You have no idea this is causing your kidney stones

Up to 60% of kidney stone formers will have this one abnormality on their 24-hour urine collection. Let's talk about that.

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 nurse Jill, your kidney stone prevention kind of gal.

Whoever you are. You had an existential moment, wondering.

All righty.

So today, a kidney stone former's abnormality that comes through, what are we talking about here, and what do people need to sort of look out for?

So, it's interesting, you know, because in the kidney stone world, oxalate is always the buzzword. And up to 60% of calcium-based kidney stone formers are going to have this one issue on their urine collection.

This issue is the whole reason I beg you to get 24-hour urine collections done because it's so prevalent. But when you don't do a urine collection, you would have no idea this is going on.

And that abnormality on your 24-hour urine collection is high urine calcium. Jill, I haven't had milk since I was five. What the heck is going on?

Why do I have too much calcium in my urine?

And there are many reasons, and this is one of the most complicated things that I fish out when I'm doing the urine consult with kidney stone patients. They send me their lab report, and we go over everything, so then I give them a whole bunch of talking points to go over

That with their doctor. So, nothing is missed in the doctor appointment and that patient get on the perfect prevention plan for them. So, I am only going to give you the top five reasons you may have high urine calcium

As a risk factor on your 24-hour urine collection report. Number one, genetics. You are an idiopathic hypercalciuric kidney stone patient, which is just a big, big fancy way to say

We have ruled out all reasons, we don't know why, but you have high urine calcium in your urine. If that is true, then up to 50% of your blood relatives will also have that.

So, I talk to patients every day, multiple times a day, that have high urine calcium. And they're saying, again, "I've had stones for years. I heard you barking on the internet.

I finally got my doctor to order 24-hour urine collection. Boom, my urine calcium is 400."

We want it to be under 200 for women, under 250 for men. And so, "Jill, why do I have that?" That takes up a bit of the urine collection consult because we have to go down, we have to go down a tree to figure it out.

So, one of the biggest reasons, that's just in your genetics. But in order to figure that out, we have to rule out other issues. Number two

Out of the five reasons you could have high urine calcium, and these are the things that we will rule out before we say this is just a genetic problem for you. And by the way, if it is genetics, then most of you will have to go on a thiazide diuretic, and that is a medication that helps lower urine calcium, okay?

But in order to find out if that's true about you, the genetic part, we have to rule out of these other things. So, number two reason that you have high urine calcium is you are eating too much salt, and that is one of the goals of the Kidney Stone Diet. And we want you to lower your sodium to 1500 mg a day.

Not less than that,

That. So, I usually tell patients between 1500 and 2000 mg a day. The American Heart Association, they used to say 2300 mg of sodium a day, but ideally, it's 1500 mg a day, so we agree on that.

So, it's about 1500 mg a day. Do not go lower,

Especially if you've been eating 6,000 mg a day. You need to adjust to this. But too much sodium will pull calcium and push it into your urine in your kidney.

Too much calcium in the urine will increase your kidney stone risk. So, we want to lower sodium

So that doesn't happen. So, that's one of the things we rule out before we say, "Listen, bud, it's just genetics." Number two, you're overeating meat protein, and meat protein is not just red meat. People of my generation, which is who I'm talking to a lot during the day, they're like, "But I don't eat red meat." Red meat is not just meat.

Meat is anything that swims, flies, and runs.

So, fish, chickens, pigs, beef, cows, all of it, all of it. "Jill, I can't eat meat? What, are you nuts?

I'm a diabetic. I have to have some protein." But you don't need a side of beef, Bobby. So,

On kidneystonediet.com, we have a meat protein calculator that Jeff put on there, so you can figure out how much meat can you have per day. That's not your total protein, that's just meat protein. And so, some people can eat more meat than others, so again,

How do you know? You have to do a 24-hour urine collection and the collection will tell you. Do you have to really, really limit your meat big time?

Or can you get away with a little bit more? All of you will be different. The fourth thing

That can be, the fourth reason for high urine calcium is high vitamin D. So, many of you, "My chiropractor, Jill, put me on 10,000 units a day for vitamin D." Why? "Well, I don't know, he just said it's good for me." Okay, and now your vitamin D level is over, you know, 160.

I've had that in my practice, I've seen it.

And for kidney stone formers, we want it to be in the mid-range, 50s. That's cool, 40s to 50s. The range is between 20 and 80, some labs say, for vitamin D.

