Kidney Stones

wabmester

You guys may know that I am fascinated by diet-induced physiological changes. One of those associated with ketogenic diets is kidney stone formation. They are reported frequently in studies, but I don't remember anybody reporting an incidence in this forum.

Until now!

I was feeling GREAT on Friday. Wasn't hungry at all. Went for a 3-mile run in the morning, and I still wasn't hungry until noon. Did a bunch of declined push ups as a show of strength and vigor.

Scarfed down some chicken wings for lunch, followed by some chocolate-covered almonds for an afternoon snack.

Bathroom break at around 5:45pm. Called 911 at 5:50. Stayed in the ER for about 8 hours, but some of the pain meds were pretty good, so only a few hours with some of the WORST PAIN I've ever felt.

Got a CT scan, which other than the cost and the high radiation dose, I was pretty excited about. I asked for and got copies of the digital scans. I now have some cool before and after low-carb/exercise pictures I may share later.

Gained 7 lbs on a dextrose IV drip. Probably overhydrated in an attempt to flush the stone.

The stone is still there. Small, but not small enough apparently. It lodged in the ureter, caused back-pressure, and my kidney ruptured.

They inserted a stent to bypass the stone and give my kidney a chance to heal. Hopefully within a couple weeks.

This is one N=1 experiment I didn't want to perform and wouldn't wish upon anyone.

Did diet cause it? Probably. Did constant dehydration after my runs cause it? Probably. Did the fact that my Dad had one make it more likely for me? Probably.

It turns out to be a fascinating subject, with not a lot of agreement on risk mitigation. The docs and nurses I asked about causative factors were mostly silent, but one did offer that he saw a bunch of athletes with kidney stones, many of them weightlifters taking lots of supplements. Interesting. More later.

FIT_Goat

Ow, I'm sorry to hear about this. I didn't even know kidneys could rupture. That sounds extremely unpleasant.

Hopefully things heal up. I've mostly come to associate kidney stones with dehydration and possibly really, really overdoing it with the green vegetables (oxalate stones). Who knows if those associations are true for you. It could be any number of factors.

Rest up.

NewSue52

Yikes! my sympathies. I had a stone before starting LCHF, it was one of the most unpleasant experiences ever. My dr suggested 100 oz. of water (2.9 L)per day . My new hobby is peeing. But no further problems

wabmester

Calcium-oxalate are the most common, and I eat a ton of almonds, so it could have been that. I'm learning that a specific gut bacterium is needed to help regulate oxalate, so it may be the lack of bacteria rather than the high oxalate that causes it. That could also explain the familial connection.

But another type of stone -- uric acid stones -- are more of a concern for low-carbers and other consumers of high protein (like weightlifters).

wabmester

Just got some blood test results. Most are in the normal range except for a couple specific to the stone and pain meds.

Ketones in the urine.

Random glucose was 125, which is "normal" but I consider it high and probably due to mild insulin resistance and the dextrose IV.

They didn't test Vit D levels, which can be causative.

Sodium and other electrolytes were normal.

Interesting to me was that uric acid was normal and urine pH was normal, but on the high-alkaline side of normal (8.0).

So I'd be surprised if it was a uric acid stone. The alkaline urine suggests calcium or phosphate:
http://www.ncbi.nlm.nih.gov/pubmed/21170875

KittensMaster

I was advised that a yogurt daily is good for bacteria and to research anti inflammatory diet to keep my fatty liver from ever coming back

Kale is very AI, and I get one Greek yogurt daily

Fingers crossed but no fatty liver pain for 2 years

I am cautious about taking many mineral suppliants for this reason. It is a caution in ignorance since I have no solid research evidence

Best wishes.

Foamroller

Omg, ouch! Sounds very painful. Did they say anything about recurrence or preventative measures at the hospital? You're such a trooper, I bet you're gonna research this more thoroughly than most doctors. Which gut bacteria is needed for handling the calcium-oxolate ?

Gotta tell ya, I have newfound respect for the field of nutrition. So much to learn!

wabmester

Oxalobacter formigenes -- apparently not found in fermented foods or probiotics.

I think most of the confusion around stones is that there are multiple causes, so docs can't give very good general advice. The kidney is like a chemistry set. The right mix of compounds, right dilution, and right pH are needed to make the stones. And whether they cause you problems or not is probably the genetic component -- things like ureter diameter.

Incidence is like 12% for men, 7% for women. More likely to happen again since I apparently have the right stuff.

kirkor

wabmester wrote: »

Gained 7 lbs on a dextrose IV drip.

They didn't have keto bags?

deoxy4

Yikes! If you ever have had a kidney stone or been in the company of anyone passing one, EXTREMELY painful.
Not life threatening but bad luck your kidney ruptured.

Did they send out the stone to get it analyzed, so there is no guessing as to its composition.

Vitamin D as causation? High or low? I will have to research.

