Are you grappling with the excruciating pain of kidney stones and feeling overwhelmed by conflicting dietary advice? You're not alone. Jill Harris, a seasoned kidney stone prevention nurse with over 25 years of experience, offers a beacon of hope. Drawing from her extensive work with Dr. Fred Coe, a world-renowned nephrologist from the University of Chicago, and her personal journey, Jill has developed the Kidney Stone Diet®. This comprehensive approach aims to empower individuals to take control of their kidney health through informed dietary choices and lifestyle adjustments.
Understanding the Kidney Stone Diet®
The Kidney Stone Diet® isn't just about restricting certain foods; it's about creating a balanced and sustainable eating plan that reduces your risk of stone formation. Jill Harris understands the challenges of implementing dietary changes, especially when faced with the discomfort and fear associated with kidney stones. Her approach focuses on education, practical application, and personalized support to help you navigate the complexities of kidney stone prevention.
The Importance of Hydration
One of the cornerstones of the Kidney Stone Diet® is increasing your fluid intake. When we drink more fluids, we dilute the substances in our urine that can lead to stone formation. Aiming for a urine volume above 2.5 liters per day, which translates to about 3 liters of fluid intake, is a crucial step. However, finding the right balance for your individual needs requires experimentation, considering factors like weather, activity level, and occupation.
Sugar's Impact on Kidney Stone Formation
Many people are unaware of the link between sugar consumption and kidney stone risk. The modern American diet is laden with refined sugars, far exceeding the intake of previous generations. This excessive sugar intake can contribute to increased urine calcium levels and decreased urine volume, creating a perfect storm for stone formation.
Refined sugar, extracted from plants and added to processed foods, is absorbed rapidly, causing a surge in urine calcium. Dr. Jack Lemann's research demonstrated that consuming just 100 grams of glucose can lead to a rapid rise in urine calcium and a decrease in urine volume, significantly increasing the risk of stone formation.
Read also: Managing Stage 3 Kidney Disease with Diet
The recommendation is that less than 10% of all diet carbohydrates come in the form of added sugar which means very little sweets. This means sugars that are added to foods, not the natural sugars in fruits and some vegetables. The latter are absorbed more slowly and are safe.
The Role of Sodium in Kidney Stone Formation
Excessive sodium intake is another significant contributor to kidney stone formation. On average Americans consume over 3,400 mg of sodium/day. We should be eating about 1,500mg/day though you should check with your physician to make sure this is right for you. Too much sodium causes calcium from your bone to spill out into your urine and increases your risk for bone AND stone disease. Salt is sneaky. It hides in foods unbeknownst to you. Olives, cereals, pickled foods, pizza, sauces, dressings, breads, condiments, and, of course, eating out! High sodium intake causes calcium to leach from your bones into your urine, increasing the risk of both bone and stone disease. Lowering sodium intake not only reduces urine calcium but also promotes weight loss.
The Importance of Calcium
Contrary to popular belief, restricting calcium is not the answer for most kidney stone formers. Eating foods that supply your body with enough calcium is just as important as lowering your intake of high oxalate foods. Calcium binds to oxalate in the colon, preventing its absorption into the bloodstream. Without adequate calcium intake, excess oxalate is reabsorbed, increasing the risk of stone formation.
High calcium intake is essential for stone formers. They have bones and many have idiopathic hypercalciuria that can cause bone disease unless there is a lot of diet calcium intake. It is not only stone formers who need a lot of calcium. More or less, throughout life, men or women, girls or boys, the range hovers between 1,000 and 1,200 mg daily. This amount of calcium is ideal for both protection against bone mineral loss from idiopathic hypercalciuria and reducing oxalate absorption.
Protein Intake and Kidney Stones
Many modern diets promote high protein intake, particularly animal protein. While protein is essential, excessive consumption, especially of animal protein, can increase the risk of uric acid and calcium oxalate stones.
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People absolutely need at least 0.8 gm/day per kilogram of body weight of protein and need no more than 1 gm/d/kg. WIthin that narrow range there is a measurable but modest effect of protein on urine calcium that can be neglected if sodium is controlled. So we see no physiological basis or trial evidence that ‘low protein diet’ is appropriate. By low we could only mean 0.8gm/kg/d.
Navigating Oxalate Restrictions
Oxalate is a naturally occurring substance found in many plant-based foods. While some kidney stone diets focus heavily on oxalate restriction, Jill Harris advocates for a more balanced approach. All things being equal we have advocated for a low oxalate intake between 50 and 100 mg daily. However Ross Holmes showed clearly that with very high calcium intakes such as 1,000 to 1,200 mg daily, absorption of diet oxalate is less and therefore the need for strict control is also less. The ideal approach as best we can tell is to put in place the high calcium diet, aim for about 200 mg of oxalate, which is easier to accomplish than lower values, and measure the urine results.
The key is to pair calcium-rich foods with higher oxalate foods to promote oxalate binding in the gut.
Practical Strategies for Implementing the Kidney Stone Diet®
Jill Harris emphasizes that the Kidney Stone Diet® is not about deprivation but about making informed choices and finding a sustainable eating pattern that works for you.
Here are some practical tips for implementing the Kidney Stone Diet®:
- Increase Fluid Intake: Aim for at least 3 liters of fluid per day, choosing water as your primary beverage. Avoid sugary drinks, which can increase stone risk.
- Reduce Sodium Intake: Be mindful of hidden sources of sodium in processed foods, sauces, and condiments. Opt for fresh, whole foods and cook at home whenever possible. The new FDA recommendations are an intake below 2300 mg (100 mEq for those of you who read lab reports). For those with high blood pressure - treated with drugs or not - 1,500 mg is ideal.
- Limit Refined Sugar: Reduce your consumption of sweets, sugary drinks, and processed foods high in added sugar.
- Ensure Adequate Calcium Intake: Consume 1,000 to 1,200 mg of calcium per day through calcium-rich foods like dairy products, fortified plant-based alternatives, and leafy green vegetables.
- Moderate Protein Intake: Aim for 0.8 to 1 gram of protein per kilogram of body weight per day.
- Balance Oxalate Intake: Pair calcium-rich foods with higher oxalate foods to minimize oxalate absorption.
The Importance of 24-Hour Urine Collections
24-hour urine collections provide valuable insights into your individual risk factors for kidney stone formation. They are single frames out of a movie that runs lifelong so it is imperative people collect as they were when they made stones or as they are pursuing their stone prevention treatments. The concept is easy and easy to ignore, put aside, forget about. These tests can help your doctor identify specific imbalances in your urine, such as high calcium, high oxalate, or low citrate, and tailor your treatment plan accordingly.
Read also: Nutrition and stage 2 CKD
Kidney Stone Diet® Resources and Support
Jill Harris offers a range of resources to support individuals on their kidney stone prevention journey, including:
- Kidney Stone Diet® Course: A self-guided online video course that provides comprehensive education on the Kidney Stone Diet®.
- Kidney Stone Diet® Meal Plans: Meal plans designed to help you implement the Kidney Stone Diet® in a practical and sustainable way.
- Private Facebook Group: A supportive online community where you can connect with other kidney stone formers and receive guidance from Jill Harris.