A THIRST FOR VARIETY

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I have heard this one million times from patients in my practice. Make stones? Drink water. Water, water, and more water. Drink it all day long, all night long. Just drink water.

What about other fluids? Are they safe? Are they high in oxalate? Will they count toward your daily intake? Is caffeine a problem?

Your Physician Prescribes How Much

I will be offering as much variety as I can, and encouraging you to drink, but the volume you need comes from your physician. This applies especially to my two day long examples. I made them to provide very large amounts of fluids for those who need them. If your physician prescribes less, just scale my recommendations back. Under no circumstances should you follow a fluid prescription in this post unless it fits with your physician’s specific recommendations for you.

Some Beverages Raise Stone Risk

Understanding what you can and can’t drink for stone prevention can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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What Did People Who Developed Stones Drink?

Perhaps the most useful study of this matter is by Ferraro and colleagues. Two large groups of nurses and one group of physicians have been followed for many years to ascertain habits and diets that appear healthy or unhealthy.

Some of the people in each group developed kidney stones. Most, as expected, did not. Because diet habits were closely monitored by well established questionnaires over the years, the scientists could determine which beverages, my particular concern here, were associated with a higher or lower risk of becoming a stone former.

The amounts are important to keep in mind. For coffee and tea it was 8 ounce servings. For juices, a small glass. For carbonated drinks and beer a glass, bottle or can. For wine a 5 ounce glass. Servings were graded from less than 1 weekly, over the range of 1, 2-4, 5-6 weekly, and more than 1 serving a day. A significant effect meant that as the amounts increased, the risk of new stones increased or decreased in rough proportion – there was a ‘dose’ effect.

Winners and losers

Sugar sweetened colas and non-cola drinks were associated with development of kidney stones. Punch was also associated with more stones. But drinks with sugar in them were not all bad. Apple juice, grapefruit juice, and tomato juice did not raise or lower risk of stones.

Coffee, decaffeinated coffee, tea, red wine, white wine, orange juice, and beer were the winners. People who used more had a lower risk of new stones.

No Special Effect on Stones

We already mentioned apple, grapefruit and tomato juices. Add to them liquor, artificially sweetened sodas – cola and non-cola (clear sodas), whole and skim milk, and water itself.

Water Is Not Your Only Option

Nothing is totally off limits when it comes to increasing fluids. The main point is that you do, indeed, increase them. If having a soda here and there helps you maintain your ultimate daily fluid goal, then by all means, treat yourself once in a while.

I am certainly not advising you to have as many Coke’s as you would like, nor am I advocating that you drink very large amounts of coffee all day long, even if coffee drinking lowers risk of stones. What I am saying is that all fluids count and water is NOT your only option. Other beverages help provide variety but my principle is to use them in moderation.

This post will help you decide which other beverages you might incorporate into your diet to help raise your total daily fluid intake. Keep in mind that you need to take into consideration other medical conditions you may have that will contraindicate some of these choices. Review your version of my plan with your physician to be sure.

Pucker Up!

Lemonade is an excellent way  to increase your total daily fluid intake and raise your urine citrate level. Citrate is a molecule that binds to calcium so that calcium does not have the chance to bind with phosphate or oxalate. It also slows the formation of stone crystals. Both actions decrease your risk of forming new kidney stones. Lemonade use was not part of the large beverage study I have already quoted, but is thought to be beneficial for stone prevention, or at least not a specific risk like sugared drinks.

The Best Tasting Ones

The Huffington Post polled people on the best store bought lemonades. The winner was Whole Foods brand 365 Pasteurized Lemonade. The next two best were Simply Lemonade and another Whole Foods product, brand 365 Organic Lemonade. Read the whole article and let us know which ones you like.

Unfortunately, all three winners have extra sugar added to them. Simply Lemonade seems free of extra sugar, but comments to a review of the product document added cane and beet sugars.

Sugar in any form can raise kidney stone riskand sugared drinks raise risk of stones – as I have already pointed out. Of course sugared drinks promote weight gain, and raise blood glucose and insulin. But if you follow my moderation principle some of these tasty treats are fine. ‘Some’ means some.

