How to drink enough water to avoid kidney stones?

This week, Jill answers a frequently asked question about how to drink enough water to avoid kidney stones.

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: It’s always a little bonus when we get a song at the beginning.

Jill Harris: Yeah, well, you know, we’re getting to the end of batching all these shows. What is this, our fourth one we’ve taped? So, I get a little loopy at this point.

Jeff Sarris: No, but I mean, this just works best for us and it’s the way to go. But it is funny because it is a lot of information, a lot of answering, but you are doing this all day everyday, too. So it’s along with all the calls, and along with all the one-on-ones, and everything, so it definitely adds up for sure. This episode, we were going to do an FAQ, instead of a listener question. Which, again, if you’re out there with a question 773-789-8763. We want to always make sure we throw in some of the FAQ’s because you have these frequently asked questions coming up all the time. So, it just helps to have a video, or an episode, or whatever it is to send people to. So, what was the topic for today?

Beware of “one-size-fits-all” medical advice

Jill Harris: Well, today we’re going to talk about, and we don’t have to name it this, but “How the hell do I drink all this water, Jill?” That’s going to be the question. So, what typically happens is a patient calls me up, “Jill, my doctor said I have to drink a gallon of water a day.” Now, let’s get this straight. Here’s a woman that’s calling me, five foot one. She weighs 92 pounds. Doctor told her to drink a gallon of water a day. An hour later, I get another private consult. It’s a guy. He’s six foot four and he weighs 262 pounds. “My doctor told me to drink a gallon of water a day.” That’s what I think a big man sounds like. So, we’re giving the same advice–and this happens all the time–we’re giving the same advice to a woman who’s tiny like me, and a big giant man, like Jeff. Tall, big guy.

So does this make sense? How is somebody supposed to drink that much when they’re that little? She’d be floating away! There’s no way! Why am I going to get upset about that advice? Because here’s what also I hear all day. A patient comes to me, “Jill, I got a stone a couple of years ago.” Now the patient has a new stone. The patient, when I look at their urine collection, they didn’t even pee two liters. So very low urine volume. They didn’t pee a lot in the jug. And I’ll say, “Well, look, you’ve been a stone patient for a while, You know to drink more water. Why is this so low?” And the patient will say, “Well, the doctor told me to drink a gallon of water a day, Jill. I can’t do it. So I gave up.” That’s why I get upset.

How can I get enough fluids?

We must think about the advice we’re giving and who we’re giving that advice to because, again, all of us are different. So can that dude drink a gallon of water a day? Yeah, he probably can. It doesn’t mean it’s not gonna be hard for him if it’s something he’s not used to, so understand that I understand that. But, again, what we’re talking about in the Kidney Stone Diet is we–the goal for the Kidney Stone Diet is not how much to take in. It’s how much we want to come out of you. We want 2 1/2-3 liters of fluids to come out of you, of urine a day. How you all get there may be different. Meaning, I do follow the Kidney Stone Diet. I do eat low salt, low sugar. Somebody next to me, my same size, may eat more sugar and salt. They’re gonna have to drink a lot more than me to get that much urine output.

I’m not gonna retain water a lot because I’m not overeating sugar and salt. We all know that salt will have us retain water, but sugar does, too. So when we lower sugar and salt, just by doing that, we’re gonna pee more. So that’s awesome without even increasing fluids. So that’s super cool. But the question remains is how do we get that much fluids in? Well, number one, you may not have to drink a whole gallon. But let’s say you do. Let’s go with that generic advice, drink a gallon of water a day. Please know that you won’t get there in one day. The orders should be, or the treatment plan, should be–the goal, eventually, Irene, is for you to get up to whatever your goal is. Eighty ounces a day? Ninety ounces a day? A gallon is 125 ounces a day, I think? I think it is.

