By Matt Gowan, BSC, ND
January 21, 2019

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Naturopathic Protocol for Kidney Stones

By Matt Gowan, BSC, ND
January 21, 2019

A naturopathic protocol for kidney stones is a multi-pronged. Several types of kidney stones exist including calcium, uric acid, cysteine, and struvite. However, roughly 80% of kidney stones contain calcium salts; usually calcium oxalate and sometimes calcium phosphate. This naturopathic protocol for kidney stones focuses on calcium oxalate stones, but most of the recommendations will likely benefit other types of kidney stones. The general approach requires increasing urine output, raising urine pH, reducing calcium and oxalate excretion, and increasing citrate levels in the urine help to prevent and dissolve stones.

1. DRINK WATER >3L PER DAY

Increasing water intake is vital in treating kidney stones.1,2  The precise amount of water required varies from person to person, but some sources recommend drinking 2-4L per day.3–6  Each 500ml increase in water intake significantly lowers the risk of stone formation.7 Hot weather and increased sweating will necessitate drinking more water.8  In general, urine should be pale yellow or almost clear. Dark urine is a visible sign that you need to drink more water.

2. REDUCE OXALATES

Oxalate (oxalic acid) is a simple molecule found in most plants. Calcium and oxalate complexes precipitate out of supersaturated urine to create the most common type of kidney stones. It is challenging to avoid all oxalate sources so focus on eliminating spinach, almonds, rhubarb, and beets from the diet, and limit the consumption of other oxalate-containing foods.

Table 1. High oxalate containing foods9

Very High (>500mg/serving) High (100-400mg/serving) Moderate (45-100mg/serving)
Spinach
Rhubarb
Rice Bran
Buckwheat
Almonds
Miso soup
Wheat berries
Corn grits
Potatoes (with skin)
Soy Flour
Bulgar
Navy beans
Beets
Cocoa powder
Millet
Cashew
Soy

Note: Almond milk is particularly rich in oxalate, and several case reports show a link to children with kidney stones. 10

3. INCREASE CITRATE

Citrate (citric acid) reduces calcium secretion in the urine and increases citrate concentration leading to a reduction in calcium oxalate stones. You can increase your intake of citrate through both food and supplementation.

A. DRINK LEMON WATER

Although lots of fruits contain citrate, citrus fruit and in particular lemons and limes, are the most abundant sources of citrate. Research shows that lemonade and lemon water help reduce the formation of kidney stones.11,12  Drinking lemon water daily increases citrate excretion in the urine, which inhibits stone formation. I recommend one freshly squeezed lemon in water rather than sweetened lemonade or orange juice, thereby avoiding the extra sugar (fructose) that can increase the risk of stones.13 If you don’t like citrus fruit, you could also eat pears, which appear to help.14

B. SUPPLEMENT WITH CITRATE SALTS

Supplementing the diet with citrate salts (potassium citrate & magnesium citrate) is also useful.15–17 Although considered safe, both magnesium citrate and potassium citrate may produce nausea, vomiting, diarrhea, and stomach aches.

It is difficult to conclude what is the best way to increase citrate. One study showed potassium citrate was more effective than drinking lemonade18 while other studies show the opposite.19,20

4. BALANCE CALCIUM

Although most kidney stones contain calcium, paradoxically low dietary calcium can increase the risk of kidney stones.21 Restricting dietary calcium is not recommended for people at risk of kidney stones.22 Consuming calcium along with oxalate-rich foods, like spinach, binds the oxalate and prevents its absorption.23 For those people suffering from kidney stones who require calcium supplements, take the calcium with meals to reduce the risk of stone formation.24 In summary, calcium with food may reduce the risk of kidney stones while calcium supplements on an empty stomach may increase the risk.

5. DIETARY CHANGES

Diet plays a major role in the development of kidney stones.  A North American diet seems to be a risk factor for the development of kidney stones.25

A. REDUCE SUGAR & LOSE WEIGHT

Sugar intake, including table sugar and fructose, increases the risk of kidney stones.26  Fructose consumption decreases urinary pH and increases urinary concentration of uric acid, calcium, and oxalate, which all contribute to stone formation.13  Obesity and blood sugar problems are associated with an increased risk of kidney stones.27 The precise mechanism is unclear, but elevated insulin levels lead to increased calcium excretion in the urine.28 Reducing sugars and losing weight not only reduces the risk of kidney stones but also other chronic diseases including heart disease and diabetes.

