While quick management of a painful stone is everyone’s first concern, it is not the end of the story. As the old saying goes, “An ounce of prevention is worth a pound of cure.” A critical consideration involves trying to prevent future stones, as prevention of stone formation is preferable to treatment of recurrent stone attacks. Numerous manageable medical conditions, like parathyroid disease, gout and digestive disorders can contribute to stone formation. Metabolism changes, as seen with major weight loss, can also cause stones to form. The most common factor, however, is dehydration. Anything that leads to dehydration can lead to stones. Thus, the most common recommendation for stone prevention is to “drink more water.” Hydration, as well as managing underlying medial conditions, will help prevent recurrent stones.
Most urinary stones are made of calcium oxalate. Contrary to popular belief, consuming too much calcium or dairy products is not usually the cause of these stones. However, if you make lots of stones and are taking lots of dairy, calcium supplements, calcium-vitamins, or TUMS, they may be implicated. Similarly, some foods have lots of oxalate composition which can trigger stones, most notably tea, beer, nuts, and peanut butter. Identifying stone composition and then assessing urine concentrations can often identify the cause. Once studied, your doctor will decide if medications might help decrease the risk of new stone formation. Above all, a complete evaluation is critical in the long- term care plan for kidney stone patients.
- Hydrate. Don’t underestimate your sweating. Saunas, hot yoga and heavy exercise may be good for your health, but they also may lead to kidney stones. The common link is dehydration. The more you sweat, the less urine you produce, which allows stone-causing minerals to concentrate.
Recommend: Your best bet to avoid kidney stones is to drink plenty of water. A simple way to assess hydration is to look at your urine. If it is dark yellow or amber, you are likely dehydrated; if it is almost clear like water, you are well hydrated. Stay hydrated to lessen stone formation. - Understand Stone Chemicals. Most stones are made of calcium-oxalate. Dietary calcium is not necessarily the enemy, although it tends to get a bad rap! While calcium intake is certainly involved, a bigger factor in calcium excretion is sodium (salt) intake. Too much salt triggers calcium release into the urine. Regarding dietary calcium, too much or too little can precipitate stones, but more importantly cut your salt. Oxalate is dietary, and is naturally found in many foods, including peanut butter, iced tea, nuts and seeds, grains, legumes, sweet potatoes, and even chocolate. Urine studies can tell if oxalate levels are driving stone formation. If so, controlling oxalate intake will be critical. Remember, calcium and oxalate will bind together, either in the gut or in the urine.
Recommend: If you love calcium and oxalate foods, eat and drink them together during a meal. In doing so, oxalate and calcium are more likely to bind to one another in the gut before the kidneys ever begin processing them, making it less likely that calcium finds oxalate in the urine to make a stone. - It’s Not One and Done. Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, it’s not always a one-time event. Having that first stone greatly increases your chances of having another. Research shows, sadly enough, that stone patients do not always heed preventive medical advice. About 15% of kidney stone patients don’t take prescribed medications and 41% do not follow the nutritional advice that would keep stones from recurring.
Recommend: Take action! Without the right medications and diet adjustments, stones will almost certainly come back. - When Life Hands You a lemon, make Lemonade. Next time you drive past a lemonade stand, consider your kidneys. Citrate, from citrus fruits like lemons, is a stone preventative. While it may seem easier to just take a citrate pill, some home remedies, like lemonade, may be just as beneficial.
Recommend: Studies have shown that limeade, lemonade and other fruits and juices high in natural citrate offer stone- preventing benefits. Beware of the sugar, though, because high levels can also increase kidney stone risk. Instead, buy sugar-free lemonade, or make your own by mixing lime or lemon juice with water and using a sugar substitute if needed. Citrus lowers stone risk. - Not All Stones are Created Equal. In addition to calcium oxalate stones, another less 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 (a type of protein). Protein with high purine content leads to a higher production of uric acid which can cause uric acid stones. Acidic urine favors crystallization of this uric acid into urinary stones.
Recommend: To prevent uric acid stones, cut down on high-purine foods 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 if you are a uric acid stone former. - Did I mention Salt? Urine calcium follows urine sodium like a shadow, so restrict your salt. The current FDA recommendations are a sodium intake below 2300 mg. per day. For stone formers, 1,500 mg should be the limit. Remember, it’s not just the white stuff in the shaker… There is red salt, that is called ketchup. There is yellow salt; called Mustard. There is green salt, called Pickles. There is Brown salt, called gravy. There is black salt, called soy sauce. In addition, stone formers should strictly limit salty snacks, like chips, crackers, and salted nuts. Fast food is full of salt; that’s why we love it!
