Review Article

Fad diets and their effect on urinary stone formation

Antonio Nouvenne1,2, Andrea Ticinesi1, Ilaria Morelli2, Loredana Guida2, Loris Borghi1, Tiziana Meschi1
1
Department of Clinical and Experimental Medicine, University of Parma, Via A. Gramsci 14, 43126 Parma, Italy; 2Internal Medicine and Critical
Subacute Care Unit, Parma University Hospital, Parma, Italy
Correspondence to: Prof. Loris Borghi, MD. Department of Clinical and Experimental Medicine, University of Parma, Via A. Gramsci 14, 43126
Parma, Italy. Email: [email protected].

Abstract: The influence of unhealthy dietary habits on urinary stone formation has been widely recognized
in literature. Dietary advice is indeed the cornerstone prescription for prevention of nephrolithiasis as well.
However, only a small amount of medical literature has addressed the influence of popular or fad diets, often
self-prescribed for the management of obesity and overweight or for cultural beliefs, on the risk of kidney
stones. Thereby in this paper we analyze the current knowledge on the effects of some popular diets on
overall lithogenic risk. High-protein diets, like Dukan diet, raise some concerns, since animal proteins are
able to increase urinary calcium and to decrease urinary citrate excretion, thus leading to a high overall
lithogenic risk. Low-carbohydrate diets, like Atkins diet or zone diet, may have a protective role against
kidney stone formation, but there are also evidences stating that this dietary approach may rise calciuria
and decrease citraturia, since it is generally associated to a relatively high intake of animal proteins. Vegan
diet can be harmful for urinary stone disease, especially for the risk of hyperuricemia and micronutrient
deficiencies, even if only few studies have addressed this specific matter. On the other side, the benefits
of a lacto-ovo-vegetarian diet on kidney stone prevention have been largely emphasized, provided that
the intake of calcium and oxalate is balanced. Traditional Mediterranean diet should exert a protective
effect on nephrolithiasis as well, even if specific studies have not been carried out yet. High phytate and
antioxidant content of this diet have however demonstrated to be beneficial in preventing the formation
of new or recurrent calculi. Anyway, at the current state of knowledge, the most effective dietary approach
to prevent kidney stone disease is a mild animal protein restriction, a balanced intake of carbohydrates
and fats and a high intake of fruit and vegetables. Other fundamental aspects, which are often neglected in
fad diets, are a normal intake of milk and dairy products and salt restriction. All these nutritional aspects
should be greatly taken into account when patients who are willing to undergo fad or commercial diets ask
for dietary advice.

Keywords: High-protein diet; low-carbohydrate diet; vegan diet; vegetarian diet; Mediterranean diet; Dukan diet;
Atkins diet; zone diet; nephrolithiasis

Submitted Oct 18, 2013. Accepted for publication Apr 20, 2014.
doi: 10.3978/j.issn.2223-4683.2014.06.01
View this article at: http://dx.doi.org/10.3978/j.issn.2223-4683.2014.06.01

The importance of diet in nephrolithiasis onset and diet (6,7), even if a new attention for the quality of diet has
prevention has been widely recognized in medical literature. risen among the general population in Western countries
Nowadays dietary advice, alongside with adequate fluid in the last decades, leading to minor but significant changes
intake and pharmacologic therapy, where indicated, is the in the daily intake of fat, fruit and vegetables (8,9). There is
cornerstone prescription in the medical management of also some evidence that dietary habits have changed even in
kidney stone disease (1-5). calcium stone formers in the last 25 years (10,11).
However, the dietary habits of kidney stone formers often People have become more and more conscious of the
do not fit together with the principles of an anti-lithogenic importance of nutrition in the prevention and treatment

