Uric Acid Kidney Stone (Not!)

[Grateful]

Since diagnosis and going on a low-carb diet in February, I have suffered two kidney stones (in May and November). The first one was a "normal" calcium-oxalate stone. The second one is being analyzed, but the doctor says my urine is acidic and the stone may be a "uric acid" stone that diabetics sometimes have.

My worry is that stones will recur.

The doctor says the condition should be treatable by taking a prescription supplement that sounds like it is just very highly concentrated lemon juice, or similar. He said that drinking enough "natural" lemon juice (instead of the prescription stuff) would be possible but very difficult (I had said I would prefer to deal with this in a natural way if possible). I am already drinking the juice of half a lemon every day, and have been for five months.

I am hydrating enough (at least 2 liters of water per day in addition to other fluids). Apart from the acidic urine, all the other tests (including kidney function) came back normal. They are now going to do an "all-day" urine test and are sending me a kit that includes a small jerrycan for the purpose (!).

Has anyone here got experience with diabetes-specific "uric acid" kidney stones? Any advice? Thanks!

 

[Kristin251]

Since diagnosis and going on a low-carb diet in February, I have suffered two kidney stones (in May and November). The first one was a "normal" calcium-oxalate stone. The second one is being analyzed, but the doctor says my urine is acidic and the stone may be a "uric acid" stone that diabetics sometimes have.

My worry is that stones will recur.

The doctor says the condition should be treatable by taking a prescription supplement that sounds like it is just very highly concentrated lemon juice, or similar. He said that drinking enough "natural" lemon juice (instead of the prescription stuff) would be possible but very difficult (I had said I would prefer to deal with this in a natural way if possible). I am already drinking the juice of half a lemon every day, and have been for five months.

I am hydrating enough (at least 2 liters of water per day in addition to other fluids). Apart from the acidic urine, all the other tests (including kidney function) came back normal. They are now going to do an "all-day" urine test and are sending me a kit that includes a small jerrycan for the purpose (!).

Has anyone here got experience with diabetes-specific "uric acid" kidney stones? Any advice? Thanks!

Not good news @Grateful A lower protein diet might be in order as protein raises uric acid. I was told low oxalate, low protein and low sodium as well as lemon juice. Protein is very hard on the kidneys. I was told 2 servings a day the size of a deck of cards. So about 6 oz per day

Sorry to hear your unfortunate news

 

[Grateful]

Not good news @Grateful A lower protein diet might be in order as protein raises uric acid. I was told low oxalate, low protein and low sodium as well as lemon juice. Protein is very hard on the kidneys. I was told 2 servings a day the size of a deck of cards. So about 6 oz per day

Sorry to hear your unfortunate news

Sheesh. Mrs. G. and I just analyzed the current diet and we reckon that since going on the low-carb diet, my protein intake has increased but only moderately -- possibly by a quarter -- because of a moderate increase in meat, and adding eggs a few times a week (which I never used to eat at all). Cutting back on protein would be quite a challenge, partly because I eat quite a lot of food in total, if only to maintain weight.

Here's hoping that it does *not* turn out to be a uric acid stone. (I have seen all sorts of pictures on the Internet but they vary a lot. My latest creation looks like the Uric Acid Stone in the picture below ... for what it's worth.)

 

[librarising]

Since first reading your post and today, 'kidney stones' rang a bell. In the intervening period, I'm sure I've seen a YT video mentioning the link between kidney stones and ........
low magnesium.
I can't recall which video, but a quick search brought up this
https://www.ncbi.nlm.nih.gov/pubmed/6764473
which points out that magnesium is needed to mitigate calcification. Note the reduction in stones to 1/10 of pre-treatment rate.
If you do a search for 'magnesium and kidney stones' you should get food for thought.

