Ladakh and the problem of Kidney Stones

Courtesy: Nawaz Kargili’s Blog on WordPress 

By Citizen Journalist Nawaz Kargili


 

Dear friends as the only land route to Ladakh namely NH1D (422KM) via Zojila pass has once again thrown open by the admistration linking Ladakh again with the rest of the state.It is obivious for me to see an overwhelming number of my native peoples from ladakh here at srinagar,but i was very saddened by knowing the fact that almost 45% of them are patients and most of them are suffering from a disease which most common in ladakh too known as  Renal calculus or Nephrolith (Kidney Stones).

Dear friends Did you know that one in ten people will have a kidney stone over the course of a life time? Recent studies have shown that kidney stone rates are on the rise across the country. Those in the know believe that some major misconceptions may be the culprit.we also are always being a target of misconceptions..

so Being a chemistry student i am giving you some information by removing your misconceptions too..

so first let me brief you the most important prevention tips giving you the actual chemical composition of different kidney stones..

1. Don’t Underestimate Your Sweat.Being a fully agriculture oriented place our ladakhi peoples are always seen busy during hot summers in agricultural processes which leads to excessive sweating which may lead to kidney stones. Why? Loss of water through sweating – whether due to these activities or just the heat of summer—leads to less urine production. The more you sweat, the less you urinate, which allows for stone-causing minerals to settle and bond in the kidneys and urinary tract.

>Precaution: Hydrate with H2O. One of the best measures you can take to avoid kidney stones is to drink plenty of water, leading you to urinate a lot. So, be sure to keep well hydrated, especially when engaging in exercise or activities that cause a lot of sweating.

2. It’s Not Just the Oxalate. Oxa-what? Oxalate is naturally found in many foods, including fruits and vegetables, nuts and seeds, grains, legumes, and even chocolate and tea. Some examples of foods that contain high levels of oxalate include: peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes. Moderating intake of these foods may be beneficial for people who form calcium oxalate stones, the leading type of kidney stones. A common misconception is that cutting the oxalate-rich foods in your diet alone will reduce the likelihood of forming calcium oxalate kidney stones. While in theory this might be true, this approach isn’t smart from an overall health perspective. Most kidney stones are formed when oxalate binds to calcium while urine is produced by the kidneys.

>Precaution: Eat and drink calcium and oxalate-rich foods together during a meal. In doing so, oxalate and calcium are more likely to bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.

3. Calcium is Not the Enemy. But it tends to get a bad rap! Most likely due to its name and composition, many are under the impression that calcium is the main culprit in calcium-oxalate stones.  A diet low in calcium actually increases one’s risk of developing kidney stones.

>Precautions: Don’t reduce the calcium. Work to cut back on the sodium in your diet and to pair calcium-rich foods with oxalate-rich foods.

4.A patient at karanagar was telling me that he got stone thrice and was blaming the medical system..this the answer for him and case like that..  It’s Not One and Done. Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, it’s not always a one-time event. Studies have shown that having even one stone greatly increases your chances of having another. Most people will want to do anything they can to ensure it doesn’t happen again. Unfortunately, it doesn’t seem to be the case that people make the changes they need to after their first stone event. About 15% of kidney stone patients didn’t take prescribed medications and 41% did not follow the nutritional advice that would keep stones from recurring.

>Precautions: Take action! Without the right medications and diet adjustments, stones can come back, and recurring kidney stones also could be an indicator of other problems, including kidney disease.

5. When Life Hands You Kidney Stones… don’t fret. And as the saying goes, “make lemonade.” It’s important to consider dietary remedies alongside prescription medications. While it may seem easier to just take a pill to fix a medical problem, consider what lifestyle changes will also make a big impact on your health.

