Introduction

all right welcome to plant-based Kidney Health

everyone Michelle crossmer renal dietitian here
and I have a very special
guest on today Melanie Betts Melanie is a fellow
registered dietitian she is
board certified in both renal nutrition geriatric
nutrition and she specializes
in kidney stones and prevention of kidney stones
with food and nutrition so thank you so much
Melanie for coming on
um and do you want to share a little bit about
yourself both professionally and personally before
we get started sure absolutely I am so excited to
be here
um thank you so much for having me Michelle um
so like you said I'm a registered dietitian I
specialize in kidney stone
prevention um I spent the last six years of my life
or so at the University of Chicago where
I kind of fell in love with getting nutrition in general
and specifically kidney stones because there's a
very
well-known Stone Department there and I honestly
just sort of fell into this and I just like I was just
fascinated
there's so much to know I realized how much I
didn't know and have really just kind of ran with it
and so that is when
1:05
I started the kidney dietitian so you can find me at
thekidney dietitian.org
1:11
or I'm on Instagram at the kidney dietitian I have all
sorts of resources
1:16
for people with kidney stones looking to learn what
you can actually do to prevent them because
there's an awful
1:22
lot of misinformation out there as there is with all
areas of nutrition I suppose
1:27
um so yes you can find me there and if you want
to work with me I have a kidney stone course
which is kidney stone
1:33
nutrition school you can go to my website thekitty
dietitian.org and learn a little bit more about that if
you want to work with me more one-on-one to help
1:41
prevent stones awesome and you have some for if
there's
Kidney Stone Dietitian Training
1:46
any other registered dietitians or renal dietitians
that are watching this you have some resources
for them as well yes
1:54
thank you for bringing that up I almost forgot it's it's
a new resource and I'm so excited about it
1:59
um so yes I have uh kidney stone dietitian training
2:04
um which is brand new and I'm so excited to offer
it because there really are no resources for
dietitians
2:11
um for kidney stones and so um yes if you are a
dietitian listening definitely check that out because
I want to all of
2:18
us kind of be on the same page with Don nutrition
because I feel like a lot of us might be saying
different things which isn't is an ideal obviously for
2:25
for a patient so again you can find that at my
website too just the kidney dietitian.org just go to
the shop Tab
2:30
and you'll see all of those different resources
perfect and I'll include that in the notes as well for
this episode so anyone
Types of Kidney Stones
2:37
can find that link there um after they watch it so
just to get started and Dive Right In then Melanie
2:43
can you tell people about the different what are the
different types of kidney stones which ones are
more common which
2:48
ones are least common yeah absolutely so there's
sort of four main types of stones
2:54
um the one we hear about most often is calcium
oxalate which is for good reason it's by far the
most common about 80-ish
3:01
percent of kidney stones are calcium oxalate
there's also calcium phosphate which is maybe
five to tenish percent so
3:08
so pretty common uric acid Stones five to ten
percent I lied there's like five
3:13
five types of uric acid um and then very rare Stone
type there's struvite and
3:18
cysteine Stones um struvite stones are almost
exclusively related to infections so
3:24
sort of recurrent UTIs you see that with um people
who have maybe indwelling catheters um so those
are kind of very
3:31
rare and in a very specific situation um you can
also have cysteine Stones which are also very rare
and those are almost
3:37
exclusively related to a genetic disease called
cystineuria so those we don't really talk about
3:43
um but the three main types of stones that are
most common that definitely all do have nutrition
considerations are
3:50
calcium oxalate calcium phosphate and uric acid
stones okay got it and how does someone know
How to Know What Kind of Kidney Stone You
Have
3:57
what kind of stone they have good question so um
of course really the only way that
4:02
you can know for sure what kind of stone you has
is you have is if when you pass it or if you have
surgery to blast it or
4:10
remove it um then they can they can analyze
those those fragments and see what kind of
4:16
stone it is um I will say a lot of people will say like
oh I'm so confused I don't know what to eat
because
4:23
um my stone was maybe 80 calcium oxalate and
20 calcium phosphate or something which is very
common it's actually rare
4:30
to have a stone that is 100 one type of stone
4:35
um so if you get those results back like know that
that's normal and no need to panic that's what
most people have
4:41
um so yeah so that's the only way to know for sure
what kind of stone you have um if you know that
you have a stone
4:48
maybe they discovered one on a scan or
coincidentally for whatever reason you haven't
passed it
4:53
um but you have stones in your kidneys currently
