Summer of Stones: How Heat & Diet Impact Combating Kidney Stones

Quickly look around your workplace — or your morning Zoom call — and there’s likely 10 people. One of those folks will get a kidney stone at some point in their lives, according to researchers.

And that number is seemingly growing, with the rate in the United States shifting from 3.8% in the late 1970s to nearly 10% in 2013-14.

That’s staggering, and there is a newer factor at play.

The heat. Yes, mainly in summertime, but also as average temperatures rise across all seasons. According to Dr. Ron Golan, a urologist at Sansum Clinic, the domino effect is a problem with hydration — a primary cause of kidney stone formation.

“People forget to drink, or they drink the wrong things,” Golan said.

And for those that believe that this is a male-only problem, Golan cautions making that assumption, as data shows that cases are increasing with both women and children.

Golan sat down to talk with the Sentinel, discussing an array of insights on how to combat kidney stones, as well as dietary suggestions that might prove fruitful for many.

Q. Hydration sounds key, but what about overall diet?

A. Diet is really important when you talk about kidney stones and obviously that changes necessarily from one month to the next or one season to the next, but it can, for example in the summer. You’re eating less calcium. Dairy products, for example, can help mitigate risk for stones, but only after several months, it’s not an immediate effect. But it’s the kind of thing that some sort of episode of dehydration, down the road that can be enough to precipitate a stone and then that stone grows with combination of poor diet, hydration, and, two months later, it can manifest as a symptomatic stone.

OK, are there foods that we should avoid?

Some of the big culprits are spinach, chocolate, nuts, almond milk, soy milk, potatoes, and sweet potatoes. And the challenge is that it’s hard to eliminate these things, so it’s important to have awareness of reducing high oxalates and to balance it with adequate calcium. For example, if you’re going to eat a spinach salad, sprinkling calcium on it, like cheese, helps balance it out. Or you can switch spinach to romaine.

What about liquids, what’s best to drink?

Water is always best. If you wanted to do like fruit-infused water, that’s probably the next best. Sparkling, not sparkling, it doesn’t matter. Next would be calcium-fortified orange juice, as it gives you dietary calcium and volume from that so that’s helpful. In general, it’s a good practice to recommend against sodas, but among the sodas, the dark ones are worse than the clear ones or orange ones. And the reason for that is clear, like Sprite, usually have citric acid, and that can help prevent stones. I would never recommend soda for someone, but they’re like, “Man, I’ve got to have a soda,” I would say probably a clear soda with low or no sugar, if possible.

What about tea or coffee, aren’t they normally good for the body?

Yes, coffee is fine. If people put a little milk in their coffee every day, that’s calcium and a good thing. As for tea, the risk factor comes in large quantities. A cup or two a day likely isn’t a problem, but people drink like a gallon of sweet tea a day.

Does geography matter when it comes to kidney stones?

The southeastern U.S. is known as the “Stone Belt,” and I think it was a combination of diet. and that there’s high tea consumption. But there is also an evolving stone belt, and it’s spreading towards the west and up north. The prediction models for who’s going to be encompassed in the stone belt, it looks like more of the U.S. and the world will be included. As temperatures rise, it’s going to put more in the stone belt.

“ Some of the big culprits are spinach, chocolate, nuts, almond milk, soy milk, potatoes, and sweet potatoes. And the challenge is that it’s hard to eliminate these things, so it’s important to have awareness of reducing high oxalates and to balance it with adequate calcium.”

— Dr. Ron Golan

How do I know that I have kidney stones?

For most people it’ll kind of hit them literally out of the blue, it is just sudden onset. They’ll have back pain, abdominal pain, groin pain. Sometimes blood in the urine, sometimes nausea and vomiting. In those situations, the safest thing is to get evaluated in the ER or urgent care.

Can it be hereditary?

Just because someone has a parent or sibling who has it, doesn’t mean that they necessarily have it, but oftentimes you do see an association with that.

What dangers are associated with kidney stones?

When the stone itself drops into the kidney, that’s when there is a problem. When it drops into the ureter, that’s the tube that drains the kidney, that can cause an obstruction of your kidney, and that’s when the problems start.

Can you wait to treat kidney stones?

Absolutely and that’s always an option for non-obstructing stones. You can just do surveillance, doing an ultrasound intermittently just to evaluate for growth or migration, periodically checking kidney function. The risks of doing nothing is that it can cause stone growth, infection, and irreversible renal function. So, everything has risks including observation, but that’s a totally viable option for many people.

What about those folks that are lactose intolerant or allergic to dairy, where can they find more calcium?

That’s a great question; it impacts a lot of people, even I’m always looking for ways to add calcium to my diet. There are plenty of good, calcium fortified items such as chickpeas, broccoli, and kale. It’s funny, spinach isn’t good, but kale is. Don’t ask me why. There are some fortified milks that can also work.

Should people utilize calcium pills?

In general, dietary is preferred to supplemental unless it’s medically indicated, and that’s something that would warrant a discussion with your doctor, particularly taking pills for calcium or vitamin D.