Kidney Stones

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Experience From - Jeff Collins , Dick Vincent , John Davis , Deb Reno , Ralph Balsamo , Jennifer Miles, M.D. , Robert Thomas , Randy Gehrke , Jay Hodde , Peter Bakwin , Fred Liebes , Robert Thomas #2,


Jeff Collins

I have been running for a number of years and have had problems with kidney stones. I don't think running should be a large factor but haven't seen anything mentioned either pro or con. Doctors say to drink lots of liquids but maybe the loss of moisture through respiration and sweating can aggravate the problem ?

Wonder if others have had similar problems ? Any reason for less or more problems due to running ?


Dick Vincent

I had my doctor tell me that if I continued to consume large amounts of cola that I would increase my chances of kidney stones. I forget now exactly why, but it is something to look into if you are a cola addict as I was.


John Davis

I had a great morning about a year ago where things started coming unglued about 3:30 AM. By 6:30, I was sitting in a chair downstairs trying to let the wife sleep because I hurt so much. (She is still mad at me for not waking her!) We sat in the emergency room for almost three hours with no medication. Yes, the pain is FAR beyond anything in ultras.

When I run (as well as when not running), my hydration is usually far below the "clear" level. I figured I was just getting my fair results from years of playing the low end on the kidneys. In fact, the exercise level usually allowed me to get more hydration than when being sedentary.

The answer came a few days later when it turned out that the wife had been giving me calcium and magnesium pills. I guess when my body sees calcium or magnesium at higher levels, it just loves to make little deposits in the kidneys. (Cautionary note: I am a male with little tendency toward osteoporosis. She has a rather advanced case of it.)

Bottom line: running probably has kept me form getting the friendly nudge rather than creating the problem.


Deb Reno

In talking to my physician about this issue, I've been told that running, per se, is not a problem. The main concern is hydration. Be even more aware of staying well hydrated. I'm sure the Doctor has examined the stones and given you some dietary recommendations. Anything caffeinated (i.e. colas, coffee, chocolate) stimulates the kidneys to produce more urine, and could contribute to dehydration during a long ultra event when you're losing a lot via sweat, etc. anyway. Keep fluids and electrolytes in good shape.


Ralph Balsamo

A medical survey was conducted in 1976 by Dr. Gabe Mirkin regarding the incidence of kidney stones. The participants were the entrants in the 1976 NYC marathon. As part of that survey I received a follow up telephone call from Dr. Mirkin asking additional details. I told him that I had 3 kidney stones by that time, the first at the age of 22 and had been running competively since high school (early 60's). Dr. Mirkin said that the incident of kidney stones in distance runners were 3 or 4 times the average population. The cause, he said, was long term dehydration and the best preventive measure was to insure by the end of the day that urine was clear as water. Dr. Mirkin asked what kind of mileage I was doing at the age of 22 and my reply was not much, I was in Vietnam at the time and had malaria 4 months prior to the kidney stone. Malaria cause sever dehydration.

Subsequently, I had 2 more stones. So, I followed Dr. Mirkin's advice 9 years after his conversation and my last stone was in 1985.

Drink up, my friend, drink up.


Jennifer Miles, M.D.

Dehydration will increase your tendency to develop stones. therefore any running you do over long distances can also potentially increase your chances of further occurrences. In addition, large quantities of Vitamin C are also associated with stones.


Robert Thomas

Overloading on electrolytes is a problem if you use concentrated sports drinks that have to many electrolytes in the volume of water and improperly balanced ratio of electrolytes. Many products can be fine if you use them sparingly, but of course ultras last a long time and you can use a lot of drinks.