you obviously can't like go in and check it but that
is one of the many
5:00
reasons why a 24-hour urine test is really helpful
um I would say and and the American
5:05
neurological Association would say that everyone
with the kidney stone essentially should have a 24-
hour urine test because that is really the only way
5:12
to know what caused your stone there's lots of
different causes for stones for the same type
5:18
um so even if you haven't passed a stone and you
haven't had a chance to analyze it or maybe you
passed a stone and couldn't catch it or whatever or
they
5:24
didn't date sometimes even the surgeons don't
send it to the lab to have it tested that 24-hour
urine test will give
5:31
you a pretty good idea as to what type of stone
that you have or what type of stone you're making
and honestly even
5:37
more importantly it'll tell you what's kind of off in
your urine chemistry that is predisposing you to
make stones and
5:44
that is where where the good stuff is where we can
really sort of Target and come up with an effective
prevention
5:50
plan okay awesome so 24 hour urine tests is very
important for people who have had a
Nutrition Recommendations
5:56
kidney stone in the past or currently have kidney
stones to see what's going on with their urine and
individualize
6:02
things okay so before I guess we get into some of
the individual nutrition recommendations based on
certain types
6:10
of stones are there General recommendations
nutrition wise that kind
6:15
of across all forms of kidney stones people can
make in their diet
6:20
yeah honestly the only thing that is consistent
across all Stones is drinking
6:26
a lot of fluid um uh so that that is going to be
important for literally all five types
6:32
of stones that I mentioned earlier um so technically
the goal is to drink enough to create at least two
and a half
6:40
liters of urine per day if we can get it to three liters
that's even better um so for most people that
means
6:46
drinking around three liters of fluid because we
lose some fluid from like talking and sweating and
feces and those
6:52
types of things so for most people we want to aim
for around three liters of
6:58
fluid per day and that does include all types of fluid
like obviously most of it should be water but I
totally understand
7:04
that water gets kind of boring and so um so even
things like coffee milk I'm
7:10
sure we'll talk about calcium later um even fluid in
foods does technically you know eventually will
raise your
7:19
urine calcium or excuse me your urine volume if
you're eating a ton of watermelon or something
like that
7:24
um so yes so technically all fluids do count
towards that three liters okay good good
clarification so water is
Tea vs Coffee
7:31
ideal and is there I think there's a lot of confusion
people will ask a lot well can I have tea or can I
have coffee if I
7:37
have kidney stones so can you address that yeah
of course um so coffee absolutely
7:43
um so both coffee and tea are actually associated
with reduced Stone risk
7:48
um there actually may be a slight benefit of the of
caffeine because of that diuretic effect it might
actually
7:54
uh lower the concentration of your urine making
Stones less likely
7:59
um of course that doesn't mean that we should go
drink tons of caffeine because that could impact
our health otherwise but um you know having a
few cups of
8:06
coffee per day totally fine as long as it's not full of
sugar because then that could actually increase
the risk of
8:12
stone that's actually the only fluid or only beverage
that can increase your
8:17
risk of stones is sugary stuff so regular soda sweet
tea punch and those
8:23
types of things um so so tea is very controversial
because black tea has oxalate in it
8:31
um a fair amount however we see in all studies
that I've ever seen black tea is
8:37
associated with a lower risk of stones kinda of
really just highlighting how important that fluid is I
know it's
8:43
boring advice but truly the most important thing
that you can do to prevent Stones is to drink a lot
of
8:48
water all the other stuff is great but if you're not
drinking a lot of water it's not really going to matter
so
8:54
um so so tea I say is completely fine despite the
oxalate content because we see a lower risk of
stones now there are
9:01
some people who have super stubborn very high
urine oxalate and then I think it does maybe make
sense to maybe limit how
9:08
much black tea you have but for the vast majority
of us I think black tea is completely fine
Types of stones
9:14
okay great so if we think of is it okay for you I
mean if we think of just the
9:20
most common um types of stones um yeah are
you okay going into like
9:25
uric acid calcium phosphate and then calcium
oxalate since the calcium oxalate is the most um
common and will
9:32
focus the most on that in just maybe a few pointers
on calcium phosphate uric acid stones and diet
and then we'll
9:38
really dive into calcium oxalate stones and diet
maybe what we could do because honestly there's
so much overlap between
9:44
the three main types of stones okay calcium
phosphate and uric acid
9:49
um I think maybe kind of touching on all of the
possible pieces of diet that might matter for you
9:55
