The SECRET about Potassium Citrate

What do I need to know about potassium citrate with kidney stones? Let's talk about that. 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.

And I'm– I'm sorry! Just– And I'm Jill Harris, your– I'm scratching my nose! That's– you're scratching your nose, I'm having a senior moment.

Thank God, bless. And I'm Jill Harris, your kidney stone prevention nurse.

Alrighty. So, today we are talking about potassium citrate. It is a huge question because we all want to get rid of stones.

We don't want to keep these stones that we have. So, sort of what do we know? What is What is the general consensus about potassium citrate and what are sort of the things about it that people maybe aren't aware of that they actually need to know and understand if they're taking potassium citrate?

Yes, so number one, what does it do? Why is it ordered? When I'm looking at urine collections, there's a lot of different values that are looked at for kidney stone risk, lots actually.

And, and actually, it's complicated, guys. I make everything adorable and cute and easy breezy, but looking at urine collections, it's it's it's a puzzle and you've got to figure it out and you better be a darn good expert in it to be able to do it well. And that's why I love doing it for years and years and years, I love it.

But there are values on your urine collection results, and citrate is one of them and pH is one of them. A 24-hour urine citrate number and a 24-hour urine pH, not a not a pee on a strip pH, full 24 hours. And if you have low urine pH, that means your urine is acidic.

And uric acid stones and calcium oxalate stones thrive in acidic urine. And citrate is a molecule in our body, and what it does is it protects calcium. So we have all of us have crystals in our kidney.

We all have, you know, the kidneys filter your blood, and it filters your blood to get all the cock-a-doodle-doos out that it doesn't want to send necessarily back up to the heart and other parts of your body. Like the colon takes away the waste, the kidneys are filtering the waste from your blood. Okay.

So, when it does that, we're going to have crystals in our kidney, calcium, oxalate, phosphate. We're all eating food, these things are going to be in there. And so, what it does, citrate binds with calcium in your urine, if you're watching, if you're on Spotify you can't see me or Audible, wherever, Apple, but if you're watching on YouTube, so, say here's calcium and here's citrate, it's it's it's protecting calcium.

Citrate is protecting calcium so these other crystals cannot bind the calcium. And so, a lot of kidney stone formers, for various reasons, if you do not eat a lot of fruits and vegetables, if you are on a GLP-1, if you are doing extreme weight loss, if you have bowel disease, ulcerative colitis, Crohn's, if you've had bowel resections like I have, all of these types of things, Whipples from pancreatic cancer, so, anything that creates malabsorption issues like those diseases can create lower citrate.

Those things, diabetes, can create lower pHs, so these kinds of things I just mentioned can create lower pH and lower citrate. But also, not eating enough fruits and vegetables create those two things, also. You're on carnivore diet?

Well, "Jill, I've never made a stone." Yes. I'll always say, "yet." If you've made a certain kind of stone, if you're a stone maker and you change your diet to carnivore to avoid oxalate, I'll talk to you soon. I always do.

I have I have carnivore and paleo patients every day in my practice. They went from eating high oxalate, they saw somebody on the internet say do paleo or carnivore, and now they have a different kind of stone. And people who are eating high amounts of meat have acidic urine and low citrate.

That's what happens, along with high urine calcium. So, potassium citrate will help those people increase their citrate and urine pH. But you should never go to the Duane Reade, CVS, or Walgreens and just go pick up potassium citrate.

You do not want to do that, especially if you're a heart patient, by the way. You don't want, or CKD patient, chronic kidney disease. You don't want extra potassium.

So, I got to say all these things because it's important when you're talking about people's health. So, potassium citrate is used to increase urine pH and increase urine citrate. And it can cause, usually I do not talk about side effects, but the side effect is so common with potassium citrate that I do want to bring it up.

I don't love talking about side effects simply because placebo effect is a real thing, but potassium citrate, especially with all the diseases I just mentioned, specifically bowel disease, you patients, people with malabsorption issues due to bowel disease, Crohn's, colitis, those kinds of things, will tend to have acid reflux, have GI upset, increase your diarrhea.

So, if you're already experiencing diarrhea because you have bowel disease, potassium citrate can also increase that more. So, I bring it up because that is common enough for me to do so. So, here's a typical scenario: I get a phone call.

"Jill, my doctor put me on potassium citrate. I have Crohn's. I'm always in the bathroom, I'm malnourished, and these pills are making it worse." And perhaps you could say, "Well, why would the doctor do that, Jill?" Perhaps the patient didn't disclose that they have a bowel issue.

It's not easy for anybody to talk about that. And also, they didn't know that potassium citrate would cause that, so that is another reason I bring it up. If you have low pH and low citrate because you are experiencing diarrhea chronically, please know that if your doctor offers potassium citrate to get increase your pH or citrate, you tell them, "I'm not going to be able to handle those, Doc, because I'm afraid they're going to bother me more." There are other things you can do instead.

