Coconut Water: An Unexpected Source of Urinary Citrate

Roshan M Patel, Pengbo Jiang, John Asplin, Ignacio Granja, Taylor Capretz, Kathryn Osann, Zhamshid Okhunov, Jaime Landman, Ralph V Clayman, Roshan M Patel, Pengbo Jiang, John Asplin, Ignacio Granja, Taylor Capretz, Kathryn Osann, Zhamshid Okhunov, Jaime Landman, Ralph V Clayman

Abstract

Purpose: Coconut water has long been touted for its medicinal qualities including natural hydration. We sought to determine whether its consumption would induce changes to urinary lithogenic factors beyond changes in urine volume.

Materials and methods: After Institutional Review Board approval, volunteers with no prior history of nephrolithiasis were recruited. Each participant was randomized initially to either the coconut water or the water phase of the study. Participants kept meticulous food and fluid intake logs during the first phase of the study and were asked to replicate that diet for the second phase. For each phase the participant consumed 2L of either Taste of Nirvana® pure coconut water or tap water daily for four days. Participants were not restricted to consume additional fluid of their choice during their assigned study phase. During days 3 and 4 of each phase the participant collected a 24-hour urine specimen. Coconut water citrate and malate content were measured and were used along with the beverage pH to calculate the total alkali content of the coconut water. Supersaturation levels were calculated using Equil2. Nonparametric paired analysis using the Wilcoxon test was performed for statistical analysis.

Results: There were 4 adult male and 4 adult female participants. Each individual's 24-hour urine collection had a creatinine excretion within 20% of the mean for each subject's four samples corroborating that all samples were collected properly. The two samples from each phase for each individual were averaged. The coconut water itself was also analyzed and it was calculated to have a total alkali content of 13.8 mEq/L. Consumption of coconut water significantly increased urinary citrate (29%, p=0.02), urinary potassium (130%, p=0.01), and urinary chloride (37%, p=0.03), without affecting urine pH (p=0.16) or volume beyond that of tap water (p=1.00).

Conclusions: Coconut water consumption increases urinary potassium, chloride, and citrate in nonstone forming individuals.

References

    1. Scales C. D., Jr., Smith A. C., Hanley J. M., et al. Prevalence of kidney stones in the United States. European Urology. 2012;62:p. 160.
    1. Coe F. L., Worcester E. M., Evan A. P. Idiopathic hypercalciuria and formation of calcium renal stones. Nature Reviews Nephrology. 2016;12(9):519–533. doi: 10.1038/nrneph.2016.101.
    1. Tracy C. R., Pearle M. S. Update on the medical management of stone disease. Current Opinion in Urology. 2009;19(2):200–204. doi: 10.1097/MOU.0b013e328323a81d.
    1. Parks J. H., Asplin J. R., Coe F. L. Patient adherence to long-term medical treatment of kidney stones. The Journal of Urology. 2001;166(6):2057–2060. doi: 10.1016/S0022-5347(05)65505-X.
    1. Lima E. B. C., Sousa C. N. S., Meneses L. N., et al. Cocos nucifera (L.) (Arecaceae): a phytochemical and pharmacological review. Brazilian Journal of Medical and Biological Research. 2015;48(11):953–964. doi: 10.1590/1414-431x20154773.
    1. Yong J. W. H., Ge L., Ng Y. F., Tan S. N. The chemical composition and biological properties of coconut (Cocos Nucifera L.) water. Molecules. 2009;14(12):5144–5164. doi: 10.3390/molecules14125144.
    1. Saat M., Singh R., Sirisinghe R. G., Nawawi M. Rehydration after Exercise with Fresh Young Coconut Water, Carbohydrate-Electrolyte Beverage and Plain Water. Journal of Physiological Anthropology and Applied Human Science. 2002;21(2):93–104. doi: 10.2114/jpa.21.93.
    1. Gandhi M., Aggarwal M., Puri S., Singla S. K. Prophylactic effect of coconut water (Cocos nucifera L.) on ethylene glycol induced nephrocalcinosis in male wistar rat. International Brazilian Journal of Urology. 2013;39(1):108–117. doi: 10.1590/S1677-5538.IBJU.2013.01.14.
    1. Hamm L. L., Hering-Smith K. S. Pathophysiology of hypocitraturic nephrolithiasis. Endocrinology and Metabolism Clinics of North America. 2002;31(4):885–893. doi: 10.1016/s0889-8529(02)00031-2.
    1. Pak C. Y. C. Medical management of urinary stone disease. Nephron Clinical Practice. 2004;98(2):c49–c53. doi: 10.1159/000080252.
    1. Hyams E. S., Gupta R., Melamed J., Taneja S. S., Shah O. Renal involvement by chronic myelomonocytic leukemia requiring nephroureterectomy. Reviews in Urology. 2009;11(1):33–37.
    1. Mattle D., Hess B. Preventive treatment of nephrolithiasis with alkali citrate - A critical review. Urolithiasis. 2005;33(2):73–79. doi: 10.1007/s00240-005-0464-8.
    1. Pak C. Y., Fuller C., Sakhaee K., Preminger G. M., Britton F. Long-Term Treatment of Calcium Nephrolithiasis with Potassium Citrate. The Journal of Urology. 1985;134(1):11–19. doi: 10.1016/S0022-5347(17)46962-X.
    1. Jendle-Bengten C., Tiselius H.-G. Long-term follow-up of stone formers treated with a low dose of sodium potassium citrate. Scandinavian Journal of Urology. 2000;34(1):36–41. doi: 10.1080/003655900750016869.
    1. GoodRx. Potassium Citrate. 2018, .
    1. Seltzer M. A., Low R. K., Mcdonald M., Shami G. S., Stoller M. L. Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis. The Journal of Urology. 1996;156(3):907–909. doi: 10.1016/S0022-5347(01)65659-3.
    1. Koff S. G., Paquette E. L., Cullen J., Gancarczyk K. K., Tucciarone P. R., Schenkman N. S. Comparison Between Lemonade and Potassium Citrate and Impact on Urine pH and 24-Hour Urine Parameters in Patients with Kidney Stone Formation. Urology. 2007;69(6):1013–1016. doi: 10.1016/j.urology.2007.02.008.
    1. Odvina C. V. Comparative value of orange juice versus lemonade in reducing stone-forming risk. Clinical journal of the American Society of Nephrology : CJASN. 2006;1(6):1269–1274. doi: 10.2215/CJN.00800306.
    1. Haleblian G. E., Leitao V. A., Pierre S. A., et al. Assessment of citrate concentrations in citrus fruit-based juices and beverages: Implications for management of hypocitraturic nephrolithiasis. Journal of Endourology. 2008;22(6):1359–1366. doi: 10.1089/end.2008.0069.
    1. Eisner B. H., Asplin J. R., Goldfarb D. S., Ahmad A., Stoller M. L. Citrate, Malate and Alkali Content in Commonly Consumed Diet Sodas: Implications for Nephrolithiasis Treatment. The Journal of Urology. 2010;183(6):2419–2423. doi: 10.1016/j.juro.2010.02.2388.
    1. Administration F. A. D., editor. Labeling Daily Values. 2017.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit