Does lemon juice prevent kidney stones?

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.

We got a hoodie today. I don't mean to comment on all the merch every time, but I just love it.

Well, where else am I going to wear it? I mean, obviously, I wear it out too, but I'm like this is the perfect place to wear it.

Yeah, you get to showcase it.

Living your best life. Yeah.

Yeah.

Yeah, I love the typography on it. I love it with my kidney stone.

Yeah, definitely.

In the back. Yeah.

It's fun. Yeah.

And they're cozy and warm.

Yeah, that is the thing. It looks really soft. I know a lot of times, it can be hit or miss with hoodies.

It is. They're very happy with the I'm very happy with the qu- And I you know, I'm the queen of hoodies, so I know quality, and this is the quality's good. This is why they're not cheap, people.

I don't care if I say that. They're not. I mean, they're not cheap, and you know, we don't make a lot of money off these.

We put these, we get a couple nickels, it's not a lot. So, when I buy these, I'm buying these too, just like you, so I know they're not cheap. But I'm not we're not going to put out things that are cheap in quality.

That's not Go look at our website. It's beautiful. I mean, we like to put a lot of effort into what we're putting out here.

And we made these things because people kept asking us for them. So, in our spare time, these were whipped up.

Yeah, and there'll be more.

In our spare time.

Yeah, always changing it up when there's an opportunity, but

Yes.

Yeah, what do you say we dive into this week's question?

Yes, sir.

It's Adam from Texas.

Adam.

Hey, this is Adam from Texas. Had a kidney stone last November, did the urinary collection 24 hour, and I was told to drink more water and start drinking lemon juice, which I had been doing religiously up to the point where I think it's doing my teeth some harm. I'm feeling some pain and everything.

Got a call into my dentist about that, but my question is, what's a good ratio of how much lemon juice per water that you need to drink when you're drinking the lemon juice? Again, I do not want that pain again, so I'm not dropped I'm scaling back on the lemon juice, but I want to make sure I'm taking it in the right dose.

And should I be using a straw versus just putting it in the water and drinking it? Yes, any advice you have on that would be greatly appreciated for the future of my teeth. Thank you.

Oh yeah, this is a question I get all the time. So, but Adam I have a lot of questions for you.

So, we as healthcare providers, doctors, nurses,

Everybody,

When we're asking a patient to do something, we should really explain it well. Go drink lemon juice! You go home, you're like, "Oh, shit.

How much, though? How much, though?" I mean, you know. Or lower your salt.

Okay, but what does that really mean? So, you go home, you know I mean, what does that mean? So, the Kidney Stone Diet, because we know,

You know, I work with thousands and thousands of people in almost a quarter century. I've talked to a lot of people and I know they don't know what that means, "lower salt." Well, if you're eating a butt load of salt, like 10,000 mg a day, who would do that, Jill? You'd be surprised, people.

You're going to think lowering it to 8,000 a day is, gosh,

Wow, could I go any lower? I couldn't possibly.

And the goal of the Kidney Stone Diet and the American Heart Association and all the big groups in medicine, 1,500. 1,500 mg of sodium a day. Jill, why are you talking about sodium when he's talking about lemons?

Hold on! The point is this, we just give this general blanket lower salt, lower sugar, drink lemon juice. What does that mean?

When I left my oncology appointments, do this, do that, but how? How much? Your level is high.

How high? Where do you want me to be?

Who cares? What does that mean if it's high, low? This is why the urine analysis consult is amazing because I help you form all the questions you're going to ask the doctor so they're not left behind.

So, so

Adam from Texas, I have questions for you. You said your dear doctor

Did a 24 hour urine collection and from that collection, the doctor wanted you to do lemon juice. How much? I don't know.

You know why? Because I don't know how low your citrate is. Typically,

Typically,

They start you on lemon juice because your citrate is low. But,

B U T,

A lot of people, doctors, will just generically say drink lemon juice. I'm going to assume this doctor didn't. I'm going to assume that doctor base that order on your citrate level,

And, or your pH level on your urine collection.

I don't know. I don't have your urine collection.