>Precaution:Chronic kidney stones are often treated with potassium citrate, but studies have shown that limeade, lemonade and other fruits and juices high in natural citrate offers the same stone-preventing benefits. Beware of the sugar, though, because it can increase kidney stone risk. Instead, buy sugar-free lemonade, or make your own by mixing lime or lemon juice with water and using a sugar substitute if needed. We believe that citrate in the urine may prevent the calcium from binding with other constituents that lead to stones. Also, some evidence suggests that citrate may prevent crystals that are already present from binding with each other, thus preventing them from getting bigger.

6. the most common in ladakhis are uric acid stones..Reason being active beef and other red meat consumption..yes exactly friends because Not All Stones are Created Equal. In addition to calcium oxalate stones, another common type of kidney stones is uric acid stones. Red meat, organ meats, and shellfish have high concentrations of a natural chemical compound known as purines. High purine intake leads to a higher production of uric acid and produces a larger acid load for the kidneys to excrete. Higher uric acid excretion leads to lower overall urine pH, which means the urine is more acidic. The high acid concentration of the urine makes it easier for uric acid stones to form.

>Precautions: To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. Limit alcohol because it can increase uric acid levels in the blood and avoid crash diets for the same reason..Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation.

yes that was it after reading this you will surely come across a lot of questions so here is the most expected questions and answers..

Q) What is a kidney stone?

A) A kidney stone is a hard mass that forms from crystals in the urine. In most people, natural chemicals in the urine stop stones from forming.

Q) What are the symptoms of a stone?

A) Some kidney stones are as small as a grain of sand. Others are as large as a pebble. A few are as large as a golf ball! As a general rule, the larger the stone, the more noticeable are the symptoms.

The symptoms could be one or more of the following:
• severe pain on either side of your lower back
• more vague pain or stomach ache that doesn’t go away
• blood in the urine
• nausea or vomiting
• fever and chills
• urine that smells bad or looks cloudy

The kidney stone starts to hurt when it causes irritation or blockage. This builds rapidly to extreme pain. In most cases, kidney stones pass without causing damage-but usually not without causing a lot of pain. Pain relievers may be the only treatment needed for small stones. Other treatment may be needed, especially for those stones that cause lasting symptoms or other complications. In severe cases, however, surgery may be required.

Q) What should I do if I have these symptoms and think I have a stone?

A) See a doctor as soon as possible. You may be asked to drink extra fluid in an attempt to flush out the stone out in the urine. If you strain your urine and can save a piece of the stone that has passed, bring it to your doctor. Or, the stone may need to be removed with surgery.

Q) Are there any long term consequences of having a kidney stone?

A) Kidney stones increase the risk of developing chronic kidney disease. lf you have had one stone, you are at increased risk of having another stone. Those who have developed one stone are at approximately 50% risk for developing another within 5 to 7 years.

Q) Are all kidney stones the same?

A) No. The most common types of kidney stones are made from calcium and oxalate. Individual treatment for kidney stones depends on the type of kidney stones that are formed.

Q) Is there a diet I can follow to prevent me from having more kidney stones?

A) Sometimes following a special diet may be enough to prevent you from forming more kidney stones. Other times, medications, in addition to a special diet, may be needed. Please note that not all dietary recommendations benefit all types of stone formers.

Q) What kind of diet will I have to follow?

A) You may be asked to make changes to the amount of salt (sodium), calcium, oxalate, protein, citrate, potassium and fluid in your diet. A Doctor can help you with making these changes.

Q) My doctor told me to drink a lot of fluids. How much is “a lot”? Does it matter what kind of fluid I drink?

A) Staying well hydrated by drinking enough water is one of the best measures you can take to avoid kidney stones. To lessen your risk of forming a new stone, it is very important that you drink at least 12 cups of fluid throughout the day. In hotter weather, you may need to drink more to make up for fluid loss from sweating. This will help keep your urine less concentrated. Less concentrated urine reduces the risk of stone formation. Most of the fluid you drink should be water. Try to drink a glass of water before bed and if you wake during the night to use the bathroom, drink another glass before going back to bed.

Q) I had a calcium stone. What type of diet should I follow? Will I have to avoid high calcium foods?

