Ever had a Kidney Stone Risk Panel? Is mine as bad as I think?

[southernlady]

Because there is far more potassium citrate in Crystal Light than in real lemon juice @southernlady as explained in the University of Chicago links.

Okay, makes sense.

However I'm seemingly not at risk for the blasted stones so I will continue to make my own.

 

[Clematis]

This thread isn't about me, Mark, but I thought I'd share what the nephrologist told me about an hour ago after calling with the results of my 24 hr stone panel from last week. Maybe some info may be of benefit to you. Maybe not.

All my values went up since the last 24 hr panel. My oxalates are now high (41, max range is 31 at this lab) and I need to go on a not-fun low oxalate diet -- essentially animal products are ok, or I can obsess (my term, not hers) and weigh and measure all other foods to keep oxalates under 50 a day. (Under 50 isn't easy. Spinach, nuts, beans, potatoes and a few other things are so super high that they're off the table... and supposedly chocolate but I have to draw the line, especially when the only protein drink I can swallow is chocolate flavored.)

Should you choose to try a low oxalate diet, read this on why oxalate content values are a crap shoot: https://drive.google.com/file/d/0B2UreNSwAenfa1lGc0c2VWhPNTA/view

And this for oxalate content of foods in various categories:
https://docs.google.com/spreadsheet...60w6eGr4dMSIeDiQdqg3MaRgQ/edit#gid=1354389148

You'd think there'd be an app for adding up oxalates like My Fitness Pal but the few apps that there are suck AND haven't been updated in years so may not even work on new IOS.

I also need to reduce sodium (another stone former) which rules out Unjury chicken protein soup, too. Sugar is another trigger. Keep your eye on those two things, too.

Oh and I'm supposed to excrete at least 2000 ml (about 68 oz) of urine a day which she says means I should drink 2.5 liters (about 85 oz) of fluid a day... but I already drink 90+ ounces a day according to my Waterlogged iPhone app but only excrete 1100 ml (37 oz). This must mean I sweat too much in aerobics class?, and need to drink more than 4 liters a day? Geez. I'm drowning at the thought, but still more tolerable than the low-oxalate diet. I know you say you already drink buckets of fluids.

When you finally get to a urologist, I hope s/he determines that you are fine and stone free.

 

[Marquis Mark]

This thread isn't about me, Mark, but I thought I'd share what the nephrologist told me about an hour ago after calling with the results of my 24 hr stone panel from last week. Maybe some info may be of benefit to you. Maybe not.

All my values went up since the last 24 hr panel. My oxalates are now high (41, max range is 31 at this lab) and I need to go on a not-fun low oxalate diet -- essentially animal products are ok, or I can obsess (my term, not hers) and weigh and measure all other foods to keep oxalates under 50 a day. (Under 50 isn't easy. Spinach, nuts, beans, potatoes and a few other things are so super high that they're off the table... and supposedly chocolate but I have to draw the line, especially when the only protein drink I can swallow is chocolate flavored.)

Should you choose to try a low oxalate diet, read this on why oxalate content values are a crap shoot: https://drive.google.com/file/d/0B2UreNSwAenfa1lGc0c2VWhPNTA/view

And this for oxalate content of foods in various categories:
https://docs.google.com/spreadsheet...60w6eGr4dMSIeDiQdqg3MaRgQ/edit#gid=1354389148

You'd think there'd be an app for adding up oxalates like My Fitness Pal but the few apps that there are suck AND haven't been updated in years so may not even work on new IOS.

I also need to reduce sodium (another stone former) which rules out Unjury chicken protein soup, too. Sugar is another trigger. Keep your eye on those two things, too.

Oh and I'm supposed to excrete at least 2000 ml (about 68 oz) of urine a day which she says means I should drink 2.5 liters (about 85 oz) of fluid a day... but I already drink 90+ ounces a day according to my Waterlogged iPhone app but only excrete 1100 ml (37 oz). This must mean I sweat too much in aerobics class?, and need to drink more than 4 liters a day? Geez. I'm drowning at the thought, but still more tolerable than the low-oxalate diet. I know you say you already drink buckets of fluids.

