Tonsils, kidneys and gall: why your body makes stones

0:00Dan Baumgardt:Oh, it's pushing it out of his mouth. I've got a mate who's got a tonsillar crypt so big that it comes out the other side of his tonsil. So he could whop a piercing through it if he wanted to. Not advisable as a disclaimer for people. Go on, tell me about stone babies. So these stone babies are calcified remains of a developing foetus that cannot get out of the body for whatever reason. And that basically puts this baby in a mummified state. Problem is that when these stones get into the wrong place, it really, really hurts. Hello and welcome to Strange Health from The Conversation. And this is the show where we explore the weird and the wonderful things that your body gets up to.

0:43Dan Baumgardt:And we decode the science behind the wellness trends. And we do this with the help of researchers who actually study this stuff for a living. I'm Katie Edwards. I'm a health and medicine editor at The Conversation. and we're an independent source of news and analysis powered by academics and journalists working together to make evidence accessible. And one of those academics is Dan. Hi, and I'm Dan Bangor. I'm a lecturer in health and life sciences at the University of Bristol, where I also work as a GP. So today's episode, then, we're talking about stones. We're not talking about, you know, you're manifesting crystals.

1:16Dan Baumgardt:It's actual stones that your body produces. And that's from the classic kidney stone that probably everybody's heard of to the more obscure ones that your body can actually hide away for years. That's right. Your body's capable of producing a wide variety of stones, including stones that you find in your tonsils, some that you find in your belly button, and some that you even find in your gut. Oh, darn. This is not glamour, is it? It's not the most glamorous subject, no. We'll delve into it in a little bit more detail. And one of the reasons why we're doing this is because we've been seeing a lot of people on social media posting about, you know, tonsil stones that you develop at the back of your mouth.

1:54Dan Baumgardt:Yeah. And they've been not getting them removed, but they've actually like been removing them themselves. Shall we have a look at one of my favourites? Oh, it's pushing it out of his mouth. Blige. Okay, so he's got a couple of, oh, there's something quite obscene about this, actually. There's a couple of holes at the back of his throat, which looks quite sore, and is popping the top one using what looks like one of those blackhead remover things. And he's just pushed it and there's like a perfect little ball, a yellow ball that's popped out. Yeah, and that's what they look like. They have this sort of like yellowish appearance and they're essentially little bits of gunk that forms at the back of your mouth from saliva and food debris and bacterial microbiome.

2:43Dan Baumgardt:and they gather in these little holes, these little nooks and crannies that your tonsils have. And some of them can be really deep. I've got a mate who's got a tonsillar crypt so big that it comes out the other side of his tonsil. So he could whop a piercing through it if he wanted to. Not advisable as a disclaimer for people, but it's, yeah, it's certainly a feat, an anatomical feat. What a claim to fame. I know. You can actually buy tonsil stone remover kits. And I mean, there's other videos in there of other people who've used other things. So, you know, strands of spaghetti, you know, those water flossers which floss your teeth.

3:17Dan Baumgardt:I've used one of those before and I actually find that to actually floss my teeth, not to remove tonsillar stones like Mason to add. But I actually found them quite painful. There's other cases where people have used other implements to dig around, like kebab sticks and stuff like that. Really, really not advisable. They're your tonsils. They're not shish kebabs. Would you actually know that you'd got any? No, not always. I think sometimes they can be completely asymptomatic so they don't have any symptoms associated with them, especially if they're fairly small and they're soft and not causing any problems in the deep within the tonsillar crypt.

3:48Dan Baumgardt:Sometimes they can give you halitosis, which is a medical term for bad breath. And sometimes they can actually see them. You can see, as I said, they start to get bigger. You can see that little protruding bit of yellow coming out the side. So it's worthwhile then to see a doctor rather than resort to self-help, I would say. Lovely. Dan, have you ever experienced any bodily stones? Well, it's funny you say that because actually I have. I, a couple of years ago, had my first episode of a kidney stone. And having had kidney stones myself, I have a newfound sympathy for patients who also suffer from kidney stones.

4:20Dan Baumgardt:It was the most horrific pain I have ever experienced in my entire life. It actually woke me from sleep about six o 'clock in the morning. That was when my daughter was young when she was really young about sort of three or four my wife and her were about to depart for nursery and for work and so I sort of tried to move them out the door and it just got worse and worse and worse and worse so I did what every self-respecting man in his uh mid-30s would do I called my mother who lives the next village down who duly transported me to the GPs and who very very kindly got me started on some pain relief and some medication to make the sickness go away and luckily I felt much better but it was horrific so what happened with your stone then down.