My Favorite for You

I recommend Crystal Lite™ lemonade for my patients, as it is a no calorie alternative. The other reason I love this for you is its convenience. Here is a link for on the go” packets. Another recent post on this site points out that those who need potassium citrate treatment can use this beverage in place of some of their pills.

Make Your Own

You can also just squeeze some fresh lemons to add to your water. If you don’t have time to always buy, cut up, and squeeze fresh lemons, here is an excellent, convenient, alternative: Pre-made concentrate. I get it at Whole Foods, but you can find it at Walmart and Amazon as well. In order to increase your citrate level with a recipe that has been tested in a research experiment, you need to add one half cup of RealLemon© to 7 1/2 cups of water. The Whole Foods concentrate may work as well, but has not been tested.

Got Milk?

Adding low fat, skim or 2% milk is a great way to increase your daily fluid intake and also help you to increase your diet calcium intake. For those of us who are lactose intolerant, here are lactose free alternatives.

Lots of Calcium and Protein

Getting normal amounts of calcium into your diet (about 1000 mg/day) is necessary for your bone health. An 8 ounce glass of milk contains about 305 mg of calcium. Two percent contains 295 mg. You can check the amounts for all milks at the site. There is a lot of protein (8 grams) and other nutrients, too. The protein content is the same whether for fat free or whole milk.

Not So Many Calories As You Might Think

Milk is a calorie bargain. An 8 ounce glass of 2% has only 120 calories, and 1% 105 calories.

Soda Pop

The Skinny on Diet Sodas

Having a diet soda a few times a week will add to your overall fluid intake and, as I have already pointed out, does not increase risk of forming kidney stones to a significant extent. But, unlike milk and lemonade, most sodas offer you no health benefits.

There May be Real Risks

There may indeed be drawbacks. For example, in one study, risk of hip fracture seemed related to diet soda intake in women.

There is Risk By Association

Among diabetic young men, use of diet, but not sugared, sodas was associated with higher average blood glucose. This was ascribed not so much to the beverages as to the generally unhealthy life style of those who consumed larger amounts of such beverages. Likewise, in another study, diet sodas were associated with new onset of type 2 diabetes in men. But with full adjustment for other factors that might predispose to diabetes, the effect of diet soda disappeared. It seems as if men who were trying to lose weight, or compensate for high diabetic risk, preferentially used diet sodas.

Cola vs Uncola

Given that there are drawbacks to sugared sodas and no benefits to diet sodas, what about the clear sodas – the non-cola drinks, as a special case?

The clear sodas have citric acid instead of phosphoric acid. We have already presented the chart of citrate levels in clear soda and you can read it over yourself: Higher is better. Likewise, in the same post, this site has presented the case for the use of beverages as a source of citrate in place of expensive potassium citrate pills.

 7UP and Sprite have no caffeine which may be an advantage for some people.

The Final Verdict

Think of diet sodas as a treat, probably not a good protection against stones. The higher urine volume is offset by what else is in the soda. It is not something to have all the time. Diet soda may increase hip fracture risk in older women. Sugared sodas raise risk of stones, so just avoid them except for a special treat once in a while.

Given the high price of potassium citrate pills, many patients may need to use high citrate beverages, which are clear sodas, as a supplement. For those who do not need supplemental citrate, and there are very many stone formers in this category, the clear sodas serve no special purpose except for variety and taste.

Unless you are using high citrate beverages to replace potassium citrate pills, limit how many times a week you are choosing soda as an alternative to water. I would recommend no more than 3 cans a week. If you’re somebody who drinks it every day, start weaning yourself off of it.

Try substituting a LaCroix for each can of soda. It is carbonated and flavored, but without the calories, sugar, and yucky stuff that soda has in it.

Wake Up and Sip The Coffee

I drink one cup of coffee every morning. Not the 72 ounce cup you can get at Dunkin’ Doughnuts, just one true cup. I need it, I love it, and I will not do without it. There is no doubt that coffee can contain considerable oxalate. Instant coffee has even more oxalate per gram than the regular coffees. The question is whether drinking coffee increases urine oxalate, which has not been determined. 

I suspect it does not because coffee drinkers have a lower, not a higher kidney stone risk. In the same prospective study I quoted  for sodas, caffeinated coffee drinkers had a 26% statistical reduction in new stone onset compared to people who did not drink coffee and there was a graded reduction in risk as the amount increased from none, through 1 cup per week, up to 1 cup or more every day. The decaf drinkers had a 16% reduction.

