Preventing and Managing Kidney Stones: No More Kidney Stones

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Preventing and Managing Kidney Stones: No More Kidney Stones

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by John S. Rodman, MD, Cynthia Seidman, MS, RD and Rory Jones

Quality paperback, 225 pp, $14.95 US, $19.95 Canada

John Wiley & Sons, New York, New York 1996

Kidney stones have afflicted many people throughout history. Egyptian mummies from ten thousand years ago show evidence of stones in X-rays. "Cutting for the stone" is one of the oldest surgical procedures. Interestingly, urology is the sole specialty noted in the Hippocratic oath. Famous historical figures such as Ben Franklin; Newton; Peter the Great; and Louis XIV all suffered from kidney stones. Although this ailment is not a new phenomenon, since World War II, the numbers of people suffering from kidney stones has increased dramatically in the industrialized world. About one in 15 people will develop kidney stones, and in some places, the numbers are one in five. More than a million Americans are hospitalized yearly for treatment of kidney stones. And, what formerly was mostly a male disease, now affects both genders.

This dramatic rise in kidney stones is attributed to dietary changes, according to the authors of No More Kidney Stones. As people eat richer and richer diets, they must get rid of more bodily wastes. Many of the wastes go through the kidney and are excreted through the urine. If people understand what causes stones and are prepared to make basic dietary and lifestyle changes, recurrent kidney stones are preventable, according to Dr. Rodman.

Two important measures to stop stone formation are (1) to drink adequate amounts of water in order to maintain a dilute urine, and (2) to alter dietary habits so that food wastes can be excreted from the body. Eating too much of certain foods, according to the authors, "is like putting coffee grounds and hair in your (sink) drain."

There are different types of kidney stones. The majority are calcium oxalate. Others are composed of uric acid, which are more common in people over 50. They increase in incidence with age. Other stones are struvite, which are infected stones. Cystine stones are rare, and result from an uncommon hereditary metabolic disorder that causes the kidney to excrete too much cystine in the urine. Often, stones contain a combination of elements -- as many as 20 different substances.

Foods of concern to stone formers are those that form oxalate that appears in the urine. Oxalate forms from intake of excessive amounts of protein; waste products of general metabolism; and certain foods.

The authors warn that quick weight-loss diets can contribute to kidney stone formation. Such diets cause an increased turnover of body tissues by "burning off" stored body weight. As the excess tissues break down, the kidney is presented with an overload of waste products similar to the overload generated after a large meal. The waste includes uric acid, oxalates, and other acids. In terms of causing kidney stones, quick-weight loss is as bad, or potentially worse, than overeating protein.

Laxative abuse is another factor in kidney stone formation. The biochemical result is chronic acidosis because of the continuing loss of bicarbonate in the stool. The urinary pH remains acid all the time, and in women, systemic acidosis also can lead to loss of minerals from the skeleton and result in osteoporosis. Laxative abuse also leads to potassium loss, which causes the kidney to make an unusually large amount of ammonium to compensate. This can cause an uncommon type of stone: ammonium acid urate.

Dehydration is a common cause of stone formation. In times of chronic diarrhea or episodes of food-borne illness, large amounts of fluids are lost through the stool or vomiting. Often, these extreme losses of fluid are more than the kidney can handle, and dehydration results in stone formation as well as body imbalance. Rehydration is imperative.

No More Kidney Stones includes practical discussions about "Finding the diet that is right for you," which discusses oxalate, calcium, sodium, protein, vitamin and mineral supplements, portion size, and fluid intake. There are helpful chapters that give guidance for modifying recipes, and how to eat at parties and other special occasions without compromising a stone-preventing diet. There are tables of high-sodium foods to avoid, and blank food diary pages to track daily food intake.

No More Kidney Stones is a helpful book. It is well organized and clearly written. Dr. Rodman is Associate Clinical Professor of Medicine at Cornell University School of Medicine in New York City, and is on the staff of hospitals in New York City. He is an internationally recognized expert and researcher on kidney stone formation, and has published extensively in professional journals and medical textbooks. Ms. Seidman is director of Dietary Services at The Rockefeller University Hospital in New York City, where she coordinates the design and development of all research diets. She has published in a number of professional journals. Ms. Jones is a writer and television producer who has done extensive work on health and medical topics.

Townsend Letter for Doctors & Patients.

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By Beatrice Trum Hunter

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