4:59Dan Baumgardt:Well, luckily, actually, I managed to pass it. It took about two or three days, and I wasn't actually aware that I did pass it, to be honest. The pain just abated and went away, which meant that I must have just passed it out by urination. But we do recommend to patients that they sieve their urine. So one thing that urologists suggest is having a sieve, so having something, a fine sieve, like a tea strainer next to the toilet. So my wife came home that evening and said, why is the tea strainer next to the loo oh if you catch the stone and sometimes um you actually feel it or hear it come out you can make a big into the toilet pan as it comes out because of the pressure that's been released but you can also catch it and sieve it and if you catch and sieve your stone away you can send it away to the lab for analysis to find out exactly what's in it i tell you what dan if ever i come to your house and you give me tea with a tea strainer and we're going to have words.

5:54Dan Baumgardt:That is absolutely vile. Luckily it's moved on to Pastures New that tea straight enough. Thank you Dan. So okay it's time that we now found out why our bodies produce stones and I called up a professor of anatomy in our Ask the Expert section.

6:13Dan Baumgardt:The Adam Taylor. You're a professor of anatomy at Lancaster University and of course you're a regular contributor to the conversation. Welcome to Strange Health. Thank you, that's very kind. Well, we're talking today about the different stones that the body can produce and you know quite a lot about this, don't you? Because haven't you studied like this unique condition? And I'm sure I'm going to make an absolute mess of this word, but it's alcapitonuria. Close, so everybody goes for A-K-U for short, but yeah, alcapitonuria. So tell me about what that is and it creates these really unusual stones what is that about so alcaptanuria is a unique disease in many ways so it's ultra rare one in a quarter of a million people suffer from it you can only inherit it you can't catch it and it is a defect in the way that we metabolize proteins so things like tyrosine for example you or i if we didn't have this condition would pass things out in our urine these patients get a part breakdown product of tyrosine called homogentic acid but we go for hga for short because it's a bit easier and that circulates around the body and it's very water soluble and it goes into all of their joints and all of the cartridges in their body and by the time they're kind of my age late 30s early 40s they've got multiple joint arthritis and when we look at their joints in surgery the color of the cartilage it's normally like a nice crystal white color it's absolutely jet black it's like somebody's gone in and painted up the cartilage black and if you look up the disease it's often called black urine disease because their urine also goes black so i've studied this disease we've actually got to a point where there's a treatment for these individuals when we're studying them one of the things that we find not only do they get lots and lots of arthritis in multiple joints both hips both knees they also produce stones within the body so most of the patients will complain that they've had kidney stones for example also submandibular stones so coming out of the salivary glands sadly for gentlemen as well prostate stones so they're reasonably common in in various parts within the the general population but for these patients they're incredibly common and again it's to do with the acid-base balance that they have because they've got this high level of acid floating around in their body it interferes with the way that they produce urine and produce other secretions in the body which increases their risk of forming stones.

8:37Dan Baumgardt:So what colour are these stones? These stones have got black and blue discolouration in them and it's this molecule, this HGA that circulates. Once you've got a couple of these molecules together, it forms a polymer and that as it polymerises it gives it this black colouration. And have you ever actually looked at these stones under a microscope? Like what are they made of? What is they like inside? So when we look at them under the microscope, they look very sharp they've got very serrated edges and kind of crystal points all over them they look like they'd be very uncomfortable to touch which with your finger they're probably not because the the points are so small when we examine them under electron microscopes you're really beginning to look at that kind of crystal structure and that's one of the reasons why say if you get a kidney stone you end up getting blood in your urine because the sharp jagged edges that dig into the tissue that lines your, say your inside of your kidneys or the ureters that take the urine from the kidneys to the bladder.

9:33If these stones get stuck, they cut the surface. Now your ureters are tubes with something in them called smooth muscle. Now smooth muscle is great because it kind of does its own thing. It moves things along happily at its own pace. And this is one of the issues with kidney stones, for example, why they're so painful and you get blood in the urine is because the stones get trapped. Our ureters are touch sensitive. So if there's a bit of urine dribbling down the ureter will twitch to move the urine along if you get a stone stuck in there it's going to twitch and then it's going to keep twitching and so if anybody who's listening who's ever had a kidney stone will know how agonizingly painful it is and that's because that smooth muscle is constantly contracting trying to move the stone along can't do it and while it's constantly contracting those little crisp sharp crystals on the outsides of the stones they're going to be cutting into the the very delicate lining of your ureters causing blood to trickle out so

10:24Dan Baumgardt:So are all these stones made, are they all like candy made in the same way? Or are there different categories of stones? So if we take kidneys, for example, there are different types of stones. So the most common type are typically made of a calcium crystal, so either calcium oxalate or calcium phosphate. They're the two most common types. Now, other things can cause stones to precipitate. So uric acid is another example of a stone type. That's made of something different. That's usually kind of dietary induced from things like purines that are found in seafood, for example, or found in red meat.

