Today’s stone age: How to eat to prevent kidney stones

Kidney stones are very common: Men have a nearly one in five chance of developing kidney stones over their lifetime, and women have a nearly one in 10 chance. And as part of what is known as the “Kidney Stone Belt,” D.C.-area residents are at even higher risk of developing kidney stones.  

This is a major problem, and it’s one that’s only gotten worse with time. The overall risk for kidney stones in the late 1970s was calculated at 3.8 percent. In the late 2000s, that number had jumped to 8.8 percent. That’s more than a 231 percent increase in the overall risk of kidney stones in just 30 years.

If you have one kidney stone, the chances of developing a second one or more over your lifetime are more than 50 percent. And having kidney stones also can put you at greater risk for long-lasting problems such as kidney failure, recurrent infections, and multiple other conditions.  

Fortunately, making smart dietary choices can prevent kidney stones from developing in the first place. And if you develop a kidney stone, we can determine what’s causing it and lower your risk for developing another one.

A formula for kidney stone protection: Drink enough water

Dehydration is the biggest risk factor for kidney stones that most people face. Our kidneys filter blood to remove waste products. These waste products enter our bloodstream from what we eat and drink. When urine is more concentrated, it’s more likely that the waste products filtered out by the kidneys will form a stone. The darker yellow urine is, the more concentrated it is. Urine should be light yellow or clear if you’re getting enough to drink.  

#Dehydration is the biggest risk factor for #kidneystones that most people face. via @MedStarWHC

Sadly, most of us don’t get enough to drink. Kidney stones tend to be more common in areas of the world with warmer temperatures, where the heat makes it easier to get dehydrated. We call this the “Kidney Stone Belt,” and it includes Maryland, Virginia and Washington, D.C., among other places.  

The simple answer for dehydration is to drink more. Water is best, of course. Citrus fruits like lemon can lower the risk for kidney stones because they contain a compound called citrate. Therefore, adding lemon to water or drinking lemonade also can help.  

Of course, drinking more water is easier for some people than others. I’ve seen patients who come in with kidney stones, and they tell me, “I have no idea what my risk factor is.” Then I find out they don’t drink water all day because they can’t go to the bathroom during the workday.  

Avoid soda and other drinks that are high in sugar when possible. Sugar alters the way the body absorbs minerals and can increase the risk for kidney stones. Sugar also increases the acid levels of urine, which makes stones more likely to form.  

A diet to prevent kidney stones: They are what we eat

It’s not just the amount of fluid in urine that determines a person’s risk of kidney stones. This risk also is based on the amount of waste products the kidneys have to filter from the blood. When there are more of certain types of waste products relative to the amount of fluid in urine, the risk of kidney stones goes up.

One of the reasons our risk for kidney stones has increased so much since the 1970s is because our diets have changed since that time. Two of the main dietary culprits for kidney stones are proteins and salt.


The modern American diet contains a lot more protein than it did in the 1970s, especially animal-based protein. We consume animal-based protein in the form of:

  • Chicken and other poultry
  • Eggs
  • Red meat
  • Seafood

I tell my patients to limit their protein intake to two servings per day. That takes some planning and thought about what you eat. If you know you’re having fish for dinner, and you had sausage with breakfast, avoiding that chicken-salad sandwich for lunch is one way to control your protein.


The salt, or sodium, that we eat plays a huge role in the formation of kidney stones. Since the 1970s, a lot more of the food we eat is processed and packaged, and that means more salt. Plus, people are eating saltier foods and more of them.

For example, just 1 ounce of potato chips can have about seven to 10 percent of the average person’s daily recommended maximum serving of salt. And as the U.S. Department of Agriculture notes, an average single-patty plain cheeseburger at a fast-food restaurant has 469 milligrams of salt—more than 20 percent of the maximum daily serving of 2,300 milligrams per day.  

That would be bad enough if people stuck to the upper limits of salt intake per day. But most people eat much more salt than the recommended maximum amount. As noted by the U.S. Department of Health and Human Services, the average woman consumes 2,980 milligrams of salt per day. And the average man consumes 4,240 milligrams of salt per day—nearly twice the recommended maximum. So people are putting tremendous loads of salt into their systems, and the kidneys have to filter all of that salt out. 

