How To Eat A Low Oxalate Diet

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LISTS – AND LISTS

I know you are all looking for THE list. Here is one from a reliable source. We have downloaded one version on their site to a separate document so it opens with one click a useful table of oxalate foods. Get yourself acquainted with it. It will tell you much of what you need to know. A lot of it will even surprise you. You are not as restricted as you think you are or as you have been told.

A more dramatic list is the 180 high oxalate foods distilled out of the big list. Here are culprits! Not on this list? Probably not very high in oxalate so far as we know – with perhaps a few exceptions. Note that quantity is critical. For example black pepper is high in oxalate but the amounts used are small enough that total oxalate intake from it is negligible.

The reliable source, as it turns out, needed some updating. Dr Ross Holmes, professor, School of Medicine, University of Alabama, was kind enough to review the work of Dr. Michael Liebman who is a professor of Human Nutrition and Food Option at University of Wyoming and determine which food entries on the Harvard list needed changing. We cannot change the original but we have updated our lists accordingly and annotated updates with *** marks. So the lists here are the most recently edited available at present.

I have created a graph for this article. Of the 180 high oxalate foods really only a fraction are really high, and it is these you need to worry about. So here they are: These are the foods that can add up. The graph shows mg of oxalate in a common portion. The details of the portion are in the list.

Eating a low oxalate 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.

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Note how about 45 or so mg/serving the bars become repetitive, and the real action is above that point. Focus on the really high foods – they are easy to spot on this graph. Serving sizes for most of these items are one cup – for cooked spinach 1/2 cup, for almonds one ounce. Some names are truncated, but it should be obvious what they are; if in doubt just check the list.

food oxalate graph

Medical research is endlessly argumentative, and food oxalate is no exception. A recent paper contrasts findings from 6 websites and 2 applications and finds some wide variations. Because the results are hard to get from PubMed I have uploaded a PDF for you. It will open as a Google Document. Of the sites, the Harvard site -used here as our reference, and the Wake Forest site – which is a legacy of an outstanding investigative group have most standing with me. Leaf through the comparisons between them in the 4 charts and in the large table at the very end. On the whole differences are modest. The hyperoxaluria and oxalosis list from the paper has been withdrawn from their site.

DO YOU NEED A LIST?

Many of you leave the doctor’s office thinking you will never be able to eat a fruit or vegetable again. If that wasn’t bad enough chocolate and nuts are gone, too. Some of this sadly is true, most of it is not. I am here to bring you good news: Almost everything, high oxalate or not, can be incorporated into your diet safely.

Do you need a low oxalate diet? You may if your stones contain calcium oxalate crystals and your urine oxalate is high enough to pose risk.

If you do need a low oxalate diet, what is your goal? Less than 100 mg of diet oxalate is good; less than 50 mg is ideal.

If you want to read some of the science about urine oxalate and risk of stones and about how we get to the diet oxalate goals, it is summarized at the end of this article.

Here we assume you do need to lower the oxalate in your diet.

CALCIUM FIRST

Low calcium diets can raise urine oxalate, and the solution may be as simple as a proper calcium intake. There is every reason for stone formers to eat 1000 mg of calcium daily to protect their bones. The common hypercalciuria of calcium stone formers puts bones at special risk when diet calcium is low.

Before changing your whole life around, ask yourself if you are avoiding calcium foods. If so, add them back and ask your doctor to check your urine oxalate again. It may fall enough that a low oxalate diet is not necessary.

If low calcium intake is not your problem, and you need a low oxalate diet, here is my take on how to do it.

WHAT IS THE DIET OXALATE GOAL?

Typical diets contain upward of 200 – 300 mg of oxalate. For stone prevention, a reasonable goal is below 100 mg of oxalate daily. An ideal would be about 50 mg daily if that can be accomplished.

To get there, consider the oxalate contents in common serving portions of all of the foods, and make up a plan for yourself.

FRUITS

FRESH

Everyone who comes to me is very unhappy thinking they can never have a berry again. This is Baloney. The only berry that is very high in oxalate is raspberries (look at the list). On the other hand, people do not realize avocado, oranges, dates, and even grapefruit and kiwi are very high and need caution.

This doesn’t mean you can never have these healthy treats. If you incorporate any of these high oxalate fruits into your morning yogurt you can reduce some of the effects of the oxalate content.

Also look at your portion sizes. You really cannot eat a lot at any one time. Dates are not a good bargain: One date is 24 mg!

CANNED OR DRIED

Canned pineapple is a problem.

Dried fruits have to be a worry because the water is taken out, so a ‘portion’ of dried fruit can be gigantic in oxalate content. Figs, pineapple and prunes are standouts. Just think: 1/2 cup of dried pineapple is 30 mg – not a lot of fruit for a lot of oxalate. If you want dried fruit, think about apples, apricots, and cranberry as lower oxalate options.

VEGETABLES

Spinach and rhubarb are standouts; stay away.

Other vegetables you need to be aware of are tomato sauce, turnips, okra, and yams (sweet potatoes) along with beans of different sorts.

I am not in the business of taking healthy foods away from people. But in the cases above you really must limit; there is just too much oxalate and these foods do not pair well with high calcium foods the way fruits can be mixed right into your yogurt or cereal and milk.

Many of you have been told to stay away from all green leafy vegetables. This is not true. Look at the list. There are plenty of salad options still available for you including kale. Even though tomato sauce is high in oxalate (see below) that is because of concentration. A whole medium tomato is only 7 mg and who eats more than one at a time?

Many of the salad vegetables are so low in oxalate they are freebies. Eat what you want.

POTATOES

These are Trouble! I put them into their own separate group even though they are vegetables.

From french fries to baked potatoes they are very high oxalate items. One ounce of potato chips has 21 mg of oxalate and who eats one ounce? Not I. Baked potatoes are terrible. One comes in at just under 100 mg of oxalate. Mixing sour cream into the potato will not help much; one tablespoon of sour cream contains only 14 mg of calcium. One ounce of cheddar cheese contains 200 mg of calcium, which could help, but it increases calories, salt and fat. But all in all, why struggle so hard? Potatoes are not ideal for stone formers.

DAIRY PRODUCTS

They have no oxalate. They are your main source of calcium. Use them. They can add a lot of salt – cheeses – and can be caloric. But they reduce oxalate absorption and preserve your bones. 

For a stone former who has to watch salt intake, increase calcium intake, and lower oxalate intake, here is how to do that. You cannot have as much cheese as you want because of the salt. So portion sizes are very important. Yogurt, milk, even ice cream are good bargains – modest sodium and high calcium. These are a great place to add in a wee bit of chocolate – high oxalate foods – for those of you who cannot live without these high oxalate treats.

