“Drink lemon water” is the #1 piece of advice kidney stone patients hear from their doctors. But is it actually helping you? In this episode, Jill Harris breaks down why this generic advice can be useless (or even make things worse) when it’s not based on your actual results.
Jill shares a real patient story: someone who made stones for 20 years, faithfully drank lemon water the whole time, and only discovered through a 24-hour urine collection that lemons were never what she needed. In her case, they were slightly raising her risk of calcium phosphate stones.
In this episode:
- Why “just drink lemon juice” is incomplete (and sometimes harmful) advice
- The difference between calcium phosphate and calcium oxalate stones
- When lemons actually DO help (low citrate, low/acidic pH)
- Why citrate levels around 500 matter—and when you need potassium citrate instead
- Why fruits and vegetables often beat lemons for raising citrate naturally
- The critical role of the 24-hour urine collection in any real prevention plan
- Why urologists are great at removing stones but not always at preventing them
Chapters
00:00 The Role of Lemons in Kidney Stone Prevention
02:46 Understanding Urine Collection and Its Importance
05:43 Personalized Dietary Recommendations for Kidney Stone Patients
08:29 Monitoring and Adjusting Treatment Plans
Transcript
Jeff Sarris (00:00)
you have a kidney stone, you need to know this about lemons. Let’s talk about that.
today we’re talking about lemons and what do they mean when it comes to kidney stones and prevention or dissolving or the myriad things we could be talking about. And actually, real quick, if you’re out there with a question, you can go to call.show/kidneystonediet or click the link in the description and we’ll feature your voice on a future episode.
Jill Harris (00:28)
Lemons, lemons, lemons. I I have nightmares about lemons. It’s one of the most popular things on the web on any website. It will say prevent kidney stones by using lemon. Most doctors will say drink lemon juice. The patient’s never done a urine collection. And so here’s what I see in real life. In real life, here’s what I’m dealing with. I get a phone call. The patient has a consult with me to go over their 24 hour urine collection.
It is their first urine collection. And they come to me and they say, and I said, I always ask when I’m doing the medical history, I’m like, what has your doctor told you to do for prevention? And I mean, nine out of ten will say drink lemon water. Okay. And so when we look at the patient’s results, their citrate is very, very high. Their pH is very, very high.
Meaning the patient never needed lemon water. Okay? Now, let me tell you what bothers me the most about this generic advice. So the reason the patient’s calling me too is they heard they watched our YouTube show. They had were making stones for twenty years. The doctor always said drink lemon. The patient never had a urine collection until
They watched our show and said, Hey, I’ve been having these for 20 years. I want a urine collection. you don’t need it. I want it. Doctor ordered it. And the patient’s like, all I ever heard was drink lemon juice, but I’ve been making stones for 20 years. So clearly that’s not working. So this is why I don’t like this generic advice. The patient is told to drink lemon juice. She thinks that’s all she needs to do.
There’s nothing else to be offered. She said, I didn’t even know there were all these goals of the Kidney Stone Diet. I never, I was never told anything except lemon water. So lemon water is not a miraculous cure for kidney stones. And in her case, she made calcium phosphate stones. Calcium phosphate stones grow, these crystals grow in your in the urine when we have high urine calcium, high urine pH.
So here she’s putting, and lemons will increase your pH a little bit. So she’s being told to do something that’s making her condition a little bit worse, actually. It’s not helpful to her. It’s not helping. So that’s why I get upset. So she’s doing the work, but she’s only being told that. And actually it’s making her condition a little bit worse. And how do you know? You get a urine collection done. So when the doctor saw the urine collection, she
She didn’t know, he didn’t know really what to do with the urine collection. He’s like, it kind of looks fine to me, blah, blah, blah. And he actually told her to call me. A lot of my patients come from doctor referrals. So, so I went over it and I said, you know, doctors, the urologist is a surgeon. We need them to take out stones. Sometimes they’re just not the best at prevention. This happens. Like when I was going through cancer, I had a surgeon that dealt with my cancer, but I had an uncle.
