How important are oxalates?

SPYR.

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.

Got a little jingle. I like it.

Got a little jingle today.

It is beautiful out today. We have not been able to say that for it feels like forever. It's only been like a week, week and a half, but

I mean, I just, you know, at some point you're like, "Well, you live in Illinois. Come on, you think you'd be used to this after decades." But you're never used to it, because one day it's truly 30° and you have a parka on and the next day you're like, "Oh my god, where's my fan?" And it's tomorrow's going to be 87°. And it's just like, how can it possibly be that moody?

That's all I'm saying, right? So,

It's wild. It's wild and it's been, but it's been, so yesterday was nasty, but we're going on a whole week where it's going to be nice. So, it makes the potty training process so much more bearable, bearable.

Yeah, how is that going?

Oh my god! So, I love him so much. I love him, but he's a handful.

He's, you know, he's he's 8 lb now, so he's grown under my care. He's a little He's growing. But I'm telling you, so you look at him and you're like, "Oh, he's the most adorable thing ever," but he has eyes like this.

"Don't even think I'm a that adorable and I won't get you." He's just all over the place,

But all in the best way possible. Like I really appreciate his nature. He's just a good dog, but he's also very mischievous and that's right up my alley.

I love it. I never know quite what he's going to do, so it keeps it interesting. But he's super smart.

He knows how to sit already, he knows how to come already, and he's doing, you know, I have I have decided that if your dog is peeing in the house, don't give me any hate mail, people,

I'm not saying 100% of the time, I'm just saying most of the time if the dog is having accidents in the house, unless they're a certain temperament, it's because you're not paying attention, right? So every time I don't pay attention to him, he's peed in the house. But because I'm a drill sergeant, that only happens like once every three days, okay?

So, I mean, so he's been awesome. You know, he's crate trained,

Which is amazing. So when I'm busy working, he goes in his crate, he doesn't make a peep. I'm like I feel like my life is too good to be true.

And I know people right now, the viewers like, "Okay, TikTok girl, and boy, I was here for kidney stones. Why are we always chatting at the beginning?" Because we are chatting! Talking about dogs, what's not to love?

How are you doing in the midst of still

Missing your little guy? Are you adjusted okay?

Yeah, like I'm doing fine.

You okay?

Yeah, it's like it becomes more and more just normal every day, but yeah, it's still hard. Like I wish he was still here. It's not really too much to say about it.

I'd like to have him here, he's not, and yeah, just accepting it. And I think I said last time, but like I wear this little brown bracelet that's like the same colors as him. It's just a little reminder every day.

Put it on in the morning, take it off before bed.

It's just kind of just what I decided to do, you know?

I love that you did that, first of all. We all know, you know, what I did. Of course, I took it to the extreme and got a tattoo of Luke.

Of course, that's what I did.

Yeah, but I love it.

But here's the thing what I found, and tell me how you feel. During the process—and we will be talking about kidney stones any second, people, I promise! But during the process of grieving, losing in this case, Jeff's cat, and in this case, my dog, Luke, it's just interesting to watch oneself in the process of it all, you know?

It's just an unbearable thing at the beginning. And as the days go on, I think you used the best word possible, because you never really get over it. You're never, "I'm fine with it." But I think you just do accept it, and now this is your life without that beautiful animal, right?

So, but it is it is such an interesting process to pay attention to, notice who you are in that process, how it's affecting you. It's just very interesting to me, you know?

Yeah, and I think when it does impact you a lot, it also really drives home what the animal, like obviously like a human or whatever, whoever you're sort of grieving over, how much they meant to you. And I think that there is a little almost a little solace there, too, because it's like you know it, but then you like feel it.

You're like, "Oh, yeah, like this was this was an important part of my life."

Yeah, it is it is amazing how much animals can bring to our life. They don't talk, to me that's a bonus, so I really appreciate that. But I mean, imagine the love you're getting from something, in this case, an animal, and they don't even talk to you.