Diabetes and low magnesium is common
https://www.diabetesselfmanagement.com/blog/magnesium-the-forgotten-healer/

Since magnesium is the #1 supplement for heart, supplementing seems a no-brainer. I find a spray to be the best method.
Geoff

 

[Kristin251]

Which reminds me...I was told to eat calcium rich FOODS and not supplement

 

[librarising]

Another longer study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064051/
Group 1 = placebo
Group 2 = conventional treatment
Group 3 = the one treated with potassium citrate, magnesium citrate and B6.

Table 3 shows the greatest reduction in stones.
Geoff

 

[Grateful]

I just looked up the online report for the kidney ultrasound that I had earlier today. It reports finding a "1.1 cm nonobstructing stone in the mid left kidney. No hydronephrosis."

I have emailed the doctor to ask for a translation into everyday language. It sounds like a bit of a whopper, about twice as large as the last stone I passed (and too large to "pass" normally I presume). Also, this time it is in the left kidney. Until now, the only other two stones I had were in the right kidney.

 

[Kristin251]

https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755

I have to wonder about your calcium supplentation as well as high protein. After my stones I went right to .8 g per kg LEAN body mass. 5-6 oz a day divided through out the day. All protein included as even veggies have protein and contribute to the protein pool.

 

[Biggles2]

@Grateful you might be interested in this "Kidney Stone Prevention Course" from a professor at the University of Chicago:
https://kidneystones.uchicago.edu/patients/
https://kidneystones.uchicago.edu/kidney-stone-prevention-course/

 

[ringi]

To reduce protein without increase carbs or losing weight you need to increase fat, there is a reason that VitaHealth talks about food like homemade blue cheese salad dressing made with full-fat Greek yoghurt. (Most of their clients will NEVER be able to reverse their diabetes, so must remain on very low carb for life, unlike most of us who can add back some carbs and still control BG.)

“low carb” becomes hard when we have little fat of our own left (not I problem I will have in the next year!), the book “The Art and Science of Low Carbohydrate Living” talk about it. (One long-term Type2 reversal program had people drinking half a glass of good olive oil a day due to it.)

Given how good your AC1 is, adding back some high fibre carbs, for example, sweet potatoes is an option to consider if you are not willing to increase fat.

 

[Kristin251]

To reduce protein without increase carbs or losing weight you need to increase fat, there is a reason that VitaHealth talks about food like homemade blue cheese salad dressing made with full-fat Greek yoghurt. (Most of their clients will NEVER be able to reverse their diabetes, so must remain on very low carb for life, unlike most of us who can add back some carbs and still control BG.)

“low carb” becomes hard when we have little fat of our own left (not I problem I will have in the next year!), the book “The Art and Science of Low Carbohydrate Living” talk about it. (One long-term Type2 reversal program had people drinking half a glass of good olive oil a day due to it.)

Given how good your AC1 is, adding back some high fibre carbs, for example, sweet potatoes is an option to consider if you are not willing to increase fat.

Sweet potato is carbs, not fat.

 

[ringi]

Sweet potato is carbs, not fat.

It has lots of fibre and is low GI, so along with food like "Fiberflour (Lonjevity)" some people find that a small amount does not put up their BG much.

 

[Kristin251]

It has lots of fibre and is low GI, so along with food like "Fiberflour (Lonjevity)" some people find that a small amount does not put up their BG much.

As a type 1 I can surely tell you it’s a fast carb. We all have different amounts of insulin production. I have none of course and can see how high and fast I go. Though some MAY be able to eat some, they MAY burn out some beta cells. To each his own...

Generally they are not recommended for type 2’s or anyone low carbing to preserve beta cells

 

[Kristin251]

https://www.kidney.org/atoz/content/kidneystones_prevent

I looked at my online records @Grateful and mine were both calcium. They said I had two small ones in my left. It’s been two years. Knock on wood

 

[Grateful]

Many thanks for the answers so far. A lot of food for thought.

For the moment I am minded to wait until the stone has been analyzed. The kidney-specialist doctor seems to have fastened upon the "uric acid stone" track. These are relatively rare, but more common in diabetics because we apparently have acidic urine compared to the general population. My reading at yesterday's appointment was Ph5.0 and apparently it is more like Ph6.0 in the general population.

