This week, Jill answers a listener question about diabetes, low carb diets, and uric acid stones.
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. And I’m very happy to be here this week. I’m very happy. I have no reason to be happy. I like my shirt because it has a little heart on it, so that’s sweet. Isn’t that cute? Can you see it?
Jeff Sarris: Yeah, I like it!
Jill Harris: Yeah, love it. And that’s all. I feel happy and sweet and good to go.
Jeff Sarris: Perfect! And, now, the technical difficulties have been resolved. So, this episode, we are going to have a listener question and it is coming from Bruce. I say we just go right to it because I want to be sure it keeps working.
Hi! My name is Bruce and I live in New Jersey. The question I have is–I feel like the information that Jill is sharing is really focused on the calcium caused kidney stones, not the uric acid ones. I may be wrong about that, and the focus on oxalates and stuff. And, also, you know, she’s trying to, obviously, it makes total sense, talk to the greatest percentage of the population suffering from kidney stones. So when you have things like diabetes, like I have, and I have to be on a special diet, if I’m going to manage my sugar, and I’m focused on eating foods, based with almond flour, which she’s saying to avoid, it’s just very confusing for people like me, who, you know, don’t quite understand if that makes sense for me.
So, I’m thinking that I still need to dive in and do a lot of research and look at a lot of different things, but my feedback is that her recommendations seem to be for people who are not dealing with uric acid kidney stones, but I do appreciate a lot of other things that she’s talking about, like I was just described the potassium citrate tablets and, again, I’m not sure that that makes sense for me. There was no urine sampling–24 hour urine sampling that I’m aware of, other than to determine whether or not I had a urinary tract infection. So, thank you. I appreciate all your great work and keep it up! Bye!
The Number One Thing a Diabetic Stone Former Should Do
Jill Harris: Oh my goodness, Bruce! Bruce from New Jersey, I’m so happy you’re here with us. So, I will tell you we do have a video on uric acid stones, and we do have a video for diabetics! This is a very common part of my practice. What happens? I’m a diabetic, not me, one. “Jill, I booked a consult with you because I’m a diabetic. You’re talking about friggin’ calcium oxalate stones all the time. What the hell? I make uric acid stones!” We have videos for you! Here’s the deal: When a diabetic is diagnosed, they’re going to be told almonds, oh boy, almonds. And guess what? Spinach, spinach spinach.
So, my beautiful diabetic patients, they go home, they can’t eat carbs. They’ve got to be very careful of their carb count now because they’re diabetics. What does this leave them with? A lot of vegetables and protein. So, a lot of diabetics will go on keto, a lot! Is a Keto, per se, or is it just they’re lowering carbs. It’s just carbs. They’re lowering their carbs which is what they need to do, but now they’re over-consuming high oxalate products. That’s when you get into trouble, again. No food, whether you’re a uric acid stone former, calcium oxalate stone former, calcium phosphate stone former, nobody should be eating as much of the want of any given food. It’s just not recommended, especially for kidney stone formers.
So, the body wants a wide variety of foods. Now, as a diabetic, you have to do low carb. So what would I do if if we were working together, Bruce? The number one thing I would say, Bruce, is that you have to get a urine collection. Why? Why are you being put on a pill? How do they know the dose? How many pills should you be taking a day? You don’t have a urine collection. Typically, diabetics have lower urine pH, which means their urine is more acidic. I am thinking, I do not know–and since I’m a nurse, I have a license to protect–so I’m just talking to my guy, Bruce. He and I are talking and I would say, “Hmm, Bruce, I wonder why the doctor put you on that medication when you haven’t done a 24 hour urine collection.”
The doctor could be assuming you do have a low urine pH because you’re a diabetic. The doctor could also be assuming, because we know you make a uric acid stone, your urine is probably more acidic based upon just the kind of stone you’re making. So, the potassium citrate is going to increase your citrate, which will alkalize your urine, meaning taking it from being acidic in the 5s to more basic or alkaline in the 6s. That alone can protect you from uric acid stones. The damn good thing about uric acid stones, they are dissolvable, which is so amazing!
So, everybody, put down your Amazon chanca piedra you’re gonna order. It don’t work for any stone. It may relax your ureter a little so you could pass it, but there are products–if you make uric acid stones, no other stone is going to break up anything. No other product is going to break up a stone, except potassium citrate. Citrate products will break up a uric acid stone. They are the one stone that can be broken up. “Jill, you’re saying that a lot of times!” I get it, Cindy, but I’m saying it because I’m asked this 27 times a day. “Can I, Jill, break up my calcium oxalate stones?” No, you can’t. Uric acid stones, you can. So that’s great, Bruce.
