I recently suffered through a bit of a health crisis. The worst part is I brought it on myself. Unknowingly (kind of). I actually thought I was doing something good for myself. Turns out, not so much.
As I type I am awaiting a procedure called a ureteroscopy. Translation: big fat bummer. Actually a ureteroscopy is a procedure where a doctor goes into the ureter (the tube that leads from your kidney to your bladder) to retrieve kidney stones that are too big to pass on their own. Good times. You may be wondering what kidney stones would have to do with moderation, actually quite a bit. But to understand why I ended up where I am today you will need…
A little history:
In 1995 at the age of 33, I had my first bout with kidney stones. I lost. I will spare you the details, but I will tell you kidney stones are extremely painful and my episode ended in emergency surgery. In 1995 the only advice the urologist gave me to prevent a future recurrence was “drink lots of water, avoid calcium rich foods, chocolate, leafy greens (no reason given and I didn’t ask because I was dumb) and soda, especially colas*”. Four of those five recommendations still apply today. Avoiding calcium rich foods turned out to be very bad advice and is no longer given.
After giving these recommendations my doctor said “Do the best you can but honestly, it may or may not help. Some people are just ‘stone makers’.” I had never heard the term ‘stone maker’ before and those words struck fear in my heart. Am I stone maker? And if so, why? I was determined to find out the reason if possible, and do my best at prevention. I NEVER wanted to experience that kind of pain again, this coming from a woman who has had six babies, four of them with no pain medication.
At the time I was definitely eating a less than stellar diet. So I set out revamping my bad habits. Gone went the soda, processed foods, most sugar and anything that came in a box. I thought I was drinking enough water but as a busy mom perhaps there was a chance I wasn’t drinking as much as I thought, so I made a conscious effort to do so. I ignored the ‘calcium advice’ because even before the days of Google after a little research I discovered that advice was on it’s way out. I wasn’t eating a lot of leafy greens back then so I didn’t give that one much thought (oops) and as far as avoiding chocolate…well
screw forget that! I hate to say it but I ignored that advice, because frankly, I am an addict.
The good news is everyone in my family benefitted from the dietary changes we made! My husband and I lost weight, the whole family got healthier and my children broadened their food horizons. I stayed vigilant as the odds of avoiding a recurrence were quite definitely not in my favor. The bad news is a whopping 80% of kidney stone sufferers have a recurrence and the younger you are when you get your first stone the more recurrences you are likely to have (insert poop emoji here) . The good news is all was well for nineteen years. Nineteen years!!! I thought I was one of the lucky few to escape. The bad news is, I was wrong. The bad news is that ‘bad habits’ are not the only thing that can cause an imbalance leading to health problems….the bad news is sometimes too much of a ‘good’ thing can too.
Ouch! The Return of the Dreaded Stones
On Thanksgiving weekend (2015) while on vacation, symptoms that were awfully familiar began. I was filled with dread. I had a pretty good idea what was going on and after a trip to the emergency room and a CT scan upon returning home, it was confirmed: two stones, both too big to pass. I was pretty disheartened. After whining and sulking for a while I pulled up my big girl pants and got to work.
What’s New in The World Of Kidney Stones?
I met with a urologist and it turns out in nineteen years there have been some new developments regarding advice given to prevent stones. My doctor said, and I quote “90% of prevention is diet related”. Well this is quite different than what my previous doctor said. This new doctor again stressed drinking enough water, no soda (I don’t drink it so that is easy) watch your salt intake (that is new advice) and last “avoid chocolate, nuts and leafy greens”. I am not as dumb as I used to be so this time I asked why. The answer: they are high in oxalate….wait, what? I had heard the term oxalate before but what exactly is ‘oxalate’? What foods have oxalate and was I eating too many of them? I needed to examine my diet closely, scrutinize it in fact, and figure out where I had gone wrong!
So what is oxalate?
