Kidney stones are ‘rocking’ more and more people according to American Society of Nephrology statistics, with greatest increase among the under-19s.
By Dona Suri
Just about every physical parameter can now be monitored minute-to-minute by a health ‘wearable’. A recently launched gadget, called a Mini SipIt, which looks like a smart watch, monitors the wearer’s level of hydration and reminds them to drink water (or any fluid) when they are getting dried out. It’s intended for people who want to ward off kidney stones.
Kidney stones aka renal calculi, nephrolithiasis, or urolithiasis, are hard deposits of minerals and salts that form in the kidneys. Most stones occur when calcium combines with oxalate but they can also form from uric acid, which is a byproduct of purine metabolism. Struvite stones, made of magnesium ammonium phosphate, are uncommon (one in ten), and usually occur along with a urinary tract infection. Cystine stones form when an amino acid called cystine builds up in the urine. It’s an inherited condition.
Tiny kidney stones usually pass imperceptibly, but if you have a larger one, you will know it. You will feel severe, sharp pain that starts from the back or the side, typically just below the ribs. The pain may get steadily worse as the stone moves within the urinary tract. As the stone descends towards the bladder, the pain may also radiate towards the lower abdomen and groin.
If you have kidney stones and a urinary tract infection, expect fever, chills, and an overall sick feeling. In fact, kidney stones increase the likelihood of UTIs, because bacteria find a favorable environment around the stone
They tend to be recurrent; if you have had one, expect another within seven years – unless you take preventive measures. And you DO want to take preventive measures. For one thing, kidney stones can really hurt. And, they lead to decreased bone density which in turn leads to fractures, they raise your risk of cardio problems and worst of all, your kidneys might pack up altogether and you would be on dialysis for the rest of your life.
Kidney stones can appear at any age but statistically, the years between 40 and 60 are the peak. The condition affects one in five men but less than one in ten women. It you are Black or Asian, you are more likely to suffer from calcium oxalate stones; if you are White, you are more likely to get uric acid stones. Annually, the number of Americans who get treatment for kidney stones is about 600,000.
The condition is becoming more common. The American Society of Nephrology reports a 16 percent rise between 1997 and 2012. What really worries the Society is that the age group that showed the greatest increase is the 15- to 19-year-olds and within this age group, kidney stone incidence was 52 percent higher among girls and women. The condition is also hitting men at younger ages, beginning at age 25. Black adults and children are also “catching up” to Whites in kidney stone cases.
Doctors think that lack of physical activity, too much meat, too much salt and too little calcium in the diet and global warming are behind the increase. Someone with a close relative who gets kidney stones is a greater risk but the exact genetic picture is not clear yet.
Hot summers and kidney stones go together. The hotter it is, the more you sweat and less you urinate. Minerals in the kidneys and urinary tract don’t get flushed out. Kidney stone incidence has always been about twice as common in America’s southern states than in the north. With global warming, it is predicted that 70 percent of Americans will be living in high-risk zones by 2095. (In 2000, only 40 percent lived in high risk zones.)
Excess weight also contributes to kidney stone risk and people who are obese are more likely to develop Type 2 diabetes and hypertension to go along with their stones. Stones are also associated with inflammatory bowel disease, gout (caused by high levels of uric acid in the blood), hyperparathyroidism, renal tubular acidosis (kidney dysfunction that leads to too much acid in the blood), and recurrent urinary tract infections.
Diuretics (drugs that remove water and salt from the body through urine) and calcium antacids (stomach acid neutralizers) increase the risk of kidney stones.
What you eat has something (but not a lot) to do with whether you will, or will not, develop kidney stones.
It’s about oxalates. Oxalate (aka oxalic acid) is a compound found in plants and it is also naturally created in the human body as a waste product. Oxalates can bind to calcium—and to a lesser extent—other minerals in the stomach and intestines. The oxalates in your urine are those that your body formed as waste product; oxalates that you have taken in as food hardly figure.
But if a person is prone to kidney stones, then sticking to a low oxalate diet is just that little bit of extra caution. Not that a low oxalate diet all by itself will be enough to guarantee stone-free kidneys. You stand a better chance of warding off stones if you simply drink lots of water so as to dilute urine and thereby prevent oxalate from collecting in the kidneys.