Given that my BG has been controlled at non-diabetic levels since May, this would appear to indicate that even well-controlled diabetics can have unusually acidic urine. I do not know what the mechanism is, but this seems to be one of those T2D complications that cannot be avoided/reduced merely by having good BG control???

Doing more reading on this issue, it seems most sufferers of uric acid stones have a very high protein diet and various classic features of the Standard American Diet. They are usually overweight or obese. The kidney doctor seemed puzzled and said at the end of the appointment: "We should be able to deal with this. After all, you're thin, that will help a lot." (I am not sure what the logic behind that is, but that is what he said!!!)

Trouble is, my first stone back in May was a (much more common) calcium oxalate stone, and for that matter so were the stones mentioned by @Kristin251.

Looking over the abundant online dietary advice for avoiding stones, it is eerily similar to the UK "Eatwell" plate. Low-fat, eat lots of vegetables and fruit, low-sodium, and don't overdo the protein. Trouble is, that is the diet that I am already on, adapted to eliminate just about all of the carbs and add a small amount of fat. If I cut the proteins further (to reduce kidney-stone risk) I will be adding more fat, as suggested by @ringi.

To confuse things even further, yesterday the kidney doctor contacted me to say he completely disagreed with an ultrasound report (also done yesterday) which states I have a new, 1.1cm stone in my (so-far-spared) left kidney. Viewing the same ultrasound, the doctor said the image is not a stone (or if it is a stone, it is much smaller than the report indicates)!!!!

This is the same doctor who, in mid-October (edited to correct month), said that the painful symptoms I was having did not indicate a kidney stone, even though a stone did "emerge" three weeks later. His argument was that there were no stones in that area on a CAT scan done five months earlier, therefore it was extremely unlikely that there was another stone now.

To be continued....

 

[Kristin251]

Many thanks for the answers so far. A lot of food for thought.

For the moment I am minded to wait until the stone has been analyzed. The kidney-specialist doctor seems to have fastened upon the "uric acid stone" track. These are relatively rare, but more common in diabetics because we apparently have acidic urine compared to the general population. My reading at yesterday's appointment was Ph5.0 and apparently it is more like Ph6.0 in the general population.

Given that my BG has been controlled at non-diabetic levels since May, this would appear to indicate that even well-controlled diabetics can have unusually acidic urine. I do not know what the mechanism is, but this seems to be one of those T2D complications that cannot be avoided/reduced merely by having good BG control???

Doing more reading on this issue, it seems most sufferers of uric acid stones have a very high protein diet and various classic features of the Standard American Diet. They are usually overweight or obese. The kidney doctor seemed puzzled and said at the end of the appointment: "We should be able to deal with this. After all, you're thin, that will help a lot." (I am not sure what the logic behind that is, but that is what he said!!!)

Trouble is, my first stone back in May was a (much more common) calcium oxalate stone, and for that matter so were the stones mentioned by @Kristin251.

Looking over the abundant online dietary advice for avoiding stones, it is eerily similar to the UK "Eatwell" plate. Low-fat, eat lots of vegetables and fruit, low-sodium, and don't overdo the protein. Trouble is, that is the diet that I am already on, adapted to eliminate just about all of the carbs and add a small amount of fat. If I cut the proteins further (to reduce kidney-stone risk) I will be adding more fat, as suggested by @ringi.

To confuse things even further, yesterday the kidney doctor contacted me to say he completely disagreed with an ultrasound report (also done yesterday) which states I have a new, 1.1cm stone in my (so-far-spared) left kidney. Viewing the same ultrasound, the doctor said the image is not a stone (or if it is a stone, it is much smaller than the report indicates)!!!!

This is the same doctor who, in mid-October (edited to correct month), said that the painful symptoms I was having did not indicate a kidney stone, even though a stone did "emerge" three weeks later. His argument was that there were no stones in that area on a CAT scan done five months earlier, therefore it was extremely unlikely that there was another stone now.

To be continued....