So, if I were looking, if I'm your doctor and I was looking at your urine collection, I would say, "This is your citrate level. It is low.

We care about that in stone disease because it's great to have a urine that's more alkaline than it is acid. Also, it will help lower urine calcium a bit.

It also will raise your pH. Again, we want a more alkaline urine as opposed to an acidic urine.

It's complicated, guys. I make this seem like, "Oh, she's just a street girl talking about stuff." But this is

Complicated.

So, there's many different factors to look in here.

So, I would need to see the urine collection. I don't know how much you should be drinking. Not enough, though, if you're drinking so much it's bothering your teeth, that's that's not good for your teeth, obviously.

So, if you are going to continue drinking

Lemon juice, you most definitely need to drink it out of a straw. But the bigger question is this, Adam:

Is your citrate really low? 'Cause there ain't enough lemon juice in the world that's going to bring it up. Is it just a little low?

For a guy, it should be over 450, the citrate.

And every reference range will be a little different, but research shows you really do want it over 450 for a guy, 550 for a

Woman.

And so, if your citrate is a bip low, yeah, suck on a lemon. Put like, you know, 4 oz of lemon juice in a gallon of water, okay? Do your best to drink as much as you can of that, okay?

But,

If it's really low, you need to be started on supplements, which would be potassium citrate.

So, otherwise you're sucking on those lemons and you ain't hitting your numbers. And, the other thing I'm going to ask is,

Make sure you do a follow-up urine collection to see if sucking on all this lemon juice is having the desired effect.

The desired effect being, your citrate's now raised,

Your urine calcium is a little lower, your pH is a little higher, if that needed to be raised, and your stone risk is lower.

But, I can't tell you how many people, their doctor starts them on a treatment plan,

Based upon a urine collection,

And nobody ever followed up with them.

So, you don't know if what the patient you asked them to do is working, because it may not be working and more tweaks need to be placed,

Put in place, and then you do another follow-up to see if it's working then. Working means looking at the lab results and saying, "You've lowered your stone risk." That equals working.

So, I don't know how much you should be drinking,

And of course, you don't know how much you should be drinking because you were just generically told to drink more lemon juice. If your citrate is very low, lemon juice is not going to hit that. You may need a supplement, but you also need a urine collection to let you know.

I cannot tell

You. First of all, I love the question. It's one I get all the time.

But, I'm just saying it's it's very important that we explain to the very best of all our abilities as healthcare people, why we're asking patients to do it,

Because when they understand the why, they're more apt to do it.

When they're not when they're not being told why, if it's just some arbitrary, stupid thing we're throwing yet again at a patient,

You know, they're

When I talk to patients on the phone, I'm telling them what it's doing to their body, so they are like, "Oh, holy bragoli! I don't want that to happen to my kidneys." And they always have Not to scare them, but to let them know. If we were walking around without all this covering on our organs, and we saw what we were really doing to them every day, we'd be a lot more passionate about how we treated our bodies and what we fed it.

But when we don't understand what a treatment plan is doing,

It's real easy to let it go down the

Wayside. This way, we're like, "Oh, my god, I know that if I don't have enough citrate, I'm drinking the lemons, I didn't have any lemon juice today, my citrate could be lower, which means my calcium can be higher, and blah, blah, blah, blah, blah." It's complicated, guys,

But there's a reason you're being asked to do that. But I worry about your teeth. Sounds like you're drinking a little bit too much.

So, you have homework.

Ask your doctor.

First of all, if you've done a urine collection, make sure that you know how low your citrate is. If it's really low,

Then, that's where you start. Is it too low that you shouldn't even be drinking lemon juice, you should have potassium citrate? Or is your citrate not even low, and it was just a generic catchall order.

There's lots of things to ask, okay? So, lemon juice can help patients alkalize their urine. That mean That means making their urine more alkaline, so crystals don't grow in it.

When you have an acidic urine, crystals like that environment. They like to grow in that environment, okay? But, also calcium phosphate stones love an alkaline

Urine, and so sometimes people's urine pH is way too high, making it even more alkaline,

And then they can grow a calcium phosphate stone. So, we've got to be careful. There's a lot of things, a lot of components.