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304 Nouvenne et al. Fad diets and nephrolithiasis

of many diseases, especially in the obesity, diabetes and been confirmed in a large number of studies, showing a
cardiovascular prevention field. Therefore, many different significant rise in the global lithogenic risk (22-25). On the
diets have been proposed in the last years and have gained other side, shifting from an ad libitum protein intake to a
popularity among general population. Some of these diets, recommended daily allowance (RDA) protein intake results
such as the Mediterranean and the hyperproteic diet (e.g., in a net 32% decrease in the levels of calcium excretion (25).
Dukan diet), have been extensively studied in medical Dietary proteins, especially of animal origin, actually lead
literature, so that a large amount of evidences on their risks to a high potential renal acid load (PRAL), a decrease in
and benefits is nowadays available. Some other diets have urinary pH and a state of mild chronic metabolic acidosis (26).
poorer scientific basis, even if there are reliable hypothesis Therefore some researchers claim that hypercalciuria comes
explaining their possible effects on human health. from high bone reabsorption due to this high acid load (24),
The purpose of this paper is therefore to review the while others show that there are no proofs to support this
present knowledge about the effects of fad diets on kidney hypothesis, thus claiming that it might have a renal origin (25).
stone risk factors and kidney stone formation, highlighting In fact, neutralization of the dietary acid load with potassium
their differences with the correct dietary prescriptions for citrate therapy is not able to prevent the hypercalciuric effect
nephrolithiasis prevention. of a high animal protein diet (27).
There are also other urinary factors driving the risk
for kidney stones in high protein diets. For example, a
High protein diets
significant reduction in urinary citrate levels has been
Raising the daily intake of protein is one of the most demonstrated (22,23). These modifications may be due to
popular dietary treatments for obesity, sometimes also the lower content of citrate in diet, since high protein diets
associated to an important reduction in carbohydrate usually do not include large amounts of fruit and vegetables,
consumption. Several studies have addressed the efficacy of but they may also be linked to the high levels of PRAL and
this prescription, showing that an elevated protein intake to urinary acidification (28).
rises total energy expenditure through a higher thermic Moreover, it has also been shown that a high animal
effect of feeding and promotes premature satiety during protein intake in diet may determine a rise in the urinary
meals (12,13). The resulting decrease in the intake of other oxalate excretion in about 30% of patients with idiopathic
macronutrients, such as carbohydrates and lipids, leads calcium nephrolithiasis, while other subjects do not exhibit
to an improvement in many parameters of the metabolic any hyperoxaluric response at all. This susceptibility is
syndrome (for example, reduction in total serum cholesterol independent from vitamin B6 deficiency and seems to be
and better glucose tolerance) and ultimately to a weight related to yet unknown genetic factors (29).
loss (14,15). The most common prescription is to eat at The connection between high protein intake and the
least 25% of total energy requirements as proteins, which risk for kidney stone onset or recurrence has also been
means at least 1.6 g/kg of ideal body weight, while the usual demonstrated in a large epidemiologic study carried out in
recommended dietary allowance for protein is 0.8 g/kg (16). male healthy subjects on their usual diet and prospectively
These prescriptions are the basis of many fad commercial followed up for four years. Men in the highest quintile for
diets, such as the Dukan diet, consisting in a first phase of animal protein consumption (>77 g/day) actually showed a
exclusive protein intake, followed by various phases of mild higher multivariate relative risk for incident kidney stones
progressive reintroduction of other nutrients such as fibers (1.33 vs. 1.00, P trend 0.05) than men in the lowest quintile
and carbohydrates (17). (<50 g/day) (30). The same group of authors carried out
There are some concerns about the adverse effects of other two similar studies on larger cohorts of healthy
these diets, especially for the progression of chronic kidney females, but they failed to demonstrate a similar relationship
disease and the increase in cardiovascular risk (16,18,19), between animal protein intake and kidney stone risk (31,32).
and some studies have also doubted their efficacy in glucose Therefore, the real-life risk for developing kidney
tolerance control and weight loss (16). stones during or after a high protein diet may be slightly
From a urinary point of view, it has been demonstrated a lower than what suggested by clinical studies carried out
long time ago that the main effect of a high protein intake is on randomized controlled conditions. The reason for this
a rise in urinary calcium excretion, independent from other discrepancy may be due to dietary questionnaires that do
dietary factors such as salt intake (20,21). These results have not discern between red meat, poultry and fish proteins.

