Current Strategies

I primarily form uric acid kidney stones, as uric acid is a byproduct of protein metabolization. Since it is currently impossible to sustainably lower my protein intake (see Problem Facets), I am trying to reduce acidity in other ways. My urologist suggested I switch from potassium citrate tabs (15 mEq 2x daily) to a powdered version (Citralith) for faster absorption, since short gut transit time seemed to be limiting how much I actually absorbed. I have noticed a slight improvement in my urine pH, but it is still much lower than we would like for uric acid stone dissolution. Currently I am drinking 16oz of water every two hours (although I sometimes have to reduce this, as it can reduce my ability to digest protein) and drinking 8–16oz of water every time I wake to pee at night. This means I usually wake 5–10 times each night, which is hugely disruptive to my sleep.

With this regimen I am testing at a pH of 6–7 when I wake, and gradually regressing to 5.5 usually by early afternoon and until bed.

The two supplements that seem to have the biggest impact on urine pH are potassium citrate and something called Emma (see Medications).

I've been introducing more carbohydrates — a small amount of boiled rice noodles in the soup, and an egg mixed into the daily porridge — as a way to try to reduce how much protein I need to feel stable, and to get more mediated, gradual digestion instead of relying on protein volume alone (see Meals). So far this has had limited effect on its own: pushing the carbs any higher, or the protein any lower, than my current soup composition, I still find I get hungrier and wake up starving. There seems to be a floor below which I can't reduce protein without disrupting sleep.

Stress reduction, mindfulness, and breathing work seem to have some positive impact — I'm currently meditating for 15 minutes daily and trying to increase that. I notice positive effects on mental health and sleep quality, but no ability to reduce chicken intake from it alone so far.

I'm also currently trying TRE (Tension & Trauma Releasing Exercises), a somatic practice that's supposed to be vagal regulating.

As of mid-August 2026 (about five weeks ago), I'm also trying a vagus nerve stimulator called Pulsetto. It makes me feel extremely full when I use it too many times in a day, to the point that it's hard to eat. But despite that feeling of fullness, I still wake up hungry and unable to sleep, and my routines get badly disrupted, unless I push through the fullness and stuff myself anyway. So whatever signaling pathway Pulsetto is acting on, it doesn't appear to be sufficient on its own.