Oxalobacter formignes is your secret weapon against oxalates in food. O. formignes is a bacteria that resides in your intestine where it breaks down all the oxalates you eat. So long as you are plentifully supplied with this bacteria you don’t have to worry about oxalates in your diet. Oxalates are its source of energy. Many antibiotics wipe out your O. formigenes and some others are barely tolerable.. If you don’t want a lot of oxalate washing up in the kidneys and binding with calcium to create a stone, don’t casually gulp down antibiotics for every little thing. Be nice to your Oxalobacter formignes.
And, by the way, cooking significantly reduces oxalate content in food.
Modifying your diet to reduce the risk of kidney stones means avoiding high amounts of salt, trans fats, meat (particularly processed meats) and certain vegetables and fruits that are high in oxalates. Eating an “anti-stone” diet also means that you are unlikely to put on a lot of weight. However, many of the foods that are high in oxalates are also healthy foods and you should not avoid them entirely. The way out is to eat calcium-rich foods during the same meal to balance out your oxalate levels. Consume 1,000 to 1,200 milligrams of calcium a day.
Calcium? Wait a minute … Isn’t the whole idea to keep oxalate away from calcium?
Here’s how it works: Calcium from food combines with oxalates in the intestines. The result is that oxalates wind up in the feces instead of the urine. With less oxalate in the urine, there is less to bind to urinary calcium so calcium oxalate stones do not form.
Calcium in the diet does not increase the amount of calcium in your urine but calcium supplements can stuff you with much more calcium than the body can use. Then it is excreted in urine so it becomes a stone risk. Before you start popping calcium supplements, get your bone density and calcium level checked and then talk to your doctor to figure out if you need more calcium and if so, how much more.
If you are stone-prone cut back on salt. The normal recommendation is 2,300 mg daily but if stones are a problem then keep your intake under 1,500 mg. Less salt means that you are doing your heart a favour too. Always check the sodium content on the food label before you eat ready-to-eat foods
Too much animal protein raises uric acid level and depresses the citrate level. This means greater stone risk. Go slow on red meat, poultry, eggs, and seafood. Your meat portion at a meal should be about the size of the palm of your hand. Vegetarian sources of protein (lentils, peas and beans) have no adverse effects.
Citrate lowers the acidity of urine. Get your citrate from lemons, limes and oranges. The natural Vitamin C in these fruits is much better for you than Vitamin C supplements. Vitamin C can get converted into oxalate in the body if it is taken in excessive amounts such as in a supplement. Check your Vitamin C level and talk to a doctor if it turns out to be deficient.
So far there is no drug that cures or prevents kidney stones but there are treatments. Alpha blockers relax the muscles in the urinary tract, helping the kidney stone to pass faster and less painfully. Or a big stone may be broken up into tiny ones by a special kind of sound wave. This is called lithotripsy. Percutaneous nephrolithotomy is a minimally invasive surgical technique to remove stones. For severe cases the doctor inserts a thin lighted tube in the urethra and through this he finds and extracts stones. This is called ureteroscopy,
The best way to spare yourself the pain of a kidney stone is to prevent its formation in the first place. It’s as easy and inexpensive as drinking a glass of water. Actually, make that eight glasses of water, or about two quarts. In hot weather, drink a little extra. By ensuring that your body maintains proper urine volume and dilution you are preventing stones or helping them to pass through the system painlessly while they are still small.
If you already have small kidney stones, increase your daily fluid intake to about three liters per day. This amount of fluid will make the stones even smaller so that they can be passed without difficulty.
You don’t have to drink plain water all the time. Tea, coffee, milk and buttermilk are all fluids. Lemonade, orange, grapefruit, pineapple and watermelon juices, as well as apple cider vinegar, are good choices because they’re full of citrate which helps block stone formation.
(A citrate is a salt or ester of citric acid. If you are curious about how the body turns citric acid into citrate here’s a link to a site that goes into lengthy but fascinating biochemical detail:
Some foods, known as diuretics, also increase the rate of urination. Picture a nice salad: lettuce, cucumber, tomato, cabbage, bell pepper with a bit of finely chopped celery, onion, ginger. That’s eight diuretic kidney-cleansing foods in one big bowl. Asparagus and brussels sprouts are good for flushing out the kidneys and many fruits do the same job. Here’s a list: watermelon, pineapple, grape, cranberries, apple, strawberries, blueberries, cherries, and peaches.
Stones or no stones, just remember
STAY HYDRATED !
It helps the body in many ways, and is particularly important for the stone-prone.