These coffee drinkers were not using coffee as a form of stone prevention. I presume they used it as a pleasurable beverage. So there is something about coffee drinking that offered a protection.

The issue is therefore not about kidney stone risk but about how much coffee people should drink every day. That is something you need to discuss with your physician. But, I cannot imagine anyone will use coffee, even iced coffee, as more than a small fraction of the many liters of fluid needed daily for stone prevention.

Terrible Teas?

Every patient I have worked with (thousands at this point) has told me that they have been told NEVER, EVER, to drink tea. Tea is known to be high in oxalate. It is true that tea is a higher oxalate beverage, but if you drink it in moderation, a cup here and there will not increase your risk of forming new stones and does add to your total daily fluid intake. In support of what I just said, in the same study I have already quoted in the prior paragraph, tea drinkers had an 11% reduction in stones.

Even though a cup or more of tea every day appears to decrease stone risk, tea, and iced tea, are not a reasonable source for the majority of the large quantities of fluid used in stone prevention. Tea is like coffee: A source of some fluids and variety.

Lovely Libations

The very important epidemiological study on beverages which I have been quoting offers perhaps a little surprise: Wine drinkers (5 ounce glass between 1 per week and 1 or more a day) had a progressive reduction in stones of 31% to 33%. Beer drinkers (1 can between 1/week and 1 or more daily) had an even higher reduction of 41%.

None of these quantities are like the scale of water drinking, or even milk drinking. These are like coffee and tea: Pleasure drinks.

Overall, your alcohol intake is between you and your physician; drinking in excess is never advisable. One glass of wine, or one can of beer a day may confer real benefits for stone reduction.

In between rounds, remember to raise a glass to your old friend water. Your body will thank you the next day.

Sport Drinks

I have not encountered very many patients who use sport drinks in important quantities. Maybe I travel in the wrong circles. Sweetened sport drinks all have the obvious disadvantages of their sugar in relation to stones, and, of course, for weight control. None were remarkable sources for citrate. They are like the sodas: Occasional treats to break up monotony.

Juicy News

If you want risk reduction specific to a juice, orange juice, 1 or more small glasses a day, was effective (12% reduction). Apple, grapefruit, and tomato juices had no effect.

But the lack of an effect is not critical here. The study refers to a small glass daily and did not test larger volumes for urine dilution. Given that none of the juices increased risk, I see no reason larger volumes cannot be used as part of the day’s fluids, apart from the problem of calories – from sugar.

Although cranberry juice may help in protecting you from recurrent UTI’s, no studies have shown it reduces kidney stone risk.

A Day In The Life

 How do these suggestions play out in normal day life?  Let’s take a look at an example weekday and weekend day. For those of you who are trying to increase urine citrate, we have a whole post to help you.

These are Examples; Your Physician Sets The Amounts

I have already said this and say it again. These examples are for very large volumes of fluid. They show you how you can achieve such large volumes with variety. Your physician will tell you how much to drink. Scale back these examples to match what you are told.

Perfection Is Not a Realistic Goal

You may notice that depending on your day you may drink less than your goal. You may not reach your intended goal every day. It is OK. You are not going to be perfect every single day. Try your best on most days, and if you have a really bad one, just make up for it on the following day.

Monday – A Weekday Fluid Plan That Provides 120 ounces (~1 gallon)

Here is a weekday example for your sunny, early riser with a job and a lot to do. The plan provides 120 ounces – one gallon – of fluids a day and aims for modest front loading so you do not have to get up at night. It includes a treat – diet coke – which could be any diet drink. It does not favor milk because many people do not like it or cannot tolerate it. If you can, milk can substitute for water whenever you wish.

Wake Up – 6 am

1 cup of coffee or tea (5 ounces).

