Kidney stones are a common and very painful problem. They often lead to expensive treatment. What makes it worse is for a majority of people the stones recur every few years. This is simply because they fail to understand and address the underlying root causes.
Prevalent treatments for kidney stones include shock-wave therapy, laparoscopic surgery and ureteroscopy. Certain medicines are used to relax the muscles of the ureter, helping the stone pass out more easily.
So let us understand why kidney stones happen? What causes them? And what can we do to avoid and if they have happened, how to rid of them?
DEHYDRATION - Before we start delving into this topic, let us remember that the single most important reason for kidney stones is dehydration. Due to low water consumption, the volume of urine decreases, making it more concentrated. This obviously increases the chances of stones getting precipitated. For those with a tendency to get kidney stones, drinking 2-3 litres of water per day is a must. This figure needs to be adapted for lifestyle factors like ambient temperature, job profile etc. For example, a person who is into sales and has to spend a lot of time daily commuting between meetings requires a much higher water intake compared to someone else whose job involves working on a computer in an air-conditioned environment.
About 80% of kidney stones are of the calcium oxalate variety. So we need to pay attention to factors affecting the metabolism of these two constituents. Here are some of the important factors that impact calcium and oxalate levels.
MAGNESIUM - Sufficient magnesium is critical for ensuring proper utilization of calcium. Magnesium is also one of the most common deficiencies found in our population today.
It is helpful to take a magnesium supplement while consciously increasing the consumption of foods that are rich in magnesium (e.g. pumpkin seeds, cashews, green leafy vegetables, etc.).
If taking supplements, target to keep the levels in the upper third of the reference range. It is best to use chelated forms as they are better absorbed. If constipation is also present, consider using the citrate form (it can also be in combination with another well-absorbed form such as magnesium glycinate).
POTASSIUM - Potassium supplementation is quite useful for patients with uric acid based stones. (Potassium should be avoided by people on certain medications like certain diuretics prescribed for hypertension). Potassium citrate is one of the more useful forms of potassium as citrate is also useful in this condition. Up to 200 mg can be taken daily.
VITAMIN K2 - K2 is critical to ensure that calcium from food/supplements is taken up into bones instead of ending up in circulation and being excreted from the kidneys. If calcium remains in blood circulation there are higher chances of it reacting and forming stones. Vitamin K2 prevents this from happening. For prevention, up to 90 mcg of vitamin K2 of the MK-7 variety can be taken daily. Dosage can be increased in the case of active stones. (people on blood thinners should avoid taking K2).
B VITAMINS, B6 - Adequate levels of all B vitamins is very important. Of special note is B6 as it is key for glutathione synthesis, oxalate metabolism and nerve health. These vitamins should be the ‘active’ type as not everyone’s body is good at converting them to active forms. E.g. for B6 the correct form is P5P and not pyridoxine. It is important to note that we need all the B vitamins to be in the upper third of the reference range. It is not good enough to have them just above the bottom of the reference range. (This is generally applicable for most nutrients).
VITAMIN D - People with a tendency to get kidney stones should be careful while taking vitamin D supplements as it increases the absorption of calcium into the body. It also uses up the magnesium present in the body so less is available to ensure proper utilization of calcium.
AVOID BLACK TEA - It is very important to avoid all black teas as they are a rich source of oxalates. As we noted earlier, nearly 80% of the stones are of the oxalate variety. Hence drinking black tea can aggravate the problem significantly.
AVOID OXALATE RICH FOODS - Foods like spinach, beets, almonds, groundnuts, chocolates, etc. have a good amount of oxalates and should be avoided or consumed in moderation by people susceptible to kidney stones.
AVOID PURINE RICH FOODS - Another common food ingredient that can cause kidney stones is purine. This is generally connected with the uric acid variety of stones. Some foods high in purines are red and a few other types of meat, some seafood varieties, all alcoholic beverages, mushrooms, green peas, cauliflower, etc.
Fresh LEMON JUICE is one of the simplest tools to both prevent the recurrence of stones as also to get rid of active stones. The juice of half a lemon can be taken twice a day to prevent a recurrence. While for existing stones one can consume the juice of 4 lemons per day. The high citric acid content binds with extra calcium and prevents it from precipitating in the form of stones.
INSULIN RESISTANCE & INFLAMMATION - Insulin resistance and chronic inflammation often play a key role in this dynamic and must be addressed for any long-lasting solution. Very often insulin resistance and prediabetes are present to an appreciable extent in kidney stone patients. The most important and easiest steps are to eliminate all sugars and refined carbohydrates.
It is well known that diabetics are at a higher risk for kidney stones because elevated blood sugar is highly oxidising in nature and damages the kidneys.
LIVER & BILE - Overall liver health and quality of bile also have an impact on kidney stones. Sluggish bile flow is also a common contributor to stone formation. Also individuals whose gallbladders have been removed are at a higher risk. These dynamics ensure that enough bile is not available for fat digestion. This unabsorbed fat readily binds with calcium in the gut. Hence calcium is not available for binding with oxalates, which in turn, gets readily reabsorbed by the gut.
YEAST - Certain yeast species (such as Candida aspergillus) produce oxalates as part of their metabolic processes. So people with yeast over growths can struggle with excessive oxalate levels (also causing issues with the urinary/vaginal tract and elsewhere in the body).
OXALOBACTER - Oxalobacter formigenes is a commensal bacteria (found in a healthy gut). It metabolises oxalates thereby reducing the amount in the body. If these are low in numbers or activity then oxalates can build up in the system.
I hope this article gives some useful insight into the various causes and solutions for kidney stones.
REFERENCES
Trinchieri, A., Esposito, N., & Castelnuovo, C. (2009). Dissolution of radiolucent renal stones by oral alkalinization with potassium citrate/potassium bicarbonate. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica, 81(3), 188–191.
Reddy, S. K., Shaik, A. B., & Bokkisam, S. (2014). Effect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis. Korean Journal of Urology, 55(6), 411. https://doi.org/10.4111/kju.2014.55.6.411
di Tommaso, L., Tolomelli, B., Mezzini, R., Marchetti, M., Cenacchi, G., Foschini, M., & Mancini, A. (2002b). Renal calcium phosphate and oxalate deposition in prolonged vitamin B6 deficiency: studies on a rat model of urolithiasis. BJU International, 89(6), 571–575. https://doi.org/10.1046/j.1464-410x.2002.02670.x
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