eating principles:
calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18%
high fiber
decrease foods that are high in purines and oxalates; dairy products
therapeutic foods: (Ni, p. 158)
foods that tonify the Kidney
grapefruit, watercress, cornsilk, watermelon, celery, water chestnuts, seaweed
foods high in Magnesium and Calcium: soy, lima beans, potato, avocado, brown rice, barley, corn, buckwheat, rye
increase dark green leafy vegetables: beet, radish, mustard, dandelion, collard greens, kale, spinach, chard
fresh juices:
carrot
carrot, celery, and parsley (Walker, p. 140)
carrot and parsley (Walker, p. 140)
lemon juice in warm water (Walker, p. 140)
watermelon (Shefi)
celery, carrot, and water chestnut (Ni, p. 158)
cornsilk tea (Shefi)
2 tsp. ground walnuts in cornsilk tea (Ni, p. 158)
foods contraindicated:
spicy, hot, rich foods, citrus, dairy products, tofu
foods rich in purines: organ meats, meat, shellfish, herring, anchovies, sardines, lentils, dry peas, dry beans, seafood, meats, alcohol, asparagus, mushrooms
oxalate-containing food: spinach, black tea, cocoa, tomatoes, red beet tops, rhubarb, parsley, cranberry, nuts (Jensen)
supplements
MAY need to restrict Calcium, oxalate, Vitamins C and D, if calcium oxalate stones exist. However, this long-held theory has not been borne out by epidemiological research. (Sowers MR, et al. Am J Epidemiol 1998 May 15;147(10):914-920)
Vitamin C: While many claims have been made as to the possible increased risk of kidney stones due to vitamin C supplementation, little conclusive evidence has appeared to confirm that suspicion. (Curhan GC, et al. J Urol 1996 Jun;155(6):1847-1851.) One recent study of individuals with recurrent calcium oxalates stones found that supplementation with ascorbic acid reduced their hyperinsulinemia and restored normal urine acidification, without increasing urinary oxalate levels. (Schwille PO, et al. Urol Res 1997;25(1):49-58.)
Vitamin B6 10-100 mg per day (Watts, 1985, p. 87; Marz)
Magnesium 500 mg per day
Potassium citrate 60-80 mcg per day
Taurine (Austin, 1987)
footnotes
Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. J Urol 1996 Jun;155(6):1847-1851.
Abstract: PURPOSE: The association between the intake of vitamins C and B6, and kidney stone formation was examined. MATERIALS AND METHODS: We conducted a prospective study of the relationship between the intake of vitamins C and B6 and the risk of symptomatic kidney stones in a cohort of 45,251 men 40 to 75 years old with no history of kidney calculi. Vitamin intake from foods and supplements was assessed using a semiquantitative food frequency questionnaire completed in 1986. RESULTS: During 6 years of followup 751 incident cases of kidney stones were documented. Neither vitamin C nor vitamin B6 intake was significantly associated with the risk of stone formation. For vitamin C the age-adjusted relative risk for men consuming 1,500 mg. daily or more compared to less than 250 mg. daily was 0.78 (95% confidence interval 0.54 to 1.11). For vitamin B6 the age-adjusted relative risk for men consuming 40 mg. daily or more compared to less than 3 mg. daily was 0.91 (95% confidence interval 0.64 to 1.31). After adjusting for other potential stone risk factors the relative risks did not change significantly. CONCLUSIONS: These data do not support an association between a high daily intake of vitamin C or vitamin B6 and the risk of stone formation, even when consumed in large doses.
Gerster H. No contribution of ascorbic acid to renal calcium oxalate stones. Ann Nutr Metab 1997;41(5):269-282.
Abstract: Even though a certain part of oxalate in the urine derives from metabolized ascorbic acid (AA), the intake of high doses of vitamin C does not increase the risk of calcium oxalate kidney stones due to physiological regulatory factor: gastrointestinal absorption as well as renal tubular reabsorption of AA are saturable processes, and the metabolic transformation of AA to oxalate is limited as well. Older assays for urinary oxalate favored in vitro conversion of AA to oxalate during storage and processing of the samples. Recurrent stone formers and patients with renal failure who have a defect in AA or oxalate metabolism should restrict daily vitamin C intakes to approximately 100 mg. But in the large-scale Harvard Prospective Health Professional Follow-Up Study, those groups in the highest quintile of vitamin C intake (> 1,500 mg/day) had a lower risk of kidney stones than the groups in the lowest quintiles.
