This week, Jill answers a listener question about 24 hour urine collection, availability of the test in different parts of the world, and what to do when you don’t have access.
Have a question? Leave us a voicemail at (773) 789-8763.
Stop Kidney Stones Once and For All
- Kidney Stone Prevention Course
- Kidney Stone Diet Meal Plans
- 24 Hour Urine Collection Analysis
- Private Coaching
Kidney Stone Diet Resources
Find more episodes of the Kidney Stone Diet Podcast here.
Who is Jill Harris?
Jill is a nurse and health coach that specializes in educating patients on kidney stone prevention. For more than 20 years she’s helped patients understand that kidney stones can be prevented with the right treatment plan. It’s one thing to be told to lower oxalate or drink more water, but HOW do you do it? That’s where she comes in. Through the educational resources at kidneystonediet.com, stone formers can learn everything they need to know to significantly lower new stone risk.
Who is Jeff Sarris?
Jeff’s co-founder of SPYR, a branding agency based out of Chicago, where he and his business partner Dave help awesome people like Jill create online platforms that make an impact. He’s also a certified health coach, Executive Producer of the Netflix documentary Minimalism, and host of the Starting Now podcast.
Love this episode? There’s more!
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.
Jill Harris: And I’m Jill Harris, your kidney stone prevention nurse. I swear to God, I know I’m immature, I don’t care. I can’t just be so serious for so long. So, when we’re shooting in the beginning, and I look at you, and I have to be quiet, it brings me back to when I was like in junior high, and we’d be in study hall, me and my best friend, and they’d be like, “No talking!” And, of course, whenever you’re not supposed to talk, I want to talk more. I was the one that was always separated. “Jill, move to the other table!” So, whenever were supposed to be quiet, I go right back to junior high. I’m not saying I’m proud of it, but that’s just what I’m doing. Every show at the beginning.
Jeff Sarris: You have to have fun. I know, I see your face sometimes.
We Ain’t Changin’ Our Style
Jill Harris: I’m happy to be here, first of all, to talk about this stuff and get the word out. Somebody wrote me, and they’re like–so people don’t think I answer my own email. They assume somebody else is doing it. No, I’m answering hundreds of them a day. Thank you very much, people. So, she said, “Somebody should tell Jill, it’s very important, her grammar is terrible. And I don’t understand if she thinks that we’re dumb, or what, but somebody needs to talk to her about it.” So I wrote “Dear, Sissy,” I’m sure she was like, “Oh, shit, Jill writes her own emails.” “Dear, Sissy,” whatever her name was, “I think my audience is extremely smart, so I know they know that it’s just my flair on things.” I know that people don’t say “ain’t,” and that kind of stuff.
I couldn’t be where I am today if I didn’t understand that, but I like to have fun because I’m talking about the same thing for 5000 years. So, I need to spice it up for you and for me. So I never want anyone here to feel like, I’m you know–Jeff’s like, “Why are you talking about this?” Because it’s important. I want people to understand that I know how smart you are. So the way I give information is very different from many nurses, you may know or anybody on YouTube. And that’s just my style. It’s who I am. I have fun with it. Please know that I would never–it has nothing to do with you, meaning that in the nicest way. I know you guys understand me, you’re way too smart not to. So I wanted to clarify that because if one person thinks something many might. And I just want to make sure people know it. I’m just goofy, right? That’s all.
Jeff Sarris: This is the thing, too: this is why the entire Kidney Stone Diet platform is so different. This isn’t meant to be sterile “Doctor Speak.” It’s all based in science, but, like this show, we want it to be entertaining. We want people to have fun and be like, “Look how silly Jill is.” Like, look how much is fun and how entertaining all of it is because, otherwise, you could read research papers and things, but we don’t absorb that, like we absorb the things that we enjoy and that we find entertaining. So I think that’s actually a great point to bring up just so people know. I think a lot of people get it, but, definitely, I would assume brand new people could very easily be like, “Oh, like, how professional is this? Like, how much experience is here?” When the experience is through the roof. We don’t always talk about that, but 24 years of experience doing this already.
