This week, Jill answers a question about high urine calcium.
Have a question? Leave us a voicemail at (773) 789-8763.
Stop Kidney Stones Once and For All
- Kidney Stone Prevention Course
- Kidney Stone Diet Meal Plans
- 24 Hour Urine Collection Analysis
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Kidney Stone Diet Resources
Find more episodes of the Kidney Stone Diet Podcast here.
Who is Jill Harris?
Jill is a nurse and health coach that specializes in educating patients on kidney stone prevention. For more than 20 years she’s helped patients understand that kidney stones can be prevented with the right treatment plan. It’s one thing to be told to lower oxalate or drink more water, but HOW do you do it? That’s where she comes in. Through the educational resources at kidneystonediet.com, stone formers can learn everything they need to know to significantly lower new stone risk.
Who is Jeff Sarris?
Jeff’s co-founder of SPYR, a branding agency based out of Chicago, where he and his business partner Dave help awesome people like Jill create online platforms that make an impact. He’s also a certified health coach, Executive Producer of the Netflix documentary Minimalism, and host of the Starting Now podcast.
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Jeff Sarris: 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.
Jill Harris: And I’m Jill Harris, your kidney stone prevention nurse.
Jeff Sarris: And we’re back at it again. How are you doing?
Jill Harris: Back at it again! I’m trying to regain my energy because some followers may know I was in the hospital. They couldn’t figure out anything wrong with me, but it got me a two-day, two-night hospital stay and they don’t know if it was viral, or bacterial, or whatever it was. I was telling people, I lost eight pounds in four days, so severely dehydrated. And, honestly, stone-former audience, I was like, “Oh, please, dear God, don’t let me get a kidney stone during this.” Now, you know, you’re not going to get a kidney stone in such a short time, but, you know, it’s what I do for a living.
So, of course, I’m like, “Oh my God, I need fluids. Get me to the hospital. I need fluids!” So, I’m back. I’m slowly mending. I’m not gonna lie. It really, really drained me and I’m anemic right now, so low and iron from all the diarrhea and everything. It was tough, I have to say, but here I am. Sometimes, people, when you wear bright colors, it cheers you up in your mind, even though you feel grey inside. So, yeah, I thought I’d wear something bright and happy.
Jeff Sarris: Yeah, for sure. That’s the way to do it. Just real quick on that, that is so much to deal with just all of a sudden. I had no idea! Dave had mentioned–like the the other third of Kidney Stone Diet Dave–he mentioned to me that you were in the hospital and I was shocked. That stuff happens so–I want to say so quickly, but something can just happen out of nowhere. Obviously, you were going through it for a period of time, for sure, but it’s just just wild. One day you’re out–
Jill Harris: Well, a lot of people didn’t know because, you know, it just it did just kind of happen. So, you’re absolutely right about that. And, you know, I thought I could handle what was going on, but when I woke up and weighed myself, I’m like, “I need to go now.” And, of course, I was worried about little Finn, but he got good care. It’s nothing worse than you have to go in the hospital, and you got a brand new puppy, and now you have to ask people to watch your puppy. So, that wasn’t easy, either, but I had great people in my life to take care of him. And so here I am. I’m mending and I’m doing okay.
Jeff Sarris: Good I’m glad to hear. So this week, we are going to dive into another listener question. And, if you have any questions, the number is 773-789-8763. And we’d love to answer yours on a future episode. What do you say we get started?
Jill Harris: Let’s go, baby!
Listener Voicemail: Hi, Jeff. Hi, Jill. My name is Julie. I’m from Maryland. First, I want to thank you both for what you do. You both are a blessing. And listening to your podcast has helped me restore my faith in humanity. So, again, thank you. I have three questions. My first question is, what is the difference between kidney stones and bladder stones? My next question is, I’m 46 years old. I still have my period, but I have osteopenia now in my hips and I’m a very active person. I lift, I do cardio, I’ve been that way as long as I can recall. And I was shocked to learn that. So, I am on potassium citrate and hydrochlorothiazide, it’s like 25 milligrams.