5 ounces of milk with cereal

One 8 oz glass of water with lemon

Mid-morning

Three 8 oz glasses of water

Lunch

One 8 ounce glass of fresh lemonade or diet lemonade beverage

One 8 ounce glass of water

Mid Afternoon

Two 8 ounce glasses of water

One (5 ounce) cup of tea

Dinner

One 8 ounce glass of water before dinner

One 8 ounce glass of water during dinner

One can of diet soda — 12 ounces toward the end

After dinner / before bed

One 8 ounce glass of water

One cup (5 ounces) of herbal mint tea

Saturday – A weekend plan that provides 148 ounces

No work for most of us but a lot of chores. Weekends may be a time to up the ante and go over a gallon. Even if you fall short on the weekdays a bit, and likewise on the weekends, these plans are large enough to give you some margin. But it would be ideal to stay on the high side more days than not. You are buying insurance by the day, after all.

Wake Up – 8 am

1 cup of coffee or tea (5 ounces)

One 8 oz glass of water with lemon

5 ounces of orange juice

Mid-morning

Three 8 ounce glasses of water

Lunch

12 ounces of iced tea

8 ounces of water

Mid Afternoon

One liter of water with workout at gym (about 34 ounces)

5 ounces of green tea

Two 8 ounce glasses of water

Dinner

Two 8 ounce glasses of water

Two 5 ounce glasses of red wine

One 5 ounce decaf

The Wrap Up

My intention was to convey that water does not have to be the only thing you choose when calculating your daily fluid intake. All fluids DO count toward the total.

I think this is important to note, as many patients tell me they hate drinking so much water everyday and then wind up not drinking at all. You can safely add items like diet soda, fruit juices, tea, and alcohol if you do it sparingly throughout the week along with your best friend: water.

Personally, I choose water most of the time. It is free, without any calories, supposedly good for my skin, and does a great job of quenching my thirst during the day and after exercise. As a middle-aged woman, it checks all my boxes.

Need more support getting in fluids or changing your diet?

I have recently put together a private FB page called THE Kidney Stone Diet.  It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound.  Come on over and join the discussion!

Return to Walking Tour about Supersaturation

Understanding what you can and can’t drink for stone prevention can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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61 Responses to “A THIRST FOR VARIETY”

  1. Joanna B

    Thank you everyone for all this useful information. Just had a second stone in 3 years and as my Father has always had them and gout then I’m obviously taking after him. Am now going to seriously look and diet and fluid intake. Even though I’m pretty fit and eat healthily I’m going to have to make some changes to try and prevent them. Keep up the good work.

    Reply
    • jill Harris

      Hi Joanna,

      Sorry you had another. Please do take it all seriously and make sure you don’t get another. Please do your testing and find out why. Thanks for writing. We love hearing from you-

      Jill

      Reply
  2. Alan

    Could some please let me know about the following:

    1) Is coconut water off the shelf and/or Fresh coconut water is a good option for staying hydrated.
    2) Could drinking coconut water cause kidney stones?
    3) Could drinking coconut water dissolve kidney stones? (I read this in an article online)

    I appreciate any advice as I have been diagnosed with a 4mm kidney stone in upper part of my right ureter.

    Thank you very much.

    Regards,

    Alan

    Reply
    • Fredric Coe, MD

      Hi Alan, I am asking Jill Harris to answer this one. Regards, Fred Coe

      Reply
    • jill Harris

      Hi Alan,

      I know that coconut water is enjoying its 15 minutes of fame right now. You may drink it, it will hydrate you. It will not increase risk for stones for all I know, but it won’t break them up either.

      Thanks for writing us-

      Jill

      Reply
  3. zende.pratik@gmail.com

    How much black coffee needs to be had during a day?
    Also what all other diuretics can be had for Kidney stones?

    Reply
  4. Bill

    I’m a bit confused about oatmeal and barley. I eat them regularly to keep my cholesterol in check. I was just diagnosed with two 9 mm stones. Should I eliminate them?

    Reply
    • jharris

      Hi Bill.

      No, you don’t have to eliminate them. They are both on the lower side for oxalate. Use the list we provide on this site for you high and low oxalate foods. I am hoping you have done a 24 hour urine collection to see why you are forming stones and if you even need to lower your oxalate.

      Happy New Year-

      Jill

      Reply
  5. Britton Campbell

    Tea in moderation can be good for the body. Studies show that tea can lower your risk of kidney stones. I have my grandfather drink tea every week for that reason.

