Kidney Stones 101: Symptoms, Root Causes & Real-Food Prevention

Transcript: 

Melanie: Hello and welcome to Dishing Up Nutrition, brought to you by Nutritional Weight & Wellness. I'm Melanie Beasley, a registered and licensed dietitian with Nutritional Weight & Wellness. Well before we get started today, if you enjoy listening to our podcast, the best way you can support us is to share with others who could also benefit from our real food message

Sharing our podcast tells someone you're thinking about them, you care about them. So go ahead and share this message if you feel like someone you know would benefit. And for the past 20 years, Dishing Up Nutrition has covered every health and nutrition topic under the sun. So if there's a topic you see that makes you think of someone, share it with them. Tell them you're thinking about them.

It really is the best way you can help spread our message of real food for real health and maybe help someone out who's on the struggle bus with one of these conditions. Now getting on into today's show, we are talking about a topic that can feel a little scary if you've been through it. Kidney stones. Wow. If you've ever had one, you probably are wincing on the other side listening to this. You don't need convincing that you want to do whatever it takes to prevent getting another one.

And if you haven't, chances are you know someone who has. Maybe you have a family history of kidney problems and you want to be proactive. It's really common and legitimate concern because kidney stones affect about one in 10 people at some point in their lifetime. And diet plays a major role in both causing and what you can do to prevent further kidney stones.

So today we're answering all those big questions. What causes them? What should you eat or avoid eating to prevent? And if you've had them, how do you prevent them from coming back again? And with me today, sharing her expertise is a fellow registered and licensed dietitian, Britni Vincent. Thanks for being here with me, Britni. As usual, it's fun.

Britni: Yes, it is. Thank you, Melanie. Like you mentioned, if you've ever had a kidney stone, chances are you are going to do anything in your power to prevent another one.

Melanie: And if you've had, if you're a female and you've had a, a partner, and he's had one, you know, I mean, they, they liken it to a male having a baby.

Britni: Yes, I've heard that too.

Melanie: I've heard that. I knew a man who said, yeah, I spent the night in the fetal position trying to pass a kidney stone in the hospital.

Britni: Oh, sounds miserable.

Melanie: Horrible, horrible pain.

Britni: And you know, the classic symptom of a kidney stone is that severe pain often described as one of the worst pains someone has ever felt. And you know, in fact, when people walk into the emergency room or urgent care, a lot of times the medical staff know just by looking at them, that it could likely be a kidney stone. And that pain typically starts in the back or the side, just below the ribs, and then it may radiate toward the lower abdomen.

And the pain may come in waves, and it's not always constant just because as the stone moves through the urinary tract, that pain can intensify, subside, intensify again.

Melanie: It’s like labor.

Britni: Yeah. Oh man. Never want to go through that again.

Melanie: Well, other early signs could be blood in the urine, nausea and vomiting, burning during urination and feeling like you urgently need to urinate, but only passing small amounts. But sometimes, especially with small stones, people may not have that severe pain.

You may feel a dull ache in your back that won't go away. It doesn't always get to the point of severe pain if you catch it early on. So if you're experiencing these symptoms, it's important to go get evaluated for sure.

What causes kidney stones & how do they develop?

Britni: All right. Well, let's talk about what causes them and how they develop, because I think that's what everybody wants to know. How can I prevent this? Well, kidney stones form when certain substances in the urine become too concentrated and crystallized. So think of it as this, like your urine contains minerals and salts, and when there's too little fluid and too many minerals, they can stick together and form crystals. Over time, those crystals can grow into, into the kidney stones.

Melanie: They're like gathering snowballs.

Britni: Yeah, it's a good way to think of it. And there are a few different types of kidney stones, but about 80% of them are calcium oxalate stones, which are the most diet related. And that's what we're going to focus our time on today.

