This is super important. It's so important that I have notes on this one, so you're going to you guys are going to see me not look at the camera sometimes, because I don't want to miss anything. And, usually, we just get together, Jeff and I, and we just go.
I don't take notes. I know this subject so well, obviously, for 30 years, but this one I wanted to take notes on because I don't want to leave anything out. And as I was going through some our videos this morning, I'm like, "You know, we haven't talked much about testing.
We say how important it is taking a 24-hour urine collection, but we don't talk about the values presented in it." And I think it's really important that you all understand. We're going to I'm not going to give you all values, I'm just going to give you today the most important value that you should know on your urine collection.
And a lot of urine collection reference ranges are much too generous. So it takes somebody looking at the urine collection with great expertise and saying, "Here's the reference range, but we really want you…" When I'm doing urine consults, the patient will say, "Well, it looks pretty good, Jill." And I say, "Well, hold on, Cindy.
These reference ranges are not as tight as we would like to lower one's stone risk." So, lots of times, or a patient will say, "Well, my doctor said everything's fine," and I'll just gently say, "Your doctor may not know exactly where we want these reference ranges. All lab results have reference ranges, but for the disease you're treating, you may want it to be a little bit more up, a little bit more down, a little bit more in the middle.
So you want to be very precise with this." So the number one value that we look at in urine collection results is the supersaturation. What the hell is that, Jill? Supersaturation is the most important value.
And what this value tells us is supersaturation means your urine is holding more crystals than it can safely hold. Meaning, on your test, it's not all test tests for this. Not all lab companies test for this.
It should say supersaturation calcium oxalate, supersaturation calcium phosphate, supersaturation uric acid. And this is telling the doctor, on the day of the collection, how saturated your urine is with each kidney stone crystal type. These saturations will tell the doctor how likely on that day were you to form a calcium oxalate stone, a calcium phosphate stone, a uric acid stone, sometimes all three, sometimes two.
I want to give you a visual, because I know visuals help me for sure. If I were to get a glass, and I put some sugar at the bottom of it, and I kept putting water in it, water in it, you know, those sugar crystals will wind up dissolving in the in the in the liquid. But if I just fill this boo-boo kitty with just a little bit of fluid, and I keep putting sugar crystals in there, eventually, that fluid's going to be very saturated with sugar crystals, and there's nowhere for them to go.
This is how stones form. Those crystals are all up in each other's business, sitting in your kidney, you ain't peeing. This is why water is number one.
The longer they sit in there, the higher the risk of forming a kidney stone. Now, are you going to form one in the afternoon? No, but that's how this process begins.
This is why water is the number one thing. "Jill, I don't want to do your stupid diet, or I don't want to I don't want to drink water, but I'll do your stupid diet." Well, you'll still make stones, Timothy. You will.
You will still make kidney stones. You must be peeing, peeing, peeing these crystals out. It makes sense.
I think about these crystals like little magnets in your kidneys. The longer they are hanging out there together, the more apt they are to form a stone. So we want you to flush those crystals out so your urine is not saturated with those crystals.
Now, let me see. The super, this is very complicated, so my job here, as we all know, is to bring everything down so we can all understand it. What brings about, besides the lack of fluid, how do these all these crystals get in there, right?
Well, it's a byproduct. First of all, if we're not drinking enough, we're dehydrated, we got a lot of crystals. If we have too much calcium in our urine because of other medical conditions or because of genetically, too much calcium, too much oxalate, lower pH.
PH will make a difference in saturation, whether it's low or high. Citrate can make a difference, okay? So all of this stuff may need fixing.
But if you fix those other things, like calcium, like salt, like pH, and you still don't drink enough water, your saturation's going to be high. I've had some people say, "Look, I'll do this diet, I'll lower my sodium," they do the follow-up, and they still have high saturations. Why?
Because they did not increase their fluids. And so that must be the case. So that's why it's so important.
We all have these crystals in our urine. We got to get rid of them. So you always start with water.
Of course, the diet matters. You don't want high urine calcium. You don't want a low urine pH.
That comes from eating way too much meat. It can come from having diabetes, but you can still get that better. When you eat too much meat, too much meat, I'm not saying don't eat meat, I'm saying too much, you are, if you're on a carnivore diet, and y'all do what you need to do, I'm just telling you what the stone risk is, if you're if you're on a carnivore diet, you will begin having, for most of you, especially stone formers, lower urine citrate and lower urine pH and higher urine calcium.
Those three things, along with lower urine volume, you're not peeing, is going to give you a very high saturation of uric acid and calcium oxalate. So it's super important. So you see, you can fix some things, but if you don't fix the water, your saturations are still going to be high.
And until you get those saturations to the point of not saturated, you will still be at risk for kidney stones. Now, what are the levels? For calcium oxalate, and most lab reports do not say this number, we want that level under 3 for supersaturations.
For calcium phosphate stones, we want it under 1. For uric acid stones, we want it under 1. So if you have urine collection reports, you should look at them.
Many doctors, this is not to bash doctors, I love doctors. Are you kidding me? I'm working with doctors all the time.
It's just saying, their urologists, their surgeons, they may not know where the research shows, but obviously, the lower the saturation, the lower your kidney stone risk. So this is why water is so important. And our job here is not just to bark, "Drink more water, drink more water, drink more water," but to tell you why it matters so much.
So for kidney stone formers, everybody should be well hydrated, but for kidney stone formers especially, the more you pee these crystals out, the less saturated your urine is, the lower risk of making kidney stones, and you become a happier person because you're not rushing to the hospital, you're not in that pain, you're not at risk for sepsis, a nephrectomy, kidney stone, anything, okay?
So water is number one. If you can't do some of the other things, I just shrugged my shoulders for people on other stations that are not looking at me. I'm not going to be happy about that because the other things we ask you to do are going to be healthy things for you, but there's no getting around the water.
And let me just say this real fast before I close. "Well, Jill, my doctor told me I got to drink 100 ounces tomorrow." Clare, you're never going to drink 100 ounces of water tomorrow if you barely had two cups today. It doesn't happen that way.
I want you guys to know that lifestyle change takes time. And so when doctors just tell you to drink 100 ounces of water, they don't understand that they are setting you up for failure, because you try to do it the next day, you can't get out of the bathroom, you're full, you don't even want to eat, maybe you're a little nauseous, maybe you're dizzy.
There's all kinds of things. But mainly, you feel hopeless because there's no way you're going to be able to do this. So what I'm asking you to do is know that this takes time.
If you drink two cups of water today, then start with three cups tomorrow, and do that for a week. So now you're getting three cups of water a day, okay? And then the next week, you try four.
The next week, you try five. You may be at five cups of water a day for two weeks, because that's all you could do at that time. Could be you go on vacation, you go right back down to two cups.
That's okay. It takes time. And so when you don't meet your goal, you don't get upset, you don't quit.
The point is you don't quit, you just get right back on track. That's what you do, okay? So get to work with the hydrations.
We want to keep lower supersaturations, as this lowers kidney stone risk. Does that make sense, Jeff? Did I make sense out of all this?
'Cause it's complicated. It's really complicated. For the complicated version of supersaturation, you can go to my mentor's site, Fred Coe, C-O-E, at kidneystone.uchicago.edu, or just Fred Coe and then kidney stone and you'll get his website.
It's complicated.