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Translational Andrology and Urology, Vol 3, No 3 September 2014 305

It is well known, for example, that fish proteins have a low and proteins (30% of total energy intake each). In zone diet
sulphur content and are associated with a high content every meal and snack should have a composition of 40% in
in n-3 fatty acids, eicosapentaenoic acid and alkaline carbohydrates, 30% in proteins and 30% in fats, especially
potassium, which may actually protect against the calciuric rich in omega-3 polyunsaturated fatty acids. The rationale
effect of proteins (33). However, intervention studies have of this approach is that this formula is the best way to limit
shown that a reduction in animal protein intake is really insulin secretion, which is seen as the main detrimental factor
effective in preventing kidney stone relapse, either alone or in the onset of overweight, obesity and metabolic syndrome
combined with a reduction in salt intake and an increase in (41,42). Some studies have actually claimed that zone diet
fruit and vegetable intake (34,35). Therefore, a mild protein is effective in decreasing insulin and homocysteine levels
restriction is generally recommended in all anti-lithogenic and has anti-inflammatory properties (43), while others
diets (2,3). Subjects who undergo high protein diets, like have demonstrated that its efficacy on weight loss is limited,
Dukan diet, for obesity or overweight management should especially if compared to Atkins diet (44).
be aware that nephrolithiasis is a potential side effect and The effects of low carbohydrate diets on urinary
subjects with a known history of stone disease should not stone risk factors have not been extensively studied and
undergo these diets at all. results in literature are partially conflicting. Some studies
carried out in renal stone patients and in healthy subjects
have addressed the effects of an acute oral load of simple
Low carbohydrate diets
carbohydrates, such as glucose or xilitol, on the urinary
Diets with a very low content in carbohydrates have profile of lithogenic risk, showing that it can result in
gained great popularity for weight loss in the last decades. an increase in calciuria (45,46). Xilitol ingestion is also
The most studied one is Atkins diet, which consists of a associated to a rise in the urinary excretion of phosphate
normocaloric, very low carbohydrate, normal/high protein and oxalate, thus increasing lithogenic risk (46). Moreover,
and high fat intake. Some variants of Atkins diet emphasize a habitual high dietary intake of sucrose is associated to
the benefits of animal protein, so they may overlap to high a high risk of kidney stone onset or recurrence in a large
protein diets described above. Two renowned randomized epidemiologic study carried out in healthy women (31).
studies published about 10 years ago compared Atkins diet High insulin levels, indirect marker of a high carbohydrate
with the usual low-fat low-calorie diet for obesity, showing consumption or metabolic syndrome, have actually been
that weight loss was higher in the Atkins diet group after correlated to high calcium excretion (47), even if more
6 months, but was similar to the usual diet group after recent research denies that euglycemic hyperinsulinemia
1 year (36,37). has a significant effect on urinary calcium excretion (48).
Severe carbohydrate restriction leads to a progressive All these evidence seem to indirectly support the
depletion of glycogen stores and associated bound assumption that low-carbohydrate diets are protective
tissue water. Therefore, it is plausible, but not properly against kidney stones. As a matter of fact, even from a
demonstrated yet, that the weight loss is due to tissue physio-pathological point of view, carbohydrates are the
dehydration and not to fat store losses (38). Moreover, main carbon donors in the endogenous liver synthesis of
the depletion of glycogen produces ketotic acidosis, glyoxylate and therefore of oxalate. However, the only
which has some effects on brain functioning, leading to study who specifically addressed the effects of Atkins diet
appetite suppression and reduced production of excitatory in nephrolithiasis showed that it is associated to a high
neurotransmitters. Atkins diet has actually proven to be lithogenic risk. The shift from usual diet to Atkins diet
effective in controlling drug-refractory forms of epilepsia in healthy subjects actually leads to an average 61% rise
in children (39). The risk of severe ketoacidosis and the in urinary calcium and a 41% decrease in urinary citrate
poor rate of adherence among patients are the main medical compared to baseline levels (22). It should be pointed out
concerns in prescribing this diet, even if there are some that in this study the low-carbohydrate diet was associated
evidences stating that it may improve glucose tolerance and to a high-protein intake, as documented by the average
cardiovascular risk factors (36,37,40). 56 mEq/day increase in net acid excretion, so probably the
Other popular diets, such as zone diet, include only a mild harmful effects of proteins, which are consistent with what
carbohydrate restriction (40% of total energy intake), with is reported above, can mask the effects of carbohydrate
a proportionally higher-than-recommended intake of fats reduction.