Melanie: Some people are more prone to kidney stones. In fact, already having had kidney stones is the biggest risk factor for recurrence. If you've had kidney stones, you're in that 50% greater risk of developing them within five years, especially if you don't change contributing factors. So it's common to have these as a reoccurring issue because if you don't change anything, that recipe that developed the kidney stones is still present. So I had a young client in her twenties and she was a pilot. She developed kidney stones regularly. Well, it would put her on hold being able to fly, of course.

Britni: Oh no. Yeah.

Melanie: And so come to find out, she would get dehydrated during the flights, so she didn't have to get up and go to the bathroom. She would also drink soda. So two big contributing factors: dehydration, soda.

Britni: Yes.

Melanie: So hydrating, hydrating, hydrating, changing her diet. She had about four kidney stones and now she hasn't had any with some of the changes we're going to talk about today is what she incorporated. So they were miserable for her. She was hospitalized with it.

Britni: Oh wow. I'm sure she is very thankful for meeting with you. So let's, let's talk about just that. What do you do to decrease your risk of kidney stones? So your kidneys, they are working for you all day, all night long. Whether you are thinking about them or not, they're doing their job in the background.

Adequate hydration is key

They're filtering your blood, helping balance fluids, minerals, and they're part of your body's cleanup crew. One of the most crucial things that keeps them functioning properly is adequate hydration. And so dehydration is actually the number one modifiable risk factor for kidney stones. I'm going to repeat that. Dehydration is the number one modifiable risk factor for kidney stones, and it sounds like it, that was a huge part of the modifications that your client made.

Melanie: Yes.

Britni: Because when you're dehydrated, your urine becomes more concentrated. I mean, you see it when it's orange.

Melanie: Orange.

Britni: That is not good. Or even dark yellow for that matter.

Melanie: Should be like a very straw colored pale yellow every time you urinate. So, you know, we talk a lot about look in the toilet.

Britni: Yes.

Melanie: Not only for stool, but for urine.

Britni: It can tell you a lot.

Melanie: Mm-hmm.

Britni: And when you are dehydrated, that is going to allow the minerals to crystallize. A prevention goal is to drink half your body weight in ounces each day. I would max that at about a hundred to 120 ounces.

Melanie: Mm-hmm.

Britni: Now over the next day or two, track your water, see where you're at. If you're only drinking 30 ounces, it's not realistic to jump from 30 to 90. So maybe you set, set yourself some shorter goals. Maybe every week you're increasing by, you know, 10 to 20 ounces. Some things I have found helpful for clients: have a large reusable water bottle.

So the least number of times you need to refill that in a day I think is really helpful. Sounds kind of silly, but pick a color you love. Find it attractive. People are more likely to drink water. It's also very important to spread that out throughout the day.

Melanie: And don't you find that if it has a straw people drink more than tilting a big water bottle upside down. Can get dangerous. I just splurged on a water bottle that's ridiculously expensive because my daughters have this water bottle. And you can turn it and it, you can turn it upside down when you've got it locked and it won't leak. It's got a metal straw inside. It's got a silicone straw on the top and I'm, I've become this water bottle girl where I want this bougie water bottle, whereas any water bottle used to do so, thanks daughters. But anyway, find one you love.

Britni: Yes, it makes a huge difference.

Melanie: It fits in your car. It doesn't spill. You love how it looks. You can take it everywhere with you. And if you lose track of how many times you fill it, put the number of rubber bands at the top that you need to fill it to get that a hundred ounces in. And then every time your water, you roll that rubber band down, every time you fill that water bottle, all your rubber bands are at the bottom. You get to go to bed.

Britni: Yeah. Perfect.

Melanie: So it works. It's just, we think because we're carrying a water bottle, we're hydrating. But how many times are you actually filling that baby up?

Britni: Yes.

Melanie: Yeah.

Britni: Yes. Pay attention. Track it. Mm-hmm.