So, my question is, is it possible that I could be getting too much calcium, and that is why my urine test is showing I’m having too much calcium? I do eat a lot of calcium. I’m thinking maybe I’m eating too much. And, my last question is, I’ve never had any issues with my kidney stones. I didn’t even know I had them. They were discovered by accident on a scan. It just seemed odd to me that I would never have had any problems with them. My question is, is that common to have kidney stones and not even know you’ve had them? So, those are my questions. Thank you, Jill. Thank you, Jeff. Take care.
Jill Harris: Julie, it is our privilege to be able to serve this kidney stone community, so thank you for your wonderful words. We appreciate them. I wanted to say that first. Okay, lots of great questions. I love when you guys call in and you have, you know, this isn’t just, “Is avocado high in oxalate?” which we’ll do. But this is what I do every day and what really excites me. So, a patient has all these questions and–so let me sum up what she just said to me, to Jeff and I. She has high urine calcium on her urine collection. That’s number one.
She is young, and she has osteopenia, which is the beginning of bone disease. She is taking calcium supplements. She also eats and/or drinks–she didn’t specify, but she said she takes in a lot of calcium. Her question is if she’s taking in too much. So, lots of good things. I get real excited with these meaty questions. So, number one, Julie, I would love to know this–and call back and we’ll talk–I would love to know this: so you didn’t know you had scans–and also the other question, the difference between kidney stones and bladder stones. Let’s get that out of the way because it’s kind of separate than all this wonderful other stuff that we can put together.
What’s the Difference Between Kidney Stones and Bladder Stones?
Kidney stones versus bladder stones. They are different things. Kidney stones happen in the kidneys. It’s where they begin making themselves. Bladder stones make themselves in the bladder. But kidney stones can go to the bladder and be found there, but they are different things. A lot of people say I have bladder stones. They are different than kidney stones, unless the kidney stone traveled down and that was waiting in the bladder to pass. Okay, so there’s that difference. That’s easy. And this is a little bit more meaty–
Jeff Sarris: Just of curiosity, I don’t even know. The bladder comes after the kidneys, right? So then basically–
Jill Harris: It goes like this: kidneys are up here, then the ureters, and then the ureters–can you still see me?–go into the bladder here. Okay, so the kidneys are here up on your back, and the ureters–the kidneys and the bladder are hooked up with that ureters. So those are the little tubes where everyone’s like, “Holy Bragoli, I’ve got a lot of pain!” Because those tubes are teeny weeny, and these stones when they try to go through those tubes into the bladder and hopefully pass, it’s like shards of glass ripping the skin in those ureters. And you may say, “Well, that’s a little dramatic, Jill,” like I always say. But if you listen to my patients every day, I’m being like a little precious, petite kitten saying what they tell me.
Those stones are very big compared to the ureters and when they’re passing, that’s why there’s blood in the urine. It’s breaking up, you know, it’s it’s hurting those ureters. So it’s very, very painful. And lots of times, they get stuck there, and then you have to go up and take them out. What also is painful with UTIs and sepsis is the stone gets stuck in the ureter and urine can get stuck and it backflows. It can’t go out where it wants to: through the bladder, and through the urethra, and then you pee into the commode. It’s getting backflowed, and that’s where stuff can happen. Because remember, now, urine is waste.
The kidney is filtering your blood and the stuff that it doesn’t need, the body doesn’t need, the waste goes out in your urine. So it’s interesting, right? And I think everybody should look at my TikTok account. I have little videos of the ureters and what kidneys look like with stones in them. It’s very interesting and real anatomy, not pictures and stuff. So, it’s really interesting. You should google the anatomy of your kidneys, and your ureters, and your bladder, and see what it looks like. Because I think, too, when we understand what our organs do, we tend to–I got off the phone with the patient this morning. They were very overweight. And they were saying you know, “This is just how hard. Blah blah blah,” and it is hard to get all this under control, that’s why they called me.
