It is well known that the problem of kidney stones is a common one. But what most of us don’t know is that the number of cases is rising rapidly. The cases have doubled in last few decades in USA. Similar is the case with other countries in Europe, and more so in Asia. In India the lifetime risk of getting a kidney stone is around 15 % (Indian journal of urology). There are many established risk factors for kidney stone disease. Probably the most important is your genetics. Your genetics decide the chemical composition of your blood and urine, which in turn may make you prone to kidney stone formation. It still remains under investigation and more research are needed to find out the details of genes responsible for it and, thus any possible treatment.
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10 Ways to Prevent Kidney Stones
The following ten steps are a summary from the most authentic sources like “the American Urology Association” and these are the only interventions proven till date to prevent the recurrence of kidney stones. Every other advice or hearsay have not been proven to be helpful in prevention of kidney stones and should be considered as myth.
1) Hydration
You need to produce atleast a daily urine output of around 2 to 2.5 litres. This roughly translates into a fluid intake of 2.5 to 3 litres a day. This fluid includes everything, like your tea, milk, juice, lassi etc. If you are 6 feet tall and near 100 kg, you will need more fluid intake, and in the same way, if you are 5 feet and weigh 50 kg, you will need less. Also, patients with heart disease or chronic kidney disease or some other ailment which requires restricted water intake, should not take more than what is advised as it can be dangerous for them. Next comes the question of, what is good and what is bad fluid to consume. So plain water, fruit juices, milk and its preparations like buttermilk or lassi, coconutwater and lemonade are all good fluids. Sugar sweetened soda, or cola drinks have been found to increase the risk of stone formation. Alcohol usually doesn’t increase the risk of stone formation nor should it be used to expel the stone out. The diuresis caused by alcohol may help flushing the stone out (this effect can be produced by consuming plain water and a cup of tea/coffee) but it leads to residual dehydration. Those who consume alcohol know that when they get up in the morning, they are thirsty and their lips are dry and urine becomes concentrated. So in nut shell, avoid alcohol for it is bad for health in many ways.
2) Normal calcium intake
This is a myth that reducing calcium intake reduces risk of kidney stone formation. If we do not take the required daily amount of calcium in our diet, the body starts absorbing the calcium from body’s calcium store, which is bones. This results in weak bones and doesn’t help in reducing kidney stones. The recommended amount of dietary calcium is 1 to 1.2 gms of calcium per day, for which dairy products are a very good source. When we take calcium in our diet, like milk or paneer, this calcium binds with the oxalate present in many of our daily food items like, spinach, nuts etc. The oxalate, which is the main component of the most common kidney stones, now bound with calcium gets excreted in the stools and is not absorbed from the intestines.
3) Normal protein intake with reduced animal protein content.
This is again a myth that you should restrict protein intake to prevent kidney stones. It is important to consume the daily recommended amount of protein, which is required for immunity, growth and development of kids and youngsters. The daily required amount of protein is 0.8 to 1 gm/kg bodyweight/day. The researches have found out that, more we consume the animal protein, more is the excretion of stone forming chemicals in urine and it also delivers a huge acidic load in urine. These, overall increase the chances of kidney stone formation. So it has been recommended by the prominent urological societies, that intake of animal protein (chicken,beef,meat,fish,pork and eggs) should be reduced to cut down the risk of kidney stone formation. This has been estimated that the animal protein content should be less than the half of the total daily protein intake. This means that you don’t need to stop eating your favorite dish, but keep the serving small, and better if calculated in grams of protein.
Know the various sources of Vegetarian Protein in this video:
4) Low salt diet
Excess salt intake (common salt) increases the stone forming calcium in urine and increases the risk of stone formation. A diet which is low in salt, 4 to 5 gm/day, reduces the risk. So for a person who has, or had a kidney stone, it would be advisable to avoid sprinkling extra salt on the salad, avoid pickles, chips and other salted snacks.
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5) Regular exercise and controlling body weight.
Obesity increases the acidic content of urine and has been found to increase the risk of kidney stone formation. Maintaining an ideal body weight for your height will obviously have many other health benefits apart from reducing the risk of kidney stones.
6) Lots of fruits and vegetables.
Fruits and vegetables make the best option as a part of your meal, or in between the meals. They are packed with lots of nutrients like vitamins, minerals and roughage. Fruits and vegetables help in reducing the acid in urine. Citrus fruits like lemon has citrate which acts as natural inhibitor of stone formation.
7) Avoid excess sugar.
Excess sugar in diet directly leads to increased excretion of calcium and sodium in urine, which promotes stone formation. Excess sugar will also lead to obesity and thus cause increased risk of stones, indirectly.
8) Replenish
Apart from maintaining a routine adequate fluid intake, you need to add extra water/fluid if you are into running, gym, outdoor in hot climate etc. This is again true if you keep your air conditioner or room heater running all through the night when you must take some fluid in the middle of the night or atleast just after getting up if you had an uninterrupted sleep.
9) Avoid indulgence
Make sure that you are keeping a check on your junk food intake. Do not indulge extra with cola and other high fatty foods like processed foods. Sugary drinks like colas and sweetened sodas are equally harmful.
10) Meet a urologist and discuss in details about your clinical condition.
He will advise about the adequate diet, fluid intake, which food to avoid and also if you can take supplements like vitamin D, calcium and vitamin C which can increase the risk of stone formation. For specific types of kidney stones, there may be additional dietary restrictions depending upon the results of blood and urine tests. For example, stone formers who excrete a lot of oxalate in urine, over and above normal limits, are advised to curtail spinach, black tea, nuts, sweet potato and chocolates. Similarly, uric acid stone formers benefit from reducing organ meat and red meat in their diet. For kidney stones caused by urine infection, antibiotics will be helpful in addition to the above mentioned ten steps.
How Is A Kidney Stone Formed?
We must try to understand how a kidney stone is formed, before understanding its prevention. Imagine there is a glass, half full of water. Now we put half a teaspoon of table salt into it and stir. This dissolves and the water remains clear. Now add another half spoon of salt and stir it. This doesn’t dissolve completely and there remain some crystals at the bottom. In the same way, if the water content of your body is not enough to dissolve the natural salts, these will precipitate in the kidneys as crystals. If this continues for months, these crystals come together and can grow in size and in number, which is now called a kidney stone. Lets go back to our glass of water. Now add more water to it to make it full and stir again. The crystals which were seen at the bottom dissolve again and the water becomes clear once again. This is the importance of hydration in your body.
Types Of Kidney Stones
We also know that the kidney stones are of different types. They are classified according to their chemical composition. For example, calcium oxalate, calcium phosphate, uric acid, cystine and infection stones. All the types of kidney stones have some common and some unique factors responsible for their formation. Common factors are dehydration and sometimes acidic content of urine. Diet plays an important role in many common types of kidney stones formation. But we cannot exclude a long list of food items from your diet because one, its not practical, and two, you will end up with malnutrition as many of these food items are packed with essential nutrients like calcium, magnesium, vitamins and roughage.
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This is but for sure for someone who has had a kidney stone pain, he/she would never want it again. Awareness is still not adequate, and most of the time the patients and the doctors both are focused only on the treatment of the current stone. A great deal of effort is indeed needed for emphasizing on the prevention, which will save many kidneys and will lower the economic burden on the society.
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