A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones.

Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.

BACKGROUND. A high dietary calcium intake is strongly suspected of increasing the risk of kidney stones. However, a high intake of calcium can reduce the urinary excretion of oxalate, which is thought to lower the risk. The concept that a higher dietary calcium intake increases the risk of kidney stones therefore requires examination. METHODS. We conducted a prospective study of the relation between dietary calcium intake and the risk of symptomatic kidney stones in a cohort of 45,619 men, 40 to 75 years of age, who had no history of kidney stones. Dietary calcium was measured by means of a semiquantitative food-frequency questionnaire in 1986. During four years of follow-up, 505 cases of kidney stones were documented.

RESULTS. After adjustment for age, dietary calcium intake was inversely associated with the risk of kidney stones; the relative risk of kidney stones for men in the highest as compared with the lowest quintile group for calcium intake was 0.56 (95 percent confidence interval, 0.43 to 0.73; P for trend, < 0.001). This reduction in risk decreased only slightly (relative risk, 0.66; 95 percent confidence interval, 0.49 to 0.90) after further adjustment for other potential risk factors, including alcohol consumption and dietary intake of animal protein, potassium, and fluid.

Intake of animal protein was directly associated with the risk of stone formation (relative risk for men with the highest intake as compared with those with the lowest, 1.33; 95 percent confidence interval, 1.00 to 1.77); potassium intake (relative risk, 0.49; 95 percent confidence interval, 0.35 to 0.68) and fluid intake (relative risk, 0.71; 95 percent confidence interval, 0.52 to 0.97) were inversely related to the risk of kidney stones.

CONCLUSIONS. A high dietary calcium intake decreases the risk of symptomatic kidney stones.

PMID: 8441427 [PubMed - indexed for MEDLINE]

Risk factors for kidney stones in older women in the southern United States.

Hall WD, Pettinger M, Oberman A, Watts NB, Johnson KC, Paskett ED, Limacher MC, Hays J.
Emory University School of Medicine, Atlanta, Georgia, USA. [email protected]

BACKGROUND: The occurrence of kidney stones is disproportionate in the southern region of the United States. Risk factors for the occurrence of kidney stones in this geographic area have not been reported previously. METHODS: The Women's Health Initiative (WHI) is an ongoing multicenter clinical investigation of strategies for the prevention of common causes of morbidity and mortality among postmenopausal women. A case-control ancillary study was conducted on 27,410 (white or black) women enrolled in the 9 southern WHI clinical centers. There were 1,179 cases (4.3%) of kidney stones at the baseline evaluation. Risk factors for stone formation were assessed in cases versus age- and race-matched control subjects.

RESULTS: Risk factors (univariate) included low dietary potassium (2,404 versus 2,500 mg/day, P = 0.006), magnesium (243 versus 253 mg/day, P = 0.003) and oxalate (330 versus 345 mg/day, P = 0.02) intake, as well as increased body mass index (28.5 versus 27.7 kg/m2, P = 0.001) and a history of hypertension (42% versus 34%, P = 0.001). A slightly lower dietary calcium intake (683 versus 711 mg/day, P = 0.04) was noted in case subjects versus control subjects, but interpretation was confounded by the study of prevalent rather than incident cases. Supplemental calcium intake >500 mg/day was inversely associated with stone occurrence.

CONCLUSION: Multivariate risk factors for the occurrence of kidney stones in postmenopausal women include a history of hypertension, a low dietary intake of magnesium, and low use of calcium supplements.

From www.YoungAgain.com

New study shows calcium does NOT cause kidney stones, but actually prevents their formation
Results from a five-year Italian study may spell the end for the standard advice for preventing kidney stones.

FELICIA BERGER, a mother of three, has been treated for kidney stones several times. She says the pain of the stones is far worse than childbirth.

"With labor, the pain with contraction comes and goes. With a stone, it's just kind of always at you," she said.

Kidney stones, which strike millions of Americans, are crystals made up mostly of calcium that cause extreme pain by blocking the urinary tract. For years, many doctors have told patients, including Berger, to eat a low-calcium diet. But a major study published Wednesday in the New England Journal of Medicine shows that advice is just plain wrong, even counterproductive.

