Kidney Stones


Kidney stones are a common medical complaint. They occur when minerals and salts that are normally found in the urine accumulate and crystalize, forming stones. Poor nutrition and lifestyle choices play a large role in the development of kidney stones. A high nutrient, plant-based diet is key to preventing stone formation.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Success Stories

Overview


According to the National Health and Nutrition Examination Survey, the prevalence of kidney stones was 8.8%, affecting 1 in 11 people in the U.S.1 As developing countries adopt a more Western diet style (the Standard American Diet), their kidney stones rates continue to increase to match those of the U.S. There are five main types of kidney stones: calcium oxalate, calcium phosphate, uric acid, struvite, and cysteine. Eighty percent are calcium oxalate stones.

Many patients with kidney stones do not experience any symptoms; however, if large enough, the stones can cause severe flank and abdominal pain, pain when urinating, blood in the urine, nausea, vomiting, and urinary frequency or urgency. If infection is present, then chills and fever can occur. Some patients require hospitalization, pain control, antibiotics, and extraction. If kidney stones are large enough to cause obstruction, then acute renal failure can occur.

The risk factors for kidney stones include:

  • Chronic disease like diabetes, obesity, gout, and hyperparathyroidism
  • Dysbiosis or imbalance of the healthy gut flora
  • Poor nutrition high in animal protein and sodium, low in calcium and magnesium
  • High oxalate consumption found in spinach, swiss chard, rhubarb, beet tops, chocolate, and tea
  • High fructose consumption
  • Vitamin C and calcium supplementation
  • Low fluid intake
  • Increased alcohol intake
  • Medications like diuretics, anti-virals, and anti-seizure medications.
 
References
  1. Scales CD, Jr., Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol 2012, 62:160-165.

Action Plan


Diet

  • A Nutritarian diet, high in fruits, nuts, seeds, and vegetables increases calcium and magnesium intake and increases the pH of urine, lowering risk of calcium oxalate stone formation.1
  • Restrict high oxalate foods like rhubarb, spinach, chard, beet tops, chocolate, tea, wheat bran, etc.
  • Phytates, found in whole cereals and legumes, can inhibit calcium salt crystallization.
  • Increase pure water intake, at least 1 glass of water in between meals. You may add lemon/lime to flavor the water, but no additives such as carbonation or sugar.
  • Avoid supplementing with vitamin C and calcium.
  • Animal protein is a causative factor for stone formation; it should be dramatically reduced or eliminated.
  • Avoid coffee, tea, and alcohol
  • Avoid extra-added salt and high sodium foods which increase excretion of calcium and acidify urine.
  • For uric acid stones, specifically avoid juices and dried fruit with high fructose levels.
  • For calcium phosphate and struvite stones, cranberries can help acidify urine. Patients may need more sodium if stone formation is related to low sodium levels from excessive sweating

Supplementation

  • Discuss supplementation with your physician.
  • High dose probiotics twice a day can help break down oxalate in the gut.
  • Vitamin B6 supplementation helps reduce the production and excretion of oxalate in the urine.
  • Magnesium supplementation helps decrease the formation of calcium oxalate stones.
  • Chanca Piedra (Phyllanthus Niruri) is known as the “stone breaker.” It helps decrease calcium excretion, inhibits stone formation, and relaxes the ureter.
 
References
  1. Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Adv Chronic Kidney Dis 2013, 20:165-174.

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

My husband has been dealing with very bad cases of kidney stones his entire life. Sometimes the kidney stones pass, but there have been four instances in a three-year span where he had to go in for surgery. After a 24-hour urine test, the doctor said he had high oxalate levels in his urine and gave us a list of things to stop eating, which included practically everything healthy and recommended on a Nutritarian diet (spinach, berries, etc.) and told him to replace with junk like white bread, white rice, etc.

I don’t know what else to do to help rid him of these constant kidney stones. My husband eats a Nutritarian diet about 90% of the time and still eats meat and some junk 10% of the time.

A.

Your husband may be in that rare category where they may still have a tendency to form kidney stones, but the diet and perhaps supplements may make it much better over time, so he should still try. Research suggests that those on a vegetarian diet actually have a lower risk of forming stones regardless of the oxalate in the diet, although reducing the oxalate richest foods should still be part of his plan. Have him restrict or eliminate spinach, chard, parsley, and maybe beets, but all the other foods that have relatively moderate amounts should not be avoided because that limits the diet too much and there is only a little benefit from restricting oxalate to that low level anyway. Review my supplemental recommendations to further reduce oxalate stones from forming here: http://forums.drfuhrman.com/showthread.php?t=40911&highlight=kidney