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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.

More You Might Like

Jill Harris on Variety of Beverages

Our Page Dedicated to Patients

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155 Responses to “HOW TO DRINK ENOUGH WATER”

  1. sandip pandey

    does the consumption of beer helps in removing the stone from kidney?do beer have any sideeffects if consumed by kidney stone patient?faithfully

    Reply
    • Fredric Coe, MD

      Hi Sandip, Beer use is associated with less stones on average, so it is fine. Nothing I know of beside surgery will remove stones. Regards, Fred Coe

      Reply
  2. Ray

    I recently had a second kidney stone… So with the advice of the doctor I have increase my water intake. Over about the past 3 months of doing this i have added about 8 pounds of weight…. Water Retention? How do i deal with that? if i keep adding 2 to 3 pounds a month i will be ginormous in a short while.
    thanks,

    ray

    Reply
    • jharris

      Hi Ray,

      Love your frankness…. the world needs more of that. So, about your weight gain (which is also a problem for kidney stone formers)- You are adding weight because you are eating too much salt. Water likes to follow salt. Too much salt, too much bloating, too much weight, too much Ray. Many women know this, drink more water, lessen salt, and you will lose weight. That 8 pounds will be lost as fast as you gained it, actually it will come off much faster.

      Lessen your sodium intake to 1500 mg/day and you will be peeing like a champ! No point in drinking more water if you are not going to pee it out. So do that. Watch your sodium intake and when I say that I mean start looking at all the labels. If you are eating out a lot, then you are eating tons of sodium. It is in everything from cereal to mustard to just about everything you put in your mouth.

      Do this and I promise you you will feel lighter in a couple of days. Keep drinking, lessen salt, you will be less ginormous quickly.

      Best,

      Jill

      Reply
      • jharris

        P.S.

        Let us know your outcome. I would like you to be our latest role model!

        Reply
  3. Alex

    Hello Jill,

    If an egg white is 88-90 water, would you include consuming egg whites as an effective way to eat your water?

    Alex

    Reply
    • Fredric Coe, MD

      Hi Alex, We need liters of water, and if you use egg white you get massive amounts of protein. In a liter of water – 1000 mg of water – there will be 10% protein or 100 gm. That is more than one would eat of protein in a whole day! So, no. Regards, Fred Coe

      Reply
      • Alex

        Thank you, Frederic. I understand what you’re saying but my question wasn’t clear enough. If a kidney stone former was eating a much smaller number of egg whites and getting most of their water by drinking straight water, would you count the water content of the egg whites as part of the daily amount needed to protect the kidneys?

        Alex

        Reply
        • Fredric Coe, MD

          Hi Alex, you could but it would be too small to matter. An egg has perhaps 10 ml of white, giving 8 ml of water which is 1.5 teaspoons. If you fry the egg the water is gone, so it would have to be boiled or raw. Regards, Fred

          Reply
  4. Majid Hussain

    Hi dear Jeff.
    I’m suffering from kidney stone tell me the quantity of water and other fruites to avoid kidney stone and to rectify this problem , I’m feeling so pained !!!!

    Reply
  5. SRoy

    For a middle-aged person staying in India, doing moderate daily exercises (equivalent to 20-30 mins brisk walking), and used to having 3 to 3.5 litres of water every day: is it okay to drink 3-4 glasses of water (nearly one litre) at a time? thanks in advance.

    Reply
    • jharris

      Hi-

      If it is not causing you ill effects to drink that much at one time, I don’t see the harm in it. Don’t drink it terribly fast is the only thing I would advise.

      Thanks for writing-

      Jill

      Reply
  6. Tali

    I noticed that you list spinach and strawberries in the section “Eat Your Water”. Just FYI, these are both foods that can cause calcium stones! I used to make strawberry and spinach salads to take with me to work almost every weekday during the summer months until I ended up with kidney stones and had to take several weeks off work to recover after lithotripsy 🙁

    Reply
    • jharris

      Hi Tali,

      Yes, we are very aware that those foods are high in oxalate, as we noted in the article. People who don’t have oxalate issues but need to find more inventive ways to get more water will benefit. Those that have high oxalate levels will not!