"For many patients, a low-calcium diet actually may have worsened the likelihood of stones as well as put them at risk for osteoporosis," said Dr. Ernest Sosa, a kidney-stone expert at Weill Cornell Medical Center.

In the Italian study, conducted at the University of Parma, researchers divided 120 men into two groups -- half ate a low-calcium diet, the other half had a diet with normal calcium that was low in protein and salt. After five years, those on the low-calcium diet actually had over 40 percent more stones.

Study co-author Dr. Umberto Maggiore explained that people on a low-calcium diet excrete less calcium in their urine but more of another substance -- oxalate -- that combines with calcium to form most kidney stones.

In addition, salt and one protein common in meat lead to more calcium in the urine.

About 13 percent of Americans -- and a much larger percentage of men, who make up 80 percent of sufferers -- will get a kidney stone sometime in their lives. Once a person has a stone there is a 50-50 chance of getting another one within five years.

Doctors now treat stones by pulverizing them with a laser device or with ultrasound. Because of genetic makeup some people cannot help getting stones, but most can.

"For most patients, it's a preventable event," Sosa said.

The best prevention:

A diet with adequate calcium, but lowered salt and protein;
Eating meals regularly throughout the day;
Most important, drinking lots of water.

It's advice Felicia Berger is following. "I don't want that pain again, cause that's awful," she said.

http://www.youngagain.com/kidneystones1.html

Digestion vs. Kidney Stones

Kidney Stones - Start in Your Stomach

Rubman's Digestion Connection

May 2, 2006:-  People think of kidney stones as occurring in the kidneys. But, as Daily Health News contributing editor Andrew L. Rubman, ND, is clear to convey, diet and digestion are significant contributors to this seemingly unrelated problem. Whether it's binge drinking or high-protein diets, how you fuel your body impacts its function. "Garbage in, garbage out" as they say. Going overboard on what you eat and drink can make you more susceptible to these painful, hard masses. Conversely, making smart and consistent dietary choices can help prevent kidney stones.

To simplify, kidney stones are formed in large part as a result of incomplete or out-of-balance digestion where nutrients are not available to the body when and where it needs them. Kidney stones are primarily made of calcium oxalate, although sometimes they also contain uric acid, cystine or struvite.

Once you have one stone, you are likely to develop more. Fortunately, according to Dr. Rubman, there are a number of steps you can take to prevent stone formation...

DRINK UP

The single most important thing you can do: Drink plenty of water, advises Dr. Rubman. Fluids make stone components such as calcium oxalate more soluble in the urine, so they are less likely to form into crystals. The standard recommendation is eight eight-ounce glasses of water daily. For a more precise calculation of how much water you should drink each day, divide your weight in half. That number in ounces is your recommended daily water intake.

What you drink matters, too. In one study, hard tap water increased urinary calcium concentration (a risk factor for calcium stones) by 50% compared with soft bottled water. If hard water is what's available in your community, it makes sense to invest in bottled water.

Other healthful drinks include mineral water with a splash of fresh lemon or lime juice. Mineral water contains calcium and magnesium that may reduce the risk of stone formation, while a half-cup of lemon juice daily raises the level of stone-fighting citrate. Note: Other citrus fruits, such as orange or grapefruit, do not have the same effect. In fact, as mentioned below, grapefruit can increase stone risk. Other studies have suggested that coffee and tea, both natural diuretics, have a beneficial impact by increasing urine volume.

Best to avoid: Cola and grapefruit juice. Cola reduces the level of citrate in urine... and multiple studies have suggested that grapefruit juice raises stone risk.

The jury is still out on beer. While some research indicates that beer acts as a natural diuretic to dilute urine and increase frequency of urination, Dr. Rubman points out that beer is packed with stone-prompting oxalates. If you do drink beer or other alcoholic beverages, do so in moderation (generally considered to be one drink a day for women and two for men). Binge drinking increases uric acid production and thus the risk of uric acid stones.