BREADS AND GRAINS

Some of the basic ingredients to make these foods are very high. White flour and brown rice flour are high in oxalate so everything you make from them will be high.

BREADS

Even so, as far as kidney stones go, breads are mainly alright because of portion size: not that much flour so one slice is 5-8 mg. French toast and New York style bagels top the list at 13 mg for two slices and 40 mg for one bagel – as much as anyone will eat of either food.

PASTA RICE AND GRAINS

Spaghetti, one cup cooked is 11 mg and most of us eat more than one cup.

Buckwheat groats, one cup cooked is 133 mg – I don’t see many of you saying ‘darn it’ or taking to your bed, but beware. Millet and bulger, wheat berries, rice bran, corn grits, and corn meal, these are widely used and are high. If you are using these, be thoughtful.

Here are some low oxalate options in this category: White rice, hummus, corn flour, corn bran, flax seed, and oat bran are popular and safe.

MEAT PRODUCTS

Since oxalate is only found in plant foods, all the meats are safe. Fish, too.

For our vegetarian friends, tofu and veggie burgers are very high.

NUTS AND SEEDS

These are just dangerous for two reasons.

Obviously they are very high in oxalate.

Secondly, I don’t know anybody who just has a few nuts at a time.

Just like chips no one eats one – the whole jar is more like it.

But, for one cup of pumpkin sunflower or flax seeds the highest is only 17 mg of oxalate and none for flax. For those of you who love foods in this category seeds are the better choice and they can be sprinkled on yogurt and ice cream.

SWEET STUFF

I have good news for my chocolate lovers. I know most of you have been sent home with a list and chocolate is high on it. But if you look at the numbers nuts are a lot worse than chocolate. Chocolate can be mixed in with dairy products, too, so as to reduce oxalate absorption.

Even so I do want to point out that half a brownie is on the high side, and who eats one half?

You can still satisfy your sugar craving but pay attention to your portion size.

Keep in mind, however, that sugar loads increase urine calcium loss which increases stone risk, so there are two reasons why this food group can be a problem.

But even without chocolate, you eat a lot of flour when you eat a piece of cake, so cake can be a problem – about 15 mg per piece, like french toast. Pies are half the risk because of their fillings  – unless they are chocolate pies!

Many of you have chosen an healthier alternative to sweeten up your coffee. Please note that Stevia is very high at 42 mg for one tsp so be careful.

CRACKERS AND CHIPS

The big enemy here is potato chips. A one ounce serving contains a whopping 21 mg of oxalate. I repeat: A one ounce serving.

Your best bet in this category if you’re looking for something crunchy is corn chips – one ounce is 7 mg, popcorn – one cup is 5 mg, and pretzels, one ounce is 5 mg.

Crackers are OK mainly because they are small and the amount of flour is not that much.

BEVERAGES

PLANT SOURCES

Hot chocolate is the clear loser at 65 mg per cup; carrot juice is the runner up at 27 mg per one cup. Lemonade, tea, tomato juices, rice dream and the like are better but still high. The are 15 – 18 mg per serving. Lemonade – frozen concentrate – is 16 mg per 8 ounces so be careful about this as a source of citrate.

Soy milk, for those of you who prefer it, is not a good option. It is very high at 20 mg per cup. We have no data from standard sources for rice milk, cashew milk, and coconut milk; almonds are high in oxalate so the almond milk product will certainly be high.

Tea is so commonly used, here are the details. If you brew your own tea it is high in oxalate. The longer you steep your tea, the more oxalate it will have in it. If you use a sweetened instant iced tea one cup has 0 mg of oxalate.

Here are some juices that are low in oxalate and better substitutes: Apple juice, apricot juice, orange juice, grapefruit juice, grape juice. For all the lemonade drinkers, diet lemonade is low in oxalate.

Here is something very important: Coffee is oxalate free – almost, 1 mg for a cup (2 mg/cup for decaf). We already told you that coffee drinkers have a reduced stone risk, so lets debunk the coffee myth here: Drink it as you wish.

DAIRY SOURCES

Everything is good except chocolate milk. Even that is only 7 mg a cup for a sweet treat here and there.

ALCOHOL

What tops the list in this category is a can of beer: 4 mg of oxalate. All the rest are low and, frankly, the oxalate in a can of beer comes with a lot of fluid. This is not the problem area for stone formers.

WATER

If I didn’t say this to you I could not sleep well tonight. Water is the clear winner in this whole category. It is free of calories, sugar, and oxalate. Please use it as your main beverage and supplement with the items above.

SPREADS AND SAUCES

Chocolate, miso, peanut butter, and tahini are all high.

SOUPS

Miso soups is extremely high – 111 mg/cup. Lentil soup is high, and so is clam chowder – the potatoes.

BREAKFAST FOODS

This is a dangerous meal if you are a cereal lover. Many cereals are high in oxalate. I am afraid you need to look them up in the list by brand. Unfortunately the healthier cereals are highest in oxalate because they contain more plant based ingredients. Probably having milk in your cereal is wise, but we have no data to show.

Eating a low oxalate 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.

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HOW DO WE MANAGE ALL THIS?

The first thing you need to do is to learn and remember what are the highest oxalate foods and beverages. Without this in mind it is impossible to shop and cook intelligently. Here is a short list of the highest oxalate foods all in one place.

BREAKFAST

For those of you who love cereal because it is quick and easy check out the list and see if the one you love is high in oxalate. If it is, choose the next best one with lower oxalate. Put milk in the cereal.

Alternatives to cereal that are also quick and easy: Yogurt or cottage cheese and fruit. The only fruits to worry about are raspberries because no one puts oranges on their yogurt. Bananas, peaches, blueberries and strawberries are perfect toppings.

More trouble, but no oxalate, eggs any way at all. Boil a batch on Sunday and have them for the week for breakfast, and snacks, too.

Your breakfast coffee is free and so is your water. For juices use orange, apple, pineapple, grapefruit  – all great. If you want tea, don’t steep more than a minute and consider adding milk to it. Green tea is better than black.

LUNCH

Typically you are grabbing a salad or a sandwich for lunch, so what now? Many clients tell me they no longer eat salads because their physicians told them to stop all green leafy vegetables.

I’m bringing salads back to you.

Arugula, iceberg, romaine lettuces, and kale, are fine as your base. Stay away from spinach. Here are good toppings. Cauliflower, corn, cucumber, mushrooms, onions, peas, scallions, squash and zucchini are all fine. Tomatoes are fine, too; it is only the sauce that is high. Broccoli and green pepper are moderately high so watch the portion size.

