(Another sample entry from our Q&A Treasure chest, a database with hundreds of entries to support students with their patient and client work. Unlimited access is included as part of our Core 101 Semester program.)
A question from a Practitioner:
I have a client with obesity and challenges with blood sugar control. She has bursitis, among other challenges, and also has struggled repeatedly with calcium oxalate kidney stones, and she seems to believe that laparoscopic surgery is the only way to deal with them. I know that’s not true…I am helping her with overall dietary changes (e.g. increasing veggies and whole grains), but I’m not sure how to help her specifically with the kidney stones remedy and preventing recurrence. She struggles with sleep as well because of physical pain. She is very eager and motivated to get better. What would you recommend for people with recurrent kidney stones and who want to lose weight?
One of the organs most vulnerable to inflammation from chronically-elevated blood sugar (as we often see in obesity) is the pair of kidneys. Reduced kidney filtration capability can cause minerals to build up, precipitate out of urine, and eventually form stones. Especially given the obesity, the key tenet for both of this client’s goals is eliminating sugar and sweeteners and also reducing refined and concentrated carbohydrates. I would be careful with encouraging too many whole grains – only small servings (~1/2 cup at a time) as a substitute for refined flour-based foods. Depending on her tolerance for carbohydrates, grains may need to be removed entirely, at least for a time during the reversal of insulin resistance.
Learn more about kidney stones here. Most kidney stones are indeed of the calcium oxalate variety (~80%), but it’s important to realize that kidney stones can be made of other substances as well. There are several key tenets for the elimination or prevention of these kidney stones. Depending on the client’s unique situation, I definitely disagree that surgery is a must; I have had many clients get rid of them naturally without surgery.
But of course, we don’t want to stop at triage or rapid relief. We want to get to the root cause and reverse it to prevent recurrence! This is a clinical write up which will be of interest for further exploring the biochemistry at play. Chronic dehydration is common. Sub-clinical prediabetes is common. Sluggish bile flow is common. Moderate oxidative stress (from myriad sources) is common – especially because of our poor intake of nutrient-dense foods that would promote adequate, ongoing synthesis of endogenous antioxidants, especially glutathione! Perhaps surprisingly to you, I also recommend putting focus on individuals who have had their gallbladders removed, who have brewing congestion in the bile duct system (perhaps look for high or very high/normal alkaline phosphatase), or who have had various types of gastric bypass surgery.
Practitioners are often curious about the role of urinary pH in kidney stone formation. Balanced urine pH is key to avoiding stone formation in those who are otherwise predisposed to these challenges. Calcium oxalate can precipitate out and form crystals at any urinary pH level if the concentration is strong enough, but pH >6.5 encourages this type of crystallization into stones. On the other hand, an overly acidic urine can encourage uric acid stone formation. The classic “old fashioned” remedy of using cranberry juice to prevent calcium oxalate kidney stones has been shown to be effective but not due to overt effects on urinary pH. And especially under circumstances such as this case, it’s important that this be low-sugar cranberry juice and used as a future preventive vs. an eradication therapy.
There are many patient profiles who are at increased risk of calcium oxalate kidney stones. Fasten your seat belts: there’s an amazing variety of interconnectedness potentially at play with this one! Certainly Type 2 diabetics and others who struggle with elevated blood sugar (which increases oxidative stress and usually (as an internal defense) the formation of more uric acid (a key circulating antioxidant). High blood sugar itself impairs kidney function via oxidative stress. On top of that urinary acids such as uric acid and oxalic acid compete for reabsorption in the kidneys. Individual who do not have a gallbladder or who have had gastric bypass surgery can struggle with excessive oxalic acid absorption via the gut because insufficient bile flow allows unabsorbed fats to bind with calcium in the GI tract. Normally, dietary calcium binds readily with oxalate and prevents excessive absorption. A fascinating example of interconnectedness in the body that has been well studied! (More here) Insulin resistance and hyperglycemia can persist to create fatty liver which promotes bile flow issues and can lead (you guess it!) to a higher incidence of kidney stones. Yeast species (e.g. candida, aspergillus) produce oxalates as part of their normal metabolism, so those with chronic yeast overgrowth challenges may wrestle with oxalate overload (think gut, yes, but also vaginal/urinary tract and elsewhere). Also, note that oxalate dissolution in the body requires ample Vitamin B6 (notably, as does glutathione synthesis). Your client’s chronic pain may also be associated with other oxalate build-up in the body as well. The role of Vitamin B6 and its power as an intervention along with citrate salts has actually been studied. (Here too)
For a more entrenched, recurrence case, I have also had a couple of clients use Dr. Schulze’s “Kidney Cleanse” to get rid of their kidney stones, and in neither case have they recurred after more than three years post-remedy. This is a rather intense five-day cleanse, so it’s not suitable for all clients. But pain can be a powerful motivator! Obviously an ongoing focus on hydration and key nutrients (as above) is key and was implemented in both of these cases. For ongoing stone recurrence, Dr. Schulze’s “K-B Formula” twice daily is quite effective as a preventive.
For individuals with more challenging chronic, recurring kidney stone challenges, you might consider chanca piedra. There is some (admittedly little) formal research into the use of this herb to relieve kidney stones, but there is a significant amount of experiential evidence of its effectiveness. I had used it quite successfully with a handful of clients with this challenge. You might find this helpful.
For recurring kidney stones, I also recommend checking health of the parathyroid gland. See if your client’s serum calcium level (part of a Complete Metabolic Panel – or CMP) has been in the high 9s or 10s (assuming she’s at least 30 years old). If so, your client can request that her parathyroid hormone (PTH) levels be measured at the same time as serum calcium again. If serum calcium is high-ish, then PTH should be quite low in the reference range. If PTH is high in the range or clinically high alongside a high-ish serum calcium, there may be PTH dysfunction promoting calcification issues in the body.
P.S. If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.
If you haven’t done so already, sign up to receive weekly clinical tips like this via email, and you’ll also get automatic access to a free mini clinical course.
Like us on Facebook to get more great clinical tips and to get notifications of my next Facebook Live!