Jill Harris: Yes, and also some people–and this is all over YouTube, and I’m guilty of this too, when I’m watching something on YouTube I’m like, “Okay, tick tock. You said you were going to talk about Fitbit, and you haven’t, and it’s now seven minutes in.” People, it’s a show, okay? We eventually get to it. Just keep fast forwarding then till you get to your answer. You can do that, too. People get very mad. I do, too, sometimes when I’m watching something. But I know just to fast forward. You know, I mean, it’s okay. Have fun with it, people. Enjoy! Absorb it all in. And if you don’t like the style, that’s okay, too! You can go find somebody else that does it differently. I mean, please, of course, please do that. But anyway.
Jeff Sarris: Yeah, just real quick on that just because you said sometimes it can be irritating because a lot of times there’s the empty promise. It’s like, “Watch this for this” and you watch 99% of it and then they’re just like, “Oh, yeah, it’s a yes.” And it’s over. It’s like, how did you hook me in for six minutes to say nothing. But that’s the one thing, we will always promise that there will be the payoff in the episode. We’re not just–there’s no clickbait. We’re not just trying to get you to click through, but we have these preambles we have this. We’re also friends, like we’re friends, business partners. So we just have time just hanging out that this is a good excuse also to talk a lot more, which is really nice.
Jill Harris: I mean, it really is. So, basically, what we’re saying, people, is we’re doing the show for the two of us. You’re along for the ride, people. We want to create a chummy atmosphere, a warm atmosphere, an inviting atmosphere, an atmosphere that’s not intimidating. When I was going through all my doctor appointments with all my cancer, it’s intimidating talking to these really, you know, doctors, sometimes, and nurses, too, don’t know how to bring it on down home so we can understand.
And as patients, and as a patient, I was really scared. And so you may say, “Well, you’re a nurse.” Yeah, but I do kidney stones. I don’t do cancer and now I’m the one with cancer. So it’s really intimidating and you do want people to talk to you like a girlfriend, like a boyfriend. I mean, we you want some kind of–at least I do. I don’t know and you guys in the audience, you can tell us. Does this make sense to you? Because I joke that it’s for Jeff and I, but it is for all of you and this is why we do this. Otherwise, Jeff and I would just get on the phone or text a funny meme to each other.
We’re doing this for you as a service. So we hope you like our style. We’re not going to change it. I mean, you could say you don’t like it, it won’t change. But we hope you do like it and we hope you get it, what we’re trying to do here: create an environment that is an easy way to talk to us, to ask questions, to understand instead of just being pelted with research. If you want that, my mentor, Dr. Fred Coe, oh, my God, a plethora of information at kidneystone.uchicago.edu. All the things that we are trying to do and talk about here on our platform is based upon all the science on his platform.
So, go there. He spends so much of his free time writing for you, the heavy duty, science-based research that we’re not going to talk about here because we lose a lot of people when we do. You’ll also find me on his website with certain articles, too. So I’m there as well, but that’s just you know, you could say, “Well, you’ve already done over 100 episodes, why are you explaining it now?” Well, it just didn’t come up until now. So I want to under I want you to understand what we’re trying to create here. Like I said, I think everyone here is pretty darn brilliant, so you get the feel of what’s going on. But, like I said, if one person says something other people may be thinking it and I just wanted to address that. So, I’m good.
Jeff Sarris: Yeah, and I mean, I think that brings us right perfectly to our question, because this is an extremely important one. Let’s fire it up.
Why Don’t Doctors Across the Globe Offer 24 Hour Urine Collections?