When I talk to patients and I tell them, what’s really hard is the excess salt and sugar, the excess fluids you have in your system because you’re not peeing them out because you’re retaining them. That’s a lot of work based upon your diet. That’s a lot of work for your heart and your kidneys to be pumping all that fluid. It’s extra work. And the kidneys are probably the most delicate organ, the most sensitive. So, you know, our other organs are a little hardier than the kidneys. The kidneys are sensitive, so that’s why a lot of us are walking around with CKD: chronic kidney disease. So we really want to be gentle with our body. We want to nourish it. We want to get rid of the excess water by limiting added sugar and salt, right? So our heart and our kidneys don’t have to pump all this extra fluid. It’s super important, but, of course, I digress.
Which Came First: The Stone or the Bone Disease?
Now, let’s talk about lovely Julie. She says I’m 46. I have osteopenia, which is the beginning of bone disease. My question for you, Julie and what I’d like for you to do is call back, or you can write me at email@example.com: why were you dose diagnosed with the osteopenia? Did you have a fracture, and you went in, and you had an x-ray, and someone said, “Oh, and by the way, you have this in your hips?” Or when I look at urine collections from patients, I’ll say, “You have high urine calcium. You might also, when you’re talking to your doctor, about this lab result, you might want to say, ‘Hey, do I need to go get imaging of my bones to make sure they’re okay?'” Because, lots of times, if it’s not diet-related, too much calcium in your urine is very indicative, of course, of bone disease because it could be you’re losing calcium from your bone and the excess is being dumped into your urine, if it’s not diet-related and other disease-related.
If a doctor looks at your urine collection, or I look at it, and I say, “Hey, your diet’s great. Talk to the doctor about these other circumstances that could be leading to high calcium in your urine.” And, if all those things are ruled out, you might just have–of course you need a doctor to diagnose you. As a nurse, I do not–but you might have I.H.: idiopathic hypercalciuria, which means, “Hey, we ruled everything else out. This is just genetics at this point.” And, even if you do, I mean, the diet is even more important for those patients because their calcium would be even higher if they didn’t pay attention to salt and added sugar. So they must do that. In kidney stone disease, wherever there is a stone clinic, a bone clinic is close by because although everyone wants to talk about oxalate, this is so much about too much calcium in the urine, and the multitude of reasons why that could be.
So I’m interested: what came first: the stone or the bone disease? It sounds like, to me, the bone disease, but let us know by calling back. So, she has high urine calcium, which probably led to–again, I’m a nurse, I don’t diagnose anybody–but it could be this high urine calcium was going around for a long time. Nobody, no audience member, would know they had that unless they did a urine collection and why I scream about getting urine collections done, people. If you’re a kidney stone former, and if you’re here you probably are, please make sure you get a 24-hour urine collection ordered from your doctor. Do not take “no” for an answer.
The 24-hour urine collection will tell you why you’re forming stones and also help you understand, or see, and have the doctor see, “Hey, by the way, you’ve got high urine calcium. That’s going to be a problem for kidney stone risk.” So she is very common, somebody who has the beginning of bone disease and also kidney stones.
A Note About Hydrochlorothiazide, Medication, and Kidney Stones
She also said she just happened to find this on imaging when she was doing imaging for something else. She didn’t even know she had that had stones. How common is that? It’s not that uncommon. I hear that a lot. I guess, you know, you don’t hear about that in the kidney stone world because I think most people who tell me they don’t have pain, they kind of feel bad that they don’t have pain because everyone who has had pain it’s so bad; that the people that haven’t had painful kidney stones, they kind of hang out in the background and don’t say much. They kind of have survivor’s guilt about it. But, you know, I hear that once a week in my practice, out of all my stone formers, so it’s not uncommon, but most people suffer pain. For sure, I hear that. You’d be surprised how much I hear that.