The average man consumes 4,240 mg of #salt per day—nearly twice the recommended maximum. via @MedStarWHC

Everyone can decrease the amount of salt in their diet. Salt is such a prevalent ingredient in food, even when you might not expect it. Most of the salt we eat comes from commercial food processing operations. And it can be found in unexpected places: ketchup, cereal, tomato sauce, bread and canned vegetables have some of the highest salt contents of our everyday food. Pay attention to the nutrition information on packaged foods, and choose low-sodium or no-sodium options when possible.

When you cook, limit the amount of salt you use in your recipes. Fresh herbs, pepper and other ingredients can add flavor to dishes without the need for a lot of salt.  

When to treat kidney stones and reducing future risk

It’s not always possible to avoid kidney stones. Request an appointment with one of our urologists if you notice the following symptoms:

  • Changes in your urine’s color or appearance
  • Nausea or vomiting that doesn’t go away
  • Sharp pain in the side or mid-back

Related reading: Kidney stone diagnosis and treatment

When I see patients for kidney stones, I use imaging studies to get a look at where the stone is and how big it is. Not every stone needs surgery. If you have a small stone, it’s probably one we can keep a close watch on with regular visits to make sure it passes on its own. If it’s a large stone that’s blocking the ureter (the tube that lets urine pass from the kidney to the bladder), it probably needs to be treated. Without treatment, those kinds of stones can lead to permanent kidney damage if they don’t pass on their own.  

For some doctors, treatment stops as soon as the stone is gone. But that’s not how we should treat patients with kidney stones. As we know, more than half of the patients who develop a stone will have another stone in their lifetime. Therefore, as with any other chronic disease, we work to figure out why the patient has the problem and what we can do to fix it, and that’s how I treat kidney stones.  

The process starts with a basic blood draw, called a BMP, which stands for basic metabolic panel. This shows us the basic chemistry of your blood, including levels of sodium, potassium, calcium and other substances.  

Then we do a 24-hour urine collection, which involves taking all of the urine a patient produces for 24 hours and sending it to a lab for analysis. We look for the same factors in the patient’s urine as we do in the blood and compare the levels. If a patient has low levels of citrate in their urine, we know to increase the patient’s citrate levels. Chances are, that’s going to help you not make more kidney stones in the future. This is a personalized process based on each patient’s unique factors.

Kidney stones may be little, but they’re a big problem for our country. Making smart choices about what goes into your body can reduce your risk for the pain and consequences of kidney diseases down the road. 

Exercise Can Lower Your Risk of Colorectal Cancer

Getting active to stay healthy

Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. But how much exercise do you need?  Fortunately, even a little exercise every week can help lower your risk.

“I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough,” says Dr. James FitzGerald, a colon and rectal surgeon at MedStar Washington Hospital Center.  “You don’t have to live at the gym or train for marathons. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill.”

Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include: aerobics, biking, climbing stairs or using a stair climber, dancing, playing basketball, swimming and yoga.  Just be sure to consult with your doctor prior to starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery.

But what about if you have never exercised before?  For older adults, making that sort of lifestyle change isn’t always easy.

“It can be intimidating to walk into the local gym and get started on a fitness plan, but I encourage my patients to do what they can,” says Dr. FitzGerald. “Even little changes in their activities or walking just a little bit can benefit them in the long term.”

Other steps you can take in addition to exercise

And exercise isn’t the only thing you can do to lower your risk for colorectal cancer.  Certain lifestyle and dietary modifications can also help.

“You should try to eat a low-glycemic-index diet with more fruits, vegetables and whole grains, and don’t eat as many red and processed meats like beef, pork, hot dogs and bologna,” says Dr. FitzGerald.  “Try to quit smoking and avoid excess alcohol usage as well.”

As colorectal cancer tends to affect people in older age groups, it is also recommended that people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer.  As always, be sure to consult with your doctor, as your needs might be different.

Our specialists are experts in the diagnosis and treatment of colon and rectal cancer. Ready to schedule an appointment? Call us at



Dr. James FitzGerald, MD
MedStar Washington Hospital Center



For an appointment, call 202-877-3627.


