Did you know that one in ten people will have a kidney stone over the course of a lifetime? Recent studies have shown that kidney stone rates are on the rise across the country. Those in the know believe that some major misconceptions may be the culprit.
Prevention of kidney stones may include a combination of lifestyle changes and medications.
1- Don’t Underestimate Your Sweat
Saunas, hot yoga and heavy exercise may be good for your health, but they also may lead to kidney stones. Why? Loss of water through sweating – whether due to these activities or just the heat of summer—leads to less urine production. The more you sweat, the less you urinate, which allows for stone-causing minerals to settle and bond in the kidneys and urinary tract.
Instead: Hydrate with H2O. One of the best measures you can take to avoid kidney stones is to drink plenty of water, leading you to urinate a lot. So, be sure to keep well hydrated, especially when engaging in exercise or activities that cause a lot of sweating.
2- It’s Not Just the Oxalate
Oxa-what? Oxalate is naturally found in many foods, including fruits and vegetables, nuts and seeds, grains, legumes, and even chocolate and tea. Some examples of foods that contain high levels of oxalate include: peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes. Moderating intake of these foods may be beneficial for people who form calcium oxalate stones, the leading type of kidney stones. A common misconception is that cutting the oxalate-rich foods in your diet alone will reduce the likelihood of forming calcium oxalate kidney stones. While in theory this might be true, this approach isn’t smart from an overall health perspective. Most kidney stones are formed when oxalate binds to calcium while urine is produced by the kidneys.
Instead: Eat and drink calcium and oxalate-rich foods together during a meal. In doing so, oxalate and calcium are more likely to bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.
3-Calcium is Not the Enemy
But it tends to get a bad rap! Most likely due to its name and composition, many are under the impression that calcium is the main culprit in calcium-oxalate stones. “I still see patients who wonder why they are getting recurring stones despite cutting down on their calcium intake,” said Dr. Jhagroo. “I’ve even had patients say that their doctors told them to reduce their calcium intake.” A diet low in calcium actually increases one’s risk of developing kidney stones.
Instead: Don’t reduce the calcium. Work to cut back on the sodium in your diet and to pair calcium-rich foods with oxalate-rich foods.
4-Not All Stones are Created Equal
In addition to calcium oxalate stones, another common type of kidney stones is uric acid stones. Red meat, organ meats, and shellfish have high concentrations of a natural chemical compound known as purines. “High purine intake leads to a higher production of uric acid and produces a larger acid load for the kidneys to excrete,” said Dr. Jhagroo. Higher uric acid excretion leads to lower overall urine pH, which means the urine is more acidic. The high acid concentration of the urine makes it easier for uric acid stones to form.
Instead: To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. Limit alcohol because it can increase uric acid levels in the blood and avoid crash diets for the same reason..Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation.
5-Balance Your Fat Soluble Vitamins
This would be my top priority for any patient suffering from kidney stones, specifically calcium-oxalate stones. As many of Chris’s readers know, we require more than just vitamin D to properly metabolize calcium in our diets and in our blood, yet unfortunately, most nephrologists and dietitians never consider the role other fat soluble vitamins play in calcium metabolism. But vitamin A and vitamin K2 are two nutrients that are critical for balancing out the effects of vitamin D and making sure the calcium from our diet gets deposited into our bones and not into our arteries.
In someone with kidney stones, vitamin A deficiency, vitamin K2 deficiency, and vitamin D excess are all prime suspects to be considered in terms of both absolute amounts and proportions between the vitamins. Chris Masterjohn, PhD has written volumes about the importance of balancing these three nutrients, and especially balancing vitamin A with vitamin D, as an excess of one will lead to a deficiency of the other. In fact, vitamin D excess is considered to be a risk factor for kidney stones in the conventional medical world, and studies show that people exposed to high levels of sunlight are at higher risk for stones. Interestingly enough, adequate vitamin A intake protects against excess vitamin D, as Masterjohn has made clear in his series on the topic.
Vitamin K2 may play an independent role in kidney stone development. As Masterjohn points out, “patients with kidney stones secrete [vitamin-K2 dependent] protein in its inactive form, which is between four and twenty times less effective than its active form at inhibiting the growth of calcium oxalate crystals, suggesting that vitamin K2 deficiency is a major cause of kidney stones.” While the research is still new, I think there’s no reason not to ensure adequate intake of these nutrients in your diet for health maintenance, and you might find it helps with preventing kidney stone formation.
So how can you get more vitamin A and vitamin K2 in your diet? For vitamin A you can eat plenty of organ meats like liver, egg yolks, and full fat dairy products. For vitamin K2, eat liver, grass fed dairy products like ghee, butter, and full-fat cheeses, or natto (if you’re adventurous). If you need to supplement, keep vitamin A around 5,000-10,000 IU per day and try to get these nutrients from a food-based source, such as the Extra Virgin Cod Liver Oil. Also, try to cut down on alcohol consumption, as excess metabolism of alcohol can impair your utilization of vitamin A, leading to deficiency.
6-Add Lemon To Your Water
This is a natural treatment that conventional nephrologists have gotten right. While lemon water is often touted as a cleansing or alkalizing drink, the main reason it is helpful in reducing stone formation is its citric acid content.
