CHAPTER 8

Osteoporosis and Kidney Stones

THREE THINGS YOU NEED TO KNOW
ABOUT MAGNESIUM, OSTEOPOROSIS,
AND KIDNEY STONES

Magnesium is just as important as calcium to prevent and treat osteoporosis.

Magnesium keeps calcium dissolved in the blood so it will not form kidney stones.

Taking calcium without magnesium for osteoporosis can promote kidney stones.

Muriel wondered how she managed to have soft bones and kidney stones all at the same time. Her recent bone density test showed obvious osteoporosis, yet she was now in the hospital with her third kidney stone attack. A young intern explained that she was losing calcium from her bones, which was being deposited in her kidneys and flushed out as hard, jagged crystals that were excruciatingly painful to pass. The high doses of calcium that she was taking for her osteoporosis were only making matters worse.

Muriel’s urologist did an analysis on her kidney stones and told her to stop eating all dairy products and to avoid calcium supplements, but Muriel was very concerned that her osteoporosis would worsen.

When she came to see me, I was able to explain that there are approximately eighteen nutrients essential for healthy bones, including magnesium, the most important mineral after calcium. Susan Brown, Ph.D., director of the Osteoporosis Education Project in Syracuse, New York, warns that “the use of calcium supplementation in the face of magnesium deficiency can lead to a deposition of calcium in the soft tissue such as the joints, promoting arthritis, or in the kidney, contributing to kidney stones.”¹ Dr. Brown recommends a daily dose of 450 mg of magnesium for the prevention and treatment of osteoporosis.

Women with osteoporosis have lower-than-average levels of magnesium in their diets, according to survey reports. Magnesium deficiency can compromise calcium metabolism and also hinder the body’s production of vitamin D, further weakening bones.

Magnesium’s role in bone health is multifaceted.

Adequate levels of magnesium are essential for the absorption and metabolism of calcium.

Magnesium stimulates a particular hormone, calcitonin, that helps to preserve bone structure and draws calcium out of the blood and soft tissues back into the bones, preventing some forms of arthritis and kidney stones.

Magnesium suppresses another bone hormone called parathyroid, preventing it from breaking down bone.

Magnesium converts vitamin D into its active form so that it can help calcium absorption.

Magnesium is also required to activate an enzyme that is necessary to form new bone.

Magnesium regulates active calcium transport.

With all these roles for magnesium to play, it is no wonder that even a mild deficiency can be a risk factor for osteoporosis. Further, if there is too much calcium in the body, especially from calcium supplementation, as in Muriel’s case, magnesium absorption can be greatly impaired, resulting in worsening osteoporosis and the likelihood of kidney stones, arthritis, and heart disease.

Other factors that are important in the development of osteoporosis include diet, drugs, endocrine imbalance, allergies, vitamin D deficiency, and lack of exercise. A detailed review of the osteoporosis literature shows that chronically low intake of magnesium, vitamin D, boron, and vitamins K, B₁₂, B₆, and folic acid lead to osteoporosis. Similarly, chronically high intake of protein, sodium chloride, alcohol, and caffeine adversely affect bone health.^2,3 The typical Western diet (high in protein, salt and refined, processed foods) combined with an increasing sedentary lifestyle contributes to the increasing incidence of osteoporosis.

Looking at her lifestyle, Muriel saw how much she had contributed to her own condition. She averaged five cups of coffee, three glasses of wine, and twenty cigarettes a day. This was causing calcium and magnesium, and the other nutrients that have to deal with toxins, to be overworked or flushed out of her body. Her diet was mostly nutrientdeficient fast food because she was constantly on the run. She drank a lot of soda, which is high in phosphorus and causes calcium and magnesium to be eliminated. She also avoided the sun and therefore got little vitamin D.

Instead of becoming discouraged, Muriel was able to look on the bright side. At least now she knew what lifestyle habits she had to change and what supplements to take. Her kidney stones soon became a thing of the past, her overall health dramatically improved, and after two years there was actually an increase in her bone density.