Schwille PO, Schmiedl A, Herrmann U, Wipplinger J. Postprandial hyperinsulinaemia, insulin resistance and inappropriately high phosphaturia are features of younger males with idiopathic calcium urolithiasis: attenuation by ascorbic acid supplementation of a test meal. Urol Res 1997;25(1):49-58.
Abstract: In idiopathic recurrent calcium urolithiasis (RCU) the state of insulin and carbohydrate metabolism, and relationships to minerals such as phosphate, are insufficiently understood. Therefore, in two groups of males with RCU (n = 30) and healthy controls (n = 8) the response to an oral carbohydrate- and calcium-rich test meal was studied with respect to glucose, insulin, and C-peptide in peripheral venous blood (taken before and up to 180 min post-load), and phosphate and glucose in fasting and post-load urine. In one RCU group (n = 16) the meal was supplemented with ascorbic acid (ASC; 5 mg/kg body weight). The mean age (RCU 29, RCU + ASC 30, controls 27 years) and mean body mass index [RCU 24.4, RCU + ASC 25.0, controls 24.0 kg/m2] were similar. Insulin resistance (synonymous sensitivity of peripheral organs to
insulin) was calculated from insulin serum concentration, as was also integrated insulin, C-peptide, and glucose. Untreated stone patients (RCU) developed hyperinsulinaemia between 60 and 120 min post-load, increased integrated insulin, and insulin resistance (P < or = 0.05 vs controls), whereas the rise of C-peptide and glycaemia (absolute and integrated values)
was only of borderline significance. Fasting phosphaturia was low in both RCU subgroups vs controls; however, phosphaturia in untreated RCU rose in response to the meal, contrasting sharply with a decrease in controls. ASC supplementation of the meal (in the RCU + ASC subgroup) normalized insulin, failed to normalize post-load phosphaturia, but reduced post-load glucosuria and urinary pH significantly (mean pH values 5.55 vs 5.93 in untreated RCU, controls 5.50). Postprandial urinary oxalate, calcium, protein, and supersaturation products were not changed. The postprandial changes in phosphaturia and insulin sensitivity were inversely correlated (n = 38, r = -0.44, P = 0.007). It was concluded that in younger RCU males: (1) postprandial hyperinsulinaemia, the failure to reduce phosphaturia and - within limits -
glucosuria, appropriately, as well as poor urine acidification are important features of the metabolism; (2) these phenomena are probably caused by insulin resistance of organs, the kidney included; and (3) the addition of a supraphysiological dose of ASC to a meal, the subsequent abolition of hyperinsulinaemia, and the restoration of normal urine acidification suggest that this antioxidant is capable of counteracting some pre-existing basic abnormality of cell metabolism in RCU.
Sowers MR, Jannausch M, Wood C, Pope SK, Lachance LL, Peterson B. Prevalence of renal stones in a population-based study with dietary calcium, oxalate, and medication exposures. Am J Epidemiol 1998 May 15;147(10):914-920.
Abstract: Little is known about the epidemiology of renal stones, in spite of the relative frequency of this painful condition. This population-based study examined reported renal stone diagnosis in 1,309 women aged 20-92 years to determine whether renal stones are associated with 1) food or water exposures or 2) lower bone mineral density and an increased likelihood of fractures. Results indicated a renal stone prevalence of 3.4%. The average age at diagnosis was 42 years. Renal stone formation was not associated with community of residence, hypertension, bone mineral density, fractures, high-oxalate food consumption, or ascorbic acid from food supplements. Women with renal stones consumed almost 250 mg/day less dietary calcium (p < 0.01) than did women without stones and had a lower energy intake (p < 0.04). The authors' findings do not support the hypothesis that increased dietary calcium is associated with a greater prevalence of renal stones, nor do they identify renal stones as a risk factor for low bone mineral density. Furthermore, lack of other identifiable environmental correlates and the relatively young age at initial diagnosis suggest that genetic components of renal stone formation need further study.