B. DECREASE ANIMAL PRODUCTS

Excess dietary animal protein leads to increase acidity in the urine, which the body attempts to neutralize by pulling calcium from the bone. Red meat consumption appears to be a risk for kidney stones.29 Vegetable based protein seems to have less of an effect.

C. INCREASE PLANTS

Eating a diet rich in fruits and vegetables is associated with a reduced incidence of kidney stones.30–32 In addition to citrate, phenolic compounds like flavonoids33–35 and caffeic acid36 help prevent kidney stones. Because fruit contains fructose that can increase stone formation13, limit fruits to 3 servings per day. Non-starchy vegetables (kale, broccoli, celery, rapini, bell peppers, celery) have virtually no fructose so eat these in abundance.

D. REDUCE SALT

A diet high in salt (sodium chloride) appears to increase the risk of kidney stones and in particular women with high salt intake.37

E. INCREASE OMEGA-3s

Increasing omega-3 fatty acid helps reduce inflammation and heart disease. Also, research shows that omega-3 supplementation effectively decreases urinary oxalate excretion and the risk of calcium oxalate crystallization,38 although some studies did not show a reduced risk of kidney stones with omega-3 consumption.39 The difference may be explained by the amount of omega-3s consumed in the study. A high dose fish oil supplement containing 2g of EPA/DHA might be helpful.

6. ANTILITHIC HERBS

Adding herbs to your naturopathic protocol for kidney stones can help dissolve stones but they should not be used alone without increasing water and changing the diet. Antilithic herbs dissolve stones. Diuretics increase urine production to dilute urine and prevent supersaturation required for stone formation. Antispasmodics help relax smooth muscles to decrease pain associated with renal colic.

A. Chanca Piedra

In the Amazon, Chanca Piedra (Phyllanthus niruri), which translates to “break stone”, is used to dissolve kidney stones. Research shows Chanca Piedra decreases calcium and oxalate levels in the urine and increases potassium and magnesium. It also appears to inhibit crystal growth through other mechanisms as well.40,41 Chanca Piedra is one of the few herbs with clinical trials to support its use for kidney stones. One study showed a reduction in stones size after 12 weeks of treatment.42 A separate study showed patients taking Chanca Pedra after extracorporeal shockwave lithotripsy reduced the recurrence rate for kidney stones.43

B. GRAVEL ROOT

North American Indians used Joe-Pye Weed (Eupatorium purpureum) also appropriately called “Gravel Root,” to treat gravel in the urinary tract. The herb possesses diuretic and antispasmodic properties making it useful for kidney stones & associated renal colic. Caution: it may be prudent to limit the use of gravel root for 1-2 months because like related species of Eupatorium it may contain significant levels of hepatotoxic pyrrolizidine alkaloids.

C. NETTLE

Western herbalists use nettles (Urtica dioica) as a diuretic for a variety of urinary conditions. The Commission E approved the internal use of nettle herb and leaf as irrigation therapy for inflammatory diseases of the lower urinary tract and prevention and treatment of kidney gravel.44 Although human trials are lacking, research in rats supports the use of nettles to prevent calcium oxalate stones.45

D. LAVENDER

Lavender (Lavandula angustifolia) is not an antilithic herb but in addition to relieving anxiety and promoting sleep, the essential oil of lavender may help decrease pain associated with kidney stones. In one clinical trial, inhaling lavender essential oil helped reduce renal colic pain.46

SUMMARY OF A NATUROPATHIC PROTOCOL FOR KIDNEY STONES

A naturopathic approach for kidney stones is based primarily on increasing water intake, changing the diet and taking antilithic herbs. Increasing urine output by drinking 3L or more of water a day is vital. In addition, reducing dietary oxalates and increasing citrate, by supplementing with citrate salts or drinking lemon water is essential. Research suggests eating a diet that is rich in fruits and vegetables, limited in meat, low in salt and high in omega-3 fatty acids may help reduce formation stones. Finally, certain antilithic herbs like Chanca Pedra, Gravel Root and Nettle have evidence to support their traditional use in treating kidney stones.

