet will not cause a kidney stone unless you’re doing it and overeating the highest oxalate foods and not getting any calcium. You will get kidney stones, but most people do do Keto and they they do exactly what I just said. How do I know because they tell me. They overate spinach, almond products, got no calcium, except salty cheese, and, also, you know, they’re not drinking their water, maybe whatever. But it’s always the high oxalate and high salt part. And you know they’re overdoing meat even though Keto isn’t a high protein diet. They’re overdoing meat because, again, when you take away carbs, which guys, carbs are a great friggin’ energy source, but when you take away a whole food group and I’m saying that as a low-carb person, but I don’t know why we vilify carbs.

Jeff and I choose a low-carb diet because it makes us feel good and, with my bowel issues, that works for me. But if I want a bun, I have a bun. I mean, I just made something for the meal plan for today. It was a sourdough–I grilled it up–a piece of sourdough bread with avocado, mozzarella, balsamic, and tomatoes. And I never have bread, but I wanted it. So that’s another thing no one asked, but I’m going to tell you anyway. It’s another thing. Sometimes we are creating such a box for ourselves that I’m like, “I really have been hankering a piece of sourdough bread.” I’ve had sourdough bread, maybe twice in 60 years. Today was one of the days I had to get it.

I made it, I moved on. I’ll probably die before I hanker it again. But we should also have things that we crave sometimes because we won’t stop thinking about it. And that’s also how diets don’t work and lifestyles get messed up. Enjoy your food. Move on. I may not feel so great in my belly, but I don’t care, whatever. I mean, it’s one piece of bread. What’s it going to do? So, I’m just saying sometimes we have to–we have a craving, we should have it. Move on, get right back on your lifestyle. That doesn’t create any illness either.

Jeff Sarris: Yeah, absolutely. We’re not depriving ourselves.

Jill Harris: No, I never feel deprived!

Jeff Sarris: Yeah, we’ve just found the things that make us feel good, so then the cravings may have shifted, even, with time. That’s just how it is. And I think it’s great to also say that we tell ourselves–we write this story, at some point, of who we are and that is always changing. We can change at any point. It’s scary to change. It’s a lot to be like, “Well, no, this is me.” Because sometimes we wrap up our identity in something like, “I don’t eat vegetables,” or something along those lines. It’s all very important stuff to consider.

Jill Harris: Yeah! And I will say this to patients, “How long have you been saying that?” “Well, ever since I was a kid.” “And, well, you might want to revisit a vegetable.” I mean, you know, it’s so sad that somebody’s deprived themselves of so many foods they may really enjoy. And then the next thing, I can’t tell you how many of my patients I’ve done this with, and then you know, some of them even became vegetarians. And they’re like, “My whole world opened up and I’m so glad you were such a wish to me!” They’re grateful that I pushed them a little. It’s like, you just might want to rethink this, especially now because you got this heart disease here.

So, you know, there’s other things going on with them, too. Nobody at my age and above is just the kidney stone-former, typically. tThey are getting other medical conditions now, based upon what their dietary habits have been. And so that’s why I say that is the one thing I’m grateful for kidney stones, because this is the time where people are like, “Never again.” People who are even diabetics, you’re taking insulin, you know, you’re not having that intense pain. It’s a chronic disease, diabetes. Kidney stones will knock you upside your head aand will make you rethink your whole existence. That’s how bad the pain is. And so that prompts the diet change, where no other medical condition they had ever did before. Okay, so that is why I’m grateful for this disease, for that and that only. But it does get people to wake up and change their lifestyle. So, that I’m grateful for.

Jeff Sarris: And with that, I think we will close for this week. If you have a question, the number is 773-789-8763. And we’d love to hear your voice in the future. And if you want to dive deeper, you can go to kidneystonediet.com, where you can find all of the resources. You can find the Kidney Stone Prevention Group on Facebook, which is a thriving group that constantly has new people coming in with questions. And it’s a community-driven experience there. Completely free. Jill’s there, curating and contributing, but it’s also it’s very community-focused. So a lot of times, it’s just helpful to realize that we’re not alone in our struggle, which along those lines, too, you have the accountability calls where people come together every week, and you discuss where you are, where you can help people along their journey. And, again, that can be found at kidneystonediet.com.

Jill Harris: That’s a very valuable piece of the thing, the services we have, that accountability group because people lose 50 pounds, 100 pounds, and then they’re there. It doesn’t mean once you lose weight, by the way, then you’ve got the hard work, the hardest work is maintaining that. And that’s why, with the course, I give that for the first month free and then, thereafter, it’s only $19. I mean, I give that away. And sometimes we’re in those calls for two hours. You come and go as you please. They’re office hours, but we’re talking about real-life stuff. People at our age that are dealing with older parents, and also still have kids at home and dealing with a lot of things right. We’re still working, all this stuff, and it’s a stressful time.

How do we maintain our lifestyle changes? What do we do when obstacles come up? We talk about real life things, and that accountability group is– I just love it and the people that are in there, we all become a family together. It’s amazing. very vulnerable, wonderful. You learn about kidney stone stuff, of course, but we talk about real life and what are the obstacles get in the way of maintaining a healthy lifestyle and we deal with it. So, then that person, who’s maybe having an obstacle can get re-motivated and get back to work after the call and they feel good and invigorated and it’s a very loving and supportive group. I get just as much out of it that I give to it. It’s amazing.

Jeff Sarris: So, thanks again, everyone out there listening, liking, commenting, and subscribing, and we’ll see you next week!

Jill Harris: Bye, Jeff!