OSTEOPOROSIS MISUNDERSTOOD AND MISTREATED

Osteoporosis is neither a normal nor inevitable consequence of aging: Our bones were designed to last a lifetime. Popular wisdom, however, is that osteoporosis in women is due to a decrease in estrogen levels with age. Doctors therefore rely on estrogen, calcium, and drugs that stimulate bone formation to treat osteoporosis. The National Institutes of Health (NIH) Osteoporosis Prevention, Diagnosis, and Therapy Consensus Statement of 2000 was developed from a conference including eighty experts, but no mention of magnesium deficiency as a causative factor in osteoporosis was made in the final report.⁴ With drug companies funding most of the osteoporosis research, there are very few large clinical trials investigating the magnesium connection in bone production. Although I found over twenty-two thousand journal articles on osteoporosis, there were only ten in the past decade that studied the magnesium connection in humans. As long as people are given false hope that there is some magic bullet in the pharmaceutical pipeline that will “cure” osteoporosis, or any other chronic disease, they will ignore the underlying reasons for their health problems.

Nonetheless, when you read the literature, there is ample evidence that many nutrients, especially magnesium, play a large role in bone development. Much animal research, for example, proves that magnesium depletion alters bone and mineral metabolism, which results in bone loss and osteoporosis.^5,6 Magnesium deficiency is very common in women with osteoporosis compared to controls.⁷

In one study, postmenopausal women with osteoporosis were able to stop the progression of the disease with 250–750 mg of magnesium daily for two years. Without any other added measures, 8 percent of these women experienced a net increase in bone density.⁸ A group of menopausal women given a magnesium hydroxide supplement for two years had fewer fractures and significant increase in bone density.⁹ Another study showed that by taking magnesium lactate (1,500–3,000 mg daily for two years), 65 percent of the women were completely free of pain and had no further degeneration of spinal vertebrae.¹⁰ Magnesium in conjunction with hormonal replacement improved bone density in several groups of women compared to controls.^11,12 In fact, if you are taking estrogen and have a low magnesium intake, calcium supplementation may increase your risk of thrombosis (blood clotting that can lead to a heart attack).¹³

It is unfortunate that the treatment for osteoporosis has been simplified into the single battle cry “Take calcium.” Calcium dominates every discussion about osteoporosis, is used to fortify dozens of foods (including orange juice and cereal), and is a top-selling supplement, but it cannot stand alone. In Chapter 1, we talked about the dance of calcium and magnesium. These minerals work so closely together that the lack of one immediately diminishes the effectiveness of the other. Even though the use of calcium supplementation for the management of osteoporosis has increased significantly in the last decade, scientific studies do not support such large doses after menopause. Soft tissue calcification could be a serious side effect of taking too much calcium.¹⁴

Osteoporosis is generally a progressive disease, and some say it is incurable, but if you avoid the risk factors, take a good range of bone-building nutrients, and exercise, you can halt the condition even if you have the symptoms. Prevention is the best defense, the key elements of which are:

Eat a balanced, nutrient-rich diet

Take supplements of calcium, magnesium, and the various bone support factors

Practice a vigorous exercise program throughout life

DIET FOR OSTEOPOROSIS

A high-protein diet, excess sugar, alcohol, and coffee all rob the body of essential minerals. Prevention in the form of fruit and vegetables containing large amounts of calcium, magnesium, and potassium contributes to maintenance of bone mineral density.¹⁵ Add more vegetables, whole grains, legumes, nuts, and seeds to your diet, and be sure to include some of the magnesium-rich foods listed on pages 218–219. The foods that are high in calcium are usually abundant in magnesium as well, including nuts and seeds, sardines, bok choy (Chinese cabbage), and broccoli.

