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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by noa on April 28, 2003, at 18:53:50
Help!
I had a kidney stone (or may still have it but it is quiet at the moment, perhaps hiding in my bladder for now).
My first, and hopefully last! Pain as I have never known it visited me (and overstayed its welcome by about 6 hours!) when the stone was passing through my ureter.
OK, so this is not exactly psychopharm material, but there are some experts on magnesium supplements here, so I figured I'd ask...
I am reading up on kidney stones and quite unsure about what to do about calcium. It *seems* the latest info is that reducing calcium intake is NOT likely to reduce kidney stone formation, but there is something about whether calcium is absorbed in the bones or eliminated through the kidneys, etc. that I don't quite get yet. However, several sites do say that calcium supplements could increase risk of stones (but I need my calcium supplements to prevent osteoporosis which runs in the family).
Anyway, a couple of web sites talk about magnesium being helpful to prevent calcium-based stones, particulary magnesium citrate (both the magnesium and citrate having different preventive actions). They also talk about potassium citrate as helpful (again, both the potassium and citrate being helpful).
Can someone explain in basic terms how magnesium and calcium relate to each other?
Also, I am at risk of osteoporosis, and I read one abstract that suggests that there could be common genetic marker between kidney stones and low bone density. I figure this must have something to do with how calcium is absorbed by the bones or not.
Any help understanding this stuff is much appreciated.
Posted by JLx on April 28, 2003, at 20:41:26
In reply to Magnesium and Calcium Questions, posted by noa on April 28, 2003, at 18:53:50
Hi Noa,
I had kidney stone some years back and have been grateful not to have another!
I wasn't sure what to do about calcium either re osteoporosis, but since my doc advised "cutting down calcium" I quit taking a calcium/mag supplement at that point.
>However, several sites do say that calcium supplements could increase risk of stones (but I need my calcium supplements to prevent osteoporosis which runs in the family).
My suggestion to you is to take a hard look at all of the osteoporosis/calcium info around. Industrial countries that drink the most pasturized milk and ingest other dairy products are the ones with the most osteoporosis, for instance. Despite years of dairy consumption and calcium supplements, osteoporosis is getting worse in this country and others. From this site: http://www.johnleemd.com/trutabos.html
"Osteoporosis is not a calcium deficiency disease, it is a disease of excessive calcium loss. In other words, you can take all the calcium supplements you want, but if your diet and lifestyle choices are unhealthy, or you're taking prescription drugs that cause you to lose calcium, you will still lose more calcium from your bones than you can take in through diet.
In fact, getting adequate calcium is only a small part of the prevention picture. ... Your body needs a certain amount of magnesium in order to get the calcium into your bones -- without magnesium, calcium can't build strong bones.
In fact, magnesium deficiency may be more common in women with osteoporosis than calcium deficiency."Or check out the calcium comments in this article about stone age diets: http://www.mercola.com/article/Diet/carbohydrates/paleolithic_diet2.htm
I think we've been sold a bill of goods by the dairy council and other moneyed interests about calcium.
My thinking now (and I'm no expert!) is that all of these dietary things -- in regard to depression as well as other considerations such as osteoporosis -- do not lend themselves to "silver bullet" thinking. Calcium has been overemphasized to us in just that way to prevent osteoporosis and here we are still getting osteoporosis AND kidney stones.
Posted by Larry Hoover on April 28, 2003, at 22:49:21
In reply to Magnesium and Calcium Questions, posted by noa on April 28, 2003, at 18:53:50
> Help!
>
> I had a kidney stone (or may still have it but it is quiet at the moment, perhaps hiding in my bladder for now).
>
> My first, and hopefully last! Pain as I have never known it visited me (and overstayed its welcome by about 6 hours!) when the stone was passing through my ureter.They say it's some of the worst pain there is. I'm sorry.
> OK, so this is not exactly psychopharm material, but there are some experts on magnesium supplements here, so I figured I'd ask...
>
> I am reading up on kidney stones and quite unsure about what to do about calcium. It *seems* the latest info is that reducing calcium intake is NOT likely to reduce kidney stone formation, but there is something about whether calcium is absorbed in the bones or eliminated through the kidneys, etc. that I don't quite get yet. However, several sites do say that calcium supplements could increase risk of stones (but I need my calcium supplements to prevent osteoporosis which runs in the family).There is a complex interplay of events to consider, so simple statements like "avoid calcium supplements" or "you need calcium supplements to deal with osteoporosis" are really not very useful. Each statment depends on a lot of other things, but you don't often hear about those conditions.
