FLUIDS

How much and what? We have already written a lot about this, but everyone has specific questions. This is the place to ask them.

24 Responses to “FLUIDS”

  1. Sharla

    Does apple cider vinegar help prevent or dissolve stones? I don’t know what kind of stones I may have, but I read that ACV alkalizes the urine and is helpful with calcium oxalate stones as well as uric acid stones. I’m wondering if I should add a few teaspoons to my water.

    Reply
    • jharris

      Dear Sharla,

      I know that ACV is all the rage right now from everything to stones to toe nail fungus. I wouldn’t waste my money on it. You know what does help? Do a 24 hour urine collection and find out what is causing them.
      Best,
      Jill

      Reply
    • Fredric Coe, MD

      Hi Sharla, You do not know what kinds of stones you form, and I gather that you have not as yet had the benefit of a full evaluation. Anything you try to do for prevention will be random, and at best – very best – simply without effect. At worst you could just raise risk. Take a look at this article about confusion, and how to make a better approach for yourself. Regards, Fred Coe

      Reply
  2. Paula Burr

    My issue is idiopathic hypercalciuria. I am currently following the diet recommended on this website and drinking 2+ liters of water a day. However, our well water is filtered through a reverse osmosis system that removes all buffering minerals and results in very acidic water (pH 4.5). Can large volumes of this water be problematic? Should I be adding small amounts of potassium citrate powder to make it more alkaline?

    Reply
    • Fredric Coe, MD

      Hi Paula, The water has a low pH but almost no buffering capacity so it is aright. Remember, the low sodium is paramount for IH! Likewise, get 24 hour urines to monitor progress. Regards, Fred Coe

      Reply
  3. Ha

    I have read the literature from the UW Hospital Metabolic Stone Clinic and have found it to be extremely helpful, Dr. Coe’s responses to the questions raised, especially so.
    Since Dr. Coe strongly recommends the product Crystal Light, I ordered a large quantity from Amazon.
    The CL mixing instructions are for lemonade, but “lemonade” is not defined in terms lemon juice, that is, the equivalent concentration of lemon juice in water.
    To my question: the clinic recommends either 4 oz per day of lemon juice in 12 oz water (for a total of 1`6 oz), or 32 oz of prepared lemonade. CL advises dissolving one of their packets in 64 oz of water to make “lemonade.” Will 16 oz of prepared CL be equivalent in lemon juice concentration to the concentration recommended by the clinic or is it only half?

    Another question: It is mentioned in the publication* that “Of the commercially-available lemonade products, those that are ready-to-consume have more citric acid than those [such as Crystal Light?] that come as a powder.” Is there a more quantitative statement available?

    *Produced by Kristina Penniston

    Reply
  4. Laura

    Vitamin Water Zero has calcium phosphate and calcium lactate. Is there any correlation with this fluid and the creation of CaP stones?

    Reply
    • Fredric Coe, MD

      Hi Laura, I read a bit on the web and do not find the filter is known to add calcium and certainly will not add lactate. But many people have had problems with the cost etc. Regards, Fred Coe

      Reply
  5. Jen Friday

    I have been increasing my water intake as suggested for prevention, however I am concerned about my well water. It has a high mineral content. Could this be a contributor to my forming.

    Reply
    • Fredric Coe, MD

      Hi Jen, Possibly it could if extreme. The mineral would be calcium, so is your urine calcium high? If so, perhaps you might do a month of bottled water and recheck. This seems easier than elaborate water testing. I would bet it is not the well, however. Regards, Fred Coe

      Reply
  6. John Kloepper

    What is the medical “thought” on Chanca-Peidra” as a means of addressing kidney stones? I’ve read alot about it’s positive effects, but since it’s an herbal option there isn’t any clear discussion on how much and how often to take. Any thoughts there too?

    Reply
    • Fredric Coe, MD

      Hi John, I cannot find even one entry for this material on PubMed which is the central repository for all published work in medicine and biology. Regards, Fred Coe

      Reply
      • John Kloepper

        Dr Coe,
        The fact that you didn’t find anything nor have you heard of chanca-piedra doesn’t give me much confidence. However in the interest of peeking your curiosity here’s a brief yet informative link. There are others but that up to you to investigate. Seems to garner a lot of attention overseas, but not much here.
        http://www.globalhealingcenter.com/natural-health/benefits-of-chanca-piedra/

        Reply
        • Fredric Coe, MD

          Hi John, I know there is information and I was remiss in not mentioning that fact. Here is my issue. I am a physician scientist and a professor at a rather rigorous university, and my basis for doing things medically is formal science, by which I mean experiments carried out in what I might call the ‘scientific manner’. This site, although personal to me for the most part, carries the UC logo and because of that, and because of me, too, advocates for science as a basis for action in regard to medicine. I understand that professional science has its limitations, and grow as impatient as anyone else with certain aspects of that slowness in this country, but even so PubMed articles are my bible and roadmap. Every paper published in any peer reviewed journal makes its way into PubMed, and I make my way into it, too. While there, I could not find anything. If anything turns up I will be happy to read it and comment. Since the site is free and open to the world – as this one is – take a look yourself, and if you find something – I am not the most perfect scholar – I am pleased to try and be helpful. Warmest regards, Fred

          Reply
          • Heather

            Hi Dr. Coe, Chanca Piedra is also called Phyllanthus niruri, and does indeed appear in PubMed under that name — between 8-12 articles related to kidney stones, depending on the precise search phrase I used. Here’s one specific link: https://www.ncbi.nlm.nih.gov/pubmed/16890682. I’d love to hear your comments on the research that’s been done. Thanks!

