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The primary purpose of the kidneys is to filter blood and excrete urine. After filtering the blood, urine is created, passed down into the ureters (the tubes that connect each kidney to the bladder), and stored in the bladder until it exits the body through the urethra. This process helps remove toxins from the body while also assisting in maintaining balance of crucial electrolytes such as sodium, potassium, calcium, and magnesium.
When the urine contains more crystal-making substances than the urine can dilute, kidney stones can develop. They also travel down into the ureter, where they can become stuck. When this occurs, the pain can be excruciating. Kidney stones are very common and occur in up to 10% of the population.
Symptoms of kidney stones normally arise quickly, and they may also fade quickly. Stones can cause colicky flank pain, which tends to radiate from the mid-back down into the groin or lower abdomen area. Stones are also associated with nausea, vomiting, or difficulty finding a comfortable position. In addition, those with kidney stones may notice blood in the urine or urine that is darker in color.
Calcium stones account for 80 percent of all kidney stones. They can be either calcium oxalate or calcium phosphate and occur as a result of an excess concentration of calcium in the kidneys or urine. However, the causes are many and not simply a consequence of too much calcium.
Uric acid is a waste product found in the urine and is responsible for its distinctive smell. When present in excessive amounts, it can lead to the formation of uric acid stones. Risk factors for elevated uric acid include prediabetes, diabetes, overweight, obesity, gout, and a diet high in animal protein but low in vegetables.
These stones occur in those who have chronic urinary tract infections.
A high intake of sugar is associated with increased calcium excretion, which likely explains why diabetics are at increased risk for kidney stones. A 2013 study that evaluated over 194,000 people concluded, “Consumption of sugar-sweetened soda and punch is associated with a higher risk of stone formation, whereas consumption of coffee, tea, beer, wine, and orange juice is associated with a lower risk.” But not all citrus juice is beneficial. A 1998 study showed that grapefruit juice was associated with a 44% increased risk of kidney stones
There is good news. According to a 2019 study, adding lemonade to your diet may be beneficial. It was concluded that “Diet lemonade may provide a low-calorie, sugar-free, cost-effective option for decreasing the risk of recurrent calcium nephrolithiasis through a significant increase in urine volume, increase in urinary citrate, and reduction in supersaturation of calcium oxalate and calcium phosphate.” A 2005 study also showed that lemon juice may also be beneficial.
Those with recurrent kidney stones should pay close attention to their diets. Traditionally, doctors recommend those with a history of calcium oxalate stones avoid foods high in oxalates, including spinach, rhubarb, grits, baked potatoes, french fries, and sweet potatoes to name a few.
A 2014 study asserted, “The most effective dietary approach to prevent kidney stone disease is a mild animal protein restriction, a balanced intake of carbohydrates and fats, and a high intake of fruit and vegetables”. A low sodium diet should also be considered as that may protect against kidney stones. A 2020 study concluded that a vegetarian diet that included dairy products is the most effective and protective diet for people experiencing kidney stones. A separate 2020 study concluded that the Mediterranean diet can also be beneficial.
A 2002 study found that a low-carbohydrate or ketogenic diet may increase risk for kidney stones. For those on a ketogenic diet or considering it, the risk and benefits need to be considered. Personally, I have seen over a hundred patients do the ketogenic diet and have not seen anyone develop kidney stones.
The usual medical approach to treating kidney stones includes medications and/or surgery. The most commonly used medications include opiates (hydrocodone, oxycodone, morphine) for pain or tamsulosin, which helps one pass the stone out of the ureter. Stones less than 5-6 mm in size may pass on their own over time.
When time or medications are not sufficient, or if the stone is larger than 6 mm in size, then surgical intervention by a urologist may be considered. The surgical interventions may include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL).
Natural supplements like magnesium, potassium citrate, calcium, vitamin c, vitamin d, and co-enzyme q10 have shown to help with kidney stones.
Magnesium is required for more than 350 biochemical reactions to occur in the human body. When the body is deficient, there is an increased risk for heart palpitations, leg cramps, high blood pressure, and kidney stones.
Magnesium inhibits the formation of calcium oxalate crystals in the urine. Its use for the prevention of kidney stones has been known since the 17th and 18th centuries. Now in the 21st century, we are rediscovering its benefits all over again.