No or low salt intake and plain water is not the way to go. You do not rehydrate as quickly or as well using plain water and you get no energizing calories using just plain water. Of course you don't want the other extreme and have over salty water. It is almost never the salt in sports products that is the problem. Usually it is all the other electrolytes in too concentrated amounts and the high ratios of these other electrolytes to salt. In addition with your food you can drink gallons of sport drink mixes with high carbohydrate content literally all day long, that have added salt in reasonable amounts and only slight trace amounts of all other electrolytes. This eliminates many sports drinks from high use in a long ultra event.

If you eat foods constantly you could use just plain water and get everything you need from your food. But it is less efficient and more time consuming to always eat and never drink any of your calories.

The issue of electrolytes and water aside there is more going on than just your drink.

Ibuprofen can cause problem for people and I would not take it before or during a race.

The last thing that may be of help is supplementing the diet with a good vitamin and micro nutrient program. Without going on endlessly about everything, the extra antioxidants can protect the cells from breakdown during a stressful event and make the cells more resistant to breakdown before the event even starts.

Very basically you take a good quality vitamin, mineral supplement that has everything possible in it. You need to take it in a reasonable large amount, you can add on top of that extra vitamin E, C, Lipoic Acid, Ginkgo and Conjugated Linoleic Acid.

This is just a brief list off the top of my head, but a good start.


Randy Gehrke

I've had problems with my kidneys hurting only on 100 milers but i believe that it is all related to water retention. They really hurt this year at WS but as soon as i switched just to drinking plain water, they were fine. And since then, i drink a combination of Allsport and just plain water and its worked for me. I would recommend that you try to limit your fluids to water or a really, really watered down electrolyte drink. Gatorade has way too much sodium in it as do others and i think also that you can get too much salt.


Jay Hodde

Rich said:

The use of NSAIDS, ibuprofen as well as any of the related drugs during ultras is playing with fire. The kidneys as well as the stomach are at risk.
I'm not going to argue that NSAIDS use during ultras is safe, because I think there is data to show that dehydration and NSAID use is a bad combination -- and that is what we have when we take the drugs during ultras.

I'm just curious if anyone out there knows how much of a risk low-dose NSAID use is? Does taking an Ibuprofen every 4 hours during a long run increase the risk of kidney toxicity by 5% or by 50%?? (And yes, you could argue that even 5% is a large enough increase to justify staying off the drug during a race -- but what if the risk is just 0.5% or even 0.05%??)


Peter Bakwin

Unfortunately, there is no data to answer Jay Hodde's excellent question: How much does taking NSAIDS increase your risk of kidney failure? There have been very few studies of exersize- induced rhabdomyolysis, which is the prelude to kidney failure. My wife spoke to a nephrologist here in Boulder (a "very" althetic town), and he had never seen a single case of kidney failure as a result of exersize-induced rhabdo. This despite the fact that perhaps as much at 40% of reported cases of rhabdo from all causes lead to kidney failure. This is not to say that kidney failure does not occur in athletes - see Don Davis' story in UR a while back - but it is rare. The nephrologist that my wife talked to also said that he feels that runners should NEVER take NSAIDS. Physiologists know well the mechanism to link NSAIDS to kidney failure, but the studies haven't been done to say how dangerous it really is. Note that taking NSAIDS apparently has nothing to do with whether or not you get rhabdo -- only how your kidneys handle the effects.

If you do get kidney failure you get to have dialysis - a real bummer. But you will almost for sure survive.


Fred Liebes

At Western States in '93 I had a back injury, so I took 400mg ibuprophen every 4 hours. In 28 hours that's 2800mg! I did the blood test study at the finish line, and although I didn't have Kidney failure and my CPK was "average" for WS, my White Blood Cell count was the highest ever recorded at WS! Normal is between 4.0-10.5. Mine was 35.6.

Needless to say this scared the hell out of me, and I now use the stuff very judiciously! Like, I never take it at all unless I'm having a major problem.

There's no hard evidence of a correlation between the use of NSAIDs and elevated RBCs, but my experience is still enough to keep me avoiding the stuff.

You can't screw up your kidneys and liver with it if you don't take it!

