How do I get calcium on a plant based diet?

This week, Jill answers a listener question about plant-based diets, calcium levels, and what to make of supplementation.

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.

Is pumpkin high oxalate?

Jill Harris: I’m Jill Harris, your kidney stone prevention nurse. Okay, all I’m gonna say is this I love Fall. It makes me very happy and as soon as the weather started getting colder, I mean, it’s not even October 1st and I don’t want to see pumpkin spice nothing ever again. I don’t want to see a Rae Dunn candle. I don’t want to see Starbucks coffee. I don’t want to see anything pumpkin spice. And it’s not even October 1st. I went a little bit too far too fast in September.

Jeff Sarris: Yeah, when we were in on our trip in Miami, they started serving pumpkin spice lattes when we were there, like it was the middle of early September. And Amara is like, “I don’t know, should I? Do I dive in?” I’m like, I don’t know! It feels early. Like for me because I want summer to stick around, I don’t want to accept that summer’s over. So it’s a weird kind of thing.

Jill Harris: I just don’t even understand how it started. I mean, it’s like pumpkin spice everything. Leaded, regular pumpkin spice. I mean, it’s just all over the place. It’s just like one season just went crazy and now it’s just like, pumpkin spice is Fall. It’s crazy.

Jeff Sarris: Yeah, it’s wild. And it is funny, too, because it’s not even pumpkin, like the whole thing is that it’s a spice in pumpkin pie. So it’s funny. I don’t even know.

Jill Harris: Cinnamon, clove, it’s sugar is what it is! There’s no pumpkin anywhere. Is pumpkin high oxalate? No, you can enjoy pumpkin because everyone’s like, “Shit, is pumpkin high oxalate?” But, first of all, there’s no pumpkin in any of that, right? Because pumpkin is just squash with a lot of cinnamon and sugar. That’s it! So, yeah, I’m already sick of it, though.

Jeff Sarris: Yeah, it gets to be everywhere. But, we have another great question today. It’s a slightly longer voicemail, but this is gonna be a good one.

Listener Voicemail: Hi, Jeff. My name is Damian from the Bronx and I want to first thank you and Jill, for providing us with this platform to be able to seek answers about preventing kidney stones. I, myself overcame cancer of the prostate 14 years ago. A kidney stone was removed in 1999 while I was eating very unhealthy. I had two calcium oxalate stones removed last year. I think not drinking of water caused my urine to be saturated and, on top of all of that, last year, I was diagnosed with AFib. I was also born with one kidney. I recently did a 24 hour urine collection volume, 3000 milliliters through Quest Diagnostic. According to the report, what was within good range was my oxalate at 21 milligrams, citrate 510 milligrams.

However, what was low was my phosphorus 240 milligrams, sodium less than 20, and EQ, I don’t know what that is. Now, I took notice that Dr. Coe recommends urine calcium to be below 200 milligrams. Now, my urine calcium was 231 milligrams. On my Quest Diagnostic report, I was told that the standard was above 250 milligrams. When I asked my nephrologist, in writing, should I not lower this to be less than 200 milligrams? His reply was a normal calcium is fine and not to make any changes. Now, during that time, I have not been meeting the RDA, 1000 milligrams of calcium, not even close to that. I am on a whole food, plant-based diet and I avoid dairy. So, my question to you Jill is by increasing my dietary calcium, is that going to lower my urine calcium or raise it? My serine calcium is within range on the higher side. Thank you again for taking my call and for the platform you provide to those looking for guidance. Thank you again.

I Don’t Eat Dairy, so Where did this Excess Calcium come from?

Jill Harris: Yo, Damien, from the Bronx in the house! I’m originally a New Yorker myself, so welcome. Y’all are on fire giving these questions. This is a doozy. I just love everything about it, Dam. So let’s talk about it. And from one cancer survivor to another, I hear you and I see with your prostate cancer. I’m happy that you were able to call in and you’re in survivorship, so good for you. So in 1999, you had a stone, 2 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. Now 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. Some labs will say we want it under 200 for women, the urine calcium, we don’t want more, you’re more than 200 Urine calcium for women and more than 250 for men. Dr. Coe would, ideally, like everybody to be under 200. What does that mean? Some people will say, “Jill, I haven’t had a glass of milk since 1962. How do I have all this extra calcium?” Now, Damien said he had 230 calcium in his urine. Some people have 500, 600, 700 and they’ll say, “What the hell is this? I don’t even use dairy!” So where’s that calcium coming from?

It 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 because those things can pull calcium from our bone and dump some in our urine, excess. He said he has less than 20 milli equivalents for sodium, so he wasn’t eating overeating salt on that day. So we know that that’s not a problem. He’s a plant-based eater, so where’s the where’s this extra calcium coming from? And, by the way, Damien, it’s not that much, but the point is, you know, let’s just say under 250, for men is typical. Yes, Dr. Coe says the ideal is 200, but nobody’s freaking out if it’s 250. He will say even 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’s this coming from?

Well, you said it was low salt and we can’t tell by your own collections if you ate too much added sugar. Now you said you’re a vegetarian or vegan, or plant-based, so I don’t think you’re eating too much sugar, but let’s just say this. A 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 over eating sugar because cake don’t have meat in it. So just because someone says they’re a vegan or vegetarian, I still ask my questions because, again, a urine collection is not going to tell me how much sugar a person ate that day. It tells me the salt, it tells me the meat, but it doesn’t tell me the sugar.

