Indian Diet for Kidney Stone Patients

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We eat 'superfoods' because its good for the heart, liver, eyes, but how often will you eat something because it is good for the kidneys?

Before I get into Indian Diet For Kidney Stone Patients , let's understand few facts.

Kidneys, the not-so-distinguished but important organs, have very vital functions to perform in your body. They work subtly and do their job in the background, which ultimately brings less attention to the priority of maintaining their health.

How and what functions do your kidneys perform?

Every healthy person has two working kidneys, each of which is about the size of an adult fist. They sit on either side of the spinal cord right below the rib cage. Although they are small in size, the kidneys carry out several complex and fundamental functions to balance the body.

Some of the most important functions of kidneys in your body are as follows:

• Filters the blood of toxins, keeping some compounds while removing others and making urine.
• Aids in removing excess fluid and waste from the body.
• Makes vitamins that control growth, such as active Vitamin D.
• It makes Erythropoietin, the hormone that stimulates red blood cell production.
• Releases hormones that help to regulate blood pressure.
• It helps regulate blood pressure, red blood cells, fluid balance, and certain nutrients in the body, such as calcium and potassium.

The kidneys are an essential pair of bean-shaped organs in the body that receive about 25% of cardiac output. They perform their life-sustaining duty of filtering and returning to the bloodstream about 140 liters of blood to make 1-2 liters of urine every day.

The waste materials pass through the ureter and store in the bladder as urine, which, when full, passes out the body through the urethra. Then, the newly cleaned blood returns to the bloodstream through the veins.

The excreted urine is storable in the bladder for approximately 1 to 8 hours. Therefore, it is essential to note that urine will not produce if your kidneys don't work. As a result, everything you drank would accumulate in your body without any of it being excreted and thus making you more swollen. Hence, maintaining your kidney health and preventing kidney-related issues are of utmost importance.

What is a kidney stone?

More than million people globally suffer from kidney stone issues every year. A kidney stone is a rigid object formed with the help of chemicals in the urine. After formation, the stone may settle in the kidney or pass down the urinary tract into the ureter. The stones that don't pass through may cause a back-up of urine, which then causes pain. More and more number of people continue to be affected and even die from Kidney stones each year. Here is a graph of a study done in Wales, England, comparing the number of deaths in 1999 through 2013.

The world statistics does not look much different that the above. With a drastic shift in the way we eat and live, kidney stone related deaths continue to rise.

Signs and symptoms of kidney stones:

• Intense and indistinct pain or stomach ache that does not go away.
• Harsh pain on either side of the lower back.
• Nausea or vomiting.
• Blood in the urine.
• Fever and chills.
• Urine that smells bad or looks cloudy.
  
  

Causes and triggers for kidney stones.

Kidney stones form from high calcium, oxalate, cystine, or phosphate and too little liquid in the kidneys. The lifetime risk of the occurence of kidney stones is around 19% in men and 9% in women. Calcium oxalate stones are one of the common forms of stone created when calcium combines with oxalate in the urine.

Other factors like excessive sweating or not drinking enough water, a high animal protein diet, excessive salt or sugar intake, obesity, digestive diseases, or surgeries absorbing calcium and water may increase the risk of kidney stones. Additionally, medical conditions like high blood pressure and diabetes too play a risk factor. If you do struggle with diabetes, make sure to read the article linked below:

• Indian vegan diet for type 2- Diabetes reversal.
  
  

Are all kidney stones the same?

Kidney stones are generally of four types depending on their origin or source of formation.

• Calcium oxalate, as mentioned above, is the most common type of kidney stone formed from a combination of excess calcium with oxalate in the urine.
• Uric acid is the second type caused by high purine intake that leads to monosodium urate production.
• Struvite is a less common type of kidney stone caused by infections in the upper urinary tract.
• And lastly, Cystine is a rare kind that tends to run in families with a history of cystinuria.

Here, it is essential to mention that since calcium oxalate is the leading type of kidney stone, limiting intake of foods containing high oxalates is beneficial.

Some foods that are rich in oxalate include beer, pork, beef, cheese, eggs, peanuts, green leafy veggies, tea, spinach, swiss chard, strawberries, beets, nuts, tomatoes and cocoa.