um because because truly again especially
especially calcium phosphate and calcium oxalate
there's a ton of the
10:01
same stuff um and uric acid may have some
different considerations but it all kind of comes
down to the same things
10:07
um so and and really all of this has to be directed
by that 24-hour urine test
10:13
um and I'll I'm sure I'll bring that up as I kind of go
into all the details but um you know but really
thinking about
10:18
nutrition based on those risk factors in your urine
um the stone type is great but we really
10:24
want to really Target it on on those urine risk
factors
Urine risk factors
10:29
so let's let's dive into those urine risk factors yeah
so what what are they um and if someone sees
any of those then
10:35
what are they doing food wise yeah so from a real
high level um the most common urine risk factor
10:41
that you'll see other than low urine volume which
just means drink more right um the most common
urine risk factor is
10:47
actually High urine calcium um and this is the
number one cause of calcium oxalate Stones as
well as
10:54
calcium phosphate Stones um and so this uh you
know it's it's
11:00
kind of funny because I feel like we assume that
high oxalate is often the cause but that's really not
the most
11:07
common um which is one of the reasons why that
24-hour urine test is just so important because if
your urine oxalate isn't High
11:14
then there's really no reason to limit how much
oxalate you're eating certainly no no reason to limit
limit it very
11:21
strictly um so it's it's just so important to know
what's going on because that's going to direct all
of what we're doing
11:27
um so again that that high urine calcium is the
most common risk factor and the number one
thing that you can do to
11:33
lower the calcium in your urine is actually to limit
how much sodium you're eating um or or make
sure you're eating a
11:39
healthy amount of sodium or salt um so the
recommendation for people with kidney stones is
actually the same as
11:45
people with kidney disease so uh and the general
population for that matter which is 2300 milligrams
of sodium per day
11:53
um so yes that that that urine calcium is is by far
the biggest one that you'll
11:59
see and does the amount of calcium someone eat
is eating affect their urine calcium
Calcium and kidney stones
12:06
levels so that is a very complicated question I'm
gonna go go uh hopefully try to give
12:14
you a concise answer so um so yes a little bit so
we know that
12:19
when you eat calcium from say milk or even
calcium and say like broccoli or
12:25
something like that it probably will raise your urine
calcium a little bit however we see very strongly
that people
12:32
who consume enough calcium from food have a
lower risk of kidney stones
12:37
um which I know is very counter intuitive because I
just told you that either in calcium is the number
one
12:43
cause of stones um but bear with me so um when
you eat enough calcium
12:51
um the that calcium loves to bind with oxalate and
any healthy dietary pattern
12:56
is gonna have oxalate in it because there's some
oxalate in literally all plant Foods um so if you're
eating a healthy diet
13:02
you're going to be eating some oxalate um and so
when we eat enough calcium that calcium binds
with oxalate in our
13:09
intestines and we excrete that oxalate in our feces
instead of that oxalate getting absorbed into our GI
system and
13:16
eventually getting excreted in our urine therefore
increasing the risk of stones and so actually the
number one thing you
13:22
can do if you do see high urine oxalate on a 24-
hour urine test is to make sure
13:28
that you're getting enough calcium and for for most
people that I work with um just simply getting in
enough calcium
13:34
you see that you're not come tumbling down and
you're totally fine and you can enjoy fruits and
vegetables with with no
13:40
concerns um so yes so that calcium is is so
important to kind of help bind that
13:46
uranoxylate and reduce reduce your Knoxville
levels essentially in addition
13:53
people who have kidney stones are actually at a
much higher risk of bone disease so bone
fractures osteoporosis
14:00
and those types of things and just because of
actually all of that high urine calcium so for
whatever
14:07
reason um many people who form Stones our
body just really wants to keep that urine
14:13
calcium High unfortunately at the expense of our
bones um so that's kind of where that
14:19
connection comes from you can see how you
know our bodies sort of constantly breaking down
that bone excreting urine
14:24
calcium so your bones are at risk and so making
sure that you are eating enough calcium can help
protect your bones as
14:30
well okay so if you have high urine calcium levels
it's low sodium diet's important
Low urine citrate
14:37
if you have high urine oxalate levels getting
enough calcium in your diets the most important
and we're going to
14:42
definitely dive more into oxalates and food
specifically but what other things in the urine 24-
hour urine test might
14:49
come up where you would make some nutrition
yeah yeah um so there's lots of things I think the
14:54
other big one is low urine citrate um so citrate in
your urine is a very
15:00
