Research on the increased incidence of kidney stones after RNY

cicerogirl
on 6/10/13 7:12 pm, edited 6/10/13 7:53 pm - OH

Recently, I have been doing some research on kidney stones, diet, and RNY since I currently have several large uric acid stones and because this is my third round of stones (the only stone captured previously was a calcium stone) since my RNY six years ago (and I never had any stones in the 45 years prior to my RNY).  Those who have had RNY definitely develop kidney stones more frequently than the general population, and now I understand why.  Here is a summary of what I have found so far. 

First, some general info about kidney stones.  There are several types and, in terms of dietary causes (there are also physiological causes), the various kinds can be due to 1) "excessive" protein consumption, particularly animal proteins  2) too few carbohydrates  3) high oxalate consumption  4) calcium carbonate supplements.

High protein consumption is hard on the kidneys, but there is no medical consensus on exactly how much is too much.  There does seem to be general agreement, however, that protein consumption should account for less than 30% of  total calories. The protein goal most frequently given by RNY surgeons is 60g per day (for women), so RNYers who eat 60g are eating around the amount of protein recommended by the NIH (.36g per pound of body weight, which would be 54g for a 150 pound woman and 45g for a 125 pound woman) once you take some possible malabsorption into account.  RNYers who are eating 100g (or more) of protein per day, however, would be eating two to three times what the NIH recommends and may be increasing their chance of kidney stones.  The type of protein also matters.  Too much animal protein (including fish and eggs) can contribute to uric acid stones.

Too few carbohydrates and too little fiber can also contribute to formation of kidney stones.  According to The Cleveland Clinic  (published in "High Protein Low Carbohydrate Diets", Department of Nutrition Therapy at The Cleveland Clinic. Edited by Cynthia Haines, MD, WebMD, October 2005... cited because I know this is going to raise some eyebrows on the carbophobes here), diets that include less than 100g of carbohydrates per day can cause your body to stay in a state of ketosis (even if you are not losing any weight), wherein your body produces ketones which can result in kidney stones (and, if too many ketones are present for too long a period of time, can result in kidney failure).

Excessive oxalate consumption (in soy products, nuts, whole wheat bread (I have seen this cited several places but don't understand why), berries, kiwi, carrots, celery, eggplant, kale, spinach, leeks, sweet potatoes, and chocolate) can produce calcium oxalate stones.  This is the type of stone that is most commonly seen in people who have had RNY and the DS. One of the effects of bypassing part of the intestine is that we have higher oxalate levels in our bodies.  Part of the reason that we are instructed to drink so much water is to help decrease the oxalate levels in the urine (by diluting it).  So, with higher oxalate levels because of the bypass and the potential dietary contributors of high oxalate foods and often not enough fluid intake, it makes sense that RNYers get these stones more frequently than non WLS folks.  (I wish my surgeon had told me that this is part of the reason for the additional fluids.  I have never been a big drinker, but have also never been dehydrated (except after an illness with diarrhea), so I have been pretty lax about my fluid intake. My current stones are uric acid stones, but I still need to make an effort to get more fluids on a regular basis now that I know this.)

For folks like RNYers who do not absorb calcium carbonate well, taking calcium carbonate supplements can cause calcium stone formation.  The good news is that calcium citrate, which is what we DO absorb, helps prevent calcium stones, as do dairy products (because the calcium binds with the oxalate before it enters the kidneys) and  foods/drinks that are high in citric acid  (lemonade and orange juice seem to be particularly effective).

Finally, "excessive" Vitamin D supplementation can also contribute to the two calcium types of kidney stones, so while we want our D to be at a good level (around 80), if it is significantly higher, it may contribute to stone formation.

Hopefully that helps explain why we are more at risk for kidney stones (of all kinds except the rare ones) both because of our surgery and because of our post-op diets.

Lora

 6 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

poet_kelly
on 6/10/13 7:25 pm - OH

I'm bookmarking this post because its such good information.

It's really scary to think about how some surgeons recommend calcium carbonate to patients, which not only puts them at risk for osteoporosis, since they won't be absorbing much of it at all, but also increases their risk of kidney stones.

Then consider that some surgeons recommend patients get most of their protein from animal sources (I recall a few posters here saying that their surgeon wanted them to eat nothing but meat, eggs and cheese for three months - no beans, not other sources of protein at all), and that's really scary.

I think beans are a great source of protein, and I like them because they are cheap and they taste good, but it seems like using beans for some of our protein would also then reduce our risk of kidney stones.  They also contain some carbs and fiber, which would further lower our risk of kidney stones.  I think surgeons and dieticians should start encouraging patients to consume more beans once they start on soft foods.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

cicerogirl
on 6/10/13 7:52 pm, edited 6/10/13 8:00 pm - OH

Yes, I thought about the meat/eggs/cheese early post-op diet as well when I was reading about the uric acid stones.  I wouldn't have agreed to such a diet, personally, simply because it is a diet and not the way of eating for the long-term, and because it is hardly a balanced diet since it includes absolutely no veggies, fruit, legumes, or grains.