So she found it on imaging by going through something else. She had been put on, I’m assuming but I do not know–did the endocrinologist or the primary who’s dealing with your bone disease put you on the calcium citrate and the hydrochlorothiazide, or did your urologist put you on these things? That’s very important for me to know to be able to answer your question properly. The reason I asked who put her on the hydrochlorothiazide, this is a diuretic. It’s a common water pill. It can be used for blood pressure. It can be used, and is used, for kidney stone disease because the side effect of that pill is it will help reduce urine calcium. So it’s used a lot to help prevent kidney stones.
Also, people are put on calcium citrate, sometimes for the bone disease, so I don’t know who put her on these pills, the hydrochlorothiazide is used commonly in kidney stone disease, but in her case, because of the high urine calcium, I don’t know who did it: bone doctor or urologist. So don’t know that. The calcium citrate: did the bone doctor put her on that or did the urologist? So I’d like to know that. Now, if the bone doctor, or whoever is dealing with her bone disease, put her on the calcium citrate, it could be that the doctor said you need this because you have bone disease and you need to get your calcium.
Most adults do not get enough calcium by food or drink. So, they are just given the pills. The pills can increase your stone risk. So, again, I need much more information. It always seems like so easy, but stone disease and just dealing with patient questions are always a little bit more complicated than they seem, and that’s why I love them so much. So, my question for you would be to ask your doctor. This is what I would say if you called me on your urine test, and said, “Let’s go over the tests so I know how to talk to my doctor about this,” I would say this– Always. Sorry, Jeff.
Jeff Sarris: Oh, no, it’s all good. And we are back.
Jill Harris: Sorry, guys. Okay, so we don’t know where I am, right?
Jeff Sarris: I actually just wanted to rewind a little because I just double checked the little transcript I have here from the call and she actually said, “potassium citrate.”
Jill Harris: Better. Okay. Great. Better. I thought it was weird calcium citrate. So the patient said–it was my mistake–the patient said she was put on potassium citrate, not calcium citrate, which is much better. That’s why I thought the bone doctor, the whoever’s dealing with her bone disease must have put her on the calcium citrate, because typically when one is ordered, hydrochlorothiazide, they automatically get put on potassium citrate, because hydrochlorothiazide can lower your potassium levels in your blood. So that’s why those two drugs.
Now, why am I always screaming about the Kidney Stone Diet? Because I want to avoid these drugs. One pill begets another pill, begets another pill. So if we can lower our salt and added sugar, and get our calcium in range by doing that, that’s best. And, by the way, those pills, the hydrochlorothiazide anyway, will not be as effective if the patient doesn’t lower their sodium. So, I always get my way with the dietary changes because some people say, “Forget you and this stupid diet, Jill. I’ve had it! I’m just gonna take the pill!” Well, listen, Bill, if the pill doesn’t work–you still have to lower your sodium, so you still have to do that. “Ugh, I hate you, Jill. Okay.”
So she’s put on the hydrochlorothiazide and the potassium citrate because the doctors–whichever one or both–want to lower her urine calcium. Now, she may say, “Look, I eat healthy. My salt and sugar are good. I still had to go on that pill.” Because sometimes people have other things going on and they still have high urine calcium, perhaps, again, like I said, it’s genetic. Did she get her parathyroid checked? The parathyroid can increase urine calcium. So, hopefully all those things were checked before the hydrochlorothiazide was introduced, meaning hopefully all those things were checked to rule them out before being put on a med.
Of course her doctor, I’m sure, took care of all that. Is she getting too much calcium? She’s like, “I like eating calcium and drinking calcium. I’m worried if I’m getting too much.” Sometimes patients hear me screaming on the internet before they do a urine collection, they change their diet. They say, “She said for me to get calcium, she said if I’m a man 1000. If I’m over woman who still gets her period 1000. If I’m a woman who doesn’t get her period up to 1200, so I’m gonna go to 1800 because more’s better right?” Not necessarily, in most cases, not, as stone formers know, as they did with spinach and almonds, right? They overdid them and got high oxalate.