Geez...the pain comes when stones move, so it’s likely your stone moved in those three weeks. I think my pain was intermittent for a month or so and then pretty much consitant for 3 weeks until they finally figured it out and stopped treating me for a bladder infection!!!

I believe I said earlier I cut way back on protein to about 5 oz animal / Fish and pick a little up in plant protein.

Why don’t you want to add fat to replace proteins? You say you eat a LOT of food. Do you really NEED all that food? If you eat a lot and are hungry then you might not be striking the right macro balance. It wasn’t until I started eating 80% fat that I could stop watching the clock until I could my next meal. It doesn’t have to be butter, chicken skin, bacon etc. I use avocado, olive oil, mayo and a few nuts as my main fats.

I also believe cutting way back on carbs as well as protein stopped spiking my insulin and lectin levels ( hunger hormones) that allowed me to be sasiety with less food. Just think of the money you’ll save haha

I am thin as well, I always have been and I can still maintain my weight with an 80% fat diet. If you’re afraid you’ll lose weight, you noticed you did when you ditched the fatty nuts so you probably won’t lose more. But who am I to say....

Just some food for though. No pun intended

 

[Kristin251]

Now you’re freaking me out. Lol.
Another thing I did was cut out completely was dark leafy greens. I was eating them everyday, at least once but usually twice.
Protein is acid as well.
I can’t find my list of high oxalate foods. Maybe I just saw it online. I’ll look.

 

[Grateful]

Why don’t you want to add fat to replace proteins? You say you eat a LOT of food. Do you really NEED all that food? If you eat a lot and are hungry then you might not be striking the right macro balance. It wasn’t until I started eating 80% fat that I could stop watching the clock until I could my next meal. It doesn’t have to be butter, chicken skin, bacon etc. I use avocado, olive oil, mayo and a few nuts as my main fats.

Good points all. When I say I eat a lot, that's by comparison with my diet prior to being diagnosed with T2D. Back then, partly because of heavy beer drinking, I was eating noticeably less than I do now. However, I am fairly sure that even now, I still eat a lot less food than many others here in America. It took me years to get accustomed to the huge restaurant portions when I moved here 18 years ago and even now, I often have to resort to "doggy bags" because there is too much on the plate!

I have just found out that another condition, gout (which I do not have, but which my 92-year-old mother does suffer from), is also associated with acidic urine and specifically, uric acid. Because of this, there are home test strips for urine PH and I am considering ordering some. I have looked over my urine tests done at the hospital over the past year, and the PH has varied between 5.0 and 6.0. I guess I could start adding, or dropping, foods in a controlled manner to see if I can bump up the PH to be closer to 7 (which is neither acidic nor alkaline).

 

[ringi]

Given that my BG has been controlled at non-diabetic levels since May, this would appear to indicate that even well-controlled diabetics can have unusually acidic urine. I do not know what the mechanism is, but this seems to be one of those T2D complications that cannot be avoided/reduced merely by having good BG control???

I don't know how long it takes the Kidneys to recover from having been exposed to high BG and high inslin levevls.

 

[Kristin251]

I don't know how long it takes the Kidneys to recover from having been exposed to high BG and high inslin levevls.

That’s kind of funny. I got kidney stones one year after DX with bg at 550. But at the same time I was eating loads of nuts of all kinds pre DX to stop weight loss to no avail of course and I was skin and bones literally and none of my organs were working so I’m sure that didn’t help. After DX I was eating loads of spinach and sweet potato everyday as well as nuts. I’m sure that didn’t help either.
So now all the dark leafy greens, sweet potato and a few other high oxalate foods are gone. Minimized nut consumption a lot. Lowers protein to the 4-6 oz recommendation so all the “biggies” are gone. Macs are the lowest nut so I do eat those and pecans. Probably an ounce or less a day. I’ve researched charts that show me how many oxalate are in foods so I have a good idea. We can only do so much. Diabetes in itself has us backed into a corner, then add other issues....man, it’s impossible. Just doing the best we can. Stress will kill us first.