So, for Irene, it may just be 90. If she’s on a low salt, low sugar diet, she’s got that down. But she’s having a hard time with the water. You know, she may not need to drink that much. So how much does she need to drink? And how is she going to get it all in? You practice! I typically tell my students and patients, they’ll say, “Jill, I drink two glasses of water a day. Two. That’s it, if I’m lucky!” That’s one of the reasons they’re making kidney stones. So I will say, “Okay, listen, Bob, add one glass of water to your two to make a total of three a day, for the next week or two. Get used to that.” Get used to that because what happens is patients start chugging all this water, they can’t leave the bathroom. They’re in the bathroom 100 times an hour and up all night, by the way, because they’re not used to drinking all that.

The bladder is a muscle. It will start getting better at holding your urine a little bit longer each time. It’s a muscle. It will adjust to what’s going on with all this new fluid increase, but you can’t go from two glasses at most the day of fluids to now a gallon. You can’t. So we want to manage people’s expectations. We want to give them manageable goals, so they can start feeling successful and not give up. Successful and confident, so they can keep on keepin’ on. And once you get something like the water done, then you’re like, “Hey, I’m good to go with my water. I’m all good with that. Now, I’m gonna work on salt. Now, I’m gonna work on sugar.”

So, how do you do that? You slowly incorporate more fluids. That’s how you start this. Get your bladder adjusted. Get you adjusted to actually remembering to get some water. Use a water app, set an alarm. I have given this advice that, you know, to keep up to make sure you’re getting enough, get a water bottle and put rubber bands up on here. And as you drink one, move the rubber band down. When you drink another bottle, move the rubber band down. So then, you know, “Hey, I drank four bottles,” or “Holy bragioli! I only drank one today and it’s eight o’clock at night. I gotta get back to work!” So there’s many different ways to skin a cat. You need to figure out what’s going to work for you. I like to have water bottles wherever I am because I can be too lazy to go fill it up. So there’s never an excuse. I always have one. There’s one on my nightstand.

So how do you get more fluids in? You slowly adjust to this and you can eat your fluids. Eat more fruits and vegetables. Lots of fluids in those, okay? That’s why they’re filling and you’ll pee more if you increase your fruits and vegetables. So that’s going to help. All fluids count. If you’re going to have a glass of wine, that counts. When you have 10, not so much. But one or two will count. If you’re going to have a beer, that will count. A six-pack? A 12-pack? Not so much. You’re gonna be dehydrated. But all fluids do count in normal serving sizes. When you drink your milk, or your non-dairy milk–get your calcium needs met–that all counts. So, it’s not just water. Also, our advice should be to students and patients, all fluids count.

You want tea? Yes, you can still have it on the low oxalate diet, just don’t drink it all day long. Have a cup or two a day and don’t let it steep all day. People sit there for eight hours with the same tea bag in there. So, all fluids count. Make sure that you’re getting a little bit extra each week until you can finally get used to having all those fluids. Before you know it, honestly, give yourself a couple months to get that much fluid in on a consistent basis. Now, here’s another thing patients do. “Jill, look, I don’t have time. I’m in my car all day. I’m not drinking all day, but let me tell you as soon as I get home, man, I pound those fluids.” Well, let’s not remember, though, we typically think that as soon as we get home, we can erase those eight hours. It didn’t matter.

“Oh, you were dehydrated.” It mattered. The little crystal’s sitting in your urine, they’re looking for each other. They’re looking to hook up, okay? They want to get real friendly. So, you can now get hydrated, but you can’t undo being dehydrated for those eight hours, meaning that ship has sailed. Now, of course, get right back to work, but what we’re looking for is consistent urination throughout the day. I recognize that it’s going to be hard. I don’t mean to ever give this advice and say “Hey, just do it. That’s got to be what it’s got to be.” I never talk to students and patients like that. I will say, “Look, this is hard. It’s going to be a process, but whatever changes you make to decrease your kidney stone risk, I promise you it’ll be worth it.” Those stents, people have lost kidneys, that I work with. They get sepsis. They’re in the ICU. These stones are dreadful, traumatic, disgusting things. We do not want them.

