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Complementary & Alternative Medicine for Prostate and Urologic Health pp 201–229Cite as

Lifestyle Changes, CAM, and Kidney Stones: Heart Health = Kidney Health

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Abstract

It appears that reducing the risk of cardiovascular disease (CVD) may also be the ideal diet and lifestyle program to reduce the risk of kidney stones. Comprehensive lifestyle changes and healthy-heart parameters have synergistic impacts on reducing recurrent or incident nephrolithiasis as observed either in randomized trials from Parma, Italy, or from the observational cohort analysis when utilizing the Dietary Approaches to Stop Hypertension (DASH) program in the USA. Hypertension, dyslipidemia, weight and waist gain and accelerated large amounts of weight loss (bariatric surgery, diet, etc.), glucose intolerance/diabetes, and metabolic syndrome increase stone risk, but a higher potassium to sodium intake ratio, increased dietary magnesium, reduced animal protein, and normalizing dietary calcium and increased fluid intake could lower risk. Soluble dietary oxalates are more concerning compared to insoluble forms. A variety of dietary supplements also appear to impact risk. Arguably the best-known supplemental source of increased oxalate is from high dosages (>1,000–1,500 mg/day) of plain vitamin C (ascorbic acid), and calcium ascorbate or buffered vitamin C may cause less profound changes in oxalate. Vitamin C may lower serum uric acid and gout risk by also creating a higher urinary uric acid load in some individuals, which could also theoretically increase uric acid stone risk. Some cranberry concentrate supplements for urinary tract infection (UTI) have unusually high oxalate concentrations and need to be tested for this compound. Vitamin B6 (pyridoxine hydrochloride and potentially pyridoxal-5-phosphate) shifts oxalate metabolism toward the production of glycine at dosages of 50–100 mg per day and could be beneficial in some oxalate stone formers apart from those with primary hyperoxaluria type I. Higher dosages (300 mg or more) could also cause a sensory peripheral neuropathy. A probiotic or Oxalobacter formigenes and other intestinal bacterial may also play a role in reducing oxalate levels. Calcium supplements in excess appear to increase the risk of stone disease, especially calcium carbonate, and calcium citrate is an alternative for those with a history of oxalate stones, but supplementation also increases constipation risk with age. Vitamin D has a controversial impact on stone risk, but megadosing is never prudent. Omega-3 fatty acids supplements via anti-inflammatory effects could reduce stone risk, and omega-6 has some preliminary similar benefits, but inosine dietary supplementation is known to increase uric acid levels and stone disease. A variety of other CAM options are discussed in this chapter. What if healthcare professionals in urology could have some role in helping patients improve the quality and quantity of their life via comprehensive lifestyle recommendations for stone disease risk reduction? It appears that this is no longer a question, but a reality.

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    Mark A. Moyad M.D., M.P.H.

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Moyad, M.A. (2014). Lifestyle Changes, CAM, and Kidney Stones: Heart Health = Kidney Health. In: Complementary & Alternative Medicine for Prostate and Urologic Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8492-9_8

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