Science and Politics of the US Diet Guidelines

Because they are so important for kidney stone prevention, the Guidelines have been featured here for quite a while. This tells about where they came from, the people, the politics, the science, and the scandals that shaped them. I have naturally emphasized the science, and it is a worthwhile matter to read about it. Entertaining, too, because against science is the marketplace that has its own sense of legitimacy and purpose: Against science not by malign intent but by the nature of businesses to promote their own interests. Thence the politics. My tale is a winding tale, of conflict and personalities, one with what I would call a happy ending. But perhaps not all happy because some blame the guidelines for the massive rise in US obesity.

Our Diet Promotes Stones and Bone Disease

As though seeking a perfection of ill choice the US population has evolved an eating pattern that is deficient in calcium and potassium, and excessive in sodium, and refined additive sugar which taken together are ideal for inducing stones and bone mineral loss in vulnerable people. As well, this combination helps produce obesity, diabetes, and hypertension. What we do now is essentially the converse of the diet we need, and of the diet the US recommends we all eat for better health. How we got this way is beyond my expertise, but that we need to change is not. Stone prevention without diet change is cumbersome and variable at best, and often impossible. As I went through the figures in this paper I could not help but pause in wonderment at the rancid unhealthy diet they depict. We are so rich a country, so well served with technology and with the public health benefits of clean water and improving air, how can this be what we eat, and what we feed our children? We must throw over this miserable

The Science of the Kidney Stone Diet

Gathered here are primary data supporting each component of an ideal kidney stone prevention diet. All the data are lifted from more elaborate and detailed articles on this site. For good reasons, I have made much of the convergence between the the ideal diet for kidney stone prevention the science I show here so fully supports and the US 2015 – 2020 diet recommendations. The US recommended diet provides almost everything we would want compared to what we eat now: More calcium, less sodium and refined sugar and protein, and more potassium as an organic anion salt. The only lack is special attention to diet oxalate below 200 and perhaps 100 mg/d and timing of high calcium foods with foods that have significant amounts of oxalate. The US guidelines offer our patients not only the component properties scientifically justified for stone prevention, but gathers these components into an intact overall diet program that many authorities have vetted. I see no reason we should not all simply endorse the US diet to our patients and their families, and leave to ourselves only the small details of oxalate management within that larger diet construction.




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 Science of the Kidney Stone Diet Evidence for the kidney stone diet
The Kidney Stone Diet Best diet for stone prevention
How to Eat the Kidney Stone Diet Special aspects of the kidney stone diet
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?
How Much Fluid 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
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
Take Charge of Stone Prevention A summary with emphasis on diet management
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
Medullary Sponge Kidney Case 4: A patient with MSK, shows OR and tissues



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