How to Eat a High Calcium Low Sodium Diet

Many patients assume that they are forming calcium stones and should therefore limit their calcium intake. That assumption could not be more wrong. Low calcium diet won’t stop your stones and may even increase your risk. Lets not forget that our bones are in desperate need of calcium to avoid osteopenia and osteoporosis.

But, many of the best foods for calcium are also high in sodium, and sodium raises urine calcium loss and stone risk.

Now what?

How Much Calcium do We Need?

The National Institutes of Health tells us age matters. Nineteen to fifty year old male or female need 1,000 mg of calcium a day. Fifty one to seventy year olds need 1,000 mg for males and 1,200 mg for females. Those above seventy one need 1,200 mg, both sexes.

We all know that much of our calcium comes from diary products. But did you know that dairy products are very high in sodium?

When we eat a high calcium food that is also high in sodium the sodium can undo the benefits of the calcium by raising urine calcium losses. This is especially true for stone formers with idiopathic hypercalciuria whose urine calcium is much more sensitive to sodium than in normal people.

So we need to search for dairy products that are lower in sodium than usual.

We also have to find what else there is because not everyone can tolerate dairy products. This means fruits and vegetables, and they may contain oxalate.

How to Read Food Labels for Calcium

All food labels are based on a 2000 calorie per day diet. Calcium is given to us in the form of a percentage.

How do we figure out how much we are getting per serving?

Take a look at the featured picture. It shows Friendship Dairy cottage cheese no salt added.

This is a great product for high calcium and low salt. On the label it tells us that per serving you will receive 10% of your daily value for calcium.

How do we convert this to milligrams?

Since we know that every food label is based upon a 2000 calorie per day diet, and gives the percent of the recommended 1,000 mg of calcium for that diet, we can just put a 0 at the end of the percent. So 10 percent is 100 mg of calcium. In this case a serving size is half of a cup. Eat more or less and the calcium from the product will vary.

Eating a low sodium, high calcium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.


We are going to continue with the example of the cottage cheese

breakstone reduced sdium cottage cheese

The low salt version of Friendship Cottage Cheese has only 60 mg of sodium per serving. The regular Friendship cottage cheese contains 260 mg/serving. This is a great sodium savings in that the ideal intake of sodium is only 1,500 mg daily.

As a contrast take a look at this product.

The label, which does not show, says a serving contains 15% of daily requirement which is 150 mg of calcium. But the sodium in that serving is 290 mg!

The Trouble with Food Labels

These Friendship and Breakstone cottage cheese products are two excellent examples of how difficult it is to distinguish between really low sodium and rather high sodium products.

The 30% less sodium label is correct, but it is 30% less than a lot of sodium. The Friendship label tells you there is no salt added, which is also true.

But the actual sodium amounts are what you want to look at. They have to be accurate by law and they are.

You have to notice the small subtleties in all food labelling. It is definitely worth the time if you want to keep sodium low while getting adequate calcium.

How to Shop for Low Sodium Dairy Products

We have to become experts at reading food labels. Don’t pay mind to the front of the package. The nutrition label is the only thing you need to look at. You want the highest calcium for the lowest sodium, and the only way to get it is by looking at the label. Sometimes this may require you to look at several brands. You may have to stop using your favorite brand.

In the beginning of this process it may seem this is a daunting task.

But before long you will become quite efficient and even a food label expert.

No Food Label?

Many of  you will shop at the deli counter or prepared food section, or eat in a restaurant. You will just have to remember that certain dairy products have a lot of salt – like cheese – and find the low sodium alternatives. When you are asking the deli counter person to cut you some cheese or the waiter to bring you a fancy cheese plate you have to ask for the low sodium varieties if there are any.

What if You Can’t or Won’t Eat Dairy Products

If you won’t maybe you should take a look at our list and reconsider. The list is ordered by how much calcium is in a serving. Dairy products win by a big margin. So if you possibly can use them, use them.

The remaining options are fruits, vegetables, fish, and supplemented foods. We have consulted the usda data laboratory charts for calcium and sodium, and our own oxalate lists to give you what we can find with modest oxalate and a high calcium per sodium ratio. We have redacted from the immense usda lists our list of the best calcium to sodium bargains adjusting for oxalate from our oxalate lists.

The list is what we think will be most useful to you. Below we highlight a few foods in each category that we specially like.