Avoid excess sodium

Melanie: We also want you to avoid excess sodium. No, we're not talking about a very, very, very low sodium diet. But if you're getting a lot of salt in your cooked meal, and then you're eating processed foods that are high in salt, and then you're eating salty chips, and then you're also eating salty Chinese food for takeout, that's a big sodium wallop that you're getting and your body has to dilute all of that sodium. So what does it do? It pulls it from your body, and it makes you dehydrated.

Britni: I mean, you've probably noticed if you have a high sodium meal, you're thirstier.

Melanie: Yes.

Britni: Afterwards.

Melanie: And it's not just because, you know, if you think make the connection, you're thirsty because your body is telling you, I've got to dilute all the sodium that you just consumed because we don't urinate salt shakers. Right? It's always fluid.

Britni: Yeah.

Melanie: Is how we get rid of waste. So it's important. And the vast majority of high, so sodium sources are ultra processed foods and restaurant meals, frozen dinners, canned soups, deli meat, chips. You know, the list goes on and on. So eating real food meals prepared at home is actually a naturally lower sodium intake because real food does not really have a high sodium intake.

There's not a food out there. So the reason this is important is that high sodium intake causes the kidneys to excrete more calcium in the urine. More calcium in the urine increases the risk of calcium based stones. So this is another cause of how reducing ultra processed foods benefits your health beyond just weight loss.

And when I get my clients eating more of real, a real food diet, when I say real food, I mean you can hunt it or pluck it in nature. And my clients will find that they don't need to spend time reading labels and going over the sodium content because real foods in nature, like I said, naturally low in sodium.

So you may still need to be mindful of things like spice blends or marinades, limit restaurant meals to once a week, but not several times a week. And now restaurants are so great about I don't add any salt or soy sauce to my food. I mean, they're great about that. And you can be mindful. And here's the benefit. When you cut back on salt, it takes two weeks and then your palate says, I'm good. And you don't miss it.

Britni: Yeah.

Melanie: But you've got to stick with it for two weeks if you're a salter, I'm a salter, I salt, salt, salt, everything. And so whenever I cut back, it takes me two weeks to not miss it.

Britni: And you know, if you are somebody eating real food, you're cooking at home. Don't be fearful of salting your food.

Melanie: Yes. We're not saying salting your food is going to cause kidney stones.

Britni: No, no. It's these ultra processed foods that are, those are the buggers.

Melanie: And all the more reason to get a quality salt, which we've talked about in other podcasts.

Britni: Yes.

Melanie: Because if you had to quality salt, a mineral salt like Redmond’s or Celtic gray salt, it's going to have minerals that balance each other out in with the sodium.

Britni: Yep.

Melanie: It's not just pure sodium chloride.

Britni: We have a great “Ask a Nutritionist” all about salt, so check that out if, if you want to learn more and you know, if you are somebody that has had a kidney stone, chances are you've gone to Dr. Google and you see what he has to say about it. I just assume Google's a he. Could be a she; don’t know.

Melanie: Dr. Google.

Do high protein diets increase risk of kidney stones?

Britni: But chances are you saw something about high protein diets increasing your risk of kidney stones. So the amount of protein that we recommend and eating a balanced whole food diet is not going to increase your risk.

Melanie: No.

Britni: And I have had several clients that have a history of kidney stones. And we've actually increased their protein intake and they don't get another kidney stone.

Melanie: Yes. Some of those research articles on meat, they were not looking at the quality of the meal they were consuming.

Britni: Yes.

Melanie: So they didn't, it wasn't, it might have been burgers, fast food burgers with French fries. It wasn't the quality food that we are talking about, so they just lumped it all in when it must be the protein.

Britni: Yeah. I mean, that's a great point. That is one of the tricky things about researching nutrition. It does not factor in, like you said, what are they eating with their meat?

Melanie: Right. And if you get a mile high above this, you know, the carnivore diet is trending, there would be this huge problem.

Britni: Yeah.

Melanie: With all the people on a carnivore diet or a keto diet for that matter.