A) Calcium is not the enemy. If you have high calcium in the urine then sodium reduction is helpful for stone prevention. Instead of reducing your calcium intake, focus on limiting the sodium in your diet and pair calcium-rich foods with oxalate-rich foods. Extra sodium causes you to lose more calcium in your urine, putting you at risk for developing another stone. Your doctor will probably advise you to limit sodium to 2,000 milligrams each day. There are many sources of “hidden” sodium such as canned or commercially processed foods as well as restaurant-prepared and fast foods. A Doctor will help you understand food labels and make changes in the amount of sodium that you eat. If you do not have high calcium in the urine then for stone reduction you might be better off focusing on other dietary changes. Your doctor can help determine if you need more or less calcium and help you plan a diet that is healthful.

Q) I had an oxalate stone. What type of diet should I follow? Do I need to avoid foods high in oxalate?

A) Calcium oxalate kidney stones are the leading type of kidney stones. Oxalate is naturally found in many foods, including fruits and vegetables, nuts and seeds, grains, legumes, and even chocolate and tea. Some examples of foods that contain high levels of oxalate include: peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes. The oxalate content of food can vary due to differences in such things as soil quality and state of ripeness. There may be variation in published data, too, as different methods may be used to determine the oxalate content of food.

Some research suggests that limiting high oxalate foods may help reduce your chance of forming another oxalate stone. However, many high oxalate foods are healthful so it is wise to not overly restrict your diet if not necessary. Most kidney stones are formed when oxalate binds to calcium while urine is produced by the kidneys. New research indicates that eating and drinking calcium and oxalate-rich foods together during a meal is a better approach than limiting oxalate entirely because oxalate and calcium are more likely to bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.

Talk with your doctor about how strictly you need to avoid oxalate-containing foods.

Q) I had a uric acid stone. What does that mean? What type of diet should I follow?

A) yes put uaself in the category if you are a active meat and beef taker as may ladakhis are..Another common type of kidney stone is a uric acid stone. Red meat and shellfish have high concentrations of a natural chemical compound known as a purine. High purine intake leads to a higher production of uric acid which then accumulates as crystals in the joints, or as stones in the kidneys.

To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. Limit alcohol because it can increase uric acid levels in the blood and avoid crash diets for the same reason. Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation.

You should also be sure to drink at least 12 cups of water a day to help reduce the risk for stone formation. Making these healthy lifestyle changes can also help reduce your risk for developing gout because high uric acid is a leading risk factor for gout.

Q) Is there anything else I can do with my diet to help prevent kidney stones?

A) Reducing the amount of animal protein may help. Sources of animal protein include beef, chicken, pork, fish and eggs. Most people need only four to six ounces of high protein foods and three servings of milk or cheese a day. Check with your doctor to be sure your protein intake is enough, but not too much.

Chronic kidney stones are often treated with potassium citrate. Studies have shown that limeade, lemonade and other fruits and juices high in natural citrate may offer similar stone-preventing benefits. It is believed that citrate in the urine may prevent the calcium from binding with other constituents that lead to stones. Also, some evidence suggests that citrate may prevent crystals that are already present from binding with each other, thus preventing them from getting bigger. Please note that juices made from actual limes and lemons contain higher levels of citrate and beware of the sugar content in juices, because this can increase kidney stone risk.

Q) Will it help/hurt me to take a vitamin or mineral supplement?

A) The B vitamins (which include thiamine, riboflavin, niacin, B6 and B12) have not been shown to be harmful to people with kidney stones. In fact, some studies have shown that B6 may actually help people with high urine oxalate. However, check with your doctor for advice on the use of vitamin C, vitamin D, fish liver oils or mineral supplements containing calcium since some supplements can increase the chances of stone formation in some people.

Q) How are kidney stones treated?

A) You may be asked to drink a lot of water. Doctors try to let the stone pass without surgery. You may also get medication to help make your urine less acid. But if it is too large, or if it blocks the flow of urine, or if there is a sign of infection, it is removed with surgery.