Lemonade and Kidney Stone Prevention
It’s about time to dispel some myths about kidney stones.
Why are we talking about them? Well, for one thing, evidence exists that
stones were around as long as 7000 years ago. they occur in as many as
2.6% of people. Stones of various shapes and sizes pass down the urinary
tract into the bladder causing severe waves of pain. Patients experience
nausea, vomiting, chills, and characteristically, it’s impossible
to remain still and the patient writhes in agony. Many men say it’s
the worst pain they’ve ever felt. Many women say it’s as bad
as childbirth! Myth number one-- the pain is due to the pressure of the
stone impacting the lining of the urinary system. Wrong! The pain is actually
due to urine backing up all the way into the kidneys where the nerve fibers
are acutely sensitive to stretching. Once the stones pass into the bladder
they pass easily and seldom cause symptoms.
Naturally, anyone who’s endured that kind of pain always asks the
same question:
How do I prevent this from happening
again? They often
receive a pat on the back and an answer like, “Well, Bob, or Mary,
just stay away from milk and cheese.” This is a gross oversimplification
of the complex field of stone prevention.
Kidney stone prevention is based on an understanding of the cause of
the stone and also the importance of good hydration. The are many types
of kidney stones (more than a dozen ) and not all are made of calcium.
Some are due to infections or complex metabolic abnormalities. Some stones
can even be caused by medicines or chemotherapy.
The basic element common to all stones is that crystalline materials
precipitate (come out of dilution to form solids) whenever there is insufficient
amounts of bodily fluids due to dehydration. Patients who drink at least
two liters of water per day are least likely to form kidney stones. Increasing
hydration does not guarantee success in stone prevention but it is the
best dietary treatment by far. Water is cheap and readily available. Lowering
calcium intake is in comparison a very minor factor since there is so
much natural calcium in our diets. To make matters even more complicated,
some rare types of stones occur in patients who are actually low in calcium?
There we’ve just dispelled another myth- that lowering calcium in
our diets is always the treatment of choice. Some patients receive very
elaborate diets to decrease the oxalates in their diets. (calcium with
oxalates together form most kidney stones). Although these patients go
to great lengths to restrict the intake of rhubarb, peanuts, fruitcakes,
colas, etc., they still proceed to form stone after stone. Why? The answer
is that 90% of the oxalate in our bodies is a normal product of metabolism
and is unaffected by diet. (No one eats much rhubarb anyway—do you?)
So, what can one do to prevent stones in the most effective manner?
Have a stone work-up.
This is where your urologist analyzes the stone itself (if retrieved)
and analyzes your blood and urine chemistries to find out which type of
stone you form and why. Then find out if dietary restrictions apply to
you. Some patients may require medications.
Next, increase your fluid intake. Of course, the next question is which
kind of fluid is best?
The answer is lemonade!
Lemonade contains six times the concentration
of citrate than any other citrus juice. Citrate acts as a natural inhibitor
of stones and is more powerful in preventing stones than any complicated
dietary restrictions that have less impact on stone formation even when
patients adhere to them faithfully. Citrate binds up the calcium and oxalates
that otherwise might crystallize together inside the kidney. Citrates
can also be taken as a medication prescribed by your urologist in liquid
or powder form. It even comes in sugarless form for diabetics. If you
hate lemonade, plain old fashioned water is the next best. The nice thing
about lemonade is the convenience and the price: 50 cents a glass on the
corner of your neighborhood the last time I looked.
