You’re not peeing enough, here’s why

You're drinking enough fluids, but you're not peeing enough. Let's talk about why.

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, fellow student, Jeff Sarris.

And I'm Jill Harris, your kidney stone prevention nurse. Hi Jeff. Hi Jeff.

I have my tree up already!

Yeah, it's just after Halloween when we're recording this, and the Christmas tree is ready to rock. Always look forward–

Look, between, yeah, I, look, between daylight savings time and the election tomorrow, I'm like, I need to calm my jets, man. I hate it dark so early, and, you know, the election is just like, crazy. So, I'm just like, I'm cozy time.

It's cozy time. So, I'm just making it all peaceful in my house. And my son's not here cuz he's at NYU, so there's no like, "Mom, why's the tree up already?" As a matter of fact, my son does not watch our show, so I can say this, he's like, he wrote me, he texted me the other day, he's like, "Oh, I'm listening to blah, blah, blah." It was a Christmas song.

And I said, "Why are you listening to a Christmas song? You always scream at me for listening to Christmas songs before Thanksgiving." and he said, "Well, I guess I'm feeling nostalgic." And I'm like, "Mission accomplished!" There you go. I love it.

I have drilled Christmas into that boy's head, so, yeah.

Yeah, just wait till he puts up his tree in like a week. A little one in his dorm.

Exactly.

All right, what are we talking about, peeing?

Yeah, so today we're talking about, yeah, not peeing enough. Because this was a question from, the Facebook group. This is from Rob.

Facebook.

Oh, and actually, we will get back to the voicemail, but if you have a question and you want your voice featured on the show, the number is 773-789-8764. Just leave us a voicemail or send a voice memo to [email protected] and we will feature you in the future. But, yeah, why don't we dive in to this question?

Yeah, Rob asked, cuz I asked on my, on my Facebook page, my private page, you know, "What can, what can we do a show about for you guys?" And he said, "What about when, you know, you're drinking, drinking, drinking, and you're not, you know, you're drinking 2 and a half liters, but 2 and a half liters is not coming out of me.

What's going on here?" Well, there, there are several reasons why that might, might be. Number one, what we drink typically, more can come out than what we actually drink, or less can come out than what we actually drink. Why is it that sometimes we pee less than we drank?

Well, you ate too much salt that day. That will, wherever, wherever salt goes, water follows. So, if you ate a bunch of salt, it's going to stay in your body.

That's why we get bloated after a salty meal. So, lowering your sodium, you will pee less. It's really important.

So, I'll tell people, this is how important salt is, not only will you lower blood pressure, you'll feel better, but you're going to pee more without even increasing fluids. You're going to pee more, you're going to lose weight, because when we hold, when we eat a lot of salt, our body holds on to water. You guys know, you go out to eat, the next day you look at the scale, you're up 3 lb.

It's all water weight, and over the course of the next few days, you'll lose that if you keep lowering your sodium. But, if you want to, pee more, please stop using so much salt and turn it around, bus brown, look at your nutrition labels to make sure the portion of food you're eating doesn't have a buttload of salt in it.

Okay? So, that's really important. Number two, lower your sugar, lower added sugar.

Lower your sugar. Why, Jill? Because, also, you will pee more.

That's the other thing. When we have too much sugar in our system, water is also kept in our body. So, you will pee more if you lower added sugar.

So, two goals of the Kidney Stone Diet, lowering sodium, lowering added sugar, both of those things help keep calcium in the bone instead of the urine where we do not want excess, cuz that's how we form stones. And, also, lowering added sugar and lowering sodium is going to make you pee more without even drinking more water.

So, that's awesome. There's that. Number three: when you work out a lot, you sweat a lot.

So, you're losing fluids through your skin, you're going to need to drink extra water to compensate for that. So, that's a big thing. You're a triathlete, you're a marathon runner, you're lifting your weights everyday.

When I'm lifting weights, I sweat a lot. And so I know I need to drink extra water that day, so, so I can get my urine output to where it needs to be. When we eat more fruits and vegetables, again, without even increasing our fluid intake, we will pee more.

So, that's really important, too. A lot of people I tell when I'm talking to them on my, on the phone for private consults or going over their urine analysis, it's like, listen, you don't even have to have another cup of water, I'm begging you to eat more fruits and vegetables. They're naturally low in added sugar, obviously, and they're low in sodium.

So, that's great and plus they'll make you pee more cuz they're so filled with water. The other reason why you may not pee as much is because maybe you have an enlarged prostate. Men, this is very common for men who are getting older, very, very common, and that can decrease urine output as well.

So, these are just a few things off the top of my head that will increase urine output or decrease urine output. So, the sodium, I can't, I really can't drill that home enough. Lowering your sodium is important for most health conditions.

Now, I know there's some of you with a health condition that may, you may need to get enough salt. I'm not talking to you, so for those of you who have medical conditions that you may say in the comments, "But, Jill, my doctor said–" I'm not talking to you. I'm talking to the average person who is eating about 5,000 mg of sodium and needs to lower that to the 1,500 to 2,000, okay, mg of sodium a day.