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306 Nouvenne et al. Fad diets and nephrolithiasis

To our knowledge, there are no studies in literature chloride and a high content in lithogenesis inhibitors
addressing the effects of zone diet on lithogenic risk. such as magnesium, citrate and alkaline potassium. Some
However, one of the main components of zone diet, i.e., n-3 studies have addressed the impact of the switch from an
fatty acid or fish oil supplementation, has been extensively omnivorous diet to a vegetarian diet on urine chemistries,
studied. Kidney stone formers generally have higher levels actually demonstrating a rise in the urinary excretion of
of plasma arachidonic acid content, which has been linked to potassium, magnesium and citrate and a decrease in the
hypercalciuria and hyperoxaluria (49,50). Several studies have excretion of calcium, thus reducing the supersaturation
demonstrated that fish oil or n-3 fatty acid supplementation indexes for calcium oxalate and calcium phosphate (63-66).
can reduce plasma arachidonic acid levels, with a concomitant Vegetarian diet also has a high alkalinizing power on urines,
reduction in urinary calcium and oxalate and lower levels leading to a higher urine pH, resulting in a lower risk for
of calcium oxalate supersaturation index (49-53). However, uric acid stones (67). Vegan diet instead has been associated
a large epidemiologic study carried out on healthy subjects to a high prevalence of severe hyperuricemia, which is the
has denied any correlation between fatty acid intake and the strongest and most common risk factor for hyperuricosuria
onset or prevention of nephrolithiasis (54). and uric acid nephrolithiasis (68).
Thus, curre nt knowledge supports neither the The positive effects of a high fruit and vegetable
prescription nor the avoidance of low-carbohydrate diets intake on lithogenic risk have also been assessed in large
in nephrolithiasis and their real effect on lithogenesis is epidemiologic studies evaluating the urinary chemistries
still poorly known. More studies are needed to address and the risk of kidney stone formation in Dietary
this specific matter; in the meanwhile, a mild carbohydrate Approaches to Stop Hypertension (DASH)-style diet.
restriction with a normal intake of n-3 fatty acids seems a DASH diet has been specifically designed for managing
reasonable prescription for those who want to avoid kidney hypertension and cardiovascular risk and encompasses a
stones (2). high intake of fruit and vegetables, a moderate intake of
low-fat dairy products and a low intake of salt and animal
proteins. Subjects who spontaneously follow diets that fit
Lacto-ovo-vegetarian and vegan diets
with DASH diet recommendations actually have a lower
Vegan diet has been defined as a diet with no intake of animal risk of incident kidney stones [multivariate relative risk 0.55
derivatives, where only vegetal derivatives are allowed. On (95% CI, 0.46-0.65) for men, 0.58 (95% CI, 0.49-0.68) for
the other side, vegetarian diet is a diet where only meat older women and 0.60 (95% CI, 0.52-0.70) for younger
and fish are prohibited, while eggs and milk derivatives are women] and higher urinary volume and urinary citrate
allowed (55). These diets have gained great popularity in than other subjects that do not eat according to DASH
Western countries in the last decades, especially for cultural recommendations (69,70). These effects are most likely
or religious reasons. A large number of scientific studies have due to the high intake of fruit and vegetables, although we
supported these diets, highlighting many benefits especially cannot fully recognize the effects of other foods, since these
on cancer prevention (56), cardiovascular disease and death diets are not strictly vegetarian. High intakes of potassium
prevention (57) and treatment of type 2 diabetes mellitus (58). and phytate, which are considered reliable indexes of
On the other side, the main nutrition concern about these fruit and vegetables consumption, are actually associated
diets is the insufficient intake of vitamin D, vitamin B12, to a lower risk of incident nephrolithiasis in groups with
n-3 fatty acids, iron and zinc, which may result in clinical different age and sex (30-32).
deficiencies (59). These concerns are particularly emphasized Despite these well demonstrated positive effects,
for vegan diet, where deficiencies are more frequent with vegetarian diets have not been extensively prescribed
possible reflections on an unfavorable cardiovascular risk for nephrolithiasis prevention or treatment. Fruits and
profile (60). vegetables, especially if eaten in large amounts, are actually
Vegetarian diets have been recognized as protective the main dietary sources of oxalate and a high dietary oxalate
against kidney stone disease a long time ago (61), and load may result in hyperoxaluria, especially in subjects
the prevalence of nephrolithiasis in vegetarians has been with idiopathic calcium nephrolithiasis (71). Moreover, an
esteemed in about half that of free diet (62). Fruit and oxalate load may raise the fractional intestinal absorption
vegetables, the main components of vegetarian diets, of calcium, thus promoting a mild hypercalciuria (72).
actually have a low content in proteins and sodium Vegetarian diet has actually been associated to hyperoxaluria

