No more kidney stones thanks to nutritional changes

Q: I recently passed a kidney stone. I've heard that once you have kidney stones, you're more likely to get them again. I don't want to go through that horrible pain again! What can I do?

A: Get yourself started on a basic kidney-stone prevention program. Limit your intake of meat, sugar, salt, and fruit juice (except lemon juice, which is high in stone-reducing citric acid and citrate). You should also increase your dietary fiber and supplement with the following: 10,000 units of vitamin A, 300 mg of magnesium citrate, and 100 mg of vitamin B6 each day. Even though studies have "dispelled the myth" that higher amounts of vitamin C promote calcium oxalate kidney stone formation, I've seen two such cases first hand. So if you take three or more grams of vitamin C each day, have your doctor measure your urinary oxalate.

There is a considerable variety of kidney stones (Renal Calculi) that you should know about, but here are the five well-known ones.

1. Calcium phosphate stones. They are very common but easily dissolved in urine acidified by vitamin C.
2. Calcium oxalate stones. These are not dissolved in acid urine.
3. Magnesium ammonium phosphate (struvite) stones. These are less common and only appear after an injection, but they dissolve in urine acidified by Vitamin C.
4. Uric acid stones may form in a condition such as gout. It is a result from a problem metabolizing uric acid and purines.
5. Cystine stones are very rare and only results from a hereditary inability to reabsorb cystine.

Risk factors of kidney stones

The risk factors for kidney stones include obesity, poor diet, low dietary intake of magnesium, chronic dehydration, and hypertension. Eleven percent of men and seven percent of women develop kidney stones. Researchers found that some drinks can increase the problem. According to a Brigham and Women’s Hospital study released on Wednesday if you have at least one soda every day, your likelihood of developing kidney stones is thirty-three percent compare to those who drink less than one serving per week.

The dietary data analyzed by researchers from Boston and Rome from 194,000 respondents in the Harvard Health professional study and Nurses Health study revealed that sugary sodas and fruit punch could increase your risk of developing kidney stones up to twenty-five percent. The high-sugar content in these drinks can increase the kidney’s excretion of calcium that can crystallize into stones. The good news is, tea, coffee, orange juice, wine, and beer can reduce your risk.

Although people are often advised to drink lots of fluid, you may have to be careful about sugary sweetened drink because according to a study published online in the Clinical Journal of the American Society of Nephrology, these drinks are associated with higher incidences of kidney stones.

Ways to Reduce Your Risk of Kidney Stones

1. Drink fruit and vegetable juices high in citrates which inhibit the forming of calcium salt as well as the build-up of uric acid.
2. Take Vitamin C because it improves the urinary excretion of uric acid.
3. Lose weight
4. Try to reduce your calcium intake and reduce excess dietary phosphorous by avoiding colas.
5. Take magnesium supplement
6. Take B-complex vitamins.
7. For purine stones/uric acid, avoid eating meat because it s a major source of purine.
8. If you have cystine stones follow a low methionine diet.
9. Lessen your sugar intake.
10. Practice good preventive health care.

Citrus Fruit Benefits

Citrus fruits have a lot more to offer than just vitamin C.

Oranges are the best citrus source of vitamin C, right?

Yes. One medium orange has about 70 milligrams (mg) of vitamin C, nearly enough to meet your basic daily needs. But ounce for ounce, lemons actually contain the most (77 mg in 3.5 ounces), followed by oranges (53 mg), pink grapefruit (37 mg), white grapefruit (33 mg), limes (29 mg), and tangerines (27 mg). The exact amount depends on where the fruit was grown, how it was handled, and even where on the tree it was located.

What else is in citrus?

Citrus fruits are a good source of folate and potassium, with small amounts of magnesium, calcium, and other nutrients. They are often rich in fiber — notably pectin, a soluble fiber that helps lower cholesterol. One medium orange has 3 grams of fiber. They also contain dozens of phytochemicals, including carotenoids and limonoids. Citrus flavonoids such as hesperetin (in oranges), naringin (in grapefruit), and tangeritin (in tangerines) have been shown in lab studies to have cholesterol-lowering, antioxidant, anti-inflammatory, and anti-cancer properties. Red/pink grapefruit is one of the best sources of the carotenoid lycopene.

