Kidney stone risk factors

This week, Jill talks about kidney stone risk factors.

Jeff Sarris: 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.

Jill Harris: And I’m Jill Harris, your kidney stone prevention nurse. I got so fired up from– you know, my cheeks always get so red. People are like–they’ll ask in the comments–”Why are your cheeks red?” Because I get so passionate about all these things. That’s why. So they feel like they’re on fire. That’s okay.

Jeff Sarris: Yeah, you are a passionate person. So, we were going to take this episode to dive into sort of a frequently asked question, because there are so many topics that come up and no question is a bad question whether we’ve talked about it before or not. We always want to be sure that we’re touching on these things with dedicated episodes, so what was the topic we’re going to do this week?

Jill Harris: This one, I wanted to do kidney stone risk factors. I mean, we’ve done what, almost 100 shows and we don’t even have this one?

Jeff Sarris: Yeah, this one’s 93.

Jill Harris: There’s so much! There’s just millions of shows to be able to do, right? So I’m like we didn’t even do kidney stone risk factors yet! Okay, let’s do that.

Jeff Sarris: Yeah, so why don’t we just dive right in, then?

Jill Harris: Okay, kidney stone risk factors. So 1 in 11–one in 11–of you will get a kidney stone. That’s a really high rate, man. And so, one of the reasons I get up every single day with the same red cheeks as the day before, is because why? Up to 80% recurrence rate. We can reduce the recurrence rate up to 80%. So that means up to 80% of you will get another stone. You shouldn’t have gotten the first one, okay? But you didn’t know what you didn’t know, eating too much spinach or almonds; of course many not getting enough fluids; nobody getting enough calcium; all the things.

What Are Some of the Risk Factors for Kidney Stones?

People on Paleo and Keto if you’re, you know, going to get a stone from genetic predisposition, there’s even more risk because you’re overeating meat in a lot of the cases, and spinach and almonds, by the way: almond flour, almond milk, all things almond. And so it has always bothered Dr. Coe and I that so many people get kidney stones when they are very preventable. Healthy lifestyle is definitely going to prevent them. But there are some other risk factors. So, there’s other risk factors that, in some cases–you still have to do the diet. The diet is lower salt, lower sugar. The kidney stone diet goals are at kidneystonediet.com, on the start page so you can see all the goals there.

Number 1:Overeating Foods

It’s just a healthy diet, but then you have the oxalate part in there, which is why we call that the Kidney Stone Diet. All of the goals of the Kidney Stone Diet will reduce your kidney stone risk and still need to be adhered to, especially if you have some of these predispositions. So, kidney stone risk factors; I’m going to read them because I will forget if I don’t. These are the things I came up with and there could be other ones, too, but these are the main things. So number one, you’ve eaten–this is kidney stone risk factors and it will also include diet– you’ve eaten spinach and almonds. Spinach and almonds, spinach and almonds, spinach and almonds, and spinach, and more almonds and spinach, okay?

In huge amounts, huge amounts! Why? Because somebody told you to do it. You have diabetes, you should eat almonds all the time. They’ll curb your hunger. Nobody eats two almonds. “Oh, honey, just get me 2 almonds. That’s all. I just need two.” Nobody eats two almonds. Two handfuls, maybe. So they’re very high in oxalate. If you had just had a few almonds a day, you wouldn’t have gotten a kidney stone from that. It’s just that you overate them because nuts are something that people overeat. All nuts, okay? So, and spinach, same thing. “I’m going to eat spinach. I’m gonna eat spinach, so much spinach because it’s super healthy. And, basically, by the time I finish chewing the spinach, I think I’m negative calories,” because there’s not many calories in it.

But one cup of spinach has 700 milligrams of oxalate. So there’s nobody who’s sautéing one cup. You’re putting five cups in a smoothie or you’re sautéing five cups of spinach because once you boil it down or whatever you’re doing, it’s this big. And, because it’s healthy, people tend to overeat healthy things, along with not getting enough what?

Jeff Sarris: Calcium!

Jill Harris: Right! So, that’s the only way people can lower their oxalate is to lower foods high in oxalate, but also make sure they get enough calcium every day because oxalate and calcium will bind in your gut and leave through the stool. If you’re eating a high oxalate diet, and there’s no calcium down yonder to bind with silicon leaf through the stool, oxalate gets reabsorbed into your body, okay? Eating too much sugar, added sugar, and too much salt. So yes, now I’m listing all the goals of the Kidney Stone Diet. Because when you don’t adhere to it, or you’re eating too much sugar and salt, and too much meat protein, which includes seafood, these things pull calcium from your bone, dump it into the urine, and when you have too much calcium in the urine, this can increase your stone risk because these other crystals can form with calcium, phosphate, oxalate, and make stones.