It's just the way they look at you, or I don't know, it's just the craziest, most unconditional, beautiful love. I don't see where else it really exists in the world. So, it's just it's rather amazing to me.

It really is. And to be responsible completely for something that cannot talk, that cannot tell you what they want. I remember when my son was younger, you know, it was so frustrating because he'd cry at night, you don't you don't know, is he does he have a pain, is he hungry, does he have gas, what the hell's going on?

You don't know. But eventually they grow up and they tell you, "I got a gas bubble." Okay, we can fix that.

But with an animal, you just never quite know where they are, but I don't know, it's just the amazing the nonverbal communication that you have and that the love that you can gather up from that is simply worldly to me, right?

Yeah, for sure. Yeah, cuz you have this sort of unspoken bond, but almost like unspoken communication style of so like you can read each other, and like they understand us more than they seemingly should, which is so, yeah, so different, but—

Crazy.

Should we actually dive into this week's question? We could talk about kidney stones I guess today, you know?

Oh yeah, so let's do it. Come on, people came here for that.

Yeah, we can. So, let's go with the first question today.

Hey, my first name is Drummond, and my question is: if kidney if oxalates are so important, why is it that everyone in Japan doesn't have a horrible kidney stone problem? Because miso soup is extremely high. It's up there with spinach and rhubarb.

And miso soup is served with everything in Japan. And it's also miso, the miso product itself, is also used in other things. And of course it's high because it has soy beans or tofu in it.

So why is it that the Japanese are not all suffering from kidney stones? And if you look at sort of world cultures sort of across the board,

Why is there no pattern of higher kidney stone incidence incident in areas that have that where food products are popular that are very, very high oxalate? So that's my question. Thanks.

Yeah, I think that's a good one because yeah, really is, and it's like looking at it from cuz oxalate, we get a lot of questions about. But this really looks at it from a different perspective because it is, yeah, it's something to consider.

Yeah, I love his question. I believe his name was Drummond, is that correct? Did you get that?

Okay. Drummond, yes, we you know, first of all, thank you. I get a lot of patients that are like, "I'm too embarrassed to call in." The reason I'm saying that is because it takes a lot of guts to call in.

I don't know why, because I am who I am in the world, it wouldn't be a lot to me, but I think for most people, it is a lot to call in, and you're just leaving this message on a voicemail.

So, viewers, we appreciate when you call in. We don't We're not glib about it. So, Drummond, thank you.

That's a That's a wonderful question. Now I'm like, holy shit, I got to address it. Let me see.

Because it is a good question. I think, first of all, how he started the question, he said this: "If oxalates are so important…" Well,

If you've listened to me on this channel, you're going to hear me say, "It's not so much oxalate." I am saying, I actually say, oxalate is the least important part of this diet. It is, however, the thing that people the thing that people always talk about,

Because there's a couple reasons why I think. I don't have any research to back this up, this is what I think after all these years of experience. I think, number one, the word oxalate is like, " oh, what is that?" So, people gravitate towards that word because they don't know what it is.

And then the other thing is, if the doctor says one or two things, they're saying, "Drink more water," and they throw an oxalate list at you.

So, that's why the kidney stone patients think it's the most important thing. Once you take away spinach and almonds, you really can eat rhubarb, you can have miso soup, you can have these things within portion size.

Now, Drummond said, "Well, what the heck? Okay, I heard you. I've listened to you.

But these people, Asian culture, is eating miso soup and soy and this and this all the time, all the time."

Mostly with every meal, is what he said. Well, genetics also play a part in this. This happens to be primarily a white person disease, a Caucasian disease.

You don't see a lot of African-Americans with it, you do not see Asian people with it, you do You just don't. So, it's just like, you know, if it's in your DNA, it's in your DNA, you know? So,

That's not very scientific, but there is a genetic component to it. Now, the viewer may say, "Yeah, but I got stones, and nobody in my family has them." Well, it's not always genetics, but there will be a certain genetic predisposition to for one who forms stones. I have kidney stones in my family, I certainly don't want them.

