In this episode of the Kidney Stone Diet Podcast we learn how diet, genetics, and other existing conditions play a role in the production of kidney stones.
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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, and I’m here as always with the Kidney Stone Prevention Expert, Jill Harris.
Hey, Jill, how’re you doing?
Jill Harris: Hi! Dr. Jill is in the office.
Do you know what I was just thinking? It’s like, isn’t it funny on these Zoom calls, when you’re ending you wave goodbye. Isn’t that weird? Like, if you and I were in the same room, and we were having a meeting, nobody would wave goodbye.
The hell is that? Have you noticed that, in the Zoom world lately? I’m like, why is everyone doing that? So funny. But I do it too.
Jeff Sarris: Yeah, if we were sitting across the table right now from each other, we wouldn’t sign off of our conversation by waving and then just stopping.
Jill Harris: No, but you know, I don’t think our world has navigated how we do all this, right? Because it’s kind of abrupt if you just like, “Hi.” I don’t know, it’s awkward. So, you know, when I figure out a better way, I’ll be the first one to promote it. Until then I’m just gonna wave.
Jeff Sarris: Oh, yeah, for sure. And then hopefully, at some point, we’ll be able to start doing this in person too so then it will be much more casual and comfortable, because it is different. We’re looking each other through a screen. And we’ve spent a bunch of time together, but right now, with everything going on, this is the most effective way to handle things right now.
So this week, I think what we’re gonna dive into are actually the causes of kidney stones. So what would you say? Where would you want to begin in talking about what causes kidney stones?
Why some people get kidney stones while others don’t
Jill Harris: Well, I think the first thing I would say is, you know, people say, “Well, how does this happen to me?” You know, why do some people get cancer, some people get kidney stones, you know, why do some people have the same diet as another person, but one gets something and the other one doesn’t?
You hear you know, somebody smoked 80 years and they don’t have cancer. But somebody smoked 10 and they have lots of it. So we all have to realize that we have a genetic propensity for certain types of things. We just do. That’s not very scientific. And it’s not fun, but it’s true. So there’s that.
But the things that we can definitely pinpoint. What are some predisposing factors for somebody who is prone to kidney stones to get them? Number one, there is a genetic component. I won’t get into that part right now because it’s meaty, but there is a genetic component. So remember to tell your doctor, you could say “Look, my sister, my brother, my mother, we all have stuff.” By you saying that that will give them a clue to actually do some testing if they weren’t going to which they all should order 24 hour urine collections.
You’re going to hear me say that all the time. There’s not enough testing done for kidney stone patients so they keep going on to forming stones. So number one, why do people keep getting stones? Because they’re not being tested. They’re told to wait for the second stone. I don’t know why somebody would wait for a second. A second occurrence of anything before there’s proper testing and then a treatment plan put in place.
I’m going to say that a lot people, get used to it. So tell your doctor if you have a family history of kidney stones, it will definitely prompt to get a test for you. Okay, 24 hour urine collection.
Medical conditions that can cause kidney stones
Jill Harris: The other things, there are some medical conditions that will predispose a patient to get kidney stones. There are surgeries that will predispose patients to getting kidney stones The medical conditions are perhaps your parathyroids these little glands here surrounding your thyroid, perhaps they’re overreacting, and they will cause your body to make too much calcium. So that can be a cause. Perhaps you have bowel disease, which is ulcerative colitis, Crohn’s, IBD, IBS. And that causes you to have a lot of diarrhea where you’re not absorbing nutrients properly or over absorbing some nutrients. So there’s that issue.
There could be things like sarcoidosis, there’s a couple of medications that could be an issue. There could be you’ve had a surgery, like my surgery where I’ve had a lower anterior resection, perhaps you’ve had part of your colon removed, perhaps you’ve had some of your small bowel removed, so you have malabsorption issues now. Perhaps you’ve had bariatric surgery, which is the big fancy name for you’ve had a weight loss surgery.
So these are some reasons why patients can form stones aside from diet. Now, a lot of patients don’t have any of those things. But they still make kidney stones. So, again, I will always say that if you have a pre-disposition, okay, you’re predisposed to making them. So again, maybe my diet is exactly like yours, Jeff, but you’re not going to make stones and I am.
How your diet affects kidney stones
Jill Harris: But a lot of the reason is you may not have any of those things I just mentioned, but you may have a terrible diet and terrible sounds very judgy. Let’s reframe that, an unhealthy diet where you’ve been eating like a 12 year old kid your entire adult life. You eat corn chips, you drink gin all day. You’re not paying attention to all the added sugar you’re eating.
You’re overweight. Being overweight will predispose you to form kidney stones. That’s a big factor too, as it is for everything. And, again, why I’m always so interested in talking about lifestyle changes. Because if we can get you to lose weight and eat healthy, then a lot of these things just disappear.