Once you start doing that, you're naturally going to pee more and you're also going to feel a lot better. And the same thing with the added sugar. So, the goals of the Kidney Stone Diet, there's five of them, but those two particularly, the salt and sugar one, are going to help you not only feel healthier, not only lose weight, not only lower A1C, not only lower blood pressure and all that good stuff, make your kidneys function better overall, but it's going to help you pee more.

And that is really important in preventing kidney stones because your urine gets saturated with all these crystals. And if you're not peeing enough, that's what happens. They get, urine gets more and more saturated because you're not releasing all those crystals.

So I think that's it for this one, Jeff. I mean, you know, short and sweet, start right there, start with that. Also, make sure what you think you're drinking you're really drinking.

A lot of people think, "Well, I think I'm drinking 2 and a half liters," but are you? Are you really measuring it? So, pay attention to that.

Also, all fluids count, so you don't only have to count water, you can count your milk or whatever you're using for your calcium needs, you have a glass of wine, you count that, too, not when you have 10, because that's not good, but a, a, a cup of coffee, that's all going to count toward total fluids, but water, remember, is always best, okay?

Definitely. And you said saturation of the urine. What does that mean?

Yeah. So, our urine gets supersaturated. So, there's some values, not all, not all laboratory companies report on this, they should, because it's the most important value on urine collection results.

But there's this thing called supersaturation. It's actually pretty complicated, but, of course, I always Jill it up and it's basically, on the day of the collection, you see how saturated your urine is with the salts, the minerals and salts that make kidney stones: calcium, oxalate, phosphate, uric acid, struvite, apatite.

These are all types of crystals. And so when we pee more, our urine is less saturated. Makes sense, because they're not just sitting in our urine and our kidneys getting more and more saturated.

Once we start peeing these crystals out, your urine is less saturated. So, the more we drink, the less saturated our urine is with these crystals, cuz they're winding up in the toilet bowl where we want them. The longer these crystals, all the crystals I just mentioned, sit in the urine in your kidney, the higher your risk for kidney stones.

So, if your supersaturations are high, that's not good. That means your stone risk is high. The lower your saturations, the better.

Also, know this, and this is why a urine consult is really awesome if you do one with me, lots of the lab results, their reference ranges are much too generous and the doctor may not know that. A lot of patients will say, "Oh, Jill, don't need to look at my report. My doctor said everything's fine." And it's not that I'm going against what a doctor says, I just educate the patient and say, "Have this conversation with your doctor because although the doctor said it falls within the reference range, that reference range is not cool for a kidney stone former." We want it here for kidney stone formers, and so I know those values because I know the research.

So, in general, the lower, the better. That means your kidney stone risk is lower. The lower your urine saturations are with these crystals, and that happens when we pee more, when we lower our sodium, when we lower our added sugar, when we don't overeat oxalate, when we're not spilling out too much calcium from our urine, from our bones.

It's all of this. Kidney stone disease, guys, is complicated. It's very complicated.

"Oh, my doctor told me nothing." He may not know, because it's really complicated, and your doctor, for the most part, is a surgeon, and what he or she does is really complicated. They're not sitting there studying diets. So, it's a disease, too, that's in the hands of surgeons and, typically, with every other disease, like my cancer, I have an oncologist that deals with the medical side of my cancer and then I have, other people that will help me with diet.

Now, I don't need that because I, I know what to do, but I'm just saying, my, my oncologist surgeon ain't helping me with the medical side. They're separate entities, and so in the stone world, you have the urologist, which is the surgeon, and the nephrologist that will deal with the medical stuff. Now, some urologists are very well-versed.

A lot of my referrals, which is a, where my business comes from, a lot of my business, is from doctors sending patients to me and they're like, "I'm a surgeon, go talk to this nurse over here in Chicago, she'll help you with everything else," okay? But then there are, I have plenty of patients that were like, "My, my, my urologist has been helpful.

They did suggest the 24-hour urine collection." So, I'm getting off point here, but I'm just saying, I don't like people badmouthing their doctors because we're expecting surgeons to know everything about diet. Most, most doctors are not studying diet, folks, that's why there's special people to do that, whether it's me or a dietitian or whatever.

You know, you got to get the, the specialized people in the diet world. Surgeons are not typically going to help you with that. But drinking water is the number one thing you can do, to prevent kidney stones.

It's just that important to lower all your saturations, and if you're drinking a certain amount and not peeing the same amount or more, you need to up your fruits and vegetables, you need to lower your added sugar and salt, and maybe get your prostate checked out, replenish with extra fluids on days you're sweating more, if you're working outside, you're exercising, your whatever, training for a marathon.

If you're sweating more, you're going to need to drink more that day. It's not the same 2 and a half liters that you did sitting on the couch yesterday. Does that make sense, Jeff?

Definitely.

Yeah. All right, cool.

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