Last Updated on January 13, 2019 by Patricia Carter

SUMMARY:  1 in 11 people have kidney stones!  They’ve been trying to formulate an oral commercial probiotic for a while because it worked GREAT in mice to decrease the urine oxalate levels.  Oxalates in the kidney are a primary cause of calcium oxalate kidney stones.  But the short of it is that in clinical trials on humans, it FAILS.  Humans are NOT mice, at least as far as this commercial product goes. Another problem was that they  couldn’t even find the target probiotics in some of the commercial products, and that means that it is really hard to process certain gut microbiome species in a manner that permits their commercialization.   The Pearl for kidney health:  Keep eating food that binds the oxalates in the gut so it stays out of the kidney where it can form stones.  Also look at what you are eating ⇒ Food should bloom beasties that neutralize the oxalates. And keep the fluids plentiful too!  ♥ Read on to learn about kidney Stones, food ♥ Why?  Because once an individual has formed a stone, the likelihood of recurrence is 50 percent or greater at five years and up to 80 percent at 10 years. 

1 in 11 Have Kidney Stones

Recent analyses of claims data suggest rising utilization of health care resources for treating patients with stone disease [2,3].  [Scales et al 2012] confirmed the increasing prevalence of kidney stones and found the prevalence of stones for men was 8.8%, and for women, 10.6%.  The last review looking at the incidence of kidney stones was 1994.  That study looked at data from the National Health and Nutrition Examination Survey (NHANES),  and found that the prevalence of stone disease was   6.3% for  men and 4.1% for women [1].  Note ⇒ Women stone prevalence more than doubled!

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The 3 studies looking at commercial oral probiotic to neutralize oxalates to prevent kidney stones, are:

[Whittamore et al 2018] The role of intestinal oxalate transport in hyperoxaluria and the formation of kidney stones in animals and man.  This is a great summary of oxalate transport from gut to kidneys.  It includes discussion of gut bacteria that degrades oxalate to reduce urinary oxalates and thus kidney stones.  NOTE:  I was surprised THEY DON’T TALK ABOUT THE MICROBIOME IN THE KIDNEY WHICH IS NOW KNOWN.  I WONDER WHAT AFFECT THAT HAS.

CLINICAL TRIAL [Milliner et al 2017] Randomised Phase II/III study oral Oxalobacter formigenes reduce urinary oxalates to treat primary hyperoxaluria. Researchers note that the mechanisms of human gut oxalate transport are poorly understood. They found:  the human epithelium is not responsive to O. formigenes effects on oxalate secretion because THIS PRODUCT DID NOT REDUCE URINARY OXALATE EXCRETION.  That’s poorly written in the article because it is probably more correct to say that THIS commercial product failed, not necessarily that the human epithelium is not responsive to this bacteria.  The finding was surprising given that failure in this human trial  contrasted to the animal models that found positive impact.  The Pearl:  Humans are not mice, or maybe they never even had the target probiotic in the oral supplement in the first place?!?

[Ellis et al 2015] Analysis of commercial kidney stone probiotic supplements. Conclusion:  The commercial probiotic products don’t even contain the oxalate degrading bacteria!  That surprised most  NOT in my microbiome space.  In my space, we know it is really hard to process the beasties that are in our gut in such a manner that they can be made into commercial products. It’s why you want to eat to bloom beneficial microbiota.  Many if not most aren’t commercially available.  Heck they’ve never even seen many of these microbiota  before RNA sequencing that is only now occurring!

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NOTE:  THE RESEARCHERS DON’T TALK ABOUT THE MICROBIOME IN THE KIDNEY (a recent finding). 

I WONDER WHAT AFFECT THAT HAS ON DEGRADING OXALATES IN THE KIDNEY?!?

If your Litholink study has a high urine oxalate finding, the microbiome in the kidney isn’t degrading them very well.  Makes me realize how important citrate (lemon juice and supplements) and other things you are supposed to do really becomes.

 

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My space is talking about if eating real food would work in humans to reduce the INCIDENCE of kidney stones. 

