Diana, The PKD Dietitian 00:00:14 Today we have another great listener question. It comes all the way from the UK from Gwen who wrote in asking is drinking lemon juice good for PCD health and can I drink it? Now, Gwen didn't say much else in her email. She didn't say why she wanted to drink lemon juice. She also didn't mention possibly what she had heard that it was good for, or what goals she hoped to achieve. And as you guys know, whenever it comes to adding something, I always want you to know the what and the why and what your goal is. Now, having worked with PCD for many years, I have a pretty good idea on all these factors based on questions I frequently get from my clients, also in my inbox and online. When it comes to lemon juice and PCD, there are two common reasons that I find folks at it in intentionally. The first is to add something called citrate, and the second is to add potassium. The part of Gwen's email that said, can I drink it? I interpret it as the question is it kidney safe or will it hurt my kidneys? This is what we are going to explore today on the PKD Dietician podcast.
Diana, The PKD Dietitian 00:01:40 There will be some talk about kidney stones and urine pH. Now stick with me, especially to the end where I will loop it all back to PKD kidney function and what the science shows. Let's first look at the nutritional content of freshly squeezed lemon juice. In a fourth of a cup. There's about 14 or 15 calories, 63mg of potassium, 24mg of vitamin C, and a little bit of calcium and even folate. One fourth cup of lemon juice equals ten milli equivalents of potassium citrate. You don't need to remember these exact details. I will come back to this potassium citrate component in a bit. What is important to remember is the basics. Lemon juice has some potassium, vitamin C and citrate in it. One of the main reasons outside of. They like the flavor boost that folks add lemon juice to their water is because it contains citric acid. Lemons have more citric acid than any other fruit or veggie. Citric acid contains citrate. Not shocking right? It's basically in the name. I'm going to keep it simple moving forward for the sake of this episode, and just stick to saying citrate.
Diana, The PKD Dietitian 00:03:04 Citrate binds to calcium in the urine, and it helps to prevent kidney stones from forming, or ones that are there from growing. It prevents oxalates or even uric acid from binding to that calcium and start in a stone. Remember, calcium in your bones equals good, but calcium in your urine isn't. If your citrate levels are low in your urine, lemon juice can be useful in naturally increasing them, helping to stop stones. To be effective, it would require you to consume a fairly large and consistent amount of lemon juice. More to come on the how much in a few minutes. If you have had stones or been told that they were seen on your kidney scans, talk to your doctor or other health care professional about which treatment options are right for you. You want to know exactly what is off balance in your urine that is creating this environment where a stone would form. Often those imbalances can be corrected with dietary changes, but you gotta know the why, the details to be able to get targeted nutrition and a plan.
Diana, The PKD Dietitian 00:04:23 I frequently have clients who have had stones or know that there are some in their kidneys. Part of our nutritional strategy is to learn the why and make nutritional changes to support not forming anymore. Because a kidney stone equals kidney damage and we want to prevent any more injury to their kidneys. Often low citrate is a big factor in their stone formation, but not always. Incorporating citrate into your diet when it's needed can help change your urine environment for the better. When it comes to PKD, low levels of citrate are often found in PCD years, even from a very early stage of kidney disease. Well before that GFR, that kidney function dips. This for sure contributes to the higher rates of stones and formation and risk that we see within the PCD community. If you want to learn more about kidney stones and PCD, I have two great episodes. You should check out episode four about kidney stones and PCD, seeing if they're connected and then following that episode five six steps to help Stop stones with nutrition. If you are someone who wants to learn more about kidney stones, perhaps you have had one.
Diana, The PKD Dietitian 00:05:48 Check out these two episodes. They're linked out in the show notes. The second main goal when it comes to adding lemon juice is to increase urine acidity. So we're going to talk a little bit about potassium here. Citrate, which we just looked at also helps to increase Uranus acidity. So does the potassium in lemon juice. Not just in lemon juice. Any potassium rich food in general will help with this. I want you to think all the way back to middle school when you learned about the pH scale. Just a little refresher. The pH scale goes from 1 to 14. Smack dab in the middle is seven. And this is neutral. So when you think of neutral, think of water. Anything below seven, so a lower number is acidic and anything above seven is considered alkaline or basic. Pause the podcast. If you are a visual learner like me and go Google pH scale. Once you get that visual, it will all come back to you quickly. When we're talking about urine, our urine is naturally slightly acidic, so naturally it's less than seven.