So, in this case, I always tell my stone formers go up to your goal, not over. Calcium is not that easily absorbed and sometimes if we’re taking too much, too much at a time, if we are people that do have to take calcium supplements, because they have gastric bypass, or whatever, and they must take supplements, they’re not taking it with food. And so, again, it’s complicated, people. There’s many different reasons why you may be getting too much calcium. The extra will wind up in your urine. The doctor just assumes there’s no way you’re eating or drinking too much and slaps a pill on it. So, we want to make sure we are not on medications without needing them.
But, again, as I always say, you guys don’t know what you don’t know. So, when you’re armed with the education that we’re providing you here, then you can have better productive office visits with your doctor. And, Julie can say, “Listen, Doc. Look, I get plenty of calcium. I’m wondering if I’m getting too much,” and you can have these conversations. Not every doctor will understand all that because it’s nutrition-based stuff and they’re surgeons, that’s what they do, but I’m just saying, you could have that conversation and see where it goes.
So, Julie, absolutely, you could be getting too much calcium. Again, if I were working with you, I would say do you think you got too much calcium on the day of the collection? Is that possible? Because when you do the follow-up, urine collection, which of course you should and especially now if you’re put on meds, you want to make sure you’re on the right dose of medications, you do have to do a 24 hour urine follow-up. So always make sure–that’s very important and that gets ordered, okay? Jeff, I think I got everything she asked. Yeah, great question.
Jeff Sarris: Yeah, it was a great question. Thank you for your call, Julie, for sure. And I just wanted to pop over to the site real quick kidneystonediet.com. Right at the top, you see urine analysis, and that’s the consult that Jill alluded to before, where she will help you understand your report. And, like you mentioned, it is such an important first step in all of this and this is why we come back to it so many times. That service, then, is just a a brief chat where you break things down for them and I think that’s extremely valuable. I know you’ve shared how valuable that is for a patient.
Jill Harris: That is very valuable because I wish, as a patient, with all my cancer stuff, somebody prep me to have better conversations with my doctor. So, again, I made that service based upon my experience as a patient with my cancer stuff. And, as a nurse, I do kidney stone prevention, I don’t do cancer. So, I felt like all of you guys do when you go in the urologist office and talk about stones. So when you know what to talk about, not only what to talk about or bring up–but I’m very good at saying, “The Doc may say this, this and this. Here’s what you say when they do.”
Because I’ve been doing this–not because I’m a genius, I’ve just had so much experience–I know what’s going to be said in that office or not said. And I also know what you should say in case the doctor doesn’t ask you and again you don’t know what you don’t know. Julie doesn’t know to say, “I drink a lot of calcium.” Maybe Julie finds me after the doctor appointment and she’s like, “Oh, man,” and then she never said that to her doctor and now she’s on more medication that she may not need.
There’s so much, there’s so much, and I know people are going, “Oh god, here she goes,” but I’m telling you, if you do the things that we’re educating you on, you really can prevent your stones, people. How could I have my own business for 23 years, how can we be doing this so long if patients weren’t successful? So, it’s getting the right information in a way that you can utilize it special for you and that 15-minute phone call is a lifesaver. It, honest to God, is so that.
Jeff Sarris: Yeah, absolutely. Again, thank you Julie for your questions. That was a wonderful call and if you have any questions, any other listeners, the number is 773-789-8763, and we would love to feature you on a future episode. I think with that we will wrap right around here. Head over to kidneystonediet.com if you want to learn more, find the free email newsletter that you’ll send out every Saturday, you can find the Kidney Stone Prevention Group, the Kidney Stone Prevention Course, which is premium, but you get the group calls with Jill every week and just so much there, so head over to kidneystonediet.com to find it all. I think that’ll do it. Thank you for listening and we will see you next time!
Jill Harris: Thank you, Julie! And thanks everybody who’s watching. Subscribe to our channel! Bye!