The hidden reason you keep making stones

Apparently, there's a hidden reason that I keep making 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 Jill Harris, your kidney stone prevention nurse.

So, today, we're talking secrets. Secret time. But what is the thing?

What are we where are we getting at here, that there's there's a hidden reason that people continue to make kidney stones?

There sure is. And did you know that 4 to 5 out of 10 people, it's going to be this reason? It's a really high percentage, and three of the Kidney Stone Diet goals are trying to help this hidden reason, and it is high urine calcium.

It is such a problem. It is the number one reason I please beg you to get a urine collection done. Please!

Do not let your doctor say, "We're going to wait for the second stone." Please, I'm begging you. What do I say, Jill, because they keep saying no? First of all, if your urologist is saying no, just say this, "Doctor, I want to do everything I can to prevent kidney stones." Show that you're really motivated.

Advocate for advocate for yourself. If he or she still says no, go to your primary. Go to your primary.

Get somebody, an OB-GYN, a nurse practitioner, anybody can any doctor, any licensed professional can order this for you. It's so important. It is the whole reason we want you to do the urine collection, the biggest reason.

There's lots of things on that urine collection, but it is the number one urine chemistry abnormality, and it's why you're making kidney stones. "How could it be, Jill? I'm not getting no calcium." Because there's three reasons, three of the three of the Kidney Stone goals: the salt, the sugar, and the meat.

Those goals are there to lower urine calcium. We didn't just make stuff up! These things prevent kidney stones because when you eat too much added sodium and when you eat too much added sugar, sodium, and meat—you can have meat, you just can't be on carnivore diet—when you eat too much of those things, it will pull calcium out, dump it into the urine.

Let me give you an example. When we eat too much sodium, the kidneys' job is to filter your blood. Filter, filter.

It does not want the stuff, the excess stuff in the blood to go to the heart! So the kidneys—God, they work so hard—they're filtering your blood. They're like, "Oh, holy frijoles!

There's a lot of sodium. Going to go up to my friend the heart. Let me get rid of some of it for him." I don't know why the heart's a him.

Here it is. But with that sodium, when the kidney starts filtering it out, calcium follows, "Hey, wait up, sodium, I'm coming with you." That's what happens. And now if you don't pee a lot, and then that calcium, by the way, doesn't get back up to your bones, and this can lead to osteoporosis, too, but then that excess calcium sitting in your urine, if you don't pee that out, oxalate and phosphate can find her.

They bump around, all these crystals, like bumper cars, and they eventually stick to each other if we're not peeing like we should, and this is why drinking enough fluids is so important. So, those three goals are there to control urine calcium. That's That's one of the reasons we have high urine calcium.

So when I'm looking at a urine collection, the first thing I look at—y'all probably think I look at oxalate—I do not. I look at urine calcium because, typically, that's the problem. And then my job, as Angie Dickinson Pepper from Police Woman—and if you're my age, you'll get the reference, Jeff, I don't know.

No, I don't know that.

Yeah, of course. Son of a… Anyway, it's my job to find out why is Trixie's urine calcium so high.

I love it! I love it so much. Where do I go?

The next thing I look at the urine collection, I look at Trixie's salt. Is it high? Is that the reason?

Then I look at her total protein. And I ask Trixie, "Hey, this is a little high, are you overdoing meat?" "No, not really." Okay. Added sugar is not shown on a urine collection, so I ask Trixie, "Are you overdo—" "Well, I love sugar, Jill." So that could be a reason.

So I'm trying to rule out diet. Lots of times it is diet, and then we talk about that, and then I teach how to change it for the person that I'm dealing with, and all of you are a little bit different. If somebody's coming to me for their follow-up, they had a consult with me, their first urine collection, and their calcium was high, and they changed some diet stuff, and then they call me, "Jill, I got the follow-up, let's go over it before I visit my doctor." I say, "All right." I look at Trixie's follow-up.

Her salt is gorgeous. Stuff looks so much better, but the so— the calcium is still a little high. Well, now we rule out other things.

How's her vitamin D? This is a blood test. How is her parathyroid?

Parathyroid are little glands right in on the on the side, here's your thyroid—If you're if you're on Spotify, you can't see me. If you're on YouTube, you have your thyroid in the middle of your neck and then you have two on each side, parathyroids, so four in total. They control your calcium.