Now, I would love to see a urine collection on you because it’s, typically, not just pH and citrate. There are other things going on. It could be you were eating high oxalate foods, too. It could be you aren’t drinking enough water. It could be, especially if you’re on keto or a low carb diet, you’re eating too much salt now. There’s so many things that go into it and nobody can really prevent a kidney stone without knowing what your urine is telling you. The urine collection will give you the answers and the insight you need to prevent new stones.
Now, one could say, “Well, my doctor won’t order it.” And I’m going to tell you push, please. I want you all to tell the doctor this: “Doctor, I know you said I don’t need it for the first stone, but I really don’t want to make a second one. I’d really like to get on my dietary changes now before I do you make another one.” And so when the doctor hears that you’re motivated, and you’re going to make the lifestyle changes needed to prevent them, I’ve never had a doctor say “no,” after the patient pushed, after I prompted the patient what to say. Then they say “yes.” And I would really, if I were you–because none of you want to go through a second stone, push for that, please.
Choose a Low-Carb Diet
So Bruce, Bruce! Here’s also more good news. So, because of my issues from my rectal cancer, I eat a low carb diet. Also, Bruce, my family makes kidney stones so I don’t eat no almond flour, I will tell you that. I stay away from almonds and spinach. I follow the Kidney Stone Diet. I do all the things I ask you guys to do. That’s why I know it’s hard, but it’s very doable once you get the education needed. So you can make other things you don’t have to–first of all, you know, almond flour, so you’re baking things, I get it. But here’s what I’m going to tell you to do. Why can’t you use, like, coconut flour? You could do that.
I’m making a new snack book right now, actually, and I’m making things with coconut flour. So you can use that. That’s not an issue. It would be great if you would email me at firstname.lastname@example.org, and let me know what kind of things that you’d like to make but you can’t. Pasta, pasta! What about spaghetti squash? You can use that. I mean, I can find out a substitute for anything you’re trying to eat, but for diabetics, stick to your lean meats. The other thing, diabetics tend to overeat meat products.
Now, overeating meat–so you got to realize this, Bruce, the goals of the Kidney Stone Diet, that meat part, the protein, the meat protein part, is for uric acid stone formers. When we eat too much meat–and meat is not just red meat. It’s chicken, turkey, fish, all of it. When we eat too much meat products and fish, that can give us high uric acid levels in our body. Also, it will lower your urine pH and make it more acidic. I have many keto patients in my practice because they’re over eating meat. Also over eating salty meat, by the way, so now they’re losing calcium from their bones because there’s sodium so high.
So, what I like about the Kidney Stone Diet is it hits all stone types. It does and it will. So, for you, Bruce, getting your meat in normal portion sizes doesn’t mean you have to give up meat, just eat it in normal portion sizes. We have on our website, kidneystonediet.com, the blog, we have a meat protein calculator. So, if you put your weight in there, you can find how many grams of meat protein you can have on a daily basis. If you’re 400 pounds, please don’t use that weight, because, obviously, you would want to lose some weight. I wouldn’t also say lose use your goal weight because that’s going to be a drastic cut in calories right away.
So I’d be like, go 10 pounds lighter, 10 pounds lighter, 10 pounds lighter. Keep putting that in your meat protein calculator to get to, you know where you need to be as you go along. So, for you, Bruce, following the Kidney Stone Diet is going to be 100% beneficial to uric acid stones. The potassium citrate you’re being given– also, like I said, is it the right dose? One doesn’t know because you don’t have a urine collection–that will help. If you have any existing existing stones left, that will help break them up, drinking a lot of water, all the other goals, the salt, the sugar, obviously, you know that you’re diabetic, and getting your calcium needs met every day.
So, the Kidney Stone Diet is for all kidney stone types. I just want to make that clear. And, also, Bruce, there is a diabetic and there’s a uric acid stone video, but I pretty much hit everything here for you. So, let us know if that helps. I’d like to know and if you want to email me with any other questions, please feel free to do so.
