Kidney Stones
Kidney Stones
12 Lines of Defense
"I used to think I could bear any kind of pain; I used to have my teeth drilled without anesthetic—but when I had my kidney stone, I cried," says Major Norman Ellis, a retired Air Force officer living in Colorado Springs, Colorado.
If you have a kidney stone, you might be crying, too. Although doctors aren't always sure why some people form these little crystals of salt and minerals in their kidneys, one thing is crystal clear: They hurt.
The Alternate Route
What's This about cranberry Juice? Folklore has it that cranberry juice is good for kidney ailments, and even kidney stones. But is there any truth to it? "I suppose the theory is that cranberries are acidic, so that drinking the juice will acidify your urine and discourage calcium stones from forming. But I doubt you could drink enough to make your urine acidic," says Peter D. Fugelso, M.D. Is this to say that drinking cranberry juice will have no benefits whatsoever? Not exactly. "To the extent it's another source of fluid, I suppose it could be helpful," says Dr. Fugelso. But plain water, he adds, would serve the same purpose, with fewer calories. |
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For some people, it can take months of patience (and pain) to pass a stone. Hopefully, you won't be one of them. Doctors today have a number of strategies for ridding you of a stone. What doctors can't always do is guarantee that you won't get another.
"Once you've had one stone, you are at a somewhat higher risk of getting another. Once you've had a second stone, your risk is markedly increased," says Leroy Nyberg, M.D., director of the urology program at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health.
Major Ellis suffered six kidney stones before his last, ten years ago. Since then, he's been taking prescription medication to help prevent their reappearance—and he's made several important changes in lifestyle.
Before you make any changes in your lifestyle, be aware that there are several kinds of kidney stones, and only your doctor can tell one from the other. Once your doctor is acquainted with your particular stone, the following tips will help reduce your chances of forming another.
Drink lots of fluids. Regardless of what kind of stone you've had, "by far the single most important preventive measure is to increase water consumption," says Stevan Streem, M.D., head of the Section of Stone Disease and Endourology at the Cleveland Clinic Foundation in Ohio. Water dilutes the urine and helps to prevent high concentrations of those salts and minerals that clump together to form stones.
How much fluid should you drink? "Enough to pass 2 quarts of urine a day," says Peter D. Fugelso, M.D., medical director of the Kidney Stone Department at St. Joseph's Medical Center in Burbank, California, and a clinical professor of urology at the University of Southern California in Los Angeles. "If you've been working out in the garden all day under the hot sun, that could mean you'll need to drink 2 gallons," he says. "It's the amount of urine that matters." He suggests you urinate several times into an empty milk carton to get a gauge on how much you are passing.
Keep a cap on your calcium. "Of all the stones we see, 92 percent are made of calcium or calcium products," says Dr. Fugelso. If your doctor says your last stone was calcium-based, you should be concerned about your intake of calcium. If you're taking supplements, the first thing to do is check with your doctor to see if they are really necessary. The next thing to do is check the amount of calcium-rich foods—milk, cheese, butter, and other dairy foods—you eat on a daily basis. The idea is to limit—not eliminate—calcium-rich food in your diet. "And almost all of the calcium in your diet comes from dairy products," says Dr. Fugelso.
Check your stomach medicine. Certain popular antacids are enormously high in calcium, warns Dr. Fugelso. If you've had a calcium stone, and if you are taking an antacid, check the ingredients on the side of the box to make sure it's not calcium-based. If it is, choose another brand.
Don't eat too many oxalate-rich foods. About 60 percent of all stones are known as calcium oxalate stones, says Brian L. G. Morgan, Ph.D., a research scientist with the Institute of Human Nutrition at Columbia University College of Physicians and Surgeons. If everything in your body were working right, the oxalate you consume when you eat certain fruits and vegetables would be excreted. But if you've had calcium oxalate stones, things obviously aren't working right. So you should restrict your consumption of oxalate-rich foods. These include beans, beets, blueberries, celery, chocolate, grapes, green peppers, parsley, spinach, strawberries, summer squash, and tea.