If you do one thing here, it doesn't mean you don't do all the other things, or you did one thing here, now it affects this. There's a flowchart here,

And it's very specific, and so, you want to make sure you're doing everything you can. It sounds like you're really trying to do everything you can.

Kidney stone disease is going to be a lot more than just lemon juice. It's going to be the whole Kidney Stone Diet, sugar. I've never seen a pa- Let's just say this, folks.

I've never seen a patient

Just minimize their risk of kidney stones by sucking on a lemon. There's usually other things going on. I really want to make sure you understand that.

The Kidney Stone Diet is just a healthy diet. We're asking people to get fluids, get enough calcium for your bones,

And to lower oxalate, because that's how we get rid of oxalate in the body,

To lower their added sugar, we eat way too much of it, lower all that salt we're eating,

And eat normal amounts of meat protein. It's a healthy diet,

Watching all of those things, paying attention to all the goals of it. You don't know the goals of the Kidney Stone Diet? Go to kidneystonediet.com.

They're all over my website.

So,

I can't answer your question, 'cause I don't know how low your citrate is,

But you should ask your doctor that based upon your urine collection results.

So, that's really important.

Makes sense, Jeff? It's a lot of words I put in there, but sometimes a simple question like he's asking, "How much?" I don't know, because there's more information needed. It should never just be a generic order, because we patients will do whatever we want or think about that.

Maybe he I have had patients drink,

You know, 64 oz of pure lemon juice until they eroded their esophagus. So, you don't you know, people interpret what we say in a whole bunch of different ways. That's why I'm very careful of what I just put out on the internet, you know.

You have to be careful, because people just, it's not anything they're doing wrong. It's just how they heard it and what they think, and typically, human nature is more is better,

Right? So, if the doctor told me to drink lemon juice, by golly, I'm drinking it, right, 'cause they never want to go through that kidney stone. And it makes perfect sense, but so, it's a little bit more complicated than knowing exactly how much.

Dr. Coe,

My mentor, his name is Fred Coe, C-O-E, not Cole.

It's Coe, C-O-E. So, if you Google Fred Coe and the Price of Potassium Citrate,

You'll get some studies that they did on lemon juice in that article. That's his that's his website at kidneystones.uchicago.edu. But if you just Google Fred Coe and The Price of Potassium Citrate, you'll see him talk about lemon juice there, too, so you can get some more information.

Yeah, for sure. Yeah, I was just pulling that up right now.

Yeah, thank you, Jeff.

Just pulled it up

On the screen. But yeah, so you'll see this right on his site, and yeah, "Price of Potassium Citrate" is the title that you're looking for. And I think the one other thing, like you mentioned, the follow-up,

The follow-up test to see if there's a change, that's something that

I think it's very easy to overlook and not even consider just because it's like, "Oh, I've been tested. Now this." But if we're

If we're doing some sort of change that we want to

Have an influence, an impact on some levels, we need to know where those levels are after the change, as well.

It's so important, and this is what happens.

The follow-up gets dropped so often, so often. The doctor never orders it, so the patient doesn't know it's supposed to be ordered, or the doctor orders it and the patient doesn't do it. Let me tell you, folks,

I can't tell you how many patients, they'll call me, "Jill, I had a stone. I'm going to do the 24 hour. I'm going to send it to you.

We'll have a consult about it." Good. Greg calls me. He gets his We go over his urine collection.

I say, "Talk to this to the doctor," and, "Greg, make sure you get a follow-up." "I know, Jill. I know."

So,

Three years go by,

I get a phone call, "Oh, shoot.

Greg is on my roster today.

I hope it's good news." Greg calls me, "Jill." Right from his tone, I'm like, "Oh."

"I got another stone." "All right, let's see what's going on. Let me see that follow-up." "Well, Jill,

I never did the follow-up."

Here's what happens, people.

If you don't do the follow-up,

You don't know

If what you're doing is lowering your stone risk.

So, you get on your initial plan, there's a couple things, over time people forget about that pain. Over time, salt starts coming back in, sugar, "Well, I haven't had a stone in two years. I'm good, I'm good."