Britni: Mm-hmm.

Melanie: …getting kidney stones. And that's just not what we're seeing.

Britni: That's a very good point.

Melanie: You know, it might be counterintuitive, but calcium is also really important for binding and eliminating oxalates. Because you remember you said stones were primarily made of…

Britni: Calcium.

Melanie: Calcium oxylates. So it would make sense to think if kidney stones are made of calcium, I should avoid eating calcium rich foods or supplementing with my calcium. Maybe you're on a calcium supplement for your bone health. But actually the opposite is true. About 70 to 80% of kidney stones are calcium oxalate stones, that the key driver isn't usually too much calcium.

There's too much oxalate being absorbed. So when you eat high amounts of oxalate containing foods, I'm thinking of clients that every morning they shove handfuls and handfuls of spinach into their smoothie, but that's not a natural way of eating. So yes, putting some greens in your smoothie is great, but always spinach is very high in oxalates. Spinach is not bad.

Britni: Yes.

Melanie: But if we're doing several handfuls every day, we're the overload of oxalates is too high. You know, other foods like almonds and peanuts and beets and chocolate, they have oxalates too. But do you have to combine calcium every time you have these foods? No, that's not really the risk.

The calcium does help bind and excrete out oxalates from the stool. So again, when you're eating real food, the balance of calcium and oxalates is naturally in your food. So you're not getting this crazy high oxalate amount of foods. So I, it's very rare. I think in 40 years of practice, I've had one client, two clients that really were oxalate sensitive; that was about gut health, that really wasn't what people are born with.

Britni: Yeah.

Melanie: So. It's good to be mindful of that, that just because your stones are made of calcium or oxalates does not mean you have to completely eliminate calcium and oxalate foods.

Britni: Yeah. Because, you know, generally speaking, these high oxalate foods are otherwise very healthy. So it would be a restrictive diet to completely eliminate them. So that's a great point. Just be mindful if you are consuming a very, very large amount. Could you swap it with something else? Maybe you put riced cauliflower in your smoothie. Maybe you have a kale salad. And on that note, it is time for our break and we will be right back.

-----

Welcome back to Dishing Up Nutrition. Melanie and I have been talking about kidney stones and what you can do to prevent them.

Melanie: So we were talking about oxalates and about how completely eliminating oxalates really is not the answer because there's so many healthy foods that are high in oxalates. So we don't want to demonize those foods and make everyone afraid of them.

Eat in balance & eat in season

But, I would encourage when we talk about how to eat at Nutritional Weight & Wellness, we talk about eating in balance, eating a variety of fruits and vegetables, a variety of proteins, a variety of dairy if you tolerate it, and always having protein, vegetables, and healthy fats at a meal.

So if you're following that balance, the next step would be is are you eating foods in season? Do you, like we said earlier, are you always eating spinach every morning with your eggs or smoothie? Mix it up. What's in season? If you're eating the foods that are typically in season, one, they're going to be fresher. Two, they're going to be more nutrient dense because they didn't have to travel from, you know, far, far away.

Three, you're going to get a good nutrient profile, a variety of both nutrients and fiber types, and that lends itself to a really rounded, out, well-balanced body as far as its nutritional status, as well as its microbiome status because of the variety of vegetables.

So think about, you know, in the winter there's a lot of root vegetables and lettuces that you can access. Well, in the summer there's a whole different, in the fall we've got, you know, asparagus. So think about eating foods in season, and then you're not so focused on one same food day in and day out. I mean, we're very lucky we live in America. We can have strawberries every day, but is it optimal for our health to only eat strawberries? No.

Britni: That's a great point.

Melanie: Is it optimal for our health to only eat almonds? No. Get a variety of nuts and seeds, not just the same old almonds. And that's going to help prevent you from overdoing one component. And for today's purpose, we're talking about oxalates.