Go Natural !


Robert Thomas #2

Subject: Kidney Stones & Vitamin C Intake

I agree with most of what has been said about some of the contributing causes of kidney stone formation. Chronic dehydration and what you choose as your long-term beverage type can have some influence. Colas, apple juice and grapefruit juice are a few of the higher risk drinks, while coffee, wine, beer and tea are a few of the lower rise drinks associated with long term use. See references (2,3,4,5).

I don't agree completely in the context of the overall reply with the blanket statement "large quantities of Vitamin C are also associated with stones.". This is a fairly innocuous statement but it may lead some people to stop taking extra vitamin C. There are so many compelling reasons to take extra Vitamin C for health and to combat the stresses of ultra running, I just could not let this statement go by with out comment.

I refer you to the references at the end of my reply. The recent study by the vitamin research dept of Hoffman-La Roche (A giant drug and vitamin making company) shows that only in persons with ascorbic acid or oxalate metabolic defects where there any risk factors with high vitamin C intake. See reference (1). To the contrary a higher intake of over 1500mg a day was associated with a reduction of stone formation risk in metabolically normal people. Whether high intake of vitamin C causes stones is an old argument that been around for years. Here is a quote out of the 1982 book "Life Extension The Scientific Approach" By Dirk Pearson, page 415 "Some claim that vitamin C increase the probability of formation of oxalate or uric acid kidney stones, but extensive observations in people using multigram doses of C for many years has not resulted in discovery of such stones, nor are such stones a general problem in animals which manufacture large amounts of vitamin C." Now this was back in 1982 and here we are in 1999. Not everyone is going to agree with Dirk Pearson on all things. There are also many other books devoted to nothing but the therapeutic effects of very high vitamin C intake. This just goes to show how long and hard it is to dispel half-truths and make clear the reasons and nutritional options there are for optimal health.

High intake of Cysteine (An amino acid found in foods. Eggs contain a large amount about half a gram each.) can lead to increased Cystine in the body (the oxidized form of Cysteine) Cystine can form damaging stones in the kidneys or urinary bladder, but Cysteine can't. Anti oxidant vitamins like vitamin C prevent the formation of cystine. This is a underlying mechanism why higher amounts of vitamin C actually help prevent stone formation, except in those with rare metabolic problems.

I bring this up to show that if you don't have a metabolic problem with vitamin C intake, you should not discontinue taking extra vitamin C out of unfounded fear.

If you really want to do something for your over all health and help lower stone formation risk. I would recommend taking Lipoic Acid. See reference (6). It's found in your locale health food stores as a supplement. It's the closest thing to a miracle drug I know of because it has so many diverse positive influences on health, you could write a book. One interesting effect is that Lipoic Acid helps recycle vitamin C that has been oxidized back into its unoxidized form making it biologically useful again. So whatever amount of vitamin C you ingest per day will have a greater effect if Lipoic Acid is also take with it. Any small amount is helpful, starting around 50 mg a day. I have taken for a long time between 100-200 mg a day, but am trying larger amounts right now. In Germany the recommended dose is 600 mg a day. It is prescribed there for diabetes. You don't need to be a diabetic to derive the good from Lipoic acid. I just mentioned its use there to show that it is not just your regular health store supplement and there are a large number of people who have taken it for a long time under a doctors supervision. We are lucky here in this country we don't need to see a doctor to get it.