Is citrus juice better than the whole fruit?

A cup of citrus juice has more vitamin C than a piece of whole fruit because it is concentrated (it takes nearly a pound of oranges to make a cup of juice). But it is also higher in sugar and calories—and lacks the fiber of the whole fruit. A glass of orange or grape-fruit juice is a good way to start the day (especially if it's fortified with calcium), but it is better to eat whole fruit, which has less effect on blood sugar and is more filling. Fresh OJ is slightly higher in C and other nutrients than juice made from concentrate.

Is the peel good for you, too?

Yes. Many of the substances in the pulp are also in the peel, though you're not likely to eat much of it. The peel consists of two parts: the inner spongy white albedo, which is the primary source of pectin, and the outer flavedo (or “zest”), where carotenoid pigments and fragrant volatile oils are found. Some nutrients in the pulp, such as vitamin C and folate, are also found in the peel.

Why are some oranges tinged with green?

Oranges grow in warm climates but need cool nights to turn orange. If nights are warm, oranges can remain slightly green. Another factor is “re-greening,” when fully developed oranges absorb some of the chlorophyll produced by the tree and turn partly green again. These oranges are extra-ripe and often sweeter. To make oranges uniformly orange, producers often expose them to ethylene (a harmless gas that some fruits naturally release) or treat them with vegetable dye. Whatever the color, oranges are always picked when mature and do not ripen further off the tree.

Do citrus fruits help reduce kidney stones?

There's some evidence that orange juice and lemonade may reduce the risk of certain kinds of stones (calcium stones) by boosting citrate levels in the urine. However, grapefruit juice may, according to preliminary studies, increase the risk. Follow your doctor's advice.

What is the grapefruit/drug effect?

Grapefruit and its juice can boost blood levels of certain medications to potentially dangerous levels. Substances in the fruit—possibly naringin, a flavonoid that provides the tart taste—inhibit an enzyme in the small intestine that helps break down the drugs. The interaction happens fast and can last 24 hours or longer. But it's highly unpredictable, varying from person to person and even from grapefruit to grapefruit. If you take medication and consume citrus, check with your doctor or pharmacist. The drugs include many cholesterol-lowering statins, as well as certain calcium channel blockers (for high blood pressure), tranquilizers, anti-histamines, and HIV drugs. Seville oranges (sour like grapefruit) may have a similar effect, as may pomelos and tangelos.

Can grapefruit help you lose weight?

It's a myth that grapefruit contains a special enzyme that digests and burns fat and promotes weight loss. While there are no such fat-burning substances, grapefruit is low in calories (40 in half a medium fruit) and filling, which is why it may help some people lose weight.

Citric Acid and Kidney Stones

What is it? How can it help?
Citric acid is an organic acid and a natural component of many fruits and fruit juices. It is not a vitamin or mineral and is not required in the diet. However, citric acid, not to be confused with ascorbic acid (vitamin C), is beneficial for people with kidney stones. It inhibits stone formation and breaks up small stones that are beginning to form. Citric acid is protective; the more citric acid in your urine, the more protected you are against forming new kidney stones. Citrate, used in calcium citrate supplements and in some medications (such as potassium citrate), is closely related to citric acid and also has stone prevention benefits. These medications may be prescribed to alkalinize your urine.

How does citric acid protect against kidney stones?
Citric acid makes urine less favorable for the formation of stones. In its natural form, such as from citrus fruits, citric acid does not alkalinize the urine as citrate (from medication) does.
Rather, it prevents small stones from becoming “problem stones” by coating them and
preventing other material from attaching and building onto the stones.