1.
Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155(3):839-843. [PubMed]
2.
Feehally J, Khosravi M. Effects of acute and chronic hypohydration on kidney health and function. Nutr Rev. 2015;73 Suppl 2:110-119. [PubMed]
3.
Meinders A, Meinders A. [How much water do we really need to drink?]. Ned Tijdschr Geneeskd. 2010;154:A1757. [PubMed]
4.
Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116(3):c159-71. [PubMed]
5.
Lotan Y, Buendia J, Lenoir-Wijnkoop I, et al. Increased water intake as a prevention strategy for recurrent urolithiasis: major impact of compliance on cost-effectiveness. J Urol. 2013;189(3):935-939. [PubMed]
6.
Jain N, Reilly R. Effects of dietary interventions on incidence and progression of CKD. Nat Rev Nephrol. 2014;10(12):712-724. [PubMed]
7.
Xu C, Zhang C, Wang X, et al. Self-Fluid Management in Prevention of Kidney Stones: A PRISMA-Compliant Systematic Review and Dose-Response Meta-Analysis of Observational Studies. Medicine (Baltimore). 2015;94(27):e1042. [PubMed]
8.
Robertson W. Renal stones in the tropics. Semin Nephrol. 2003;23(1):77-87. [PubMed]
9.
Attalla K, De S, Monga M. Oxalate content of food: a tangled web. Urology. 2014;84(3):555-560. [PubMed]
10.
Ellis D, Lieb J. Hyperoxaluria and Genitourinary Disorders in Children Ingesting Almond Milk Products. J Pediatr. 2015;167(5):1155-1158. [PubMed]
11.
Bodnar R, Zimmerman E, Nilaver G, et al. Dissociation of cold-water swim and morphine analgesia in Brattleboro rats with diabetes insipidus. Life Sci. 1980;26(19):1581-1590. [PubMed]
12.
Koff S, Paquette E, Cullen J, Gancarczyk K, Tucciarone P, Schenkman N. Comparison between lemonade and potassium citrate and impact on urine pH and 24-hour urine parameters in patients with kidney stone formation. Urology. 2007;69(6):1013-1016. [PubMed]
13.
Taylor E, Curhan G. Fructose consumption and the risk of kidney stones. Kidney Int. 2008;73(2):207-212. [PubMed]
14.
Manfredini R, De G, Storari A, Fabbian F. Pears and renal stones: possible weapon for prevention? A comprehensive narrative review. Eur Rev Med Pharmacol Sci. 2016;20(3):414-425. [PubMed]
15.
Jaipakdee S, Prasongwatana V, Premgamone A, et al. The effects of potassium and magnesium supplementations on urinary risk factors of renal stone patients. J Med Assoc Thai. 2004;87(3):255-263. [PubMed]
16.
Odvina C, Mason R, Pak C. Prevention of thiazide-induced hypokalemia without magnesium depletion by potassium-magnesium-citrate. Am J Ther. 2006;13(2):101-108. [PubMed]
17.
Zerwekh J, Odvina C, Wuermser L, Pak C. Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of bed rest. J Urol. 2007;177(6):2179-2184. [PubMed]
18.
Shen J, Zhang X. Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study. Med Sci Monit. 2018;24:1924-1929. [PubMed]
19.
Kang D, Sur R, Haleblian G, Fitzsimons N, Borawski K, Preminger G. Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol. 2007;177(4):1358-62; discussion 1362; quiz 1591. [PubMed]
20.
Aras B, Kalfazade N, Tuğcu V, et al. Can lemon juice be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia? A prospective randomized study. Urol Res. 2008;36(6):313-317. [PubMed]
21.
Kaaroud E, Harzallah A, Chouchi S, et al. [Pathogenic factors in calcium oxalate stones: Epidemiological investigation]. Prog Urol. 2016;26(8):450-456. [PubMed]
22.
Prezioso D, Strazzullo P, Lotti T, et al. Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group. Arch Ital Urol Androl. 2015;87(2):105-120. [PubMed]
23.
Bong W, Vanhanen L, Savage G. Addition of calcium compounds to reduce soluble oxalate in a high oxalate food system. Food Chem. 2017;221:54-57. [PubMed]
24.
Sorensen M. Calcium intake and urinary stone disease. Transl Androl Urol. 2014;3(3):235-240. [PubMed]
