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HOW TO DRINK ENOUGH WATER

Jill jpegIn my 13 years of working with stone formers, as a nurse in residence at Litholink Corporation and in my own practice, the number one question has always been: ‘How much water do I really need to drink?’ Maybe as important is: ‘How Do I Do It?’

Tread Slowly

Many patients leave their doctor’s office with the vague instruction to increase their water input. How much are you supposed to drink to reduce your stone risk?

Even more, patients are told to go home and start drinking a gallon of water a day. If you don’t drink more than a couple of glasses per day now, how are you supposed to drink a gallon tomorrow?

Drinking more water is a simple way to reduce your stone risk, but simple does not mean easy. Most of you find this task extremely hard. I tell everyone to start out slowly. If you drink one glass per day now, then drink two tomorrow. Set new goals to increase your water consumption each week. I have seen people go from 1 glass per day to 10 glasses per day within a month.

Spend Time to Avoid Pain

I can hear you saying now; I don’t have enough time in the day to spend it in the washroom”.

This is a legitimate response and one I have heard many times throughout my career. I will not lie. You will spend more time in the bathroom, but you will get accustomed to your more frequent bathroom visits. The bigger picture is the one to focus on. Better hydration means you will be less likely to form more stones; this means that water can reduce ER and doctor visits, and lost time away from work.  What is going to the bathroom a few more times a day compared to all of the pain, suffering, and expense you will endure if you don’t drink more water?

Be Willful

I have seen my share of pilots, teachers, surgeons, nurses, and traveling salesman all increase water intake despite the time constraints of their occupations. The one thing they all do is make the time.

I have worked with surgeons and surgical nurses before and it is true that they cannot leave the OR to use the bathroom during an 8 hour open heart surgery. Intermittent dehydration can be a real problem in this case. My clients who work in the OR do their best to drink for the rest of the day to try and make up for the loss. Sometimes there is really no choice. Thankfully this is the exception, not the rule.

Once you make up your mind that you do not want to suffer with the severe consequences that kidney stones bring to your life, you will find a way to incorporate more water into your daily routine. It is your choice, your commitment to your health that creates a one day at a time habit of drinking more water.

How Much?

Under the usual conditions of life, 3 – 4 liters of fluids a day will provide 2.5 to 3 liters of urine volume, and this is enough. The average healthy adult bladder holds about 1/2 liter, so this means 7 – 9 bathroom trips in 24 hours.

Input Doesn’t Always Equal Output

Four factors make the answer harder to come by: sodium intake, geographical location, occupation, and exercise.

Sodium intake

High sodium intake can confuse people. It is does not by itself change how much you need to drink, but salt intake can shift the timing of water loss so you think you are not increasing your urine volume even though you are drinking. It does something more. It increases urine calcium losses, a matter we will come back to at a later time.

When you eat a meal that is high in salt, you can count on it decreasing your urine output. I have clients tell me that they drink “a ton” of  water but they never have to use the bathroom. The reason is that water is retained with the excess sodium. High sodium meals will decrease urine output that day and even that night, thus causing bloating, worsened hypertension, and higher risk for stones because of higher urine calcium.

But a steady high sodium intake, not just the effects of one meal, will cause a steady water retention and stable weight gain so after a while the extra water you drink will appear in the urine. In fact, when people lower their salt intake they become less thirsty so they have to focus more on drinking or they will ‘forget’.

Even so, keeping your water intake high and lowering your sodium consumption is best. Stone formers who have no medical contraindications to lower salt diets should be aiming for about 1500 mg of sodium per day. People become accustomed to high water intake and low sodium intake, and can benefit not only from the stone prevention but often from a lower blood pressure. How you lower your sodium intake to this number will be discussed in a future post.