Sandwiches will cost you between 12 and 16 mg of oxalate depending on the bread you are using – 2 slices. This doesn’t mean you can never have a sandwich, it just means you have to keep track of how much. You can have 50 to 100 mg daily. What goes inside between the two slices of bread is usually cheeses and meats which are oxalate free. So sandwiches are not something to be afraid of.

SUPPER

Beef, chicken and fish are all fine, and those the main courses for most of us. You will run into problems if you are a pasta or potato eater. If you are you need to limit the amount of times you have these foods each week and also the quantity each time you use them. Substitutes are a problem: White rice is a nice substitute for potatoes but there are few others. It is more veggies that have to fill in – very healthy but not as much fun.

Here is a recipe for cauliflower – ‘mashed potatoes’ you will like and even think, sometimes, is the real thing. There are many versions on the web, choose the one that makes you happy but be careful about the ingredients.

There is also quinoa which is not on our lists, but may well be high. A recent scientific article on this plant does not give oxalate contents which suggests they are not reliably known.

I have recently put together a private FB page called THE Kidney Stone Diet.  It is a group that helps educate you on your physician prescribed treatment plans.  As you can imagine, oxalate comes up in many posts.  I moderate it to keep it clinically sound.  Come on over and join the discussion!

URINE OXALATE AND RISK OF KIDNEY STONES

I promised you some science – here it is for those interested. It concerns only highlights from the food – urine oxalate research recently performed and seemingly germane to the problem of how stone formers should control oxalate intake.

The most useful data about urine oxalate we have so far is from three cohorts studied by Dr. Gary Curhan. Two are cohorts of nurses one a cohort of physicians. These people have kept track of many aspects of diet and health for decades, and among their records are onset of kidney stones.

OXALATE PENTILE VS STONE RISK FROM CURHANAs he did for urine calcium, Curhan measured urine oxalate in properly selected subgroups from each cohort, including people who did and did not begin forming stones. From these samples he could calculate the relative risk of new onset of stones in relation to 24 hour urine oxalate excretion.

The two nurse cohorts are red, the physicians – all men – are blue. The dotted line at 1 is the risk threshold: Above that line, risk is present.

The top of each crosshatched bar shows the mean relative risk for each of the five urine oxalate ranges. Clearly the mean goes up as urine oxalate goes up.

But the mean relative risk has a range of uncertainty around it. The bottom of the solid portion of each bar is the lower 95th percentile for that range of uncertainty. When that bottom lies above 1, risk is very likely to be present.

For both the women and men groups, that point is reached between 25 and 30 mg of urine oxalate a day. Therefore one wants to try to get urine oxalate below 30 mg daily and even lower, below 25 mg daily if possible. The average urine oxalate excretion among the women in this study was close – 26 and 28 mg/day for those who did not form stones and just a bit higher for those who did – 28 and 30 mg per day. The men are a problem: 39 and 41 mg/day for those who did not and those who did form stones.

This is not diet oxalate, it is urine oxalate. Urine oxalate is how much the body makes and how much is absorbed from foods. Mostly, we can control only the second part – how much is in the food.

HOW MUCH DIET OXALATE DAILY

All dietary advice depends on having a reasonable goal in mind for oxalate intake. My goal of 50 – 100 mg of oxalate from food daily is not unreasonable given the research that has been done in normal people and stone formers.

Holmes and colleagues found a urine excretion of oxalate of about 10 mg/gm urine creatinine in normal Capturepeople eating a synthetic oxalate free high calcium diet (graph at left). As diet oxalate increased, urine oxalate rose from 0 to 10 mg/2500 kcal/d, urine oxalate rose steeply from 10 to 14 mg/gm urine creatinine. It rose more slowly, from 14 to barely 15 mg/gm urine creatinine as diet oxalate was increased to 50 mg/2500 kcal/d, and more or less at the same slope thereafter so that an increase from 50 mg/2500 kcal/d up to 250 mg/2500 kcal/d increased urine oxalate only from 14 to 18. The closed symbols are whole food the open symbols synthetic diets.

From this work the percent oxalate absorption could be calculated as around 10 – 15% and the contribution of diet oxalate to urine oxalate excretion as around 25 – 40% when intake of oxalate was between 50 and 350 mg/2500 kcal. Therefore one can consider a whole food 1000 mg calcium 50 mg oxalate as a usable low oxalate diet, and a 150 – 250 mg oxalate diet as relatively high.

The balance between diet calcium and diet oxalate does not matter greatly if diet calcium is high. Among normal men and women eating 1000 mg/day of calcium and 750 mg/day of food oxalate, 24 hour urine calcium was about 110 mg/day and oxalate about 44 mg/day.

If the calcium oxalate balance is altered so calcium intake is 400 mg and 20 mg of oxalate at breakfast and lunch, and 200 mg of calcium and 710 mg of oxalate at dinner, as compared with simply 333 mg of calcium and 250 mg of oxalate in all 3 daily meals, urine oxalate is lower after the high calcium low oxalate meals, but only slightly higher after the high oxalate low calcium evening meal than when calcium and oxalate intakes were balanced. This means that when diet calcium is at least 1000 mg daily the balance of calcium to oxalate within any one meal is not likely to affect stone risk.

Seiner and colleagues make clear that stone formers are different from normal people. They divided male and female stone formers into 2 groups of 93 people each, one with urine oxalate above 0.5 mmol (~50 mg) of urine oxalate daily and the other with urine oxalate below 0.4 mmol (~40 mg) daily. They found virtually identical calcium and oxalate intakes: 845 vs. 812 calcium and 101 vs. 130 mg daily of oxalate respectively in the lower and higher urine oxalate groups. But the below 0.4 mmol group excreted only 27 mg of oxalate daily on average, whereas the high oxalate group excreted 64 mg daily. In other words diet was not responsible for the higher urine oxalate excretion, suggesting a difference of oxalate absorption. Those prone to high oxalate excretion seem, therefore, to most need diet modification.

knight et al oxalate absorption and 24 hour urine oxalate scatterplotKnight and colleagues found a wide range of oxalate absorption among 38 calcium oxalate stone formers eating a self choice diet. Urine oxalate excretion (vertical axis) varied with percent of diet oxalate absorbed (horizontal axis). The mean absorption centered around 5%; a few outliers absorbed over 15% up to 25%. This supports what Seiner found – some stone formers will have urine oxalate levels very responsive to diet oxalate and sans a research protocol we will not know. This is another good reason to keep diet oxalate low – 50 to 100 mg if possible.

PROTEIN AND GELATIN

Diet protein intake does not affect urine oxalate excretion. In 11 normal people fed a 1000 mg calcium, 51 mg oxalate, 3000 mg sodium fixed diet, varying protein intake from 0.6 to 1.6 gm/kg/day – a very wide range – did not alter urine oxalate appreciably (mean values were 23, 23, and 25 mg daily for the three protein intakes) even though oxalate precursors like glycolate rose markedly (25, 22, and 46, mg daily).