Getting adequate magnesium is important for kidney stone prevention

You know, we have clients that come in all the time that are so terrified of calcium because they have calcium oxalate stones, and they have osteoporosis. So I feel like we need to talk about magnesium because magnesium deficiency also lends itself to kidney stones. And so when I put people on magnesium, it decreases their risk.

Like they're so afraid of the calcium. And I'm like, well, you know, you've been throwing calcium at yourself for your bones, but you haven't taken any magnesium. And it's that balance that they need.

Britni: So I want to share a client story about kidney stones. I have been seeing a client for about a year now, and he has a history of several kidney stones.

Melanie: Yikes.

Britni: And was meeting with a urologist, I believe every six months for lab work. And at the time when we first started meeting with him, his lab work indicating that he had an increased risk of stone formation, all of that was out of range.

So what, what we really focused on hydration, of course. So he's really got that down. And then limiting those processed foods. He's getting more vegetables, he's getting more balance, really eliminated sugar as well. And so all the things that we have been talking about thus far, and he recently, within the last couple months, went back to his urologist. All of his lab work is within normal range.

Melanie: Winning.

Britni: And the urologist doesn't need to see him in six months.

Melanie: That's fabulous. I bet he's thrilled.

Britni: Yeah. He's so happy. And you know, another thing we did do is we added magnesium. So we talked about magnesium rich foods and adding magnesium. Because magnesium is also very beneficial at stone prevention is it works by binding those oxalates in the digestive tract, preventing it from being absorbed into the blood and then excreted into the urine.

It also acts as a crystal inhibitor in the urine, and we talk about magnesium all the time. I mean, the vast majority of Americans are deficient. And it plays hundreds of different roles in our body. So eating magnesium rich foods, it's a great idea for overall health.

And that would be leafy greens, legumes, dark chocolate even; I mean, within reason; nuts and seeds, those would all be great sources of magnesium. As far as adding it as a supplement, that can also be a great idea. Helps with sleep, it helps with, you know, anything muscle related.

Melanie: Three over three enzymatic processes need magnesium. We would love to say you can get it all from food, but it's not, the food of today is not the food of 20 years ago.

Britni: Yep.

Melanie: And it's lower in minerals, it's lower in calcium, it's lower in magnesium, it's lower in potassium. So we are finding that we do have to really supplement magnesium for sure.

Britni: Mm-hmm.

Melanie: And people feel amazing once you optimize that magnesium level. But the bonus is they're decreasing their risk of kidney stone formation.

Britni: It’s a win-win.

Melanie: Real food magic.

Britni: Yep.

Melanie: And then adding some magnesium in there also magic. And, you know, I have clients that come to me and they're really afraid of putting calcium in their diet. Let's say they have osteoporosis and they, they know they need to supplement with a good calcium supplement, but they're so afraid of these kidney stones.

Britni: Sure.

Melanie: And so I try to explain to them that the, both the calcium, you know, when you have a good absorbable form of calcium and the magnesium, a good absorbable form of magnesium, it actually balances itself out. We're, we're not going to put you at further risk, and I've yet to have anyone who's on a calcium supplement with magnesium develop stones.

But food is magically put together in a way that when you're eating balance of all the fruits, vegetables, nuts, and seeds, and then you're having the meat and then you're having some healthy fat, it optimizes absorption and utilization of everything the way it's supposed to be.

Britni: Nature made it how, how it's intended for us to absorb.

Britni: Yeah.

Big risk for kidney stones: sugar

Melanie: Yeah. Well, let's talk a little bit, you touched on the sugary foods that your client decreased. And the sugary drinks. And one of the biggest modern risk factors for kidney stones is sugar, especially in sugary drinks like soda. And the reason for this is that sugar actually changes urine chemistry and increases urine calcium.

It, it really makes us not absorb our minerals well when we eat a bunch of sugar. So high sugar foods increase insulin. High insulin makes your kidneys spill more calcium into your urine, and more calcium in the urine equals higher risks for stone development and even short term high sugar intake increases urine calcium levels. If you want to hang on to the calcium for your bones and you don't want it to go towards stones, you want to be avoiding sugar and sugary foods.