Fruits and Juices

Fruits have very little sodium when raw and fresh, so it is all about their calcium content.

The most calcium in this category will be found in one cup of calcium fortified orange juice – 366 mg. Calcium supplemented grapefruit juice gives 350 mg of calcium in 8 ounces. The oxalate in grapefruit is modest and will fit into most diets. Apple juice fortified with calcium has little oxalate and is a good choice. We emphasize that these are calcium supplemented juices, otherwise they will not do.

Some useful foods have too little calcium to make our list but are good, Pineapple juice, 6 ounces gives 84 mg of calcium. Plums and apricots are very low in oxalate and a cup gives about 70 mg of calcium. Blueberries and pears are low in oxalate and give about 60 mg for a cup. Peaches give about 50 mg of calcium/cup.

Fish and Seafood

Sardines, no salt added, have about 150 mg of calcium and 50 mg of sodium in a serving. Three ounces of canned salmon provides 212 mg of calcium and 64 mg of sodium. Most other fish, even fresh, have about 80 mg of sodium for every 120 mg of calcium, which is not a great ratio. Crustacea have very high sodium levels even when fresh.


From the list, here are a few highlights.

Kale, frozen, boiled, and drained without salt has 179 mg of calcium, 20 mg of sodium and little oxalate – a great bargain. Mustard greens, frozen, are low in oxalate and have 152 mg of calcium with 38 mg of sodium. Chinese cabbage (bok choy) has 158 mg of calcium and 58 mg sodium in 1 cup, and very little oxalate.

Several foods are too low to make the list but are tasty and can be used. Winter squash gives 80 mg calcium and 8 mg sodium in one cup. Raw onions have little oxalate but 72 mg of calcium and 8 mg of sodium in a cup. Cowpeas, if you find them, also known as black eye peas,  have 184 mg of calcium, and 27 mg sodium in a cup.

So Now What?

You may not like what I am about to say but that’s not going to stop me from saying it. For people who choose to avoid dairy products by choice or because of lactose intolerance or food allergy, it is difficult to get enough calcium into the diet without an excess of sodium and in the case of fruits and vegetables too much oxalate. There is one usable alternative milk and yogurt product: coconut. Soy and almonds are too high in oxalate.

That leaves supplements. We have already mentioned calcium supplemented juices. Pill supplements can be used – check with your physicians – but only with substantial meals. Taken without food they can raise urine calcium a lot and it is not clear that bone cells will use the calcium. So used improperly supplements can increase stone risk. With meals, supplements can and do lower urine oxalate.

Eating a low sodium, high calcium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.


29 Responses to “How to Eat a High Calcium Low Sodium Diet”

  1. Linda Santomenna

    Dear Dr. Coe, Thank you for your wonderful resources! I was wondering if you have any thoughts concerning Vitamin D supplementation for IH patients? My vitamin D is quite low and I do now have osteoporosis. My nephrologist has given his blessing to 10,000 IU/day for 10 weeks followed by 2,000 IU/day thereafter as prescribed by my endocrinologist. The general recommendations from my Litholink report advise against Vitamin D supplementation excess, however no upper limit is given. Thank you.

  2. Jason

    Why are calcium supplements frowned upon for people with calcium stones and yet dairy products and fruits/veggies that contain calcium are not? Are they absorbed differently?
    I’m really in a bind here because I have mixed calcium oxalate and phosphate stones and suffer from osteoporosis, so I need my calcium and have always had dairy in my diet, however, since finding out about the stones, my doctor and dietician wanted me to ramp up dietary calcium intake and I’m finding the increased amount is too much for me–it’s actually making my stomach turn. I also suffer from IBS and severe acid reflux, so excess dairy is causes symptoms and I cannot drink acidic orange juice (yes, I know…my whole body’s a mess). I’ve looked into lactose free milk, however, most people don’t realize that the potassium levels in it are astronomical (I’m not sure why), and, as we know, potassium is not great for the kidneys either. Is it ok just to take a calcium supplement and if so, what’s the best ratio?

    • jharris

      Hi Jason,

      I am sorry to hear of your troubles. It is very hard to adhere to a treatment plan when that treatment plan stirs up trouble with other medical conditions. I would discuss with your doctor about switching over to supplements, but you can do this. It is true that the body does like its nutrients from food best, but sometimes that is not possible. Supplements should be taken with meals and split throughout the day.