Listener Voicemail: Hi, Jeff! Hi, Jill! I’ve called before. I just want to give you a brief backstory. I’m an American living in Japan and I have a long history of calcium oxalate stones, goes back into my family, several generations, even had a stone lasered out on me a couple of years ago, which was not fun. And living in Japan, sometimes it’s very difficult to get some medical help and have questions answered for you. So, recently, I went to my urologist, and I asked him, “Hey, in America, they’re doing this kind of 24 hour urine collection, can I get one?” And I was very surprised when my urologist told me, “No, that’s really not a same here. We don’t do that.”
And so I checked with some other urologists here in Japan and, surprisingly, they said, “Yeah, we don’t really do that. Tests are inconclusive, and it doesn’t really work that well. And if you want any solid tests, you know, you need to go back to the hospital and get those.” So my question is, what exactly does a 24 hour urine collection do? I mean, what exactly are the doctors looking for? Does that really apply to every kind of stone or just some specific stones?
Also, if I can’t get a 24 hour urine collection, sort of study, is there something else, I can go to the hospital and request and say “Hey, give me this test or that test.” And, also, if I follow the Kidney Stone Diet, which I have been doing regularly and very religiously, do I really need to get a 24 hour urine collection? Should? Or is this probably just something in my DNA that I’m gonna have to live with and there’s not really another issue? Thanks for answering my questions.
Jill Harris: I remember him because he did ask some questions before about soy sauce and all the salt and why is there–I believe it was him who was like, you know, why don’t a lot of Asians get kidney stones. He did not say his name, unfortunately, and I do like addressing people by name, a friggin’ beautiful question. So much to unpack here. People in the audience are like, “Oh, shit! Get a pillow and a blanket.”
Jeff Sarris: No, but this is an important one, especially having regional differences. I mean, it’s a big question. As soon as he brought it up, I was like, “Huh, well, that is interesting.”
Jill Harris: Wonderful, wonderful! So, I’m gonna try to remember all the things. I typically write it down. So, for synopsis, he’s living in Japan. I have a lot of international patients, by the way. There are some countries that will do urine collections, many do not. Many do not. In England, you can’t get them there. There’s a couple of countries that them, so when I’m coaching people over across seas, they’re telling me what their diet is, some people come in The States to get a urine collection, but let’s talk about a few things.
What are doctors looking for? And so why are these doctors saying “Eh, we don’t really do them here?” Well, there’s probably no lab that does them. Also, if there’s not a need because Asians are not prevalent stone makers, ain’t nobody gonna make money off 24 hour urine collections in Asia. So we got to remember, everything’s a business as well. What are doctors looking for? We are looking for–I’m not a doctor, I’m a nurse–so a doctor should order 24 hour urine collection.
Many do not. Many will say, “Let’s wait for the second stone.” Why? That’s like saying, “Let’s wait for your blood pressure to get even higher.” Why are we doing this? Why are we waiting for a medical condition to get worse? If you have kidney stone, people, knock knock! Tell your doctor you want a 24 hour urine collection. “Ah, you don’t need one.” “Yes, I do, doctor. I want a 24 hour urine collection because I want to do everything I can to prevent another kidney stone.” When you say that, you typically get it. Okay?
Now, we’ve got to recognize. and I’ve said this before, these men and women are surgeons. That’s what they went to school to do. A lot of years. My experience shows me and tells me, these surgeons, they do a damn good job, overall, getting kidney stones out. That’s their job, along with other things. They’re not just doing kidney stones. “Ah, they just want to make money, Jill. That’s why they’re not talking about prevention.” They have no time to tell you how to do a low-salt diet. They are running from follow-up to follow-up after all these surgeries, okay. And then they’re in surgery three days a week. So that’s not the case. They’re not not telling you about prevention so they can make money off you. That’s not. They make plenty of money. Promise.
What are Doctors Looking for in a 24 Hour Urine Collection?