Britni: Absolutely. And when we think about drinks, fructose and high fructose corn syrup, you know, it's everywhere. Every soda, sweet teas, energy drinks sometimes, fruit juice concentrates. So this type of fructose is going to increase uric acid production, which can also form stones.

So to clarify though, eating fructose when we're consuming whole fruits, you know, that's different. We really want to avoid that high fructose corn syrup and even if it's a sugary beverage that is sweetened with something else, not high fructose corn syrup, for the reasons you just explained, Melanie, we still want to be really avoiding those.

Melanie: Yeah. Agave in the margarita is still sugar. So, in fact it's very high in fructose, so we want to avoid sugar in all forms.

Britni: Yeah.

Melanie: Yeah.

Britni: And then it's also leading to dehydration, so it's a double whammy really when we're talking about kidney stones.

Melanie: Yeah.

Britni: When you're replacing water with sweetened beverages, urine becomes more concentrated. Those mineral levels rise and crystals are going to form more easily. So remember that fluid intake is not the same as hydration. When we're talking about hydration, we are talking about pure water.

Melanie: Pure water. Pure water, pure water. Water. Water. Water.

Britni: That should be your primary beverage throughout the day.

Melanie: Yeah, because if you're drinking a caffeinated beverage, it's going to be dehydrating. The caffeine dehydrates you if you're, you know, anything that you consume that's more than water, there's something in there that the body then has to utilize fluid in order to get rid of it and process and metabolize it so that it does pull from your fluid quota. But you know, when we're talking about foods like, or beverages like alcohol. Alcohol we all know is very dehydrating.

Britni: Yep.

Melanie: And even diet sodas that don't contain sugar, those are not a water replacement. Sodas contain phosphoric acid, which may negatively affect calcium balance and potentially increase kidney stone formation. Sodas are a big risk factor.

Britni: And just high sugar intake, even if it's not from beverages, if it's from food or in, we can say high carbohydrate intake as well, that's going to contribute to insulin resistance, prediabetes, type two diabetes, and these conditions are going to make urine more acidic and more stone friendly. So as you can see, a high sugar diet or a high carbohydrate diet…

Melanie: Or a high processed food diet.

Britni: Yeah. All of these things are not just impacting your weight and metabolism. They have a lot of negative impacts throughout the body systemically, including directly changing urine chemistry in ways that promote kidney stones.

Melanie: So if you're thinking, I'm just that unlucky person that gets kidney stones, it is something that is relatable. There's a reason and a causative factor that we've gone over today with this podcast that it's really, you're just not unlucky, but there are some proactive things that you can do so that you don't have those terrible, painful stones.

In many cases, it's influenced by hydration and just your overall diet quality. So the really, the big takeaways are going to be drink enough water and make water your favorite beverage, sip on it throughout the day, and make sure you're getting your quota of the amount of water that you need.

You want to eliminate sweetened beverages and sugary foods as much as possible. Prioritize lower sodium as far as avoiding processed foods and salted foods or over salting your food and then eating plenty of vegetables and fruits and your animal protein with some healthy fats, good nutrient absorption, good oxalate and calcium absorption are going to be key players.

Britni: Mm-hmm. And whether you've had a kidney stone or not, prevention should always be a priority. And if you're unsure where to start, I know this can be very overwhelming, working with a registered dietitian like myself or Melanie, we're always here to help you, support you, come up with an individualized plan, and to find out more about counseling, see if your insurance would cover your appointments. You can visit weightandwellness.com or give us a call, 651-699-3438.

Schedule Nutrition Counseling

Melanie: Our goal at Nutritional Weight & Wellness is to help each and every person experience better health through eating real food. It's a simple yet powerful message. Eating real food is life changing. Thank you for joining us today.