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Kidney Stones

My guess is that there’s never been a human being in the history of mankind who ever answered “Yes, sure, okay!” to the question “Would you like to pass another kidney stone?” We’re not positive why some people get stones and others don’t, but stone formation does run in families, and has less to do with diet than we once thought. When the stone, which forms in the kidney, decides to move, it’s during the l-o-n-g passage down the ureter (the tube from the kidney to the bladder) that causes so much pain.

If you ever start feeling a breathtakingly sharp colicky pain that seems to start in your back and spread toward your groin, get thee to an emergency room for fluids and pain control. Once it’s passed (blessed relief!) come back and start reading our WholeHealth Chicago recommendations. The program we outline is excellent at prevention, and, if you’ve ever had a stone, it should especially interest you.

What are Kidney Stones?
Kidney stones (also known as renal calculi and to doctors as nephrolithiasis) are one of the most common–and most painful–disorders of the urinary tract. They form when minerals and crystallized salts in the urine concentrate and coalesce into hard, solid lumps in the urine-collecting system of the kidney. There are several different types of stones. About 70% to 80% of them consist of calcium in combination with oxalate or phosphate. The remainder are made up of either uric acid or a mix of magnesium, ammonium, and phosphate.
Stones vary in size–from no larger than a grain of sand to as big as a golf ball. Larger ones may never leave the kidney and are detected only if an abdominal x-ray is taken for other reasons. Others are so small that they may pass through the entire urinary tract unnoticed.

If a stone is small enough to enter the ureter (the narrow tube connecting the kidney to the bladder), but too large to pass further on its own, the ureter tries to push it forward in a series of severe and excruciatingly painful contractions (called renal colic). The pain will continue until the stone reaches the bladder, a process which can take a few hours or as long as several days. Most of the time, a stone is passed without risks or complications. Sometimes, however, it can get lodged in the ureter. In this situation, it may obstruct urine flow or an infection can occur.

Traditionally, removing stones was a surgical procedure performed under general anesthesia. In recent years, new methods for removing stones use high-intensity ultrasound devices to break the stone into smaller pieces; this has dramatically changed the treatment of kidney stones.

Some 10% of the American population is afflicted by kidney stones, mostly people over the age of 30. The incidence is highest among men and occurs more often during the summer months. This is probably because during hot spells we remove fluids from the body by perspiring more heavily, making the urine more concentrated. Some people experience a single episode in middle age and never again. But at least half of all victims are less fortunate: They suffer kidney stone attacks at the rate of one every two or three years.

Key Symptoms

  • Usually no symptoms until a stone becomes dislodged from the kidney and begins to move through the ureter
  • Severe, sometimes excruciating, pain–starting in the lower back below the ribs, then traveling through the lower abdomen toward the groin
  • Interrupted flow of urine, frequent urination, or inability to urinate
  • Bloody, cloudy, or darkened urine
  • Nausea and/or vomiting
  • Burning upon urination, accompanied by fever or chills (the result of a related bacterial infection)

What Causes Kidney Stones?
While heredity and persistent dehydration are considered factors in the formation of kidney stones, the exact causes have not been determined. Research has shown, however, that certain kinds of stones may be linked to certain conditions.

About 70% of all kidney stones are calcium oxylate stones, making them by far the most common variety. They occur for unknown reasons. Some individuals simply have higher levels of calcium in their urine than others, causing them to be more susceptible to stone formation. This situation, termed hypercalciuria, does seem to run in families. Although doctors once believed a diet high in calcium increased your risk for developing kidney stones, this is not the case, and calcium restriction is no longer necessary. Oxylates are an end product of body metabolism and occur naturally in the urine. They can be increased by eating certain foods (coffee, rhubarb, spinach), which will increase your risk for stone formation.

Certain types of intestinal surgery may also increase your chances for oxylate stone formation. Sometimes, an overactivity of the glands responsible for maintaining proper levels of calcium, called the parathyroids, will result in kidney stones. So will taking too much vitamin D, which the body uses to absorb calcium from the intestine into the blood.

About 20% of kidney stones are a combination of calcium, magnesium and ammonium phosphate and are linked to chronic infections within the urinary tract.

About 5% of stones consist mainly of uric acid. These usually occur in people with gout, in which the blood level of uric acid is also elevated. Uric acid stones also occur in people who are constantly dehydrated or who have certain types of cancer.

Treatment and Prevention
If you believe that you are passing a stone, start by drinking plenty of water–at least a quart or even two to flush the stone into the bladder. If this is your first experience with what you think may be a kidney stone, you should y be reading a print version of this information en route to an emergency room or urgent care center to verify your self-diagnosis.

Once there, you’ll have your urine analyzed and the doctor will order an x-ray of your abdomen to try to locate the stone. Whether or not you’ll be admitted to the hospital will be up to the physician. Patients usually get hospitalized when the pain is severe, or if it looks as if complications are developing because the stone is large or because infection is present.

Initial treatment for a kidney stone–whether at home or in the hospital–consists mainly of pain relief and taking in plenty of fluid. You’ll be asked to urinate through a strainer or filter to try and trap the stone, so it can be analyzed later. After the stone is passed, your doctor may want to collect urine for a full 24 hours to determine if you have an excessive amount of calcium or uric acid in your urine.

In especially severe cases, stronger painkillers are prescribed along with antispasmodic drugs to relax ureter muscles and ease passage of the stone. In the past, if a stone became lodged in the kidney or ureter, it was removed surgically, usually by passing a small basket up the ureter, grasping the stone and moving it slowly down toward the bladder. Now the preferred choice is lithotripsy, using high intensity shock waves to break the stone into small pieces.