Testing Options for High-Risk Pregnancies

For pregnant women over the age of 35, extra monitoring and screening may be recommended to detect for chromosomal abnormalities in their pregnancies.  

In order to determine if there are extra or missing chromosomes, there are several testing options.

First, women can do a blood test. The one most recommended is called non-invasive prenatal testing. It is 99% accurate in screening for the most common chromosomal abnormalities.

A diagnostic option is called an amniocentesis. Through an amniocentesis, we can culture your baby’s cells to search for missing or additional chromosomal information. Finally, another test called a microarray looks even more in depth.

These screenings can be valuable, but also confusing at times.   Dr. Rachael Overcash, a maternal-fetal medicine specialist at MedStar Washington Hospital Center, has a unique explanation for how these tests search fetal DNA, looking for the missing chromosomes.

“I like to explain the testing options to my patients using the analogy of a set of encyclopedias, with 23 volumes representing the 23 pairs of chromosomes. The amniocentesis examines the set of encyclopedias for missing volumes or entire books. The microarray looks deep into the pages and can find missing or additional sections or paragraphs. And in the future, testing may be so advanced that we will be able to see if a single word or letter is missing.”

Ask your doctor or a maternal-fetal medicine specialist which screening options are best for you and your family.

Our specialists are experts in the care of high-risk pregnancies. For an appointment, call us at


As heard on WTOP Radio:

Rachael Overcash, MD

Rachael Overcash, MD
MedStar Washington Hospital Center

For an appointment, call 202-877-3627.


Gestational Diabetes


It is estimated that up to 10 percent of women with gestational diabetes are diagnosed with type 2 diabetes soon after delivery. Over 10 years, the risk can increase up to 50 percent.  But the risks can be mitigated if preventative screenings are scheduled. Yet, too many women are skipping the required postpartum glucose tolerance test, usually given to women six to 12 weeks after they’ve delivered. Recent studies show that up to 50 percent of patients do not show up for this important test.  The low compliance is likely because too many women are overwhelmed after bringing home a newborn baby and simply forget.

 Dr. Sara Iqbal, a high-risk obstetrician at MedStar Washington Hospital Center says, “Educating the patient and providing test reminders is essential in order to improve the rate of testing postpartum."

Type 2 diabetes can be prevented by simple, easily applicable lifestyle modifications. Dr. Iqbal advises patients to:

  • Exercise
  • Choose healthy food portions and monitor caloric intake
  • Avoid gaining too much weight, as obesity is a major risk factor for type 2 diabetes
  • Follow up for the postpartum glucose tolerance test
  • Have your blood sugar levels tested every one to three years, depending on the glucose tolerance test results



Our specialists are focused on the health of you and your baby. Call us today to schedule an appointment at


As heard on WTOP Radio:

Sara N. Iqbal, MD

Sara N. Iqbal, MD
MedStar Washington Hospital Center

For an appointment with a high-risk pregnancy specialist, call 202-877-3627.


New Vein Treatment Option

There is a new treatment option for those who suffer from vein problems: the VenaSeal™ Closure System.

How it works:

  1. A small amount of a medical bonding agent is injected to seal off the diseased veins
  2. Blood reroutes itself around the sealed-off area, through your healthy veins, restoring normal flow
  3. Symptoms often improve immediately
  4. The bonding agent is naturally absorbed by your body over time


  • Symptoms often improve as soon as the diseased vein is closed
  • Recovery time is quick and many patients return to normal activity right after the procedure
  • Minimal pain during and after the procedure as compared to radiofrequency or laser ablation, due to avoidance of multiple needle sticks
  • Minimal post-procedure bruising as compared to radiofrequency or laser ablation, due to avoidance of a large amount of numbing medication
  • Compression hosiery is not required pre- or post-procedure
  • Minimal chance of nerve damage as compared to other current ablation methods, due to the avoidance of thermal heat

MedStar Heart & Vascular Institute is the first in Washington, DC, and Maryland to offer this new therapy.

For more information, or to schedule an appointment, call


As heard on WTOP Radio:

Misaki Kiguchi, MD

Misaki Kiguchi, MD
MedStar Heart & Vascular Institute

Misaki Kiguchi, MD, is a board-certified vascular specialist with special interest and experience in treating vein disorders. A graduate of Yale University School of Medicine, the University of Pittsburgh Medical Center and its Magee-Womens Hospital, Dr. Kiguchi has extensive training in the complete spectrum of arterial and venous diseases. Dr. Kiguchi specializes in vein disorders, using the most advanced and effective treatments and therapies.

