Yo, Damian from the Bronx in the house! Damian! I'm originally a New Yorker myself, so welcome.
Another, look, a y'all are on fire giving these questions. This is a doozy. I just love everything about it, Dame.
So, let's talk about it. And from one cancer survivor to another, I hear you and I see you with your prostate cancer. I'm happy that you were able to call in and you're you've got you're in survivorship, so good for you.
So in 1999, you had a stone, two calcium oxalate stones removed last year, and you were born with one kidney. So, this beautiful man has one kidney. He needs to treat it as if it's a gift from God because it is.
So, he really needs to get his diet together, as he self-admittedly said, hasn't had the best diet. And he has heart issues as well. So, he's taking life seriously now and he's ready to make some changes.
And so, his questions are wonderful. And it's interesting because we're doing a few shows at once as Jeff and I usually do here. And so, the video before I was just talking about urine collections and how you're going to have reference ranges that are very different.
One lab will say this, one lab will say another. For example, his calcium. And so Dr.
Coe will say some labs will say, "We want it under 200 for women, the urine calcium. We don't want more you more than 200 urine calcium for women and more than 250 for men." Okay? So, Dr.
Coe would ideally like everybody to be under 200. What does that mean? Some people say, "Jill, I haven't had a glass of milk since 1962.
How do I have all this extra calcium?" Cuz a lot of people will have Now, Damian said he had 230 calcium in his urine. Some people have 500, 600, 700. And they'll say, "What the hell is this?
This is really I don't I don't even use dairy." So, where is that calcium coming from? Could be your bone. If you're eating a high-salt diet, high-added-sugar diet, too much meat protein, could be from your bone.
Cuz those things can pull calcium from our bone and dump some in our urine, okay? Excess. He said he has less his less than 20 milliequivalents for sodium, so he wasn't eating overeating salt on that day, so we know that's not a problem.
He's a plant-based eater. So, where's the where's this extra calcium coming, and by the way, Damian, it's not that much, okay? But the point is, you know, let's just say under 250 for men is typical.
Yeah, Dr. Coe's going to be the idealist 200, but nobody's freaking out if it's 250. He will say, in even in that article I know you're referencing, 250, but maybe ideally for both 200.
The point is this, so it's not crazy, because I see crazy amounts of calcium. But his question is, "I don't even get enough calcium, where is this coming from?" Well, are you said it was low salt, and we can't tell by urine collections if you ate too much added sugar. Now, you said you're a vegetarian or vegan, you're plant-based, so I don't think you're eating too much sugar, but let me just say this.
Twinkie doesn't have meat in it, but it has a lot of sugar. So, I know a lot of vegans and vegetarians that are way overeating sugar, cuz cake don't have meat in it, okay? So, just because someone says they're a vegan or vegetarian, I still ask my questions.
Cuz again, a urine collection is not going to tell me how much sugar a person ate that day. It tells me the salt, tells me the meat, but it doesn't tell me the sugar. So, Damian, you do need, like your doc said, you do need a normal calcium diet.
There's plenty of ways to get it as a vegetarian and a vegan. Go to kidneystonediet.com, the blog, and I have articles specific for you plant-based patients that need to get your calcium. "Jill, if I have too much in my urine, why do I need to get any?
I don't want to make it worse." Sometimes, that, like I said, is coming from your bone, so you really need normal amounts of calcium. It's very important. So, for Damian, it's up to 1,000 mg a day.
You get it spread throughout the day. Could be from non-plant milk, non-dairy milks, there's vegetables. I even have I even have an article that will show you the high-calcium low-oxalate foods.
So, look in my blog, okay? It will say these are these are vegetables that have calcium, and I know my patients well enough to know they're going to say, "Yeah, but how much oxalate's in that?" So, I already did all the work, and that's in an article, too. So, you need up to 1,000 mg a day, you need to spread that throughout the day, not having it all at once, not saying you will, Damian, but I got to sleep well at night, got to make sure I'm clear, and we don't want patients having more than 500 mg at a time because we don't absorb calcium that great.
Now, again, like I said in the video prior to this one, there's a flowchart we go through. If I'm looking at a urine collection, I don't look at the oxalate right away. That's not my first thing.
I look at urine calcium. If it's high, I then look at the sodium. If it's high, I know to talk to the patient about diet.
If it's not high, I know to talk to the patient to talk to the doctor about these things during the upcoming visit, and this is why the urine consult is so wonderful. It's how I think about it. Patient has high urine calcium on his urine collection, salt looks good, I'm going to ask him about sugar, make sure we're cool there, meat protein, he's a vegetarian, ain't overeating that, so the next things I'm going to go to, when was your vitamin D checked?
Not a long time, check it. Because if you're not getting enough vitamin D, you may not be absorbing the calcium you're taking in. If you're getting too much vitamin D, because somebody put you on a supplement really high and never rechecked your blood to make sure your vitamin D was normal, you could be overabsorbing calcium, okay?
If that's all cool, if your vitamin D is straight, the next thing you want to do is get a blood calcium. If it runs on the higher side, you might want to check your parathyroid hormone, which is also a blood test. What's on the higher side, Jill?
More than 10.2 for blood calcium, typically. Okay? So, there's many different things to ask the patient.
But again, Damian, yours is just a little high. So, one the other thing I would ask you is you're not overconsuming calcium, right? He said no, but that is what I would ask the patient.
Cuz sometimes, when patients find out they should be doing calcium, they start drinking milk with every little 2 mg of oxalate. Before you know it, they drank over 3,000 mg of calcium. Okay, that's don't do that.