good thing because it makes calcium-based
Stones more difficult to form it it basically makes it
harder for
15:06
calcium oxalate or calcium phosphate to bind um
and so so people can form Stones just
15:11
by not having enough citrate in their urine it's a
pretty powerful inhibitor of stone formation
15:17
um and so this is where you hear people say like
oh I put lemon juice on things or you know oh I'm
eating a lot of
15:24
oranges because there's citrate in it or whatever it
is um and that's that's fine but in order
15:31
to really move the needle that you're in citrate
there's more effective ways of going about it if you
are going to use
15:38
lemon juice it can work but you need to drink a lot
of lemon juice like somewhere around a quarter to
a half a
15:44
cup of lemon juice per day is what actually is going
to move the needle with that urine citrate
15:50
um so so again if you're squeezing a lemon wedge
in your water cool if that makes you drink more
water but
15:58
um but it's probably not gonna actually put more
citric in your urine
16:03
um and actually the um so citrate is a
16:08
base when we think about acid-base pH world
right um citrate is a very powerful base
16:14
um and so when we eat a dietary pattern that
produces less acid I imagine probably talked about
this on on this
16:21
channel before um because we talk about that a
lot with kidney disease as well um when we eat
less acid our body
16:27
doesn't need to hold on to that base as much to
neutralize the acid from the foods that we eat so
eating literally
16:34
any type of fruit and vegetable that's going to
produce base which is literally all fruits and
vegetables um that will
16:40
sort of push your body to excrete more citrate in
your urine because it doesn't need it again to
neutralize that acid
16:46
from the diet so um so yes so literally any fruit
vegetable can raise urine citrate levels
16:53
we don't necessarily need to focus on those citrus
fruits necessarily because
16:58
the citrate in them isn't really what we're after it's
actually we're just after like the general Alkali that
we
17:04
find in all fruits and vegetables um and the flip side
of that of course is if you have low urine citrate
making
17:10
sure that you're not eating too much animal protein
specifically can help which produces acid can help
increase
17:16
those urine citrate levels as well got it okay and
what else anything else in the urine what about PA
oh my gosh I
Low urine pH
17:23
mean I could talk for hours um all right let's put uh
one other really big one
17:29
um so this will flow well so the next uh common
thing that I see is having too
17:34
much acid in your urine so having low urine pH
which makes you more more likely to make
calcium oxalate stones
17:42
but this is a very big driver of uric acid Stones um
low urine pH is uh you can't form
17:48
your acid Stones unless you have a very low urine
pH or too much acid in your urine and so um sort
of just like the
17:55
citrate thing we were just talking about the best
way to get your urine pH Up is to eat lots of fruits
and vegetables and
18:03
to make sure that you're not eating too much um
non-dairy animal protein because that
18:08
non-dairy animal protein is what produces acid
that eventually gets excreted in your urine so we
just want
18:14
to okay yeah lots of alkali from from fruits and
vegetables and less acid from animal protein okay
so I'm anticipating
18:22
questions on okay the recommendation is to eat
more fruits and vegetables but then fruits and
vegetables contain more
18:28
oxalates can we dive into that very confusing lots
of misinformation around
18:33
oxalates and how how much someone should
have and how like what's the truth
18:38
behind that gosh I mean again I could talk for 17
hours on that
18:45
um so so yes oxalate has been demonized um
and it makes sense right so I calcium
18:52
oxalate stones are by far the most common um
and urine oxalate we we don't want to
18:58
see that high that is absolutely true however um
we've sort of one assumed that high
19:04
urine oxalate is the cause of all Stones so so often
people come to me and they
19:10
have stone they got to analyze it was calcium
oxalate they never did a urine test and the doctor
just gave them a list from 1973 of high absolute
foods
19:18
that is not accurate probably and like hey like this
is what you can do and like oh my gosh like so
many things
19:24
um because one we know that that person likely
didn't even have higher and oxlet to begin with
that's that's likely it
19:31
was calcium or dehydration or something that was
causing those stones um but even if you're an
apps that was
19:37
high we now know that calcium is actually a much
more effective way to get that urine oxalate down
rather than
19:43
trying to uh stress about a low oxalate diet um in
addition
19:51
um this low oxalate diet sort of assumes that how
much oxalate we eat equals how much oxalate is
in our bodies and like
19:58
oxalate metabolism is very complicated um we do
know that eating less oxalate
20:05
will reduce the amount of oxalate in your urine
however I would argue that it also would put you a
low oxalate diet is
20:12
going to be limiting a lot of things that we know are
really good for kidney stones um in addition