> Anyway, a couple of web sites talk about magnesium being helpful to prevent calcium-based stones, particulary magnesium citrate (both the magnesium and citrate having different preventive actions). They also talk about potassium citrate as helpful (again, both the potassium and citrate being helpful).
>
> Can someone explain in basic terms how magnesium and calcium relate to each other?I'll talk about the part I do know. Bone is composed of calcium phosphate in a crystal structure known as hydroxyapatite. Magnesium replaces a bit of the calcium in the crystal structure such that the ratio of these two in bone is something like 40:1. Just as the dominant storage site for calcium is bone, the same is true for magnesium. If your body needs either mineral, bone is resorbed. It can be said that you won't long survive low calcium or magnesium in the blood, but you'll probably survive weakened bones.
Your bones are constantly being renewed, in a balancing act between deposition of new bone by osteoblasts, and destruction of bone by osteoclasts. There are three major hormones which interact to affect the balance, parathyroid hormone, calcitonin (from the thyroid, and dependent on zinc), and vitamin D (actually a steroid hormone). There are different sensors in the gut, bone, parathyroid gland and kidney which determine circulating levels of calcium and magnesium, and regulate uptake and secretion. The take-home message is that there's a lot going on. Some things increase bone strength, while simultaneously, others are weakening it. Your kidneys try to keep blood calcium and magnesium from leaking into the urine, but stress hormones can override that.
Back to simple statements. Magnesium citrate can help with certain stone-forming processes, because one major cause of high blood calcium (and thus calcium load in the kidney) is magnesium deficiency. Get the magnesium back up, and blood calcium levels will fall. I'm not sure, but I think the citrate helps to keep any calcium that does get into the urine dissolved.
I'm not sure that simple statements are a good idea. I think you need to find out what is causing your stones (there are a number of causes, and types of stones), and you probably need to know something about your current bone density and circulating levels of calcium and magnesium. In other words, I think a good workup is in order.
> Also, I am at risk of osteoporosis, and I read one abstract that suggests that there could be common genetic marker between kidney stones and low bone density. I figure this must have something to do with how calcium is absorbed by the bones or not.
>
>
>
> Any help understanding this stuff is much appreciated.Here's probably more than you wanted to know about calcium and bone:
http://www.endotext.org/parathyroid/parathyroid2/parathyroid2.htm
Good luck with this. It is a manageable condition, once you know what it is you're trying to manage.
Lar
Posted by jemma on April 29, 2003, at 12:05:28
In reply to Re: Magnesium and Calcium Questions, posted by Larry Hoover on April 28, 2003, at 22:49:21
You might want to be checked for hypercalcuria via a 24-hour urine test. Hypercalcuria greatly increases the risk of kidney stones, while at the same time drawing calcium out of your bones. It can be worsened by too much calcium, but it means that 1200 to 1400 mg of elemental calcium intake daily (including dairy) is essential for the health of your bones.
- jemma
Posted by noa on April 29, 2003, at 19:14:56
In reply to Re: Magnesium and Calcium Questions, posted by jemma on April 29, 2003, at 12:05:28
Thank you Jemma, Larry, and JLx.
I certainly have some reading to do.
Larry, as it happens, I had gotten a scrip from my gyno to do the bone density test, just to get a baseline since my mom has severe osteoporosis.
I know that a lot depends on what kind of stone it is but I am not sure I'll ever know that.
I learned from some more reading that it is now no longer believed that calcium, via food or supplements, is bad for people with stones, but it is recommended that the supplements be taken with meals containing foods that have oxylate in them (esp. vegetables), because of some relationship between calcium and oxylate in forming stones.
There clearly appear to be a bunch of different factors that could come into play, and therefore, there doesn't seem to be a clear message from the health experts on what works and what doesn't.
I'll keep on reading. Thanks for the links and the advice.
Posted by JLx on April 30, 2003, at 13:20:34
In reply to Re: Magnesium and Calcium Questions, posted by noa on April 29, 2003, at 19:14:56
> I learned from some more reading that it is now no longer believed that calcium, via food or supplements, is bad for people with stones, but it is recommended that the supplements be taken with meals containing foods that have oxylate in them (esp. vegetables), because of some relationship between calcium and oxylate in forming stones.