Sometimes they overproduce calcium, so that can be a problem. So, again, we're trying to rule out the reasons a kidney stone former has high urine calcium. It could be not enough vitamin D, it could be too much vitamin D, these are blood tests.

The parathyroid could be overreacting, check your parathyroid, it's a blood test. Check your blood calcium, is it too high? That can also indicate primary hyperparathyroidism.

So there's blood tests your doctors should be ordering, too. If everything comes back cool, then, what we say, you may have idiopathic hypercalciuria, which is a big fancy name for Trixie's got too much calcium in her urine, hypercalciuria, too much calcium in her urine, idiopathic means we've ruled everything else out, there's no medical reason for this, she's just got it.

And if you ask Trixie, which is always part of my medical intake, "Does anybody in your family have kidney stones?", she could say yes. If you have IH, up to 50% of your blood relatives could have it as well. So this is something that runs in families.

And then that is when you can use a medication, thiazide diuretics, and then they help control urine calcium. But I will tell you this: what I don't love is when I don't like saying anything bad about anything in the medical field, but what I don't love is when people are automatically put on these diuretics before your diet has been checked and helped and the blood work, too.

Let's not just slap pills on things. A doctor could say to me, "Well, Jill, the calcium's really high, I'm going to have to." I know, but the sodium, he ate 5,000 mg of sodium, and you're starting him on a very high dose diuretic. Let's teach him how to lower sodium, get that lowered, the calcium will come down some, and at the very least, we can at least treat him with a lower dose diuretic, Dr.

Chill? But that's how I would do it if I were a doctor, because less medication is always a happy thing. And again, people my age, in their 60s, we're just one medication begets another medication and another medication, so let's try to minimize.

And by the way, you're still going to have to teach the patient how to take care of their diet because the pill doesn't work as well if we don't lower our sodium. It's just not helping. The pill needs to be You need to be on lower sodium anyway, otherwise the pill isn't as effective.

And we should be teaching people diet changes anyway. Doctors don't have time to do this, but I'm just saying, if medicine was better or more perfect, we would be able to sit down with patients and talk to them about diet. You know, and yes, Jeff, I'm going on a tangent, but I have really smart people that I'm doing consults with.

I mean, really smart people, and they don't know much about diet because there's so much misinformation on the internet about diet. It's just like you don't know if you're coming or going. One day, fiber is the little darling, the next day, we're supposed to be eating 300 g of protein, the next day this and that, and you don't know what you're supposed to be doing.

And it's really quite simple: eat more fruits and vegetables, eat within portion size of all of these things, don't overeat high-oxalate foods, watch sugar and sodium, and get enough fluids, and get your calcium needs met. You need your calcium because that helps lower oxalate. And for those of you who have high urine calcium, you may say, "Well, Jill, I read I got high urine calcium, why are you telling me to get more?" Because your body's losing this calcium, which means your bones are not getting it.

So you do need calcium. You need whatever who if you're, you know, a man, 1,000 mg a day, a woman, 1,000 mg a day, if you don't get your period anymore, up to 1,200 mg a day. So you need it for bone health and you also need it to lower your urine oxalate.

So high urine calcium is one of the biggest drivers of why you're getting kidney stones, and the majority of people I talk to have no idea about it, and they've been getting stones for decades until they finally get a urine collection 25 years later, and they can clearly see they have osteoporosis now, and they also have this high urine calcium, and that's why they're making kidney stones.

And it's the number one reason you keep making them, but if you don't do a urine collection, or the doctor doesn't understand high urine calcium and doesn't know what to help you with, you will keep making kidney stone kidney stones. You're being told you're just a stone maker, but you don't know the hidden reason why.

Yeah, so, I think that's a great spot to wrap. And if you want to talk to Jill directly, go to kidneystonediet.com where you can have a private consultation where she will review your 24-hour urine collection, which is immensely valuable. And the only thing I wanted to touch on, you mentioned if you're on Spotify, you can't watch.

I've been adding the videos to Spotify. If you If you listen immediately—Yeah, if you listen immediately on Tuesday morning, the video won't be there yet, but once I am able to add it later, you can actually go back and watch the latest episodes on there, which is kind of fun. Something that they do now, which is really nice.

But anyway, I think that's a great spot to wrap. So, we will see you next week.

Bye, everybody. Get your urine collection done. Bye.