oxalate metabolism is
20:19
very complicated uh your gut microbiome has a
big role to play in excellent
20:25
metabolism um where that Oxford is coming from
what other Foods you're having that oxalate
20:31
with are you having that calcium like there's so
many things that are going on so simply only
focusing on limiting
20:37
oxalate in this very strict way to limiting oxalate to
say sometimes people say 50 milligrams of
oxalate and that's
20:44
that is so low like I think you could not literally
could not put together a
20:49
healthy diet a diet diet on a 50mg Maxwell some
people say 100 which is
20:54
more generous but still I I don't recommend
counting oxalate like that again oh my gosh I'm on
a soapbox I
21:02
could go on and on um because they're you know
it's impossible to know also how much oxalate
21:07
is in everything you eat like it's so difficult to know
we often talk about the Harvard absolute list which
is
21:12
definitely considered to be the gold standard and
we we know that the absolute amounts on that are
as accurate
21:18
as we can get but obviously there's not all Foods
on there so it's really really difficult to actually track
how much oxalate you're consuming
21:25
um in addition to knowing like if you even have to
so um like I said I'm all over the place
21:31
with this I'm very passionate about oxalate um so I
think so if you do find that you
21:38
have a stone I think the first thing you need to do
is to get that urine test and if your urine oxalate is
High Get Enough
21:44
calcium in get another urine test if you see that
your oxalate is still high um do some assessment
and see if you
21:51
have some very concentrated sources of oxalate
because I do see people getting into trouble
sometimes times if you're
21:58
doing um you know like a spinach smoothie or
you're having a spinach salad every day
22:03
um because spinach specifically is very high so
there's around like 750
22:09
milligrams of oxalate per half cup cooked spinach
um the next highest thing is almonds
22:15
that have the 120 milligrams so spinach is like
crazy high so you so you can see and
22:22
almonds you know are are pretty high too
compared to some other high oxalate Foods
22:28
um so so look and see like oh am I having a
spinach salad every day am I juicing things
because uh oxalate is
22:35
water soluble so when you juice something you're
going to get a huge dose of oxalate all at the same
time
22:41
whereas if you just ate that Fritter vegetable you're
not going to get as much um I sometimes see
people getting into
22:47
trouble with supplements um so specifically
cinnamon and turmeric
22:53
supplements um those two spices are pretty high
in oxalate so using cinnamon and turmeric
22:59
in on your oatmeal or in a curry like no problem
like realistically you're not
23:04
going to eat that much but in supplement form
again it's very very concentrated so that is maybe
where we see problems
23:11
um so so again just kind of assess and see you
know my accidentally binging out
23:17
of that oxalate or these very high oxalate Foods in
some way um a lot of times I see it with almonds
23:23
so um you know people on gluten-free diets a lot
of times gluten-free products are made with
almond flour which is just
23:30
soup you know it's just grown down almonds
different very very concentrated so um so I think
my point is excellent
23:37
matters um but we don't need many of most of us
99 of us do not need to be on these
23:44
super low oxalate diets I think we need to maybe
avoid huge doses of oxalate we
23:49
need to make sure that we're getting enough
enough calcium and then for all of those other
fruits and vegetables we
23:56
should be eating them because we see that
people who eat more fruits and vegetables in
general have a lower risk
24:01
of stones fruits and vegetables are very high in
things that we think that are
24:07
good for Stones so things like magnesium
magnesium most comes from nuts which are
notorious
24:13
also Alkali so we talked about how that kind of
plays into stone so the all fruits and vegetables are
going to help
24:19
us there they're also something called phytate um
if you Google phytate it comes up as
24:26
this big scary thing because it's an anti-nutrient um
it's but but for Stones we actually think it's good
because
24:32
phytate is a very very strong inhibitor even
stronger than citrate actually
24:37
um stronger inhibitor of kidney stone formation and
so phytate comes from whole grains which are
restricted on a
24:43
low oxalate diet um so so yes so lots of good
things in all of
24:49
these foods that are removed on low oxalate diet
and so I truly feel that a
24:54
strict low oxalate diet could actually be doing harm
because it removes all of these good things
High oxalate foods
25:00
yeah and thank you for saying that yeah we see
that in like you know it's so
25:06
important looking at the diet as a whole versus just
one single nutrient with kidney stones and kidney
disease for
25:13
this reason that if you're following a very low
oxalate diet you're missing out on these other
things that can actually
25:19
help prevent kidney stones yeah um so let's say so
number one ensuring
25:25
I was just say number one in Sharing adequate