Citric acid (not to be confused with vitamin C or ascorbic acid) inhibits stone formation and breaks up small stones that are beginning to form.It works in a few different ways. Citrate binds with calcium in the urine, reducing the amount of calcium available to form calcium oxalate stones. It also prevents tiny calcium oxalate crystals that are already in the kidneys from growing and massing together into larger stones. It also makes the urine less acidic, which inhibits the development of both calcium oxalate and uric acid stones.
You’ll need about a half a cup (4 oz) of lemon juice added to water throughout the day to get the same benefits as taking a potassium citrate pill, which is one of the standard pharmaceutical treatments for kidney stones. You can either take this all in one shot, or spread your intake of the lemon juice throughout the day. Try adding half a cup (or more!) of lemon or lime juice to a 32 ounce bottle of water and sip on it throughout the day. If you prefer, you can also try adding apple cider vinegar, which also contains citric acid and is an alkalizing addition to your beverages.
7-Get your Magnesium
Sometimes it seems like magnesium might be the cure for everything: muscle cramps, headaches, fatigue, insomnia, anxiety, constipation, back pain, brain fog… it might even solve world hunger. I’m kidding of course, but magnesium is definitely one of those magic cure-all dietary supplements that seems to help with a great variety of maladies without much risk for toxicity. That’s why I, like Chris, believe everyone should take a maintenance dose of a magnesium supplement, since it’s hard to get adequate magnesium even in the healthiest ancestral diet.
However, it may surprise you to learn that there’s some research suggesting that magnesium can lower the risk of stone formation. While scientists are still trying to figure out why magnesium has this stone preventing effect, and to determine which forms of magnesium are the most effective at preventing stones in humans, I think it’s safe to say that if you suffer from kidney stones, you’d be smart to ensure that your magnesium intake is adequate.
There are a few ways to up your magnesium intake. The easiest is to simply take at least 400 mg of magnesium in supplemental form on a daily basis. The best types to take are the chelated forms such as magnesium citrate and magnesium malate, as they’re well absorbed. You can also increase your dietary intake by eating pumpkin seeds, spinach, swiss chard, and nuts like almonds and cashews. Be sure to soak your nuts and seeds before eating them, which will help make the magnesium more available. Some people have reported benefits from taking epsom salt (magnesium sulfate) baths, as magnesium is able to be absorbed through the skin.
Whatever your method, just make sure you’re getting it daily in adequate amounts, since at least 50% of Americans have magnesium deficient diets, consuming less than 400 mg per day.And coffee, a common “paleo” treat, may actually cause magnesium deficiency so be careful not to overdo it in the mornings.
8-Eat More Carbohydrates
Another problem that people on a run-of-the-mill Paleo diet might encounter is an inadequate intake of carbohydrate. While carbohydrate is not an essential macronutrient in the most basic biochemical description, a very low carb diet can lead to profound health problems in certain individuals, such as depressed thyroid function, nutrient deficiencies like scurvy, and even insulin resistance. Many people eating a Paleo diet tend to eat lower carb simply because of the nature of the ‘banned’ foods being higher in carbohydrate, such as grains and dairy.
While eating Paleo does not equal low carb, it’s a common situation, especially if someone is new to the diet and doesn’t understand that foods like white potatoes are okay for most people to eat. (In fact, it might be good to alternate sweet potatoes with white potatoes regularly, since sweet potatoes are very high in oxalate which could contribute to stone formation!)
Paul Jaminet, PhD has written a great deal of information about the dangers of carbohydrate restriction, and kidney stones is one of them. While I won’t go into the great detail about why very low carb (VLC) diets can increase the risk for stones (you can read Jaminet’s article for that), the issue is likely due to the fact that VLC diets (<15% of calories from carbohydrate) make the urine more acidic due to the excessive amount of protein metabolism, potentially leading to uric acid stone formation. Generally, this is more of an issue on ketogenic diets, but is a risk for anyone whose diet and exercise routine requires a significantly high level of gluconeogenesis (i.e. forming glucose from amino acids/protein). A high protein diet with adequate carbohydrate intake, contrary to popular belief, will not necessarily increase your risk of stones, unless you already have underlying kidney disease.
In addition, per Jaminet, the degradation of oxidized vitamin C is a likely contributor to the development of stones by increasing oxalate excretion. So if you’re not getting enough vitamin C in your diet and your vitamin C needs are increased on a low carb diet, you may be unintentionally contributing to stone development.
Jaminet recommends a minimum of 20% to 30% of energy intake coming from carbohydrates. For a moderately active woman eating 2,000 calories per day, that’s 100-150 grams of carbohydrate from fruits, starchy vegetables like potatoes and sweet potatoes, white rice, and some dairy if tolerated. For a moderately active male eating 2600 calories, they might need more like 180-200 grams of carbohydrates per day.
As activity level and calorie needs increase, you’ll need to increase carbohydrates appropriately to support glycogen stores and activity levels. If you’re eating a low carbohydrate diet (less than 15% of calories per day) and getting kidney stones, I would reconsider your carbohydrate intake and try bumping it up. If you’re eating low carb and have never dealt with kidney stones, then you might be alright staying low carb – it’s up to you to decide!