    Reply
    • jharris

      Hey Britton,

      I don’t mind tea here and there, but be careful as black tea can be higher in oxalate.
      Happy to hear you are watching out for your grandpa-

      Jill

      Reply
  6. Hanusia Tkaczyk

    I am caffeine sensitive and drink herbal coffee made of extract of roasted malt barley, roasted barley and roasted chicory. Barley is fairly high in oxalates and I wonder if its preparation for an instant herbal coffee concentrates it. I use 2-3 tsp per 8 oz cup and like to have 2-3 per day. Herbal coffee may be too obscure to have been tested, but i thought i would ask. Thanks.

    Reply
    • jharris

      Hi Hanusia,

      I do not have access to those numbers as I assume that herbal coffee has not been studied. Going on the premise that barley is high, I would say to watch how many cups you are drinking a day and or lowering the amount you drink at a time. Perhaps ween yourself down to one cup per day? Also adding some milk to it will help, if you like that.

      I’m glad you did ask.

      Jill

      Reply
      • Hanusia Tkaczyk

        Makes sense to me. It will have to a treat rather than a staple.

        On the ither hand, at least i can still drink rooibos tea, though the flavour is not as intense as herbal coffee. According to this article it is low in oxalates.

        http://lowoxalateinfo.com/introducing-african-red-bush-tea-rooibos/

        Thanks for your info and advice. Your article is very helpful.

        Reply
        • jharris

          Glad to help Hanusia. I have no experience with the source who wrote that article, so cannot comment on it. We stick to our lists and those researchers that conducted the studies.

          Thanks for writing in-

          Jill

          Reply
  7. Jason

    I have calcium oxalate stones. A 24-hr urine test showed that I have hypercalciuria and low levels of citrate. The doctor suggested adding lemon juice to my water daily. However, I suffer from GERD/reflux and there’s a strong possibility that I might have developed ulcers, or at least have gastritis, so lemon juice would be very irritating to my stomach. What are my options to increase citrate, and is this the only solution to lower the excretion of calcium in the urine? I feel caught in a catch 22 situation.

    Reply
  8. Maureen

    Interesting article. Thank you.

    Reply
    • Jill

      Hi Maureen,

      Glad you enjoyed it and thank you for taking the time to tell us.

      Warmly,

      Jill

      Reply
  9. lee

    I read that recent studies show that Green Tea helps prevent stones. Then again, I read that tea is still a stone former. Who are people supposed to believe??

    Reply
    • Jill

      Hi Lee,

      Black tea is high in oxalate. Best to stay away, if you do drink it, use milk with it to counterbalance the oxalate. The longer you steep it the worse it is. Green tea is deemed acceptable and has many other health benefits.

      Hope this helps.

      Jill

      Reply
  10. Whitney

    Forgive me if the answer to my question is clear and I miss something, but I am reading two of your articles, this – “Thirst for Variety,” and also, I just read “How to Eat a Low Oxalate Diet.”

    The one I read first, “How to Eat a Low Oxalate,” article says
    “BEVERAGES – PLANT SOURCES
    Hot chocolate is the clear loser at 65 mg per cup; carrot juice is the runner up at 27 mg per one cup. Lemonade, tea, tomato juices, rice dream and the like are better but still high. The are 15 – 18 mg per serving. Lemonade – frozen concentrate – is 16 mg per 8 ounces so be careful about this as a source of citrate.”

    Then the “Thirst for Variety” article says
    “Lemonade is an excellent way to increase your total daily fluid intake and raise your urine citrate level. Citrate is a molecule that binds to calcium so that calcium does not have the chance to bind with phosphate or oxalate. It also slows the formation of stone crystals. Both actions decrease your risk of forming new kidney stones. Lemonade use was not part of the large beverage study I have already quoted, but is thought to be beneficial for stone prevention, or at least not a specific risk like sugared drinks.”

    These seem a bit conflicted, and my physician encouraged me to make my own lemonade, similar to the recipe you provided in one of your articles.

    Can you comment on where you stand with lemonade please? I am curious if it is on a case-by-case basis, and why you have recommended to those seeking a low oxalate diet should avoid lemonade in the “How to Eat…” article,, but this “Thirst for Variety” article seems to recommend drinking it to prevent stone formation? (which is what my physician told me)

    Thanks!