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Translational Andrology and Urology, Vol 3, No 3 September 2014 307

and hypercalciuria in a famous clinical study published Mediterranean diet

more than twenty years ago (73), and has been considered
The traditional Mediterranean diet is characterized by
detrimental for stone formers ever since.
a high intake of olive oil, fruits, vegetables and cereals,
More recent investigations have actually pointed out
a moderate intake of fish, poultry and wine, and a low
that vegetarian diet does not increase oxalate excretion
intake of dairy products, red meat and sweets (82). It is not
and lithogenic risk per se, but the global calcium/oxalate
properly a fad diet like the others discussed above, which
dietary content should be taken into account to define
have gained popularity for cultural or commercial reasons,
lithogenic risk. As a matter of fact, a balanced intake of
but it should be instead considered an evergreen model of
calcium and oxalate can promote chelation in the intestinal
a healthy way of eating, recognized worldwide as one of the
tract, so that a smaller fraction of the two substances is
cornerstones of nutrition.
excreted in urine. It is also important that the dietary
Mediterranean diet, as a matter of fact, has been
intake of other substances able to chelate calcium, such
extensively studied, especially in recent years. A huge
as phytate, is low, making calcium available for chelation
with oxalate. Therefore, the ability of a vegetarian diet amount of evidence has shown that it has protective effects
to promote or prevent nephrolithiasis also depends on its against cardiovascular disease (83), hypertension (84),
composition in calcium, oxalate and phytate and on the metabolic syndrome (85), cancer (86,87), neurological
timing of their ingestion (74). Simultaneous intake of high- diseases like stroke and cognitive decline (88) and kidney
oxalate foods and high-calcium foods is the best way to function (89). Mediterranean diet has also been linked to
limit the absorption of both substances (75). On the other biochemical and genic parameters of a successful aging (90).
side, simultaneous ingestion of calcium and substances However, the epidemiologic and biochemical impact on
with a high chelating power, such as fibres or rice bran, urinary stone risk factors of this diet has not been studied
may result in a rise of lithogenic risk due to the higher yet in literature, even if our research group has published a
excretion of oxalate, that leads to higher levels of calcium 5-year trial demonstrating the efficacy of normal calcium,
oxalate supersaturation index, even if stone recurrence rate low salt, low protein diet very close to a traditional
is prospectively not affected (76,77). Mediterranean diet (35). There are indeed no studies, at the
It should also be noted that only a few vegetables have current state of knowledge, comparing Mediterranean diet
demonstrated to significantly raise oxalate excretion, with the usual Western diet focusing on urine composition
if eaten regularly, such as spinach, rhubarb, beets and and the risk of stone relapse. Nevertheless, the composition
tomatoes (78). Moreover, even a massive dietary oxalate of the traditional Mediterranean diet highly fits with
load results in a relatively mild increase in oxaluria (79): the main dietary recommendations for nephrolithiasis
hyperoxaluria is indeed determined more frequently by prevention, such as the low intake of animal proteins and
genetic than environmental factors, and it generally affects the high intake of fruits and vegetables. For many aspects,
only a small portion of calcium stone formers (4,80). Finally, Mediterranean diet is very similar to DASH diet, which
both vegan and lacto-ovo-vegetarian diets have shown not has proven to be effective in the prevention of kidney stone
to significantly affect calcium metabolism, bone turnover onset and relapse (69,70).
and calcium excretion on a short-term period, even if their An aspect of Mediterranean diet that has been
effect for a long-term period is still poorly known (81). particularly emphasized is the high content of antioxidant
Therefore, current evidence shows that a balanced lacto- substances, such as beta-carotene and vitamin E. These
ovo-vegetarian diet is generally not detrimental for kidney substances have been overall associated with a better health-
stone prevention and can on the contrary be protective, related quality of life, both from a mental and physical
provided that there is an adequate and simultaneous intake point of view (91). In the nephrolithiasis field, there are
of calcium and oxalate and that there is not an excessive some evidences stating that low levels of antioxidants such
intake in fibres. On the other side, the effects of vegan diet as alpha-carotene, beta-carotene and beta-cryptoxanthin
in kidney stone disease are not fully understood; the risks are associated in general population to a history of kidney
of micronutrient deficiencies and of hyperuricemia may stones, thus indicating a possible protective role of these
outweigh benefits for kidney stone prevention. Thus, at substances in stone prevention (92). There are also reports
the present state of knowledge, vegan diet should not be showing that antioxidants may prevent renal cell injury
recommended for kidney stone prevention. and stone formation in idiopathic calcium nephrolithiasis