Jello is a source of hydroxyproline which converts to glycolate and oxalate, and oral loading with gelatin can raise urine oxalate. Ten normal people eating a 1000 mg calcium, 150 mg oxalate diet (typical normal level) were fed supplemental gelatin as one quarter of daily protein intake. Urine oxalate was 24 mg daily vs. 17 mg daily when the same diet was supplemented with whey protein – containing little hydroxyproline – as a control. So lots of jello is not an ideal plan for stone formers. 

Where does this leave us about how much oxalate is alright for a day. If diet calcium is high, as it should be, at about 1000 mg, then one should try to limit diet oxalate below 100 and even to 50 mg daily. Perhaps this is most important in those patients whose baseline oxalate excretions are higher – in the range of above 40 mg daily.

Eating a low oxalate 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.

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527 Responses to “How To Eat A Low Oxalate Diet”

  1. Vicki

    I am contemplating bariatric surgery and the after surgery diet is highest in meat protein (60-90g a day). According to your list this shouldn’t be a concern but my urologist (after 1 calcium oxalate stone) gave me a list that said don’t eat animal protein. I’m confused on why not to eat meat and the best way to get protein if it should be restricted. Thanks for any advice.

    Reply
    • Fredric Coe, MD

      Hi Vicki, The physician was concerned that protein loading would increase urine calcium and promote stones. That is true but plant protein will do just as animal protein. If you want to use low carb high protein diet for weight loss the source does not matter. Bariatric surgery raises risk of stones because urine oxalate frequently rises considerably. Be sure and discuss this with your physicians. Sorry I have not as yet written an article on this site about the matter. Regards, Fred Coe

      Reply
  2. Erin

    I’m wondering if you have data regarding the oxalate content of various spices (i.e. tumeric, cinnamon, ginger, cayenne) and herbs. Thanks, Erin

    Reply
    • Fredric Coe, MD

      Hi Erin, I will ask Jill Harris to answer this one. Regards, Fred Coe

      Reply
    • jill Harris

      Hi Erin,

      Cinnamon is ok, tumeric is high. Ginger too tends to be a bit high. Do not know about cayenne. You can use the spices that are high here and there. Just like any food that is high, use it sparingly. I know the tumeric thing bums a lot of people out because it is very healthy and very “in” right now.

      Eat a normal amount of calcium and you can get away with eating these higher oxalate products.

      Hope this helps-
      Jill

      Reply
  3. Mark

    I am still sorting my diet out and learning. Searched through the paper and all the responses for foods that have oxalate in them. What about nonsoluble oxalate? One example ground cinnamon is high in oxalate but non soluble unless I am mistaken.

    Reply
  4. Vinny

    hi, i am 54 years old. i suffer from kidney stones both calcium and uric acid. i have passed 4 stones that were between 5 and 6 mm. i also had the shock wave procedure to break one up and also spent 2 days in the hospital getting another one pulled out. all this in the past 15 years. the stones have appeared on both sides of my kidneys. i also suffer from gout. my first attack was 2005 on my toe. since then it has progressed to my ankle,knees and shoulder. my gout attacks have become more intense,frequent and last longer. i am careful in what i eat and drink. no beer, alcohol, meat or shellfish for the past 12 years and yet i still suffer. i am at a wits end. i am constantly reading but i still suffer. no idea on what else to do.

    Reply
  5. Karen

    Thanks for a fantastic and informative site. I have a comment and a question. As a person with kidney stones, who has been put on a low-oxalate diet combined with potassium pills, I have been seeing a urologist and dietician at a reputable Canadian hospital for stone sufferers in Toronto. One thing that’s helped me is drinking Rooibus Tea (grown in South Africa) instead of black or green teas. I’ve been told it has no oxalate and that its green version is even better than its red (the more commonly found.) On my last visit to this hospital, I was told that there have been changes to the diet (they, too, follow the Harvard list) and that it’s now considered acceptable to eat beans, and grains like brown rice. I’m confused after reading this site. Do you suggest I not eat beans and brown rice? As well, I had been eating sweet potatoes. Should I stop? I’ve been almost religiously combining my food intake with yogurt and / or cheese. Thank you, Karen

    Reply
  6. Leo Ortega

    Just want to throw this out here to ponder on. Being diabetic, about three years ago I switched to Stevia in its powder form as a sugar substitute. I used a couple of different brands, Truvia being one of them. I only used two packets a day for my morning coffee and soon after, my kidney stone problems began. I never put two and two together and did the meds my doctor gave me, had a few kidney stone procedures, and was even hospitalized for 5 days once when a stone caused an infection in the duct between my kidney and bladder that spread. After my second 24 hour urine test, it was determined that I needed to cut down my oxalate intake. Hardly any of the foods in the above chart were in my diet as it was, except for the stevia. I immediately cut out the stevia from my diet and have been using raw sugar instead. I am happy to say, it has been over 6 months and there is no sign of those nasty rocks in my system. I know everyone’s body chemistry is tuned a little different, but it would be hard for anyone to convince me otherwise that stevia was the culpable party.

    Reply
  7. StanTheMan

    I really enjoyed the info on oxalates. I would like to echo the other posters’ collective confusion. Many (and i dont mean 2 or 3) websites claim that avocados are low-oxalate food; but you state above “avocado, … are very high and need caution.” And not just “high” but “very high”. The Harvard study could be wrong — just because it was published in a peer-reviewed scientific journal doesnt make it correct, i am sorry to say. i am a scientist myself, and i can tell you that a published paper could easily be refuted by another paper published later. You not only have to study that specific paper, but ALL the papers that cite the paper in question, which means you would have to do a thorough search, and keep up with the research trends. Moreover, you say you had success treating your patients based on the study, but i am not sure if this is really anecdotal, or for a statistically meaningful sample. The other problem with the sample, of course, are age and demographics. In any case, i still enjoyed reading all the articles on this page – keep it up. In the mean time, i will be on the fence when it comes to avocados – and i am not suggesting they are completely devoid of oxalates, just not sure what “very high” means

    Reply
    • jill Harris

      Hi Stantheman!

      I know these lists are confusing. When I work with patients privately or within group settings I advice them to indeed enjoy avocados. They are healthy. I know they are listed as high, and of course, depending on the source, the food itself, the soil conditions in which it was grown, the amounts can vary.
      My advice to all is that you typically have a bank of 100 mg of oxalate a day to draw from. How you decide to make your withdrawals is up to you. I tell them that eating avocados are healthy, keep it within moderation, and you will be fine. So all my clients eat them. They are also reminded to get their normal values of calcium per day as well to help with the absorption of oxalate.
      Hope this helps.