And my biggest thing for all of you is that you don’t have to go on medications. Now some of you still will. You will do your lifestyle changes and you’re still going to have to go on medications, but the whole goal is to never go on medications. That’s the goal. So when you eat too much sodium when you eat too much added sugar. When you overeat foods that are very high in oxalate. When you do not drink enough fluids, especially water because you may say well, “I drink Coke all day what’s going on?” Not soda. Not soda, water, hydrating fluids.
When you don’t get enough calcium, many patients come to me. Look, in 21 years I’ve never worked with an adult that says, “Oh Sister, I got the calcium down. Got it all down. Not a problem here. Bones are great.” Now your bones may be great because you’re 30, but by the time you get to my age and older, you may be losing bone we so you need calcium not only for stone disease, but you got a skeleton too. As Dr. Coe always says, you got to feed it.
And so it makes sense to people that if they have a calcium based stone (there’s calcium oxalate stones or calcium phosphate stones, uric acid stones, and so you have different types of stones), but the calcium based ones, a lot of doctors, still to this day, they will tell patients, “if you make a calcium stone, you better cut out all calcium.”
Well, studies will show when we cut out all calcium, our risk is increased, because that’s the only way we can get rid of oxalate that’s building up in our body from eating high oxalate foods. And sometimes from other medical conditions, one has like the malabsorption issues and also eating too much protein. So that is also a precursor and can make you more prone to kidney stone disease.
So a lot of these diets that people are on: high protein diets, Atkins-like diets, low carbohydrate diets, they can definitely be a factor. So it’s very important to know what each of the aspects of the Kidney Stone Diet does to minimize your risk and when you make these lifestyle changes. It’s helpful
We can get rid of up to 80% of reoccurrence of stones. The other 20% is because there are other medical conditions going on. But even with those medical conditions, we can at least lower the risk.
So I have had many patients come to me over the years and they say, “well, I’ve just been told that I’m a stone factory.” You know, that’s that’s taking away all their hope. That’s not true. If we if we can’t because you have – and there’s another Medullary Sponge Kidney, MSK, some patients have that. And that can be a precursor for stone disease too. And those patients have certain things going on, where they may not be stone free, but we can certainly lessen their reoccurrence.
And again, by the way, the side effect of the Kidney Stone Diet is just a good healthy diet. So when we’re lowering sodium, when we’re eating our food in normal portion sizes and not as much as we want, all of this is very important in our overall health so kidney stones, lessening the risk of them, is the number one thing I’m interested in.
But then, right up there, is also just great general health for you. So if you take my Kidney Stone Prevention Course, many people also lower their their blood sugar they get to lower their medications, some get off medication, their cholesterol goes down. Why? Am I the tooth fairy? No, I’m teaching you how to eat. So you get your just overall healthy, low sugar, low salt-come on, say goodbye to blood pressure, say goodbye to the obesity and all these things come into place.
So you know, and when, by the way, you lose a little weight and you get healthy and you feel better in your mind, you might want to move more.
So again, it’s all a catch-22 It’s all a vicious cycle. When you’re overweight, you’re not eating well. You don’t want to move either. So you know all of this. All of this plays an important role in kidney stone prevention. So there are medical conditions that will predispose the patient. There’s also genetic issues that can predispose the patient. But mostly it’s people who have some kind of propensity to make stones. That’s just part of their DNA. And it’s diet-related once we change the lifestyle and diets with some meds here and there thrown in. Now, for the majority it’s just lifestyle changes for the majority of my patients.
I still get Christmas cards 20 years out that says “still stone free!” Again, Tooth Fairy? No. Santa Claus? No. People are working their butts off on maintaining their lifestyle. So it’s not something you’re going to do and then forget about. You’ve got to do this for the rest of your life if you don’t want to have stones. And, by the way, if you don’t want to become overweight again, and all these other medical conditions that are being caused by a terrible diet. So can we please not take medications and just get on lifestyle changes? Please.
Jeff Sarris: Yeah, I mean, it’s amazing how complex it is. I think we would hope that it’s as simple as all I need to do is reduce oxalate, all I need to do is increase calcium. Which the calcium side of things I think bears repeating even. Because we do assume calcium stones = too much calcium. And I think that I think that’s going to be revelatory for a lot of people who are just learning about stones right now.
To say that you would increase calcium to reduce your incidence. Can you do something as simple as take supplements?
Do you have to drink milk to get more calcium or can I take supplements?
Jill Harris: Well, that’s the thing. So the first thing patients say to me, is, you know, “I don’t do dairy.” Never in my whole life, never in my life have I said drink milk. But as soon as a doctor may say increase your calcium, the first thing we think of, because we’ve all been brought up with Got Milk, the first thing we associate with calcium is dairy.