The other thing is, they don’t know how to tell you about dietary changes. They didn’t go to school for that. They’re surgeons, so a lot of them may not think to order the urine collection. Some of them don’t know how to really read the urine collections and tell you what to do with them after they get it. So if you have a doctor that does order urine collections, and they do not have to read the urine collection, here’s the things they’re looking for: how much water is the patient drinking? What’s their sodium like? What’s their citrate level like? How is their 24 hour pH? What is their calcium number telling us? What is their potassium number? What is their super saturations?
Take the Kidney Stone Prevention Course it’s $40 off right now, you’ll learn about all this. What are the super saturations for uric acid, for calcium phosphate, for calcium oxalate? Super saturations is a very complicated thing, but there are certain testing companies like Litholink that will do super saturations. Those are very important. Those numbers are the driving force of stone formation and they’re going to tell the doctor how saturated your urine is with each crystal type, which will tell the doctor what your propensity is for each stone type on that day. So, again, this is complicated. I’m not going to bore all of you with the details of it, but I also have the urine analysis. Buy that service. I’ll tell you exactly what your urine collection is about and then your numbers so you can have an educated visit with your doctor.
And I will put in here that I tell you about my services because they will be valuable to you, and you will get the best possible outcome. But you need to understand your lab results, too. Many times you go to the doctor’s office, they don’t tell you a lot about your lab results for many different reasons. I can, because my mentor is Dr. Coe, and then you can have a really great doctor office visit. That’s a promise. So, the doctors are looking for all these values from the 24 hour urine collection and that is going to tell the doctor why you’re making stone. So it’s incredibly important! So my friend says, “But, Jill, I’m already doing the Kidney Stone Diet. So why do I need it?” Let me tell you why.
This is what’s so very important about doing the urine collection. So very important, a couple things. What we think we’re doing and what we’re really doing can totally be two different things. “Jill, I don’t eat no salt!” I go over their urine collection, they ate 8,702 milligrams of sodium that day. They don’t realize that is the food they’re eating, not just not using the salt shaker. Super important. The other thing–people do the same thing with water. “I’m drinking plenty, like a fish.” It’s a liter I see here, so not so much. But here’s why they think that: they have increased their water from zero to, you know, 500 milliliters now. So they are drinking a lot for them. Again, you’ve got to talk to people what somebody says it’s a lot and a lot for me. So you’ve got to talk to people, there’s that.
The Most Important Part of Kidney Stone Prevention!
The most important thing: calcium. Now, dear listener, dear question caller, question person, you said, you have a family history. So you do have a propensity to make kidney stones. I would really want a 24 hour urine collection on you because if that’s the case, it could be you have high urine calcium, despite doing the Kidney Stone Diet. This happens. In that case, you may need goes down the whole tree again, complicated–I make things things seem funny and adorable, but it’s complicated. If somebody has a high urine calcium, and a 24 hour urine collection, it’s the only thing that’s going to tell you that. Don’t talk to me about blood. I’m not talking about that. Talking about– “My blood calcium is normal,” urine is different.
If you have high urine calcium, you’re only going to know if you do a 24 hour urine collection. And, if that’s the case, it could be for many different reasons. One of them could be even though you’re eating like a nun, could be your vitamin D is out of whack. Could be your parathyroid is out of whack. Could be family history and now you need a medication. It’s not just for stones, you’ll need it because you’re losing bone from your skeleton, which could lead to osteopenia and/or osteoporosis. So that urine collection is important for all stones, all stones. It’s a must, an absolute must. If a doctor is telling you it’s not, push back. I never say as the nurse or as a person that a doctor’s wrong. That’s not my place and, plus, I have a nursing license to protect. But I will say, as a patient myself, push back. You need it.
Many doctors will tell me, “Jill, they don’t want to change their diet.” And they’re not being harsh. Most people don’t. That’s why there’s millions of kidney stone farmers because most people–well, I’d be rich! I’d be done with work years ago if everybody was calling me! It’s not the case. People call me when their incident was so bad, they are ready to change their diet. Okay, so the urologists are not wrong in that nobody changes their diet. Well, I’m not gonna go with nobody, dear doctor, because there are people, there are people that do because I talk to them every day. So, that’s why I tell you guys tell the doctor, “I’m gonna do whatever, whatever. I never want to go through that again.” When you say these key things I ask you to say, you’ll get what you want.
