How much oxalate is in pomegranate juice?

Welcome back to the Kidney Stone Diet podcast, the show about reducing your kidney stone risk and living your best life. Are you waving over there?

I don't even know what to tell you right now. I don't even know what I'm doing right now. You know, I well you were doing things and I left the screen because I just do whatever I want to do, obviously.

You're trying to be all professional and I'm the clown. But I'll tell you when it comes up. You know, you don't know what I'm going to say.

Okay. Well, I am your host and fellow student, Jeff Sarris.

And I'm Bozo the clown, Jill, who also knows about kidney stone prevention. Oh, my goodness. Unbelievable.

No, it's perfect. Yeah, I was just I was always try to look at the camera for that intro, and I guess out of the corner of my eye, I just saw arms waving. I wasn't sure what was happening.

Okay. Well, you know, we're shooting a lot of shows right now so we get a little punch- punchy after a while.

Oh, yeah. Yeah, we try to batch them together. It's just the most efficient for us, you know?

And one day we'll be doing this in person, and we'll do the same thing, a bunch in a row. But yeah, right now, this has been this has been good so far. I like it.

Yeah, me too.

Yeah, so we have another question this week and it is about oxalate.

It's Fred from Pennsylvania. My question is it's very important for me to find out the oxalate level of pomegranate juice.

Okay. That question was from Fred.

So, yeah. Hello, Fred. So, you're going to be unhappy, Fred.

Here's the deal. So, Harvard didn't study every food and I do use the Harvard list. So, I'm not quite sure about pomegranate juice.

And when I'm not quite sure about something and I don't have a credible source, instead of saying, you know, it's don't have it, I'm not going to tell people that because most things are not terribly high in oxalate, right?

It's when we overeat the same things every day in any amount that you possibly want and not getting enough calcium, because that's the only way oxalate can leave our body. Instead of getting re- if we don't get any calcium, then oxalate gets reabsorbed back into our body instead of leaving through the stool, which is what we want it to do so you don't overaccumulate it.

So,

Pomegranate juice, and some people may be using this for things, their doctor said drink some, or they wanted to, it's healthier than, you know, Kool-Aid. I don't know why Fred wants to have it, but he does want it and it's important to him. So, here's what I would say.

Well, here's what I will say. I would when it's not on the list, I tell people to have it. I mean, you know, in normal portion sizes.

So, if it's something important for you, for whatever reason,

Maybe you want to have 4 oz a day, okay? I don't something tells me juices aren't terribly high in oxalate. I'm not really worried about it, but I don't know.

Also, there will be, and even though it's natural sugar, make sure, Fred, that when you are picking pomegranate juice, there's not added sugar in there, that is naturally occurring. But even so, with all juices, that's a lot of sugar and no fiber.

So, you know, I'm not a huge fan of juices overall. That being said, I don't know why he wants to include it in his diet, but he said it's important to him, so I take that seriously. I would have 4 oz.

Maybe you want to dilute it a little with water, so maybe you're like, "You know, I just want something different in my water. I'm sick of just drinking plain water." Some people do take, for instance, a juice and put 16 oz of water in, you know, they'll have their 16-oz glass of water or jug and then they put 4 oz of their favorite juice in there.

Hopefully, it's not, you know, Kool-Aid, but, you know, something that cranberry juice, unsweetened, no added sugar pomegranate, orange juice that's lower in sugar, but also has calcium. So, there's different reasons people want to may want to use juice. So, I don't have a good answer for you as far as an oxalate level.

So, if you're going to have it, make it in smaller amounts each day. And

Also, to make people or so people are less anxious when they are eating or drinking a food that we don't know about the oxalate level, please make sure when you do a urine collection, and/or a follow-up urine collection, and/or your annual, you should be doing you should be doing a urine collection if you find out you have kidney stones,

Then also do a follow-up after you've been put on a treatment plan, and then every year do a urine collection, so you can keep abreast on what's going on in your urine. Does everything look like you're still minimizing your stone risk? And when you start incorporating foods that we're not sure about the oxalate level, make sure you do drink or eat those foods on the day of your collection.

So, you can see, is your oxalate higher than it was the last time, and it will make it will, first of all, make me feel better. Second of all, make you feel less anxious. And if it did happen to increase your oxalate, that's never happened to me so far in 21 years,

But if it did happen to, because, and it hasn't happened, knock on wood, a genie, it hasn't happened because normal portion size, get your calcium every day, and typically, you never have an oxalate problem again, unless you have malabsorption issues somewhere, or you have other things going on. So, do a urine collection to see how that's affecting you, the pomegranate juice, Fred.

Yeah, and in case he's not aware, what is a urine collection? Like, how do you approach getting one of those?

Yeah. So, when this is one of the things I scream about the most, and really I have my fan out for mostly talking about that all day long. So, urine collections, urine collections are very important.

When we have a kidney stone, it is often it is often that a patient will not be asked to do a urine collection, and this makes me sad. Many times the patient will be told, "Let's wait for a second one to get a urine collection."

Why would you wait for a second of anything to get a test to see if you can minimize the risk of that second occurrence? So, a urine collection is a is something to be ordered by your urologist. Typically, it's a urologist because that's who you're dealing with the stone.

Sometimes, you know, if the urologist doesn't want to order it for you, for whatever reason, I'm going to tell you to push back. I'm also going to tell you this is what you say to the doctor, "Dear Doctor,

I know you say we could wait for the second stone, but I want you to understand that I'm very motivated to make whatever lifestyle I can change in order to never make another stone again." I find that's helpful, that the doctor understands that the patient will is really interested in preventing new stones. Many doctors have told me, "Look, Jill, nobody changes their diet.

I mean, why am I going to put them through that urine collection, right?" So, that happens.

