Sweet tea is a staple of George Westmoreland’s diet, and over the course of a day, he downs four 16-ounce bottles.
At restaurants, he drinks a few glasses of the traditional Southern beverage with meals, taking advantage of the free refills.
“I sip on them throughout the day,” the 51-year-old Easley man said. “It’s like an addiction.”
Then one day last month, he felt some pressure in his abdomen and had trouble emptying his bladder. He thought maybe he had a kidney infection.
But after a few tests, the label salesman was told he had a kidney stone 7 millimeters in diameter, or roughly a quarter of an inch.
Bad enough to have a kidney stone. But then he learned that his favorite drink may have been to blame.
“He (the doctor) said that sweet tea could be the cause of my kidney stone,” Westmoreland said. “I never heard that tea itself was an inducer of kidney stones.”
But sweet tea and other Southern favorites can in fact lead to the development of stones, said Dr. David Rice, a urologist with Palmetto Greenville Urology, a part of Bon Secours Medical Group.
And here in the “Stone Belt” — a swath of the country that spans the South — the incidence is even higher, particularly now as summer heats up, he said.
“It’s kind of a joke how in the Southeast a lot of people drink iced tea and in Southwest they drink brewed sun tea,” Rice told GreenvilleOnline.com. “And tea has high concentrations of a chemical called oxylate, which is one of the main components of kidney stones.”
Simple or complex
One in 11 Americans has had a kidney stone, according to the National Institutes of Health. And every year these painful crystalline creations send more than 300,000 people to the ER and more than 1 million others to the doctor.
Kidney stones can form when substances in the urine — calcium, uric acid, struvite and cystine — get too concentrated, NIH reports. They can range in size from “a grain of sand to a pearl,” with some “as big as golf balls,” and cause excruciating pain or no symptoms at all.
“Stones can be pretty simple or pretty complex,” Rice said. “Some stones are smooth and some jagged. The more jagged they are, the more likely they are to get hung up. And most stones get hung up at the bladder.”
Symptoms of kidney stones include pain while urinating, blood in the urine, and sharp pain in the back or lower abdomen, sometimes with nausea and vomiting, according to NIH.
“You can get sick as a dog,” Rice said, “almost on the verge of death.”
The condition afflicts men more than women, and whites more than minorities, Rice said. People with a family history of stones are also more likely to get them, as are obese people and those with diabetes and certain metabolic conditions, he said.
But the most common reason to get a kidney stone is dehydration, which leads to concentrated urine production, Rice said.
“It’s like if you left glass of salt water out in the sun, and the water evaporates, all you’re left with is the salt,” he explains.
Diet also plays a role. And sweet tea tops the list.
“When you’re out at a restaurant, you can have four or five glasses,” Rice said. “You never know how many glasses you had.”
Some 90 percent of stones are calcium oxylate, he said. Walnuts, almonds and other nuts also contain a lot of oxylate, along with chocolate and dried fruits, he said.
The Southern fried diet is also high in oxlyate — fried okra, rhubarb, poke salad, turnip greens, Rice said.
Another culprit is beer.
“You’re on the beach, in the hot sun, drinking beer and your urine gets concentrated,” Rice said. “You can end up with beer stones.”
While most kidney stones are made of calcium oxylate and calcium phosphate, according to NIH, others are made of uric acid from diets rich in meat, fish and shellfish.
Other causes include renal disease, intestinal and genetic conditions, chronic kidney infections, and a parathyroid disorder that predisposes sufferers to high calcium levels, Rice said.
Some drugs can also lead to stones, including diuretics, calcium antacids, and anti-seizure medicines, NIH reports.
The best way to prevent stones is to drink a lot of fluids, Rice said. Water is best, but citrus drinks can inhibit stone formation, he said.
Once they do form, some stones can be dissolved with medication, he said. In other cases, drugs can be used to relax the body so the stones can pass on their own.
If those treatments aren’t options — and stones larger than 5 millimeters typically require another approach, Rice said — doctors can employ other treatments.
One is called ureteroscopy. It uses a fine scope threaded through the urethra to break up stones with a laser, like a “mini-jackhammer,” so they are small enough to pass on their own, Rice said. The stones can also be retrieved and removed with this method, the NIH reports.
Another treatment is lithotripsy, which can be used on about half of all patients. With a machine called a lithotripter, shock waves are used to break up the stones into tiny pieces so they can then pass on their own.
“It’s an amazing device,” Rice said. “It’s like a sonic boom kind of energy.”
Both procedures are performed while the patient is under anesthesia.
Some stones must be surgically removed, though.
Ann Singer developed a 14-millimeter stone in what remained of her left kidney after nearly half of the organ was removed due to cancer.
“It was awful,” said the 42-year-old Easley woman. “It was constant pressure in the back.”
The surgery was tough because of scar tissue from her earlier operation, she says. And she wound up hospitalized for about a week.
Though she recovered, some small fragments remain in the kidney that she hopes can be blasted with lithotripsy should they become too large and painful.
Westmoreland, whose stone was lodged at the point where the kidney and ureter meet, had lithotripsy about a month ago.
“They blasted a good bit and I had no problems, except my right thigh and calf felt like I had run a marathon,” he said. “Eventually, I passed the stone. It was a couple millimeters.”
Westmoreland, who also owns a professional network connection company, was back at work the next day.
When a new X-ray revealed that he still had a stone caught in the ureter, he underwent another lithotripsy last week.
Rice said the best advice he can give is to stay well hydrated, particularly in the summer, eat a low-salt diet, consume everything else in moderation, and don’t drink too much tea.
Westmoreland said he started drinking more water recently, but that since he didn’t have a lot of pain with his first stone, he’s unlikely to stop drinking tea.
“I am a tea addict,” he said. “I guess it would take some pain to give it up.”