food for jills page

FOODS

Many of you will leave your doctor’s office with questions about foods and kidney stone prevention. You will go home. You will sit down at your desk and the Googling will begin. Here is a spot for you to ask me anything you like about this topic. We already have things on this site about salt, oxalate, and calcium but this space is for specific issues for anyone who comes.

65 Responses to “FOODS”

  1. Al R.

    Hi Jill,
    Before CaOx kidney stones began, I looked for healthy high protein snacks with a minimum of empty sugar calories, trans fats, and saturated fat. ½ oz of low salt peanuts offered a long lasting, high energy snack. But nuts pack a lot of protein (Dr. Coe explained I need to limit protein), as well as oxalate.
    “How To Eat A Low Oxalate Diet” is exceedingly helpful. However, do you happen to have a few healthy, kidney-stone-friendly snack suggestions beyond the every faithful apple up your sleeve?
    Thanks in advance, Al

    Reply
    • jharris

      Hi Al,

      Considering the time of year I think low oxalate fruits might be a good fit for you. Take a look at the list and pick a banana, some berries, or melons. Ditch the apples til fall!
      Other snacks that you may enjoy would be yoghurt if you like it. You could even sneak a few higher oxalate fruits on top of it as you are getting calcium with the yoghurt that would balance the oxalate in it.

      Lower salt cheese (including cottage cheese) would be good as well. I know you are watching proteins, but remember you just have to watch your portion sizes on your food, not so much the food itself.

      Nuts are such an easy portable snack, it is a shame to totally go without. If your oxalate levels are totally high really avoid them, but if not, have a few here and there. Drink lots of water, eat them with some other food that contains calcium and you CAN still enjoy them.

      Hope this helps, even a little-

      Jill

      Reply
  2. Al R.

    Hi Jill,
    I have a bit of a puzzle here. I’ve painstakingly calculated the sodium, calcium, and protein in everything that goes in my mouth the day before and day of two recent supersaturation tests. I even know where our tap water comes from, how much salt it reportedly contains, and how much I drank.
    But when the supersaturation report comes back, the Na 24 has been a full 1/3 higher than my calculated intake for the day. I was expecting a much closer match. By the way, the creatinine variation from test to test (as a sanity check on the tests) is just 6%.
    For example, I calculated 90 and 100 mEq intake for the day before and day of, and the Na 24 result was 134 mEq. I’m not sure how long it takes for sodium to make its way out, but although I didn’t calculate sodium for the week before, I hadn’t eaten out and would not expect a wide variation.
    Thank you in advance for any ideas on what I may be missing, or suggestions you may have!
    Best regards,
    Al

    Reply
    • Fredric Coe, MD

      Hi Al, calculated sodium and urine sodium of 100 vs 134 is pretty good! Sodium balance integrates over a 4 day average, so it is possible you saw a bit of carryover from the day before your last calculation (day -3). I am pretty happy with your calculating, given the general averaging in the system. Regards, Fred Coe

      Reply
      • Al R.

        Hi Dr. Coe,

        Thank you for the helpful info and encouragement! It’s good to know that just one, possibly unknowingly, very salty meal isn’t going to dump out all the sodium at once, hopefully limiting the stone risk somewhat. I also read “Control of Urine Oxalate Excretion” with interest. And although much of it was over my head, there were plenty of precious nuggets. For example, the point that with sufficient daily dietary calcium, a single high oxalate meal is not likely to affect stone risk.

        As you might guess, I am also very interested in how the effects of intake of calcium and protein are averaged. These are probably don’t only have an effect in the hours immediately following a meal either.

        Question – Do you happen to also have any data on the period of time over which calcium and protein intake have their effect on supersaturations?
        In other words, are the greatest effects of calcium and protein intake seen in the hours immediately following a meal, or is there more of an averaging through the day, across several days, or something more complicated?

        Best regards,
        Al

        Reply
        • Fredric Coe, MD

          Hi Al, You are a great reader! Thanks. Calcium losses rise immediately with food whether there is calcium in the food or not. So if there is no calcium in the meal, bone must donate it to keep the blood calcium constant. Raw calcium, like in supplements, but without nutrients, raise urine calcium immediately but it is not clear that bone will use that calcium. It is a real stone risk. We do not advise using supplements except as part of a meal. Protein raises urine calcium immediately, like any other nutrient. So there is no averaging over days, just a peak with meals, and a general decline over a few hours. It is very complicated but not in terms of time averaging like sodium. The message: Get your diet calcium when you eat food. Best, Fred

          Reply
          • Al R.

            Thank you so much, Dr. Coe. That is incredibly helpful!
            While we’re on a roll…Any thoughts on what side effects drinking an extra liter of water per day might have on both 24-hour Ca excretion and urine pH?
            (I’m guessing there may be significant variability depending on the kind of IH.)
            Best regards, Al

            Reply
            • Fredric Coe, MD

              Hi Al, water has no known effect on urine calcium excretion but may increase urine pH. These are not certain comments, as our newest research has uncovered some odd effects of water – but all in a direction that would reduce stone forming. Regards, Fred

              Reply
              • Al R.

