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Old 04-30-2009, 03:03 PM   #1
Ryan Whipple
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Kidney stones, blood pressure, medications, etc

I got quite a shock today when I went into the doctor to get my test results for blood and 24 hour urine. My numbers were:

Uric Acid: 1100 (750 considered high end)
Urine Calcium: 500 (300 considered high end)
Blood pressure: 144/85
Sodium: can't remember exactly, but also too high.

As a result, I am at risk for gout, more stones, and all the things that come with high blood pressure.

Doc said uric acid was the cause of the high blood pressure, and recommended treating it with hydrochlorothiazide. Also recommended Allopurinol (Zyloprim) for the calcium, and the fact that it happens to be a high blood pressure medication makes it a two-for-one in my case.

I'm trying to avoid medications because I am attempting to get into pilot training in the near future, and these meds would require a waiver. I asked the doctor about dietary changes and he said besides eating less sodium there was nothing I could do. He also said exercise was not a factor.

I eat almost entirely Paleo except for peanuts, milk and an occasional (~2x a week) cheat. Is there really nothing I can change at this point? Is it likely that any of this affected my athletic performance or feelings of wellbeing over the past weeks/months/years? I'm still in some amount of disbelief that I'm looking at medications for gout at the age of 22...things like that and kidney stones and such seem (at least to me) like problems associated with people 30-40 years older than me!
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Old 04-30-2009, 03:33 PM   #2
Katherine Derbyshire
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Re: Kidney stones, blood pressure, medications, etc

You might talk to a nutritionist. There's some evidence that legumes in particular, but also high-protein diets can induce high levels of uric acid. So yes, diet might help.

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Old 05-01-2009, 08:32 AM   #3
Jose M. Perez
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Re: Kidney stones, blood pressure, medications, etc

Increasing your water intake can help also. An additional 10 to 20 ounces per day will help thin your blood, thereby lowering blood pressure and reducing the sodium count. It might also reduce the chances of getting kidney stones. There are a lot of variables to consider. You might also want to check your family history and see if your grandparents or parents have had similar problems.
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Old 05-01-2009, 11:42 AM   #4
Dave Matteson
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Re: Kidney stones, blood pressure, medications, etc

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Originally Posted by Jose M. Perez View Post
Increasing your water intake can help also. An additional 10 to 20 ounces per day will help thin your blood, thereby lowering blood pressure and reducing the sodium count. It might also reduce the chances of getting kidney stones. There are a lot of variables to consider. You might also want to check your family history and see if your grandparents or parents have had similar problems.
No.

First, this will not "thin" your blood. A better word would be "dilute." But even that will not happen. Yes, drinking some extra water might temporarily dilute your blood a VERY SMALL extent, but your body works very hard to maintain a constant concentration of ions (such as sodium and potassium), etc. in your blood. Any extra water you drink that your body doesn't want or need is peed out.

Second, drinking water will ADD to your blood volume (again, only temporarily) which would actually RAISE blood pressure.

Will extra water reduce your chance of kidney stones, possibly, but only if you're not drinking enough water to begin with. Dehydration does increase your chances of kidney stones forming, but drinking extra water on top of what your body needs does very little to decrease stone formation.
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Old 05-01-2009, 12:31 PM   #5
Scott Allen Hanson
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Re: Kidney stones, blood pressure, medications, etc

Ryan,

The Paleo Diet Newsletter, Volume 2, Issue 4, September 15, 2006, is primarily about gout.

In a nutshell, he states that 90% of gout sufferers are under-excretors of uric acid. Contrary to popular wisdom and conventional advice, reducing dietary purine does not work very well, because it doesn't cure the underlying mechanism which is underexcretion of uric acid. According to Cordain, the paradoxical effect of a higher purine (i.e., meat) consumption actually ameliorates gout by increasing uric acid excretion by the kidneys.

He also implicates high glycemic carbs and, in particular, high fructose consumption as causes of gout.

Given that you are already adhering to a mostly paleo diet and Cordain identifies fructose as the primary dietary cause of gout, there are obviously other considerations, but I thought you might find this of interest.
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Old 05-01-2009, 01:52 PM   #6
Evan Hobbs
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Re: Kidney stones, blood pressure, medications, etc

Just out of curiosity, for paleo are you eating lots of veggies too or just lots of meat?

Also, did they check blood urea nitrogen (BUN) or creatinine levels?
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Old 05-01-2009, 01:56 PM   #7
Ryan Whipple
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Re: Kidney stones, blood pressure, medications, etc

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Originally Posted by Dave Matteson View Post
Will extra water reduce your chance of kidney stones, possibly, but only if you're not drinking enough water to begin with. Dehydration does increase your chances of kidney stones forming, but drinking extra water on top of what your body needs does very little to decrease stone formation.
This surprises me a little bit because I figured the more solution (water) run through a solute (all the chemicals my kidneys are filtering), the less chance of any of them percipitating out into stones. Are there other considerations beyond basic chemistry I should be thinking of?

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Ryan,

The Paleo Diet Newsletter, Volume 2, Issue 4, September 15, 2006, is primarily about gout.