calcium um you know potentially if they have high
urine oxalate levels and avoiding
25:32
those very high oxalate Foods aside from spinach
and almonds what are some of those other very
high oxalate foods that
25:38
someone might want to watch yeah so the so
spinach like I said is truly by far
25:44
the biggest like truly seven times more than
anything else but almonds are pretty high
25:49
um navy beans specifically you know sometimes
all beans and all nuts get ostracized but um navy
beans and white
25:56
beans um for whatever reasons the way God
made them I don't know um
26:02
um but other than that like there's not a lot so
sometimes the um so so baked potato with skin
26:08
um the skin has a lot the potatoes do but the skin
is very concentrated um raspberries rhubarb and
beets are
26:16
sort of those highest ones um but other than that
just eat just eat fruits and vegetables
26:23
and get your calcium and you'll be fine yeah
there's plenty of other options of fruit and fruits and
veggies if you do
Calcium
26:28
too many right you need to eat this out and so can
you talk a little more on the calcium how does
someone ensure they're
26:35
getting enough calcium like do they need to eat it
with their meal um and how is the you know I
guess the
26:41
difference between someone taking a calcium
supplement versus them getting it from the food
yeah good depression I
26:47
forgot to mention that supplement piece earlier um
so so ideally in a perfect world I
26:53
would love to see all of my people with higher
Knoxville having a good calcium source with each
meal so three meals a
27:01
day three servings of calcium um and that is
because since we want to
27:06
really use that calcium to bind the oxalate and the
food that we eat ideally we really want to have that
that calcium
27:13
with food or with a meal so then it's all in our
intestines at the same time and blocking
absorption if you're having
27:19
yogurt say as a snack that's cool it's not going to
hurt you but it's not really like maximizing that
calcium
27:24
effect on reducing oxalate absorption um so ideally
we want to do that or
27:30
especially if you you know maybe um really want
some raspberries maybe
27:35
just make sure that you have some yogurt with
them you know especially if you're having a really
higher oxalate food just
27:41
be really cognizant that you're having a calcium
source with it um so a lot of times and and like
27:48
calcium sometimes get gets old you know until we
can certainly and I think we will talk about some of
the plant-based
27:53
sources but um you know milk and yogurt get old
when you're trying to have them three times a day
27:59
um and so people will often say you know well why
can't I just take a calcium supplement um so so
calcium supplements will
28:06
definitely uh reduce oxalate absorption just as well
as natural calcium however
28:12
calcium supplements raise urine calcium much
much much more than natural calcium
28:17
and we see in big studies that people who take
calcium supplements have a increased risk of
stones whereas people
28:24
who eat enough calcium have a much lower risk of
stones and so for the vast
28:29
majority of people um we really want to get
calcium from food there are a couple exceptions
28:36
um the one that I I see most commonly is people
who have Stones as a result of bariatric surgery
28:41
um their physiology is very different and so their
urine calcium likely isn't going to be high they're
making Stones
28:47
because they have crazy high oxalate absorption
um so in those instances it does sometimes make
sense
28:53
um but for for most of us who are forming Stones
uh because not because of some specific
28:59
thing like that we really want to avoid calcium
supplements whenever we can got it and so can
you go over some good
Calcium Sources
29:07
calcium sources both in you know for just in
general and then also if someone
29:13
is you know vegan or plant-based or dairy and
tolerant or allergic absolutely absolutely so yeah
so for
29:19
most people I recommend uh milk and yogurt
Dairy that's gonna have the the most calcium in it
most natural calcium
29:26
but obviously people avoid that for a variety of
reasons um and if that's the case
29:32
um then doing those plant-based milk substitutes I
think are completely fine
29:38
um I I so specifically milk so um things like rice
milk coconut milk
29:44
macadamia nut milk um those those are all good
options I would be careful with almond milk just
29:51
because even though we don't all need to avoid
oxalate I don't want you to you know start drinking
a whole bunch of
29:56
almond milk and you're introducing this huge sort
of concentrated oxalate Source right um so those
lower oxalate uh
30:04
lower oxalate plant-based milks I think are a good
option I actually have a post on my blog that that
goes into all the
30:11
different options so maybe we can add that to the
show notes as well um so people can easily find
that
30:17
um so yeah I think those are kind of what it comes
down to um I think cheese can be an option too
30:23
um again just because milk gets really old um
cheese is going to be higher in sodium um but
that's okay because you
30:29
can easily fit it into your daily amounts um I think