Just a thought about circulating dietary trends. HighFatLC, Intermittent Fasting, supplementing with vitamin D, lots of greens (high oxalate content), vitamin k2 supplementation (keep calcium where it belongs...), 1500 mg calcium daily calcium RDA, magnesium supplementation.

What effect positive or negative do these components have on someone who may be prone to kidney or gall stones.

Not trying to hijack the thread. I had a physical where there was a very small cyst found on my liver. They monitored it @ 6 months and a year and it turned out to be "nothing." At the yearly they made comment that I had some gall stones which they had not mentioned prior. Doesn't rule out they were not existent before. I had implemented or experimented with every one of the dietary trends I listed above in the prior two years. Whether they had any effect on the formation of my gall stones isn't clear to me. One trend that I don't follow is supplementing with calcium. I personally don't believe the high RDA or taking mega doses of calcium is beneficial.

deoxy4

Did a quick search: kidney stones vitamin D

Interesting, first 10 articles seem to be split. For every reference I found linking Vitamin D supplementation to kidney stones, I found a contrary reference. Like everything else you research.

Here is a pretty good reference about kidney stones.

http://orthomolecular.org/resources/omns/v09n05.shtml

FIT_Goat

I saw one reference that suggested high levels of vitamin C supplementation (over 500mg/day) were linked to it. I think, if you look hard enough, you'll find a way to link just about everything to them.

wabmester

Yup, that article was great. Drink orange juice, but don't eat sugar. And don't eat meat. That's the problem -- different stones are formed from different compounds. The best advice is to drink a lot of water. I drink a lot of water -- that's all I drink, so probably not my problem.

My stone is still there, so no idea what it's made of, but my alkaline urine is the only thing I can go on. I need more fruit juice.

KenSmith108

Sorry to hear about the stone but you're right they gave me great drugs!
Dilaudid I didn't care about anything after they put that in my IV. Mine was 5mm and
I had a heck of a time getting it to my bladder, still good pills for that too, Oxycodone.
They also gave me Flomax I could pee like a young man again.
I was supposed to screen my urine to retrieve the stone. After 2 weeks and no stone
I had to have another cat scan to see where it was, no stone! Somehow I missed it.
The only recommendation was the usual "You should lose weight!"

So take it slow & get better soon.

BTW: I'm sure this is just a coincidence but I was doing physical therapy shortly
before I went to the ER.

wabmester

The stones supposedly take a while to form, but yeah, the dehydration from exercise may have caused it to be a problem. I think the only argument for drinking a lot of water is to increase the odds of eliminating stones before they get too big.

I'm going to try to acidify my urine -- lemon and lime mixed with water seems pretty harmless to try.

Edit:
http://www.ncbi.nlm.nih.gov/pubmed/17721827

Lemon juice was also found to inhibit the rate of crystal nucleation and aggregation. But orange juice did not have any effect on the calcium oxalate crystallization.

deoxy4

Sorry, totally missed that you haven't passed the stone and totally agree sugary juices are a poor idea.
Must be an effect of the 7 screwdrivers I've had today. Hope you are able to pass and retrieve the stone without too much pain.

deoxy4

Another-

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472830/

wabmester

For your amusement, here's a gallery of removed kidney stones:
http://www.kidneystoners.org/information/stone-gallery/

That last one was described to me by a nurse. A "staghorn" stone. In the case described by the nurse, the patient had been eating baking soda as a stomach acid home remedy and that caused the kidney stone.

KittensMaster

Your findings inspire me to squirt some lemon juice in my water bottles I take on my bike rides

Foamroller

If you need acid, could vinegar be of help ? I try make french vinegraitte with olive oil. My dad used that almost every day, so I prefer it. After reading dr. Fung, my vinegar consumption has gone up as well.

ki4eld

This entire thread hurts just reading it! *hugs* to you @wabmester

wabmester

Thanks for the well-wishes and entertainment.

I think ACV is probably as good as lemon juice. Evidence seems to point to citric acid binding to Ca as the factor more than effects on urine pH.

GaleHawkins

I hope it passes soon. The pain I had was like nothing I had experience.

SkinnyKerinny

Oh no. I'm so sorry to hear this news. I hope you're feeling better.

I haven't experienced this before and don't know if this works with your diet but supposedly it will break up the stones . . .

http://www.amazon.com/Planetary-Herbals-Stone-Tablets-tablets/dp/B00C7XUZN0/ref=sr_1_1?rps=1&ie=UTF8&qid=1440373587&sr=8-1&keywords=kidney+stones&pebp=1440373643979&perid=09W81786DKAX0NAMH8CZ

Hope you feel lots better soon and are home from the hospital.