I agree about the beans. They are an overall excellent choice for us, especially in light of this information. I have already increased the amount of beans I eat in order to reduce the amount of meat (and, in this case, meat includes fish... I guess I should edit my post to add that!) since the uric acid stones are considerably larger than the calcium stones I had previously! 

Lora 

 

 6 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

poet_kelly
on 6/10/13 7:56 pm - OH

I would not have agreed to it because since I am ethically opposed to eating meat, that would have meant nothing but eggs and cheese for several months.  And I actually have ethical issues with eggs and dairy, especially eggs, I just eat them anyway sometimes.  Well, often, in the case of dairy.  But I would not have been willing to increase the amount of cheese in my diet and certainly would not have been willing to increase the amount of eggs I eat.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

PetHairMagnet
on 6/11/13 7:38 am - NC
RNY on 05/13/13
On June 10, 2013 at 7:25 PM Pacific Time, poet_kelly wrote:

I'm bookmarking this post because its such good information.

It's really scary to think about how some surgeons recommend calcium carbonate to patients, which not only puts them at risk for osteoporosis, since they won't be absorbing much of it at all, but also increases their risk of kidney stones.

Then consider that some surgeons recommend patients get most of their protein from animal sources (I recall a few posters here saying that their surgeon wanted them to eat nothing but meat, eggs and cheese for three months - no beans, not other sources of protein at all), and that's really scary.

I think beans are a great source of protein, and I like them because they are cheap and they taste good, but it seems like using beans for some of our protein would also then reduce our risk of kidney stones.  They also contain some carbs and fiber, which would further lower our risk of kidney stones.  I think surgeons and dieticians should start encouraging patients to consume more beans once they start on soft foods.

How do you bookmark a thread?

    

HW333--SW 289--GW of 160 5' 11" woman.  I only know the way I know & when you ask for input/advice, you'll get the way I've been successful through my surgeon & nutritionist. Please consult your surgeon & nutritionist for how to do it their way.  Biggest regret? Not doing this 10 years ago! Every day is better than the day before...and it was a pretty great day!

        

    

    

poet_kelly
on 6/11/13 8:03 am - OH

I bookmark it the same way I bookmark anything else online.  The internet browser I use is Mozilla Firefox and in the upper left hand corner is a thing that says "bookmarks."  When I click on that, it gives me the option to click on "bookmark this page."

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

cajungirl
on 6/10/13 8:12 pm
Interesting read. I've never had a kidney stones but hear they are painful. I also need to increase my water intake.

Proximal RNY Lap - 02/21/05

 9 years committed ~  100% EWL and Maintaining

www.dazzlinglashesandbeyond.com

 

Lizzie S.
on 6/10/13 8:12 pm

Thanks Lora, what great information.   Hope you get relief soon, and that this is the last time for you.    So far, so good here (knocking on wood) but my surgeon recently cautioned me about kidney stones and hernias even though I have had no indication of problems. 

Lizzie in OR

    
RosyKate 73
on 6/10/13 8:50 pm
Thank you. This is important and timely info.

                

R&R-it's not a group-it's a lifestyle.

The single biggest problem in communication is the illusion it has taken place-George Bernard Shaw

"If anybody call either of you a son of a whore, you must bear it; for you are so: but if they call you bastards, fight till you die; for you are an honest man's sons." Catherine Sedley

bbearsmama
on 6/11/13 4:16 am
RNY on 02/28/13 with
Wow-great information!! I am bookmwarking it and printing it out. I have had a few stones (prior to rny) so I want to do what I can to decrease further episodes. The first time that I had a stone-I was in the ER and the ONLY drug that gave.me releif was toradol.in my iv. Morphine didnt even touch the pain! I know that toradol wont be good for my new anatomy since it is an nsaid. Thank you again!! Pam

"B" bears' mama from Texas
Follow my journey on youtube: "bbearsmama" 

SW: 210 CW: 123.6

    
cicerogirl
on 6/11/13 11:04 am - OH

The one I had actually pass about a year ago (these are too large to ever pass on their own) was excruciating and the morphine was only marginally helpful.  After the morphine they gave me dilaudid and that finally gave me some relief.

Lora

 6 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

bbearsmama
on 6/11/13 7:55 pm
RNY on 02/28/13 with

That's good to know!! I will have to remember that-dilaudid-lol! When it happened (back in 99), I told myself that I would never ever forget the name of "toradol" so that I could request it again should the need arise-lol! It completely took the pain away!! But now that's certainly not my best option.