      Jill

      Reply
  8. Bob S.

    I have stones that are a mix of calcium oxalate and phosphate. My doctor has made me do a few 24 hour urine tests and they all show high levels of calcium in my urine, a normal to low-normal citrate level and non-existent urine oxalate levels. I’ve since increased my water intake to over 3 litres a day and have limited my sodium to 1500mg/day suggested on your blog (my doc says 2300mg/day is ok), but limiting oxalate seems to be the biggest challenge. For example: the other evening I went out to dinner and ordered a salad that was not supposed to have spinach in it, but I ate it because I was starving and it would have been impossible to change the order. I read somewhere that combining high oxalate foods with calcium can help, so I ordered a glass of milk to eat with the salad. This just seems strange and ridiculous to me to be panicking. If I am not excreting oxalate in my urine, does this mean that I still have to follow a low oxalate diet? I’m not sure I understand how calcium, oxalate, sodium and citrate all tie together.

    Reply
    • jharris

      Hi Bob,

      Read the kidney stone prevention diet on this site and you can learn how it all ties together. You do NOT need to worry about oxalate if your urinary oxalate levels are ok. You need to do a 24 hour urine collection to make sure that is the case.

      Best,

      Jill

      Reply
  9. Alex

    Hi,

    My main issue is trying to balance low-oxalate diet with low-sodium diet.
    For example, cheese is good for one, but high in sodium. Same with deli meats. And many other things.
    My calcium intake is quite decent, as I like dairy quite a bit.
    Any suggestions?

    Reply
    • jharris

      Hi Alex,

      All foods can be found in low sodium varieties, even deli meats and cheeses. Make sure you really need a low oxalate diet and if you do then see how low you need to limit oxalate. You may be able to eat more than you think and this will help you with the low sodium issue as you can eat more fruits and veggies than you think, and they are of course all low in sodium.

      Get a 24 hour urine collection done to see what you really need to do!
      Warmly,
      Jill

      Reply
      • Alex

        Thank you, Jill

        I’ve had my 24hr urine done twice in the past year. First time oxalates were low (22), but sodium was normal (124).
        Second time, oxalates were high (43) and sodium high (241). So my doctor advised to follow low oxalate, and if possible, low sodium diet.
        My stones are CaOx.

        Reply
        • jill Harris

          Hey Alex!

          So you can see how you vary from day to day. What you put in your mouth shows up on your report. If you had just done the one collection, you would not think you have much of a problem. Now you know that depending on the day and what you are eating, it varies.

          If you form CaOx stones you need to keep your fluid output to at least 2.5 liters per day. Sodium less than 1,500 mg/day, and keep oxalates to lower than 100 mg/day. Calcium for you, 1,000 mg/day. That is your goal. If you need help doing that, considering taking one of our prevention courses (jillharriscoaching.com/course) You will learn the “how” part of the equation. And you will have a heckuva lotta fun too!

          Warmly,
          Jill

          Reply
  10. Lisa

    Thank you for this resource! My question will be appropriate but a little explanation…I have a life long struggle with constipation. Lower back and abdominal pain these last few years resulted in ultrasound which showed constipation. My more recent CT scan in ER for kidney stones (2- 4mm, 4 smaller,calcium oxalate) and 2 subsequent KUBs also showed constipation. My Obgyn. suggested Benefiber a few years ago and it does help me a lot. I didn’t use every day but for a week at a time here and there. Other measures that have helped don’t seem good for kidney stones, smoothies, brief period of a vegan diet, etc. I also have osteopenia. I am trying to increase calcium, lower salt, drink a lot of water, stay away from high oxalate. My question is I would like to use Benefiber again, but it is wheat dextrin. My general practitioner suggested there may be more benefit getting bowels under control and using it vs. risk of kidney stone development. My urologist could not answer whether to stop using or not. I also contacted Benefiber and they referred me to my urologist. Do you have any knowledge of this product? Would it help to maybe use it in milk or calcium fortified OJ, etc.? Is there another product that might be better?

    Reply
    • Fredric Coe, MD

      Hi Lisa, The preparation is simple fiber and should be neutral with respect to stones. I would use it. Regards, Fred Coe

      Reply
    • Raul

      I use HEMP FIBER, it does not give any problems that I can tell from my experience, nor does it give you gas nor bloating… unlike the other bottled fiber suppliments!

      Reply
      • jill Harris

        Thanks for sharing that Raul. We love it when others jump in to help and offer advice.

        Jill

        Reply
  11. Emily

    I’m new to all of this and feeling very overwhelmed, especially with the dietary restrictions. I have other chronic conditions that require dietary modifications/restrictions. I’m off completely: gluten, dairy, corn, potato, peanut, canned everything, top-of-the-food-chain fish, and mushrooms. Add to that the new restrictions and rules for the kidney stones (I passed one, but the other is still in my left kidney, despite the lithotripsy), and that eliminates just about everything! Help!! I wish I knew my levels, but this is all so new…I just don’t remember.

    Reply
  12. valerie

    I am also a diabetic and am finding it difficult to incorporate the oxalate diet with how I’m suppose to eat for people with diabetes particularly when it comes to grains, beans and potatoes. I’m not sure what to substitute for bread, I can’t eat white rice, it raises my blood sugar too high so I’m not sure what to do. Any suggestions?

    Reply
    • jharris

      Hi Val,

      Incorporating a low oxalate diet depends on how high your oxalate level is? Do you know? To be safe you should keep your oxalate to less tahn 100 gm/day and make sure you get enough calcium for your age group. Postmenopausal women 1,200, premenopausal, 1,000/day.

      The low oxalate diet still has plenty of fruits and veggies you can eat. And the higher items can still be eaten within moderation.

      Hope this helps-
      Jill

      Reply
  13. ellen

    Because of kidney stones my whole diet had to be revamped. And I lost about 10 pounds. The trouble is everywhere I look, there are conflicting instructions. I stopped eating carrots, green beans, broccoli, ice cream… And I started eating avocado which you mention has oxalates. Twenty years ago, my mother was warned only against tomatoes, chocolate and nuts. I started eating less meat. But then I started eating more carbs, which is better for lessening arthritis. My arthritis is gone, but I’ve substituted it for hives caused by gluten. I’ve got rid of the hives by going gluten free

    Reply
    • Fredric Coe, MD

      Hi Ellen, I am hoping Jill Harris will offer some details for you – she is better than I. Regards, Fred Coe

      Reply
    • Hi jill

      Hi Ellen,
      You do not have to completely stop eating these veggies. You do have about 100 mg/oxalate/day to use up. So if you feel like carrots or half an avocado, please have it. It is also important to pair the higher oxalate products with some dairy if you can to help absorb the extra oxalate these foods may produce.
      Please use the list we use in the article so that you are not confused by all the different info out there on the web. We know much more about oxalate now than your mom was told and more foods have been studied. Good for you to go gluten free if gluten is bothering you.
      If you follow the info above in the article you will be ok. You don’t have to give up your favorite, healthy, foods. Eat them in moderation and with enough calcium in your diet and you will be ok.
      Thanks for writing-
      Jill

      Reply
      • ellen

        Thanks. But I’m also allergic to milk. I’ve read there is calcium in peas would they offset the carrots or the broccoli?

