I wrote this post because I get some form of this question every single day.
“Jill, I have been drinking lemon water, but I’m still making stones. Why is this happening?”
First off, those of you who have been with me a while will know what my first question will be? Has your doctor ordered a 24-hour urine collection to see WHY you are making stones? There are MANY reasons one might be a stone maker. Without completing this essential first step, you cannot prevent new stones or keep current ones from growing.
Lemons make our urine more alkaline and increase our citrate level. Citrate is vital in preventing kidney stones because it envelopes calcium and protects it from other minerals combining with it (think phosphate and oxalate).
People who have malabsorption issues typically have less citrate in their urine. If you have Crohn’s or ulcerative colitis, have had bariatric surgery, or have any other condition that leads to frequent diarrhea, your body may not produce enough citrate. Other causes of low citrate include overeating meat protein, certain meds, gout, and low blood potassium. For some, there is no known reason.
If you ever wonder why I’m a bit negative when it comes to the generic advice of eating lemons, it’s because I hear about this every day from people who follow it. The same people who continue to make stones.
Patients told to drink lemon water often think this is all there is to staying stone-free. It isn’t. There is so much more to preventing kidney stones than cutting up a lemon. If that were the case, we would see a lot fewer ER visits for kidney stones each year.
Adding SOME lemon to your water will not hurt you, but what patients are told to do and what they actually do are two different things. I’ve worked with a lot of people who have lost tooth enamel and increased their reflux symptoms because they were drinking too much lemon water. More isn’t always better, especially in this case.
When patients complete the 24-hour urine collection, they often find that their citrate level was never an issue to begin with, but other values on the results are out of whack. They never needed to use lemons to prevent their kidney stones. I can’t stress how many upset patients I have talked to in my career regarding lemons. But you don’t know what you don’t know until you become educated.
If you do a urine collection and find your citrate is a little low, and your doc says to incorporate lemon juice into your water, that’s fine. Just make sure you get a follow-up urine collection ordered. Completing a follow-up urine collection ensures that your kidney stone prevention plan is working and that you are decreasing your stone risk.
Lemons should only be added if your citrate is just a tad below the normal range. Lemons are not going to pull a severely deficient citrate level into the acceptable range. That is when potassium citrate (one of a number of supplements often prescribed for raising pH and citrate levels in kidney stone formers) is added to one’s kidney stone treatment plan.
To summarize, adding a bit of lemon juice to your water will not cause issues in general. But please know that it is not a miracle cure for kidney stone prevention.
Your friend and advocate,