So, yes, is it difficult to make these changes? A hundred percent it is, but it is so worth it if you can stay on to the hospital, not put any damage, not to have any of those surgeries–any of the stuff that we go through with kidney stones, you do not want it. So, every time you’re feeling like, “Oh my god, this is so much!” I want you to think about just staying with that day. Don’t be thinking about what you’ve got to do next week, or that, or that. When I was going through my cancer stuff, I just thought about what I had to do that day because when I started thinking, like, “Oh my god, I have this procedure, and then I got to start more chemo, and then I’ve got to go to New York for that treatment, and all the things,” I would freak the hell out and get overwhelmed.

So, forget about nurse Jill and all that crap, patient Jill–me the patient–I understand what it’s like when you’re thrown into a disease state and then you have to change things or, you know, you just start thinking ahead about, you know, “I’ve got to change salt, then I’ve gotta change suga, then I–” Yes, you do. But just focus on what you can do that day. That’s all you have to do is just get through that day. And, if it’s not a perfect day, which I don’t expect from anyway because that’s incredibly boring, and silly, to ever think that, if you’re having a less than healthy day, or you didn’t meet any of your goals, who cares? Just recognize that and get back to work the next day. The water thing will be something you practice for the rest of your life and you’re not going to always make your 80 ounces, or 100 ounces, or whatever works for you and your body.

Again, if you sweat more, you’re going to need to drink more water because you’re losing it through perspiration. So, everybody’s a little bit different. I have marathon runners with kidney stones. They drink a lot of water, but they’re sweating it all out. Bowel disease patients, how are they going to get their water? “Well, Jill, the doctor said drink a gallon, but the more I drink the more I have diarrhea. It’s not working. I can’t keep up with it. It’s making my bowel stuff worse!” Everybody’s different! This is why I do my private work with people. This is why we have the Kidney Stone Prevention course, so you can get–”okay, I’ve got these orders, but how do I do it?” Slowly, that’s how you do it. Step-by-step. When you feel yourself get a little overwhelmed, take a breath and just focus on what you can do that hour.

It may be you can’t get a glass of water that hour. That’s okay. You get it as soon as you can. That’s it. We’re practicing a healthy lifestyle. We’re practicing the Kidney Stone Diet, you’re doing the best. The only thing I ask of you, the only thing I expect from you, is that you stay in the game. That’s the only thing I care about. If you stay in the game, you’ll be successful. It’s when you get overwhelmed because you’re not setting the right expectations–nor or your health care providers–you get overwhelmed and you give up. This happens all the time. This is why people gain weight back after losing weight. But when you learn how to do things correctly for you and your lifestyle, magic starts to happen. That’s what I gotta say. Did I miss anything, Jeff? Anything to add with that?

Jeff Sarris: I think that’s really good! One of the things I was just thinking when you were saying about the different sizes, I always have this mason jar. What are these–four cups, three cups? I don’t know. It’s huge! But I’m 6’4″. You’re five, two! So, it would be ridiculous if you were walking around drinking this. To me, this is just the normal thing I’m doing. I’ve become accustomed to it and if I don’t have a big glass of water, it just feels weird. I mean, a lot of times I switch the camera when I’m drinking just because I don’t want to be like distracting, but I’m drinking this the whole time. For me, I like having more water and I’m used to doing it over years. But I couldn’t just ever be like, “Oh, okay, I don’t drink any water. Here drink like several of these a day.” That would be such a big leap that wouldn’t make sense and to expect that is not helpful.

Jill Harris: Yeah, I think one of the most valuable things I provide people is common sense. And also taking a look at–because when I was nurse at University of Chicago, you’re in a rush, man. You’re not able to skew things to everyone’s individual needs and that broke my heart as a nurse because that’s what I wanted to do. It’s not like I cared about the science as much. I wasn’t caring about that. I really wanted to be with people and make their life better, but you don’t have time to do that. So I’ll have a lot of patients say, “My doctor is in a rush!” Yes, he or she is because he has to get to 40 more patients! Insurance is dictating our health care, people. So it’s not like they signed up for medicine and said, “I want to see 100 patients a day and barely be able to help them.” I mean, nobody signed up for that, but that’s the way healthcare is practiced.

