By Matt Gowan, BSC, ND January 21, 2019
Naturopathic Protocol for Kidney Stones
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
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.