To monitor whether you're taking in sufficient fluids, keep an eye on the color of urine. If it's dark yellow, you're not drinking enough. Urine should ideally be pale and light in color.

UP YOUR CALCIUM CONSUMPTION

Nearly three out of four kidney stones are composed of calcium oxalate, so it stands to reason that restricting calcium should prevent stones, right? Wrong! There is an inverse relationship between calcium consumption and stone formation, explains Dr. Rubman. He points out that many people with osteoporosis develop calcium stones not because of calcium in food or supplements, but because of the body's reabsorption of calcium. If the body is not supplied adequate amounts of calcium, it steals its own from the bone. This results in more calcium circulating in the blood and eventually passing into the urine.

To make sure you get enough calcium in your diet, eat foods such as broccoli, kale, collard greens, almonds, sesame seeds and canned salmon or sardines. (Although dairy is the most obvious source of calcium, as I've written here before, cow's milk is best left to the calves.) If you don't get enough calcium in your diet, consider taking a supplement. The generally recommended dosage is 1,200 mg daily in two or preferably three divided doses. According to Dr. Rubman, calcium citrate is the supplement form most readily utilized by the body, and for best absorption he recommends that you take calcium with magnesium. In particular, he recommends Butyrex, made by T.E. Neesby, which already combines calcium and magnesium for you.

Caution: Do not take larger-than-recommended dosages of calcium supplements, because it can backfire and lead to stone formation. There is also a subset of calcium stone sufferers who have supersaturated calcium in the urine and must restrict calcium consumption. Only your doctor can determine if you are in this group. Do not take magnesium without calcium to attempt to offset the excess calcium. Always take calcium and magnesium together unless specifically told otherwise by a properly trained physician.

WATCH PROTEIN AND SODIUM INTAKE

Diets high in protein (especially animal protein) have consistently been associated with kidney stones. Protein raises levels of stone-causing calcium, oxalates and uric acid in the urine, and reduces protective citrate. Does this mean that those on the protein-heavy Atkins diet are more prone to kidney stones? As a matter of fact, Dr. Rubman worked for Dr. Atkins early in his career and in his experience, yes, they are.

Your best bet: Keep meat portion sizes moderate (about the size of a deck of cards), and fill the rest of your plate with fresh vegetables and whole grains.

Bad news for vegetarians: One study found no difference in kidney stone risk between people who consumed equal amounts of beef and plant protein. Dr. Rubman theorizes that this may be because soybeans, a common source of protein eaten by vegetarians, contain high levels of oxalates.

Sodium increases the level of calcium in urine, so those with calcium stones are best off restricting their intake of salt (whether from sprinkling it on food or consuming sodium-packed processed or fast foods). How do you know the type of stone you have? Use a cup to catch it and give it to your doctor for analysis.

MORE STONE-FIGHTING FOODS: FISH OIL AND FIBER

As if their heart-healthy benefits were not enough, eating cold-water fish such as salmon, mackerel, herring and sardines may also help prevent kidney stones. Inflammation plays a role in kidney stone development, and fish oil is naturally anti-inflammatory.

Goal: Try to eat fish at least twice a week. If you're not a fish eater, consider a daily supplement of 2,000 mg fish oil.

Fiber-rich foods such as vegetables and whole grains are an integral part of any healthful diet, and a compound called phytate in foods such as rice bran and wheat, which may inhibit formation of calcium oxalate crystals, may help prevent kidney stones.

MULTIPLE FACTORS -- MULTIPLE CHOICES

Just as there are multiple causes of kidney stones, there is no one single thing you can do to prevent them, says Dr. Rubman. A multi-pronged approach is required, one that emphasizes more fluids, calcium, fiber and fish oil, and more moderate consumption of protein and (for those with calcium stones) sodium. Next month: Strategies to ease the passing of stones.

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Be well, Carole Jackson, Bottom Line's Daily Health News

Sources:

Rubman's Digestion Connection

Andrew L. Rubman, ND, adjunct professor of clinical medicine, I.W. Lane College of Integrative Medicine, Orlando, and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.