                Hi Dr. Coe, Stumped again! I thought testing the benefits of a low protein diet would be easier. I did a pair of new supersaturations – one with my current typical diet, and one with low protein vegetarian meals the dinner before and all day during the test. I worked hard to keep other factors such as volume, Na 24, etc. constant.
                The normal diet with 1.35 g/kg protein yielded a PCR of 1.4. The low protein vegetarian diet with 0.85 g/kg of protein only dropped PCR to 1.2.
                I was expecting a much smaller PCR. Any idea what I may be missing?
                Thx again, Al

              • Fredric Coe, MD

                Hi Al, many vegetable sources have a lot of protein. PCR is derived from measurement of urea nitrogen, and if you had suddenly reduced your caloric and protein intake you might have been catabolizing your own protein stores which will produce urea, in other words it is as if digesting protein but really using up your own. Hard to tell which. REgards, Fred Coe

  3. Bob Kimble

    Jill,
    I’m Diabetes Type 2 and last tests showed too much Oxalates in my system. I’m cutting way in high Oxalate foods in the chart and I’ve eliminated nuts as a snack. I also saw that Shredded Wheats were high in Oxalates. I’d been eating it for breakfast because of no sodium, sugar. I have 2 questions: 1) Should I switch breakfast to Cherios or Special K. (Low Sugar and Sodium, lower Oxalates? 2) Do you have an idea of how many oxalates there are in Matzo? I’ve been eating it with a cream cheese spread to boost Calcium.

    Reply
    • jharris

      Hi Bob,

      Good to hear from you again. I would definitely switch to the other cereals. Wise choice. Also, if you are talking about Matzo crackers they must be on the higher side as they are made of white flour and water. That is it. So I would eat them sparingly.

      Let me know what value your oxalate level was and we can see how low you really have to go on your oxalate foods.

      Warmly,

      Jill

      Reply
      • Bob Kimble

        My number was 140. I’m increasing Calcium intake with sour cream, cream cheese, and various low to medium sodium cheeses in salads. I’ve cut out nuts as snacks and am switching cereals from Shreaded Wheat to Cherios.
        I’m also cutting back on sweet potatoes from once or twice a week to every few weeks. I let myself eat whatever I want within reason once a week. Should I do more? We’re testing again in a month.

        Reply
        • jharris

          Thanks for getting back. That oxalate level is very high, so you need to cut back as best you can. You sure the oxalate was 140? Jill

          Reply
  4. Bob Kimble

    Jill:
    Dr. Coe has told me about a website for low sodium, but high calcium dairy products (Cheeses). Can you point me to the right web site? Thanks.

    Reply
    • jharris

      Hi Bob-

      I am not quite sure of which website he told you to go to. He will reply to you, but I do know that you must go “low salt” on all your dairy products. Many dairy items now come in “low salt” versions. When you go grocery shopping look for items that say low salt, but also make sure they really are. Many claims that you find on packages are false. You want to eat meals that contain around 500 mg/sodium/meal. This divides your sodium throughout the day nicely. Of course I realize that life is not perfect. You may eat more salt at lunch, but then watch it for dinner…..

      Let me know if you have more questions-

      Jill

      Reply
  5. Al R.

    Hi,
    The next step for me to try to reduce calcium excretion and supersaturations is to lower protein intake. Some sources specifically recommend limiting animal protein (e.g. NIH), others speak of limiting total protein. Frankly, substituting plant-based protein for a part of the animal protein would make a large reduction much more palatable.
    Protein seems to have to be a myriad of impacts. E.g. excretion of calcium, phosphorous & citrate, absorption of calcium, effects on urine pH, and the effects of sulphur-containing amino acids.

    Question…Can you please tell me about the differences between consumption of animal and plant-based proteins when it comes to calcium stone risk?

    Also, do you have dietary guidelines for each?

    Thank you. I will greatly appreciate any help you can offer to sort this out!
    -Al

    Reply
    • jharris

      Hi Al,

      The difference between animal and plant protein is that the plant protein will not produce an acidic urine and animal protein does. Why do you care about that? Stones love forming in your urine when it is acidic.

      You should aim for meeting this equation for your protein needs: 0.8 to 1.3 gm/kg/day. Many people who are doing high protein diets are increasing their risk of forming new stones. There is also the problem of eating a high salt diet. This will definitely increase calcium consumption, so please be aware of this if you are not already. You want to aim for about 1,500 mg/day of sodium.

      Hope this helps-

      Jill

      Reply
      • Al R.