11:01And then there are some people who have conditions that result in increasing an amino acid called cysteine, which can't be broken down properly. And stones can form from that. And then there are a different type of stone called struvate or struvite stones. And they are typically associated with infection. So bacteria in your urinary tract, for example, get an infection, the bacteria there, and they convert urea, which is in our urine, into ammonia.

11:27Dan Baumgardt:What kind of stones then are caused by inflammation? Inflammatory stones are typically in response to things like infection. So you can get calcification in areas of the body. Sometimes they're stones if they're in a duct, but you can get calcification in tissues where infection or damage or inflammation is. And that's one of the body's kind of inflammatory ways to prevent something doing more detrimental damage to tissue or tissue breakdown. Tissue damage is to calcify. You get calcium precipitated around them. And apologies if anybody's having their breakfast, lunch or dinner. And things like the subbandibular glands, those ducts open into our mouth.

12:03And my favorite thing is thinking about tangfastics, you know, the good old Haribo tangfastics. Now, if I say, oh, think about, you know, chewing those really nice cherries, you can probably already feel your cheeks beginning to kind of tense up. And that's the glands. That's the nervous control of those glands producing saliva there. And again, if you do the same and do this at home, looking in the mirror, think about it, lift your tongue up and you'll see the openings of the sublingual submanabular ducts into the bottom of the mouth. You'll see the saliva coming out. Now, obviously when that happens, stuff's coming out, but stuff can also go in there.

12:33obviously our mouth is full of bacteria and some people find that things like toothbrush bristles you're brushing your teeth you know yeah and so they can end up going into those ducks getting stuck they can you know people end up with bits of them going backwards we can end up with little bits of gristle from bone and sausages and foodstuffs all that can end up blocking these ducks now if that happens if those if we get something in there that's not supposed to be because our mouth is such a hotbed of bacteria, good and bad bacteria, depending on your diet, they will congregate around those foreign objects that are in there.

13:09So those kind of stones may form around things that aren't supposed to be in there. And this calcification process is to kind of block it off, stop it from moving and trying to prevent any further infectious transition through the body. They'll probably beat me up if they ever watch or listen to this. But I had a family member who was one of the toothbrush bristle gangs and there's got all...

13:31Dan Baumgardt:They are definitely going to be you up. Yeah well it's alright I'm used to it. They had a toothbrush bristle stuck in in the gland opening into the duct coming out into the bottom of their mouth and you know me being an anatomist I was like oh can I have a look and it was huge and then as they're describing to me what the dentist did to insert a scalpel and squeeze out the sorry yeah that should have come with a disclaimer they're going it was the most disgusting thing I've ever because obviously you have the mirror above you don't you and if you don't you can kind of see off the reflection of the light above your head they're regaling me with what they described as one of the most awful things that they've ever smelled and I was like oh that's really interesting what what color was it what like was it hard what could you see the toothbrush you know and that's just the morbid anatomist in me I'm always like oh that's really interesting um but yeah I look forward to getting beaten up at the next family family gathering if they've watched and listened to this uh to this piece no do you know I'll tell you what Adam I do like a bit of like gross body stuff but gristle in your gob is a bit far even for me i mean imagining that stuck in your yeah sorry right we'll move on to something actually i think it's both bizarre and a bit heartbreaking this go on tell me about stone babies stone babies so the good thing about stone babies is they're incredibly rare so their kind of medical name is a lithopedian and if you want to be really grossed out I'll talk to you about how they used to get stones out in a minute we've talked about stone babies but a lithopedian is a rare a really rare medical phenomenon where unfortunately a woman has been pregnant and for whatever reason the fetus does not continue to develop and it remains in the abdomen but stops developing and if the uterus doesn't abort the fetus and it remains there maybe maybe mum didn't know she was pregnant maybe you know that's the body if it can't get rid of it what it does is it begins to calcify and so these stone babies are calcified remains of a developing fetus that cannot get out of the body for whatever reason it's the mother's immune system encasing the deceased fetus in a layer of calcium again to prevent infection taking over and that basically puts this baby in a mummified state.