Specialized treatment for kidney stones varies. Since the exact cause of most kidney stones is not well understood, and since the cause may vary from one person to another, treatment mainly depends on the type of stones passed, or the composition of the urine if the passed stone accidentally went into the toilet.

Patients with calcium oxalate stones are usually checked for hyperparathyroidism and then advised to keep well hydrated and reduce oxalates in their diet. Thiazide diuretics, given by prescription, will also lower urinary calcium and reduce the risk of developing a stone. Increasing your dietary calcium will actually reduce your risk of kidney stones by lowering oxalate levels in the urine.

Patients with uric acid stones are treated similarly to gout, with prescription medications to lower uric acid. Calcium-magnesium-ammonium stones usually require treating the underlying urinary infection.

To help prevent a recurrence, dietary measures may help, and vitamin and mineral supplements also have an important role to play. Just a reminder: If you have a serious medical condition, it’s always a good idea to talk to you doctor before beginning a new supplement regimen.

How Supplements Can Help
During an acute episode of passing a stone, drinking warm water to which you’ve added liquid extract of wild yam can help calm muscular spasms of the ureter, allowing the stone to pass more easily.

Vitamin B6 and magnesium are key nutrients for preventing the formation of calcium stones, by far the most common kind. Magnesium reduces calcium absorption and lowers urinary oxalate. B6 works well with magnesium. Stone formation is associated with a deficiency of both these nutrients. Magnesium also makes it easier for the body to dissolve calcium oxalate (one form of calcium found in stones).

A daily tablespoonful of flaxseed oil or of flaxseeds themselves can be added to your salad or to a fruit smoothie. If you’re using the seeds, you will need to grind them fresh each day. Flaxseed can help reduce the amount of calcium in the urine.

Taking zinc inhibits the crystallization of minerals carried in the urine. (Zinc taken for the long term should be combined with copper.)

Cranberry, taken as juice or in capsules, acts to acidify urine and reduces the amount of ionized calcium in the urine, so is helpful to prevent both oxalate and uric acid stones from forming. You can also accomplish the same effect by drinking the juice of one lemon (diluted in water) each morning.

Traditionally, most doctors used to recommend restricting calcium intake for anyone prone to stones composed of calcium. But there is evidence that increasing calcium via supplements–for example, by taking calcium citrate–reduces stone formation by binding oxalate in the intestine so that it’s not absorbed into the urine.

Vitamin A in higher than normal doses is used during the week or so after the passage of a stone to help heal the mucous membrane lining of the ureter. After about a week, reducing the dose of vitamin A to a maintenance level helps discourage stone formation. However, try to increase your overall consumption of vitamin A-rich foods instead, including apricots, cantaloupe, carrots, sweet potatoes, and squash.

Self-Care Remedies
Drink lots of water. To help prevent recurrences, drink at least three quarts of water per day–more in hot, humid weather. If your urine is not virtually colorless, you’re not drinking enough water.

Reduce foods high in oxalate. Eat a healthy, balanced diet, but take it easy on asparagus, beets, beet greens, spinach, nuts, rhubarb, chocolate, and cola beverages.

Eat less meat. If you are a heavy meat eater, try to reduce your overall intake of animal protein. It encourages the body to excrete calcium, phosphorus, and uric acid in the kidneys. Actually, the very best diet to prevent kidney stones is a basically a vegetarian one, high in a variety of fresh fruits and vegetables, whole grains, and void of animal protein and processed foods, with plenty of fresh water, juices and herbal teas.

Increase your potassium intake. Foods that contain potassium include bananas, orange juice, fresh fruit and vegetables. Low blood levels of potassium reduces levels of urinary citrate, which in turn raises levels of urine calcium. Like zinc, potassium is a potent inhibitor of calcium crystallization.

Get more magnesium in your diet. Many vegetables, grains, and fruits contain magnesium, including almonds, peanuts, brown rice, avocado, papaya, and prunes.

If your stone was found to be uric acid, avoid organ meats, sardines, anchovies, and brewer’s yeast. All of these are high in purines, which can elevate the uric acid in your blood and contribute to this type of stone formation.

When to Call a Doctor

If you have any symptoms of passing a kidney stone.

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: Here are some supplement suggestions you might want to start if you’ve passed a stone and are a little nervous about the thought of passing another. The doses I’ve used here assume you’re already on a good high-potency multiple vitamin, and a complex of the new “super antioxidants.”

How to Take the Supplements
Acute phase: If you now, right now, think you are passing a stone for the first time, start drinking plenty of fluid and take any good painkiller you may have in your medicine cabinet. Then, begin the vitamin A (to start the healing process), cranberry (to reduce the risk of infection), and the wild yam (to relax the ureter); and head for an emergency room to verify your diagnosis. If you get admitted, your doctor may allow you to continue these supplements during your stay; keep asking your nurse for more cranberry juice. Once you’ve passed the stone, you can stop the wild yam, and a week later, reduce the vitamin A.

Maintenance: Once you learn the type of stone you have, you can begin the appropriate dietary changes, and for stone prevention add the maintenance supplements–flaxseed, calcium, magnesium, vitamin B6, and zinc/copper–on a long-term basis.

The supplement program here assumes that your stone is the garden variety calcium oxalate type. If your stone is the less common uric acid variety, see the dietary and supplement recommendations for gout.

Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.

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