            Reply
            • Fredric Coe, MD

              Hi Heather, I have read articles on this material, and If I did not say so in some prior comment I am sorry. This trial is more or less similar to those others I have read. In what appears to have been a non blinded and perhaps non randomized trial of stone free rates after shock wave lithotripsy there were no significant differences between those who used the material and those that did not except in the lower poles, and the effect was small. Here are the results:

              ‘Stone-free rate (stone-free defined as the absence of any stone or residual fragments less than 3 mm) was 93.5% in group 1 and 83.3% in group 2 (p = 0.48) at the end point of the followup (180 days). For lower caliceal stones (56 patients) the stone-free rate was 93.7% in the treatment group and 70.8% in the control group (p = 0.01). Re-treatment need for group 1 was 39.7% and for group 2 it was 43.3% (p = 0.2). No side effects were recorded with extracorporeal shock wave lithotripsy or P. niruri therapy’.

              They tested stone free rates – insignificant; they tested stone free rate only in the lower poles – significant; they tested retreatment rate, no significance. When you do this kind of multiple testing it is called fishing for a p value; the chances of getting a significant one increases with the number of tests. I suspect they found nothing and then saw that the lower poles were better with than without the drug. Perhaps the drug helps, perhaps not, but this is a very weak kind of trial. If the agent is safe and cheap why not use it? But I have little confidence so far. Regards, Fred Coe

              Reply
  7. Michele Lewris

    Dear Stephanie, How much lemon juice per day? I’m currently squeezing half a lemon in 16 oz of water three times a day. Also, can I use concentrated lemon juice or is fresh squeezed better? I’ve tried True Lemon, which is crystalized lemon but they say it doesn’t contain potassium citrate but does contain citric acid.

    Reply
  8. Ellen Key

    Water is not my problem. I take Potassium Citrate regularly (10mg 4 times a day) to prevent kidney stones. My stones are of Uric Acid> Is there an over the counter product or supplement that I can buy to take and cut the cost of my prescrition drug?

    Reply
    • Fredric Coe, MD

      Hi Ellen, Your stones form because of an excessively acid urine pH. Potassium citrate is ideal and will absolutely prevent stones. There is no OTC equivalent. Sodium bicarbonate would work but impose a large sodium load. A number of less expensive workarounds have been mentioned because of high cost. Crystal light lemonade will substitute – one liter is two of the pills you take. But be careful: Uric acid stones can grow rapidly and lead to surgery yet your present meds are a virtually perfect cure. Regards, Fred Coe

      Reply
  9. Stephanie

    This post is not so much a question as it is a recommendation for a product that has dramatically helped me in my quest to drink more water. First off I should say that I am in no way linked to the company that makes this product. What follows is simply my humble opinion as someone with kidney stones that has struggled to maintain high fluid intake. The link below is for the Thermos water bottle with smart lid. This product connects to a mobile app and tracks all water that is consumed from it. It was easy to set up my personalized daily goal of 4 liters and the bottle sends me mobile alerts if I get off pace to reach my goal for the day. Custom reminders can be set for times when I know I struggle to remember to stop and hydrate. I also like being able to see my progress over a day, week, and month. It has really helped me to identify the parts of my day that I need to make a greater effort to get my water in. I find this product to be so helpful and motivating that it was well worth the money spent. If others are struggling to find a useful method to track and propel their water intake I highly recommend this product!

    Thermos 24 Ounce Hydration Bottle with Connected Smart Lid, Teal https://www.amazon.com/dp/B00ZQUNHO0/ref=cm_sw_r_cp_awd_ibCKwbCS7AKFR

    Reply
    • jharris

      Dear Stephanie,

      What I love about this site is that it provides a space for all of us to suggest ideas, products, and revelations that have helped in the aid of kidney stone prevention. I am grateful that you wrote and suggested the above item. It IS very helpful and motivating to track progress when trying to get in all the required water one needs to prevent new stones.

      Thanks for the suggestion, I will be sending it off to my patients.

      Warmly,

      Jill

      Reply
    • Meekah

      Hi Stephanie,

      Thank you for the recommendation, I’m going to order this! I’m currently using an app on my phone called Plant Nanny that sends me reminders to water my plant (by drinking water) throughout the day! I really like it and think it will work well with my new ‘smart’ water bottle!

      -Meekah

      Reply

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