    Reply
    • Fredric Coe, MD

      Hi Whitney, Thanks for your careful reading. We should reconcile these articles, but it is just the few of us and we have so little time. Of course, in the oxalate article we were focused on it and in the beverage article on citrate so in one we emphasized to us and our readers the oxalate and in the other we were pleased with the citrate. In truth the confusion is because the amount is significant but not disastrous in beverage planning, and citrate is not easy to come by. The 50 mg oxalate diet ideal is usually not attainable, 100 mg is more reasonable, and this juice may well fit into a day of meal planning. In our recent article on high calcium low sodium food sources we mention calcium supplemented juices, and note the oxalate. But the calcium in the juice will prevent the oxalate from being absorbed well. So overall the calcium supplemented juices are probably a better bet and we should go back and edit our variety article. Regards, Fred Coe

      Reply
  11. Jeanne O'Brien

    How do I measure oxalate in my urine? My urologist has never
    mentioned this. He just gives a list of foods to avoid. Thank you.

    JO

    Reply
  12. syam

    is red wine good for kidney stone ?

    Reply
    • Fredric Coe, MD

      Hi Syam, As far as I know it is not a risk nor a special benefit. Regards, Fred Coe

      Reply
    • Diane Stephenson

      I had a heart attack on 3-12-16 on the way to the E.R. passing a 9.5 mm stone……….Then I had to have a heart cath; I was advised that the heart enzymes became elevated due to the intense pain of passing that stone. I had no blockages. I never want another kidney stone………….all prevention methods would be appreciated. Thank you.

      8-5-16

      Reply
      • Fredric Coe, MD

        Hi Diane, I am not sure if that was a heart attack or just massive cardiac overload from hormones released because of all that pain; I Hope your heart recovers perfectly. As for prevention, the best way is to follow an organized approach. Here is one I wrote and like. Let me know. Regards, Fred Coe

        Reply
  13. คลิปโป

    You ought to take part in a contest for one of the mօst useful blogs on thе web.
    I will recommend this website!

    Reply
  14. Dana

    Crystal Light “Pure” is now available in their “on the go” packets. Apparently it contains no preservatives or artificial flavors. It does contain 3 grams or sugar and Stevia, a natural sweetener from the stevia leaf. Do you see this product in the same positive light that you see the artificially sweetened Crystal Light? Thanx!

    Reply
    • Fredric Coe, MD

      Hi Dana, My colleague Dr John Asplin measured citrate in the product I mentioned, and we published what we measured. I cannot know if the pure product is the same. But, you could tell. If you are using it in place of potassium citrate, see if your urine pH remains as high with the new product as with the old one. Get a 24 hour urine on the old one, and then the new, of course, so you can do this. Also notice the urine ammonium ion; it should be low using the old one and if it stays low then the new one is fine. Old and new are in relation to urine sulfate. Here is a link to how to read this on your lab reports. The uric acid link says a lot about ammonia, the calcium one less so. Regards, Fred Coe

      Reply
  15. Nilesh Pandey

    I have had a surgery of kidney stone in 2012 and have developed again.I have 2cm stone in my right kidney and 1cm in my left kidney.I dont want to go for surgery again.Please help if you have any ideas.

    Reply
  16. Colin

    I have had a ct scan which confirms I have 2-3 stones per kidney which are 3-5mm in size. My doctor has told me not to drink tea and has offered little less advice. What do you think?

    Reply
  17. MegRN

    I’ve gone back to coffee after my last kidney stone, and although I love coffee, my stomach does not! Someone recommended Teeccino. I tried it (with milk of course!) and it’s good; but I am concerned about the oxalate levels. I could not find any resources about the oxalate levels in Teeccino, but the ingredients include almonds, figs, and dates; those ingredients are high. Thoughts?
    Thank you.

    Reply
    • Fredric Coe, MD

      Hi Meg, The constituents are high, so I guess the product has a lot of oxalate. One possibility is to use the product and recheck a 24 hour urine to see if oxalate has risen. Regards, Fred Coe

      Reply
  18. M Mohammed

    This study shows that grape fruit increased the risk of kidney stone formation: http://aje.oxfordjournals.org/content/143/3/240, unlike some other studies sited here.