KarlaYP

Kidney stone pain is some of the worst pain I ever treated patients for during the time I worked in the ER. Bless you for that terrible experience! This is another case of finding what causes them for you. Then eliminating the substance, or circumstances, that lead to the stone formation. I hope you can retrieve the stone and have it analyzed. That will surely help, just knowing what it's made of. Hope you get better fast!

wabmester

Good info on stone formation here:
http://kidneystones.uchicago.edu/how-much-is-enough/

In a nutshell, a stone is formed via supersaturation by the kidney. These guys measured concentrations of CaOx and CaP and determine how much urine flow is needed to keep concentrations below supersaturation, and then estimated intake to maintain that flow.

Fasting, 2 hours, at 5 ounces an hour, 10.5 ounces (0.3 liter) total.

Fed, 14 hours from first meal to bedtime, we need 14 * 5.25 = 73 ounces (2.1 liters) total.

Overnight, 8 hours, at 5 ounces an hour, 40 ounces (1.2 liters) total.

Altogether this makes 123 ounces (3.6 liters) of fluid intake a day in this example. One can calculate for the fasting, fed, and overnight periods of a patient to obtain a more refined estimate.

So they argue it's all about fluid intake, and you need to drink a LOT to avoid stone formation.

wabmester

Researching kidney stones has exhausted me.

My friends and family are convinced that my "crazy diet" was the cause of my stone. They may be right.

Probably the best analysis is from Paul Jaminet:
http://perfecthealthdiet.com/2010/11/dangers-of-zero-carb-diets-iv-kidney-stones/

I'm not going to summarize it, and his conclusions may be wrong. The only thing he got right for sure was this:

A 100-fold odds ratio is hardly ever seen in medicine. There must be some fundamental cause of kidney stones that is dramatically promoted by clinical ketogenic diets.

Just over half of ketogenic diet kidney stones are composed of uric acid and just under half of calcium oxalate mixed with calcium phosphate or uric acid. Among the general public, about 85% of stones are calcium oxalate mixes and about 10% are uric acid. So, roughly speaking, uric acid kidney stones are 500-fold more frequent on the ketogenic diet and calcium oxalate stones are 50-fold more frequent.

So the biggest increase in risk is for uric acid stones, probably due to the increased uric acid load and acidic urine from protein metabolism on some ketogenic diets.

In my case, my urine was alkaline, and I wasn't on a hard-core ketogenic diet. I think the content of my diet was a minor factor.

I think it was fluid levels. I ran 5 days a week. I would lose 2lbs of water via sweat during a run.

But my urine was never dark, and I drank a lot of water, so WTH?

Ready for my theory? This could be wrong, of course. We all lose water weight on a low-carb diet. Sure, part of it is due to glycogen stores being burned out, but most of it is due to sodium loss.

Why do we lose sodium? Because we have ketones in our urine, and the ketone anions get covered by sodium cations. Sodium blood concentration is TIGHTLY regulated, so our body has to dump water to maintain blood sodium concentration.

We end up with less sodium, less blood volume (water), and higher CONCENTRATIONS of other solutes in the urine.

Like I said, I could be wrong, but I think the water weight we lose is possibly a kidney stone risk.

minties82

I don't know how much pain you must have been in, I've never had kidney stones but did have gall stones for 8 years. Many of them passed into my bile duct where they remained until they were surgically removed. Worst f-ing pain ever, I was apparently pretty heavily sedated but screamed and screamed for the 40 minutes it took to shove 'em through. Screaming with a camera down your throat is pretty hard haha.

I never ever want a stone of any sorts again in my life so I'm watching this with great interest. I spent way too many years lying on my side crying and vomiting from the stupid gallstones. I'd rather eat donurs than have stones. A million times over.

wabmester

I agree with you. If the CIA ever uses kidney stones as a torture device, all of our enemies will gladly divulge their secrets to us.

Jaminet uses this as one of the reasons he recommends a carb minimum of around 200g/d. That's probably not going to fly very well around here.

One of the things running does to a low-carber, besides dehydration, is produce MEGA ketones, so a bunch of them end up in your urine.

If I'm right, then it's best to minimize ketones in the urine. Or, if you insist on peeing out a lot of ketones, you've got to eat a bunch of sodium (which Jaminet also recommends).

The recommendation for salt is contrary to the standard medical advice for kidney stones, but I think we need it.

minties82

Any excuse to eat salt and be a couch potato sounds good to me. Not that I can run far enough to ever get dehydrated but I often ignore thirst. I should see if the hospital will send me a pic of my bile stones, there was so many they said they'd use the picture for teaching medical students.

How are you feeling now? Are you in agony? And exploded kidney sounds excruciating.

200g of carbs might be a wee bit high for stumpy lumps such as myself but for an active man it sounds good.

wabmester

I may try to increase my carbs a bit, but not that much. Just talked to my Dad, who said he had two of them, so genetics is obviously a factor for me.

Pain isn't too bad, but my doc says there's a low probability of passing it on my own, so surgery is scheduled for Oct (to give the kidney a chance to heal first).

I wish us both a long and happy stone-free future.