Misaki Kiguchi, MD

To discuss your unique condition and possible risks,
call 202-877-3627 to schedule a consult with Dr. Kiguchi at her Chevy Chase office.


Blue Light Cystoscopy

Blue Light Cystoscopy: A Better Way to Detect Bladder Cancer

Bladder cancer is the fifth most commonly diagnosed cancer in the United States with a high rate of recurrence. Unfortunately, up to 30% of bladder tumors are overlooked, because they are often too small to see with the standard testing method called cystoscopy.

Fortunately, a new, FDA-approved method now available at MedStar Washington Hospital Center is helping doctors identify bladder tumors earlier thanks to better imaging. The technology is called Blue Light Cystoscopy with Cysview®.

During this test, the patient is given a solution that is absorbed by the cancerous tissue. This causes it to appear fluorescent when exposed to “blue light,” which is created by a special camera and lens. This allows urologists to detect more of the cancer, remove it, and provide treatment to keep it from coming back.





For more information, or to schedule an appointment, call


As heard on WTOP Radio:

Lambros Stamatakis MD

Lambros Stamatakis MD
Director, Urologic Oncology
MedStar Washington Hospital Center

Lambros Stamatakis, MD

To schedule an appointment with Dr. Stamatakis, call 202-877-3627


New Protection Against Pneumonia

New guidelines from the Centers for Disease Control and Prevention recommend that adults 65 years and older receive two vaccines to protect against pneumococcal disease, up from the previous recommendation of only one.

Pneumococcal infections may range from sinus infections to pneumonia, which is one of the leading killers of older adults in the United States.

Historically, adults over 65 without certain health complications were instructed to receive the pneumococcal polysaccharide vaccine (PPSV23) after turning 65. Now, they are encouraged to also get the pneumococcal conjugate vaccine (PCV13). These two vaccines work in different ways to expand protection against pneumococcal infection.

Healthy adults older than 65 who have never been vaccinated should first get the PCV13, then the PPSV23 one year later. For those that have previously been vaccinated with PPSV23, the PCV13 is recommended at least one year after the last PPSV23. Adults with certain health conditions may require a different vaccination schedule.

Dr. Wortmann recommends asking your primary care doctor if this vaccination should be added to your immunizations.

For more information, or to schedule an appointment, call


As heard on WTOP Radio:

Glenn Wortmann

Glenn Wortmann, MD
Director, Infectious Diseases
MedStar Washington Hospital Center

To schedule an appointment with Dr. Wortmann, or to get a referral for a primary care doctor, call 202-877-3627.


Treatment for Fibroids

Minimally Invasive Treatment for Fibroids

Jim Robinson, MD, says the most common problem that sends women to their gynecologists is abnormal uterine bleeding. And one of the most common structural reasons for abnormal bleeding is the presence of fibroids. More than 50 percent of all women, and 80 percent of African-American women, have them.

But this doesn’t mean you should be overly concerned. Dr. Robinson says that fibroids can be taken care of – usually in a minimally invasive way.

Procedures are usually done on an outpatient basis, using small incisions and precise targeting – which means less pain and a quicker recovery than traditional, open surgery. If you haven’t completed your family, fibroids can be removed through keyhole incisions. If a hysterectomy is the route that you and your doctor choose, Dr. Robinson says that “it isn’t your mother’s hysterectomy – you won’t automatically go into menopause.” Whenever possible, the ovaries are preserved; they create testosterone, which is important for healthy aging. The surgery can be performed through a small incision and is now often an outpatient procedure.

The goal is to get women back to living their lives in the least disruptive way possible. “It’s important to get you back to the rhythm of your life a bit faster,” Dr. Robinson adds. “That’s something I’m pretty passionate about.”