Diana, The PKD Dietitian 00:07:08 Now PCD ers tend to have a urine with a much lower pH, meaning you generally have a urine that is acidic. I see stuff in the low fives all the time when urine gets too acidic. That environment makes it much easier for kidney stones to form, specifically oxalate stones. Not surprisingly, what you eat and your dietary patterns can impact your urine pH. Potassium, which is a component of lemon juice, helps to keep your body's acid and base balance in check and raise your urine pH. That's why potassium is often called a quote unquote alkaline rising agent. It also gets bonus points for helping to reduce the amount of calcium leaking into urine. Now, if you're thinking but lemon juice is acidic, how could it possibly help my kidneys make less acidic urine? You might be surprised to know that, yes, lemon juice itself is acidic in your mouth because it contains that citric acid. That's what gives it the sour taste that puckering. But in your body, that acid piece is removed during digestion and the citrate portion is not acidic.
Diana, The PKD Dietitian 00:08:32 So lemon juice in your mouth is acidic, but lemon juice in your body is basic. It is much higher on the pH scale. Back to that potassium. That potassium and lemon juice does contribute to your daily potassium goals and needs. We know that the combination of potassium plus citrate is very effective in helping to reduce stone formation, and stoners and higher intakes are associated with a much lower risk of kidney stones. Potassium plus citrate is a good combination. They work together in synergy. If you want to know more about potassium and PKD and if you should restrict, check out episode 25. I'll link it out in the show notes. You will find both potassium and citrate in ketosis, which is the first medical food for PCD. These are some of the reasons why and how it was specifically formulated for PKD to help balance those urine imbalances with the citrate and the acidic pH. We know having more acidic urine plus lower citrate levels is not a good combo for PKD. It is also associated with having larger kidneys and earlier decline in GFR that kidney function.
Diana, The PKD Dietitian 00:10:01 If you aren't familiar with ketosis or haven't explored if it's a good option for you, I will link out more information for you in the show notes, plus my personal coupon for you to get 20% off your first order. There you have it. The two main reasons PKD is add lemon juice to their routines. Number one, it's a solid source of citrate. Number two, the combination of potassium plus citrate in it. Now know this lemons and lemon juice aren't your only source for citrate. All fruits and vegetables have some citrate in them. Since we are talking about food and diet. High protein diets like bulletproof, meadow, keto, carnivore, or any dietary pattern that has protein in excess will reduce the citrate in your urine. Folks, that's not a good thing. That citrate is sucked back up by your kidneys to help your body deal with balancing its acid and base balance because of the high protein intake. Just one more reason to understand and know what a good protein balance for you and your kidneys is.
Diana, The PKD Dietitian 00:11:19 You can also get potassium and citrate from medications and supplements. Potassium citrate is often prescribed for folks who have had stones for stoners, and it's given an oral tab that they take several times a day for the exact goal. If it is required to make their yarn less acidic and to help prevent stones. The dose of the medication really does depend on that person's actual citrate level in their urine and their goals. Again, we're back to that targeted nutrition. It's not the same thing for every single person. More often than not, I see that my clients have been put on potassium chloride by their nephrologist with the goal to help increase their acidic urine, but also their acid and base balance pretty darn common in the PKD community. How much lemon juice is actually needed to make a difference? Most of what we know about the how much. When it comes to lemon juice is from research around kidney stones. That is really where we have the science, knowhow and research. Studies have shown that drinking half of a cup of lemon juice concentrate in water every day, or more specifically, the juice of two lemons that can increase urine citrate levels and likely reduce kidney stones.