Taking high doses of Vitamin C (over 2000 mg in supplemental form) has also been associated with elevated oxalate level's in the body. Excess vitamin C is metabolised into oxalates in the body. It is advisable to avoid supplemental form of Vitamin C for people with kidney stones.

Are gout and high uric acid-related to CKD?

What are high uric acid and gout?

Uric acid is a chemical created when the body breaks down substances called purines. Purines are usually found in our bodies and also in many foods such as alcohol, seafood and red meat.

Uric acid does not have any specific function, and most of it dissolves in the blood, passes through the kidneys, and leaves the body in urine. High concentrations of uric acid in the blood lead to hyperuricemia, which causes the formation of crystals of uric acid (or urate).

Truthfully, plant-based diets have been shown to be safe in all patients at all stages of life. These types of diets may reduce the risk of the development of CKD by reducing risk factors for CKD, like diabetes, hypertension, and obesity. For those with CKD, the diet may be able to reduce complications of CKD and the pill burden associated with treating those complications. - Dr. Shivam Joshi

These crystals, if they settle in the joints, cause gout, a form of arthritis. High uric acid in the urine leads to Hyperuricosuria, where the crystals settle in the kidneys and form kidney stones.

Are high uric acid and gout related to kidney diseases?

Uric acid moves through your blood to your kidneys. Your kidneys then add that uric acid to your urine so that it can leave the body. However, sometimes uric acid in the blood gets too high if the body makes more or the kidneys can’t add enough to your urine.

This untreated build-up that leads to Hyperuricemia or Hyperuricosuria, and may eventually be signs of kidney disease. Uric acid kidney stone is also a common type of kidney stone and accounts for about 10% of all kidney stones.

Symptoms and risk factors of Uric acid and gout

The most common symptom of high uric acid and gout is pain and swellings in your joints that limit your movement and may also change your shape. Tenderness, stiffness, and redness are other common symptoms. More than half of patients get their first gout attack in a big toe which is called podagra.

Several factors may increase uric acid levels in the body, including certain foods, other diseases, or certain medicines. Purine-rich food also plays a factor in high levels of uric acid that include seafood (like salmon, lobster, sardines), red meat, organ meats (like liver), high fructose drinks, and alcohols (especially beer). Being dehydrated can also increase the concentration of uric acid in the blood. Other possible risk factors are obesity, age, and family history of gout.

What should my doctor test for?

Your doctor will check for signs and symptoms related to gout through a physical exam. The uric acid levels in the blood and urine and fluid from an affected joint will also be checked. Tests for gout include:

• Imaging through Ultrasound, CT scan, or magnetic resonance imaging (MRI).
• Arthrocentesis or synovial fluid aspiration of the joint where a needle takes fluid from a joint to see if it has uric acid crystals.
• Uric acid level with the blood test for uric acid called serum uric acid (sUA).
  
  

Does diet play a role?

Numerous trustworthy studies emphasise that vegan or vegetarian diets cause more significant health benefits and fewer chronic disorders than the current meat-heavy Western or standard American diet.

A plant-based diet proves to help avoid most of the high-purine foods typically derived from animal sources in case of high uric acid and gout. It is however important to avoid spinach, swiss chard and beets from your diet.

Purines are also necessary to build DNA and synthesize proteins in the body. Nevertheless, research confirms diets consisting of animal meats and seafood with high-purine content trigger gout more frequently than diets consisting of only fruits, vegetables, whole grains, and legumes.

A 2019 review on uric acid and plant-based nutrition concluded with studies that compared UA serum concentrations in vegetarians and non-vegetarians that have consistently shown a lower mean UA serum concentration in vegetarians.

Additionally, in a 2019 article by the American College of Rheumatology, they state, ‘new research has found purines in vegetables appear to be safe.’ In another study published in 2019 in the Clinical Journal of American Society of Nephrology (CJASN), long-term statistical results indicated subjects following a healthy plant-based diet had a lower risk of developing kidney disease.