Jeff Sarris: I think that’s so important to touch on because we don’t say it enough how the Diet does cover the breadth of stones. It’s not just oxalate, but as you’ve said before, someone who maybe has an oxalate stone that doesn’t preclude them from getting a uric acid stone or a combo of the two. There’s so many so many possibilities and why the Diet is so important to hit all the bases.
Jill Harris: Yes, and diabetes, kidney stones they go hand-in-hand. Kidney stones can cause chronic kidney disease because of all the damage it’s doing to your kidneys. All of these things–well, they’re all kidney related problems, obviously–but they can bring each other on. So, the diabetes because diabeticss have metabolic syndrome, they can have lower urine pH and then when they are told they’re diabetics, they go, you know, start eating all these high oxalate products or because they’re dropping carbs, they’re going to overeat vegetables and meat protein because they’re taking away a whole food group which is what non-diabetic keto diet people do as well and still they to get uric acid stones.
And, by the way, calcium oxalate stones. And Jeff pointed out something that happens often. “Okay, I made a uric acid stone. My doctor told me to go vegetarian,” so one does and then they’re overeating all the oxalate products and they’re not getting enough calcium and boom! They have, now, a calcium oxalate stone. So you absolutely can flip between stones, people. That’s why the Kidney Stone Diet is for all stone types. It is all foods within moderation. Honestly, Jeff, I really I really want that to be, you know, we have our goals and I want the last one to be “All foods within moderation, normal portion sizes.”
I can’t tell you how many times I say that throughout the day. I really think at the end of the day, that is why 75%–I’m making up a number, but it’s a very high number–why people are coming to me with stones. They’re overeating, whatever that is, for the latest, greatest diet they are on, especially when we take away a whole food group. Of course people are going to overeat the other ones, right? Take away carbs, people are overeating the other ones. You can absolutely, unless you’re a diabetic or you have a medical condition that tells you to lower carbs, please carbs are not evil, people.
It’s how we eat them, the ultra-processed ones, again, in as much as we want to mount. So it is time to start eating like a grown-up, somebody who really wants to take care of their body, not eating just ultra processed–by that, I just mean cakes, and cookies, and junky food. Of course, you’re gonna have it once in a while, but don’t make it your staple diet. I can’t tell you how many grown adults come to me and that’s what they–hotdogs and hamburgers, like a child eats. And I’ve had people say that in the comments, “Boy, she sure is judgmental.”
I’m not being judgmental. I’m being very honest and I’m telling you what my experience shows me for, now, 24 years, okay? And, so, my biggest passion is to get as much health into your body as I possibly can. In order to do that, I have to be honest, and I have to educate you in a way that maybe you’re not used to. I sleep like a baby at night knowing that I really am giving you honest information and, at some point, whether it’s a kidney stone that has woken you up now, diabetes, or whatever the deal is, it is time to wake up and really treasure our body and appreciate it and feed it properly. It doesn’t mean you can’t have stuff here and there. Of course you can! I’m just saying to eat healthy foods in normal portions and also a nice wide variety on a daily basis. That’s all. So that’s it, folks.
Jeff Sarris: Yeah, that was perfect. And thank you! That was a wonderful question that really was something we needed to touch on because it’s so important and affects so many people. Just knowing that you’re out there with that question means there’s certainly more people with the same exact question. Along those lines, if you’re out there with a question that you want us to touch on, want to ask Jill directly, that number is 773-789-8763, and we will feature you on a future episode.
I think this is a really good one. This will be really helpful to a lot of people and, if you want to dive deeper, the website again is kidneystonediet.com. Jill mentioned the protein calculator. You can go to kidneystonediet.com/protein. I throw it up on the screen earlier, but you can go there, just type in your weight in pounds, and it automatically will calculate the range of grams of protein per day. So just a lot of tools like that on there.
Jill Harris: For meat, for meat! And that confuses people. It’s not your total protein because that’s what most protein calculator do, but we have this is a meat protein calculator, how much meat you can have, and then have greek yogurt, or have eggs, all that other protein is totally up to you. But that’s specifically for meat to lower uric acid and to make sure your pH doesn’t go too acidic.
Jeff Sarris: Yeah, that’s a good point. I should update that to say “meat protein” instead of just protein. We will we will do that, so, hopefully, by the time you’re listening or watching this, that will be updated. But, anyway, thanks again, everyone for tuning in. Thank you, Bruce, for your question, and we’ll see you next week.
Jill Harris: Thanks, Bruce. Thanks, everybody.