        Reply
  14. Roger

    Being very new at being a kidney stone patient, I have found this site to be the fairest so far, so thanks.
    So far I have quit peanuts and replaced my daily black tea with korean ginseng, which I take with a shot of maple syrup.
    Problem is, I have not yet found one list anywhere that gives me an oxalate mg value for ginseng and maple syrup.
    Am I doing well?

    Reply
    • jharris

      Hi Roger,

      I am not sure of the oxalate values of either products as they have not been studied far as I know. Without knowing your oxalate values I will not be able to tell if you “are doing well”. Make sure to hydrate, keep your sodium levels low, and get enough calcium into your diet.

      Warmly,

      Jill

      Reply
  15. Natalie

    I passed my first large stone 2 years ago, and discovered I had 8 more. I have since flushed them out. After testing, my doc advised against high-oxalate foods. I did really well for a while, but gained about 10 pounds. I went off the diet for a bit, and am now forming stones again. I’ve found even with regular exercise, I am still not maintaining the weight. He has prescribed me with UROCIT-K 15, which upsets my stomach. I would like to go back to changing my diet, but need the vitamins I am missing out on without my spinach, berries, and nuts. I was nearly vegan before. My question may be obvious, but I must ask it: Does a multi-vitamin contain oxalates as well? if they contain spinach in pill form, will it still contribute to stone formation? What about these nutrition shakes? example: shakology?

    Reply
    • jharris

      Hi Natalie,

      If there are vitamins made with spinach and higher oxalate ingredients then the pills may contain too much oxalate for you. Do you know how high your oxalate was. Perhaps you don’t need to curtail as much as you are? Also, making sure you get enough calcium is also helpful in keeping your oxalate levels down as well.

      Talk to your doc about the pot citrate pill you are taking and tell him it is giving you GI upset. It is rather common and he can help prescribe something else that will be gentler on your stomach.

      I am not sure about the shakes, again they have not been studied, so I am unsure.

      Hope this help,

      Jill

      Reply
  16. Jason

    I have mixed calcium oxalate and phosphate stones. I have had a few 24-hour urine tests and it shows that I am peeing out too much calcium. The lab value range that they use here in Canada is 1.0-7.0 mmol/d and I’m at 8.8, so higher than normal. My urine oxalate has come up undetectable all times tested. I still limit the major oxalate foods and have reduced my sodium and increased my dietary calcium. I also drink between 3 and 4 litres of water a day, however, I cannot seem to reduce the calcium in the urine.
    A few questions here and first of all thanks for taking the time to answer our questions on this site.

    1) I hate drinking as much milk as I have to in order to increase calcium in my diet. How bad are calcium supplements to take? I don’t mind having some low sodium cheese or maybe one glass of milk a day, but milk at every meal is turning my stomach.
    2) Nuts and legumes are great animal protein alternatives. How bad are they to eat and what would be considered moderation regarding them? Once a week? Twice a week? Never?
    3) I need more fiber in my diet, as some other medications I take constipate me. Is psyllium husk high in oxalate? I know I have read to avoid wheat bran, although I do have small quantities of whole wheat products.

    Thanks

    Reply
    • jharris

      Hi Jason,

      Thanks for writing. Change out the milk to less per day and add lower sugar yoghurt and/or cottage cheese. Salmon has calcium too. Google foods with calcium and you will see there are many. Just make sure they are not also high in salt (get lower sodium versions) and not too high in oxalate.
      Nuts and legumes are high in oxalate. You can have them within reason. Add almonds to yoghurt so that the oxalate will not be reabsorbed. Beans can be eaten a couple times a week if you watch portion size. It is when we overdo these products. Also, remember, it depends how high your oxalate is. Do you have to lessen much or not too much at all? This will depend on your oxalate values.
      I do not know if psyllium husk is high as it has not been studied. I use it myself and it is a tremendous help when needed. Again, if you use it a few times a week, and you are getting enough calcium you will probably be ok, but since I don’t know as it has not been studied, not sure.

      Perhaps you need to reduce your sodium even more or if that doesn’t work that doc may prescribe a thiazide med to help with the hypercalciuria.

      Hope this helps a bit. Think about taking the kidney stone prevention course too. Go here to read about it- http://www.jillharriscoaching.com” It is very helpful to patients.

      Jill

      Reply
      • Jason

        My urinary oxalate is undetectable with two separate tests so far, so I think I’m going to ease up on the limiting of dietary oxalate. My daily sodium is around 1500, with some days as low as 1000, so I think that’s pretty reasonable. I’m kind of coming to the conclusion that I am doing everything I can and have to try and balance the theoretical risk of another stone with my current quality of life (which is lacking).

        Reply
    • Tina

      My son is a calcium oxalate stone producer. We are working on changing his diet. Do red, yellow and orange peppers contain the same oxalate amounts as green peppers or can they be used as a substitution?
      Thanks

      Reply
      • Jill

        Hi Tina-
        They all have oxalate- he can have them within moderation!

        Jill

        Reply
  17. Amy Nicolle

    I am vegetarian / vegan at times – how can i do this diet as it requires a lot of meat and dairy? I have tried it and definitely get a lot of benefit from cutting out the listed food, but I’d be really interested to see a vegetarian / vegan variant, if there is one please point me in the right direction 🙂 Thanks

    Reply
    • jharris

      Hi Amy,

      If you would like to remain mostly veggie, it can be difficult. I rarely do this, but you should work with someone privately to help you with this. You do need calcium, which of course can easily be found in dairy products, but there are ways to avoid it if needed. Also, protein is NOT recommended in high amounts and can lead to stone disease. I have worked with many vegetarians and it takes more than a reply here. Let me know if you would like more help. You can also go to my website at jillharriscoaching.com to learn more and contact me there. Let me know if you have done a urine collection too so I can see what your values look like.