Treatment plan

Treatment plans usually consist of:

• Medications and dosages from your doctor to treat symptoms of gout.
• Self-management strategies to keep your body healthy and robust, such as getting regular physical activity, quitting smoking, curbing alcohol use, eating a healthy diet, and controlling stress.
• Avoiding or limiting high purine foods and drinks like organ meats, shellfish, anchovies, sardines in oil, fish roes, herring, yeast, legumes (dried beans, peas), meat extracts, consommé, gravies, mushrooms, spinach, asparagus, cauliflower, beer, and products with high-fructose corn syrup.
• As per the AMA, a balanced diet for people with gout includes foods high in complex carbohydrates (whole grains, fruits, vegetables), low in protein (15% of calories), no more than 30% of calories from fat (no animal fat) and adequate amount of fluids
• Adopting foods with low-purine and anti-inflammatory benefits such as dark berries, cherries (fresh or frozen), tofu, flax or olive oil, and nuts.
• Measurable targets to reach to determine that your disease is well controlled, such as measures of inflammatory proteins in your blood, signs of joint damage on X-rays, or range of motion and strength in your joints
  
  

Herbs and spices that play a role

Beware of certain herbal medicines as they may have ingredients that can harm the kidneys or worsen kidney disease. They can also interact with prescription medicines to either increase or decrease how well the medicine works.

Work with a naturopath or holistic nutritionist to understand the use of herbs and spices for gout management.

Should people with kidney stones avoid all leafy greens?

Kidney stones and high oxalate food have a known correlation. Foods that contain high levels of oxalate can elevate the potential of developing kidney stones. Therefore, people with kidney stones are recommended lesser consumption of foods like spinach, rhubarb, beets and beet greens, peanuts, etc. which contain high levels of oxalate.

However, not all leafy greens contain the same amount of oxalate. According to studies, juicing leafy greens like spinach, beet greens and chard can give more than 1,200mg of oxalate with just two cups a day. But these particular once really seem to be the outliners. It is practically impossible with most other greens, like kale, for example. To get that much oxalates, you will need to consume 600 cups of Kale!

Another study had participants consuming 250mg of oxalates a day. That would be 25 cups of collard greens, 60 cups of mustard greens, 125 cups of kale, or 250 cups of bok choy at a time. However, that amount was still less than one-half cup of spinach. High-oxalate foods like spinach and beet greens also bind more to their calcium, preventing its absorption. Thus, more is excreted in the urine. Even steaming, boiling or just cooking them would not reduce the oxalate levels much since they are so high.

Therefore, the bottom-line is that anyone with a history of kidney stones or otherwise at high risk need not avoid all the leafy greens but only the ones with a high oxalate level. They should limit their consumption of spinach, beet greens or chard but can instead consume more of other leafy greens like kale and collard greens.

Green leafy veggies like Kale, curry leaves, coriander, brahmi etc are essential to a healthy diet.

What are the most important factors to prevent kidney stone formation?

There are three primary effects to dilute the causes leading to the formation of kidney stones:

• Drink more water. Dehydration is a considerable risk factor for getting a kidney stone. Consider eating fruits and vegetables that are loaded in water content. Water from plans is better absorbed by the body that drinking water alone. Aim to consume 4-5 cups of water rich plants such as zucchini, cucumbers, watermelon, cantaloups etc.
• Monitor sodium: Salt increases the calcium quotient in the urine, and that calcium is one of the ingredients needed to form a calcium oxalate stone.
• Avoid animal protein. Foods containing animal protein are not only high in sodium, but also trigger calcium and bone loss from the body. Excess calcium is flushed out by the body, in an attempt to balance the pH of the gut, leading to kidney stones. Excess sodium is stored in your urine, leading to more calcium formation in the urine. It may then lead to calcium oxalate stone formation, which is the most common type of kidney stone. Additionally, the acid content in animal protein can also lead to developing a kidney stone.
  
  

What kind of diet plan is recommended to prevent stones?

In recent years, a growing area of evidence has been emerging on the benefits of plant-based diets to prevent and treat diseases such as kidney stones.

"Truthfully, plant-based diets have been shown to be safe in all patients at all stages of life. These types of diets may reduce the risk of the development of CKD (chronic kidney diseases) by reducing risk factors for CKD, like diabetes, hypertension, and obesity. For those with CKD, the diet may be able to reduce complications of CKD and the pill burden associated with treating those complications"- Dr. Shivam Joshi, MD. Nephrologist.

This study shows that vegetarians and vegans have a 40- 60% reduced risk of kidney stones. Red and processed meat is associated with an increased risk of Chronic Kidney Disease and issues such as kidney stones and faster progression in those with such pre-existing diseases.

