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    Dietary Guidelines for Managing Kidney Stones

    As anyone who's had them knows, kidney stones are very painful. About 10 percent of Americans will experience this condition during their lives, with men more vulnerable than women. There are a number of dietary practices, however, that can help prevent kidney stones.

    Although most kidney stones pass out of the body through the urine, sometimes they're too big, and that's when trouble starts. The stones are formed when crystals from the urine, most often made of calcium, build up on the inner surface of the kidney. The medical term for this is nephrolithiasis.

    According to Charles Y.C. Pak, M.D., of the University of Texas Southwestern Medical Center in Dallas, there are several simple approaches to preventing recurrence of kidney stones, including changes to diet. He presented his guidelines to an audience of physicians at the annual meeting of the American College of Physicians/American Society for Internal Medicine, in Philadelphia.

    One simple and important lifestyle change to prevent stones is to drink more liquids--water is best. If you tend to form stones, says Pak, you should try to drink enough liquids daily to produce at least 2 liters of urine in every 24-hour period. Fluids make the urine less concentrated.

    In addition to lots of water, people prone to kidney stones should drink plenty of fruit juice, says Pak-at least 10 ounces a day. Eating fruit itself is also helpful. Because potassium helps to prevent stones, Pak recommends oranges, tangerines, grapefruits, and pineapples. Lemons, limes, and grapes are low in potassium and thus not as useful.

    Because most stones are made of calcium, people who tend to develop them should watch their intake of calcium, but not avoid this important nutrient. Pak recommends about 800 mg/day. A cup of milk has about 300 mg of calcium, an ounce of cheese has about 200 mg.

    Pak also recommends a moderate meat intake of two servings a day, including beef, poultry, and fish. These foods increase the amount of acid in the urine, and can contribute to the formation of stones if too much is eaten.

    Restricting salt is also important in preventing kidney stones. Salt causes excretion of larger amounts of calcium and thus increases calcium in the urine. Pak suggests less than two teaspoonfuls a day. Remember that most packaged food contain salt; try looking for those that are salt-free or have reduced salt content.

    Foods that are high in oxalate should be limited, says Pak. Oxalate combines with calcium to form calcium oxalate crystals, which in turn form one of the more common types of stones. If you're prone to stones, limit your intake of spinach, tea, chocolate, and nuts.

    The goal of these dietary practices, explains Pak, is to maintain appropriate levels of calcium, reduce oxalates, raise potassium and magnesium levels, and keep the urine diluted and flowing. Following the simple guidelines he suggests can make a big difference in preventing the formation of common kidney stones.


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