Why?  Because once an individual has formed a stone, the likelihood of recurrence is 50 percent or greater at five years and up to 80 percent at 10 years. [UW Health, University of Wisconsin, Madison. How Common are Kidney Stones]

They describe real food as:

• • Loads of colorful plants (vegs and fruit like avocado/berries) for fiber and phytochemicals which nourish and are messengers to the microbiome (pre-selecting who is in there and how many are present),
  • Quality protein (meats/poultry/eggs/dairy/nuts/seeds).  Note:  Dairy provides a double bonus.  Its dietary calcium is important because it binds with dietary oxalates in the gut for excretion thereby keeping oxalates out of the kidneys.  If lactose is a problem, lactose-free calcium rich options are SCD yogurt (or   most commercial yogurt because its lactose is so low that many can tolerate it, but don’t choose those with added sugar) or SCD lactose-free cheeses like these ↓ provided they are aged at least 30 days, or made of raw milk which has a mandatory 60 day age:

    

    

  • Some food that contains live probiotics (cheese, yogurt, kimchi, sauerkraut…).
  • In conjunction with getting the crap out that harms the microbiome (processed foods with nonfood ingreds like emulsifiers and obesogenic fats like vegetable oil, canola oil…).

They are suggesting that this blooms the beneficial bacteria and that should include those that degrade the oxalates.  The studies above talk about who those beasties are.

You guys can actually see for yourself on your Litholink 24 hour urine testing for kidney stone prevention studies (journal really well what you diet is) to LEARN how diet affects your readings in order to keep your risk of stone formation low.  Here’s an example of Litholink   studies over TIME (see 7/15/10? Topical RXX ⇒⇒ UA24 crisis!):

The people in my space follow oxalates because they affect people beyond kidney stones including autism, depression/cognition/brain disorders, and digestive disorders.

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How should you eat the MANY vegs & grains that contain high oxalates?  Read Ornish, Does Being a Vegetarian Cause Kidney Stones? AND University of Chicago, Kidney Stone Diet.

♥♥ The solution for many is to eat calcium along with the high oxalate food so that it binds in the gut and is expelled there instead of going to the kidneys. ♥♥

Why do you want to eat vegetables?  Beyond nutrients and fiber, they have the biggest impact on nudging the microbiome towards higher diversity, which means increasing health due to increasing beneficial species ⇒ that should include the oxalate neutralizers.  The Optimal Diet from American Gut says to target 30 different vegs each week. I am not aware of anyone talking yet about microbiome ⇔ diet studies for kidney stone formation, but I am asking UChicago and some key microbiome researchers.  I will update this post when they respond! Listings for oxalate levels in food can be found here.  As well, this Litholink Low Oxalate Patient PDF is a goldmine for info. IN the meantime:

1. The University of Chicago Kidney Stone Diet notes that oxalate absorption is individualized.  Eating calcium along with the oxalates can alone accomplish the reduction of urinary oxalates for any one person, but that needs tested and confirmed by testing your oxalate levels with urine collections [like Litholink, 24 hour urine testing for kidney stone prevention].   How much calcium? Litholink’s Low Oxalate Patient PDF says:  Unless told otherwise by your doctor, your diet should have between 800 and 1,200 mg of calcium per day. Eating a diet low in calcium is not advised. In fact, studies have shown that eating low calcium diets will increase calcium oxalate stone risk.  Oxalate and calcium bind together in your intestine and leave the body together. If you eat a low calcium diet then oxalate has no partner to leave the body with. Oxalate will then be absorbed back into your system leading to higher oxalate levels in your body.
2. An excerpt:  All things being equal we have advocated for a low oxalate intake between 50 and 100 mg daily.  However, Ross Holmes showed clearly that with very high calcium intakes such as 1,000 to 1,200 mg daily, absorption of diet oxalate is less and therefore the need for strict control is also less. In the one diet trial by Borghi diet oxalate was 200 mg/day but diet calcium was high and urine oxalate actually lower than in his contrast group with low calcium diet and less oxalate intake.

   The ideal approach as best we can tell is to put in place the high calcium diet, aim for about 200 mg of oxalate, which is easier to accomplish than lower values, and measure the urine results. If despite high calcium intake urine oxalate is creating risk of stones then diet needs to be altered appropriately.