Okay, so let me get off that train. If you're taking a diuretic, hydrochlorothiazide, chlorthalidone, indapamide, if you're taking those medications to lower urine calcium, that is why they are commonly prescribed for kidney stone formers, those three drugs can lower blood potassium. That is why you may be given potassium citrate along with a diuretic, okay?

It can also lower, taking a diuretic can also lower your citrate, so the doctor is preempting that from happening and saying, "Here, we're going to put you on hydrochlorothiazide and you're going to take hydrochlorothiazide and you're going to take two potassium citrate pills, too," okay? So, that's common. Now, I'm going to tell you a couple things as a nurse.

If you are on potassium citrate, and it is bothering you, let your doctor know, please. But before you did that, I would also say, are you taking it with food? That will really help any kind of GI upset while you're taking it, okay?

The other thing I will say, ask your doctor f– don't just stop taking them, ask your doctor for substitute for it. There are substitutes for potassium citrate. Ask your doctor about that.

Now, here's what I will tell you. Let's say I have a patient for the first time, they wanted to talk to me before they met with their doctor, so they could be really educated for that doctor appointment and get all the information they need so they're armed well for the doctor. So, they visit me first, "Jill, here's my urine collection.

Help me, old lady, figure it out." Okay, we sit down, and I say, "Here's this, here's this, here's this value, here's what it means." So, I'm explaining what the values mean, so the patient can really understand. I will tell the patient this: As a nurse, I don't write any doctor's orders, but I will tell you this, if your citrate's a little low and your pH is a little low, if your doctor, Cindy, if your doctor offers potassium citrate, ask the doctor, "Doctor, I'm barely eating any fruits and vegetables.

Can I start there before I start on that pill?" Most doctors are going to say, "edit." Absolutely. Because if your citrate for a woman should be over 550, okay? If it's 500 or 450, you can raise that by eating more fruits and vegetables, plus as a nurse that would make me happier because nobody is getting enough fruits and vegetables.

So, let's start there because fruits and vegetables naturally increase your citrate and pH. And then when you do the follow-up test, you can see, "Okay, I'm eating my fruits and vegetables. Oh, my god, I don't need the pill!

I got it where it needed to be." Or, "I'm eating my fruits and vegetables and I still am not getting it where I need it to be." So, instead of three pills of potassium citrate, the doctor only put me on one. Isn't that so much better? I love that.

Now, remember, I'm the diet girl, so the less pills and medications we need, the better. So, I always tell people to please ask their doctor before starting on potassium citrate pill, if there's just a little discrepancy in pH and citrate, "Can we just manipulate those numbers with diet first, more fruits and vegetables, before we go to the pill?" And if I can do that enough, then we won't need the pill, the follow-up will tell us that, or at the very least, I can go from not taking four pills, but two pills or one pill.

A lot of people are put on anywhere between two and six potassium citrates a day, a lot, and those pills are huge. And, by the way, for all of you that tell me, "Jill, I'm not absorbing it," that's a wax casing, you are absorbing it. What you're seeing in the toilet when you go to the bathroom is just the casing it's in.

You are absorbing the pill, I promise. That's a very common thing. I wish it was the pharmacist would tell you that.

I wish it would say it on the wrapper, maybe it does, but people aren't reading it, but people stop taking it because they think they're not it's not being absorbed, and it is, folks. It's a it's a wax matrix that the pill is inside of and that you don't absorb, that comes out when you're going to the when you're having a bowel movement.

So, you are absorbing it. I think that's it. Oh, and one more thing, "Well, Jill, can I not take that and take some lemons?" You could.

Talk to the doctor about it, though, okay? So, lemons work only if your pH and citrate are a little low. If they're really low, you're going to get GERD from those lemons or take the enamel off your teeth way before it's going to bring that pH and citrate where we need it to be.

And the pH, we like it to be between, you know, 6, 6.2, in that range. You can manipulate an acidic pH, you cannot manipulate an alkaline pH, a high pH, 6.3, 6.7, 6.9. That is typically because that's how you run, or you can manipulate it if you're drinking electrolytes and things that are manipulating it.

Lots of lemons, you know, flavor enhancers that has have a lot of citric acid, a lot of you are drinking Smartwater, electrolyte water, mineral water, all these things that have alkaline properties, and you're making your calcium phosphate stone risk worse, so just know that, too. But that's for another day, Jeff, that's for another day.

Yeah, and if you want to sort of have a complete framework for the Kidney Stone Diet, you can find that and everything else at kidneystonediet.com. Everything is right on the homepage or if you're ready to really take your health into your own hands, you can sign up for the All-Access Pass, which gives you everything including group calls with Jill, the prevention course, and sort of the flagship product of Kidney Stone Diet, the meal plans, where every day you get four recipes from Jill, breakfast, lunch, snack, and dinner to just showcase how much you can still eat while adhering to a Kidney Stone Diet and preventing future stones.

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Bye, everybody. Thank you.