You’ll never stop making kidney stones until you do this

In this episode of the Kidney Stone Diet Podcast, hosts Jeff Sarris and Jill Harris discuss essential strategies for preventing kidney stones. They emphasize the importance of hydration, dietary choices, and understanding the relationship between sodium, calcium, and oxalate in urine. The conversation highlights practical tips for listeners to reduce their risk of kidney stones through lifestyle changes and proper nutrition.

Takeaways

• You need enough water to dilute your urine.
• Lowering sodium helps you pee more and prevents stones.
• Calcium is crucial for bone health and preventing stones.
• High sodium intake leads to higher calcium loss in urine.
• Calcium and oxalate bind in the gut to prevent absorption.
• Added sugar can pull calcium from bones and lower urine volume.
• Too much meat can lower citrate and increase acidity in urine.
• Hydration is the most important factor in preventing kidney stones.
• Aim for 2.5 to 3 liters of fluid intake daily.
• Moderation is key in dietary choices to prevent kidney stones.

00:00 Introduction to Kidney Stone Prevention
00:10 Understanding the Kidney Stone Diet Goals
06:56 The Importance of Hydration in Preventing Stones
10:16 Practical Tips for Managing Kidney Stone Risk

Jeff Sarris (00:00)
You’ll never stop making kidney stones until you do this.

Jill (00:03)
We can’t prevent kidney stones unless we do this. What’s the this, old lady?

Jeff Sarris (00:09)
You tell me.

Jill (00:10)
There’s reasons for each of the goals of the Kidney Stone Diet. They’re not there just because Dr. Coe and I are being a pain in the tush and Jeff, they’re not there for that. You need enough water to dilute your urine so your urine is not saturated with these crystals. What crystals? Calcium oxalate, calcium phosphate, struvite, uric acid, all of them. Apatite, all the different crystals that we can make. Cysteine, that’s a very rare type of kidney stone.

You definitely need water. You will not prevent kidney stones unless you drink enough water. You will also not prevent kidney stones unless you lower your sodium. Why do we care about lowering your sodium? Lowering sodium will help you pee more. You know how many people say, Jill, I drink all day. Nothing’s coming out of me. Well, Bob, you ate 11,000 milligrams of salt that Tuesday. No, nothing’s coming out of you. Now you’re bloated. And so wherever sodium goes, calcium goes. And so when we eat too much salt and the kidney is trying to get rid of that excess salt, it also is getting rid of calcium. It’s like two minerals going out the same revolving door. So wherever sodium goes, calcium goes. And so you lose calcium when you eat too much salt and you don’t pee enough. So you won’t stop making kidney stones unless you start lowering your sodium.

Jeff Sarris (01:41)
And why is calcium important?

Jill (02:05)
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 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 is looking for phosphate, phosphate is looking for calcium, oxalate is looking for calcium. And so they’re all looking for each other in there. And 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 mean? You have one phone call. Then I tell him, 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 bone density check? No, Jill. Guy, Jill, you have 600 levels of calcium in your urine, you better go. 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 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. It 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 back up. 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. 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. 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, the 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 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 two and a half liters 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 three liters. Two and a half to three liters 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 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, 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, because most of you eat them every day. That’s all. It’s just a handful of foods we take away, otherwise everything in moderation. So all of these goals are critical. Water is number one.

Jeff Sarris (10:32)
Yeah. And just to throw almonds in there too, just on that list, almonds and spinach always, number one and number two right there. But yeah, if you want more help, you want to work with Jill directly or learn everything you need and learn everything that you can eat from meal to meal. We have kidney stone diet meal plans. We have one-on-one private consults with Jill that you can find at kidneystonediet.com or head on over and sign up for the free weekly newsletter and Jill will arrive in your email inbox every week and Jill is there just to keep you on track. But I think with that we’ll wrap. Thanks for tuning in and we’ll see you next week.

Jill (11:05)
Bye everybody, happy holidays.