For more information, or to schedule an appointment, call


As heard on WTOP Radio:

James Robinson, MD, MS, FACOG

James Robinson, MD, MS, FACOG
Director, Minimally Invasive Gynecologic Surgery
MedStar Washington Hospital Center

To make an appointment, call 202-877-3627


Preventing Colon Cancer

Preventing Colon Cancer

Colon cancer is one of the very few preventable cancers. However, it typically has no symptoms in its early stages, making it critical to take advantage of available screenings, namely colonoscopy.

Men and women of average risk should have regular screenings beginning at age 50. However, your doctor may recommend more frequent or earlier screenings if you have other risk factors, such as a family history of colon cancer.

Common symptoms of colon cancer may include:

  • Change in bowel habits, including diarrhea or constipation
  • Change in consistency of stool
  • Rectal bleeding or blood in stool
  • Persistent gas, abdominal pain or cramps
  • Feeling that your bowel does not empty completely
  • Weakness or fatigue
  • Unexplained weight loss

Many people avoid the screening due to the inconvenience or perceived discomfort. But following this recommendation could very well save your life – twenty percent of those screened show a polyp or other growth. Caught early, it can be identified and removed before it becomes cancer.

For more information, or to schedule an appointment, call


As heard on WTOP Radio:

Jennifer Ayscue, MD

Jennifer Ayscue, MD
Colorectal Surgeon

To make a screening appointment, call 202-877-3627


Spontaneous Coronary Artery Dissection (SCAD)

SCAD—A Silent Killer of Healthy Young People

What is Spontaneous Coronary Artery Dissection (SCAD)?

Artery walls have three layers. When a tear or dissection occurs blood is able to flow through the inner most layer and become trapped and bulge inward. This narrowing of the artery or blockage can cause a heart attack because blood cannot flow to the heart muscle.

Spontaneous Coronary Artery Dissection or SCAD is an uncommon medical event because it occurs spontaneously in otherwise healthy younger people without prior symptoms.

Who is at risk for SCAD?

SCAD usually occurs in people who do not have the well known cardiovascular risk factors such as high cholesterol, atherosclerosis, high blood pressure and diabetes.

The average age of a SCAD patient is 42 years old, but it can occur in people in their twenties. SCAD is more than twice as common in women as men. SCAD may result from blood vessel changes, hormonal and other changes associated with pregnancy or menopause. Extreme exertion appears to play a role in both men and women.

What are the signs and symptoms of SCAD?

The signs and symptoms vary widely with some people reporting the classic heart attack symptoms of an “elephant sitting on my chest” to just mild discomfort. Many women still think that heart disease affects only men, but more than half of the 500,000 Americans who die each year of a heart attack are women. Women’s heart attack symptoms can be more subtle than men’s; so many women brush them off as insignificant because they don’t see themselves at risk. Women are more likely to experience the following:

  • Chest discomfort or fullness
  • Blackouts or fainting
  • Shortness of breath during activities or upon waking up
  • Chronic fatigue that interrupts routine activities
  • Dizziness
  • Swelling (especially the lower legs and ankles)
  • Rapid heartbeats that may cause pain or difficulty breathing
  • Nausea or vomiting that’s unrelated to diet, indigestion or abdominal pain
  • Sweating
  • Impending feeling of doom

If you experience any of these symptoms frequently (about once a day), don’t wait, call 911 immediately. Minutes count during a heart attack. Time is muscle. These symptoms are serious and should not be ignored.

How is SCAD diagnosed and treated?

Cardiac angiography or cardiac catheterization is the primary means of diagnosing SCAD. While this diagnostic test can identify the narrowing or blockage of the artery, it does not allow visualization of the vessel walls. Other imaging modalities such as intravascular ultrasound, optical coherence tomography and CT angiography may be ordered to assist your physicians in making the definitive diagnosis.

Treatment options vary by the type and severity of the SCAD event. Some patients respond favorably to conservative treatment using medication only. Certain drugs such aspirin, Coumadin, nitroglycerin, beta blockers and ACE inhibitors will be likely be given and some drugs may be prescribed for life. Some patients may undergo cardiac angioplasty and receive a stent or coronary artery bypass surgery.

For more information, or to schedule an appointment, call


As heard on WTOP Radio:

Susan K. Bennett, MD

Pictured: Susan K. Bennett, MD,
Cardiovascular Disease

To find a cardiac specialist, please call 202-877-3627