And so my vegan patients come to me and say, “I’m not drinking milk, Jill. So what do you got for me? I’m going to take pills.”
But research will show that taking supplements will also increase your risk. So there’s so much information and misinformation about kidney stones. And this is why by the time people get to me, and they’re on their 20th stone, because they’re finally doing something about it. Because that 20th stone sent them to the ICU and they lost their kidney. So now they’re willing to do something about it. And the doctor got serious about it too, by the way, by the time they get to me, they’re very interested in making changes.
And the one of the first things they’ll say is, “you know, I will take a supplement.” But supplements are not digested as well as when it’s in food, when calcium is in food. The other unfortunate part for vegans is they’re like, “Well, I was eating spinach, and it has a lot of calcium.” But the problem with that is spinach is so high in oxalate, it doesn’t even matter that there’s calcium in it.
Why more healthy food does not mean more health
Jill Harris: Lots of times when we eat healthy, we overeat healthy foods thinking we’re going to gain more health. And a lot of cases, unfortunately, and very frustrating is that these patients formed kidney stones because they had spinach smoothies and they ate spinach all the time. And with the lack of calcium, and all these high oxalate foods, like almonds too, you know, they’re very healthy diet caused their stone. And that’s unfortunate, because I have dealt with so many patients, thousands of patients that have come to me and said, “okay, sister, I have worked my tush off on my diet. After my endocrinologist said, and my nephrologist said, You’ve got to lose 100 pounds. And Jill, I did that. I lost my hundred pounds. And then I gained 5 stones. And now I’m at a loss as to what to do because I was eating spinach and almonds all day long. And so what am I supposed to do if I can’t gain my weight back? I don’t want to go back on my high doses of insulin. So what am I supposed to do?”
And that’s where I come in. And that’s what excites me to teach somebody that although they were eating healthy, just because the food is healthy does not give us the right to overeat it. More healthy food does not equal more health. And in this case, unfortunately, it led to a kidney stone.
So it’s about everything in portion size. Everything even healthy foods. And the problem with spinach and almonds, they can’t be eaten any more on the Kidney Stone Diet. They’re just so high in oxalate. So that’s unfortunate because the patient has worked so hard on losing weight. And then, you know that they’ll say to me, “I gave myself a stone.” And I always say you didn’t give yourself a stone, you had no idea about this. So, you know, they feel so sad and defeated that they worked so hard, and they landed up in the hospital anyway. So my heart always feel so sad for patients and really, I can’t wait to help them because of that alone.
You know, there’s nothing worse in life when you’ve worked really hard at something and come to find out that you were doing something that became a detriment to you. It’s heartbreaking, right? So that story never gets old to me. And it’s quite a frequent story. I deal with patients eight hours a day. I’m doing patient calls, we’re one-on-one or working in my Kidney Stone Prevention Course. I’m dealing with that story all day long. So that’s a big deal.
Jeff Sarris: Yeah, that that just has to be heartbreaking. Like, I’m a certified health coach and before we started working together and talking. I knew nothing about oxalate. I knew nothing about kidney stones.
It’s just, you don’t even know what you don’t know. And that’s why I think this is such a valuable podcast, platform, everything for people because we want them to be aware. Just to get the message out that you may be checking all those boxes, doing exactly what everyone’s saying. Like, “this is how one is healthy.” But it isn’t. It isn’t always that cut and dry. I mean, there’re so many factors.
Jill Harris: It really isn’t. And when I lecture nutritionists, I’ll be invited to their conferences, and they’re always like, “what the heck is this nurse doing in our conference?” But I tell them, when you’re dealing with people who have diabetes or weight loss, please ask them. I’m like, I’m not trying to be bossy. I’m just saying it would be helpful.
Because they don’t know, none of us. I didn’t learn this in nursing school. No one’s talking about kidney stone disease. Everyone is doing what they’re doing, right? And so, when you go to nutrition school or dietetics school, you’re learning the main things: obesity, diabetes, cardiovascular disease. These men and women in nutrition are so busy dealing with this stuff, you know, so what are we telling them? We’re telling the general population to eat spinach, eat almonds.
So please, when I lecture nutritionists at their conferences, or when I’m talking to other doctors and nurses, I’m like, ask these patients you’re dealing with, if they have kidney stone disease, or if it’s in their family. And please remind these patients not to overeat spinach and almonds.
Portion not perfection
Jill Harris: So, lots of the time my Stoners, this is what they call themselves, my Stoners are going to get help before they met me with weight loss or other medical conditions they’re dealing with. And so, you know, they’re being told eat eat spinach. “It’s really great for you and healthy and, you know, the almonds will keep you full.” So by the time patients get to me with their stones, like I don’t know what happened, “Jill, I was eating a handful of almonds, handfuls, just a few handfuls,” and I’m like, “Bob, look at your hands they’re as big as my head! “That’s a lot of almonds!”