A lot of people don't want to change their lifestyle and they continue making kidney stones. So, the urine collection is very important to see how high your risk is to form another stone. And so, when you do a urine collection, and there is a YouTube video on that, and Spotify, and Apple, iTunes, or whatever the hell we're on, all the places, all the places.

We have one on a 24-hour urine collection.

So, what you would do is you eat and drink normally on the day of your urine collection. You'll get a kit from your doctor or a company will send it to you. You'll collect your urine for 24 hours.

You send it back to the company or your doctor's office, whatever your instructions say. And the doctor will get a report saying, "Here's Fred's kidney stone risk. This is high, this is high, this is high, this is low, this is low, this is normal, this." It's a set it's a pretty big set of panel, and it will really help the doctor determining a treatment plan for you.

And based upon that treatment plan, the tests will say what kind of treatment plan you need to do, and then you try to change your stuff, and then in about 2 months, you get a follow-up test to see if that treatment plan is indeed working. Did the lifestyle changes work? Do you now have to add a medication at this point because the lifestyle changes were not enough?

Meaning, you did a great job, but you have genetic things going on that now warrants a medication.

The urine collection is very important. It can also rule out other medical conditions you may have that you wouldn't know unless you did a urine collection, which then, if there's a couple things that are high or a little awry, the doctor may say, "Hey, look at this, Fred. Now we should do a blood test to see what's going on here." So, the urine collection is so very important and so many times it's not ordered.

So, please ask your doctor for it.

If the doctor says, you know, "We don't need it right now," say, "I want it." And all doctors, once a patient says that, they, of course, will order it for you.

Yeah, for sure. And that's a big part of what you do, too, is you have the urine analysis, where you're helping people decode really what are these results? How does this apply to me?

Yes, and how to talk to your doctor about it so the doctor can, you know, get you on the best treatment plan. But, you know, lots of times you don't know what to ask during those visits. And me as a cancer patient, I remember going through, and even till this day, you know, when I just got out of the I just was in the hospital today, and I was, you know, I really had to prepare for my oncology visit and make sure I got all my questions for some next steps that I have to go through.

And it's nerve-wracking going in those appointments, and I understand that from a patient's point of view.

And so, you know, I can't tell you that urine analysis service that urine analysis service, say that three times fast, or maybe having a sip of a margarita, that won't go well. That service is one of my favorite ones because, from a patient perspective, because you get your 24-hour urine collection report sent to you, the lab will send it, if you ask for it,

And then you call me. We have a 15-minute call, and I'll say, "These are the things you want to talk to the doctor about. This is very important.

This is very important." Have an educated conversation with your doctor. I can't tell you how many patients come to me after that doctor visit. They're like, " I wish I knew all this before my doctor visit because I would have had a better visit, right?

So, I wish I had somebody to just teach me a few things about a report and how to talk to my doctor about it, so I could be on the best treatment plan and how I can make out of the most out of that doctor appointment. I just paid 50 bucks on a copay for." So, I mean,

You know, it's a great resource. I love that service. I do, for from a patient perspective.

It's very useful and helpful to patients.

Yeah, and there's even more resources on the website, kidneystonediet.com. I think it's actually kidneystonediet.com/resources, where you can find things like the form to ask better questions of your doctor when you're in your appointment. Just all sorts of resources are available, absolutely free, whether you're on the Kidney Stone Prevention Facebook group or kidneystonediet.com, you can find tons of information and tons of helpful little nuggets and things that will help you just navigate this world better.

Yes, I you know, I think I remain so passionate. I even, you know, I remain so passionate about this disease because there's just not enough resources out there that you can really count on. And all in one place, too.

So, that's what's exciting about it. And again, I'm talking to you as a nurse, someone who's been dealing with kidney stones for a long, long time, teaching it, educating patients on kidney stone prevention. But I also come to you as a patient, and that's, again,

Where all my empathy comes from because I've been there, man. And yes, it hasn't been kidney stones, it was cancer, and it is cancer stuff. But I understand what it's like to be in an office and you're scared, and you're anxious, and someone's telling you to change a bunch of things or now you have to have a surgery and it's hard.

It's just hard. So, a lot of the services that we have made on the website is purely out of my heartstrings and the boys here just make everything so beautiful on the website and make it all function.

But it comes from my heart because I know what it's like to be a patient of any sort, and it's very overwhelming, to say the least. So, the more free things we can put out there to help you, and guide you, and better educate you, so you can have better doctor office visits, then I sleep like a baby at night knowing all the hard work we're putting into it, so you get the resources you need from a source you can trust without any bull doo, by the way.

Yeah, absolutely. Yeah, so head over to kidneystonediet.com, where you can find all those resources. You can find the blog, the email newsletter.

You can find a bunch of things that hopefully will help you help you on your journey. And, yeah, and if you're enjoying the show, be sure to subscribe on Apple Podcasts, Spotify, wherever you're listening right now, or the YouTube channel, which is, yeah, I think it's both of our preference. Like, if we can get more people on YouTube, which

Yeah, we love YouTube.

Yeah, it's growing immensely. Like, we're so like thankful and grateful to all of you.

Well, yes, we are. And also, so, what are we talking What did we just talk about? Because we're doing a lot of shows today.

What's the one we just did?

Yeah, so this one was Fred and he was asking about the oxalate level of pomegranate juice.

Oh, yeah, okay. So, put in the comments, I'm really going to go far in this, what is the one food that you're like "I wonder what the oxalate level is," okay? And tell me, what one bothers you the most that you'd like to bring back into your diet, but you're afraid to?

Write it down in the comments.

Yeah, I think that's perfect. So, thanks again for listening, and we will see you next week.

Bye, everybody. Thanks, Fred.