Can too much potassium citrate cause kidney stones?

The following is designed to entertain and inform, not provide medical advice. Always consult your doctor before starting a new treatment.

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 Jill Harris, your kidney stone prevention nurse.

And we are back at it again with another episode and question. I do really like being in person.

It's so funny.

It's just it's so different because we don't we don't do it this way. So I'm like always thinking about everything a little bit more, just how it sounds and how it's working out. But yeah, it's fun.

I like it.

We love each other.

Yeah, we can never hug or cross the across the computer like that. But it's so nice. It's so nice to be in person.

It is nice. We love it.

Yeah, and I love seeing you, seeing your place. And it's a great neighborhood. And a beautiful day, finally.

And I know we're starting with weather again, I'm sorry.

I know, but god, there's so much to talk about in Chicago when it comes to weather. It's like one day you're in a bikini, the next day you're in a sherpa. So, I mean, it's ridiculous.

I mean my whole line of sherpas, but I think we'll– should we dive right in into this first question? This is a good one from Laurie.

Laurie.

Hello, my name is Laurie and I am calling from Ontario, Canada. Hi Jeff and Jill, I love your pictures posted today. My question is about this.

I think I have asked it at some point, but forgot the answer. Question involves taking potassium citrate to raise my urinary citrate. I ran a pH the last several years ranges from 6.5 to 7.5,

But my urine citrate has been super low-normal on all of my 24-hour urine analysis. The recent being 360. The range for women, from Litholink, says 550 plus to help reduce stone risk.

My question is, how to navigate not increasing my pH to raise risk of infection, calcium phosphate stones, but still raise my citrate using potassium citrate? Should I be concerned? And

Should I be continuing to take the supplement? Thank you. That's all.

Well Laurie, so it's a great question and one that when I'm going over urine collections is common. So a patient has low citrate.

Citrate is a molecule in the body and what it does in for kidney stone prevention, what it does is it surrounds itself around calcium in the urine. And I think of it as like the knight in shining armor

Protecting his lady or man.

And it's like, sorry, it's like a shield so phosphate and oxalate can't connect to her or him, okay?

So, it's a shield. It surrounds itself around calcium and then these other minerals and crystals can't connect to her. Laurie is saying her shield is low, so it leaves it naked and these other little crystals and minerals can connect to calcium and form a stone.

So, people are put on potassium citrate. When we are put on that,

The doctor will say, "Look, I'm looking at the urine collection. The citrate's low. We're going to bump you up with potassium citrate." And so, what's going on with her is she's like,

"My pH is going really high and that is a risk for calcium phosphate stones." She's correct. 'Cause she knows things, 'cause she's been on the Facebook page and she's in my course, so she knows, she's educated herself.

And so she's worried and she's like, "Okay, so do I continue taking this potassium citrate while it's raising my pH still, but this damn citrate still is not increasing? What to do, old lady?" Well,

When we have low urine volume, meaning we're not peeing enough, and we have high urine calcium, we have too much calcium in our urine, and we have a high urine pH,

Those three things are a perfect storm for calcium phosphate stones. Calcium phosphate stones, even though everyone wants to talk about calcium oxalate stones, phosphate stones are a little bit nuttier. They grow faster, they grow bigger,

And they're tough. So, we don't want people to get them, okay? Now,

The doctor saw that Laurie's citrate was low, so he said or she said, "Please, you know, take this potassium citrate." So now Laurie is taking these 24-hour urine collections, her citrate's not rising enough, but her pH is getting hella high. So what are we going to do about that? The doctor can say, "You know what?

We won't care about the pH so much because your urine calcium is fine." Whether Laurie's is or not, I don't know, but if I'm– if the doctor's looking at a urine collection, he's going to look at all those things. "Okay, I see your urine pH is high,

But it alone is not a risk factor for calcium phosphate stones if you're peeing enough because that's protective, and your calcium is where it needs to be. You don't have too high of urine calcium."

So, if those two things are fine, the doctor may not care about the urine pH so much. If those two things aren't fine, or one thing isn't fine, her calcium phosphate stone risk will go up.