especially the the vegan
30:36
cheeses tend to be very very high in sodium so
just kind of be mindful of that but I still think there's
room for
30:41
that um again just to kind of mix it up when we're
trying to get three servings a day and it we have to
have variety
30:47
definitely so can you give an example of a day
that's you know
Example Day
30:54
um for someone who is trying to prevent their
kidney stone from reoccurring that's breakfast
lunch and dinner and
31:00
just an example of what that meal would look like
um so breakfast I think oatmeal is
31:07
always a great option um I I like it also because
um you can make it with milk
31:13
um and so again people get so sick of milk so if
you just make your oatmeal with milk you sort of
hide it and you
31:19
don't have to have another glass of milk with it um
so you could have oatmeal and then put whatever
fun toppings you love so
31:26
maybe you could do cinnamon and apples and a
little bit of brown sugar you could do um like
pistachios and
31:32
blackberries um you know adding some extra
making sure you have some fruit or vegetable with
it so fruit I feel like fits really
31:39
well here um and having some nuts I think adds
some extra fiber and some other good
31:44
magnesium and phytate for kidney stone
prevention if you do have high urine oxalate just
avoid those higher oxalate
31:49
nuts and you'll be totally fine so I think that's a
good option for breakfast um for lunch you could
maybe do a salad
31:58
maybe with some garbanzo beans for protein um
you know you could do I don't know
32:03
you could do like a spring mix with some tomato
and avocado onion carrot whatever
32:10
vegetables you love throw some I love garbanzo
beans on salads just because they're easy I get
the low sodium canned
32:15
ones rinse them off and throw them on so easy um
and then to make sure you're not
32:21
blowing your sodium budget with dressing just
make your own dressing at home you could use
whatever vinegar you like and
32:26
olive oil a little bit of garlic powder or whatever um
so that might be a good lunch maybe
32:32
add a whole grain roll with it so you have a healthy
carb to help fill you up um and then dinner
32:38
um maybe have a piece of salmon uh you could
have some wild rice and asparagus
32:44
um maybe have a cookie for dessert because
there's certainly room for a little bit of sugar and
then some treat in there
32:49
um yeah so you know kind of a hopefully that
gives you some idea of what an example day
might look like
Sugar and Kidney Stones
32:55
definitely and so since you brought up sugar again
can you I know you mentioned it earlier with you
know beverages that
33:01
contain sugar but what is the link with added sugar
and kidney stones
33:07
yeah so we actually don't quite know um they're
actually one of my old
33:12
colleagues at the University of Chicago is looking
into this um we don't fully understand the
physiology of why
33:19
um added added sugar specifically increases the
risk of stones we're not afraid of sugar and fruit in
fact fruit
33:25
is very wonderful for kidney stones as we talked
about earlier also wonderful for kidney disease as
I'm sure that you
33:31
talk about all the time um but the we know that it
has some link
33:36
with higher urine calcium for for whatever reason
we used to think it was insulin mediated but now
we think maybe
33:41
that's not the case so we're not quite sure how but
we know that more added sugar is associated with
higher urine
33:48
calcium and so um so you see and specifically
those drinks
33:54
um perhaps because they are just you know so
high in that added sugar we definitely see a higher
risk of stones
34:00
and so um certainly some sugar is fine all foods fit
I'm a strong believer in that
34:05
but having you know a huge piece of cake every
day or tons of ice cream or whatever right that's
um that could
34:12
increase your risk of Stones by increasing urine
calcium okay got it thank you and before we kind
Supplements for Kidney Stones
34:19
of wrap everything up you had mentioned avoiding
cinnamon and turmeric supplements because they
can be very
34:26
high or concentrated in oxalates are there any
other supplements that can be risky that people
should avoid and are
34:32
there any supplements that are good for people
with kidney stones yeah
34:37
um I think the only other ones is calcium which we
touched on already and the other big one is
Vitamin C
34:43
um so vitamin C uh to add to the confusion and
complication of oxalate
34:49
metabolism your liver can make oxalate from lots
of different things um excess protein being one of
them so
34:57
um sometimes people in the extreme low oxalate
world will say like oh like carnivore diets are good
because uh
35:03
there's no absolute but in addition to many many
things um it doesn't even make sense because if
you're eating just a ton of meat your
35:09
liver is actually going to make oxalate from all of
that all that protein which you know it's kind of
ironic but
35:15
um so uh so one of the things in addition to those
that protein in amino
35:21
acid that your liver can make oxalate from is
excess vitamin C so
35:26
um very high vitamin C supplements I would
definitely avoid especially if you have high iron