So, if you do have them in your family,

You really want to pay attention to what we're talking about on this channel because you have a higher propensity to make a kidney stone. So, Asian population is rather low, like I said, African-American population rather low, Latino community low. This is primarily a Caucasian disease.

So, there's that.

It's interesting, isn't it? Also, I don't have any data on this, but are they eating smaller portions? I don't know, could be.

It's just a small part of their Listen, a lot of people a lot of people will say, "Well, you know, I ate spinach all day long, I had smoothies, I had salads, fistful of spinach in my salad, right? Or I had

Almonds all day long, all day long, all day long." So, if somebody just had a spinach salad three times a week and a few almonds a day, I would bet they didn't make a kidney stone. It's what we do every single day in the large, vast amount we do it.

I think especially American culture, when we are told something's healthy, we typically eat it over and over and over in large amounts, because we think more of it will mean more health. And as kidney stones, unfortunately, kidney stoners find out, that's not true, right? So, in other cases, though, it may be true, it may be like you can eat as much as you want of something, and that's great and you're not going to form a stone,

But for kidney stone formers, it's a problem. The other thing that's interesting to me from Drummond's question is, the other part of this diet is a high salt aspect of it. And, you know, all those things we just talked about, the miso soup, it's very, very, very salty, right?

So,

But are they are Asians eating a whole bunch of other vegetables and, you know, to make up for, you know, maybe they're eating high salt there, but it's a smaller portion and the other things in their meal are not. But again, I think it's always going to come down to genetics in this population. They're just not a culture that forms kidney stones,

You know, primarily. So, that's really what it comes down to, right? And it can be frustrating because, like he said, look at them eating the soy and everything else.

And I want everyone to look at their list. I think it's something like half a cup of soy, it's only 13 mg of oxalate, don't quote me, but check your list, people, you can definitely add soy. If you're vegan or vegetarian and you want to get have access to more protein,

Please, because you don't eat meat, please use soy. Look at the list. Look at the Harvard list and you can see you can actually work that into your diet.

So, you know, we often—go ahead, Jeff.

I was just going to say, and the daily sort of tab that everyone has, what's what's the number again? Sort of how much oxalate you want to stay within?

Yeah, we say this: up to 100 mg a day of oxalate. Now, there will be a subset of patients, like bariatric patients, who have malabsorption issues, or perhaps bowel disease patients, these people who have malabsorption issues, their doctor may tell them 50 mg of oxalate a day.

Now, if your doctor just threw out a number, 25, 50, 70, make sure you push back, because we want to make sure the doctor is I'm very careful here, because I'm a nurse, you always follow your doctor's advice, but you can certainly

Push back and say, "Oh, I thought I could have up to 100. Are you sure, doc? Cuz I don't have any malabsorption issues." And then 99.9% of the time the doctor will be like, "Oh, yeah, yeah, you can have 100," okay?

So, sometimes we just get these numbers stuck in our head and generically throw them out to the world. So, unless you have malabsorption issues, you can easily have 100 mg of oxalate a day.

The most important thing, which is another thing that's interesting for the Asian culture, are they getting their calcium needs met? Because in order to reduce urinary urine oxalate, you have to get your calcium needs met, too. So, that's another interesting factor, and yet again will point towards it's just not in their DNA to get kidney stones, right?

So.

Yeah, and jumping over to the oxalate list real quick on the website, too. I was I was asking about the number, because when you look up miso soup, it like it says very high, but one cup is 111 mg. So, it's sort of if that's the main source of oxalate for them in a given day, it's right there, like right about at that 100 mark.

And remember this: if you're getting your calcium needs met, it's not like you're going to pee out 100 mg of oxalate, right? So, I mean, I have many patients that after they work with me, they're like, "You know what? I know she said I can easily have 100," because they're vegan or vegetarian, "I'm going to go all the way up to the 100 and see where my oxalate level is."

She says as long as I get my calcium, it will be within normal range. And most of the time it is, unless the person has other issues going on. So, it's a very safe number, meaning actually Dr.

