Calcium is important, we want to keep calcium in your bone so you don't get osteopenia, and that's the beginning of osteoporosis. And we don't want too much- if too much calcium is flying around in your kidney, then oxalate and phosphate- so you got all these little crystals sitting in your urine in the kidney. If you don't pee a lot, they're going to find each other, like little bunches of magnets looking for each other.
Calcium's looking for phosphate, phosphate's looking for calcium, oxalate's looking for calcium. And so they're all looking for each other in there. This is why we want you to pee more.
If you eat too much salt, you'll have too much calcium also in your urine. That usually follows pretty well. So I'll look at a urine collection and maybe Bob comes to me, he did a urine collection, his sodium was 6,000 in the first collection.
He works with me. What does work with me? You have one phone call, then I tell him tell the make sure the doctor does a follow-up test to see if we can lower that urine calcium because too much calcium again in the urine is going to cause kidney stones and you're at risk for bone loss.
I've had a lot of men, too, by the way, when they finally get a urine collection and I'm looking at it, I'm like, "Have you had a- have you had a bone density check?" "No. I'm a guy, Jill." You have 600 levels of calcium in your urine. You better go- "Oh, Jill, I got osteoporosis." So the urine collection tells you a lot more than you think it does.
Get it done, folks. So you will keep making stones if you don't lower your sodium. You will keep making stones if you don't get enough calcium.
Well, now I don't even understand what's going on, Jill. You just said I if I have too much calcium in my urine, why would I want to get calcium? Well, and Jeff knows this, I've never worked with anybody that gets plenty of calcium in their diet until they do a urine collection and see all these things going on.
Most of you have never thought about getting calcium into your diet until a doctor has told you to do it after you make a kidney stone or a doctor has told you to do it after you got bone disease. Now, all of a sudden in our 50s and 60s, we're being told to get enough calcium. So, even though you have high urine calcium, that doesn't- it wasn't because you were eating too much calcium.
You need calcium for your bones. You're losing it. A lot of you are losing it from your bones, so you better be getting it from food or drink, whether it's plant-based or dairy.
And so you need calcium. And the reason also, not just to replenish bone, but you need calcium because that will lower oxalate. Calcium and oxalate will join in your gut and go out through the stool.
If you don't have any calcium after you eat stuff, if you ate something that was higher in oxalate, and it goes through your stomach, then it's going to the small intestine. After the small intestine, what happens is that's where we soak up nutrients, goes into the blood. Oxalate won't go into your bloodstream and get reabsorbed if it has calcium with it when you ate it, because calcium and oxalate joined together in your small intestine is too big of a molecule for the blood to sap- sop back up, okay?
So calcium and oxalate will leave through the stool. And that's how we lower oxalate. I have blog posts on that.
And so the other thing is we want to lower added sugar. Think about candies, cookies, cakes, ice creams. We want to do less of that.
Too much added sugar, too much junk food can also pull calcium from the bone and also lower urine volume. We all know that when we eat too much salt, we can pee less, but also when we eat too much added sugar or sugar, we can pee less, too, okay? Added sugar, specifically.
And so, and then the other part is the meat protein goal. I have a blog post how to calculate meat protein on my blog at kidneystonediet.com. And when we eat too much meat, too much, like carnivore diet, paleo, too much meat, this can lower citrate, lower your pH and make it very acidic.
And that is a problem, okay? Typically, too, when you're eating a lot of meat, you're eating a lot of salt. It just goes hand-in-hand, especially on carnivore, paleo, all that.
You'll have those products that are okay for that diet and there's no sugar. Keto is another one. Even though that's not a high-protein diet, it's a high-fat diet, but most people are overeating protein on keto.
A lot of the keto products are very high in sodium. So, pay attention to all that. The other thing about too much meat is it can also pull calcium out of the bone and dump it into the urine.
So, it can lower your pH, making your pH very acidic. And that acidic environment, calcium oxalate crystals and uric acid crystals love it. Love it.
They cherish that environment and flourish in it. So when you eat too much meat, your pH can be acidic. It will lower your citrate, because especially on carnivore diet, you're not eating vegetables.
And so what happens, and that's another reason for the pH being so low, but also you're lacking fruits and vegetables, for the most part, so your citrate goes lower. And citrate envelops calcium in the urine and protects calcium so oxalate and phosphate can't connect to her. It's like a shield and that's why carnivore can be will lower your citrate.
So those are three good reasons. So doing all the goals of the Kidney Stone Diet, they all have to be done. But what is to lower your risk of kidney stones.
But what is the most important part of that out of all the goals? Getting enough fluids. You can eat low salt, you can eat just the right amount of meat, you can lower your oxalate, and you can lower your added sugar.
But if you're not diluting your urine, you can still make kidney stones. Because no matter what, crystals are always a byproduct of what we're eating, right? So there's always some crystals in and out of our urine.
But the thing is the longer they sit in there, the longer they have to connect to one another and form stones. So the number one thing you can do to prevent kidney stones, because people will say, "I'll do your diet, I ain't drinking no more water." And I'll say, "You'll probably make more kidney stones." You have to keep your urine clear.
How much do you have to drink depends on the rest of your diet. If you're eating well, low salt, low added sugar, typically 2 1/2 L is just fine. If some of you, if you sweat more, you live in a hot climate, you exercise a lot, all those things, you may have to drink up to 3 L.
2 1/2 to 3 L of urine is what we want. Each of you will have to find the right amount of fluids for you to get to that amount. But, typically, if your urine looks like water coming out of you, you're pretty well hydrated, okay?
All fluids count. Water is best. Doesn't mean you can't have a glass of wine.
It doesn't mean you can't have your morning coffee. I have coffee every morning. Doesn't mean you can't have a tea.
You can also have tea. All of those things, but not every- not lots, because it's higher in oxalate. Blog posts on that at kidneystonediet.com.
All things within moderation. Really boring advice, not sexy. It's hard, but God, it's worth it.
Listen, I Jeff and I wouldn't be around all these years if this didn't work for people. We're very successful because our patients, my patients work hard, they do all the things, they lower their stone risk, and also eating this way will help lower hypertension, diabetes might get better, A1C could be improved, doesn't mean you'll get off metformin, but a lot of people do.
You lose weight. A lot of good things happen when you pay attention to those goals: lowering salt, lowering added sugar, getting enough calcium for your bones, drinking enough fluids, stop eating a side of beef every day. If you eat meat, normal portions of it, and you'll be fine.
And the oxalate part, guys, even though you guys are always freaking out about it, it's really the easiest part of this diet. Get your calcium needs met and don't eat things like cashews, spinach, and chia seeds, cause most of you eat them every day. That's all.
It's just a handful of foods we take away. All otherwise, everything in moderation. So all of these goals are critical.
Water is number one.