      Warmly,
      Jill

      Reply
  18. Vince

    Can I ask about Optimum Nutrition Chocolate Protein powder and chocolate almond milk? For the last 2-3 weeks or so, I’ve started every day with a cold brew coffee, one scoop chocolate protein, and about a 1/4 cup chocolate almond milk. (Previously I had been using regular 2% milk) I just finished passing my first stone this morning. It was horrendous, and I’m wondering if this change may have had anything to do with it? In the alternative, can I continue with the morning ritual if I switch back to regular milk?

    Reply
    • Fredric Coe, MD

      Hi Vince, Sounds like trouble but I will ask Jill to handle this one. Regards, Fred Coe

      Reply
    • Jill

      Hi!

      Can’t be sure since I don’t have a 24 hour urine collection on you- but would say if you have an oxalate problem then the almond milk won’t help the situation. Have you done a urine collection?
      Go back to regular milk until you know for sure-

      Jill

      Reply
  19. William

    brussel sprouts also at two ends of the scale in ‘low oxalate cookbook’ and here…. how is this possible?

    Reply
  20. William

    in the comment below please substitute strawberries for oranges!! sorry

    Reply
  21. William

    Apologies for previously asking a question that had already been answered earlier.

    I think I am just looking for clarification as to how testing has been done in your studies relative to those of Dr Liebman and which studies are most up to date? This is an important issue as could be consistently slipping up in their consumption of what they believe to be low oxalate foods (that are actually high) and avoiding others such as strawberries, which, according to your data are ‘low’ in oxalate. This is an extremely important point as most people trying to follow a low oxalate diet refer to the ‘low oxalate cookbook’ or website which themselves quote from this source. To have some healthful foods at completely different ends of the scale in two ‘reputable’ lists is worrying and needs clarifying.

    thanks again for your feedback

    Reply
  22. William

    Dear Dr Coe,

    I was hoping you could tell me why there is a disparity between oxalate values for turnip, avocado, pumpkin seeds and sunflower seeds (among others) in the data you present and that of Dr Liebman in the low oxalate cookbook. These are all high in oxalates per serving in your data but either ‘low’ or ‘medium’ int he low oxalate cookbook. I’ve already planted up my garden with a fair bit of turnip!!

    many thanks

    Reply
    • Fredric Coe, MD

      Hi William, I have referred your questions to Professor Ross Holmes, a world authority on food oxalate who also helped curate the lists on this site. I am hoping he has time to answer. IF he cannot, I will attempt to find answers but do not have his extreme expertise. Regards, Fred Coe

      Reply
      • William

        Many thanks

        Reply
      • jeneese hilton

        I have osteoporosis and would like to know how to get enough calcium without too many oxalates in my diet. I am 75 years and female

        Reply
      • Jenna Brooks

        I have the same question. Much of the advice here is directly opposed to other sources that say, for example, that strawberries are high in oxalates, that caffeine must be avoided, that avocado is low oxalate, etc. What are the sources here? How could one expert say that something is at one end of the spectrum and another say it’s at the other? Isn’t there any hard data to define this?

        Reply
        • jharris

          Jenna,

          It is confusing to say the least. We understand your concern and frustration. Depending upon where a plant has grown and what soil conditions it found itself in will effect the oxalate content. The list we use and suggest for you is from Harvard. We highly recommend using only one list and sticking to it. The reason we promote the Harvard list is because we have been using it for our patients for many years, and we trust it as our patients do lower their urinary oxalate. This, along with incorporating the right amount of calcium into your diet will help.

          But, please make sure you do need a low oxalate diet. Have you done a 24 hour urine collection?

          Hope this helps-

          Jill

          Reply
  23. Mike O

    I greatly appreciate the synthesis of divergent and sometimes conflicting information provided by this overview! I have independently found many of the same source information, but the informed analysis is extremely helpful.

    And now, a question: I’ve always wondered how food oxalate levels are measured for these studies. Is there an agreed upon methodology that the various studies use, similar to calorimetry for caloric value? And, admittedly a long shot, is the methodology home-replicable? There are some foods that I’ve never been able to find on any list, and it would be very good to be able to determine their oxalate levels instead of avoiding them due to the lack of information.

    Thank you!

    Reply
    • Fredric Coe, MD

      Hi Mike. Do do food oxalate is very complex lab work and doable at home only if you have a well equipped lab and are well trained. But food oxalate need not be so picky – it is old fashioned. If your diet has the recommended amount of calcium urine oxalate will fall a lot and often food precautions become much less. Take a look. Regards, Fred Coe

      Reply
      • Mike O

        Dr. Coe,

        Thanks for your response. I figured it was a long shot to test at home.

        I appreciate the reference you link to, and have re-read it. What’s funny is that, after receiving this document (https://www.dropbox.com/s/7f8o4ukiv9k9wb5/Oxalate2008.pdf?dl=0) from my urologist (it’s only available digitally via the Internet Archive’s Wayback Machine that I can find), I asked him if a 24 hour urine test would tell me what kind of hyperoxaluria I had, if any to better understand what “group” I fit in for restrictions. He asked, “Why? So you can cheat?” >:(

        Reading your post, I’m still not sure if stone composition (stone analysis) or urine analysis is more indicative of how oxalate-restrictive one must be? Or is this getting in the weeds enough that I should set up a one-on-one consultation with Jill?

        Thank you again!
        Mike

        Reply
  24. Laura

    Dr. Coe, I appreciate so much this information. My husband just came home from the urologist today with news of 3 more kidney stones. It has been 7 years since his last stones were removed in 2010. They were oxylates. Nick is pushing age 70. He has never been good about drinking water. Doesn’t like to pee all the time. Besides being a stone former he produces a lot of cholesterol and his HDL/LDL ratio is not good and he had a quad bypass in 2009. A strict vegan diet is very important to control the cholesterol. Today his urologist again gave him a list of allowed foods and foods off limits. He wants Nick to drink enough water to pee 2 quarts a day and to limit his calcium intake. Being vegan his source of calcium and protein is nuts, beans, soy milk and tofu and whole grains to give him a complete protein. Is it OK for him to take a calcium citrate supplementation to help get the calcium intake up to the MDR? If these two diets aren’t difficult enough, I am also near 70 and have the beginnings of macular degeneration and all the foods I am supposed to eat are off limits for him. Help!

