DASH Diet for Kidney Stones

Overseen By Joseph Crivelli, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Alabama at Birmingham

Must not be taking: Acetazolamide, Topiramate, Zonisamide

Disqualifiers: Dialysis, Kidney transplant, eGFR <60, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 1 week

48 Participants Needed

Trial Summary

What is the purpose of this trial?

The true capacity for a healthy diet to improve urinary stone risk factors is not well-defined. The objective of this study is to measure the effect of adopting a healthy dietary pattern on kidney stone disease (KSD) risk. The working hypothesis is that a Dietary Approaches to Stop Hypertension (DASH)-style diet will improve 24-hour urine stone risk parameters. The approach to testing this hypothesis will be to randomize participants with KSD to a standardized DASH-style vs. Western-style diet for one week. The Bionutrition Unit of the Center for Clinical and Translational Science will provide all meals to participants. The rationale for this study is that by measuring the effect of a DASH-style diet on urinary stone risk parameters, a benchmark for future real-world, implementation studies will be established. Based on available evidence, this will be the first controlled diet study to assess the DASH dietary pattern for improving urinary stone risk parameters.

Will I have to stop taking my current medications?

The trial requires participants to stop taking multivitamins and dietary supplements, including calcium and vitamin C, for 7 days before and during the study. Other medications are not specifically mentioned, so it's best to discuss with the trial coordinators.

What data supports the effectiveness of the DASH-Style Diet treatment for kidney stones?

Research shows that following a DASH-style diet, which is rich in fruits, vegetables, nuts, and low-fat dairy, and low in sodium and red meats, is linked to a significantly lower risk of developing kidney stones. This diet was associated with a 40-45% reduced risk of kidney stones in both men and women over several years of study. ^{1 2 3 4 5}

Is the DASH diet safe for humans?

The DASH diet, which includes lots of fruits, vegetables, nuts, low-fat dairy, and whole grains, is generally considered safe for humans. It has been associated with a reduced risk of kidney stones and chronic kidney disease, suggesting it is beneficial for kidney health. ^{1 3 4 6 7}

How does the DASH-style diet treatment differ from other treatments for kidney stones?

The DASH-style diet is unique because it focuses on high intake of fruits, vegetables, nuts, legumes, low-fat dairy, and whole grains, while reducing sodium, sweetened beverages, and red and processed meats. This dietary approach is associated with a significant reduction in the risk of kidney stones, unlike other treatments that may not address dietary patterns. ^{1 3 4 8 9}

Eligibility Criteria

This trial is for individuals with Kidney Stone Disease (KSD) who are interested in seeing if diet changes can affect their condition. Participants will be provided all meals and must follow either a DASH-style or Western-style diet strictly for one week.

Inclusion Criteria

Willing to consume meals prepared by Bionutrition Unit

I have had kidney stones before.

Willing to stop dietary supplements including calcium and vitamin C for 14 days before and during study

Exclusion Criteria

I have nephrotic syndrome.

Urinary diversion

I have an overactive thyroid.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants are randomized to a DASH-style or Western-style diet for one week

1 week

Daily visits for meal provision

Follow-up

Participants are monitored for changes in urinary stone risk factors after the dietary intervention

1 week

Treatment Details

Interventions

• DASH-Style Diet
• Western-Style Diet

Trial Overview The study aims to compare the effects of a healthy DASH-style diet versus a typical Western-style diet on factors in the urine that contribute to kidney stones. Participants will be randomly assigned to one of these diets, which they'll eat exclusively for the duration of the trial.

Participant Groups

Group I: Western-Style Diet Experimental Treatment 1 Intervention

For seven days, participants will consume a diet characterized by characterized by higher intake of red meat, sweets, and items containing added sugar, processed starches, and seed oils, in addition to lower intake of fruits, vegetables, and low-fat dairy.

Group II: DASH-Style Diet Experimental Treatment 1 Intervention

For seven days, participants will consume a diet characterized by higher intake of fruits, vegetables, and low-fat dairy, in addition to whole grains, poultry, fish, and nuts, but smaller amounts of red meat, sweets, and sugar-containing beverages.

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Findings from Research

A DASH-style diet, which emphasizes fruits, vegetables, and low-fat dairy while reducing sodium and processed foods, is linked to a significant reduction in the risk of developing kidney stones, as shown in a study involving over 240,000 participants across three large health studies over up to 18 years.

Men and women with the highest DASH scores had relative risks of kidney stones that were 45-40% lower compared to those with the lowest scores, indicating that this diet may be particularly effective in preventing kidney stone formation, regardless of calcium intake.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

DASH-style diet associates with reduced risk for kidney stones. Taylor, EN., Fung, TT., Curhan, GC.[2022]

High protein intake is a significant factor contributing to the rise of kidney stones (nephrolithiasis) in developed countries, as it may increase urinary calcium excretion in susceptible individuals.