Some labs say 20 to 100. So, if you're too low, you're too high, that's going to affect your calcium absorption.

So, that's important. And then the fifth reason some of you will have high urine calcium is you have primary hyperparathyroidism, and your parathyroids sit alongside your thyroid. They control, they're over here in your neck, and they control

Calcium absorption. They, they can see in your body, " oh, she's got a lot of calcium floating around there. I'm going to turn myself off a little," or "She doesn't have enough calcium floating around.

I'm going to turn myself on a little bit more," says the parathyroid glands. So, they can go up and down. And in primary hyperparathyroidism,

They're shooting off too much calcium. Here's another thing I will tell you what. So, and let me specifically say, excess PTH, parathyroid hormone, can increase calcium release from your bone and increase calcium absorption.

So, that is why many of you

Have osteoporosis along with kidney stones. I cannot tell you over the years how many patients I said, "Hey, this may be what's going on with you." As a nurse, I never diagnose, that's out of my scope, but I can educate and empower you to ask questions to your doctor,

And that is what I am known for. So, I will tell patients, "This is a conversation you might want to have with your doctor. I see the doctor took your PTH blood level, and it's running high.

I also see your blood calcium is high,

And your urine calcium is high. You may want to talk to your doctor about hyperparathyroidism." And then you may have something on your parathyroid that's increasing the calcium output. So, this is something that needs to be ruled out.

Some of you have been walking around with primary hyperparathyroidism for years. You're making stones, you're being told you're just a stone maker, and not until

You find somebody that says, "Hey, tell your doctor to check your parathyroid hormone and also check your blood calcium." So, if your urine calcium is high, your diet is in check, you might want to check your parathyroid hormone. It's a blood test

To see if that's causing the high urine calcium. And as you guys can see, this is it's a lot. It's a lot.

It's confusing. It's like, "Oh, my god, what's she say? She's so boring right now.

Usually, she's adorable and funny!" But this is complicated. And remember, most of you are dealing with surgeons, that's not what they do. A lot do.

Look, a lot of my business comes from urologists referring patients to me. "Talk to that old lady nurse in Chicago, she'll tell you. She'll go over the urine collection, we'll figure it out.

Let's see what she says," okay?

Because they're surgeons. That's, and they don't have time to be talking about diet, for sure, okay? So, you can see there's many reasons you may have high urine calcium.

And if you're doing the diet, if you don't have hyperparathyroidism, that's been ruled out, if you're not having too much vitamin D, it's in the normal range,

All those things are cool, your salt's where it needs to be, that is when you are said to have, you just it's idiopathic hypercalciuria. Idiopathic means we've ruled everything else out, we still got this problem. What are we going to do?

You're going to get be put on a diuretic. And, and last thing I'll say, Jeff, before you go to sleep, as everybody else is sleeping right now,

The last thing I'll say about this, patients will say, "Oh, Jill, shut up. Good, I'll go on the diuretic. I don't want to lower my sodium." You keeping on a higher sodium diet will make that pill less effective.

So, I get I still get my way of you eating healthier. And, by the way, too much urine calcium can cause too much

Calcium in the urine is increasing your osteoporosis risk. So, not only am I concerned about your kidney stones, when you work with me, I'm concerned about everything that's going on in your body. And I'm going to remind you, don't forget you're losing this calcium, so your bone isn't getting it.

And that's why a lot of you have osteopenia or lot or osteoporosis.

But I will also tell you, because you can say, "Well, Jill, I won't have no calcium, then." That's not going to fix your problem, especially if you have osteoporosis. You're losing calcium. You must get it from food or drink, and at kidneystonediet.com, we have plenty of blog posts on calcium, so you can learn about that.

And also YouTube, we have all kinds of YouTube videos on calcium, so check them out. That's it, Jeff. I know that I was a little boring this time, but this is important because up to 60% of calcium stone formers have this going on, okay?

Yeah, it's an important topic. And if you're out there with a question about calcium, about oxalate, about the Kidney Stone Diet that you want us to talk about on the show, go to call.show/kidneystonediet or click the link in the description down below, and we will feature your voice on a future episode. And when you're ready to really take control and prevent stones moving forward,

Go to kidneystonediet.com where you have access to the meal plans, to the Kidney Stone Prevention Course, and one-on-one access to Jill through her private consultations. But I think with that, we'll wrap, and we'll see you next week.

Bye, everybody. Have an excellent week.