What diet should be followed to prevent kidney stones while taking Zolpidem (ZON)?

From the Guidelines

To avoid kidney stones while taking Zonisamide (ZON), it is crucial to follow a diet that prioritizes calcium-rich foods, limits sodium and animal protein, and stays hydrated with at least 2-3 liters of water daily. The most recent and highest quality study suggests that a higher calcium diet is associated with a reduced risk of stone formation, as it binds dietary oxalate in the gut, thereby reducing oxalate absorption and urinary excretion 1. Key dietary recommendations include:

• Limiting sodium intake to less than 2.4 g/day, as high sodium increases calcium excretion in urine 1
• Moderating animal protein consumption to 5-7 servings of meat, fish, or poultry per week, as these foods increase uric acid levels and reduce urinary citrate excretion 1
• Including calcium-rich foods like dairy products in meals, rather than taking supplements, to bind oxalate in the intestines and reduce urinary oxalate excretion 1
• Reducing oxalate-rich foods such as spinach, rhubarb, beets, chocolate, nuts, and tea, to minimize oxalate absorption and urinary excretion 1
• Increasing citrate intake through lemons, limes, and oranges, which helps inhibit stone formation by increasing urinary citrate excretion 1
• Avoiding excessive vitamin C supplements (over 1,000 mg daily) as they can convert to oxalate and increase urinary oxalate excretion 1. Regular monitoring of urine pH with a healthcare provider is also recommended, especially since Zonisamide can increase the risk of kidney stones by promoting metabolic acidosis and reducing citrate levels in urine.

From the Research

Dietary Recommendations for Kidney Stone Prevention

To prevent kidney stones, especially when on a specific diet or medication like ZON, it's essential to understand the composition of the stones and how diet affects their formation. The following dietary recommendations are based on the type of kidney stone:

• Calcium Oxalate Stones: Reduce ingestion of animal protein, oxalate, and sodium while maintaining an intake of 800 to 1200 mg of calcium 2. Increase consumption of citrate and potassium.
• Calcium Phosphate Stones: Reduction of sodium intake to decrease urinary calcium excretion is recommended 2. However, the effect of potassium citrate on calcium phosphate stone formation is complex and may not be beneficial 3.
• Uric Acid Stones: Weight loss and urinary alkalinization provided by a more vegetarian diet are recommended 2. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion.
• Cystine Stones: Restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine 2. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones.

General Dietary Measures

Regardless of the type of stone, the following general measures are recommended:

• Increase fluid intake to achieve a daily urine output of 2 liters 4
• Moderate dietary salt restriction to limit urinary calcium excretion 4
• A low-normal protein intake to decrease calciuria and preserve bone mass 4
• Adequate calcium intake (≥ 1 g/day) to prevent stone formation and maintain skeletal wellness 4, 5
• A diet rich in fruits and vegetables, excluding those with high oxalate content, to increase citrate excretion and protect against stone formation 4

Specific Considerations

For specific populations, such as children, elderly, or those with certain medical conditions, additional considerations should be taken into account:

• Children: Moderate dietary salt restriction, implementation of potassium intake, and a balanced consumption of fruit and vegetables are recommended 4
• Elderly: A restriction of sodium intake, higher intake of potassium, magnesium, and citrate, and a diet rich in calcium (1200 mg/day) are advisable 4