What are the best food sources of citric acid?
Citric acid is most prevalent in citrus fruits and juices. Of these fruits, lemons and limes have the most citric acid. While oranges, grapefruits, and berries also contain appreciable amounts, lemons and limes will most significantly contribute to the citric acid content of your urine.
Pharmacological doses of citric acid, prescribed as potassium citrate, are effective in the
treatment of stones. However, treatment may be costly and require as many as 12 tablets daily.
A half-cup (4 ounces) of pure lemon juice per day or 32 ounces of prepared lemonade provide about the same amount of citric acid as does pharmacological therapy.
Keep reading for tips to increase your citric acid intake and minimize your risk for developing kidney stones. In addition to increasing your citric acid consumption, drinking adequate fluids (at least ten 8-ounce glasses per day) – more in hot weather or when physical activity promotes heavy perspiration – may be the most powerful way to decrease your risk of developing stones.

Increase Your Citric Acid Intake: 10 Easy Tips
1. Eat 5 or more fruits and vegetables daily.
As lemons and limes provide the most citric acid per gram, these tips focus on them. Remember, though, that increasing your intake of all fruits and vegetables – especially the citrus variety – will add to your citric acid intake
and provide other health benefits as well. For example, the potassium, magnesium, and
phytate contained in fruits and vegetables protect you against forming new stones. Other
phytochemicals in plant foods prevent cancer and other chronic diseases.

* Here’s a tip to get more juice from lemons –
roll them on a hard surface while pressing down
with your palm. Or, heat them for about 30
seconds in the microwave before squeezing.

2. Squeeze fresh lemon (or reconstituted lemon juice) into ice cube trays before freezing.
Directions: Fill trays almost full with water. Then, squeeze half a lemon or more over the tray, and freeze. Use these cubes for sprucing up plain tap water and other beverages. If you like the taste of lime, use lime instead of, or in addition to, lemons. Remember to drink at least 10 glasses of fluid every day to keep your urine dilute enough to prevent stones.

3. Squeeze fresh lemon or lime juice directly into your soda, fruit juice, tea, or water.

4. Use lemon juice. Dilute 2 ozs. lemon juice with 6 ozs. water and drink twice a day – once in the morning and once in the evening – to reach the goal of 4 ozs. lemon juice per day.

5. Drink lemonade every day. Depending on your urinary citrate concentration, 16-32 ozs.
daily may be recommended, distributed throughout the day. To make homemade
lemonade, squeeze a ½ cup (4 ounces) of fresh lemon juice into a pitcher of cold water; bottled lemon juice may also be used. Add sugar or sugar substitute, if desired. Make it by the glass for a single serving. Or, use commercially available lemonade products and mixes. We strongly recommend low-calorie lemonades and lemonade mixes (such as Minute Maid Light, Tropicana Light, or Crystal Light). These are high in citric acid but have little sugar and few calories. Of the commercially-available lemonade products, those that are ready-to-consume have more citric acid than those that come as a powder.

6. Make a lemon or lime spritzer. Here’s how: Pour 2 cups fresh lemon or lime juice (from about 9 medium size lemons or limes; or use lemon or lime juice concentrate) into a large pitcher. Add 1 cup Splenda®, a no-calorie sweetener made from sugar. When sugar is fully dissolved, add 1 liter chilled club soda, thin lemon & lime slices, and a few ice cubes. Stir and chill thoroughly before serving.

7. Use fresh lemon on lettuce or spinach salads. You may find yourself using
less of those high-fat salad dressings!

8. Use freshly squeezed lemon or lime on fruit salads. Besides adding a zesty taste, the acid in the juice will prevent cut fruits, such as apples, from browning with exposure to air.
You’ll have better-looking and healthier fruit salads.

9. Use lemon or lime juice on fish and in marinades for any type of meat. When looking for marinades and other recipes, try the ones that call for lemon or lime juice, and incorporate them into your menus at home.

10. Read the label. Choose products that are high in citric acid. Some lemon-lime sodas, for example, are relatively high in citric acid. If you drink soda, consider switching to one that’s high in citric acid.