Geographical location

There are actually places on the map that we who deal with kidney stones call the “stone belt”. Basically these are the states that are consistently hot and humid or hot and dry. Why is where you live a problem?  Simply put, you sweat more. If you sweat more, you run the risk of becoming dehydrated, and being dehydrated reduces your urine volume and makes you more prone to form a stone. If you live in a hot, humid or dry state, you need to drink more to compensate.

Occupation

Are you working construction in the summer in Texas? Are you a camp counselor in Arizona? Do you wash windows for a living in Florida? Your occupation can be the increased risk factor for your stone disease. The reason is the same as above. You are sweating more and need to drink more than the office worker seated in the air conditioned office whose windows you are washing.

Exercise

I am very proud of you that you are doing your daily exercise. We all know how important that is to maintain good health. Exercise plays an important part in stone prevention so make sure you do it. Just remember to hydrate before, during, and after to balance the water lost from sweating!

Tricks

Here are few ways to make water drinking more enjoyable.

Stylish water bottle

Find a water bottle http://www.zazzle.com/fun+water+bottles  that you really like carrying around. Seems like such a silly thing, but it really does help. I like big ones so I don’t have to keep getting up to fill it and it makes me very proud to see it empty. You may find smaller ones keep you inspired and you can easily go refill it as you make your bathroom pit stop. Here is an awesome water bottle I have found to help http://www.amazon.com/Basily-Infuser-Bottle-Around-Hydrated/dp/B00M1UOF3K/ref=dp_ob_title_sports

Make Tasty

Add fruit to your water. Adding lemons to your water has the added benefit of increasing your citrate level which is a natural inhibitor of stones, but use fruit that makes you smile most.

Using the product Mio http://www.makeitmio.com/ has helped many patients who constantly tell me that water is BORING. My reply is always, “better boring water than excruciating stones”. It is at that point that they take another sip.

Water is the most benign way to increase fluid intake, but don’t forget to include other beverages in your daily intake: Green tea, lemonade (no sugar), flavored waters, even fruit like watermelon, grapes, etc. will be helpful.

Be Techy

If you’re a phone app geek like me, download this app and track your progress https://itunes.apple.com/us/app/waterlogged-drink-more-water/id352199775?mt=8

Treats

Eat Your Water

Here is a list of foods that are made up of at least 90% water. Be careful. Some of them are high in oxalate and for those of you who need to limit your oxalate intake I have asterisked them: cucumbers, radishes, iceberg lettuce  celery*, tomato*, green peppers, cauliflower, spinach*, starfruit, strawberries, broccoli, grapefruit, baby carrots*, and watermelon.

Channel Your Inner Child

I have straws on my counter top in a cute container. They add color, fun, and make drinking water a much more whimsical experience. They also makes the water go down a bit faster. I find myself downing a glass with ease when I have a straw. My son likes it too. No matter what your age or disposition, straws add fun to an otherwise boring activity.

If you are enjoying some grape or apple juice, dilute it with half water. You will cut down on your sugar and increase your water intake. This is a win-win.

A neat way to add color and zest to your water without added calories or artificial flavors: Freeze grapes, or lemon, lime, or orange peels, and add to your water instead of boring ‘ole ice cubes.

Make new habits

Every time you reach for a diet soda, replace it with water. Soon you will just reach for water and your old diet soda will be a long forgotten bad habit.

Upon waking, drink a glass or two of water with lemon. This helps keep your urine alkaline and gets you feeling ready for the day.

In winter, get some hot water, lemon and honey. It will warm you up on a cold day.

Green tea (yes, low in oxalate).

Le Croix. For those of you who are addicted to bubbles. Try this no calorie, carbonated water. It comes in many flavors and has been a staple in my house for the past year. There are generic versions of it for budget conscience stone formers.

Drink a glass of water before and after a meal. Drink water. Eat less. Yet another win, win. Who knew it would be this fun?

Be Patient and Persist

I want you to know that incorporating large amounts of water into your life takes a bit of time. New habits are built with commitment, patience, and an understanding that you are not perfect. You will have days that you cannot get in the amount of water that you would like to. It is ok. Your goal is to do your best on more days than not. And when you don’t, you can get back on track the next day.