Also, you can increase your risk of bone disease. So the Kidney Stone Diet, although everybody wants to talk about oxalate, it’s mostly a calcium issue. Calcium leaving your bones, going into your urine, and also not getting enough calcium. So I’ve never met a patient in 23 years that says, “Shut up. I get enough calcium.” Nobody does. The average American gets 200-250 milligrams of calcium just by happenstance because it’s in their food. So we don’t get enough calcium. Typically, kidney stone disease and bone disease, they go hand in hand. So, the other reason people–

Jeff Sarris: I just wanted to jump in real quick because you said too much meat, animal and fish–and just real quick that it’s we’re not saying don’t eat meat or don’t eat fish. It’s the extreme quantity.

Number 2: Dehydration

Jill Harris: Listen, everything we’re talking about in the Kidney Stone Diet, we eat too much food in, in most cases, viewers, we do. We know that. So, if we ate things within normal portion sizes, even the healthy foods–i.e. spinach and almonds–if we ate food within a normal portion size, we’d get rid of a lot of disease states, not just kidney stones. We tend to over eat, because it’s fun. You know, just plain and simple. It’s fun. It brings us brings us a little bit of momentary joy. The other reason people get kidney stones, they’re dehydrated. Their whole life not drinking enough water. I can’t tell you how many patients have come to me, “I thought I was drinking enough.” And they’ve maybe peed twice a day.

So you don’t know what you don’t know. Many of us are running around being dehydrated. Are you hungry? Could be you just need a glass of water. Lots of times being dehydrated will signal in our brain that we’re hungry. I always tell patients, especially mine who are trying to lose weight, if you are hungry, try drinking a glass of water first because the brain can mix up that signal. So, being dehydrated. The longer these crystals sit in your urine and become saturated in your urine, we call this super saturation, the longer they’re sitting there–they ain’t wearing a mask and they’re not social distancing–they want to find other crystals, like little magnets and join together.

Number 3: Other Medical Factors

So the longer you hold that urine in your body, the higher risk you have for forming these little stones. So that’s another risk factor. Now, there are some medical conditions that can increase your kidney stone risk, and I will list them: diabetes, number one. That doesn’t mean that’s the most important one. It just means first. Diabetes, gout–if you have gout, which is a buildup of uric acid, big toe pain, you can that will also put you at risk for kidney stones. GERD, which is acid reflux–”Why GERD, Jill?” Because a lot of you help your acid reflux and eat tons of Tums every day, which are basically hundreds and hundreds of milligrams of calcium. Now you’re eating all this excess calcium, the body doesn’t absorb it all and winds up in your urine.

So that is definitely a risk factor. If you have GERD–I always tell my patients this, what’s causing the GERD? “Well, every time I eat sauce, Jill, I get–” could you just not eat the sauce? Is it from a food that you’re constantly eating that’s causing the symptoms? Because once you take away that factor, you won’t have symptoms, you won’t need the Tums. It’s not always as easy as that, people. A lot of people have medical conditions, obviously, but a lot of my patients are eating foods that are causing the GERD because–”I love pizza. What am I going to do?” Eat less of it! I get that you love pizza, but don’t eat it as much as you’re eating it. They’re eating it five days a week! They get GERD, they’re taking 20 Tums a day. That’s what led to their stone.

Obesity, obesity, which just means you’re eating too much sugar, salt, all the things, right? So you’re eating too much, which can increase your risk of kidney stones. Also, you know, if you are obese, you can have other medical conditions like the diabetes that can also cause kidney stones. Chronic kidney disease, where the kidneys don’t filter and function as well, also is a predisposition. Having parathyroid issues, your parathyroids are these glands that are around your thyroid and they can not regulate calcium in your body, and then now you have too much calcium in your blood, too much calcium in your urine. Lots of times patients come to me, their urine collection shows that they have high urine calcium.

They’re on the diet, they’re doing a great job with the diet, but they have this high urine calcium. The next step would be go get a blood test to see is your blood calcium also high? That can be indicative of a parathyroid issue. You would also get a blood test to check your parathyroid hormone and rule all these things out. But that can also be a risk factor for kidney stone disease. If you have bowel disease, IBS, IBD, constipation, mostly it’s going to be more diarrhea. If you have issues that cause malabsorption issues, like diarrhea, you can have higher oxalate, lower citrate, lower pH, and you would know all these things by doing a urine collection.