So, more is not better, people. Less is not better, people. We try to stick close to the goals.
All right? So, for him, because he has one kidney, so this is really serious for him. I want that kidney to be treated like it's the biggest prize of his life, because it is.
He can live with one kidney very happily. He cannot live with zero. So, this is important.
And the kidneys are the most sensitive organ of our body. They do a lot of work for us, man. They're always regulating our fluid volume, our blood volume in our body.
They're They get pissed. They don't work as well quickly. So, meaning, they're sensitive.
They're filtering blood. They're working really hard. You know, so we really want to take care of them.
They're the least hardy out of our organs. So, we want to take care of them. So, get your calcium needs met.
If you're not overeating sugar, get your vitamin D checked. If you're not overeating calcium, which you said you weren't, that's not the reason why you have higher calcium. Also, to address the other question I think you asked, but I know is popular, So, if you high have high urine calcium, like I said, maybe it's coming from your bone, I'm certainly not diagnosing you, your doctor will have to do that, but you have to make sure you're getting enough calcium, and as long as you're not going over and you don't have any issues why you're not absorbing it, that's not going to affect your urine calcium number.
So, you do need to get up to 1,000. Kidney Stone Diet.com, the blog, to find out vegetarian options for you to get that. And what was the last thing I wanted to tell you?
Yes, I want to bring up your sodium. It's very low. You don't need to go that low.
So, I want to make sure you're eating enough food. That's important. I mean, that's very low.
When I say something's very low or very high, pay attention to it, cuz I see thousands of urine collections a year, and I'm not hyperbolic about this stuff. Yours is very low. Now, I would ask you about that, too, if we had a consult.
I would be like, ". Was that just for urine collection day or have you changed your diet that much, and that's what you're always doing now? And if so, I'm worried if you're restricting yourself too much from food.
And are you losing too much weight, and is it coming off quickly?" I would ask a lot of questions, cuz I see myself as Angie Dickinson, Pepper from Police Woman, if you're my age, you'll get the reference, okay? So, Pepper is saying, low-sodium low-sodium, Dame, we want to look at that. Otherwise, I think I think we answered everything.
I do want to make this clear, too. Is 231 So, if Dr. Coe is saying to you, he may tell you to pay attention to the 231, but overall for a man, under 250 is just fine for urine calcium.
But, you know, with your sodium that low, that, you know, I get it. I get it. You want to pay attention to it.
Most urine collections, Litholink would say under 250 is fine. I know Dr. Coe says 200, but, you know, is that warranted for a medication or anything else?
I don't think your doctor would ever put you on a medication for that at all. So, I hope that answers your question. I loved your question.
I love when you guys ask me questions, so please, and the more detailed the better. Thank you. I'm I'm not going to always go over people's urine collections here because it's way too laborious, that I'm not going to do.
I've never done that before, but for Damian, for my fellow New Yorker, I'm going to do it. So, don't call in with your urine collection results, because there's HIPAA stuff, too. We really shouldn't be doing that.
So, but thank you. I loved it, and the calcium one is so super important, and this is why I say, guys, you must do a urine collection, because you always want to check your urine calcium, it tells you so many things and super important, and if you don't get that checked, you don't know if that's the cause, and you could be saying, "Well, I did the Kidney Stone Diet, it didn't work for me." Well, you never did a urine collection, you have a urine calcium problem, you must get that fixed, and even though you did the diet, that doesn't necessarily mean you're going to fix that.
It's going to help, because lowering sugar, salt, and added meat protein will, but you still may have a genetic issue, and that needs to be pointed out from a urine collection, because you may need a medication, otherwise you can have bone loss, and you will still make stones. So, please get a urine collection. I will never get tired talking about that.
You must, people, you must. It's so important for prevention.
Act- Absolutely. I think, you know, as what we're always trying to do is create a community where people feel, you know, kidney stone formers don't feel very heard in the world. And so, and I really take that to heart.
It's very important to me. You know, it just is. I feel like kidney stone former kidney stone formers are kind of one of the underdogs in the in the medical field.
They just kind of get overlooked. You know, it's not something that's studied a lot in school, the diet and things like that, because there's so much there's so much obesity and chronic kidney disease and diabetes and cardiovascular disease. It's just, sometimes, the kidney stone people get just pushed to the side.
So, of course, I'm I'm going to gravitate towards that. You know, as a nurse, I can pick whatever I want to do. It's really easy, especially nowadays.
But my heart's always been here, because so many people don't have the correct resources. And so, I've been blessed enough to have a mentor like Dr. Coe, and his website is kidneystonediet.uchicago.edu.
And he's a scientist and a nephrologist at University of Chicago. He's thought of as the granddaddy of kidney stone prevention, and I've been, I mean, you know, without him, I wouldn't be here, because he gives me my credentials. Otherwise, I'd just be some middle-aged broad with fuzzy hair, screaming on the internet about low salt.
I mean, you know, so, you know, everything I'm talking about, although I have my own special way of doing it, is just drenched in science in his website, and he puts a lot of effort, and he wants that to be his blessing to the world at 86 years old, you know, that's what he wants to leave. Also, the Kidney Stone Prevention Course is $40 off.
Today is I think September 30th. This is not going to last forever. I'm saying the date now, 2022, because I don't want people watching this in six months saying, "Hey, you said it was a It won't be, so this is temporary because of the recession.
We acknowledge that. It's the lowest price it has ever been, so we want to give back and do whatever we can, $40 off at 149. You will never be able to beat that price.
So, we want to give that to you, as well, temporarily.