June 5, 2006

Rubman on Digestion

Last month I spoke with Daily Health News contributing editor Andrew L. Rubman, ND, about how to prevent kidney stones. (See Daily Health News, May 2, 2006 issue.) All well and good, but what happens if despite your best efforts you still develop one? Are there any secrets to success that can reduce the pain and suffering of the process?

Dr. Rubman told me that kidney stones generally do not constitute an emergency, and -- if you have a good support system and sufficient stamina to tolerate the pain -- in most cases you can pass a small stone in the relative comfort (if "comfort" can be used in the same sentence as kidney stones) of your own home.

A GOOD SUPPORT SYSTEM IS A MUST

If you're going to attempt to pass a kidney stone at home, the first thing you must have is a tolerant and understanding caregiver or partner, advises Dr. Rubman. He told me that under no circumstances should you attempt to take on this task solo in the event that the pain becomes intolerable. If you live alone, enlist the help of a friend or neighbor. Why the need for company? In case you say: I give up. I can't take it anymore. Take me to the nearest emergency room.

Fortunately, when Dr. Rubman had to pass a stone several years ago, his wife was there to help him through the process with unflagging support and good humor. Pleasant? No. Doable? Yes.

DRINK, DRINK, DRINK!

Last month, Dr. Rubman told us that the single most important thing you can do to prevent kidney stones is to drink plenty of fluids. This keeps the urine less concentrated and flowing freely. (A good benchmark: Aim for urine that is pale and watery, not dark yellow.) When it comes to passing a stone, fluids are if anything even more critical, and Dr. Rubman recommends that you drink a minimum of two quarts a day. Fluid choices include...

Still water. If the water out of your tap leaves something to be desired (for example, hard water is a risk factor for very common calcium oxalate kidney stones), reach for the bottled water.
Sparkling water. Interestingly, sparkling water provides special benefits, as the carbonation -- a combination of carbonic and phosphoric acids -- decreases the tendency for spasm and allows for increased pain tolerance by buffering the acidic changes that accompany inflammation. Dr. Rubman's favorite sparkling water is San Pellegrino. He also recommends the carbonated spring water Gerolsteiner. Packed with electrolytes, this is an excellent water to help pass stones.

Of course, not all fluids are created equal, and it's best to steer clear of sugar-packed products such as sodas and sports drinks. Sugar contributes to inflammation, which contributes to kidney stones. When in doubt, look closely at the list of ingredients. You'll be surprised to learn how much sugar lurks in even so-called health drinks. I asked Dr. Rubman about drinking juices as part of the two quarts a day. His recommendation: Pomegranate diluted with water is best.

FEEL THE HEAT

Another important strategy is to apply heat. Heat can help relax muscles that are tense from pain and spasm, allowing for easier passage of a stone. In particular, Dr. Rubman recommends that you apply a thin layer of a highly aromatic, icy hot preparation such as capsaicin, menthol or eucalyptol over the painful flank (lower back). Once the cream or ointment soaks in, cover the area with a heating pad.

A variety of icy hot preparations is available at your local health-food store. Dr. Rubman's recommendation: Flex-A-Gesic (manufactured by Progressive Labs in Irving Texas and available at http://organicpharmacy.org), which was originally developed for the Dallas Cowboys. This is a no-nonsense, industrial-strength remedy that you will need to don plastic gloves to apply. (Caution: Icy hot preparations sting mightily at first, and some people cannot tolerate them. But if you can wait out the initial sting -- about 10 minutes -- the pain relief will soon begin to kick in. Be sure to wash your hands very well after application so you don't accidentally get it in your eyes.)

Another simple but effective option: Take a hot bath with Epsom salts. Alternatively, Dr. Rubman suggests that hydrotherapy -- alternating hot and cold -- is beneficial, but it may cause nausea. If you want to give it a try, make sure you have a strong caregiver nearby in case you feel dizzy or faint. If you do feel dizzy, get out of the water and lie down.