So, what to do, because her urine citrate is still on the lower side? Okay, and this is why I say these urine collection consults I do, they're complicated, people. They're complicated.

And so, I hope you can follow this.

Sometimes people who have bowel disease will have lower citrate. Anybody who has malabsorption issues will have lower citrate. So, remember, that shield is low and calcium's naked in your urine,

And that will make you have a higher stone risk. So, the doctor can say, "Well, we certainly don't want to raise the potassium citrate 'cause that's going to raise the pH even more,

And it's really not doing so much for the citrate. So, we'll keep you where you're at so that pH doesn't go up any higher, or maybe even take you off one of those pills if you're on multiple ones. And as long as everything else is cool,

We just won't worry about the citrate as much." Now, it's a problem if she has a bunch of other abnormalities on her urine collection, but if it's simply a citrate issue, then the doctor may say, "Okay, we'll just monitor you and just make sure you're following all other aspects of the diet."

I may also say, "Make sure that you eat your fruits and vegetables, because that will raise naturally your citrate." But, you know, the doctor has some work to do here figuring out what will be the best thing specific for Laurie. This isn't generic advice for all of you. It's just explaining her certain collection, her urine collection,

And some of the things he may do. So, if everything else is cool on her urine collection, just having the citrate be a little low may not be a huge factor for her stone risk. It just depends on the other things.

And as far as the urine pH, if she's peeing enough

And she doesn't have high urine calcium, we may not care about that either. Does that make sense, Jeff?

Yeah, and what is peeing enough again?

Well, peeing enough, thank you, is 2.5 to 3 L. How do you get there, Jill? It just depends.

If you're eating a low-salt, low-sugar diet,

Like Jeff and I do, then we're going to pee a lot more than somebody who doesn't, right? So usually doctors will say drink 100 oz of fluids a day. But for somebody who's tiny like me at 5'2", I'd be swimming away, okay?

So,

We– Dr. Coe and I and in the Kidney Stone world will give you the output we want. And you have to adjust your diet in order to help that output.

It's not just drinking water, it's lowering added sugar and salt as well.

Yeah. And is there a way to actually sort of ballpark it? So if you if you're like, "Oh, I'm peeing this many times a day." I mean, you know me, I always have water with me everywhere I go.

I drink a ton of water. But again, we are also very different sizes, as you can see on the camera.

Right, right.

But yeah, like is there any maybe a frame of reference, too, like not necessarily like, "Oh, you should be peeing this many times," but I don't know, is there any frequency?

Well, it's hard, because maybe a man has prostate issues, so he's peeing 20 times a night, but barely anything's coming out. So, it's hard to tell, right? Typically, when I was nursing at U of Chicago,

And I would empty the, you know, you'd pee in pee in the toilet and you'd have a little hat there for a woman, or a man would put it in a urinal, usually you're peeing about 200 cc's a time. And so you add that up, you can get to it. But, you know, it's very difficult to say.

So, I say,

You know you're hydrated pretty much, it's a nice generic indicator, if you're peeing what looks like water out of you. Once you see it kind of looking yellowish or a little tinged with some color, drink up, okay? But everyone will get there differently.

I have people come to me,

I had a patient this week that peed 7 L and in 25 years, I've never seen that, and she was a very small woman. And I'm like, "How are you leaving the house?" And she's like, "Well, I just want to make sure I'm getting enough fluid." So, I told her, and I don't say this very often, but I'm like, "Slow your roll, Sissy, because you could also then lose too much salt in your system, so you've got to be careful of that." So,

I would, if I were saying anything, I would generically say, drink at least eight ounce glasses of water, eight glasses of 8 oz of water. 64 oz a day, that's your minimum. You should be, I would say on a ballpark, would be 80 to 90 oz of fluids a day.

But again, if your diet is super good and low in sugar and lower in salt and you're eating lots of fruits and vegetables, you're also going to pee more just from that, so you can eat your water as well, right? So that's why we like the output.