That’s why they’re so very valuable. You really can’t get on a good Kidney Stone Diet treatment plan unless you have a urine collection done. So people who have bowel disease, people who are on chemo, people who have ileostomies, people who had bariatric surgeries, are at higher risk for kidney stones, because their plumbing has been changed and they’re not absorbing things well. People who don’t absorb fat well, also. So these are all malabsorption issues. If you have a medical condition that is causing you not to absorb nutrients well, or you have a frequent diarrhea, you could be at risk for kidney stones, okay?

That’s basically it. That’s all I want in this video, basically. That’s a lot. There’s also some medications that can cause kidney stones, so, you know, that’s where we’re gonna leave this one. We’ll do a medicine one at some point, too, but that’s a lot for this one. Basically, people will say, “Well, if I get these other things in control, do I have to do your stupid diet, Jill?” Yes, you still do! Number one it’s just healthy. I want everyone, I don’t care if you have kidney stones or not, you should not be eating a ton of salt and added sugar every day. You just shouldn’t because that means you’re eating junky food. The body wants to be well-nourished. It wants good nourishment, not Doritos, and ding dongs.

It doesn’t mean you can’t have these things once in a while. I think it’s very important to have flexibility into your diet because if you’re not flexible and have the things that you love–like I love a hotdog and krinkle fry now and again, and I’m going to have it when I really want it–if you don’t allow yourself to have flexibility in your diet, you’re never going to be able to sustain that diet. And here’s the other things, too, that’s very important: some of these medical conditions will have its own set of dietary restrictions and guidelines. And people often come to me and say, “I have diabetes. How am I supposed to–my nutritionist is telling me to eat almonds for the diabetes, because it’s not going to raise my blood sugar and now you’re barking never have almonds.”

And that’s my specialty, putting all these things together and coming up with a plan that not only satisfies me and the nutritionist, but also satisfies you. Because unless you’re happy with what you’re eating, you can’t sustain it. So that’s a little video on some of the stoners factors, kidney stone risk factors, and then also people there is a genetic predisposition to them. Oh, and one more thing, you will not know unless you’ve had a urine collection, idiopathic hypercalciuria, which is a big fancy way of saying we’ve ruled everything else out. We’ve ruled out the parathyroid, we’ve ruled out vitamin D issue, we’ve ruled out the diet. They’re eating a great diet. They have low sugar, low salt, everything’s great, but they have this thing called idiopathic hypercalciuria.

Which means, idiopathic, we’ve ruled everything else out; hyper, too much; cal, calcium; urine, urine. So, there’s too much calcium in the urine, and there’s nothing here that we can pinpoint, except perhaps genetics. So if someone has I.H., or idiopathic hypercalciuria, typically 50% of their blood relatives will, too, and that’s when you see it in families. I’ll always take a family history when I’m talking with the patient. “Does anybody in your family–” “Yes, my sister, my brother, my mother,” so I know on their urine collection, 95% of the time, that patient is going to have idiopathic hypercalciuria. Now, as a nurse, I don’t diagnose anybody, but I will expect to see high urine calcium. And then I talk to the patient and make sure that they talk to the doctor about that, make sure they tell their doctor, they have a family history, so the doctor can put that all together. That’s what I’ve got to say about kidney stone risk factors.

Jeff Sarris: Yeah, that’s perfect. It is good to have everything together in one video, in one podcast episode, because it is a lot. There’s a lot that goes into it. It’s not just cut and dry one thing. If you have a question, whether about this topic or another, that number is 773-789-8763. Just leave us a voicemail, and we will feature you in a future episode. I think these FAQ episodes are really valuable as well, just like the voicemails, because sometimes this is a slightly more broad topic than what someone would ask, so we want to be sure that we touch on everything. So it’s really important.

So, the website is kidneystonediet.com, where you can find all the free resources, the course, the meal plans, the weekly email where Jill sends out inspiration, and then a link to the Kidney Stone Prevention Group on Facebook, just so many resources. If you’re watching on YouTube, and you haven’t subscribed yet, hit that little subscribe button, the little bell, it really means a lot. It helps us out to reach more people because that’s the entire goal with with the podcast. We’re talking about the products, but we’re not selling anything. We don’t have sponsors. Maybe in the future, we will, who knows? This is really just to get the word out and reach as many people as we can, so every little bit helps and we really appreciate each and every one of you.

Jill Harris: We sure do. Thank you so much for your support. And thanks for being such a great community. We value you very much.

Jeff Sarris: Absolutely! So, with that, we will see you next week.

Jill Harris: Bye, Jeff!

Jeff Sarris: See ya!