      Thanks for writing!

      Jill

      Reply
  7. marie

    Do you think it could be cancer

    Reply
    • Fredric Coe, MD

      Hi Marie, It can always be a tumor as I noted below. Usually not, but have your physician make sure. I deleted the duplicate of this question for you. Regards, Fred Coe

      Reply
  8. marie

    I have a stone in my left kidiney about 10 years l have pain inmy
    Kidney and if i sit on the toilet and move to the left or lie down i have pain most of the time i have microscope blood in my urine.

    Reply
    • Fredric Coe, MD

      Hi Marie, Perhaps the stone is indeed causing pain – it certainly could cause bleeding. If the pain is very bothersome, it consider having it removed. The fact that the pain is related to movement makes me wonder if it is really from the kidney or from the back muscles. Kidney pain is not usually affected by movement or posture. As for the blood, you should have a urologist be sure it is indeed from the stone; I would much advise you do that. Almost all the time it is, but as you point out above sometimes a very early cancer can be present – even the beginnings of a cancer. These are easily cured at the beginning. Regards, Fred Coe

      Reply
  9. Pam

    Four years ago I had lithotripsy to break up stones two large to pass. On my follow up appt I still had a smaller stone in the upper right pole. Two years ago I was experiencing pain again and the CT scan showed the exact same stone was now 5mm in size. I was told at that time it could not be causing pain. I have just dealt with the on again off again pain. I was diagnosed in January for a UTI and then again in April. I was experiencing severe right groin pain and right back flank pain recently which landed me in the hospital. They did an ultra sound and pap smear but said they could not find anything except the urine culture came back and they put me on Cipro for an infection. Went to Urologist and had another CT scan and I have a 10mm stone lodged in my upper right pole of kidney, same exact spot where the 5mm stone was. The urologist again is stating that this can not be causing the pain. I drink 64 -94 oz of water a day and keep forming calcium stones. What would you recommend my coarse of action would be at this time? Why would they not do lithotripsy again?

    Reply
    • Fredric Coe, MD

      Hi Pam, It is very hard for me to tell if the enlarging stone is the cause of your pain, but it certainly could be doing so. The episode of flank and groin pain sounds like stone passage, perhaps a small fragment. Lithotripsy would no longer be the single choice for your stone, if any procedure were indicated; flexible digital ureteroscopy might be preferable, depending on the details of location and anatomy. If you have a lot of pain, and your personal physicians are not sure about the best course, I would think they might want to help you seek a second opinion about treatment options. You have growth of a stone, but you speak of forming calcium stones – are you indeed making new ones. If so, you need prevention measures to stop that process. Regards, Fred Coe

      Reply
    • Jeff

      Try Chanca Piedra “stone Breaker” herbal supplement (pure stuff without a whole lot of additives!). I took 2 500mg pills every 6-8 hours for a week along with 2 tablespoons of Braggs Apple cider vinegar 2-3 times daily and passed a 7mm CALCIUM stone … the stone actually came out 7X3X2 mm and was very brittle and porous and seemed to be kind of slimy when I passed it. Also my pain level went from a 9 to a max of 4-6 and usually just annoying while on this protocol. I drank a lot of water and stopped adding salt to food. So do some research …. also you may want to start off with a lower dosage of the Chanca Piedra but still take the Braggs vinegar. I still take 1 Chanca Piedra daily at night on an empty stomach. You may want to try this for awhile and then go get another CT scan to see if it helped … Also this worked for a Calcium stone … if you have a different type then I don’t know if it will work …. Best of luck

      Reply
      • Fredric Coe, MD

        Hi Jeff, I am happy to post this, but I have to make clear as a professor and physician that I do not know anything about it and can neither endorse it or raise objections to it as a treatment. If we find a number of people using it, I will try to get some research on it and post an opinion. Best, Fred Coe

        Reply

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