15:46Dan Baumgardt:But won't that need removing at some point or can that just live in the body and you not know about it? So it depends I mean yes it can be removed but often some cases are found where sadly mummers died later on in life and they find a very small stony remnant within the uterus. Obviously a lot depends on people's accessibility to healthcare provision, you know, ultrasound and a variety of things. Some women have had that for 10, 20, 30 years, I believe they've had them for a long period of time located within their uterine cavity and only at death of themselves or post-mortem is that seen beyond mum's death.

16:28Dan Baumgardt:Good grief. Just thinking about stones more broadly, what can increase the risk of developing these stones and is there anything that we need to watch out for is there anything we need to avoid one of the biggest things is is sufficient levels of hydration so if you're drinking plenty of water and your urine's a nice crystal straw you've got nothing to worry about but where you are beginning to not drink enough and your urine's coming out yellowy or syrup color if you're in a really bad way that's when you're increasing the risk of of these particularly calcium phosphate and calcium oxalate stones forming because they are high in levels of calcium and therefore it begins to come out of solution and form stones in the various tubes as we go along the urinary tract and in the kidneys and calcium is not the biggest thing it's phosphate that seems to be implicated in so many of them one of the big things that's been in the press recently is bubble tea yeah yeah and the lady who was drinking nothing but bubble tea well that'll get you 300 stones to be removed from your kidneys you know that poor lady drank nothing but bubble tea clearly the phosphate is in there and that's precipitating into stone formation and 300 stones is the result of not having sufficient diluted urine so are these stones are they a real risk to health yeah i mean they can be so stones in the urinary system it depends where they are and how big they are so anything under kind of you know two millimeters will pick up on imaging scans for example two millimeter stones aren't usually going to cause you much significance and you'll probably pass them without even really knowing that they're there but if we're getting to kind of five ten millimeters so we're talking about stones that are a centimeter in size so that's going to cause you pain but the biggest issue is if that blocks the flow of urine that then creates back pressure into the kidneys kidneys need pressure they need ultra filtration to filter the blood if that back pressure goes into the kidney you're going to begin to interfere with how the kidney exchanges ions and electrolytes and you're going to cause significant kidney damage so stones if they're left long enough or they're dislodged and they're big enough they can cause serious serious damage to the kidneys to the point where you may need a stent putting in you may even if you do enough damage actually get to the point where your kidney's so damaged that you may need dialysis and obviously if it's not picked up at all in in any point you know you do the run the risk of sadly dying from it because our kidneys are fundamentally important for maintaining our acid-base balance our fluid levels throughout the body so yeah so you know if you've got some signs and symptoms of kidney stones getting them looked at is obviously quite important i know people describe it as up there with some of the most painful things you can experience because it's what we call visceral pain there's not really a lot that you can do for it and it's going through the kind of spine in and around the kidneys and it's this it's horrible i mean i hope i never i hope i never experience it we're good at treating it nowadays and i look back at how they used to treat kidney stones previously and and as painful as things are nowadays they're nowhere near as how it used to be for getting things out so how did they used to treat kidney stones then back in the day okay so make sure you're sitting for this one they would put you in a position on a bed so if you've ever given birth usually to start with you start on your back with your legs in stirrups this is known as the lithotomy position and this comes from what was known as cutting cutting the stone or cutting for the stone so if you had kidney stones or bladder stone urinary stones in the old days they would put you on your back put your legs up on benches on stirrups give you a bit of wood to bite into because there was no such thing as anesthesia back in in the good old days then they would get a couple of very barely individuals to pin you down and then they would take a look between whatever whether you had a scrotum or a vagina and your anal opening and they would make a small incision and go in through the back of there with a small scoop and then cut in under it into the back of the bladder to try and catch the stones as they would fall out and there is images on the internet from historical times of people having this procedure done obviously if you were lucky enough to survive the procedure not only was there no anaesthetic there was no kind of antiseptic and you know no aseptic techniques you know if you go for surgery these days everybody's got gloves on everything's been autoclaved everything's clean back in those good old days if the operation didn't kill you the secondary infection usually got you so be thankful for for what we've got in healthcare these days for a lot of these conditions well i'd love to say it's been lovely to talk to you adam it and that's very kind of you Katie so that's Adam Taylor from Lancaster University is also known as the stone meister thank you so much Adam um I will never invite you to come and speak to me around mealtimes thank you thanks thanks Katie thanks so much

21:24Dan Baumgardt:I'm Gemma Ware host of the Conversation Weekly podcast each week I speak to an academic expert about a topic in the news to understand how we got here. From global politics. World War II has this very long shadow in all of East Asia because there's a lot of unfinished business. To the latest scientific breakthroughs. The drug has been shown in real world environments to be highly effective at preventing HIV. All the big dilemmas facing our planet. We have actually stumbled in the last few decades into a system where those products that we rely on for the economy to be sold every day are pollutant.