In a nutshell, he states that 90% of gout sufferers are under-excretors of uric acid. Contrary to popular wisdom and conventional advice, reducing dietary purine does not work very well, because it doesn't cure the underlying mechanism which is underexcretion of uric acid. According to Cordain, the paradoxical effect of a higher purine (i.e., meat) consumption actually ameliorates gout by increasing uric acid excretion by the kidneys.

He also implicates high glycemic carbs and, in particular, high fructose consumption as causes of gout.

Given that you are already adhering to a mostly paleo diet and Cordain identifies fructose as the primary dietary cause of gout, there are obviously other considerations, but I thought you might find this of interest.
I'm not sure I understand. Are you suggesting I might be under-excreting uric acid even though my count for it is very high? That seems somewhat unlikely, although I have blood work being processed that will determine levels of uric acid in my blood. If it turns out that I am high in my blood as well than I am not excreting it fast enough, but since what I am excreting is so high, where is it all coming from? 3-4 servings of fruit a day?
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Old 05-01-2009, 02:58 PM   #8
Scott Allen Hanson
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Re: Kidney stones, blood pressure, medications, etc

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Originally Posted by Ryan Whipple View Post
I'm not sure I understand. Are you suggesting I might be under-excreting uric acid even though my count for it is very high? That seems somewhat unlikely, although I have blood work being processed that will determine levels of uric acid in my blood. If it turns out that I am high in my blood as well than I am not excreting it fast enough, but since what I am excreting is so high, where is it all coming from? 3-4 servings of fruit a day?
Ryan,

I'm not really suggesting anything in your case, just that Cordain states that 90% of gout results from under-excretion of uric acid. Your right, it doesn't make sense for you, if you are excreting a ton of uric acid. Also, since your already eating a paleo-diet, which Cordain advocates as beneficial for gout, I'm not sure how beneficial the paleo-diet could be in your case. I just thought you might find his take on gout as interesting. He does review a lot of the science in the article.

I have a hard time believing that the fructose in 3-4 pieces of fruit is the cause. Cordain was talking primarily about the standard western diet with high amounts of HFCS and sucrose (50/50 glucose and fructose).

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Old 05-01-2009, 03:09 PM   #9
Dave Matteson
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Re: Kidney stones, blood pressure, medications, etc

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Originally Posted by Ryan Whipple View Post
This surprises me a little bit because I figured the more solution (water) run through a solute (all the chemicals my kidneys are filtering), the less chance of any of them percipitating out into stones. Are there other considerations beyond basic chemistry I should be thinking of?
Basic chemistry is about all you need. You are certainly right in that the more solvent present, the less chance of the solute precipitating. However even at the low end of normal for urine concentration, it doesn't come close to the saturation point for most* substances that could potentially precipitate into stones. It's only when you're significantly dehydrated is it a problem for most* people.

*That being said, there are some conditions that result in abnormally excessive amounts of stone-forming solutes in the urine.

My point, and I should have been more clear, is that if you're already consuming the equivalent of 6-8 cups of water a day, an additional 10-20 ounces should not make a significant difference.
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Old 05-01-2009, 03:25 PM   #10
Dave Matteson
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Re: Kidney stones, blood pressure, medications, etc

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Originally Posted by Ryan Whipple View Post
I got quite a shock today when I went into the doctor to get my test results for blood and 24 hour urine. My numbers were:

Uric Acid: 1100 (750 considered high end)
Urine Calcium: 500 (300 considered high end)
Blood pressure: 144/85
Sodium: can't remember exactly, but also too high.

As a result, I am at risk for gout, more stones, and all the things that come with high blood pressure.

Doc said uric acid was the cause of the high blood pressure, and recommended treating it with hydrochlorothiazide. Also recommended Allopurinol (Zyloprim) for the calcium, and the fact that it happens to be a high blood pressure medication makes it a two-for-one in my case.
Just to clarify a few things about your meds. I will defer to any of my GP, urology, or endocrinology colleagues for actual advice on the medications themselves as well as other options.

You are right that Hctz is a blood pressure medication. It basically works by increasing the sodium that your kidneys excrete (puts more into your urine). Since water follows solute, this decreases your blood pressure by reducing blood volume. For most people, this is a very safe and effective drug.

While I'm on that topic, there is not really such thing as urine sodium being "high" or "low." It's more appropriate to say that your urine sodium is "appropriate" or "inappropriate." Since you have high blood pressure, and I'm guessing eat a fair bit of salt, your urine sodium is "appropriate" since you have more salt to remove from your blood to bring it to a normal level. Don't be too concerned with that lab value. In fact, if you start taking the Hctz, your urine sodium might go up further. Despite being higher, this is still an "appropriate" value.

As for the calcium and uric acid, those ARE too high and do place you at risk for stone formation. Both of these values can be elevated in people who consume large amounts of protein. The allopurinol is for the uric acid. I am not aware of any significant effects on blood pressure or calcium.

Bottom line, consider talking to a urologist or endocrinologist to see if there are options besides medications for your lab values.
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