When you finally get to a urologist, I hope s/he determines that you are fine and stone free.

Thank you so much for all of your info and concern. I really just hope I'm one of those special guys who doesn't form stones, or forms ones that are so small they pass without my noticing. A little over a a year ago I had a CT scan on an unrelated matter and they didn't report any stones then. That was before my DS.

I'm wondering what is the shelf-life of the 24 hour urine test. Is it only an indication of the oxalate heavy foods you've eaten recently, or is it more of a cummulative effect? For example, what would happen if you ate a low oxalate diet for quite a while, but then ate an entire can of almonds and three pounds of spinach right before your test?

 

[Clematis]

I don;t know the answer to that so Googled. I didn't find the answer (but I suspect what you eat in 24 hours is reflected in results, not what you ate last week, b/c taking calcium at the same time as oxalate foods can reduce oxalate excretion) however THANKS -- my research for you is uncovering things I missed in my original research, like stone formers should not eat gelatin either in jello or in cheap protein drinks (whey protein is ok). I have some of these gelatin protein drinks because they taste better and don;t clump like whey -- but I'm tossing them out. It's an incomplete protein anyway.

Most important for you in everything I am reading is that stone formers are not like normal people. They can eat the same foods, excrete the same oxalates and never form a stone. You may be normal. Ergo, your high numbers may mean absolutely nothing. Don't worry about something that may never happen.

But read on if you want to obsess, or for others reading this who do form stones...

According to this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518810/ dietary oxalate is not necessarily a determinant of stone production. It may be that stone formers simply do not process oxalate in the same manner as non-stone formers and/or excel at producing oxalate from other substances. (Similar to dietary cholesterol having little bearing on the cholesterol levels of people with "familial" high cholesterol.) Other stone formers are very sensitive to dietary oxalate as shown in their urine oxalate output. [But there's not much definitive on how dietary oxalate relates to the quantity and size of stones produced as it is too individual.]

I found it interesting to learn that vitamin C can increase oxalate excretion, especially in amounts of 2000 mg a day as is the Vitalady protocol ... and my rapid stone forming occurred after taking 2k vit c post DS. I'm dropping back to 1000 mg immediately.

I saw this from the mayo clinic http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8669
"Increased urinary oxalate excretion results from inherited enzyme deficiencies (primary hyperoxaluria), gastrointestinal disorders associated with fat malabsorption (secondary hyperoxaluria), or increased oral intake of oxalate-rich foods or vitamin C."

I had a couple of stones 35 years ago when I was very young and thin (after months of a poverty-induced not-for-weight-loss diet of spaghetti with butter and Kraft parmesan) and then one 2 years ago (after a 7 month strict no-veggie Atkins diet with ZERO oxalates) -- before the fat malabsorption of the DS. Personally, I think my stone formation is more complex than oxalates in/oxalates out and may have much to do with insufficient fluids. The #1 thing docs tell patients to prevent stones is to drink more fluids -- you already drink an ocean, Mark.

 

[Clematis]

Additional information regarding how DS can cause stones:

After oxalate is formed, it normally combines with calcium to be excreted in the stool. When large amounts of unabsorbed fat are available (e.g. from fat malabsorption), calcium preferentially binds to fat instead of oxalate. (Why we need more calcium supplementation than general population.) This leaves oxalate available to be easily reabsorbed by the colon and ends up in the urinary tract. In conditions where fat malabsorption is present, oxalate in the urine is elevated.

 

[bearmom]

I'm curious what specifically is off in your stone formers panel (the names can vary a little based on who orders/processes them). What is often seen is that as high risk is high oxalate, and low citrate, which is sounds like what you are trying to address.

If citrate is really low, as your dr about Urocit-K. It's a potent potassium citrate that certainly helps with my calcium / oxalate stones. I think someone else already mentioned to take the calcium WITH food, and why.

The other interesting thing my endo talked to me about, is that after years of telling people like me to eat low oxalate, there is no evidence that that makes any difference, so she told me to quit abstaining from tea and kale, because they KNOW they have health benefits, but cant verify that abstaining from then helps prevent stones.

 

[Marquis Mark]

Follow up:

Had a brief phone consult with urologist today.

