My Question

Tell me what you want next on this site; that is my question.

I have been writing this site – with the able help of my co-authors – since July 2014, and have reached what I might call a kind of plateau. Much of what I came to say about the most common kinds of kidney stone patients is said. Because the main work is done for the moment I have come with my question to you.

The readership of the site has grown from 50 people in the first month to a present running average of 55,000 – 65,000 people monthly, depending on the season, and many of the visitors read quite a bit each. People find the site valuable, and I am happy for that.

But, what next? I can guess, I can plan, and I can write.

I can also ask.

You might question why I chose Wedding Dance Outdoors by Pieter Bruegel the Elder. The picture is wonderful, so my reasons may not matter all that much.

Up Till 2017

Because I set out to create a definitive site, not a mere collection of opinions, I built a three layer cake.

Primary articles rest on peer reviewed literature and have links in them – some say too many, some say not enough – to scientific papers on PubMed. Secondary articles elaborate on and explain the primary ones in less technical detail. They link back to the primary articles rather than to PubMed. Public articles are for patients and their families. They show how science gives us useful ways to prevent stones. They have fewer links, and those are mainly to secondary articles.

Since 2017 to now – July 2018

Since I first wrote this article I created the Kidney Stone guide Book, and new topic listings for the whole site. Some of what people asked for I have done. Here is the table of all of it. Done means just that. Part means I know I need some components. Some means I have examples and can add more.

Going Forward

As I did in 2016, I am asking again for your suggestions. Please leave them as comments. Since I have added a lot this past year, perhaps your topic is already here. If so it will be a link or at least an entry in the table.

169 Responses to “A QUESTION TO MY READERS”

  1. Sarah

    Dear Dr Coe,

    In your opinion, does the ketogenic diet increase the risk of kidney stones forming? I say forming, rather than breaking off and becoming symptomatic? thank you for your website.

  2. Sarah

    Dear Dr Coe,
    I came to your site to research kidney stones and was very impressed, and grateful. You know so very very much and wondered if you wouldn’t mind answering my “odd” question please, if it is at all within your interest. Feel free to answer it via my email rather than on your site, if you prefer, as it is off topic. And, of course you can tell me, you are totally disinterested in my question, and I’d fully respect that too!

    My question is: do you know what form magnesium is excreted in the urine? Does it form complexes/molecules with citrate, sulphate, phosphate, bicarbonate, etc…
    I’ve read that magnesium is lost in the urine at times of stress…and wondered in what form the Mg leaves. Do you know, or know where I can find such information?

    PS. I’ve also heard that Mg binds with oxalates, and is anti-inflammatory. Apart from any concerns re. GI irritation, would perhaps Mg citrate be better than K-citrate given so many people are Mg deficient, anyway and need supplements? Sorry if it is a dumb question, too.

    • Fredric L Coe, MD

      Hi Sarah, Urine Mg forms complexes with oxalate, phosphate, sulfate, citrate – all the anions. As for renal Mg handling I do not know about stress per se, the reabsorption is regulated mainly in the thick ascending limb and distal convoluted tubule. As for magnesium citrate it has laxative properties, so may not be absorbed well and could cause GI fluid losses. Mg supplements are usually as the oxide. Regards, Fred

  3. jennifer

    how much of a oxalate restriction is required in someone on a vegan diet and hx of Uric and Oxalate stones? Would supplementation with calcium or plant based milks with added calcium be helpful to add to meals with higher Ox content?

  4. Les Madore

    I am a Physician Assistant in Urology.
    I have a 55 y/o M, obese but no other medical issues , granted he doesn’t go see physicians regularly.
    We are treating him for bladder outlet obstruction (BOO), uric acid stones.
    We are working on his obstruction. His urine pH is 5 despite taking Potassium Citrate 45 mEq TID.
    Two questions
    1. Am I missing a metabolic issue?
    2. what else can I do to increase his urine pH?

    • Fredric L Coe, MD

      Hi Les, Given 45 mEq of K Citrate 3 times a day = 135 mEq of alkali – the urine pH at 5 is impressive. I wonder if he takes it or absorbs. Is his urine K appropriate – should be well over 130 mEq/d; is his urine ammonia suppressed – should be < 10% of his urine sulfate. Is his citrate perhaps remarkably high >2000 mg/d? Somewhere in all this is the reason. Let me know. Fred

  5. maggie

    Newly diagnosed with 8mm in kidney, not sure what kind (how do I find this out) and so my main question is can I dissolve the stone with supplements like:
    biotics Super Phosphoric liquid
    and Stone Free by Planetary Herbals
    or any other means???
    I saw what my husband went through a couple weeks ago and am mortified.

  6. Nick Krawczyk

    Given the Covid-19 pandemic, I’ve been trying to enhance my immune system. However, I wanted to better understand what (if any) issues may develop with certain supplements. In particular, what are your thoughts on VitD, VitC, Zinc, turmeric, and curcumin.

    • jharris

      Hi Nick,
      Many of those supplements can increase your oxalate levels. Eating well, hydrating, sleeping well, and managing your stress, will all benefit your immune system. You need to check blood to see if you need Vitamin D, C in doses of 2,000 mg/day converts to oxalate, and turmeric is high in oxalate.
      Best, Jill

  7. Nick Krawczyk

    Given the Covid-19 pandemic, I’ve been trying to build up my immune system. However, I wanted to better understand if any supplements promote stone formation and growth. In particular, what are your thoughts on VitD, VitC, Zinc, turmeric, and curcumin intake? Thanks.

    • Fredric L Coe

      Hi Nick, Vitamin D at doses up to 2000 u/d are not in general a concern for health. Vitamin C above the daily minimum required does pose risk of stones – two studies. About zinc, and the two spices I have no knowledge. Regards, Fred Coe

  8. Louise D

    What are your thoughts on the influence of oxalobacter formigenes on stone formation? O. Formigenes is sensitive to multiple antibiotics so, is it possible that the effect of antibiotics on gut bacteria plays a role in the development of kidney stones?

    • Fredric L Coe

      Hi Louise, It has been tried and alas dies unless you eat extra oxalate for it. So it is not a usable stone treatment. Regards, Fred Coe

  9. Kathryn Brooks

    What causes a stone to leave the kidney and try to make an exit? I’m a 65 year-old woman. I presently have a 7mm stone in my ureter, with a stent in place. Stone and stent will be removed in two weeks. My urologist said there are more stones in my kidneys. How do I encourage them to stay in place? Thanks.

    • Fredric L Coe

      Hi Kathryn, Stones in your kidneys will do as they choose. Your surgeon can remove them, but the benefit depends on how many and how much surgery is required. In general stones need not be removed unless they are causing obstruction, pain, serious bleeding, or infection. Of import is what kind of stone, in an older person they may be uric acid, and therefore can be dissolved and absolutely prevented. If calcium, you need to find out what causes them – here is a good starting place. Regards, Fred Coe

  10. Marilyn

    Dr. Coe,

    What are your thoughts on probiotics and fiber impacting oxalate absorption? Do you know of any studies?



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