By Pete Williams
Paid a visit to the nephrologist today. Six months ago, I had no idea what that specialty entailed. Some sub-specialty of neurology, perhaps?
Actually, a nephrologist is a kidney doctor. Urologists deal with kidneys, but they only take care of the surgical part. The nephrologist helps keep patients away from the urologist. If you think this doesn’t pertain to endurance athletes in Florida, think again.
When you’ve had a kidney stone, as I did on New Year’s Day, you want to see the nephrologist to avoid having another. Actually, you’ll see anyone to avoid having another. The idea is for the nephrologist to take a look at your diet and determine what’s causing the problem.
As I chronicled in January, this has been a frustrating process and not just because of the epic pain – worse than childbirth say women who’ve endured both – and the medical bills. As a triathlete, co-author of fitness books, and someone downright OCD when it comes to healthy eating, how could I end up with a kidney stone?
I’ve learned that many healthy foods contribute to kidney stones including nuts, berries, spinach, and sweet potatoes. Too much coffee, tea, and chocolate is a bad thing, though the research is mixed on coffee, tea and other caffeinated beverages. Eating too many beets also is bad, as if there’s anyone who eats too many beets.
But few people consider the role of protein. Kidneys have a tough time processing excess protein and that produces tiny particles that enable other stuff to latch onto and form a stone. From mid-2009 through the end of 2010, I was eating way too much protein – actually, whey too much protein in the form of powdered shakes.
As soon as I got out of the hospital, I cut my protein powder by 90 percent, quit eating spinach and nuts and limited my intake of berries. I’ve only consumed water and an occasional glass of wine for years, but post-stone dialed up the water consumption.
By the end of March, it was time for some bloodwork and a 24-hour-urinalysis. It is what it sounds like. The lab provides a large plastic jug that looks like it should contain liquid laundry detergent. It helps for that 24-hour period to have the option of working from home.
Today I visited the nephrologist’s office, a truly depressing place. There were some poor folks with serious kidney issues in the waiting room, a lot of wheelchairs and tubes. The nurse asked what medications I was taking. After all, this is not a place where healthy people visit.
The doctor took a look at the “StoneRisk Diagnostic Profile” the lab provided and mentioned that my calcium/oxalate levels were good. Most stones, like mine, are of the calcium oxalate variety. Foods such as nuts, berries, and spinach are high in oxalate. That’s not my problem. (Pass the spinach).
Too much salt also is a problem since it causes the kidneys to dump more calcium into the urine. I eat frequently at Chipotle and have worried that Chipotle’s high-sodium burritos might be a contributor. Nope, my sodium levels are “reasonable.” (Pass the burrito bowl).
My problem is twofold. I’m only producing 1.9 liters of urine a day, nearly enough to fill a 2-liter bottle. That sounds sufficient and might not be so bad if I was a sedentary person in a cooler climate. But it’s dangerous for a Florida-based triathlete and stand-up paddle boarder. Sufficient water can take care of a lot of kidney problems; it literally washes the stone-producing stuff away. But limit the water and everything else is exacerbated.
Pass the water.
Then there’s the protein issue. Even with my diminished intake of protein powder, I still logged a 1026 on the uric acid scale in which anything below 700 is considered good. My level of phosphorus urine was 1452; anything under 1100 is acceptable.
Bottom line, the report concluded, is that I suffer from “hyperuricosuria,” or excessive amounts of uric acid. Suspected problem? “High animal protein intake.”
Red meat is especially bad, though I rarely eat it. I left the nephrologist’s office more puzzled than ever. I’ll dial down the protein more and drink even more water. We’ll revisit in six months.
“How will I know if this isn’t working?” I asked the doctor.
“If you have a kidney stone.”