The kidney helps in regulating electrolyte levels, water levels, as well as blood pressure. When you adopt a plant-based diet, many of these not-normal parameters also tend to improve for people who already have kidney disease. Here is another study showing the drop in blood sugar level and HbA1c by just following a plant- based diet.

Meatbolic Acidosis and Kidney stones.

One of parameters for Kidney stones is metabolic acidosis, which is the amount of acid in the blood. Animal protein's such as dairy and meat are acidic to the body. Read the below blog for more:

• Milk- is it slowly poisoning you?

Plant-based diets are naturally alkalising. Thus improve blood pressure in people with kidney disease and lower serum phosphate levels. There are also observational data suggesting that people who follow a plant-based diet have a lower mortality rate. But what about dairy? Watch the below video to know more:

Protein requirements and CKD

The amount of protein a person with kidney stone should take depends on the functioning capability of the kidneys and its condition.

For example, if a person is on dialysis then they would require higher protein diet. This is approximately 1.2- 1.3 grams of protein per kg of body weight. However, in the stage 1 and 2 of CKD, a low protein diet exceeding no more than 0.8 grams of protein per kg of body weight is suggested.

Additionally, the protein needs of the body also vary according to the person’s age, sex and the health.

The source of protein plays an important role. Make sure to consume plant- based protein sources that are easier to digest and alkalising to the body than animal based protein sources.

Sources of plant-based protein for people with kidney ailments

A person with kidney stones or any kidney ailment can supplement the body with sufficient amount of plant-based protein from the following sources:

• Pea protein
• Beans and lentils
• Nuts
• Whole grains.

It is essential to check the protein and the nutrient quotient of the source before including them in the diet.

The best diet for Kidney stone management.

Plant-based diets entail eating typically whole grains, vegetables, fruits, legumes (beans, peas, and lentils), unsalted nuts, and healthy oils. It mainly focuses on reducing animal foods such as eggs, dairy, meat, fish, and poultry.

To follow a plant-based diet, one should avoid processed foods like many types of canned foods and soups, refined grains (white bread and pasta, highly processed or high sugar cereals, white rice), and sugar-sweetened beverages.

Plant-based diets are highly recommendable to prevent kidney stones. They are rich in fiber, vitamins, and minerals that help lower risks of developing several diseases.

Whether or not you have kidney disease, you can benefit from a plant-based diet. It will help maintain a healthy weight, lower blood pressure and cholesterol, improve antioxidant levels, and reduce the risk of getting kidney stones any other kidney disease.

The below infographic will help you customise a sample meal plan. Your protein intake and meal plan will change depending on the stage of your diseases. Click here for a customised meal plan.

Is there anything else to do to help prevent kidney stones?

It is essential to keep few other factors in mind to prevent kidney stone:

• Do not underestimate your sweat: Water loss through sweating, whether heavy exercises and heat, leads to less urine production. Hence, the more a person sweats, the less is the urination, which allows for the stone-causing minerals to settle in the body and bond in the kidneys and urinary tract. Therefore, drinking water is the most critical factor in preventing such issues.
• Calcium is not the enemy, supplemental calcium is: Dietary calcium is essential. Dairy is not an ideal calcium source as it leads to metabolic acidosis. Aim to consume whole- food plant- based calcium sources instead. Avoid calcium supplements and multi- vitamins.
• To reduce uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish. It also indicates following a plant-based diet to prevent uric acid stones.

Diet Recommendations for Kidney Stones.

A plant-based diet is generally recommended. Here, the emphasis is on consuming foods that are high in fiber, vitamins, minerals, phytonutrients. These include whole grains, beans, lentils, fruits, vegetables, nuts, seeds, things like that.

Historically, the big concern in consuming these foods in patients who have kidney diseases is that patients might not get enough protein, and two, that their potassium levels will go high. However, studies have proved that protein intake is enough even in plant-based diets and should not be an area of concern. Watch this video to know more:

The other big concern is levels of potassium. Here, certain foods to watch out for remove the mitigating factors for a rise in potassium and give patients more potassium than they otherwise would consume.

These problematic foods are fruit juices, vegetable sauces, and potassium additives. Therefore, eating whole fruits and vegetables would not be an issue. When they start doing maneuvers to concentrate the fruit juice or extract potassium inherently in those foods into a higher concentration, that can lead to trouble.