s What Really Causes Kidney Stones (And Why Vitamin C Does Not) | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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What Really Causes Kidney Stones (And Why Vitamin C Does Not)

Staff Writer

articles by this author...

Editing and Researching news and stories about global and local Pharmacy Issues

Orthomolecular Medicine News Service, February 11, 2013

What Really Causes Kidney Stones
(And Why Vitamin C Does Not)

(OMNS Feb 11, 2013) A recent widely-publicized study claimed that vitamin C supplements increased the risk of developing kidney stones by nearly a factor of two.[1] The study stated that the stones were most likely formed from calcium oxalate, which can be formed in the presence of vitamin C (ascorbate), but it did not analyze the kidney stones of participants. Instead, it relied on a different study of kidney stones where ascorbate was not tested. This type of poorly organized study does not help the medical profession or the public, but instead causes confusion.

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The study followed 23,355 Swedish men for a decade. They were divided into two groups, one that did not take any supplements (22,448), and another that took supplements of vitamin C (907). The average diet for each group was tabulated, but not in much detail. Then the participants who got kidney stones in each group were tabulated, and the group that took vitamin C appeared to have a greater risk of kidney stones. The extra risk of kidney stones from ascorbate presented in the study is very low, 147 per 100,000 person-years, or only 0.15% per year.

Key points the media missed:

* The number of kidney stones in the study participants who took ascorbate was very low (31 stones in over a decade), so the odds for statistical error in the study are fairly high.

* The study was observational. It simply tabulated the intake of vitamin C and the number of kidney stones to try to find an association between them.

* This method does not imply a causative factor because it was not a randomized controlled study, that is, vitamin C was not given to a group selected at random.

* This type of observational study is fraught with limitations that make its conclusion unreliable.
It contradicts previous studies that have clearly shown that high dose ascorbate does not cause kidney stones.[2-6]

* The study authors' conclusion that ascorbate caused the low rate of stones is likely due to a correlation between the choice of taking a vitamin C supplement with some other aspect of the participants' diet.

* The study could not determine the nature of this type of correlation, because it lacked a detailed study of each patient's diet and a chemical analysis of each stone to provide a hint about the probable cause.

So we have a poorly designed study that did not determine what kind of stone was formed, or what caused the stones that were formed. These are serious flaws. Drawing conclusions from such a study can hardly be a good example of "evidence based medicine."

Different Types of Kidney Stones (Renal Calculi)

There is a considerable variety of kidney stones. Here are five well-known ones:

1. Calcium phosphate stones are common and easily dissolve in urine acidified by vitamin C.

2. Calcium oxalate stones are also common but they do not dissolve in acid urine. We will discuss this type further below.

3. Magnesium ammonium phosphate (struvite) stones are much less common, often appearing after an infection. They dissolve in urine acidified by vitamin C.

4. Uric acid stones result from a problem metabolizing purines (the chemical base of adenine, xanthine, theobromine [in chocolate] and uric acid). They may form in a condition such as gout.

5. Cystine stones result from an hereditary inability to reabsorb cystine. Most children's stones are this type, and these are rare.

The Oxalate Oxymoron

The oxalate/vitamin C issue appears contradictory. Oxalate is in oxalate stones and oxalate stones are common. Ascorbate (the active ion in vitamin C) may slightly increase the body's production of oxalate. Yet, in practice, vitamin C does not increase oxalate stone formation. Emanuel Cheraskin, MD, DMD, Professor of Oral Medicine at the University of Alabama, explains why: "Vitamin C in the urine tends to bind calcium and decrease its free form. This means less chance of calcium's separating out as calcium oxalate (stones)."[7] Also, the diuretic effect of vitamin C reduces urine concentration of oxalate. Fast moving rivers deposit little silt. If on a consultation, a doctor advises that you are especially prone to forming oxalate stones, read the suggestions below before abandoning the benefits of vitamin C. Once again: vitamin C increases oxalate but inhibits the union of calcium and oxalate.

Oxalate is generated by many foods in the diet, including spinach (100-200 mg oxalate per ounce of spinach), rhubarb, and beets.[8-10] Tea and coffee are thought to be the largest source of oxalate in the diet of many people, up to 150-300 mg/day.[8,11] This is considerably more than would likely be generated by an ascorbate dose of 1000 mg/day.[5,12]

The study we are discussing didn't tabulate the participants' intake of oxalate, but on average they had relatively high intakes (several cups) of tea and coffee. It is possible that those who had kidney stones had them before the study started, or got them during the study, due to a particularly high intake of oxalate. For example, the participants that took vitamin C may have been trying to stay healthy, but the subset of those who got kidney stones might also have been trying to stay healthy by drinking a lot of tea or coffee, or eating green leafy vegetables such as spinach. Or they may have been older people who got dehydrated, which is also very common among men who are active outside during the summer. Among the most important factors in kidney stones is dehydration, especially among the elderly.[13]


Summarizing:

* Ascorbate in low or high doses generally does not cause significant increase in urinary oxalate.[2-6]

* Ascorbate tends to prevent formation of calcium oxalate kidney stones.[3,4]

* Risk factors for kidney stones include a history of hypertension, obesity, chronic dehydration, poor diet, and a low dietary intake of magnesium.

