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Take Charge of Your Kidney Stone Prevention

Jill Harris who has written some of the most popular articles on the site offers this gracious and easy read about perhaps the most important topic of all – how patients fit into the treatment process. Diet and fluids are for stones specific treatment and always have been. What is so new is the merging of US national opinion about the proper healthy diet with what we have gradually come to understand about the ideal diet for kidney stone prevention: The two are about the same in most ways apart from the specially high fluids for stone prevention. Given this merger we can be bold indeed about pushing all stone patients to use the kidney stone diet or – said from the other perspective – pushing them toward the US ideal diet. But to achieve this diet is not easy, especially given the extra fluid needs. Also not easy is to negotiate the complexities of testing and proper use of physician time – always a precious and limited resource. She comes to the final view that perhaps on a national level many patients will come to need a middle layer of professional helpers – nutritionists, nurses who take an interest in the special needs of stone formers. I am impressed with her ideas, and believe she may indeed be right.

How to Eat the Kidney Stone Diet

Being so important, the kidney stone diet needs more explication. Here, we review in brief how generations of kidney stone research gradually led to the value of high calcium low sodium diet, low refined sugar, and sufficient protein to maintain nitrogen balance as the ideal diet platform for calcium stone prevention. The review makes clear the exceptionalism of stone disease, because of idiopathic hypercalciuria and what appears to be a wider range of intestinal oxalate absorption than in normal people. A brief glance at the massive online diet resources from the FDA and other important agencies raises the issue of how these will be used by and for kidney stone patients.

The Kidney Stone Diet

If you put together our articles on diet calcium, sodium, oxalate, protein, and the effects of refined sugars on urine calcium, you come up with a fairly obvious single diet complex that is ideal for treating the idiopathic calcium stone former: High calcium, low sodium, controlled oxalate, low refined sugar, normal protein and of course high fluids. There is the subtlety that the diet calcium should be taken in with foods that contain oxalate. This diet pattern happens to accord well with the present 2015 – 2020 US guidelines on the ideal diet for the American people – of course excluding the higher fluid intake for stone prevention. Here Jill Harris and I specify the diet, reference it to the articles on the site and to the FDA tables of nutrient recommendations. I see no reason this diet should not be followed after even one stone. To me it more or less fits the needs we have for the dietary component of idiopathic calcium stone prevention.



Kidney Stones

What is In It?

What stones are Structure of stones
Matrix of Stones The organic part of stones
Types of stones A primer showing stone types
Stone analyses How it is done; how often is it needed
Quality of stone analysis Flaws in commercial labs
Nephrocalcinosis A radiological term easily misunderstood
Stones Themselves  A review of several articles on stones
Pain from Stones  How stones cause pain
Theory of Stone disease A sketch of the whole field




What is In It?

The Kidney Stone Diet Best diet for stone prevention
How to Eat the Kidney Stone Diet Special aspects of the kidney stone diet
How Much is Enough How supersaturation varies with urine flow
Variety of Fluids Fluid options and how to plan a day
How to Drink enough Tips on ways to make high fluids a pleasure
The Low Flows What makes some people avoid fluids
How to Eat a Low Salt Diet How to shop and select for low sodium diet
The Low Oxalate Diet  Our best oxalate lists and how to use them
High Calcium Low Sodium Diet Our best list of the best bargains
How Much Protein Should you Eat Does protein cause stones or bone disease?
ACP Fluid guidelines  Faulty but useful


What is In It?

Cost of potassium citrate How to lower the cost of alkali treatment
Stone prevention by citrate How citrate prevents stones
Thiazide to Prevent Stones  The drugs and how they work
Ureteroscopy New techniques vs. old ones
Prevention of Calcium stones The treatment trials and what they say
ACP  Med Guidelines Faulty but useful
Rebuke of ACP Guidelines Critique by an expert
Coke Treatment Probably nonsense but popular on the web



What is In It?

Putting it all together The whole process of prevention
5 Steps to Stone Prevention Details of the stages in evaluation and treatment
How to Be a Successful Patient Organize properly for medical visits
How To Do 24 Hr Urines The central test: Common mistakes you can avoid
Web apps & smart bottles Are fancy new devices worthwhile?
24 hr urines – Ca Stones How to read your own tests
24 hr urines – UA Stones How to read your own tests
My Lab Report: 5 Questions How treatment follows test results
Style of Practice My personal clinical approach to stone prevention
Assessment of Plaque CT estimate of kidney calcium deposits

How Stones Form

What is In It?

Video: How Stones Form Crystal formation in kidneys
Growth on Plaque Tissue calcium deposits anchor growing stones
Tubule Plugging Crystals plug nephrons; stones overgrow
Medullary Sponge Kidney A disease with tiny crystals in cysts
Role of Immunity Innate immune system and plaque



What is In It?

An Introduction A simple explanation and home experiment
Video: Supersaturation Serious but narration makes things easier
Use of Supersaturation Role in clinical practice
Why Use 24 Hour Urines?  Benefit of 24 hour urine averages
Science of Supersaturation Review of selected scientific papers
Supersaturation  A review of multiple articles


Urine Risk Factors

What is In It?

Oxalate Physiology  Control of Urine Oxalate
Hypercalciuria in General Idiopathic and from systemic diseases
Idiopathic Hypercalciuria Pathophysiology of IH
How Salt Works Sodium physiology BP and IH
Salt Stones and Bones  Bone disease in IH and role of sodium
How Citrate Works Physiology of urine citrate regulation
Calcium binding Importance of citrate calcium binding
Crystal Inhibition Citrate effects on stone crystals
Citrate and Metastable limits  Citrate inhibition of crystal formation
Dr. Charles Pak An homage to a founder of citrate usage



What is In It?

CaOx Stone Formers General appearance – plaque emphasized
Phosphate Stone Formers Plugging, young women predominate



How Stones Form

What is In It?

Cystinuria A general overview



Science and medicine

What is In It?

Three Medical Sciences  Discovery, trials, and diagnosis
Science in medicine Basic science in clinical practice
Applied Medical Science  The scientific basis of trials
Science Marries Medicine Stone disease as an instance