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308 Nouvenne et al. Fad diets and nephrolithiasis

(93,94). Moreover, a high dietary intake of vitamin E has Nevertheless, some renowned intervention studies
been able to prevent calcium oxalate crystal deposition have shown that reducing salt intake is a really effective
in the kidneys, thus confirming the hypothesis that a diet prescription for diminishing calciuria and the risk for
rich in antioxidant substances, such as vitamin E, may be kidney stone relapse in idiopathic calcium nephrolithiasis
protective against nephrolithiasis (95). (35,102,103). The same results have been obtained
Mediterranean diets usually encompass a high intake of assessing the effects of DASH-style diet, whose primary
cereals, nuts and legumes. These foods have a high content recommendation is the reduction of salt intake, on
of phytate and their consumption has been associated to nephrolithiasis onset and recurrence (69). Therefore,
a high urinary excretion of phytate (96). There are some dietary salt reduction is nowadays one of the fundamental
reports in literature stating that a high urinary phytate prescriptions in nephrolithiasis prevention (1-5).
excretion may exert a protective role against the formation The second issue often neglected in fad diets is calcium
of renal calculi, especially against the regrowth of calcium intake. Given that hypercalciuria is the most common
oxalate dihydrate fragmented calculi (97,98). Therefore, a risk factor for nephrolithiasis, it was believed in the past
Mediterranean-style diet may be important in preventing that stone formers should eat a low-calcium diet, poor in
calcium stone relapse. milk and dairy products. However, since the early 1990s
a large amount of clinical evidence has pushed against the
prescription of low-calcium diets in nephrolithiasis, and
Additional nutritional aspects in nephrolithiasis
Martini et al. in 2002 definitely demonstrated that dietary
There are at least other two nutritional aspects that are calcium diminish, rather than increase, stone risk (104). As a
generally poorly considered in fad popular diets, but that matter of fact, a high dietary calcium intake is able to reduce
are a basic part of any diet prescription in nephrolithiasis: oxalate intestinal absorption, and consequently urinary
salt and calcium intake. excretion, since oxalate and calcium may complex together
There are many reports in literature demonstrating that to form unabsorbable aggregates (105-107). Low-calcium
a dietary sodium chloride load results in a linear increase diet seems to be suitable for nephrolithiasis prevention only
in calcium excretion, thus affecting global lithogenic risk, when it is associated with a very low intake of oxalate (108).
in cohorts of healthy subjects, idiopathic calcium stone These findings have also been confirmed by the large
formers and post-menopausal osteoporotic women (99). epidemiologic studies carried out by Curhan & coll,
A 3.5 g increase in sodium chloride intake may result in showing that people in the highest quintile of milk and
a 1.63-fold increase in the relative risk for hypercalciuria, dairy product consumption are at the lowest risk for kidney
while healthy subjects with a daily salt intake higher than 10 stone onset (30-32). Moreover, a normal-calcium low-