oxalate so
35:33
um you know if there's a little bit like I don't know
60 milligrams or something and a multivitamin that
you take or
35:39
whatever like that's fine but um it's it's the very
high doses of Vitamin C that we want to want to
avoid
35:46
um other than that I don't think there's any to avoid
any other ones to avoid um supplements that are
good
35:52
definitely nothing uh that I recommend universally
um in rare instances I will recommend
36:00
fish oil for stubborn um High uranoxyl there's some
data to show that fish oil supplements could
36:05
bring that down um yeah other than that some
sometimes
36:11
sometimes magnesium um I have a whole post
about this as well um low urine magnesium could
be
36:17
problematic but the data showing that magnesium
supplementation makes any difference is very very
lacking
36:24
um but if you have low magnesium I think that
perhaps there could be a role there
36:30
um but these are very rare uh very specific
situations and there's really no supplements that I
recommend for
36:36
everyone or even for big big groups of people got
it okay so to sum everything up what
Nutrition Tips for Kidney Stones
36:44
are your top three to five nutrition tips for people
with kidney stones if you can just pick three to five
okay
36:53
um I would say um for everyone drink water um
again we want to drink for most of us
36:59
around three liters of fluid per day that's about a
hundred ounces of fluid per day
37:04
um mostly from water that's obviously going to be
your best choice but mixing it up um my my
favorite recommendation
37:11
are those unsweetened Sparkling Waters um
sometimes people ask you know does carbonation
matter it doesn't um if
37:17
there's lots of sugar in what you're drinking that
does matter but um like uh Lacroix or Spindrift or
37:23
bubbly or any of the gazillion different brands
they're all fine as long as there's no no sugar
added in them
37:29
um so drink water is definitely my number one tip
um I would say the next thing
37:34
um and this is specific to each person but but
because calcium oxide stones are so common and
most of us are eating more
37:40
salt and then we need to anyway I would say
limiting how much salt you eat um is or not limiting
making sure you're
37:48
not eating too much salt because some of us may
be fine but most of us are eating way more salt
than we need right so I'm
37:54
trying to aim for around 2 300 milligrams of sodium
per day that's also going to be good in general
right it's
37:59
going to be if your kidney is good for your heart um
and just dizzy is prevention in general so I would
say sodium and then
38:07
I'll say I'll have four things the next thing um would
be making sure that you're getting enough calcium
38:13
um this recommendation for three servings of
calcium per day or around 1 000 to 1200
milligrams of calcium is
38:19
actually the recommendation for the general public
as well um for people with kidney disease that
might be a little different so
38:25
definitely ask your doctor your dietitian what's best
for you um but I would say for for stone formers
38:31
and for for the general public trying to get in that
calcium is very important and then my last point
would be just
38:37
make sure you're eating your fruits and vegetables
um at least five servings a day
38:42
um that's gonna help with stone prevention and
and also General Health and every chronic
disease under this one
38:48
so there's my four tests awesome well thank you
that's very very
Resources and Services
38:53
helpful and Melanie can you I will again we'll put
links in the notes for this
38:59
episode but do you want to remind everyone um
kind of what resources and services you have for
kidney stones and how
39:06
people can find you yeah absolutely so my blog
has a ton of
39:13
information on there about kidney stones so that's
the kidneydietition.org
39:18
um I also post on Instagram I'm at the kidney
dietitian with periods in between each word
39:24
um I'm on Facebook if you want to check me out
there um I have a Facebook group on the kidney
dietitians kidney stone prevention
39:30
Community if you want to want to look at that as
well um and so those are all of my resources
39:36
and if you want to work with me or really help
really dive into that 24 hour urine test to
understand what's
39:42
going on and what you can do for prevention for
you um definitely check out kidney stone nutrition
school
39:47
um that lays it all out for you and I also help
students dive into that test
39:53
and you can join in group calls with me to kind of
get my direct help in understanding what this
should be for
39:58
you got it well thank you Melanie this is so helpful
we get lots and lots of
40:04
questions about nutrition for kidney stones so it's
great to have an expert on to really lay it out and
again I
40:11
think this is a listen to this episode a couple times
you guys and take notes because there's a lot of
great information and then if you need more
then you can go to Melanie's website you can go
to her Instagram you can join her Facebook group
her course she is really
40:24
the renal dietitian expert in kidney stone so I'm so
happy that you came on
40:29
and thank you yes thank you for having me