Questions from fellow kidney stone formers.
Here you will find the answers to the most common questions I receive from kidney stone formers.
Your doctor should order both a 24 hour urine collection and also a fasting blood draw to rule out any systemic diseases that may be causing your kidney stones.
There are many reasons why you could be making stones. After you have your FIRST stone, your doctor needs to look at your urine test results in order to customize a treatment plan for you. A doctor would not start you on blood pressure medication before taking your blood pressure. How can a doctor prescribe a preventative stone treatment plan if he doesn’t know what is causing your stones?
Please always ask for a copy of your results (this goes for all of your medical testing) so you have them for your records.
No. Eat and drink as you were when you were making kidney stones. It is important that you do not make changes before the urine collection.
Many doctors do not order a fasting blood test, but it is important, so your doctor can rule out medical issues that could also be a factor in your stone disease.
If you pass a stone at home, save it and take it to your doctor’s office so that it can be analyzed. If you have a surgery to remove the stone(s), please ask your doctor to send them out for analysis. Just because you made one type of stone doesn’t mean you will always make that type. Get all stones analyzed.
Once you get on a treatment plan, you want to make sure it is having the desired effect, and by that I mean lessening your kidney stone risk. You will only know the answer if you do a follow up urine collection.
Many doctors do NOT order the follow up tests, and I have many patients who say, “I did the first urine collection and changed my diet, but was not told to do the follow up collection”. Why did they come to me? Because they made another stone. They thought they had changed their diet sufficiently but in reality had not. The follow up test would have indicated that more dietary changes were needed.
As we age, our urine chemistries may change. Your urologist or nephrologist should do yearly urine and blood work-ups to make sure you managing the recommended dietary changes correctly and that they continue to be effective. The annual urine collection is a good way to stay on top of things. Another great way to stay compliant is to join the Kidney Stone Accountability Group.
Diet, Fluids, Medications.
Portion size is key, even with a healthy diet. Many, many, patients have to come to me feeling angry and anxious that their newly implemented healthy diet caused their kidney stones.
It can be very difficult when you are faced with conflicting dietary orders. Did your diabetes doctor tell you to incorporate more plants foods into your diet and your kidney stone doctor tell you to stay away from green, leafy, vegetables? It is difficult to know what to do in this scenario. If you sign up for The Kidney Stone Prevention Course, you will learn how to make the changes necessary to keep all your doctors happy and you healthy.
This will not only increase your risk of kidney stones, but will also increase your risk of bone loss. It is very important that you get enough calcium every day.
The calcium that is coming out in your urine could be from your bones. If you don’t eat enough food that contains calcium, you might be increasing your risk for stone and bone disease. You also need calcium to rid your body of the extra oxalate you consume.
Eating too much sugar, salt, and protein can increase the amount of calcium in your urine and create bone loss as well. Other causes of high urine calcium could be medical conditions that could be ruled out by doing the fasting blood test.
Did you just come from Dr. Coe’s website and read where we tell you to add dairy into your diet for your much needed calcium intake but you are lactose intolerant? Thankfully, there are many non-dairy alternatives today.
Look for lactose free milk (I love Fairlife). If you are sensitive to casein (a protein found in milk), then you can use unsweetened flax milk or fortified coconut or rice milk.
Yes, is the short answer. You can remain a vegan and still lower your kidney stone risk.
Click here to read about a private client who had dangerously high levels of urinary oxalate.
After working with me, she was able to get her oxalate levels down from over 100 mg/day to 29 mg/day. She happily continues her vegan lifestyle and keeps her oxalate levels within normal range.
It is recommended that you drink enough fluid to produce at least 2.5 liters of urine per day.
I get asked this a lot. All fluids count, but water is best, not to mention, healthiest for you.
Eating foods high in sodium can cause calcium to be leached from your bones and put you at risk for forming stones. It will also lead to decreased urine output.
Lowering your sodium is also very important in managing blood pressure, risk of stroke and other cardiovascular conditions.
Eating too much added sugar will cause calcium to be leached from your bone and into your urine. It will also lead to decreased urine output and increase your risk of obesity and diabetes.
Dr. Coe and I recommend the oxalate list put out by Harvard which you can download at the bottom of this page. We have used it for many years and our patients do lower their urinary oxalate when they follow it and our other advice.
Oxalate content is dependent on the soil and growing conditions of the plant. The Kidney Stone Prevention Course will teach you how to understand and use the list.
Somewhere within this range.
0.8 gm/kg/d – 1 gm/kg/d
Example: I weigh 125 pounds. Divide 125 by 2.2 to get to kg. The kg would be 56.8. If I use the equation above and plug in my numbers it would look like this: 0.8 x 56.8 = 45.4 and 1.0 x 56.8 = 56.8.
I can eat between 45.4 gm/day – 56.8 gm/day in animal protein. After converting the grams to ounces it equals 1.6 – 2.0 oz/day. Not very much is needed as you can see.
Sometimes you have to start medications to lessen your stone risk due to genetic issues that cannot be resolved by diet alone. Most of the time implementing the dietary changes will at least lower the dose you were originally asked to go on.
If your doctor wants to start you on medications, ask if you can first make an effort to change your diet to see before you start medication. If you do need medications, even after incorporating dietary changes, perhaps you will require a lower dose of the meds being prescribed. Check your progress by doing a follow up 24 hour urine collection to see if the dietary changes had a positive effect on your urine results.
If you have low citrate levels in your urine (determined by a 24 hour urine collection), it has been shown that you can add lemons to your water to help increase your citrate levels.
There is no science to back up these claims.
Unfortunately, statistics show 50 percent of you will form another kidney stone within the next 5 years.
Another way to say it is 1 in 2 will form another stone in 5 years. Those are NOT good odds! Prevention is key and education is power. Take the Kidney Stone Prevention Course so you can learn how to lessen the chance of it ever happening again!