It can be very disheartening. So, I found a way to do this, where I’m like, “If I want to sit here and talk about water for an hour. I’m doing it and I’m gonna do it a little bit different with everybody. I’m listening, I’m hearing about what their lifestyle is.” Some people hate straws because they have reflux, or they have they have other things going on. Me? I go and I change it up. I can drink more out of this water bottle because it has a straw thing. You should put this in a link: Hydro Flask. I love this company! Nobody sponsors us. We don’t look for sponsors, but this Hydro Flask and with this straw on top, it’s very sturdy, and I love it.

So, that’s great. There’s plenty of great water bottles, people. Pick whatever you want, but I’m just saying that straw helps me guzzle it awesome because there’s nothing very petite and precious about me spilling less with that straw. Sometimes, I’m like in a hurry, or, you know, my normal stuff, and I get water all over me because it’s just who I am. I’m a broad at the end of the day and so the straw helps me navigate the fluids better, too. There’s always a method to my madness!

Jeff Sarris: Yeah, absolutely. Again, it’s what works for you. You find you found it because you were reflecting and seeing sort of what works. “How does this keep me hydrated?” That internal motivation is very valuable, like once you can once you get there from starting, from taking the first action.

Jill Harris: Yes, and if something doesn’t work– I have a patients that I’ve had for the 24 years say, “Jill, I’m doing this now and it’s not working.” Let’s think of a different way. I’ll have patients call me, “Jill, I want four goals that I need to make this month,” and I know that patients so well, I know damn well that I have to do certain things otherwise, they’re never going to do it. So, the best thing about my job is connecting with people and really, even if it’s just the one hour phone call I have with them or a half hour I get a feel. I can hear things on the phone because I’ve just been doing this for so long.

So, I can really feel the heart even over the phone lines and get who I’m talking to you, but I’ll also ask people: “What has worked in the past? And what has not?” WE don’t want to repeat the “not” because I don’t want people to get discouraged. We’ve got to think of a plan that’s going to get you, Trixie, to drink more water. Not Sammy, not Penelope, nobody else but Trixie. It’s very specific and so that’s the best part about my job, figuring that out. I feel like, like I’ve said before, Angie Dickinson Pepper, policewoman. Thank God, most of my patients are my age. They’ll get the reference. But, yeah, it’s like trying to figure out a puzzle. It’s amazing. I love it so much.

Jeff Sarris: Absolutely! If you want to have the weekly calls with Jill, that is part of the Kidney Stone Prevention course and then there are the accountability calls that go with it.

Jill Harris: And it’s on sale, by the way!

Jeff Sarris: Oh, yeah, that’s a good point!

Jill Harris: $40 off.

Jeff Sarris: And that’s a monthly membership from then on for as long as you want to have those calls. There are privates, but those are very expensive just because, of course, your time doesn’t scale. So there can only be so many of those a month. The group calls are a wonderful way to connect directly, but also with one another to understand and like see that, like you’re not the only one going through this. There are a lot of people, so many people, who are experiencing the same thing, the same struggles the same, just pain of kidney stones. It’s such a such a valuable part of all of it and we don’t always touch on that.

Jill Harris: It is, Jeff, because, again, as a patient myself, it is very–you could have a whole house full of people. It’s very isolating, being sick. Whether it’s cancer, stones, heart disease, diabetes, whatever you got. It can be very isolating, so that support group that we have with the course, the accountability group, we are family in that group. We are family. That’s the highlight of my week. We do it about three days a week and the highlight of my week are those calls. I love all my calls, but those calls are special. We’re like family, our little stoner family.

Jeff Sarris: Absolutely! So with that, I think we will wrap for this week. Thanks so much for tuning in, for giving a thumbs up, leaving a comment below, all of the above. We’ll talk to you next time!

Jill Harris: Yes, subscribe, people! It really helps get the word out about kidney stone disease. It’s helpful to people. Everybody have a wonderful day! Drink your water!