SUPPLEMENTS FOR OSTEOPOROSIS

Calcium: 800 mg per day (organic veal bone is the best source, followed by calcium lactate, calcium citrate, or calcium malate)

Magnesium: 300 mg twice a day

Boron: 2 mg daily (involved in vitamin D conversion)

Copper: 1–3 mg daily (for collagen cross-linking)

Manganese: 5–10 mg per day (stimulates the production of mucopolysaccharides, the organic matrix of bone)

Zinc: 10 mg daily (important for bone matrix)

Vitamin A: 20,000 IU daily (forms bone matrix)

Vitamin B₆: 50 mg per day

Folic acid: 5 mg daily

Vitamin B complex: 50 mg per day

Vitamin C: 1,000 mg per day

Vitamin D: 400 IU daily (for calcium absorption)

Progesterone for postmenopausal women under the advice of your doctor and after hormonal saliva testing to determine deficiency of progesterone: days 1–25, use ¼ tsp of progesterone cream, rubbed into the skin, twice a day; take a break days 25–31 (make sure the product contains USP progesterone)

You can obtain about half your mineral needs from good organic foods. The supplement doses on the previous page assume that you are already getting minerals in your diet. If you do not eat a good diet, your mineral supplement amounts should be increased by 50 percent.

KIDNEY STONES

Kidney stones occur when the microscopic debris excreted in the urine becomes too concentrated to pass freely out of the kidneys into the bladder. Kidney stones are quite common in the general population. Risk factors for kidney stones include a history of hypertension and a low dietary intake of magnesium.¹⁶ One percent of autopsies reveal stones in the urinary tract, but most are small enough to pass unnoticed. Up to 15 percent of white men and 6 percent of all women will develop one stone, with recurrence in about half of these people. Approximately one in a thousand people in the United States is hospitalized annually with excruciatingly painful stones trapped in their urinary passages. The pain begins in the lower back and can radiate across the abdomen or into the genitals or the inside of the thigh.

Most kidney stones are made up of calcium phosphate, calcium oxalate, or uric acid. Calcium stones are seen chiefly in men, often with a family history. Calcium phosphate and calcium oxalate alone are responsible for almost 85 percent of all stones. Uric acid stones make up 5–10 percent of all stones. They are also seen mostly in men, half of whom have gout. The remaining 5 percent are rare stones that can be formed during kidney infections.

Diagnosis is made by urinalysis and X ray. A few calcium crystals or small stones often need no treatment but may be relieved with painkillers and muscle relaxants. Larger stones are treated with surgery or with lithotripsy (the breakdown of the stones into little pieces using special ultrasound machines).

Several factors can be involved in stone formation:

Elevated calcium in the urine is caused by a diet high in sugar, fructose, alcohol, coffee, and meat. These acidic foods pull calcium from the bone and excrete it through the kidneys. Calcium supplementation also causes elevated calcium in the urine.

Higher-than-normal levels of oxalate found in the urine may relate to a high dietary intake of oxalic-acid-containing foods: rhubarb, spinach, raw parsley, chocolate, tea, and coffee. The oxalic acid in them promotes stone formation by binding to calcium, creating insoluble calcium oxalate.

Dehydration concentrates calcium and other minerals in the urine. Six to eight glasses of water a day are an essential requirement for flushing the kidneys properly. Increased sweating and not enough water intake create concentrated urine.

Soft drinks containing phosphoric acid encourage kidney stones in some people by pulling calcium out of the bones and depositing it in the kidneys.

Kidney stones and magnesium deficiency share the same list of causes, including a diet high in sugar, alcohol, oxalates, and coffee. An important animal study shows that a high dietary intake of fructose (from high-fructose corn syrup, used as a sweetener) significantly increases kidney calcification, especially when dietary magnesium is low.¹⁷ The U.S. Department of Agriculture warns that young people, especially, derive too many of their daily calories from the high-fructose corn syrup in sodas and eat few greens, which are rich in magnesium. The phosphoric acid in soft drinks is also punishing to the magnesium in the body and depletes magnesium stores while wearing away bone.^18,19

One of magnesium’s many jobs is to keep calcium in solution to prevent it from solidifying into crystals; even at times of dehydration, if there is sufficient magnesium, calcium will stay in solution. Magnesium is the pivotal treatment for kidney stones. If you don’t have enough magnesium to help dissolve calcium, you will end up with various forms of calcification. This translates into stones, muscle spasms, fibrositis, fibromyalgia, and atherosclerosis (calcification of the arteries).