Damien, 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, like I said, it’s coming from your bone. So, you really need normal amounts of calcium. It’s very important. So, for Damien, it’s up to 1000 milligrams a day. You get it spread throughout the day. Could be from non-dairy milks, there’s vegetables–I even have an article that will show you how the high calcium, low oxalate foods. So look in my blog. It will say these are vegetables that have calcium. And I know my patients well enough to know they’re gonna say “Yeah, but how much oxalates in that?” I already did all the work and that’s in an article, too.

So, you need up to 1000 milligrams a day, you need to spread that throughout the day, not having it all at once. Not saying you will, Damien, but I gotta sleep well at night. Gotta make sure I’m clear. And we don’t want patients having more than 500 milligrams 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 how 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. 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. So it looks good, I’m gonna ask them about sugar, make sure we’re cool there. Meat protein? He’s a vegetarian. Ain’t overeating that. So the next thing is I’m gonna 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 puts you on a supplement really high and never rechecked your blood to make sure your vitamin D was normal, you can be over absorbing calcium. If that’s all cool, if your vitamin D is great, 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 it’s on the higher side, Jill?” More than 10.2 for blood calcium, typically. So, there’s many different things to ask the patient. But , , Damien, yours is just a little high. So 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 because sometimes when patients find out they should be doing calcium, they start drinking milk with every little two milligrams of oxalate. Before you know it, they drink over 3000 milligrams of calcium. Don’t do that. More is not better, people. Less is not better, people. We try to stick close to the goals. 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.

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 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 hearty 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.

So if you 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 while you’re not absorbing it, that’s not going to affect your your urine calcium numbers. So you do need to get up to 1000. Kidneystonediet.com, the blog to find out vegetarian options for you to get that. And what was the last thing I wanted to tell you? Ah, 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 because 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 your own 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 because I see myself as Angie Dickinson Pepper from Policewoman. If you’re my age, you’ll get the reference. So, pepper is saying, “Low sodium, low sodium, Dam, we want to look at that.” Otherwise, 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, it’s just fine for your calcium. But, with your sodium that low, 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 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 and the more detailed the better. Thank you! 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 Damie, 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. But thank you, I loved it.

And the calcium one is so super important. 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 it’s super important. 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 medication, otherwise, you’re gonna 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.

Jeff Sarris: I think that was wonderful. I feel like I don’t want to touch it. I don’t want to jump in because that was a beautiful, complete look into really how you can help people work through these numbers and understand everything better. And that was a great question to be able to hear from someone who’s in it and he’s been in it for so long. “Where am I at? How can I go from here?” Because we’re all at a different point in the journey. A lot of people come in brand new. They’ve never had a urine collection. They’ve never experienced any of the proactive part of doing this. So it’s great to hear from Damien and, sort of, have a little vantage point into that part of the process of this. That’s huge.

Jill Harris: And, also, what I am thinking, and what a urine collection call entails, there’s a lot of things, there’s a lot of ladders I go down and up to figure out exactly how to navigate that patient’s doctor’s office visit. I do want to say this, too. As a nurse, I never override a doctor’s order. What my job is–you listen to your doctor–what my job is and Jeff’s job is our job is to educate you, so you can have educated conversations with your doctor and get on the best treatment plan possible. That’s my job. From one friend to another, what I’m trying to do is educate people, so they can make the best discussion points with their doctor so that doctor can see how motivated you are. Maybe the doctor is really in a rush and you bring something up and they’re like, “Oh, yeah, and that and that.” And then the two of you can talk and really get on the best treatment plan, which is always going to be the Kidney Stone Diet. But other things, you know, blood tests and medications, that may be a part of your treatment plan as well. Very, very important. So I wanted to say that, too.

Jeff Sarris: Yeah, absolutely. Yeah. And, on the website, right at the top, you’ll see urine analysis, urinalysis. You can find all the details there and sign up if that’s something that will help you on your journey. I think this is a wonderful question. Thank you so much, Damien! And if you’re out there with with a question, something we’ve never covered, something we have covered, no matter what it is, the number is 773-789-8763. And we would love to have your voice on a future episode because this is really nice. It’s so nice. Being able to bring people in like this in a way that’s different than like over Facebook or over email or whatever, sort of in this like public forum sense because it is it’s a little different. Like you do it with your accountability calls and you have the groups and everything, but it’s nice to be able to hear someone’s story, hear where they are, and allow other listeners and community members who might not be active to be like, “Oh, I’m there. I’m at this point in my journey. This is so helpful for me to understand how I can relate to this.”

Jill Harris: Absolutely! 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 I really take that to heart, it’s very important to me. It just is. I feel like the kidney stone formers are kind of–one of the underdogs in the in the medical field. They just kind of get overlooked. It’s not something that’s studied a lot in school, like 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. Sometimes the kidney stone people get just pushed aside, so, of course, 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 kidneystone.uchicago.edu. He’s a scientist and a nephrologist at the University of Chicago. He’s thought of as the granddaddy of kidney stone prevention, and 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, it’s 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, that’s what he wants to leave. Also, the Kidney Stone Prevention course is $40 off. Today is, I think, September 30. 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–” 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. Forty dollars off, at $149, you will never be able to beat that price. So we want to give that to you as well, temporarily.

Jeff Sarris: That’s kidneystonediet.com and you can find everything. So, I think we will wrap here. Thanks again for tuning in and we will see you next week.

Jill Harris: Damien, you made me so happy, baby! Thank you for that question. Take care of that one kidney. God bless you being a prostate survivor and take care of that heart, honey. I’m so glad that you’ve turned things around. I’m so proud of you! Keep it up!