22:00Dan Baumgardt:And they're polluting things very badly indeed. My guests draw on their deep research knowledge to pull out what really matters so that you can understand the context without the spin. Follow The Conversation Weekly for new episodes every Thursday, wherever you listen to podcasts, and read more stories direct from academic experts every day on theconversation.com.

22:25Dan Baumgardt:So, Dan, stones, eh? Quite a broad category. Very much a broad category. It turns out that the body's quite a sculptor. It's managing to sculpt all these stones. The problem is that when these stones get into the wrong place, it really, really hurts. So shall we talk treatment and prevention? We all love a good health tip. So how can we avoid developing stones and also having to pass them in excruciating pain? So actually, it goes back to those old chemistry lessons that if a solute exceeds its concentration, it precipitates out into crystals. So hydration is probably the strongest defense that you have going.

23:02Dan Baumgardt:The other thing that we found as well is that obesity is a risk factor for developing kidney stones. And so exercise not only helps things flow, but also is a good way to combat obesity, as is diet. And when we're on the subject of diet as well, if you are particularly prone to developing oxalate crystals, you can avoid high oxalate containing foods. So typically things like beetroot, chocolate, rhubarb, and tea. It is interesting that some people have been found to drink tea in large amounts can be at more risk of developing kidney stones. It's when it becomes a recurrent problem that we suggest going and speaking to a doctor because then it's worthwhile for a GP to start making a workup and doing some blood tests to have a look and make sure that your calcium levels in your system aren't too high or to see whether there might be some underlying cause as to why you might be developing stones.

23:53Dan Baumgardt:So it might be as a result of diet, it might be as a result of an underlying medical condition, or it might be as a result of the fact that your urinary tract has some anomalies in it, which means that stones get stuck more easily or develop more easily. So we've talked about kidney stones, but what about the tonsil stones? How do you stop those from being created? Hydration is really, really important. More dehydrated you are, the more likely that your mouth is going to be drier and more likely it is to result in bacterial buildup. So good oral hygiene is really important, making use of a really, really good brush twice a day, or more than that if you're taking sweets on.

24:30Dan Baumgardt:Gargling does more than people think as well. So gargling salt water can also sort of help remove and wash away collections of bacteria, as can really, really good hydration. But essentially, if someone's getting repeated stones and they think they might have deep tonsillar crypts or think that they might have bad breath caused by tonsillar stones, go and see a doctor instead. Please don't start poking around with a chopstick or anything in the back of your mouth because it's really not going to do you any good at the end of the day. And please stop filming it. Yeah, no one likes to see a deep tonsillar crypt, does it?

25:01Dan Baumgardt:No, not at all. So that's it then for today's episode. And what a journey it's been. We've learned that stones can form in far more places than most of us would even want to imagine, that chemistry is always looking for an excuse to crystallise and that your body is constantly trying to balance the minerals that you take in with the ones that you excrete. So steady on on the old bubble tea. A huge thank you to Professor Adam Taylor from Lancaster University for guiding us through this geological tour of human anatomy. And if you enjoyed this episode, hit subscribe, share it with a friend who has a mysterious pain in their side and leave us a review so we know what you want more of.

25:37Dan Baumgardt:And we want to hear from you. If you've got a health question and it doesn't matter how strange, in fact, the stranger the better as far as we're concerned. or if you've seen something online that you want an expert to explain, then get in touch with us at strangehealthattheconversation.com. That's strange health, it's all one word, attheconversation.com. Strange Health is produced by Gemma Ware, with editing and mixing for this episode by Sikanda Khan. Alisa Tibbet and Alice Mason help with all our socials and promotion. And since today was all about stones, here's our closing thought. Your body's not trying to hoard mineral.

26:13Dan Baumgardt:drink water keep things moving and if you insist on removing your own console stone please stop filming it on TikTok it is proper minging catch you next time on Strange Health until next time bye