Diana, The PKD Dietitian 00:12:48 That's actually a lot of lemon juice. So when you think about it, a half of a cup is four ounces. Which is really eight tablespoons. So that's eight tablespoons of lemon juice. And yeah you can add that to the fluid that you're drinking and dilute it. So that's typically about two large lemons juiced. Before we get to the potential perks for PCD, I just want to list off what we know and what the science shows around PCD. We know that many PCD ers have low citrate levels in their urine. We know that many PCD years have urine that runs on the more acidic side, so a lower p h. Low citrate levels with PCD are connected to having more urine crystals, and that's connected to faster growing cyst. We also know that low levels of citrate consistently in the urine, plus PKD is associated with faster kidney function decline. Looking at PCD ers. They found low urinary citrate levels even in early stage PCD. Guys that's folks with a GFR greater than 60. Even greater than 90.
Diana, The PKD Dietitian 00:14:10 Kidney function that's considered normal. When they looked at people who had quote unquote normal kidney function, about 50% of them had low citrate levels. This is what we know about PCD. And if you flip it to Percs for PCD, having the citrate and the potassium increases the urinary citrate, but also the urinary pH, or at least it has the potential to. So there's definitely potential perks for PCD. Now I'm not going to break down all these studies, but what I want you to know is that the studies showing this very generalized list, I just told you about our observational, that means that no trials or experiments were done, the human studies, because they were observational and often looked back on information. They don't prove that low citrate levels caused faster function decline with the kidneys. What they do show is there is a connection between the two factors. The big question is, are low citrate levels a cause of the decline or a consequence of the progression? We just don't know. And there studies going on to look at this, looking at animal studies, it tells us a little bit of a different story.
Diana, The PKD Dietitian 00:15:44 Animal studies actually showed that including potassium citrate as a supplement helped to prevent GFR decline. The belief was that it was related to that alkaline izing effect, that neutralising effect, making stuff more basic. We don't have cause and effect, but we do have a connection. I would be amiss if I didn't bring up some of the quote unquote negatives that come with drinking lemon juice or lemon water. There are some possible disadvantage of having it in excess, and some of these come from a dental perspective. So if you're worried about your teeth, yes, it is possible to have too much lemon for some folks. And the American Dental Association says that having too much citrus because it is an acid can weaken tooth enamel, and lemon juice contains citric acid. The lemon juice, like I mentioned earlier, has a pretty low pH, and in the mouth that pH is two, so pretty darn low. That acid. Also, if you have Gerd or reflux, it can trigger it. And folks who have stomach ulcers can get worse if they have consistent intake of acidic foods.
Diana, The PKD Dietitian 00:17:07 Here's what the American Dental Association recommends. They say if you're going to drink lemon water, use a straw to protect your tooth enamel and rinse your mouth out with plain water. And notice these negatives are really associated with consuming acidic drinks frequently and daily. Bringing it all down to your key takeaways. Number one, with PKD, you may have lower citrate levels in your urine. Number two. Chances are your urine runs on the more acidic end. Number three consuming lemon juice may help increase both your citrate levels and your urine pH. Having those both balanced is a good thing, not only to prevent formation of kidney stones, but it is also associated with better PKD kidney health. Number four all fruits and veggies have citrate. Some of course have more than others. And number five, eating more plant forward and less meat forward is an overall pattern that will support better citrate balance. So sipping on lemon water, adding lemon juice to fluid that squeeze over nicely grilled salmon or in a vinaigrette. None of this is going to hurt your kidneys, and it actually could help.
Diana, The PKD Dietitian 00:18:32 Back to Gwen's question. Can she drink lemon juice? Yes, you can, and it is not going to hurt your kidneys. If you really want to explore if lemon juice will benefit you. You can do that. And if you want to explore your opportunities for PKD and have targeted nutrition therapy specific to your needs, your first step is to hop on a PKD connect. Call with me. You will learn more about working together, what that looks like for your goals, and your opportunities to slow the progression and to support PKD health. I will also link out the information to schedule a PKD connect call.