Bad habits come back into play, new stone, or

You did your first 24-hour urine collection, the doctor told you to follow the Kidney Stone Diet,

You think you're so, okay,

You go back home, you practice the Kidney Stone Diet, you lower salt, you lower sugar

To what you think is a low-sugar, low-salt diet.

You think, "Hey, I was eating 10,000 mg of sodium. I got it down to eight, so low-salt diet to me."

You never do the follow-up,

You get a new stone. The follow-up, that's the gold standard. You do a 24-hour urine collection, you get your first kidney stone, many doctors say, "Wait till the second stone." Why would you wait for a second stone?

That would be like a doctor saying to me, "You got one tumor, Jill. Let's start chemo We'll start chemo after the second tumor." That would never happen!

So, why are we doing that in the stone world? You have a kidney stone, let's find out. We're going to do a urine collection, 'cause that's going to tell us why you're forming stones.

Then, based upon that urine collection, you're going to get on a treatment plan.

You're going to do the treatment plan for a couple months,

And then you're going to do a follow-up.

And the follow-up is going to tell you, "Hey,

He's doing the Kidney Stone Diet, but we still have things out of whack. Now we got to bring a medication into play,"

Because a lot of kidney stone patients have to go on a medication along with the Kidney Stone Diet.

Two more months go by, then you do a follow-up to make sure the medication is having its desired effect. If it does, boom, great! You're done until the next year.

You do an annual,

Obviously, every year.

And your doctor is not going to send you a little note like the dentist, "Time for the annual." That's not going to happen.

Be your own advocate, "Dear doctor, I'm ready for my annual. Please order my test."

Okay? Because then you can see, maybe you got another medical condition. Maybe now you have diabetes.

You forget about the almonds and spinach, and the nutritionist for your diabetes says, "Almonds, your best friend."

You start re-eating almonds again, because now your priority is diabetes. When we're juggling a lot of medical conditions, it's very difficult. And our latest medical condition becomes our largest priority.

And so, again, old foods creep back. Maybe we stop eating calcium, but we brought nuts back, or almonds specifically.

Boom, new kidney stone! But not if you do your annual urine collection, and you say, "Holy bragoli! I got some high oxalate again.

Got to get back to work," and then you juggle both. I help many patients juggle the diabetes and the kidney stones, because that's a very common twofer.

So,

Again,

I don't even know who I'm talking to anymore. Adam with the

Lemons, is that where we were? So, it's important though, to do all this stuff. And so, you know, I know people would say, "Oh, here she goes about urine collections." But again,

We've got to monitor these things. We've got to find out,

The number one thing to do to prevent kidney stones is figure out why you're making them. How to do that? Get a urine collection.

If a doctor says you don't need it, push back. It's your body. You don't want another kidney stone.

Get your testing done, people. Get your testing done.

The end.

Yeah, I mean, that's the perfect message, perfect message to end on. And

Yeah, it's just so important. The testing is everything, because you can throw a bunch of things at the wall and see what sticks,

Yeah.

But what's it what's it sticking to even? What is the effect that it's having? You don't know what you're trying to do, but anyway,

With that, if you want to dive in deeper, head over to kidneystonediet.com, and there you'll actually find the urine analysis, where you can

Send your urine analysis to Jill and have a discussion over what is happening, what she sees, and how you can have that better doctor's visit, or you can download the free doctor visit resources and all the myriad free resources we have on the site, including the oxalate list and everything right there. You can find the prevention course, the weekly newsletter, where Jill's in your inbox every Saturday with a little dose of inspiration to sort of keep you on track and on your journey, but

All of that can be found at kidneystonediet.com.

So,

Yeah, and the course is on sale right now. Of course, we're we're we're taping this at the end of October, so by the time you by the time you see this, it could be off, but go to kidneystonediet.com. We're offering a once in a lifetime $40 discount, because of the recession.

The lowest it's ever been, so take advantage of it if it's available for you when you're watching this.

Yeah. So, with that, I think we'll wrap. Oh, if you have a question, the number again is 773-789-8763 and we'll feature you next time.

But with that, we will see you next week.

Thank you, Adam!