Dr. George Bunce has clinically proven the relationship between kidney stones and magnesium deficiency.²⁰ As early as 1964, Bunce reported the benefits of administering a 420 mg dose of magnesium oxide per day to patients with histories of frequent stone formation.

When there is more calcium than magnesium, kidney stones can form. Let’s look at that simple experiment from Chapter 1 again to prove the point. Crush and stir a calcium tablet in 1 ounce of water; note how much dissolves and how much is still swirling around in the bottom of the glass. Then add a crushed magnesium tablet, or the contents from a magnesium capsule, to the water and see how much more calcium dissolves. If calcium is dissolved properly in the blood, then it won’t form crystals in the kidney.

Several older studies show the benefits of magnesium hydroxide in preventing stone formation. Fifty-five patients with a combined 480 stones in the previous ten years were placed on 200 mg of magnesium hydroxide daily. Patients were followed for two to four years, and only eight patients developed new stones. Of a group of forty-three kidney stone patients who did not receive magnesium, 59 percent developed new kidney stones over a four-year period. ²¹ An even earlier study using magnesium oxide and vitamin B₆ (a natural diuretic) showed a decrease in stone formation for 149 patients, who went from an average of 1.3 stones per year to 0.1 stones. Patients were followed for between four and a half and six years.²² In another study, fifty-six patients were given 200 mg of magnesium hydroxide twice per day. At the two-year mark, forty-five were free of kidney stone recurrence; of thirty-four patients not taking magnesium, fifteen had recurrences after two years.²³

Other studies show that urinary magnesium concentration is abnormally low and urinary calcium concentration is abnormally high in more than 25 percent of patients with kidney stones. Supplemental magnesium intake corrects this abnormality and prevents the recurrence of stones. Other researchers acknowledge that magnesium oxide or magnesium hydroxide therapy causes a considerable lessening of kidney stone recurrence in men and feel that soft tissue calcifications can be stopped and even prevented by magnesium therapy. ²⁴ Magnesium seems to be as effective against stone formation as diuretics, the major drug treatment for kidney stones.²⁵ Avoidance of calcium, taking diuretics, and mechanical intervention, however, seem to be the current medical approach to kidney stones.

Epidemiological findings round out the picture of kidney stone occurrence and its association with low magnesium intake. The disease pattern in Greenland includes a low incidence of heart disease and kidney and urinary tract stones, few cases of diabetes mellitus, and little osteoporosis, all of which may be related to low calcium and high magnesium in their diet.²⁶

DIETARY TREATMENT FOR KIDNEY STONES

On a regular basis, drink six to eight glasses of water a day; increase intake of green vegetables and fiber (vegetarians have a 40–60 percent decreased risk of stone formation) and foods high in magnesium, such as seeds, vegetables, and whole grains; and decrease consumption of sugar, alcohol, coffee, and meat.

For uric acid kidney stones, decrease consumption of high-purine foods such as alcohol, anchovies, herring, lentils, meat, mushrooms, organ meats, sardines, seafood, meats, and shellfish. For oxalate stones, decrease consumption of foods high in oxalic acid: red beet tops, black tea, cocoa, cranberry, nuts, parsley, tomatoes, rhubarb, and spinach. The citric acid in lemons, limes, oranges, pineapples, and gooseberries dissolves calcium oxalate and calcium phosphate, preventing stone formation.

SUPPLEMENTS FOR KIDNEY STONES

Magnesium: 300 mg twice per day
Calcium: 800 mg daily
Vitamin B₆: 50–100 mg daily