      Thanks for writing-

    • Fredric Coe, MD

      Hi, Jason, I do not know of any reason to say that the potassium in lactose free milk poses any dangers to your kidneys. There is no evidence for your belief and you can indeed use the product. One glass of this produce contains 4120 mg of potassium, which is just over 10 mEq. A common dose of potassium citrate for stone prevention is 20 mEq twice daily. US diet recommendations for normal US citizens is 4,500 mg of potassium daily from fruits and veggies in addition to whatever is in other foods. Regards, Fred Coe


    Just wanted to say “Thank you so much” for all that you both do. I have been through 3 urologists that gave me incomplete and inaccurate information. I have had several lithotripsies and ureteroscopies. The urologists don’t seem to care and I am now extremely pro-active and research, research, research. I have not been placed on a diet but only told to stay away from nuts and tea. My current urologist never mentioned magnesium and B6 supplements and, when I brought it up, said not to bother. My last two (at the same time) 24 hour urine analyses show that I drink plenty of water and citrate and I just got cleaned out (again) and am determined never to go through the pain and expense of more stones. I did not even know I should be drinking things like Crystal Light to help me (although I was drinking it anyway in the last few months) as I can no longer drink lemon juice due to stomach upset. My sister got a referral for me for a new urologist and after some research on her I will be changing urologists again.
    My point being that one has to be their own advocate and I was very pleased watching Jill’s video that she said this. I’ve learned so much from both of you as none of my doctors have ever mentioned high-sodium as a reason calcium can be leached from my bones into my urine (I am post-menopausal and have osteoporosis that runs in my family). Most everything I know about prevention of kidney stones comes from my own research. So everyone out there – do your own research – try Google Schoolar – and, if you do use Google, look up the doctor’s name because if it’s some place like South America, or they have ads on their page, you can’t trust what they are saying. And if your gut tells you that your health and well-being is not in your doctor’s best interest – keep changing doctors until you can find one that does care about your health. Surgery should be a last option – not the only resort.
    There is a special place in Heaven for both of you and, again, I can’t thank you enough for giving me more information that corresponds to my own research and what I have found in the last couple of months. Bless you both for getting this information out to the world!

    • jharris

      Hi Susan,

      Glad that you are finding all the info helpful. We know that the missing link is education. You are not getting enough of it and we plan on truly doing all we can to get it to you. But, yes, you are your own best advocate. If it doesn’t seem right, it probably isn’t. Thanks for writing. It is always helpful to know that we are.

      Your friend,

  4. Randy

    I have been looking for the cheeses you list on the spread sheet that accompanies this article. I cant find any brand that has calcium as high as these and/or as low in sodium. Do you have a list of some brands / products that have these levels?
    1175 247 CUP – SWISS CHEESE

    • Fredric Coe, MD

      Hi Randy, Jill and I did and I will ask her to respond separately. Regards, Fred Coe

    • Jill

      Hi Randy- I think it is because of the quantities of these products that the calcium is so high. You are most likely seeing the calcium levels not as high bc the serving size is not the equivalent to our chart-

      Thanks for writing-

      • Randy

        Thanks so much for your response. I am so grateful to have an authoritative resource like you and Dr. Coe. I understand what you are saying about the serving size, however, the serving size should not affect the ratio of calcium to sodium.
        For example, you list that 1 cup of CHEDDAR OR COLBY LOW SODIUM CHEESE has 928 mg of calcium and 28 mg of sodium. So the ratio of calcium to sodium is about 33 !!! I cannot find any cheese brand that makes any cheese (with the exception of Swiss) that has a ratio over 1.4 (see below).
        I love colby and cheddar cheese. Do you know the brand that your chart is based on? Otherwise, it seems that Boar’s Head or Tillamook swiss are the only real options