Magnesium

Kidney stones and magnesium deficiency share the same list of causes, including a diet high in sugar, alcohol, oxalates, and coffee. Magnesium has an important role in the prevention of kidney stone formation.[14] Magnesium stimulates production of calcitonin, which draws calcium out of the blood and soft tissues back into the bones, preventing some forms of arthritis and kidney stones. Magnesium suppresses parathyroid hormone, preventing it from breaking down bone. Magnesium converts vitamin D into its active form so that it can assist in calcium absorption. Magnesium is required to activate an enzyme that is necessary to form new bone. Magnesium regulates active calcium transport. All these factors help place calcium where it needs to be, and not in kidney stones.

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 a 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 (as in calcification of the arteries). Dr. George Bunce has clinically demonstrated the relationship between kidney stones and magnesium deficiency. As early as 1964, Bunce reported the benefits of administering a 420 mg dose of magnesium oxide per day to patients who had a history of frequent stone formation.[14,15] If poorly absorbed magnesium oxide works, other forms of better-absorbed magnesium will work better.

Calcium oxalate stones can effectively be prevented by getting an adequate amount of magnesium, either through foods high in magnesium (buckwheat, green vegetables, beans, nuts), or magnesium supplements. Take a magnesium supplement of at least the US RDA of 300-400 mg/day (more may be desirable in order to maintain an ideal 1:1 balance of magnesium to calcium). To prevent a laxative effect, take a supplement that is readily absorbable, such as magnesium citrate, chelate, malate, or chloride. Magnesium oxide, mentioned above, is cheap and widely available. However, magnesium oxide is only about 5% absorbed and thus acts mostly as a laxative. [14] Milk of magnesia (magnesium hydroxide) is even more of a laxative, and unsuitable for supplementation. Magnesium citrate is a good choice: easy to find, relatively inexpensive and well absorbed.

The Role of Vitamin C in Preventing and Dissolving Kidney Stones

The calcium phosphate kidney stone can only exist in a urinary tract that is not acidic. Ascorbic acid (vitamin C's most common form) acidifies the urine, thereby dissolving phosphate stones and preventing their formation.

Acidic urine will also dissolve magnesium ammonium phosphate stones, which would otherwise require surgical removal. These are the same struvite stones associated with urinary tract infections. Both the infection and the stone are easily cured with vitamin C in large doses. Both are virtually 100% preventable with daily consumption of much-greater-than-RDA amounts of ascorbic acid. A gorilla gets about 4,000 mg of vitamin C a day in its natural diet. The US RDA for humans is only 90 mg. The gorillas are unlikely to all be wrong.

The common calcium oxalate stone can form in an acidic urine whether one takes vitamin C or not. However, this type of stone can be prevented by adequate quantities of B-complex vitamins and magnesium. Any common B-complex supplement, twice daily, plus about 400 milligrams of magnesium, is usually adequate.

A Dozen Ways to Reduce Your Risk of Kidney Stones

1. Maximize fluid intake.[13] Especially drink fruit and vegetable juices. Orange, grape and carrot juices are high in citrates which inhibit both a buildup of uric acid and also stop calcium salts from forming. [16]

2. Control urine pH. Slightly acidic urine helps prevent urinary tract infections, dissolves both phosphate and struvite stones, and will not cause oxalate stones. And of course one way to make urine slightly acidic is to take vitamin C.

3. Avoid excessive oxalates by not eating (much) rhubarb, spinach, chocolate, or dark tea or coffee.

4. Lose weight. Being overweight is associated with substantially increased risk of kidney stones.[17]

5. Calcium is probably not the real culprit. Low calcium may itself cause calcium stones [18].

6. Most kidney stones are compounds of calcium and yet many Americans are calcium deficient. Instead of lowering calcium intake, reduce excess dietary phosphorous by avoiding carbonated soft drinks, especially colas. Cola soft drinks contain excessive quantities of phosphorous as phosphoric acid. This is the same acid that is used by dentists to dissolve tooth enamel before applying bonding resins.

7. Take a magnesium supplement of at least the US RDA of 300-400 mg/day. More may be desirable in order to maintain an ideal 1:1 balance of magnesium to calcium. Many people eating "modern" processed-food diets do not consume optimal quantities of magnesium.

