Should You Reduce or Increase Calcium Intake to Prevent Kidney Stones?

Q: Should You Reduce or Increase Calcium Intake to Prevent Kidney Stones?

Pharmacist： Hello, actually, according to current understanding, as you mentioned, there is no absolute conclusion regarding calcium intake. <br>The established conclusion is that high sodium intake has a definitive correlation with stone formation. <br>The amount of calcium abso

To prevent kidney stones, should one consume less calcium or more calcium?

Hello, Doctor.
The New England Journal of Medicine article from February 16, 2006, titled "Calcium Plus Vitamin D Supplementation and the Risk of Fractures," mentions that increased calcium supplementation may raise the risk of kidney stones.
However, some past journals present a contrary argument, such as the Cleveland Clinic Journal of Medicine in 2002, Vol.
69, No.
11: "Preventing Kidney Stones: Calcium Restriction Not Warranted," and the Journal of Clinical Pathology in 2001, Vol.
54: "Why Oral Calcium Supplements May Reduce Renal Stone Disease: Report of a Clinical Pilot Study," which suggest that increasing calcium intake can help bind oxalate in the gastrointestinal tract, facilitating its excretion and preventing it from entering the bloodstream or urine to combine with calcium and form stones.
Could you please clarify whether preventing kidney stones requires reducing or increasing calcium intake? Thank you.

Yao Shi, 30~39 year old female. Ask Date: 2006/12/12

Dr. Xu Weikai reply Urology

Pharmacist: Hello, actually, according to current understanding, as you mentioned, there is no absolute conclusion regarding calcium intake.
The established conclusion is that high sodium intake has a definitive correlation with stone formation.
The amount of calcium absorbed from the diet is quite limited; unless special formulations of calcium are used, such as high-dose calcium supplements or those combined with vitamin D3, nasal sprays, etc., these can indeed lead to the formation of kidney stones.
In Taiwan, the prevalence of stones is similar to that of the world, with calcium-containing stones being the most common, such as calcium oxalate stones.
Additionally, Taiwan has a higher incidence of uric acid stones compared to other regions, which may be related to dietary habits that emphasize broth and alcohol consumption.
Currently, the established recommendations for preventing stones are: drink more water and consume less salt.
This is for your reference.
Furthermore, in some patients with dietary restrictions, stones have been observed, which should be attributed to dietary influences.
Therefore, a balanced diet along with adequate hydration and reduced salt and oil intake (avoiding high-concentration broths) should be effective methods for preventing stones in our country.
This is provided for your reference.
Department of Urology, Taitung Hospital, Ministry of Health and Welfare, Director Xu Wei-Kai.

Reply Date: 2006/12/12

More Info

The question of whether to reduce or increase calcium intake to prevent kidney stones is a nuanced one, and it has been the subject of considerable debate in the medical community. The conflicting findings from various studies can be confusing, but they highlight the complexity of kidney stone formation and the role of dietary calcium.

Research has shown that calcium plays a dual role in kidney stone formation, particularly with calcium oxalate stones, which are the most common type of kidney stones. On one hand, high dietary calcium intake has been associated with an increased risk of stone formation in some studies, such as the one published in the New England Journal of Medicine in 2006. This study suggested that calcium supplementation could lead to a higher risk of kidney stones, particularly when taken in high doses.

Conversely, other studies, including those published in the Cleveland Clinic Journal of Medicine and the Journal of Clinical Pathology, suggest that adequate calcium intake may actually help prevent kidney stones. The rationale behind this is that dietary calcium can bind to oxalate in the intestines, reducing the amount of oxalate that is absorbed into the bloodstream and subsequently excreted in the urine. Since oxalate is a key component in the formation of calcium oxalate stones, having sufficient calcium in the diet may help mitigate the risk of stone formation.

The current consensus among many urologists and nephrologists is that individuals prone to kidney stones should not restrict dietary calcium. Instead, they should aim for a balanced intake of calcium through food sources, as this can help prevent the absorption of oxalate. Foods rich in calcium include dairy products, leafy greens, and fortified foods. It is important to note that calcium supplements, particularly in high doses, may pose a greater risk for stone formation compared to dietary calcium.

In addition to managing calcium intake, other dietary modifications can also help prevent kidney stones. Increasing fluid intake is crucial, as it helps dilute the urine and reduce the concentration of stone-forming substances. Aiming for at least 2 to 3 liters of water per day is often recommended. Reducing sodium intake is also important, as high sodium levels can increase calcium excretion in the urine, thereby raising the risk of stone formation.
Furthermore, individuals should be cautious with foods high in oxalate, such as spinach, rhubarb, nuts, and chocolate, especially if they have a history of calcium oxalate stones. However, it is not necessary to eliminate these foods entirely; moderation is key.

In summary, the current understanding suggests that individuals at risk for kidney stones should not reduce their calcium intake but rather ensure they consume adequate amounts of dietary calcium. This approach, combined with increased hydration and reduced sodium intake, can be effective in preventing kidney stones. It is always advisable for individuals with a history of kidney stones to consult with a healthcare provider or a dietitian for personalized dietary recommendations based on their specific health needs and stone composition.

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