        Helluva Good Cheese Ca Na Ratio Ca=Calcium Na=Sodium
        Extra Sharp cheddar 1 oz 200 180 1.11
        Colby 1 oz 200 190 1.05
        Monterey Jack 1 oz 200 170 1.18
        Colby-Jack 1 oz 200 170 1.18
        Muenster 1 oz 200 180 1.11
        Boar’s Head
        44% lower Sodium provolone 1 oz 200 140 1.43
        Canadian Cheddar 1 oz 200 170 1.18
        Colby Jack 1 oz 200 180 1.11
        Longhorn colby 1 oz 200 170 1.18
        Swiss 1 oz 300 60 5
        Mozzarella 1 oz 150 150 1
        Reduced sodium Colby-Jack 21 gm 150 105 1.43
        Extra Sharp chedar 21 gm 150 140 1.07
        Land O Lakes
        Swiss 1 oz 200 140 1.43
        Baby swiss 1 oz 250 115 2.17
        Provolone 1 oz 200 200 1
        Medium cheddar 1 oz 200 170 1.18
        Colby 1 oz 200 190 1.05
        Reduced Fat Monterey Jack 1 oz 200 200 1
        Swiss 1 oz 300 60 5

  5. Anita

    FYI – Tropicana Trop 50 calcium fortified orange juice provides 350mg calcium, 10 mg sodium and only 50 calories in one cup (8 fluid ounces). Some people with dairy issues might like having this option?

    • Fredric Coe, MD

      Thanks Anita, The fortified juices are good. But the sugar load is a bit high so they are not ideal long term. Regards, Fred Coe

    • jill

      Anita, Hi!

      As Dr. Coe states, OJ can be a good source of a non-dairy, calcium fortified drink but can be high in sugar. Make sure you get the low sugar version and then it will be a better choice.

      Thanks for writing-

  6. Lisa Viviano

    Thank you for all your hard work. I am juggling a low oxalate and diabetic diet and I have seen so many differences in the oxalate findings. Knowing your diligent work for all of us I am confident when I follow your recommendations. Looking forward to Part II.

  7. robert hawkins

    I have had several stones, some very large, but are uric acid stones rather than oxalate stones. Should I be concerned about consuming foods with high or moderate oxalate values?

  8. Kim Gallagher

    Perfect timing! Really working on this with Jill. Any and all info regarding this topic is helpful. Looking forward to part two.

  9. Midge Gilmour

    Thanks so much for this list. I continue to follow a low salt, high calcium diet. I have found that Kroger makes a
    low carb yogurt, low in salt and sugar. I thank you for your continued research, it has been a great help to me.

    • jharris

      Hi Midge,

      Your compliment is kind. Thanks for it. Also thanks for sharing your find at Kroger. Maybe you could share the name of it so that everyone might gain from your knowledge?



  10. Michael Atella

    Thank you for your and Jill’s and colleague’s information and care. Including care enough to say what we need to hear. It helps me reduce my risk of stone forming accurately.

    A question: I am taking Allegra as needed (the antihistamine) which has significantly helped me get past bronchitis — even today. I am trying to take more water to compensate for the dehydrating effects and possible stone formation. Any thoughts or recommendations? Thanks again!

  11. Lisa

    I sent a question regarding having hypothroidism, fibromyalgia and kidney stones…and the diet restrictions for each “issue” leaves basically nothing to eat. Please advise…

    • Fredric Coe, MD

      Hi Lisa, Jill answered on the article you first replied to – on oxalate. You are now on the calcium article – not even finished yet!! – so her comment is not apparent. She sent you a reference and a an answer. Put another way you have lots to eat. Let us know if you need more. Regards, Fred Coe

  12. chris

    Thanks so much for this food list. I’ve twice had kidney stones, and was looking at dietary options from a “legit” 🙂 site such as yours. I am lactose intolerant so it’s very useful info for me. Thanks much!

    • Fredric Coe, MD

      Hi Kris, Thanks. The article is actually not finished – Jill and I had hoped to finish it weeks ago and things got in the way. What is on it is correct but there is more to come. Regards, Fred Coe

    • jill

      Hi Chris,

      As Dr. Coe said, we are not finished with this article but everything on it as of today is of course correct. I am lactose intolerant and casein intolerant so getting enough calcium by food for me is difficult. Lowering salt is such a big factor in controlling calcium levels as well, so really try to get your sodium intake to around 1500 mg/day (more days than not). No one is perfect, but have that be your goal.

      Thank goodness there are so many dairy free options these days. Kite Hill makes great products (cheese and such) and I love them, but they are made with almonds so that is a problem for many stone formers b/c of the oxalate. Super annoying.

      Dr. Coe and I will finish this article soon. Look for it and thanks for writing.



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