Oh, god. I love these questions from people, and, you know, we often pick questions that are very common, so it appeals to a lot of people, meaning more people can get educated. Okay.
So, that's the first time I've heard the question. And I want to address what was said before the lemonade part, cuz this really gets me. This is so important, and I, as a patient, got this when I was going through my cancer treatments.
"Well, you need to pay attention, keep an eye–" quote unquote, "keep an eye on your diet." What in God's green earth does that mean to a human being? What does that mean? And we wonder why there's so much diet misinformation in the world.
My interpretation of that could be, in my generation, watch calories; also in my generation, low fat; younger people today, pay attention to sugar. I'll tell you what people are not thinking about, and all kidney stone formers will know, keep an eye on water, but most kidney stone formers and most doctors do not talk about: pay attention to how much calcium you're getting, lower your sugar–a lot of doctors will talk about oxalate–but this keep an eye on your diet, or lower sugar, or lower salt.
We need more specific numbers, folks, because if somebody's eating 10,000 mg of sodium–I see this all the time on urine collections–if they lower it to 8,000, they think they've lowered their sodium. Meanwhile, in the Kidney Stone Diet world, and heart disease, and everything else, we want sodium more to 1,500 mg a day, okay?
That's where you should be. And I always say 1,500 to 2,000. So, we need to be very specific: how much calcium?
How much oxalate are we should supposed to be keeping an eye? How many fluids? KidneyStoneDiet.com, the start page, has all the very specific numbers you should be shooting for.
And I say "shooting for" because nobody here is perfect; that's too boring. So, that kills me. Patients and people of the world to lose weight: lower calories.
If you're eating 6,000 calories a day and you lower them to, you know, 5,000, you've lowered your calories, and then people come to me for weight loss: "You ain't losing no weight because you're not where you should be!" "Well, the doctor just said lower." So, we need to be specific. We need to talk to people and see what they're doing.
Peep- doctors will say, "Well, Jill, the doctor told me to eat meat, and I left the office going, 'Holy braciole! I'm a vegan. I can't–I'm not gonna eat meat!'" So, I'm saying, folks, we need specifics.
We need to talk to the doctor and tell him or her what we're doing in our lifestyle. I can go on and on, and I'm not going to because this is about lemonade powder. But the whole "My doctor told me to keep an eye on the diet"–that patient's going to still make stones because he or she doesn't know what that means!
All that folk- all that patient is going to focus on is lemonade. So, let's talk about lemonade. Now, I'm already annoyed, but let me talk about lemonade.
First off, as a patient, if a doctor has told you to do something, your next question is: why? Not to be mean, not to be sne- you know, snappy, but as a patient, I want to know why I'm being asked to do that, because I want to know how it helps. And then I want to know, because I want to know why it's going to help me, because when–just use me for example–"Jill, do this," or, "Jill, take this pill." Do you know how many of my patients are just, "I don't know why I'm on this pill.
He said to take it, I'm taking it." If a doctor puts me on a pill, I want to know why, because I'm going to make a decision on why that, you know, I want to understand why it's important because it'll ensure that I keep doing it. Instead of when you don't know why you're being ordered something, you're like, "Eh, this pill makes me kind of feel weird.
I'm going off of it." I hear that all the time. "Jill, I just stopped taking that pill, cuz it made me a little dizzy." "Did you tell the doctor you stopped?" "No." "You should. Do you understand that your stone risk is going to be increased if you stop taking it?" "No." So, there's so many things, folks, there's so many things.
Lemonade: You're being asked to take that, first of all, was it based upon a 24-hour urine collection, or is this just generic advice? "Oh, Jill, you're such a pain in the ass." Let me tell you the difference here. If it's being based upon your urine collection results, the doctor is probably noticing you have low citrate.
The doctor could also be noticing your urine pH is low, the- meaning more acidic. Lemonade will increase these things. "Why do I care about citric acid, Jill, or citrate, which lemonade has?" You care about that because if your citrate is low, which is very common with people who have chronic diarrhea, malabsorption issues, and just some of you don't eat any fruits and vegetables, diabetics, there's many reasons why your citrate could be low, diuretics that you're on, many reasons.
But if your citrate is low, that means you're at risk, more at risk for kidney stones because citrate acts like a shield, and it surrounds calcium in the urine, and it protects calcium from other crystals binding to it, like oxalate and phosphate. So, if your citrate is low, your shield is low, and the calcium is not protected.