    Reply
    • Fredric Coe, MD

      Hi M, It is true that this article makes that comment. But in a much larger and much more recent article the same lead author – Curhan – found no effects of grapefruit juice. It was that more recent article Jill referenced. It is not all about recency, it is that in the later article the group had better access to more data. The values for grapefruit juice were RR values of 1.06, 1.01, 0.99, and 1.10 for 1 week, 2 -4 weeks, 5-6 weeks and >1/day usages; the 95% CI for all five values passes through 0 meaning lack of deviation from 1, and the p value for a trend with time was 0.26 age adjusted and 0.22 fully adjusted. So grapefruit juice poses no detectable risk of stones. Thanks for your careful reading. Regards, Fred Coe

      Reply
  19. m Smith

    Is it okay to use Mio water enhancers when you have a body that’s makes kidney stones?

    Reply
    • Fredric Coe, MD

      Scientifically there is no data at all, so I am just guessing. It seems harmless although loaded with chemicals. The amounts of the additives is small, and if the flavoring does it for you it is a fair trade off. Regards, Fred Coe

      Reply
  20. Brian

    When I search for “Crystal Lite Lemonade” I get results for Crystal light which isn’t lemonade at all and the #1 ingredient is Sugar.

    Reply
    • Fredric Coe, MD

      Hi Brian, There is a crystal light lemonade as a standard product and it is without added sugar. Just Google it and you will find an array of products everywhere. There is also a sugar version, which is probably what you encountered. Fred Coe

      Reply
  21. Ari

    Hi, Jill. I need more citrate in my diet according to my test results. I’m planning on upping the use of lemon juice (not lemonade, as I don’t want to add sugar or sugar substitutes in any way). Was just reading about a study that said the citrate in orange juice actually raises citrates more than that of lemons, due to the accompanying ions. It’s here: http://www.utsouthwestern.edu/newsroom/news-releases/year-2006/orange-juice-is-better-than-lemonade-at-keeping-kidney-stones-away.html

    Are you familiar with this study? Thoughts?

    Reply
    • Fredric Coe, MD

      Hi Ari, I am answering for Jill. Citrate is a weak acid. Citric acid itself will do nothing to help kidney stones. The sodium and potassium salts of citric acid, sodium and potassium citrate, are helpful because as citrate is metabolized as citric acid the citrate must take up a proton which produces alkali in the blood. It is this alkali which signals the kidneys to raise urine citrate and it is the urine citrate that helps prevent stones. Many fruits contain citric acid and the less acid the fruit the more is available as citrate as opposed to citric acid. Potassium salts are preferable to sodium salts because sodium raises urine calcium losses. But no trials support fruits, as yet, so eating oranges or their juice is not necessarily a way to prevent stones. Likewise orange juice is caloric. The study was done in 2006 and we are familiar with it. Regards, Fred Coe

      Reply
      • R

        Hello, up in the article the author suggests lemon juice. But this comment seems to suggest that wont help anything. Can you please clarify for me? Do studies show that lemon juice will reduce the chance of developing stones?

        Reply
        • Fredric Coe, MD

          Hello R, The article mentions lemonade preparations as a part of variety in fluid choices. Lemon juice is useful for flavoring water. Lemon juice and lemonade drinks have never been tried in formal stone prevention, so no studies show they prevent stones. Fred Coe

          Reply
  22. Hope

    I had a 24-hr urine collection test and the report says that my urine pH of 6.762 and urine calcium of 152 mg. puts me at an increased risk for stone formation. My doctor told me to drink orange juice, but I’m pre-diabetic so that’s not a good option for me. I asked about adding lemon juice to the water I drink and she said that studies have shown that it doesn’t prevent kidney stones so it wouldn’t do any good to drink it. The only other alternative she offered me was to buy a vitamin/mineral supplement called Theralith XR. First of all, have you heard of these studies? Second, is Theralith XR a supplement you recommend to your patients? It contains 99 mg of Potassium and I take Lisinopril (5mg/day) for high blood pressure and supposedly I need to watch my Potassium intake. Thank you.