So along with absolutely no calcium in your diet because, again, most grownups are not getting enough calcium. It was a perfect storm to make a stone. And, again, it’s heartbreaking because you didn’t know what you didn’t know.
And even with healthy food, my message is always this. People on my Facebook page always hear me say portion not perfection. So you can definitely have treats and you can definitely put healthy foods back into your diet except things like almonds and spinach. They are no no, but even if you’re eating a little higher oxalate food, and most of them are healthy, it’s always about portion sizes.
I don’t know why in goodnesses name we think we can eat as much as we want of any food, even if it’s a healthy food. We need to eat normal portions on our plates, end of story. It’s boring. Nobody wants to hear that. That’s why Atkins and and keto and all these other diets are so popular because you take away one food group, but you can eat as much as you want. Come on, what sense does this make.
I don’t win no friends saying that, I don’t care. It’s common sense. You can eat as much as you want and so that’s what happens with people who are eating a healthier diet to lose weight. They’re eating as much as they want, the really high oxalate foods and, you know, on paleo and some of these other diets you’re supposed to just cut out dairy in big amounts, right. So no milk or whatever dairy source you’re eating. So, you know, it’s a perfect storm for kidney stones. And yeah, there you go.
It does make me sad, but you don’t know what you don’t know. So it’s nobody’s fault that they got a stone. It really isn’t. And then you learn about it. And then you make the changes, and then you don’t form stones anymore. And then everybody’s happy.
Jeff Sarris: Yeah, I mean, I think that’s the thing there. There is hope. I hope that this this show really shows that there is hope.
And when you’re in it, because I’ve never personally experienced a stone, but I’m sure when you’re in it it feels like there’s no hope, there’s no way out. Because everything that I’ve come to understand about it, it is a horrific pain.
And I think that’s actually the next episode. I think we’re going to dive into some of the symptoms how someone might know if they’re forming stones or are likely to form stones. But I think we’ll wrap this episode here.
This was great. And in the future, we’ll also dive in deep to oxalate and we’ll dive into calcium, to sodium. This is a never ending rabbit hole of learning for people. So yeah, we’ll wrap here. For anyone to dive deeper they can go to kidneystonediet.com to check out your course. Do you want to give just a little run through of what’s in the course along with the the calls that are included?
The Kidney Stone Prevention Course
Jill Harris: So the Kidney Stone Prevention Course is a series of five videos teaching you what the Kidney Stone Diet is, how to get proper testing, how to talk to your doctor during a doctor’s visit, things you should be thinking about. And then how to get more calcium, how to lower your protein, how to lower salt and sugar, step by step, really great.
But really even better, is that it comes with a month of calls. They’re like office hours. So after you watch the videos, or while you’re watching the videos, I have daily office hours where you come in, whether you come in once a week, every day, whatever you want. And I motivate you and we talk about exactly what’s getting in your way of making the changes.
Everyone in the course, there’s a lot of people in it, and there’s a big group call and everybody gets to learn from each other, figure out how to improve, implement the changes based upon what you have going on. So it’s not generic advice. The calls are, I think the most important part of the Kidney Stone Prevention Course. You’re getting a nurse who has been teaching kidney stone prevention for over two decades. I help you specifically with all you’ve got going on and implement the changes your doctor has asked you to do. So they’re very helpful and the bread and butter of the course for you. You’re gonna love it. I promise you’ll love it.
Jeff Sarris: Definitely. Yeah, you have a great community you’ve put together and people just keep coming back. I mean, as you’ve said you’re getting Christmas cards directly from people this
Jill Harris: Yes, but I think it’s what you said, Jeff. It’s like people come to me and they’ve lost all hope. They were told, oh, well, you’re a stone factory, nothing you can do. That’s not true. You can prevent kidney stones up to 80% of reoccurrence. Gone. But you’ve got to be willing to do the work. There’s no magic wand here, I’ll say it every episode. No magic wand. You’ve got to be ready.
The only good thing about pain is that’s a powerful motivator. So I’m looking forward to helping anybody who wants to join the Kidney Stone Prevention Course at kidneystonediet.com.
Jeff Sarris: Absolutely. And yeah, we’ll call it a wrap for this week. And again in the next episode, we’re going to talk about the symptoms of kidney stones and how you can know if maybe you are in the early stages or even late stages of producing stones. So thanks again, Jill, for doing this. And if you’ve enjoyed this episode, don’t forget this is a podcast and video. You can follow the video version of this show on YouTube at Kidney Stone Diet and subscribe to the podcast on Apple Podcasts, Spotify, or wherever you listen to podcasts. So we’ll call that a wrap today. Thank you so much, Jill.
Jill Harris: Bye, Jeff.
Jeff Sarris: Yeah, we’ll see you next time.
Jill Harris: You will, bye.