Psychologist, a doctor that deals with all my treatment and stuff. Two separate people. And we’re asking the surgeons here to help people prevent kidney stones when their job is to take them away. So it some urologists do a great job, but you know, some don’t know how to do diet stuff. Of course. A lot of doctors don’t know how to do diet changing. So lemons are used in kidney stone prevention when a patient has a little
Lower citrate levels, and I’ll talk about that in a second. And or the pH is low, meaning acidic. Uric acid stones and calcium oxalate stones, they like acidic urine. Less than 5.5, typically, less than 5.6. That’s an acidic urine. And these levels are specific for each person. Maybe somebody has a 5.6.
pH on their 24-hour urine collection. I’m not talking about peeing on a strip, talking about a 24-hour urine collection. And they don’t form uric acid stones. but somebody else would. So again, it has to be specific for the patient. There’s many other factors that go into this, but I’m generically saying 5.5 is an acidic urine. A lot of diabetics have an acidic urine. A lot of Crohn’s or colitis patients, bowel disease patients, cancer patients may have an acidic urine.
It’s complicated. We don’t need to go into it, but that’s what these consults are for. We go into the nitty-gritty of this. So lemons can be used to increase citrate level level levels a bit. It’s not a miracle. For people who have very low citrate, lower than 350. Ideally, we want it to be around 500 the citrate level. But if yours is starting to get too low, you’re going to have to go on potassium citrate pills.
If you are just on the borderline, yes, you can use lemons, but you have to be mindful that it’s not increasing somebody’s pH now too much, because then you can cross over and make calcium phosphate stones like this woman was. So calcium phosphate stones are different than calcium oxalate stones. They grow for three different reasons. Not enough fluids, as all stones grow, all crystals grow. Too much calcium.
And the pH is too high. Those are three things you need to make calcium phosphate stones. So just generically increasing lemons or using lemon water may and not doing a urine collection to see if that’s needed could increase your risk for calcium phosphate stones. So we need to base the treatment plan on the 24-hour urine collection results. Otherwise, we are making stabs at in the dark.
And patients think they’re on a treatment plan because the doctor said that, and that’s the only thing they’re doing, and it’s not doing anything for this patient. And in some cases, it can make the risk of kidney stones a little bit worse. We must be very careful. So the reason I don’t like the lemon juice thing is because people think they’re doing something not based on any kind of results, and it’s not doing anything. They’re not paying attention to salt, they’re not paying attention to
Eating overeating meat, they’re still on paleo diet. So it’s not doing anything. So that’s why I don’t like the generic dietary stuff for anything, really. They should be based on 24-hour urine collection results. so that’s why it’s really important. And
Not going to go into citrate, we’ve talked, we’ll do another video on what citrate means, Jeff. But for now, if you need lemons and a 24-hour urine collection, we’ll tell you that by all means, it’s not going to raise your citrate phenomenally, it will help, but everything else is also gonna must be monitored, and you do that with ideally the patient has a urine collection, their citrate is just a little low.
The doctor says you might want to increase that. I would say, forget lemon juice. I would say fruits and vegetables, because that is just healthy for everybody anyway. And it will naturally increase the citrate. but it’s okay if they also say I start with diet always. Okay. And so I would tell that patient, fruits and vegetables will naturally raise the citrate, which is awesome. And then yes, yours is low enough where a little bit of lemon here and there, too, maybe half a lemon a day, okay.
So work on that. Then you do a follow-up test a couple months later after patients have made these changes. See where everything falls. Maybe then she did a great job with fruits and vegetables. She don’t need the lemon. Maybe she’s doing more fruits and vegetables, but the lemon is not hurting anything and it makes her drink more water. 100%. Keep it, Tricia. Keep the lemon. But you gotta monitor what you’re telling a patient to do.
We would never put patients on insulin and not check how much their blood sugar is going down. Why are we doing this with stone disease? So what we how we treat in stone disease, and this is for the doctors, how we treat, we must follow up to see if the treatment’s working. Is it lowering kidney stone patients risk? Is it increasing the risk? What do we do next? Monitoring these results are so important. That’s it.
Jeff Sarris (09:27)
Yeah. And when you’re ready to dive deep, head on over to kidneyston diet.com where you can find everything Kidney Stone Diet related, including the private consults with Jill, the all access pass that includes meal plans, the prevention course, group calls with Jill, everything under the sun at Kidney Stone Diet. And if you have a question, again the link is in the description, but it is call.show/kidneystonediet and we’d love to feature you on a future episode. With that will wrap and we’ll see you next week.
Jill Harris (09:57)
Have a great week, everybody. Thank you.
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