Dietary modifications, including increased fluid intake, can help reduce the risk of recurrent kidney stones by lowering urinary calcium and oxalate levels while increasing urinary citrate, suggesting that lifestyle changes may be more beneficial than long-term medication use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of diet in the pathogenesis and therapy of nephrolithiasis. Goldfarb, S.[2013]

A DASH-style diet, which emphasizes fruits, vegetables, and low intake of processed foods, is associated with increased urinary citrate and volume, potentially reducing the risk of kidney stones in a study of 3426 participants.

Higher DASH scores correlated with lower relative supersaturations of calcium oxalate and uric acid, suggesting that components of the diet may contain unidentified stone inhibitors, particularly from dairy and plant sources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

DASH-style diet and 24-hour urine composition. Taylor, EN., Stampfer, MJ., Mount, DB., et al.[2022]

In a study of 264 men with kidney stone issues, high adherence to the DASH diet was linked to significantly lower odds of urinary factors that contribute to kidney stone formation, such as hypercreatininuria, hypocitraturia, and hypercalciuria.

The research suggests that following the DASH diet can be an effective preventive strategy against kidney stones, as most components of the diet were associated with reduced urinary lithogenic factors, except for nuts, legumes, and sodium.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The association of Dietary Approaches to Stop Hypertension-style diet with urinary risk factors of kidney stones formation in men with nephrolithiasis. Maddahi, N., Aghamir, SMK., Moddaresi, SS., et al.[2021]

A normal-calcium, low-animal protein, low-salt diet significantly reduced oxalate excretion in patients with idiopathic calcium oxalate nephrolithiasis, decreasing mean oxaluria from 50.2 to 35.5 mg/d over 3 months.

In comparison, a traditional low-oxalate diet only reduced oxaluria from 45.9 to 40.2 mg/d, indicating that the new diet may be more effective in managing hyperoxaluria.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet to reduce mild hyperoxaluria in patients with idiopathic calcium oxalate stone formation: a pilot study. Nouvenne, A., Meschi, T., Guerra, A., et al.[2022]

A systematic review and meta-analysis of 6 studies involving over 568,000 individuals found a significant inverse relationship between adherence to the DASH-style diet and the risk of chronic kidney disease (CKD), suggesting that following this diet may help prevent CKD.

The DASH diet was also associated with a reduced risk of rapid decline in kidney function and microalbuminuria, indicating its potential benefits for maintaining kidney health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adherence to the dietary approaches to stop hypertension-style diet is inversely associated with chronic kidney disease: a systematic review and meta-analysis of prospective cohort studies. Taghavi, M., Sadeghi, A., Maleki, V., et al.[2020]

In a study involving 192,126 participants over 3,259,313 person-years, five modifiable risk factors (body mass index, fluid intake, DASH diet, dietary calcium intake, and sugar-sweetened beverage intake) were found to account for over 50% of kidney stone incidents, highlighting their significant role in prevention.

The most impactful risk factor was lower fluid intake, which had a population attributable fraction of 26.0%, suggesting that increasing fluid consumption could substantially reduce the occurrence of kidney stones in the general population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dietary and Lifestyle Risk Factors Associated with Incident Kidney Stones in Men and Women. Ferraro, PM., Taylor, EN., Gambaro, G., et al.[2019]

The study of 222 stone formers (SF) and 136 non-stone formers (controls) revealed that SF had significantly higher sodium and protein intake compared to controls, indicating dietary patterns that may contribute to stone formation.

Despite consuming more vegetables and legumes, SF did not follow a DASH-style diet, as their overall dietary profile was characterized by low calcium and high salt and protein, which are not ideal for preventing kidney stones.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dietary pattern analysis among stone formers: resemblance to a DASH-style diet. Rodrigues, FG., Lima, TM., Zambrano, L., et al.[2021]

In a study of 44,444 men over 26 years, a higher DASH diet score was linked to a 32% lower risk of developing gout, indicating its potential effectiveness in preventing this condition.

Conversely, a higher Western diet score was associated with a 42% increased risk of gout, highlighting the negative impact of this dietary pattern on uric acid levels and gout risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. Rai, SK., Fung, TT., Lu, N., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

DASH-style diet associates with reduced risk for kidney stones. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

The role of diet in the pathogenesis and therapy of nephrolithiasis. [2013]

3. United States pubmed.ncbi.nlm.nih.gov

DASH-style diet and 24-hour urine composition. [2022]

4. England pubmed.ncbi.nlm.nih.gov

The association of Dietary Approaches to Stop Hypertension-style diet with urinary risk factors of kidney stones formation in men with nephrolithiasis. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Diet to reduce mild hyperoxaluria in patients with idiopathic calcium oxalate stone formation: a pilot study. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Adherence to the dietary approaches to stop hypertension-style diet is inversely associated with chronic kidney disease: a systematic review and meta-analysis of prospective cohort studies. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Dietary and Lifestyle Risk Factors Associated with Incident Kidney Stones in Men and Women. [2019]

8. Brazil pubmed.ncbi.nlm.nih.gov

Dietary pattern analysis among stone formers: resemblance to a DASH-style diet. [2021]

9. England pubmed.ncbi.nlm.nih.gov

The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. [2020]