Coe will say, " sweetie, you're being a little conservative with that." But I know that a lot of times when we give people this, they go to this.

So, we do keep it around 100, okay? It's a safe number, everybody It's very doable, nobody's ever like, "Oh, my god, I got nothing to eat." Most patients don't get more than 60. Once people get their portion sizes in control, the world just opens up as far as the diet world, okay?

Their lifestyle.

We have to get our portions in check, and that goes for healthy foods as well. You really shouldn't be overeating anything. Love, the party pooper.

I have no friends! I've lost every friend I've ever made. She sucks!

No, no, no.

She's dumb! She's no fun. It's true!

Well, yeah, you're just You're sharing the truth here, but you absolutely have friends and you are so much fun. Everybody knows this, but—

You know what I mean.

Yeah, that is like that is the thing, is like coming When you think about portions and things, it's not the it's not a sexy answer, it's not something that we're like, "Ooh, this is exciting." It's that, "I'm going to eat a little bit less." But, it's—

Nobody wants to buy that program. That's why you have other lifestyle choices that are like, "Just give up that and you can eat whatever you want here." And then, guess what? I get a phone call!

Because now somebody has a kidney stone, not in every case, of course, but lots of times, right?

So, people want to buy the program that says, "Just don't eat a piece of bread for the rest of your life, but you eat mangia to everything else." And so, because we enjoy eating, it's that's the that's the plan you want to buy. But you know, we can't live without bread for the rest of our lives. Some can, please don't write me.

God bless, that's great. But most can't,

Right? So, most just can't, and you have to find the plan that is sustainable for you, that you can work with. I always say this, too, it's like I always look at my food and I'm thrilled to have it, even though if my mother was looking at my plate, she'd be like, "Oh brother, here she goes again." I mean, how could that be fun?

It's not that it's fun, I just like that it's nourishing me and I'm satisfied, you know? But it is also fun for me. So, you know, you have to float to your own

Tune, I guess, I don't know. You have to sing your own song, right? So, once you really get a healthy lifestyle down, and that means attaining the Kidney Stone Diet goals, notice we're not telling you what you can and cannot eat except spinach and almonds, we're telling you, "You do, you want to do keto, you want to do paleo, you want to do, you want to do Mediterranean, I don't care what you do."

"I want you to do the diet that works for you, but fit into these lower sugar guidelines, lower sodium guidelines, get your calcium needs met, don't overeat meat products and seafood products, and get your fluids in." I mean, it's just the most rational thing in the world, it's just really hard, right? And we're asking you do this on more days than not, not every day, right?

Cuz you can't be perfect.

Yeah, for sure. I think that's a great wrap up of everything. Like, thank you, Drummond, for your question.

And, as always, if you have a question and you want to be featured on the show, the number is 773-789-8763. Again, 773-789-8763. And, yeah, we'd love to feature your voice on a future episode.

And we're just talking a little bit about the foods you can and can't eat, like not really taking anything away, but we have the Kidney Stone Diet meal plans on the website at kidneystonediet.com, which gives you inspiration for seven days a week,

Four meals a day, including a snack, where it's just it's a little nudge in the right direction, so you can see just how diverse a Kidney Stone Diet approved approach is, because there's a lot of things you can eat.

Yes, and not only that, people are like, "Jill, I don't want to figure out the oxalate and the sugar for every meal." I've done it for you! All these This is the best part, is all these recipes I had figured out, beads of sweat on my brow, I have figured out all the oxalate, all the salt, all the sugar, it's all there, so you don't have to worry about it.

Every recipe is Kidney Stone Diet safe, that's the beauty of it. It's wonderful. It's very, you know, it's

It's a lot of work doing it. Oh, yeah. But, my god, I mean it's been really a lifesaver, an awesome tool, so I'm really proud of that service we offer.

That's a great offer. Always cheap, because all of our services are very reasonable considering the time and effort that goes into it. For sure.

All right, I'm done.

Well, yeah. So, thanks again for tuning in, and we will see you all next time.

Bye!

Bye.