BOTANICAL OPTIONS

There are also a number of botanicals that can be helpful at both easing the pain and passing the stone. These include corn silk, crampbark, gravel root, stone root, seven barks or khella to ease the discomfort of passing a stone. And wild lettuce, black hellebore, arnica and gelsemium can help ease the pain. Dr. Rubman warns that all of these medications should be prescribed and monitored by a professional. It is unwise to attempt to self-administer the pain remedies.

If you're prone to kidney stones, it's a good idea to have a naturopathic physician on board your health-care team, observes Dr. Rubman. He or she can help you develop and put into practice preventive strategies. If there is blood in the urine, severe pain, fever, an inability to urinate or a stone that fails to pass within 48 hours, go to a critical care facility or the hospital emergency room. In most cases (70% to 80% of the time) stones pass on their own with urine. If you have a good support system in place and know what you're in for, you may be more comfortable (or at least less uncomfortable) seeing the process out in your own home.

Be well, Carole Jackson, Bottom Line's Daily Health News

Sources:

Rubman on Digestion

Andrew L. Rubman, ND, adjunct professor of clinical medicine, Florida College of Integrative Medicine, Orlando, and director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.
Focus On: Calendula

David Winston, RH, and founding member of the American Herbalists Guild, www.americanherbalistguild.com. He is coauthor of Herbal Therapy and Supplements: A Scientific and Traditional Approach (Lippincott).

See also:  Diet If U have Kidney Stones     Herbs for Kidneys 

Alternative Medicine Cabinet:

Kick Kidney Stones

By Lisa Turner

Any man who’s gone through it will tell you that passing a kidney stone is the male equivalent of giving birth. In other words, it really, really hurts. Stones—ranging in size from a grain of sand to a small plum—form in the kidneys, when minerals and other substances in the urine aggregate.

Small stones often pass through the urinary tract on their own (albeit sometimes painfully), but larger formations can get stuck in the ureters or kidney, causing much greater pain. About 5 percent of adults develop a stone sometime in their life, with men being more susceptible to them. Once you’ve had a stone, you’re more likely to have another one. The trick is to stop them before they start. For oxalate stones—by far the most common type—avoid foods such as spinach, rhubarb, wheat bran, and chocolate; drink lots of water; and cut back on meat and salt. Additionally, a medley of natural remedies can help keep you stone free. Try one or two of the following supplements at a time, to see which ones work for you. (For more supplements, go to Web Exclusives at naturalsolutions.com.)

Solidago (Solidago virgaurea L.). Also called goldenrod, this flowering weed grows mainly in the southeastern US. It has long been used to treat bladder, kidney, and urinary-tract problems. By increasing blood flow to the kidneys and increasing urination, solidago helps flush out small stones and reduces calcium buildup. You can buy it as capsules, tinctures, or as a dried herb. Dosage: 2 to 4 ml of a 1:5 tincture, two to three times a day

Magnesium. The body uses magnesium and vitamin B6 to convert calcium oxalate into magnesium oxalate, a soluble (and, thus, peeable) compound. Opt for magnesium citrate supplements, since citrate has been shown to reduce recurrences of stones as well. Take it with meals to more effectively lower urinary oxalate levels. Dosage: 500 to 800 mg of magnesium citrate a day, along with 10 to 200 mg of vitamin B6

Potassium. Found in foods like spinach, cremini mushrooms, and of course, bananas, potassium wards away stones by reducing the amount of calcium in urine. Research indicates that 5 grams of potassium citrate three times a day can significantly reduce the rate of stone formation. Dosage: 15 grams daily of potassium citrate in divided doses

Inositol hexaphosphate (IP-6). You find this carbohydrate, also known as phytate, in cereal grains, beans, brown rice, and other high-fiber foods. In one study published in Anticancer Research, 120 mg a day of IP-6 significantly reduced calcium oxalate crystal formation in people with a history of kidney stones. For greater effectiveness, choose an IP-6 supplement that also contains small amounts of calcium and magnesium. Since phytate can slightly inhibit iron absorption, take it separately from when you eat iron-rich foods or take iron supplements. Dosage: About 2.5 to 5 grams a day

Lisa Turner is a frequent contributor to Natural Solutions magazine.

From:   [http://www.naturalsolutionsmag.com]