Watch this if you’re eating right and STILL making kidney stones

Are you eating right, but still 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.

All righty, so this is a, I wouldn't say tricky topic, but it's a topic that I can only imagine would be so painful in that I'm doing everything right. Like, I'm checking all the boxes, I'm following the Kidney Stone Diet, but, for some reason, I'm still making stones. Why would that be?

Yeah, it is, patients get so, well, I think everybody can imagine, just like you said, you're working so hard. My patients that work with me, obviously, are motivated never to go through this again, forming a stone, having a surgery, having a stent, all the things. The pain in the middle of a vacation, you're out of the country,

All of that. And so, they're highly motivated patients and, you know, they'll do, they'll do everything right and they'll say, "I'm still making kidney stones. What is the deal?" Now, number one, many of them have never done a urine collection, so what they think they're doing

And what they're actually doing are two different things. The most common thing with that is people will say, "Jill, I'm eating low salt." And then they get the urine collection and they're eating 5,000 mg of salt. But if they were eating 10,000 mg of salt and lowered it to that amount, then, of course, they're eating a lot less salt, right?

So, maybe nobody ever gave them, exactly, the doctor just said lower your sodium, and not given them a goal, right? So, the patient did, in fact, lower their sodium, but not to where it needs to be. So,

It's very frustrating when patients are working so hard and they're still making stones. One of the biggest reasons is, obviously, they have high urine calcium, that's not being tested, and you need a 24-hour urine collection. To be more specific here,

Say a person worked with me on the first 24-hour urine collection, they call me to go over the follow-up, and they will say this, "Jill, I did exactly what you told me. I took away spinach and almonds and, excuse me, my oxalate's still high." So, this is specifically going to be, "Jill, I don't eat spinach and almonds anymore.

You couldn't pay me to do that, and my oxalate's still on the higher side. What is going on?" Well, there are reasons some of you will have higher urine oxalate, typically, even if you're

Even if you're eating lower oxalate foods, typically, these are the reasons why that happens. Number one,

You're not pairing oxalate and calcium together. So, you should be getting calcium with meals because

What happens is, I always use this example, but say, which I had today, say you have half a sweet potato, okay? We know that's a, you know, 28 milligrams of oxalate for half a cup or a cup, whatever it is, of sweet potato. So, with that half a sweet potato, I had some cottage cheese because there's calcium in there, okay?

But if I just had the sweet potato by itself, what would happen is I eat the sweet potato, it goes into my stomach, the stomach does its thing. What's left of what's left from the stomach goes into the small intestine.

From the small intestine, that's where the small intestine sends nutrients to our blood. And that's how we get nutrients in our body. The problem is

If you didn't have calcium with that sweet potato, there's a little bit extra oxalate in there, so that extra oxalate is going to go into the blood, and now the body gets more oxalate. As opposed to, you did what Nurse Jill did today because I have stone formers in my family and I don't want them. So, I had half a sweet potato, not a whole one, a half a one, with kind of low-sodium cottage cheese.

So, I ate both of those things together.

The calcium and the oxalate went to my belly, then it was sent to the small intestine, and I'm saying this very crudely so everyone can understand and not fall asleep, but from the small intestine, the blood's like, "Okay, what do you got for me, small intestine? I need to be fed with healthy things." But calcium and oxalate

Will be bound together in the small intestine, and that molecule is too large to be sapped up by the blood. So, what happens to them together is they go out through the colon then, and then out through the stool. So, the body doesn't get that extra oxalate.

That's why we're always screaming about calcium in the kidney stone world. Plus, you need it for healthy bones, okay? So,

One of the top three reasons people have excess oxalate in their urine is because they're not having calcium every day. You need it for your bones as well, so it's a two-for-one. The other thing that's pretty common, and a lot of

A lot of doctors don't talk about, really, because patients not may not be bringing it up or they're not looking at the total health history, but there's

Fat malabsorption and/or bowel disease. These patients may have higher urine oxalate. And so, that's a problem.

Why is that a problem? Well, if you,

If you have bowel disease, short bowel syndrome, pancreatic issue pancreas issues, things like that, Crohn's, colitis, certain bariatric surgeries. So, if you

If you have fat malabsorption issues, here's what happens. Remember how we just talked about house calcium and oxalate hanging around in the small intestine? Well, sometimes three is not the easiest in a friend group.

Somebody seems to always be left on their own. So, if you have Pam, Diane, and Fran

Hanging out together, calcium, fat, and oxalate.

Those three things are happening in the small intestine. What happens is Fran and Pam are going to hang out, fat and calcium together in the small intestine, and then oxalate is left by itself. And so oxalate, instead of going out through the stool, gets reabsorbed back into the bloodstream, and that's why some of you will have higher oxalate because of that.

You have fat malabsorption issues and fat and calcium are binding together in the small intestine, which leaves out oxalate.

So, that's what happens. So, oxalate gets sapped up into the small intestine. Does that make sense, Jeff?

'Cause it is really complicated. Just like, "I don't know, Jill, I fell asleep. What the hell are you talking about?

Shut up, Jeff!"

When you said the word "malabsorption," Jill, I just closed my eyes.

I closed my eyes. So, so, yeah, you want to make it simple for people to understand because it is very complex, so it's just breaking it down into, yeah, in into your like your approach to the terms because it's a little less science-y, but it's all based in science. Yes, it is.

It is. It's all based in science. So, when fat and oxalate and calcium

Go to the small intestine,

Calcium and fat are going to bind together, which leaves oxalate by itself, and it gets reabsorbed back into the body. There's that. And then the other the other common thing is your body's just making more oxalate.

Some of you will just make more oxalate, maybe again, your,

You know, one of your healthcare people put you on high doses of vitamin C, or you decided to do high doses of vitamin C because it's cold and cough season, okay? High doses of vitamin C can increase urine oxalate. "Well, Jill, I'm worried about catching something." Wash your hands.

God, I hate you, Jill. Eat better, sleep,

Get hydrated, watch stress, do all those things. You don't need pills. Save your nickels, but overdoing

Vitamin C supplements can also increase your oxalate. So, those are just three of the reasons that you have high urine oxalate and you ditched all the high-oxalate foods, which, by the way, are only a handful, we don't we don't have to give up all fruits and vegetables. And, not only that, I have patients that set say, quite common, unfortunately, "Jill, I haven't touched a fruit or vegetable since 1972.

How the heck do I have high oxalate?" And these are the reasons you may have it. That's about it, Jeff, because I could go into more, but people would never watch us again because it's it's there's a lot of different things and they're all medical things. But these are the most common, this is what's going on.

I don't really deal or see too much of like, you know, radiation enteritis or an exocrine pancreatic insufficiency, or Whipple procedures, so there's complicated things, it can happen and increase oxalate, and those of you who have had a Whipple surgery, I see you, I love you, that is it's up there, but it's not the top three, so I'll end it there, Jeff.

Yeah, but if you're out there with a question that you'd like to dive a little deeper on from here, definitely let us know. Leave a voice message at call.show/kidneystonediet or click the link in the description below and we will feature your voice on a future episode. And, again, kidneystonediet.com is everything Kidney Stone Diet related: the absolutely free weekly email newsletter that Jill sends out to keep you on track every week, the prevention course, the prevention meal plans, and the prevention private consultations with Jill.

All of that can be found at kidneystonediet.com. Thank you again for tuning in and we'll see you next week!

Go crush the week, everybody! Bye!