8. Take a good B-complex vitamin supplement twice daily, which contains pyridoxine (vitamin B6). A deficiency of vitamin B6 produces kidney stones in experimental animals. Vitamin B6 deficiency is very common in humans. A vitamin B1 (thiamine) deficiency also is associated with stones. [19]

9. For uric acid/purine stones (gout), stop eating meat. Nutrition tables and textbooks indicate meats as the major dietary purine source. Natural treatment adds juice fasts and eating sour cherries. Increased vitamin C consumption helps by improving the urinary excretion of uric acid. [12]. For these stones, use buffered ascorbate "C".

10. Persons with cystine stones (only 1% of all kidney stones) should follow a low methionine diet and use buffered vitamin C.

11. Kidney stones are associated with high sugar intake, so eat less (or no) added sugar. [20]

12. Infections can cause conditions that favor stone formation, such as overly concentrated urine (from fever sweating, vomiting or diarrhea). Practice good preventive health care, and it will pay you back with interest.

 

References:

1. Thomas LDK, Elinder CG, Tiselius HG, Wolk A, Akesson A. (2013) Ascorbic acid supplements and kidney stone incidence among men: A prospective study. Published Online: February 4, 2013. doi:10.1001/jamainternmed.2013.2296

2. Wandzilak TR, D'Andre SD, Davis PA, Williams HE (1994) Effect of high dose vitamin C on urinary oxalate levels. J Urology 151:834-837.

3. Hickey S, Saul AW. (2008) Vitamin C: The Real Story, the Remarkable and Controversial Healing Factor. Basic Health Publications ISBN-13: 9781591202233

4. Hickey S, Roberts H. (2005) Vitamin C does not cause kidney stones. http://orthomolecular.org/resources/omns/v01n07.shtml

5. Robitaille L, Mamer OA, Miller WH Jr, Levine M, Assouline S, Melnychuk D, Rousseau C, Hoffer LJ. Oxalic acid excretion after intravenous ascorbic acid administration. Metabolism. 2009 Feb;58(2):263-9. doi: 10.1016/j.metabol.2008.09.023.

6. Padayatty SJ, Sun AY, Chen Q, Espey MG, Drisko J, Levine M. (2010) Vitamin C: intravenous use by complementary and alternative medicine practitioners and adverse effects. PLoS One. 5(7):e11414. doi: 10.1371/journal.pone.0011414.

7. Cheraskin E, Ringsdorf, M Jr, Sisley E (1983) The Vitamin C Connection. Bantam Books. ISBN-13: 9780553244342

8. Noonan SC, Savage GP (1999) Oxalate content of foods and its effect on humans. Asia Pacific Journal of Clinical Nutrition. 8:64-74.

9. Kawazua Y, Okimurab M, Ishiic T, Yuid S. (2003) Varietal and seasonal differences in oxalate content of spinach. Scientia Horticulturae 97:203-210

10. Proietti S, Moscatello S, Famiani F, Battistelli A. (2009) Increase of ascorbic acid content and nutritional quality in spinach leaves during physiological acclimation to low temperature. Plant Physiol Biochem. 47(8):717-23.

11. Gasinska A, Gajewska D. (2007) Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones. ROCZN. PZH 58(1):61-67.

12. Pauling L. (2006) How to Live Longer And Feel Better. OSU Press ISBN-13: 9780870710964

13. Manz F, Wentz A. (2005) The importance of good hydration for the prevention of chronic diseases. Nutr Rev. 63(6 Pt 2):S2-S5.

14. Dean C. (2007) The Magnesium Miracle. Ballantine Books. ISBN-13: 9780345494580

15. Bunce GE, Li BW, Price NO, Greenstreet R. (1974) Distribution of calcium and magnesium in rat kidney homogenate fractions accompanying magnesium deficiency induced nephrocalcinosis. Exp Mol Pathol. 21(1):16-28.

16. Carper J. Orange juice may prevent kidney stones, Lancaster Intelligencer-Journal, Jan 5, 1994

17. Bagga HS, Chi T, Miller J, Stoller ML. (2013) New insights into the pathogenesis of renal calculi. Urol Clin North Am. 2013 Feb;40(1):1-12. doi: 10.1016/j.ucl.2012.09.006.

18. L. H. Smith, et al (1974) Medical evaluation of urolithiasis. Urological Clinics of North America. 1:2, 241-260.

19. Hagler L, Herman RH, (1973) Oxalate metabolism, II. American Journal of Clinical Nutrition, 26(8): 882-889.

20. J. A. Thom, et al (1978) The influence of refined carbohydrate on urinary calcium excretion. British Journal of Urology, 50(7): 459-464.

 

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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