Drinking more water is the number one thing you can do to help prevent further stone formation. It also has no bad side effects. So what do you say?  Let’s raise a glass, a refreshing, ice cold glass of water. It might just save you from your next ER visit.

A Reservation

Water is always the first line of treatment for stones.The most important thing to do about supersaturation is lower it, and water will do just that. In relation to kidney stone prevention, more is better. In a perfectly healthy younger (below age 50) person taking no medications, up to 5 or even 6 liters a day is safe provided it is consumed over the whole day and never all at once. But if you have heart disease, kidney disease, or liver disease, or are elderly, great caution is important and the amount of water needs to be determined individually for you. When diuretic drugs are being used, to lower urine calcium excretion for stone prevention or for blood pressure control, water intake needs to be no more than 3-4 liters a day and testing is necessary at intervals to be sure blood sodium levels have not fallen. Many other medications interfere with water excretion; psychoactive drugs can do this, for example. All drugs in use must be reviewed with  your physician before drinking large volumes of water, above 2.5 liters daily. It is true that most people can easily and safely drink the extra water needed for stone prevention, but the reservations are important, always.

More You Might Like

Jill Harris on Variety of Beverages

Our Page Dedicated to Patients

Tips On How To Get The Most From Your Physician

Supersaturation: The Key To Stone Disease

 

 

171 Responses to “HOW TO DRINK ENOUGH WATER”

  1. Linda J

    I’ve suffered from kidney stones. Since my last attack, I drink at least 84 oz of water a day. I started drinking decaf green tea but was told not to by my doctor because it could cause stones. Is this true? I enjoyed the tea but don’t want to go thru that pain again. I would appreciate your input

    Reply
  2. Sailon

    Every morning I drink 2 liters of water at the same time. is there any other side effect for kidney?

    Reply
    • jharris

      Hi Sailon,

      I think it is great you are drinking so much in the morning, but does this mean you don’t drink anything else for the day? I always say that each of you needs to find out what works for you best, that is the only way you stay on your treatment plans. But I think that although you are doing an excellent job in the am, you might want to think about incorporating more fluid throughout the day.

      Let me know what you do for fluids after the morning.

      Best,

      Jill

      Reply
  3. Bella Roberts

    Hello! I am a 13 year old girl and this advice will be helping me! I first learned about My kidneys being in danger when I was at my doctor. Now I am drinking fluently of water. But my problem until now was: It was not helping much! It will be a pain to eat vegetables, but I will live through it. I already spin in a circle for 40 or 30 minutes, but I will pick it up. And I am now saying it: NO MORE SODAS!

    Reply
    • Fredric Coe, MD

      Hi Bella, It is unusual for stones to damage kidneys so I wonder what it is your physicians have found that puts them in danger. The only thing I know about like that is very high urine oxalate. Is that what you have??
      Regards, Fred Coe

      Reply
  4. imran

    Hello Dear jharris,

    Hope you are doing well. I am 38 year old male, On 25/5/2016 i got sudden pain in right kidney when i did the ultra sound i found 2mm stone there. i was very worried but the doctor told me no medication at this point just take more and more water daily. So from 1/6/2016 to 31/8/2016 in my daily diet i include almost 5-6 litter bottle water . The water which is available in our market mostly bottle and almost every brand have such composition like Bicorbanates. 26, Sulphates,26,Cholorides,19.Calcium,11,Magensium,3.4, sodium,17. During 1/6/2016-31/8/2016 my salt intake was normal . on 1/9/2016 i did my ultra sound again and was surprise bcz stone size was now 3.7mm in right kidney i am very worried now bcz i was thinking since i m drinking water daily so might be stone will be gone but its actually increase.

    In short now my dr told me that i should not eat salt at all.
    My question is:
    should i stop eating salt at all?
    can i continue to drink bottle water with above mentioned composition? is it safe ?