Try magnesium and B6. Swedish researchers found that a daily supplement of magnesium curtailed stone recurrence by almost 90 percent in a group of patients. Scientists speculate that magnesium works because it—like calcium—can bond with oxalate. But unlike the calcium/oxalate bond, this link-up is less likely to form painful stones. Vitamin B6, meanwhile, may actually lower the amount of oxalate in the urine. In one study, 10 milligrams a day seemed to do the trick.
MEDICAL ALERT
Three Good Reasons to See a Doctor If you've had a kidney stone and are experiencing pain, chances are you may be getting another. You should see your doctor to be sure. - Any intense pain and/or blood in your urine calls for a physician's assessment, says Peter D. Fugelso, M.D.
- If you pass a stone, you should take it to your doctor for laboratory analysis. "Finding out what kind of stone it is will help you to prevent future ones," says Leroy Nyberg, M.D.
- A doctor can look at your stone via an x-ray to see how large it is. "Large stones can create significant blockage and even infection," notes Stevan Streem, M.D. That's to say nothing of the pain. With shock wave therapy or other relatively noninvasive procedures, such as laser or ultrasound treatment, your doctor can see to it that you won't suffer. Medication can then be prescribed to prevent recurrences.
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Eat vitamin A-rich foods. It doesn't matter which kind of stone you've had, vitamin A is necessary to keep the lining of the urinary tract in shape and help discourage the formation of future stones. "Be sure to get 5,000 international units—the Recommended Dietary Allowance [RDA] for healthy adults—of vitamin A daily," says Morgan. This is not particularly hard to do. One half cup of canned sweet potatoes, for instance, will give you 7,982 international units, and a similar portion of carrots will give you 10,055. Other foods high in vitamin A include apricots, broccoli, cantaloupes, pumpkins, winter squash, and beef liver. (Vitamin A supplements, however, should not be taken without your doctor's supervision. Vitamin A is toxic in large doses.)
Stay active. "People who are inactive tend to accumulate a lot of calcium in the bloodstream," says Dr. Nyberg. "Activity helps to pull calcium back into the bones, where it belongs." In other words, if you're prone to calcium stones, don't sit around all day and wait for them to form. Get out, take a walk, fly a kite, or ride a bike.
Watch your protein intake. "There is a direct correlation between the incidence of kidney stone disease and the amount of protein eaten," says Dr. Morgan. Protein tends to increase the presence of uric acid, calcium, and phosphorus in the urine, which, in some people, leads to the formation of stones, he says. Be concerned about consuming excessive protein if you've had calcium stones, and especially if you've had uric acid or cystine stones. Limit yourself to 6 ounces of protein-rich food a day, says Dr. Morgan. This includes meat, cheese, poultry, and fish.
Lay off the salt. If you've had calcium stones, it's time to cut down on salts. "You should reduce your salt intake to 2 to 3 grams per day," says Dr. Morgan. This means reducing your consumption of table salt, pickled foods, and salty foods such as luncheon meat, snack chips, and processed cheese.
Take a look at vitamin C. "If you tend to develop calcium oxalate stones, you should restrict your consumption of vitamin C," says Dr. Morgan. "Large amounts—more than 3 to 4 grams a day—can increase oxalate production and increase the risk of stones." It is highly unlikely that you could consume this much vitamin C in your diet (you would need to eat 37 navel oranges a day), so your concern here should be with high-potency supplements. His suggestion: Don't take them.
Don't get too much vitamin D. "Excessive amounts of vitamin D can lead to excess calcium in all parts of the body," says Dr. Morgan. "You should never get more than the RDA of 400 international units," he says.
PANEL OF ADVISERS
Peter D. Fugelso, M.D., is medical director of the Kidney Stone Department at St. Joseph's Medical Center in Burbank, California. He is also a clinical professor of urology at the University of Southern California in Los Angeles.
Brian L. G. Morgan, Ph.D., is a research scientist with the Institute of Human Nutrition at Columbia University College of Physicians and Surgeons in New York City.
Leroy Nyberg, M.D., is director of the urology program at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health in Bethesda, Maryland.
Stevan Streem, M.D., is head of the Section of Stone Disease and Endourology at the Cleveland Clinic Foundation in Ohio.