3. READ both articles because there are other things you should do to reduce urine oxalates. University of Chicago, Kidney Stone Diet says:  Reduce sodium (to 1,500 to 2,300 mg ⇒ that happens automatically if you do the next suggestion which is eliminate/reduce refined sugar.  WHY? ⇒ simply eating 100 gm of glucose causes a rapid rise in urine calcium with – can you imagine worse? – a concomitant fall in urine volume so supersaturations in the kidneys rise extremely high ⇒ that situation is a high risk for stone formation, limit protein  to 1/2 to 2/3 lb for most because excess can convert to oxalates, avoid excess vitamin C supplements (stay below 2,000 mg or more per day because the excess converts to oxalate), and perhaps the greatest protection from stone formation is to drink high fluid volumes (the urine volume you want is above 2.5 l/d, the amount of dietary fluids needed to achieve that is about 3 l/d, increased for exercise and hot weather).
4. Dean Ornish and Ben Brown, both MD, Founder and Medical Director, respectively of Ornish Lifestyle Medicine (this is the hypertension DASH diet group) also said to boil high oxalate vegs and then toss the water where the oxalates are (but note:  that gets rid of many nutrients too).
5. Here’s an excerpt from the Ornish article with links to evidence based studies ⇒  Carnivores Get More Stones:

Oxalate and calcium are more common in certain foods that are found in a vegetarian diet, but it appears vegetarians get fewer stones than meat eaters.  In a study done in 1979, men with the highest meat consumption were more likely to be recurrent stone formers due to the increase urinary excretion of calcium, oxalate and uric acid. This study was again repeated in 1982 and vegetarians had a 40-60% decreased risk of kidney stones. In another study from 2009, the DASH diet (usually recommended for hypertension) that includes high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains, some lean meats and low intake of sodium, sweetened beverages, and red and processed meats, found that this diet cut the risk of kidney stones almost in half. This may be due to the decrease in animal protein, the higher amounts of magnesium and potassium in vegetables or the higher amount of phytic acid in grains.

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In conclusion:  You guys can actually see for yourself using your Litholink studies (journal really well what your diet is) to LEARN how diet affects your readings in order to keep your risk of stone formation low.

Just sharing in case you are interested…

Best in health through awareness,

References: 

1. [Scales et al 2012] Prevalence of Kidney Stones in the United States.
2. [Whittamore et al 2018] The role of intestinal oxalate transport in hyperoxaluria and the formation of kidney stones in animals and man.
3. CLINICAL TRIAL [Milliner et al 2017] Randomised Phase II/III study oral Oxalobacter formigenes reduce urinary oxalates to treat primary hyperoxaluria.
4. [Ellis et al 2015] Analysis of commercial kidney stone probiotic supplements. Conclusion:  The commercial probiotic products don’t even contain the oxalate degrading bacteria!
5. Litholink 24 hour urine testing for kidney stone prevention.
6. [UW Health, University of Wisconsin, Madison. How Common are Kidney Stones]?
7. Lactose free calcium rich options are SCD yogurt or SCD cheeses.  Dietary calcium is important because it binds with dietary oxalates in the gut for excretion thereby keeping oxalates out of the kidneys.
8. Microbiome, Emulsifiers, IBD & Metabolic Syndrome.
9. Soybean Oil, Corn Oil, Diabetes, Metabolic Syndrome & P-450.
10. Does Being a Vegetarian Cause Kidney Stones? Dean Ornish and Ben Brown, both MD, Founder and Medical Director, respectively of Ornish Lifestyle Medicine (this is the hypertension DASH diet group) addressed this important question.
11. University of Chicago Kidney Stone Diet.
12. The Optimal Diet from American Gut says to target 30 different vegs each week.
13. Oxalate levels in food listing can be found here.
14. Litholink’s Low Oxalate Patient PDF is a goldmine for info.

Last updated: January 13, 2019 at 17:01 pm to add the link to Litholink 24 hour urine testing for kidney stone prevention, Litholink’s Low Oxalate Patient PDF, and to add the section: 

How should you eat the MANY vegs & grains that contain high oxalates?  Read Ornish, Does Being a Vegetarian Cause Kidney Stones? AND University of Chicago, Kidney Stone Diet.

Last updated: January 13, 2019 at 17:01 pm to fix due to WordPress Changes.