        Hi Jill,

        Thank you very much for your reply. Actually, urine pH is a big concern for me. My doctors have no explanation for this: My urine pH was 6.8 in my baseline supersaturation test. Then it rose to 7.1 when we tried 20 mEq of potassium citrate, and 7.3 when we tried 40 mEq. That coupled with Olympic-class calcium excretion raised my SS Cap to 2.44 even when passing nearly 4 l/day! Chlorthalidone has helped a bit. I have also been reducing salt, but unfortunately that hasn’t made a dent in this. So I’m working on protein and salt together now-Dr. Coe’s helpful suggestion.
        I’m starting to wonder if animal protein could possibly be better than plant in my odd case…?
        -Al

        Reply
        • Fredric Coe, MD

          Hi Al, I gather you have a very high urine calcium excretion and an alkaline urine pH. Potassium citrate may not be an ideal treatment. Chlorthalidone is indeed an excellent treatment if combined with low diet sodium. But if these together do not work, perhaps you have something more complex. Be sure and do followup measurements: If urine sodium is as low as 65 mEq daily and you are taking chlorthalidone and protein intake is not more than 1 gm/kg/day (PCR gives this) and your urine calcium remains very high along with a high supersaturation for CaP you need expert consultation to rule out some systemic causes. I am sure your personal physicians are already aware of all this, and they will be able to do what is needed. Regards, Fred Coe

          Reply
  6. Carla

    I have recently re-adopted a lowfat, low sodium, vegetarian diet after emergency gallbladder surgery on 2/14/16, and passing a kidney stone 2 weeks later. I have lost 12 lbs., my cholesterol levels look better, and I have cut my blood pressure med in half (under dr. care). I have been a stone former for at least 30 years. The stones are calcium oxalate. My most recent 24 hour urine oxalate levels are 41 (2015), 33 (2014), and 27 & 34 (2009). Calcium levels are 188 (2015), 185 (2014), and 254 & 286 (2009). I am anticipating that the new nephrologist I am seeing tomorrow will order a new 24 hr. urine. I have adopted my current diet plan for several reasons – post surgery I have had a harder time digesting animal fat, I had been reading Dr. Joel Fuhrman, Dr. Michael Greger, and Dr. McDougall who say that a plant based diet is best for all types of stones, I feel better eating this way, and I wanted to improve my heart health (family history of heart disease). I am lactose and gluten intolerant. I have looked at the oxalate list and noted that I am eating very high oxalate foods daily, such as beans, brown rice, nuts, and some veggies and fruits. Is it possible to eat the way I am eating in a healthy manner and eat low oxalate? Also, since I am lactose intolerant, can I get enough calcium on heavily plant based pescatarian diet? I do eat salmon, and have some kale every day in a smoothie. Additionally, is it safe for kidney stone formers to supplement with vitamin D3? My last two labs have shown levels to be low – 247 and 24 – and my doctor wants me to supplement D3 with K2 1000-2000 IU daily.
    Thank you for your help!

    Reply
    • Carla

      *my vitamin D level should say 27 and 24, not 247!!!

      Reply
    • Fredric Coe, MD

      Hi Carla, I gather your diet was adopted because of food intolerances and issues after gall bladder removal. If this diet suits you, I see no reason to not use it. No trials support vegetarian diets for stones, but certainly some forms of vegetarian diets may benefit urine stone forming factors like calcium and oxalate. To get adequate absorbable calcium from all plants is not necessarily easy. I think your urine calcium may be high – given the results you send along, and low sodium diet should be beneficial. Given 30 years of stones, perhaps your new nephrologist might want to offer more than just diet. A new 24 hour urine is a good idea, and you should look at the supersaturations now compared to prior years and ask if they are falling; you will need to lower them, one way or another, if stones continue. Regards, Fred Coe

      Reply
  7. James Joslin

    Dr. Fred Coe, Jill Harris: Thanks, For your help in understanding the pathway to Kidney Stone Prevention. I came across your articles after a random Internet search. After having various “kidney stone” incidents over a 15 yr. period. It became evident, no one, was helping me understand how to “prevent” future kidney stone incidents, (primary care doctor, urologist, nutritionist). Aside from giving me conflicting dietary restriction handouts, I received mainly “crisis intervention” With out a doubt, there is a lot of info. to digest in your articles. I am just now, understanding how to be a “successful patient” I am currently working with a nephrologist, We are in the process of understanding the “cause” of kidney stones in my case, through (urinalysis), So I can work toward “prevention”. My nephrologist was very encouraged, when I mentioned your name, He asked me “is Fred Coe a friend of yours?” I replied “no” “I have been reading the info. on his website” Things instantly started to “click” between myself and the Dr. at that point! I plan on using the info. you have provided, in the future, as a “guide” to work toward “stone prevention” For now I have three specific questions: Is “Wheatgrass” a known “high oxalate” food source? Should it be avoided? What is the best info link to access the “Harvard” list of low-oxalate foods? Thanks a Million, James J.

    Reply

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