And so these other crystals can connect to her and form stones. Lemonade is not the best thing to do this, because it's filled with sugar. I would never tell a patient to drink lemonade.
I might tell them, if we're going to start there, to drink Crystal Light, and there's a nice article on Dr. Coe's website at KidneyStone.uchicago.edu, and it's called "The Price of Potassium Citrate," and he will talk about Crystal Light there. Go read that.
Some of you may say, "I don't want to drink Crystal Light because it has a lot of artificial junk in it. I don't want that." I would always tell patients to start with more fruits and vegetables. If you're looking to raise your citrate, I would start with more fruits and vegetables.
If you're looking to raise your pH, I would start with more fruits and vegetables. However, if the doctor is looking at a urine collection, it may be that the citrate is so low that it will need potassium citrate. Crystal Light ain't going to be enough.
Fruits and vegetables aren't going to need enough, but I always encourage doctors, if they're looking at a urine collection and the pH is low and the and the citrate is low, I always suggest to doctors to suggest more fruits and vegetables. Number one, it's healthy for everybody. You take away the highest oxalate ones.
I take away no fruits for high oxalate. I do take away spinach and, you know, beets, we should watch out for, and, you know, rhubarb. I think that's a fruit.
No, is it a fruit or a vegetable? I don't even know.
I think it's a- I know. Who knows? You can You can Google it, folks.
I'm I'm out of my game today. But I would say to always start with fruits and vegetables first, depending on how low the citrate is. If it's just a little low, that's where we want to start.
Then you do a follow-up urine collection in a couple months, once you have attained this lifestyle, and you see where you're at. At that point, you could say, "Listen, I'm eating a lot of fruits and vegetables. The citrate is still not high enough where it needs to be.
Maybe it is time for potassium citrate, or maybe a little Crystal Light." But I always start with fruits and vegetables. Number one, they're healthy. Number two, it's there's natural sugar in those things and fiber, and you all need that.
The average person is getting so little fiber in their diet. So, I'm always going to suggest natural produce first to increase citrate and pH. I really want you to pay attention to this.
If a doctor has told you generically to drink Crystal Light and/or lemonade–not a fan of the lemonade because of the sugar, again– but if you have been told to do that and you were not given a urine collection, I want you to push back on that. "Dear doctor, before I do any kind of treatment, can I please get a urine collection so I can see why I'm forming stones?" I say that to you because many of you may be walking around with very sufficient citrate, and actually your pH is already high!
So, adding lemons, lemonade, Crystal Light could make it worse! And a really high urine pH can increase your risk for calcium phosphate stones. We do not want that.
And this is why that should never be a generic order to drink lemonade, lemons, or Crystal Light. And that, again, I hear on the daily. I doubt that patient had a urine collection, cuz most people who are being told to drink lemonade have never had a urine collection.
And he doesn't know. Yes, he makes calcium oxalate stones, but even with a high urine pH, you can make a combination stone. Calcium oxalate, calcium phosphate can be in one stone type.
It can be a mixture. So, you must get a urine collection before you start doing this generic advice. The only generic advice I love is lower salt and added sugar, and drink more water, take away spinach, stop using almond products, don't use chia seed, get enough calcium, follow Kidney Stone Diet, but cuz that's what that is.
It's not generic advice, but it's it's good generic advice for everybody. It's just healthy to do those goals, and that's why so many people lose weight, their A1C gets better, they- their GERD is better, they A lot of things get better. Their diabetes meds go down.
Their A1C goes down. You're going to be shocked once you start following a healthy lifestyle, which is what the Kidney Stone Diet is and why I'm so passionate about it. It also just so happens to lower stone risk, okay?
But, in order– the lemonade, I'm not a fan of; it has too much sugar. If you need a little bump in citrate, lemons can help, Crystal Light can help, fruits and vegetables will always help. And then, whatever you are doing, get a follow-up to see if it has helped enough, because if it hasn't helped enough and your citrate still remains low, that is a kidney stone risk.
You may have to be put on potassium citrate, but I always say, let's start with the healthy route, natural things, before we start adding medications, and Urocit-K is a prescribe drug. So, let's start with that. Lemonade, not a fan because of the sugar.
Crystal Light, a more of a fan of because it doesn't have all that sugar in it; it has fake sugar. But you need a urine collection to see what the best treatment is for you, and it will be all dependent on how low that citrate is and whether or not you have a high urine pH. Crucial stuff, folks.
Crucial stuff.