The other thing is a lot of them don’t know what to do with the results once they get them. They just don’t because they’re not. They’re not teaching dietary changes. So that’s really important. It’s nothing against them. Again, they’re surgeons. A lot do, though, people. So if you have questions, ask them! Lots of times, you don’t know what you don’t know. That’s why I say get the urine consult with me, so I can teach you all this stuff to ask it those appointments so you make them a lot better. I made that service because when I was going through my cancer stuff as a patient, I didn’t know what I didn’t know until I got back home, and I started Googling stuff, and I’m like, “Oh, I should have asked this, this, and this!” You go in the portal, ain’t nobody answering you for days, and you’re sitting there freaking out. So I understand as a patient, more so than a stupid kidney stone nurse.
So, that urine collection, love, is very important, especially because you told us your family history. If everything is ruled out with high urine calcium, say he says, “Well, my vitamin D is fine, Jill. My blood calcium is fine–”because if it was high, he would need a parathyroid hormone check, which would be another blood test. So if all this stuff is fine, and he’s doing the Kidney Stone Diet, and he really has lowered his thought that it’s sugar, getting enough water, all the things and his calcium is still high, it is at that point, a doctor will say you have idiopathic hypercalciuria, which just as a big fancy name, that means he has hypercalciuria. Hyper-“too much,” cal-“calcium,” Uria- “in the urine,” and idiopathic, meaning we’ve ruled everything else out. This has to be genetics now.
And if he is diagnosed with IH, it’s about 50% of his blood relatives that will also have it, which will put him and his blood relatives at a higher risk for bone disease and kidney stone disease. And, again, wherever there’s a stone clinic, a bone clinic is close by because of this calcium aspect. So you see, I get very serious about this. I’m very passionate about it because I see this every day, every day. And although you all want to ask about oxalate, kidney stone disease is so much about calcium. So it’s very, very important and this little blurb of education is going to show you–and this is a nugget–just how complicated this all is. If it wasn’t complicated, nobody would make stones. So not only does somebody need to interpret the urine collection results, well, really well–
The urine collection results, too, depending upon which lab you use, everybody has different reference ranges. “Oh, your citrate can be between as long as it’s over 300.” It should be over 550 for women and over 450 for men. “Oh, as long as your sodium is between 100-700.” That’s ridiculous. So you also need somebody who knows. So patients will come to me and say, “Well, my doctor says I’m in the reference range.” 8000 milligrams of sodium is not in the reference range, but they’re going by what the laboratory said is the reference range, so they think that’s good enough, right? So, again, guys, I know where it should be because I understand the research and where we really want kidney stone formers to be.
The lab could have just had generic reference ranges, not even for stone formers. So, again, again, there’s just so much that goes into this. And if I talk like this all the time, I’d get really bored with myself. So let’s get back to business. His question was great. So, there’s a reason why, even though he’s following the Kidney Stone Diet–and that was the brilliant part of your question–even though he’s following the Kidney Stone Diet, why should he have to do the stupid urine collection? Because of what I just said: the urine calcium and because of certain things like–here’s another great example. “Well, my doctor didn’t do a urine collection but he put me on you know, lemonade, or litholight, or Moonstone, or potassium citrate.” Why?
You don’t even have any results to put you on something like that. And your results may, if you did the urine collection, may say, “Oh my god, you have this and now that is going to increase it and we don’t want that increased!” Think about your pH, that’s what I’m talking about. Anyway, it’s way too complicated for one little video. Buy the urine collection consult, guys, if you have if you have questions about urine collections. They’re complicated. But, for this guy, a brilliant question. You must do your own collection. You must, you must! That’s how you’re going to find out what’s going on. You need a metabolic workup of your urine to find out why you’re forming stones. You must, people! I’m adamant about it. Dr. Coe, adamant about it. Any guy or girl on the top of their game, urologist, first thing they’re going to say, “You gotta get a urine collection.”