He said a few interesting things:

He said since my urine output was three liters, my uric acid is actually OK because the amounts are not adjusted for urine amount, but are based on two liters flat.

So my citrate is "very, very low" and my ph indicates acidic urine. I don't know what that means or the ramifications. If someone can explain that to me, please chime in.

Also, if I take my calcium with food, does that decrease the other benefits of taking calcium (i.e lowering PTH)? Why do some people take calcium without food? What is the advantage?

He ordered an x-ray.

On the positive front, he said that oxalate tests really only indicate what you ate recently. When I had the test I was eating a lot of nuts. Since then I have been avoiding oxalate heavy foods. Hopefully, that will make some difference.

 

[DSRIGGS]

Follow up:

Had a brief phone consult with urologist today.

He said a few interesting things:

He said since my urine output was three liters, my uric acid is actually OK because the amounts are not adjusted for urine amount, but are based on two liters flat.

So my citrate is "very, very low" and my ph indicates acidic urine. I don't know what that means or the ramifications. If someone can explain that to me, please chime in.

Also, if I take my calcium with food, does that decrease the other benefits of taking calcium (i.e lowering PTH)? Why do some people take calcium without food? What is the advantage?

He ordered an x-ray.

On the positive front, he said that oxalate tests really only indicate what you ate recently. When I had the test I was eating a lot of nuts. Since then I have been avoiding oxalate heavy foods. Hopefully, that will make some difference.

Dr K recommends taking half of your calcium with food so the excess goes out with your feces and not through your kidneys for excretion through urine.. The more you have in your urine the more chances of it forming a stone. That is how I understand it.

 

[Clematis]

Calcium: calcium citrate as in Citrical can be taken at any time but the cheaper calcium carbonate (what's in Caltrate and Tums) needs to be taken with food.

According to Harvard Health:

The calcium in most supplements is either in the form of calcium carbonate or calcium citrate. Research shows that they are absorbed equally well with meals, but calcium carbonate is harder to digest than calcium citrate. People are usually advised to take calcium carbonate with or soon after a meal. Calcium citrate can be taken at any time.

But specifically regarding stone formation...

Much of what is written on the University of Chicago Urology website is by the urologist Frederick Coe MD who is my new stoner hero. I'm always clicking on a link on the pages and BOOM learn something new. For example my calcium output in 24 hr urine is 261 with a normal range of 100-300 so I'm OK, right? Dr. Coe says NO because his data shows amounts above 200 are signs of idiopathic hypercalciuria http://kidneystones.uchicago.edu/idiopathic-hypercalciuria-ih-general-facts/

Dr Coe shows data that stone formers are also at risk of bone disease. When stone formers ingest sugar without calcium, calcium leached from bones shows up in urine. And the research is on data collected over just 2 hours, so this loss is damn near immediate. So calcium with carb ingestion is important for stone formers. (Of course this tells me I should eat ice cream instead of a candy bar. haha)

But again, Mark, as of now you are not a stone former.

 

[Marquis Mark]

Calcium: calcium citrate as in Citrical can be taken at any time but the cheaper calcium carbonate (what's in Caltrate and Tums) needs to be taken with food.

According to Harvard Health:

The calcium in most supplements is either in the form of calcium carbonate or calcium citrate. Research shows that they are absorbed equally well with meals, but calcium carbonate is harder to digest than calcium citrate. People are usually advised to take calcium carbonate with or soon after a meal. Calcium citrate can be taken at any time.

But specifically regarding stone formation...

Much of what is written on the University of Chicago Urology website is by the urologist Frederick Coe MD who is my new stoner hero. I'm always clicking on a link on the pages and BOOM learn something new. For example my calcium output in 24 hr urine is 261 with a normal range of 100-300 so I'm OK, right? Dr. Coe says NO because his data shows amounts above 200 are signs of idiopathic hypercalciuria http://kidneystones.uchicago.edu/idiopathic-hypercalciuria-ih-general-facts/

Dr Coe shows data that stone formers are also at risk of bone disease. When stone formers ingest sugar without calcium, calcium leached from bones shows up in urine. And the research is on data collected over just 2 hours, so this loss is damn near immediate. So calcium with carb ingestion is important for stone formers. (Of course this tells me I should eat ice cream instead of a candy bar. haha)

But again, Mark, as of now you are not a stone former.

