Recently, an excellent review on kidney stones came across my desk.1 The highlights of this article are the basis of this two-part series.
Ask anyone who has passed a kidney stone what it felt like, and even the most laid-back person will suddenly become animated. Ask them if they look forward to having the experience again, and the answer is almost universal; that is, they would not wish the experience on their worst enemy.
Kidney stones (nephrolithiasis) occur in a little over 10 percent of North Americans.2 When a patient informs you that they have kidney stones, or have had them in the past, and the patient wants nutritional advice, the first step is a record request from the physician who managed their problem. This is because your advice will vary depending on the pathophysiology of the kidney stone. You need to determine the cause, which could be hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, hypomagnesuria, or renal tubular acidosis.
Hypercalciuria
Hypercalciuria can generally be divided into two types: idiopathic and absorptive. Idiopathic hypercalciuria shows elevated urinary calcium levels with normal calcium serum levels. Absorptive hypercalciuria shows calcium elevations in both the urine and serum.
Other types of hypercalciuria include resorptive and renal. Resorptive hypercalciuria accounts for 5 percent of all cases. It is caused by subclinical hyperparathyroidism and has the classic findings of bone demineralization and elevated fasting urinary calcium levels. Renal hypercalciuria is due to the kidneys' decreased ability to reabsorb calcium. This causes the body to increase vitamin D synthesis. Fasting urinary calcium levels are normal.
A recent paper showed that keeping dietary calcium at normal RDA levels and lowering sodium, protein and oxalates with high levels of fluid and citrus consumption was superior to a low-calcium diet in reducing the risk of recurrent stones.3 All patients with hypercalciuria should be referred to rule out hyperparathyroidism.1
Next month, in part two, we will review the other metabolic defects that promote stone formation, including hyperoxaluria, hyperuricosuria, hypocitraturia, hypomagnesuria, and renal tubular acidosis.
| Dietary Treatment for Hypercalciuria* | |
| Low: | |
| Sodium - | Less than 2,000 mg/day |
| Protein - | RDA level (USA): No more than 0.8 grams per kilogram of body weight a day |
| Oxalate - | Spinach, rhubarb, strawberries, chocolate, nuts, tea, wheat bran, beet greens |
| Normal: | |
| Calcium - | RDA level (USA): Depending on age and sex will range form 900 milligrams to 1300 milligrams a day from all sources (food and supplements) |
| High: | |
| Citrus fruit - | 3 servings a day |
| Fluids - | Enough to produce at least 64 ounces of urine daily |
| *Please note: These are general guidelines only and will very depending on a patient's specific need. | |
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