    In vegitable and in fruits which exact things i should NOT EAT AT ALL?

    Just for your kind ref i am taking mutton only once in a month and chicken once in a week

    Your advise will be so appreciate.

    Reg

    Reply
    • Jill

      Hi!

      First off- you know I am going to ask this question- have you done a 24 hour irine collection to see if you need diet alterations? You need to if you haven’t.

      I cannot recommend any diets to you until we know that vital information!

      Whether you make stones or not, limiting sodium to 1,500 mg/day is best for stone prevention and general good health.

      As far as fruits and veggies you need to do a collection to see if these healthy foods need to be limited. Come back and let us know that answer to that.

      Thanks for writing!

      Jill

      Reply
  5. Reka

    Hi I have a question too. I recently started having high bp 160-130/110-90 for the last month. It keeps varying. Few months ago my bp spiked when I had fever. It came normal later on. I had done tests, ecg and echo to check my heart function, which seems to be fine. My cholesterol is also ok. Doc says I don’t have ashma. Sometimes I keep getting breathless. How woken up at night a few times due to it. I took a urine test and scan which showed 2-3 kidney stones biggest of which was 3mm.

    My questions are: does high bp cause breathlessness? Does high bp cause stones or is it beacouse of high bp that i got stones?

    Also, recently I have been under stress. Had a loss in the family. My dad had cardiovascular problems. His bp was normal though. My cousins from mother s side have kidney stones previously.

    Please reply.

    Thanks in advance,
    Reka

    Reply
    • Fredric Coe, MD

      Hi Reka, The stones should not be causing high blood pressure nor will high blood pressure cause stones; I assume your kidneys function normally as your physicians have been careful about your care. The intermittent breathlessness with high pressure, also intermittent, coupled with stress in the family could be panic attacks – they mimic heart disease. Your doctors would have thought of pheochromocytoma, a rare benign endocrine tumor that raises blood pressure. I think panic attacks are worth thinking about with your physicians although at this distance I am just guessing. Be sure and seek prevention against more stones. Regards, Fred Coe

      Reply
  6. Austin

    Hi there!

    I have a question about family history and the possibility of stones. I’m 30 and have never had a stone but I know that my grandfather on my mother’s side suffered with them. My mom also had one a few years ago, though the doctor believed it was due to taking huge amount of calcium supplements and that they had built up over time. Once she cut back on those she’s thankfully had no issues. My father and sister have never had one either, yet I’ve been doing some research and found that family history can play a big role in how susceptible you are to stones. Once I learned this I panicked and have been doing everything I can do watch what I eat, from cutting back on meat and sodium to drinking 3-5 liters of water a day.

    I’m not a health nut but I do try to take care of myself but I’m worried that all of this may be for nothing if it’s something that’s inherited. I’ve been losing sleep and stressing out over the thought of being unable to do anything about. Is there anything else I can do? Thanks!

    Reply
    • jharris

      Hi back Austin-

      I understand your stress regarding family history and stones. The best advice I can give is to you is to keep on doing what you are doing for drinking. Sodium consumption should be limited to 1,500 mg/day. You can also ask your doc to order a 24 hour urine collection to see what your values look like just to keep on top of it. I would not do anything else with your diet until you know for sure. The less meat is always a good thing as we tend to overeat it. Anything other than that could be in vain and I don’t want you to avoid healthy foods when you don’t know if you need to.

      Hope this makes sense. If not, I’m here.

      Jill

      Reply
      • Austin

        Thanks Jill. I try to keep an eye on the nutrition contents on what I eat and to make sure everything is balanced. I feel like I’m going crazy but I believe the horror stories and want to do whatever it takes to prevent it.

        Reply
        • jharris

          Water is your very best bet, and the least invasive. Keep it up. The salt is imperative too. Do these two things for now and you will be doing everything you possibly can.

          Good luck-

          Jill

          Reply

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