Oxalate, also called oxalic acid, is an organic acid found in many plants, fruits, vegetables, legumes, coffee, tea and nuts that protect the plant from being eaten by pests. Most high oxalate foods taste bitter when eaten raw. Oxalates are also made within our own bodies. Most kidney stones, including mine, are ‘calcium oxalate’ stones. When consumed in high amounts oxalate and calcium bind together to form crystals, these crystals eventually form a stone. This is why back in the day you were told to avoid calcium if you had kidney stones. It turns out that was terrible advice as calcium is an essential mineral the body needs to survive. On the other hand as long as you eat a balanced diet, limiting oxalate does not cause health problems. Could I have been consuming too many of these high oxalate foods? And what foods are high in oxalate? I googled and found a great website (link below) that listed foods and their oxalate values. What I discovered was shocking! I had unknowingly and inadvertently made changes to my diet in the last three years that were a kidney stone disaster waiting to happen.
It is important to note that a diet rich in oxalate is not the only ‘over consumption villain’ when it comes to kidney stones. The second most common stone, uric acid stones, are related to the over consumption of protein and often occur in people with a history of gout. And if you are wondering why cola is a villain when it comes to stones, it is because colas are high in oxalate and phosphorus which bind with calcium and create calcium phosphate crystals that eventually create stones. Cola drinkers are up to 23% more likely to have stones than non cola drinkers (link below) So again, whether it’s greens, nuts, cola or meat…moderation, moderation, moderation. (Unlike meats, veggies and nuts, cola has no redeeming qualities and therefore shouldn’t be consumed even in moderation IMO)
Why do some people have problems with oxalate and others don’t?
Well, therein lies the mystery. The fact is no one knows for sure, but there are some interesting theories (hint: magnesium deficiency, gut problems and/or thyroid issues)! Most people process oxalate and excrete them with no problem. Others don’t and oxalate binds with calcium creating sharp, jagged edged crystals that congregate in the kidney (stones), joints (causing arthritic like pain) and even in the brain and heart. We do know the incidence of kidney stones is higher in men than women, it is on the rise in children, that it seems to run in families (although there is argument over whether this is due to genetics or the fact that habits run in families). For instance, not one member in my family on either side of the tree has had stones except me, lucky me. It is also believed that some of us may over produce oxalate, could I be in that category?
Where I Went Wrong
When I examined the changes I had made to my diet in the last three years I could only come up with three changes: I had begun juicing and making smoothies with raw dark leafy greens, I was eating more nuts, nut butters and drinking nut milks, and to add variety to my repertoire I added new vegetables into my daily routine: Brussels sprouts, sweet potatoes, beets, and kale. I had always eaten raw spinach but had recently upped the ante with the juicing and smoothies.
When I looked at my handy dandy new list of high oxalate foods, guess what I discovered? Before three years ago I had naturally been eating a low oxalate diet, not on purpose, it just so happened the foods I liked were low in oxalate. BUT everything I had added to my diet in the last three years was super high in oxalate...and of course I was still stubbornly eating chocolate. Dark, rich, bitter, delicious oxalate filled chocolate.
Now before you panic I want to make something clear…
I AM NOT saying greens are bad for you. I am not saying potatoes are bad for you, or dates, or nuts are bad for you. Even chocolate is not bad for you. What I am saying is that for a certain segment of the population (about 20%) these ordinarily healthy foods consumed daily may wreak havoc. (People with hyperthyroid can also be affected by consuming large amounts of leafy greens, link below) Anyone with a history of kidney stones or gout may want to exercise caution when it comes to high oxalate foods. And even if you have none of these conditions, the new year is a great time to remind everyone that balance and moderation is always a good idea. What I am saying is I wish had I heeded my own advice, the advice I dispense on this very blog! What advice is that? Eat foods that are in season and practice moderation.