REFERENCES

(1).
Ann Nutr Metab 1997;41(5):269-82
No contribution of ascorbic acid to renal calcium oxalate stones.
Gerster H
Vitamin Research Department, F. Hoffmann-La Roche Ltd., Basel, Switzerland.
Even though a certain part of oxalate in the urine derives from metabolized ascorbic acid (AA), the intake of high doses of vitamin C does not increase the risk of calcium oxalate kidney stones due to physiological regulatory factor: gastrointestinal absorption as well as renal tubular reabsorption of AA are saturable processes, and the metabolic transformation of AA to oxalate is limited as well. Older assays for urinary oxalate favored in vitro conversion of AA to oxalate during storage and processing of the samples. Recurrent stone formers and patients with renal failure who have a defect in AA or oxalate metabolism should restrict daily vitamin C intakes to approximately 100 mg. But in the large-scale Harvard Prospective Health Professional Follow-Up Study, those groups in the highest quintile of vitamin C intake (> 1,500 mg/day) had a lower risk of kidney stones than the groups in the lowest quintiles.

(2).
Am J Epidemiol 1996 Feb 1;143(3):240-7
Prospective study of beverage use and the risk of kidney stones.
Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Patients with kidney stones are routinely advised to increase their fluid intake to decrease the risk of stone recurrence. However, there has been no detailed examination to determine whether the effect on recurrence varies by the type of beverage consumed. The authors conducted a prospective study of the relation between the intake of 21 different beverages and the risk of symptomatic kidney stones in a cohort of 45,289 men, 40-75 years of age, who had no history of kidney stones. Beverage use and other dietary information was measured by means of a semiquantitative food frequency questionnaire in 1986. During 6 years of follow-up (242,100 person-years), 753 incident cases of kidney stones were documented. After adjusting simultaneously for age, dietary intake of calcium, animal protein and potassium, thiazide use, geographic region, profession, and total fluid intake, consumption of specific beverages significantly added to the prediction of kidney stone risk (p < 0.001). After mutually adjusting for the intake of other beverages, the risk of stone formation decreased by the following amount for each 240-ml (8-oz) serving consumed daily: caffeinated coffee, 10% (95% confidence interval 4-15%); decaffeinated coffee, 10% (3-16%); tea, 14% (5-22%); beer, 21% (12-30%); and wine, 39% (10-58%). For each 240-ml serving consumed daily, the risk of stone formation increased by 35% (4-75%) for apple juice and 37% (1-85%) for grapefruit juice. The authors conclude that beverage type may have an effect on stone formation that involves more than additional fluid intake alone.

(3).
Br J Urol 1990 Oct;66(4):357-62
Chronic dehydration stone disease.
Embon OM, Rose GA, Rosenbaum T
St Peter's Hospitals, London.
A study was made of 819 patients attending a metabolic stone clinic. A firm diagnosis was made in 708 (86%) and in 132 of these (19%) the diagnosis was thought to be chronic dehydration. The records were available for study for 87 males and 11 females in the chronic dehydration group. The mean age at presentation was 43 years. The causes of chronic dehydration were hot climate (62%), with hot occupation and low water intake almost equal in second place. In patients with a single cause of chronic dehydration, 57% also had a dietary risk factor for urolithiasis and this was most commonly high oxalate intake. Following dietary advice, the mean urinary volume increased from 1720 to 2475 ml/24 h. This was accompanied by a rise in mean urinary calcium from 6.02 to 6.96 mmol/24 h, presumably due to the calcium in the additional water drunk. Urinary oxalate did not change significantly. The mean follow-up time was 4.85 years and the stone recurrence rate was low. It was concluded that chronic dehydration is a common cause of urolithiasis; this can be treated satisfactorily by increasing water intake plus dietary advice in certain cases.

(4).
Occup Med (Oxf) 1992 Feb;42(1):30-2
Dehydration from outdoor work and urinary stones in a tropical environment.
Pin NT, Ling NY, Siang LH
Department of Community, Occupational and Family Medicine, National University of Singapore.
A questionnaire survey was carried out to determine the prevalence of urinary stone disease in 406 male workers in several occupations. There were 119 quarry drilling and crusher workers (outdoor, physically active), 77 quarry truck and loader drivers (outdoor, physically inactive), 92 postal deliverymen (outdoor, physically active), 75 postal clerks (indoor, physically inactive), and 43 hospital maintenance workers (indoor, physically active). The prevalence of urinary stone disease was five times higher in outdoor workers (5.2 per cent) compared to indoor workers (0.85 per cent, P less than 0.05). Contrary to expectation, no increased risk of urolithiasis was apparent in physically inactive workers. Chronic dehydration is likely to be the most important risk factor for the increased risk of urolithiasis in outdoor workers in the tropics, and should be easily prevented by increased water intake.