grams have 21.8% prevalence in hypercalciuria, compared salt low-animal protein diet has proven to be a better
to 3.9% prevalence in those with a lower intake (100). approach for kidney stone prevention than a simple dietary
Moreover, the levels of calcium excretion are generally calcium restriction in a renowned prospective intervention
higher in stone formers than in healthy subjects with the study (35). So, nowadays low-calcium diets are no longer
same sodium intake, so that a 6 g/day rise in salt intake may recommended for nephrolithiasis.
result in an 80 mg/day increase in urinary calcium (1). Salt-
induced calcium excretion also exhibits an additive effect
Conclusions
with animal protein-induced hypercalciuria (21). Finally,
sodium chloride ingestion is also associated with a reduction Different diets generally have different effects in outlining
in the urinary excretion of citrate (101). the overall lithogenic risk. When prescribing a new diet or
The strong connection between salt intake and giving dietary advice, physicians and nutritionists should
nephrolithiasis has also been demonstrated by Curhan & also take into account its effect on kidney stone formation.
coll. in a large epidemiologic study on healthy middle-aged Many popular fad diets, such as high-protein diet, low-
women, highlighting a higher risk for calcium stone onset carbohydrate diet and vegan diet, may raise the overall
or recurrence in those who have a daily salt intake in the lithogenic risk. On the other side, lacto-ovo-vegetarian
highest quintile (31). However, the same authors failed to and traditional Mediterranean diets seem to be at least not
demonstrate an analogue correlation in younger women and harmful, or even protective against kidney stone formation.
in men (30,32). Anyway, a dietary approach with low salt, low animal

Translational Andrology and Urology. All rights reserved. www.amepc.org/tau Transl Androl Urol 2014;3(3):303-312
Translational Andrology and Urology, Vol 3, No 3 September 2014 309

protein and high fruit and vegetable intake, together with a diet selectively reduces fat mass and improves glucose
normal and balanced consumption of milk, dairy products, tolerance in Western-type diet-induced obese rats. Am J
carbohydrates and fats, is the best way to prevent kidney Physiol Regul Integr Comp Physiol 2013;305:R582-91.
stone onset and relapse at the current state of knowledge. 13. Westerterp-Plantenga MS, Lemmens SG, Westerterp KR.
Dietary protein - its role in satiety, energetics, weight loss
and health. Br J Nutr 2012;108 Suppl 2:S105-12.
Acknowledgements
14. DeHaven J, Sherwin R, Hendler R, et al. Nitrogen and
None. sodium balance and sympathetic-nervous-system activity in
obese subjects treated with a low-calorie protein or mixed
diet. N Engl J Med 1980;302:477-82.
Footnote
15. Skov AR, Toubro S, Rnn B, et al. Randomized trial on
Conflicts of Interest: The authors have no conflicts of interest protein vs carbohydrate in ad libitum fat reduced diet for
to declare. the treatment of obesity. Int J Obes Relat Metab Disord
1999;23:528-36.
16. Eisenstein J, Roberts SB, Dallal G, et al. High-protein
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Cite this article as: Nouvenne A, Ticinesi A, Morelli I, Guida
in the kidney by improving renal tissue antioxidant status.
L, Borghi L, Meschi T. Fad diets and their effect on urinary
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