Eating Foods In Season = Forced Moderation
Eating foods in season has many benefits. When in season produce has more nutrients, tastes better and is cheaper to buy, but here is an angle I never thought about before: eating foods in season is ‘forced moderation’. Most fruits and vegetables are in season for a few months, therefore our access is to these foods is limited. If I had been heeding my own advice when it came to my morning juices and smoothies I could not have consumed spinach, collard greens and nuts year round…almost 365 days a year for three years. See the wisdom in this? The seasons and nature itself has designed a system which protects us from ourselves. Eating the food I was eating everyday went against how nature would have it, and therefore I was consuming way more oxalate than nature intended.
Moderation: A Wise Principle
In our society we tend to go overboard. We seem to have the mentality that if something is beneficial it is even more beneficial if we do more of it, more often. “If a little spinach is good for us, lots of spinach is better!” Not so much. When it comes to many things in life this is simply not so. Even good things when over done can cause problems. The key to a happy healthy life is finding balance. Moderation is balance’s best friend, compadre and cohort. Let it be yours too.
Three Possible Culprits: Magnesium Deficiency, Benign Thyroid Tumor, and Lack of Certain Gut Bacteria
Harvard researchers found that taking 180 mg of magnesium along with 10 mg of vitamin B6 daily will prevent kidney stones by 92.3 percent per year! (See links below) Another study showed about a 90 percent reduction with magnesium alone (500 mg daily). So obviously I am supplementing with magnesium now. I take magnesium salt baths and take an oral magnesium supplement (affiliate links). I cover my bases. Another plus, correcting my magnesium/potassium deficiency has improved my chronic insomnia and leg/foot cramps!
Interesting Theory: Several genera of probiotic bacteria including Lactobacillus and Bifidobacteria, appear to be capable of metabolizing oxalate, thus reducing urinary oxalate and decreasing kidney stone risk. In an uncontrolled trial, six people with calcium oxalate kidney stone disease and high urinary oxalate concentrations consumed a supplement containing Lactobacillus and Bifidobacterium strains for four weeks. Urinary oxalate concentrations dropped by nearly half at the end of the study. (See Link Below)
So Now What Will I Do?
Aside from supplementing with magnesium, I will drink plenty of water with lemon and go back to how I ate before three years ago. I was eating a healthy, balanced, low oxalate diet and had never looked or felt better. Will I continue to juice and make smoothies? Yes, but I will use vegetables lower in oxalate and add more variety instead of making the same juice and smoothie every morning (recipes will be coming). Will I still eat salads? Yes, but not with raw spinach. I will make my salads with arugula, baby greens and romaine, all low oxalate lettuces. Will I eat nuts? Not if I can help it! As far as potatoes (sweet and regular), Brussels sprouts, beets etc…I will use moderation, cook them properly to remove most of the oxalate (links below) and rotate my choices within the season. The goal is not to never have vegetables high in oxalate, the goal is eat low oxalate over all. My urologist’s exact words were “Don’t go crazy with the diet”. Again, moderation.
Onward and Upward!
If 19 more years pass without stones I will be very happy. If I have a recurrence then I will know I have done all I could with the current knowledge and be satisfied with that (and maybe cry a little). The fact is there is still a lot mystery when it comes to kidney stones and some controversy over the best ways to prevent them. So I will continue to research, listen to my doctor, do what feels right for my body and pray for the best. ~ Linda Spiker
References, links a great information:
Kidney Stone Prevention ~ general and prevention info here
lowoxalate.info is a very helpful website with a lot of information about oxalate, conditions caused by high oxalate consumption and a printable list of foods and their oxalate values.
Why it Takes Rose Colored Glasses to Love (most) Green Smoothies: The Scoop on Oxalates by Megan Stevens at Eat beautiful is an informational article about oxalates and a guide to preparing foods to make them easier to digest. Includes recipes!
How to Prepare Nuts Properly: a tutorial from Megan Stevens at the Eat Beautiful Blog
The Dark Side of Kale and How to Eat Around It: Greens and Hyperthyroidism from Common Health Blog
MAY I PLEASE ASK A LITTLE FAVOR?
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