    Reply
    • Fredric Coe, MD

      Dear Hope, Of course, with no immediate information about you except a few numbers there is little specific I can say. Lemon juice will flavor water and make it easier to drink, so feel free to use it, but expect no benefit from the lemon in relation to stone prevention. As for Theralith, I had never heard of it, but I did go on the website. At the bottom of the page I found this: ‘This product is not intended to diagnose, treat, cure or prevent any disease.’ Certainly this disclaimer shows good faith in that no claim is made that the product will help you. It contains amounts of potassium magnesium and citrate in levels not of obvious use in stone prevention. Vitamin B6 has never been shown to prevent stones. The amount of potassium is negligible so it offers no risk given your use of Lisinopril. So, it seems a remedy with no force and no likely benefit. As for your tests, the high pH value is indeed noticeable and raises risk for calcium phosphate stones. Perhaps your physician might want to focus there. Such an elevated pH sometimes goes with other abnormalities. I am afraid I cannot say much more having so little to go on, but I am sure your personal physicians are thinking about the alternatives for you. Among them, however, the Theralith does not seem promising. Fred Coe

      Reply
  23. Brad Mainster

    Jill,

    What’s your take on Mountain Dew? Citric acid, not phosphoric acid. Contains caffeine (54mg/12 fl. oz.) But the #2 ingredient is high fructose corn syrup, which I know isn’t a good thing.

    Been dealing with kidney stones since about 1992. Used to be about every 5 years. Recently I had episodes 10 months apart, the second involving the largest stone I’ve ever had (7mm), got wedged in the ureter, and had to be dislodged and then fragmented for passing. That soda could potentially be my biggest contributor, but it doesn’t fit the classic “dark cola” description – actually is more like the clear colas – except for the sugar substitute. I don’t have any other issues typically associate with excess sugar intake – BMI is reasonable (26.2), no triglyceride problems, no diabetes, etc.

    Your thoughts and comments would be greatly appreciated.

    Thanks.
    Brad

    Reply
    • Fredric Coe, MD

      Hi Brad, I am not an expert on Mountain Dew but the fructose, like sucrose and glucose can cause marked spikes of high urine calcium in those stone formers with a tendency to high urine calcium because of genetics – so called idiopathic hypercalciuria. The site is a work in progress and hypercalciuria has not yet made much of an appearance but when it does the sugar effect will be highlighted. So, I think the drink may indeed be a problem. Fructose is not a sugar substitute, it is a sugar, and acts like one. Thanks for the great story and question. Fred Coe

      Reply
  24. Tom

    You mentioned sports drinks with sugar. What is you take on low calorie like G2 (40 calories) and Power Aid Zero (0 calories).

    I love the information on this site. There are so many sites out there with contradicting information.

    Reply
    • Fredric Coe, MD

      Hi Tom, It is this way. The closer a drink is to water, the better, but who can live that way? Sugar is bad for stone formers because sugar loads raise urine calcium. I have not written about that yet because the site is being built and the part about calcium is not ready. But just between us this important fact is coming one of these days. So lack of sugar is good. Sodium loads also raise urine calcium and that is not good. So check the label for sodium – bad numbers would be above 100 – 200 mg for a bottle, a good daily amount of sodium is 1500 to 2000 mg daily (I have not done much with sodium, yet, either: Coming). Fred Coe

      Reply
  25. Fredric Coe, MD

    Thanks for the research and this comment. Malate and citrate are similar in being metabolized to bicarbonate and therefore both provide an alkali load. Later this site will host materials about the importance of high calcium intakes in stone formers, and this kind of beverage will be of considerable value – if it remains on the shelves.

    Reply
  26. Kim gallagher

    Thank you. I appreciate all the info you share. It has been very helpful.

    Reply
  27. Laura

    Love Crystal light pink lemonade! Great post!!! Thanks

    Reply
    • Jill

      Hi Laura,

      Thank you for taking the time out to reply and to share your thoughts. Others will benefit from it!

      Be Well,

      Jill

      Reply
  28. Jill

    Hi Kim –

    Good to see you back on the site!

    Green tea is said to have “inhibitory effects” on kidney stone formation (http://www.ncbi.nlm.nih.gov/pubmed/16724910).

    I would recommend incorporating a cup or two of green tea into your beverage menu. It is also known to have many other health benefits that could benefit you (http://www.nlm.nih.gov/medlineplus/druginfo/natural/960.html.).

    Glad you found the post helpful.

    Cheers,

    Jill

    Reply
  29. Kim gallagher

    Is there a difference between green tea and regular tea? Is one a better choice than the other? Thank you for more great info!

    Reply

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