25.
Alatab S, Pourmand G, El H, et al. National Profiles of Urinary Calculi: a Comparison Between Developing and Developed Worlds. Iran J Kidney Dis. 2016;10(2):51-61. [PubMed]
26.
Johnson R, Perez-Pozo S, Lillo J, et al. Fructose increases risk for kidney stones: potential role in metabolic syndrome and heat stress. BMC Nephrol. 2018;19(1):315. [PubMed]
27.
Carbone A, Al S, Tasca A, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70(4):393-400. [PubMed]
28.
Lemann J, Piering W, Lennon E. Possible role of carbohydrate-induced calciuria in calcium oxalate kidney-stone formation. N Engl J Med. 1969;280(5):232-237. [PubMed]
29.
Dongre A, Rajalakshmi M, Deshmukh P, Thirunavukarasu M, Kumar R. Risk Factors for Kidney Stones in Rural Puducherry: Case-Control Study. J Clin Diagn Res. 2017;11(9):LC01-LC05. [PubMed]
30.
Meschi T, Maggiore U, Fiaccadori E, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int. 2004;66(6):2402-2410. [PubMed]
31.
Sorensen M, Hsi R, Chi T, et al. Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women’s Health Initiative report. J Urol. 2014;192(6):1694-1699. [PubMed]
32.
Szendrői A, Tordé Á, Vargha J, et al. [Role of the diet in urinary stone formation and prevalence]. Orv Hetil. 2017;158(22):851-855. [PubMed]
33.
Zhu W, Xu Y, Feng Y, et al. Prophylactic effects of quercetin and hyperoside in a calcium oxalate stone forming rat model. Urolithiasis. 2014;42(6):519-526. [PubMed]
34.
Zeng X, Xi Y, Jiang W. Protective roles of flavonoids and flavonoid-rich plant extracts against urolithiasis: A review. Crit Rev Food Sci Nutr. February 2018:1-11. [PubMed]
35.
Ahmed S, Hasan M, Khan H, Mahmood Z, Patel S. The mechanistic insight of polyphenols in calcium oxalate urolithiasis mitigation. Biomed Pharmacother. 2018;106:1292-1299. [PubMed]
36.
Yasir F, Wahab A, Choudhary M. Protective effect of dietary polyphenol caffeic acid on ethylene glycol-induced kidney stones in rats. Urolithiasis. 2018;46(2):157-166. [PubMed]
37.
Sorensen M, Kahn A, Reiner A, et al. Impact of nutritional factors on incident kidney stone formation: a report from the WHI OS. J Urol. 2012;187(5):1645-1649. [PubMed]
38.
Siener R, Jansen B, Watzer B, Hesse A. Effect of n-3 fatty acid supplementation on urinary risk factors for calcium oxalate stone formation. J Urol. 2011;185(2):719-724. [PubMed]
39.
Taylor E, Stampfer M, Curhan G. Fatty acid intake and incident nephrolithiasis. Am J Kidney Dis. 2005;45(2):267-274. [PubMed]
40.
Campos A, Schor N. Phyllanthus niruri inhibits calcium oxalate endocytosis by renal tubular cells: its role in urolithiasis. Nephron. 1999;81(4):393-397. [PubMed]
41.
Freitas A, Schor N, Boim M. The effect of Phyllanthus niruri on urinary inhibitors of calcium oxalate crystallization and other factors associated with renal stone formation. BJU Int. 2002;89(9):829-834. [PubMed]
42.
Pucci N, Marchini G, Mazzucchi E, et al. Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention. Int Braz J Urol. 2018;44(4):758-764. [PubMed]
43.
Micali S, Sighinolfi M, Celia A, et al. Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study. J Urol. 2006;176(3):1020-1022. [PubMed]
44.
für Arzneimittel und Medizinprodukte (Germany) B, Council A Botanical. Therapeutic Guide to Herbal Medicines. Lippincott Williams & Wilkins; 1998.
45.
Zhang H, Li N, Li K, Li P. Protective effect of Urtica dioica methanol extract against experimentally induced urinary calculi in rats. Mol Med Rep. 2014;10(6):3157-3162. [PubMed]
46.
Irmak S, Uysal M, Taş U, et al. The Effect of Lavender Oil in Patients with Renal Colic: A Prospective Controlled Study Using Objective and Subjective Outcome Measurements. J Altern Complement Med. 2015;21(10):617-622. [PubMed]