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Written by Dr Pallavi Patri
Many of my patients ask me if they should stay away from calcium supplements, fearing having them would lead to kidney stones. Some even give up milk and yogurt without asking. This has stemmed from the many posts they see on social media on the subject. Truth is calcium alone is not responsible for kidney stone formation.
In fact, if you consume an inadequate amount of calcium (the body needs 1,000-1,200 mg/day depending on age), then your body starts dissolving bones to release calcium to maintain adequate amounts in blood. This leads to excess excretion in urine and crystallization to form stones.
Kidney stone disease is very common in India, affecting about 12 per cent of the population. Some people are genetically predisposed to developing kidney stones. However, there are several modifiable risk factors that contribute to stone formation including diets high in salt, low in fluid intake and high in oxalates and uric acid.
DIETARY CALCIUM VS CALCIUM SUPPLEMENTS
The large proportion of stones (70-80 per cent) are made up of chemical compounds like calcium oxalate, calcium phosphate (15 per cent) and others of uric acid and other components. Since most stones are calcium-based, it would seem that restricting calcium intake in our diets would reduce stone formation. However, studies show that high dietary calcium is actually associated with lower risk of stone disease, lower than even calcium supplements.
This happens because calcium from food binds with dietary oxalate in our gut resulting in reduced oxalate absorption which is excreted as faeces. Therefore, there is reduced oxalate excretion through the urine.
If calcium supplements are taken alone without food, then calcium derived from them cannot bind with oxalate in the intestines. Then both calcium and oxalate are absorbed and passed into the urine, leading to formation of crystals and stones. So, take your supplements along with food. If you have a history of kidney stones, then calcium citrate salt, citrate being a natural inhibitor of stones.
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WHY DEHYDRATION IS THE BIGGER ENEMY
When you don’t drink enough water, your urine becomes more concentrated, allowing minerals and salts to crystallise and bind together to form kidney stones. Drink at least eight glasses of water everyday unless your water intake is restricted for other medical conditions. Reduce intake of salt and caffeine as they increase calcium excretion in the urine. Take lemon with water as citrate in lemon helps in reducing stone formation.
(Dr Patri is Chief of Nephrology, Manipal Hospital, Sarjapur, Bengaluru)
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