I am so sorry you are going through this! Thank you for helping us by sharing what you've learned!

 

Sincerely,

Pam

"B" bears' mama from Texas
Follow my journey on youtube: "bbearsmama" 

SW: 210 CW: 123.6

    
Denise B.
on 6/11/13 7:52 am - Binghamton, NY

Very good information.  Thank you for the research and taking the time to share.

Get a dream, make it yours, and let no one steal it!
Nothing great was ever achieved without enthusiasm. - Ralph Waldo Emerson
Highest weight 285, day of surgery 265, current weight 209, and holding steady.
            
nfarris79
on 6/11/13 12:48 pm - Germantown, MD

Ugh.... setting myself up for kidney stones apparently. Except for the water thing. Hopefully that weighs in my favor.... Still not giving up my animal proteins though!!kiss

First Full Marathon: Marine Corps 10/27/13 4:57:11, Half Marathon PR 2:04:43 at Shamrock VA Beach Half-Marathon, 12/2/12 First Half-Marathon 2:32:47, 5K PR  Run Under the Lights 5K 27:23 on 11/23/13, 10K PR 52:53 Pike's Peek 10K 4/21/13(1st timed run) Accumen 8K 51:09 10/14/12. 6  Half-Marathons finished


HW 267/SW 227/CW 130/ GW 140
     
 

april89love
on 6/11/13 4:30 pm - NC

Great post! It really answers a lot of questions I have had over the last couple of years.

 Sandy

HW 225, SW 219, GW 140, CW 124

I can do all things through Christ who strengthens me!  
    

65rosesmom
on 6/11/13 8:07 pm

Thanks, Lora, this is great information.   It confirms many of my own gut instincts about trying to make sure I don't completely eliminate all carbs, nor rely on only once source of protein, and get in my dairy.   Its a good reminder to keep up the fluids....I agree the surgeon's should have told us this is one of the reasons!!!

Heather   Mom to 3  
Surgery August 9, 2012
HW = 225, SW= 205, CW 135 

    

MyLady Heidi
on 6/12/13 2:18 am

All purine rich food can contribute to excessive uric acid and stones and/or gout.  Lean meats and low fat milk and yogurts may be a healthy alternative even for someone with high uric acid.  This is a very delicate balancing act of our diets.  I am pulling back on my protein consumption, especially from meat and going back to a normal healthy balanced diet without the protein obsession. I am dropping the artificial vitamins also, I want everything to come from food and I am not convinced all these chemicals/vitamins do any good anyway.

You have worked hard to do the right thing that the doctors told you to do and look what it got you.  Too much protein is not healthy. Period.

Ingrid K.
on 6/20/13 1:36 pm - Canada
I just had my RNY on Monday and am really glad to come across this post. As a newbie, I really rely on the experience and kindness of those who have gone before me. Thanks so much for this information!!!
Sherry T.
on 6/20/13 2:00 pm - GA
RNY on 05/22/12

Lora,

Interesting!!    I know this may sound weird but I had the strangest pain this morning....I knew it wasn't gas never expelled any either (sorry TMI) but it almost felt like when I had perforated my small intestine....but after drinking water it has subsided...I'm not a big drinker either...but I know I need to do better.   I still feel sore like but it feels more lower intestinal and never knowing if I had a kidney stone....where does the pain likely feel like its coming from?  I almost posted about it  but wasn't sure and when it subsided I thought it could have just been the grapefruit I ate this morning. Glad to know it has some good to it...was worried all that citric acid might not help.  

Sorry if this is crazzzzzzzzzy!!

 

Thanks!

Sherry

cicerogirl
on 6/20/13 2:14 pm - OH

It can vary a lot depending on where the kidney stone is at, but in general, the pain can be in the lower back, down your flank area, or in the very center of the body.  Pain in the back and flank appear to be most common since the pain (which can be EXCRUCIATING... during my first attack, which was the most painful, I couldn't walk or even keep my eyes open (let alone focus them) because it hurt so badly!) usually comes about when the stone is trying to pass down the ureter from the kidney to the bladder.  With smaller stone  though, the pain would not be as bad.

In two of my three episodes, the pain started in my lower back but very quickly moved to my side (but it feels like a deep pain) and then hurts so bad that it felt like that entire half of my body was generating the pain! This last episode was different (pain was entirely in the lower back) since the stones stayed in the kidney and one was just partially blocking the ureter.  The pain was the kidney reacting to the extra fluid that kept building up as the stone would move slightly and block most of the ureter connection (and it felt like I needed to pee but I couldn't). 

Lora

 6 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”