Not yet a stone former, but a former stoner in college...

When I was taking 3,000/day of calcium my 24 urine was 427. Now that I dropped it to 1,500 it's 212. So I guess I was peeing a lot of it out? I sure like taking less because of constipation, but not sure yet what effect taking less will have on my PTH. I'm waiting for the Vitamin D shot to kick in, hopefully that will lower my PTH without the need to take more calcium?

I take 1,200 calcium citrate and about 300 Jarrow. I don't take any carbonate. So, you're saying I can take all of that with or without food (inc sugar) and it will still bind to the oxalates and serve it's bone preserving purposes as well?

 

[Clematis]

No. I'm saying that food isn't necessary to absorb calcium CITRATE. "Normal" people who don;t have to worry about oxalate binding or funky DS bowels can take calcium citrate whenever they please and have the calcium absorbed. To prevent stones, one still needs to take calcium WITH oxalates, with carbs/sugar so it can bid with these "bad" things.

 

[Marquis Mark]

No. I'm saying that food isn't necessary to absorb calcium CITRATE. "Normal" people who don;t have to worry about oxalate binding or funky DS bowels can take calcium citrate whenever they please and have the calcium absorbed. To prevent stones, one still needs to take calcium WITH oxalates, with carbs/sugar so it can bid with these "bad" things.

Got it. Glad I asked for clarification.

So why do some people say take half your calcium with food and half without?

 

[Clematis]

I dunno. They like to ride the fence?

I'd never heard this before Scott posted Dr. K's recommendation above. Perhaps the thought is that calcium is binding with oxalates so we aren't absorbing them or calcium is binding with our unabsorbed fat (more likely scenario as calcium prefers to bind with fat over oxalates), and so in a "clean" bowel, calcium will just be absorbed unfettered. Considering I eat every 1-2 hours, I doubt my bowels are ever pristine so I don't think it much matters when I take calcium. Never the less, I do try to remember to swallow a calcium tab when I know I'm eating a chunk of oxalates.

BTW I have been using the app Oxalator a little bit. It only provides High/red, Medium/yellow, Low/green rankings not actual oxalate counts, but most of the lists physicians have given me only do high, medium and low too. The idea is to never eat anything off the high list and try not to eat anything off the medium list. It's kinda hard to use the app as it's search terms are either vague or specific. For example Rice Chex returns no results; Cereal, Rice Chex returns no results; Cereal, Chex, Rice with all the commas is the winner. Cereal alone will produce a list you can scan through, so go for the generic term alone if you can't find what you're looking for. But the app comes in handy when you're standing in the produce department and can't remember whether cucumbers or zucchini have higher oxalates. Both are low, however cucumber is medium unless its skin is removed. Yet another reason why there is incredible discrepancy among lists. Some lists "forget" that often vegetable skin (where much oxalate may reside) has to be removed. Other lists measure with the skin on and then dismiss the entire vegetable as too high. The variation between different health organizations oxalate lists is astonishing -- one list will have something as high, another says its low. Just to let you know how crazy it is, the Dayton CHildren's Hospital's list even contradicts itself: the first page of their list has "Apple (raw) .5 (100g)" which puts it on the safe "ultra low" list, but on the very next page it has "Apple, raw with skin, 1 medium, 41" which places it in the "VERY HIGH" list!! Oxalate content varies by the vegetable's or fruit's variety (Braeburn and McIntosh have higher oxalates than other apples, at least on one chart) as well as when a vegetable is harvested, affected not only by ripeness but by soil conditions during spring, summer or fall. So what does the poor stoner do? I think just pick a reputable source, like U of Chicago (which formulated their list by aggregating the reputable sources of Harvard etc) and try not to obsess about it.

 

[Clematis]

For you and anyone reading this thread in the future, everything you could ever want to know about kidney stones and their management is here:

http://kidneystones.uchicago.edu/kidney-stone-book/

 

[Marquis Mark]

Well, guess what? Just got my Xray back -- no stones! Given my numbers is that a miracle or what?!