I'm curious where you have read that. This article, Calcium by Elson M. Haas M.D. http://www.healthy.net/scr/Article.asp?Id=2019, has a table of "Factors Affecting Calcium Absorption"
INCREASED BY:
Body needs—growth, pregnancy, lactation
Vitamin D
Milk lactose
Acid environment—hydrochloric acid, citric acid, ascorbic acid (vitamin C)
Protein intake and amino acids such as lysine and glycine
Fat intake
Exercise
Phosphorus balanceDECREASED BY:
Vitamin D deficiency
Gastrointestinal problems
Hypochlorhydria (low stomach acid)
Stress
Lack of exercise
High fat intake
High protein intake
Oxalic acid foods (beet greens, chard, spinach, rhubarb, cocoa)
Phytic acid foods (whole grains)
High phosphorus intake> There clearly appear to be a bunch of different factors that could come into play, and therefore, there doesn't seem to be a clear message from the health experts on what works and what doesn't.
I agree, it's confusing. I'm reading a good book book now, "The Estrogen Alternative" by Raquel Martin and Judi Gerstung which quotes a doctor, Norman W. Walker, who says there is a distinction between oxalic acid in raw and cooked foods. Oxalic acid in raw foods readily combines with calcium, he says. She notes this is contradictory from the usual advice, but adds that Dr. Walker lived to be a hundred and nine by following his own advice, and his wife died in her nineties. :)
Posted by noa on May 1, 2003, at 19:39:00
In reply to Re: Magnesium and Calcium Questions » noa, posted by JLx on April 30, 2003, at 13:20:34
Here is the source you asked about:
http://www.calciuminfo.com/prof/3_8.htm#1
" Since 20-40% of recurrent stones are associated with elevated urinary calcium, it has been thought that consumption of high levels of calcium might cause or contribute to stone formation. In the past, it was not uncommon for patients with renal stones who also have hypercalciuria to have their intake of calcium sharply restricted. Medical science has shown, however, that stones can be prevented successfully without restricting calcium intake, provided that a number of other measures are also followed. Moreover, there is some evidence that calcium restriction may actually increase the risk of kidney stones under certain conditions.
"Calcium Intake and Stone Prevention"The largest prospective trial ever published on calcium and kidney stones, (New England Journal of Medicine,1993), concluded that high calcium intake decreases the risk of symptomatic kidney stones.1 Perhaps just as importantly, the study, conducted among over 45,000 men, found that those individuals consuming less than 850 mg of calcium per day had a higher incidence of kidney stones.
"The authors concluded that calcium may actually have a protective effect by binding to oxalate in the gut and preventing its absorption in a form that leads to kidney stones. Calcium restriction led to an increase in absorption and excretion of oxalate in the urine in both normal subjects and patients with kidney stones. The authors, as well as many previous investigators, have also concluded that urinary oxalate appears to be more important than urinary calcium in the formation of stones.
"This conclusion was supported by a subsequent study on long-term calcium supplementation in premenopausal women which found no increase in stone formation.2 Calcium supplementation lowered both urinary oxalate and urinary phosphorous (also thought to contribute to the formation of stones) by binding both agents in the intestine...............
"Calcium Intake and Kidney Stones: Risk Benefit
"While the NIH Consensus Development Conference on Optimal Calcium Intake cautioned those patients with a history of kidney stones and high urinary calcium about increasing their calcium intake excessively, the report also cited the large study showing a protective effect of higher calcium intake against kidney stones8.
"Most recently, Drs. Curhan et al, authors of the 1993 prospective study, published further data on calcium intake and stones.9 In this latest study, the authors conducted an analysis among women participating in the Nurses Health Study over a 12-year period who had no prior history of kidney stones. They found that higher dietary calcium intake was correlated with fewer kidney stones.
"Although those subjects taking calcium supplements had a slightly higher risk of stones, the incidence was only 1 case of stones per 1,000 person years. The authors propose that since 67% of women taking calcium supplements took them between meals or with breakfast, a meal usually low in oxalate, the calcium could not perform its role of blocking oxalate stone formation the same way that calcium at meals is able to do.
"In a recently completed trial, only two cases of kidney stones were reported in 2,295 women taking 2,000 mg of supplemental calcium carbonate per day.10 These results indicate that reduction of calcium intake is not advisable as a way to reduce kidney stone risk, particularly given the other benefits of adequate calcium intake, and that supplemental calcium may reduce kidney stone risk if taken with meals."
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