A 1982 study reported that taking magnesium resulted in a ten-fold reduction in stone formation in those afflicted. In addition, 85 percent of the patients who normally averaged nearly one stone per year were without kidney stones three years later. Researchers concluded, “..magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.”
Further, a 1988 study showed that lower levels of magnesium in the urine increased the risk of developing kidney stones. This was echoed by a 2020 study, which showed that low blood levels of magnesium were associated with an increased risk of kidney stones. Suggested dose: 125 to 500 mg per day.
Potassium citrate binds with urinary calcium, preventing the formation of calcium stones. In addition, the citrate binds to calcium-oxalate, preventing calcium stones, if present, from enlarging.
A 2009 study in Pediatrics demonstrated that potassium citrate was an effective treatment in the prevention of kidney stones. A 2010 study also demonstrated the effectiveness of potassium citrate in preventing kidney stones in patients afflicted with medullary sponge kidney (MSK), a condition associated with recurrent calcium stones. It is acceptable to take both magnesium and potassium citrate. Suggested dose: As directed on the label.
Traditionally, a low-calcium diet was recommended to help prevent kidney stones. On the surface, this would appear to make sense, but studies do not support this, as a low-calcium diet actually results in an increase in the intestinal absorption of oxalate, resulting in more kidney stones. In reality, diets high in calcium-rich foods actually appear to prevent the formation of kidney stones.
The benefits versus harms of calcium supplements and kidney stones are not as clear. A 2015 study of those who took calcium supplements showed an increased risk in the formation of kidney stones. A 2019 study also repeated the same concern. However, a 2004 study in the Archives of Internal Medicine did not find an increased risk of calcium supplements and kidney stones.
Despite this, it is commonly recommended that a person taking a calcium supplement should also add magnesium. Further, a calcium citrate formulation may be a better option for those concerned about kidney stones.
There are conflicting reports when it comes to vitamin C and kidney stones. Vitamin C is metabolized into oxalate, which increases the risk of kidney stones. As a result, it is commonly recommended that those at risk for kidney stones should avoid vitamin C doses larger than 1,000 mg per day.
However, a 1999 study in which 85,557 subjects were prospectively studied concluded, “Routine restriction of vitamin C to prevent stone formation appears unwarranted.” Some clarity was offered by a 2016 study in the American Journal of Kidney Disease, which found that supplementing with vitamin C was associated with a significantly higher risk of kidney stones in men only, while there was no increase among women. A prudent recommendation would be to keep vitamin C to less than 1,000 mg per day if you are at risk for kidney stones. In addition, adding magnesium and potassium citrate can be considered.
Vitamin D deficiency is common. Thousands of studies over the decade have shown that lower levels of vitamin D are associated with an increased risk for heart disease, neurological diseases, and various cancers. There is also evidence that those who are at risk for kidney stones are more likely to be deficient than others. Some are concerned that vitamin D supplementation may increase the risk for kidney stones, but the majority of evidence suggests otherwise.
A 2013 study stated, “Short-term nutritional vitamin D repletion in stone formers with vitamin D deficiency also does not appear to increase urinary calcium excretion.” Similarly, a 2016 study showed that supplementation with vitamin D did not increase the risk of kidney stones. A 2019 study gave patients 50,000 IU weekly and found that patients deficient in vitamin D who supplemented with conventional doses, did not necessarily experience an increase of kidney stones. However, a 2020 study showed that vitamin D may increase the risk for calcium excretion.
The bottom line is that a person who is vitamin D deficient but at risk for kidney stones may consider taking vitamin D but should also take dietary precautions and perhaps add magnesium and/or potassium citrate to their daily vitamin regimen. Suggested dose: 1,000 IU to 5,000 IU daily.
Co-enzyme Q10 (CoQ10), also known as ubiquinone, is a naturally occurring antioxidant nutrient required for life and required for cells to generate energy. This is done, primarily, in a part of the cell called mitochondria, the cellular power plant that generates energy in the body. CoQ10 may also help protect the kidneys and be beneficial for those who undergo ESWL, a surgical procedure to break up kidney stones.
In the 2014 study, subjects were given 200 mg of CoQ10 daily starting one week prior to surgery and for one week after. Those who took the CoQ10 had better kidney function and less inflammation after the surgical procedure.
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By Dr. Eric Madrid, M.D.
