Are you at a higher risk of developing kidney stones on Keto compared to a high-carb diet?
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You can actually expect quite the opposite, since a Ketogenic Diet is naturally low in all kinds of sugar and keeps insulin levels down.

We know since 1967 that the breakdown of fructose can raise uric acid levels very quickly. Table sugar for example is 50% fructose, corn syrup has an even higher percentage and many fruits, especially dried fruits have a high fructose content as well.
Apart from being more easily stored as fat than glucose, eating more fructose also increases your risk of developing a fatty liver, higher blood pressure and higher triglycerides. Alcohol also raises uric acid levels. And when your uric acid level builds to a level higher than 6mg/dl, you run the risk of a formation of kidney stones.
The hormone insulin also plays an important role. While your kidneys want to get rid of some uric acid by pushing it out through urine, high insulin levels force your kidneys to reabsorb uric acid into the blood instead and your uric acid levels stay elevated.

Here is the problem with typical 'anti kidney stone diets' that are prescribed when someone is at risk for kidney stones:
You're told to reduce purine rich foods like sardines, mackerel, organ meats, meat in general and vegetables like spinach, asparagus and cauliflower, which coincidentally are some of the most nutrient-dense foods out there and to replace them with some foods that barely have any nutritional value. Bread, cereal, fruit & fruit juice, fat-free dairy or even sugar and sweets.
They also ask you to maintain a healthy weight at the same time, which is pretty much impossible when you start replacing protein with more sugar which can also cause a lot of other metabolic diseases. Also, dietary purines don't actually contribute to total uric acid levels by more than 1mg/dl.
The protein in many so called "high purine foods" actually helps eliminate purines through the urine and can therefore actually lower uric acid levels.
And lets not forget what I mentioned before, when your insulin levels are elevated because you're now eating bread instead of spinach and you replace protein & fat with more carbs, your kidneys have to reabsorb the uric acid into your blood instead of helping you get rid of it.
So you're likely not lowering your risk for kidney stones by doing that and instead causing many more problems. There are drugs that lower uric acid levels successfully, but they don’t solve the actual, underlying problem either.

A well-formulated Ketogenic Diet, that naturally lowers insulin levels and raises ketones, is a fantastic way to decrease uric acid levels without the need for meds. You don’t have to give up your sardines, bacon, grass-fed beef, spinach or other nutritious food that is higher in purines. So Keto doesn’t put you at higher risk for kidney stones but actually helps to prevent the creation of kidney stones or gout.

Now, maybe you heard some stories of some people who had kidney stones even though they were doing Keto. Here is what you'll most likely hear:
1. They were at a higher risk for kidney stones to begin with, possibly a family history of kidney stones or gout
2. They heavily cheated before getting their kidney stones and this is the critical part! They had a ton of Christmas cookies, birthday cake or something similar and got wasted on beer over the weekend. So lets see what happened - they had lots of sugar, raising uric acid levels, alcohol, raising uric acid levels, high insulin because of the carbohydrates which in itself made it harder for their kidneys to get rid of uric acid through urine and to make things worse, because of the alcohol, they were dehydrated as well. When you combine all of these factors, kidney stones can build quickly, it doesn't matter whether or not you were doing Keto before. So it's wise not to take cheating too far.

A great way to prevent Kidney stones:
1. Follow a well-formulated Ketogenic Diet which is naturally low in sugar and fructose and keeps your insulin levels low. Try to eat mostly whole, unprocessed food.
2. Drink lots of water and stay well hydrated
3. Don't yo-yo diet and keep cheating to a minimum, especially if you or someone in your family had kidney stones or gout before
4. If you do happen to cheat, make sure you're staying well-hydrated by drinking plenty of water
5. Another thing you can do as an additional protection against kidney stone formation and for kidney health in general is squeezing half a lemon in a glass of water and drinking it on an empty stomach.

Most people quickly see an improvement in uric acid levels in the blood as well as a decrease in calcium oxalate stone formation on Keto without the need for meds. Some physicians like Dr. Nally, who you might have heard of, even specifically use a Keto Diet to successfully kidney stone risk with their patients.

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