(5).
J Clin Epidemiol 1992 Aug;45(8):911-6
Soft drink consumption and urinary stone recurrence: a randomized prevention trial.
Shuster J, Jenkins A, Logan C, Barnett T, Riehle R, Zackson D, Wolfe H, Dale R, Daley M, Malik I, et al Research Assistance Corp, Gainesville, FL 32605.
The object of this study was to determine if a strong association between soft drink (soda) consumption and recurrence of urinary stone disease, found in an earlier case-control study of adult males, had a causal component. The study sample consisted of 1009 male subjects, who completed an episode of urinary stone disease, who were aged 18-75 at that time, and who reported consuming at least 160 ml per day of soft drinks. Half of the subjects were randomized to refrain from consuming soft drinks, while the remaining subjects served as controls. The intervention group had an observed 6.4% advantage in actuarial 3 yr freedom from recurrence (p = 0.023 one-sided) over the control group. One important secondary finding was that for those who reported at the time of the index stone that their most consumed drink was acidified by phosphoric acid but not citric acid, the experimental group had a 15% higher 3 yr recurrence-free rate than the controls, p = 0.002, while for those who reported at the time of the index stone that their most consumed drink was acidified by citric acid with or without phosphoric acid, the experimental group had a similar 3 yr recurrence-free rate to the controls, p = 0.55. This interaction was significant, p = 0.019.

(6).
Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Patients with kidney stones are routinely advised to increase their fluid intake to decrease the risk of stone recurrence. However, there has been no detailed examination to determine whether the effect on recurrence varies by the type of beverage consumed. The authors conducted a prospective study of the relation between the intake of 21 different beverages and the risk of symptomatic kidney stones in a cohort of 45,289 men, 40-75 years of age, who had no history of kidney stones. Beverage use and other dietary information was measured by means of a semiquantitative food frequency questionnaire in 1986. During 6 years of follow-up (242,100 person-years), 753 incident cases of kidney stones were documented. After adjusting simultaneously for age, dietary intake of calcium, animal protein and potassium, thiazide use, geographic region, profession, and total fluid intake, consumption of specific beverages significantly added to the prediction of kidney stone risk (p < 0.001). After mutually adjusting for the intake of other beverages, the risk of stone formation decreased by the following amount for each 240-ml (8-oz) serving consumed daily: caffeinated coffee, 10% (95% confidence interval 4-15%); decaffeinated coffee, 10% (3-16%); tea, 14% (5-22%); beer, 21% (12-30%); and wine, 39% (10-58%). For each 240-ml serving consumed daily, the risk of stone formation increased by 35% (4-75%) for apple juice and 37% (1-85%) for grapefruit juice. The authors conclude that beverage type may have an effect on stone formation that involves more than additional fluid intake alone.

(6).
Int Urol Nephrol 1986;18(4):363-8
Induced precipitation of calcium-oxalate crystals and its prevention in laboratory animals.
Gotz F, Gimes L, Hubler J, Temes G, Frang D
Induced precipitation of Ca-oxalate crystals and the possibility of its prevention were studied in dogs. In the first phase of the experiments precipitation of Ca-oxalate crystals in canine renal tubules was induced by intraperitoneal administration of Na-glyoxylate. Preventive medication (lipoic acid, vitamin B1, Milurit), applied in the second phase, resulted in a significant depression of induced precipitation. The successful experiments serve as a basis for clinical research aimed at a preventive medication of recurrent Ca-oxalate stone formation.