And if yours doesn’t, people, it doesn’t mean they’re bad. It just means they don’t know or they’re telling you what I already told you. So, push back. In this day of medicine, the way everything is all kind of backed up and everything, please be your own advocate. This is also what we’re trying to teach you in this channel. You must be your own advocate. It is up to you to get educated, so that you can ask for what you need at your doctor’s appointment for better health. There. Did I miss anything? I think that’s it. So, oh, and so in Japan, you’re not going to be able to get ’em. I doubt there is a lab that does it and the hospitals, they may not even know what you’re talking about, either. It’s not a thing there because it’s probably not prevalent enough for it to be a thing, but many places abroad do not do urine collections.
Jeff Sarris: Do you know, is there any like independent way that you can do that away from a doctor?
Jill Harris: No, because of insurance and shipping because the urine has to be shipped. And so it expires, bacteria starts growing into it over a certain amount of time. So that’s what happens. There are people that also have like, you know, family in The States, so they’ll come for a week or whatever, and do their urine collection and send it but, you know, it’s it’s just tough. I do deal with people all across the world that they just don’t have access to it. So we still tweak their diet, of course, but it’s a lot harder. I always tell them–like I said, this is a lot for this video. I could talk for hours about urine collections. The bottom line is you must get one in order to prevent kidney stones. You must. I’m just that adamant about it and Dr. Coe is as well. And it’s not just us. There’s many people. Research “24 hour urine collections,” PubMed and NIH will tell you, okay? It’s not obscure, people.
Jeff Sarris: Well, I think that is a wonderful question. And I didn’t realize, also, that it’s not accessible everywhere. So it’s almost a reverse medical tourism, where people would leave The Staets to go to get procedures elsewhere because it’s cheaper, but it’s interesting then that this is one that is not even a procedure, but a test that you can’t get everywhere. So, I feel for people going through that because that is challenging on top of everything else, then. Very good to know, very helpful. Thank you so much for that question.
Jill Harris: It’s a wonderful question. And he always–and I wish he left his name–he always asks really just brilliant questions. They’re thoughtful, they’re pertinent, and they’re awesome. But everybody that leaves a voicemail, we really love hearing from you guys because this show is for you. So please call us. Don’t be shy. Nobody’s shy here. We’re all family. And leave a question. There’s no silly question. Whatever you’d like to know, if it’s about weight loss we’ll do that, too. That living your best life, whatever we can help you with. We’re here and we love it. And we’re thrilled. And we feel privileged that you do call us it’s amazing. So, thank you for being part of this community. And thank you so much, ur dear American expatriate.
Jeff Sarris: Yeah, and that number is 773-789-8763. We would love to hear from you and I think with that, we will we will wrap. If you want more, head over to kidneystonediet.com where you can find the weekly newsletter, the free newsletter, the prevention course, the prevention community on Facebook, just everything in one easy, accessible place. Everything under the sun Kidney Stone Diet. Again, that’s kidneystonediet.com. And thank you again for tuning in. Leave a comment below. Did you have a question for this one? Did we start off with a question? No, I don’t think we did.
Jill Harris: I don’t think we did, but, oh, I always have something to ask them to write about. I mean, guys, how many of you have had a hard time getting a 24 hour urine collection ordered? And how did you get it? Did you yet? Tell us about your story about getting a 24 hour urine collection, please, because I want to know and I can help prompt you on what to say in the appointment in the comments. I’ll write you back.
Jeff Sarris: So, thanks again, everyone, and we will see you next week.
Jill Harris: Bye, guys. Thanks for that question. So awesome.