People who have done urine collections, which everyone should do one, it's the number one thing to do so you can see why you're forming stones, save the hat or the jug, and every once in a while when you, you know, you're you're you're drinking, just or save your urine and see what you're doing on an average. Six months go by, you forget about that kidney stone, now you're not drinking anymore.

So, people do save those urine jugs or the hats that women use and they fill them up once a day and say, "Oh my god, I'm only, you know, you know, 40 oz came out of me today." So then they're like, "Okay, let me get back on track," you know?

Yeah. Yeah, once things seem better, it's hard to stay on track. Like when you have pain or when you're suffering through something, it's like, "Oh, I'll change." But then we sort of get back to our habits, that's why we talk about habits so much.

Oh, that's why we talk about habits! Unless we have something dangling right in our face that's making something a priority, we tend to forget about it. And this is again why we ask for 24-hour urine collections to be done every year.

I can't tell you how many people come to me,

They called me, they got on track, they stopped making stones, and then 2 years, 3 years go by and I say, "Tommy, don't forget to do your–" "I know, Jill, I'll do the yearly urine collection, 'cause the doctor won't remind you, Tommy, I'll do it."

4 years later, he calls me, "Tommy, where's that urine collection from last year?" "Oh, Jill, well, I– I didn't do it."

And then you just get off track. Why do people gain weight, lose weight, gain weight, lose weight? Once you got to Cousin Vinnie's wedding, you lost your weight, now you're done.

You don't have anything to worry about, so you start eating again. It happens all the time.

So, one of the reasons I do like kidney stones, and the only reason, is typically it's a great impetus to keep that change going, 'cause the pain was so terrible, you never want to deal with that again. All I have to do is say "#stent", and most people will be like, "Babe, get me some water."

'Cause it's it's that awful.

Yeah. But I think that was a wonderful question, and great to touch on something, even though– even if specific to her, it's good because there's so many people out there, and everyone has their own different situation and journey through this.

And it shows Laurie was very smart, no I didn't pay her to call, but she was very smart to bring It's showing how complicated the urine collection is. So, she didn't know what she was doing, meaning she didn't put it there to show how complicated it is,

But it is a great example of how complicated the urine collection is, the thoughts that go behind the results, and the reasons why and what's going on. So, it's again, I know I'm a broken record with get a 24-hour urine collection, but if all of you did, and all of you got on the prevention plan, and the diet is always part of that, you'd just your stone risk would just plummet.

So, please pay attention to that advice, please.

Yeah. Yeah, and it's I think that's a perfect way to wrap because that is the perfect place to start on your journey to make sure that you know where you're where you're coming from. So, kidneystonediet.com is where you can find all the info, the urine analysis, all the free resources, the Kidney Stone Prevention Course,

The Kidney Stone Meal Plans, which were crafted right around the corner here in the kitchen.

In my tiny kitchen. A lot of stuff came out of that tiny kitchen.

It's a beautiful kitchen, though. I love I love your space here. It's like perfect.

And it fits you perfectly.

Little, like me.

But yeah, if you're out there with a question, the number is 773-789-8763 and we would love to feature you on a future episode. And if you like this video, give it a thumbs up, hit that little bell and subscribe to be notified when we post again, 'cause that really helps us reach more people and we appreciate each and every one of you who have been doing that and commenting down below.

It means a lot. So, thank you so much.

Yeah, we're trying to reach 10,000 subscribers. God knows we're working on that. I think we're at like 7,500 right now, so.

Yeah, it's moving right along. And we know so many people out there are suffering. So, it's really it's I mean, it's not even about the numbers.

It's not for us, it's for you guys and everyone else who doesn't even know that they can get the help.

Yeah, I don't care if there's two people listening, there's two people we can help. I don't care about that. It's about if we don't get a lot of subscribers on YouTube, they don't show our channel when you're looking for kidney stone stuff.

So, it's very important that we get the information out and we appreciate all of you that took the 0.5 seconds to press that red button.

Yeah, so thanks again and we will see you next time.

Thank you, Laurie. I appreciate that question. It was a great one.