    Reply
    • Fredric Coe, MD

      Hi Laura, I am afraid I do not fully agree with the suggested treatment. Here is a more modern approach to stone prevention which may be easier to use. Here is a special focus on the low oxalate diet issue. Regards, Fred Coe

      Reply
      • Laura

        Thank you so very much for all the work you are doing to educate us, the public. I have been all over your site and am learning so very much. One thing I have noted is the great variation in values attributed to various foods. We will prefer your charts but are unable to find values for many foods we find important in our vegan diet. Do you know of a more complete source for food values? We are adding supplementation: 250mg of Calcium Citrate BID, increasing water intake to 3 quarts/day and limiting sodium intake to 1500mg/day. I came across a post re. Magnesium supplementation and wonder if it would be helpful to add in perhaps 200mg Magnesium Citrate to this plan. He is already taking D3 supplementation but his D levels have not been measured for at least 2 years. The last level was 40. Thank you again. Laura

        Reply
        • Laura

          I would like to add that the above supplementation is taken with meals. Thank you. Laura

          Reply
        • Fredric Coe, MD

          Hi Laura, The charts I put up arose from the Harvard lists and we added and corrected. I do not believe better charts are out there – there is a lot of variability and some errors on the web. I do not think you need to be so fussy about oxalate. Is your urine oxalate high? How far above 25 mg/d is it? If the calcium comes right with the meals, urine oxalate will be low, and if you really keep sodium low the urine calcium will stay reasonable but you must check to be sure. With high calcium and low sodium diet oxalate precautions needs be only moderate – less than 200 mg/day should be fine. Magnesium has no role I know of. Vitamin D levels are best kept in the normal range so retest. As a rule look to the whole 24 hour urine panel, not just oxalate. Regards, Fred Coe

          Reply
  25. David

    Hei!, this article its very interesting, I was diagnosed osteopenia recently, the worse is that I’m a 36 years old man. And I’m trying to find the perfect diet. I read that oxalates and calcium didn’t match, and I read its good to reduce oxalates for osteopenia. But I have a question, does the oxalates avoid calcium to be assimilated in the body or bones? The thing is, for osteopenia I must eat certain food, for example spinach are really good for me, but high oxalates. The thing is, if I avoid eating together calcium and oxalates is fine?, or eating them together does not affect to the kalcium? If its better separate, how many hours in between?, thank you. David

    Reply
    • jharris

      Hi David,

      In order to absorb oxalate, calcium must be eaten with the oxalate product. For example, have a few almonds with your yoghurt. Of course you must get in enough calcium with your history of stones and bone disease. Have you done a urine collection? Do you know how much oxalate was in your urine? If you do have an oxalate problem (maybe you don’t, maybe by eating the correct amount of calcium you won’t need to worry about oxalate as much) please do not eat spinach as it is very high and not worth the trouble.

      Warmly,
      Jill

      Reply
  26. Lisa

    Hello. Thank you so much for all that you are doing to help everyone here. You are both so kind and it warms my heart to see how much you are helping people through this post. I am looking for guidance. For about 8 years I had Interstitial Cystitis, but DR.s didn’t know what it was at the time, which is why it took so long to treat. I finally gave up on Western Medicine and did my own work to figure it out. I treated it naturally, cleansing, and with a Natropath as well. It took time, but it went away for 3 years. As of one month ago it came back. Along with a yeast infection/bacteria infection in my vagina. I think that triggered the IC. The pain was so great and scary. Through limiting my foods and research I began to notice that the pain got worse when I ate foods that were high in oxolates. If I stayed away from high oxolate foods, the pain and burning went away. I’ve seen other sites where they are saying IC it is connected to high oxolates. I am feeling this in my own body. I have been a “healthy” eater for years..all the raw spinach, chia seeds, stevia, quinoa, raw chocolate…my whole diet has been pretty much high oxolate and I had no idea this was even thing. I’ve searched this site for any help with people with IC and oxolates but haven’t seen much. I trust the information here, more then what I have seen elsewhere. Can you please guide me, direct me to help with my bladder and oxolates? Also what testing do you recommend I do for this and to make sure there aren’t deeper issues? A big concern I have right now, which is what led me to this site, is this thing called “oxolate dumping”. Everyone makes it sounds scary and I may have had it this morning, as I was feeling good for a few days, on a low oxolate diet, and then at 5 am woke up with bad burning on urination and afterward, and this intense anxiety feeling, which they say is common. My urine does look cloudy at times. So “they” say not to go all low oxolate at once, step it down slowly. So today I ate boiled carrots, hoping this would add some “medium” oxolates in. Anyway, what do you know about this oxolate dumping thing? Any place you can direct me that you think is a good source to deal with this? Im feeling fear, as I dont know what to do with all of this. It’s overwhelming, am I even on the right track? And I’m hungry. Been living on vegetables and flax seeds and coconut oil for a few days to keep pain levels down. It’s worked, but I know can not last eating like this. Im ok eating Salmon, but worried its acidic and will make my bladder burn, which is why I’ve been eating all alkaline. Trying to balance the IC diet with the oxolate diet, I feel like Im more stressed out trying to manage all of this. My apologies for the length of this, I want to get it all out for the best possible information. God bless you and this website.

    Reply
  27. Judy Bell

    Opinion on alkaline water, and did’nt see mention of pinto beans. Thank-you Judy

    Reply
    • Fredric Coe, MD

      Hi Judy, I looked at recipes for the stuff. Alkaline water is just water to which one has added some chemical buffers such as sodium bicarbonate and often lemon which, though itself acid, contains some citrate that can be metabolized to bicarbonate. Obviously the sodium loading can be a problem. What matters about alkaline water is simply how much actual buffer is in it. One I saw used a teaspoon of sodium bicarbonate in a half gallon, or a bit below 2 liters. The teaspoon of sodium bicarbonate weighs seven grams, which is 0.083 mole or 83 mEq, a huge amount of alkali! By comparison a standard dose of potassium citrate would be 40 mEq. It is also a massive amount of sodium. The tolerable upper limit of diet sodium is 100 mEq, so that 2 liters would be the day’s supply of sodium. I guess from my first glance this is not a very good idea. Regards, Fred Coe

      Reply
    • jharris

      Hi Judy,

      I don’t have concrete numbers on pinto beans so I assume all beans are high in oxalate. Please eat them in normal portions and once a week to be safe.

      Warmly,
      Jill

      Reply
  28. Gary Hennis

    I really appreciate the info I’ve found here, however I’ve read in a few places where the amino acids in animal meat are broken done by the liver and one byproduct of this process is oxalate. So I’m wondering if anyone has any kind of a table/info on this ~ie 1/4 lb red meat while not containing any oxalate itself will produce say, 100mg of oxalate when it is digested. I’ll keep looking but at the moment I only know that I’m a hereditary stone former, had so many over the years that I’ve lost count and after this most recent batch I don’t want them anymore, I’m moving to a goal of 50-75mg of oxalate a day, potatoes are gone 100%, I love how I can still have a few nuts as long as I monitor their intake. I’m also eating so many lemons and limes that I’ve started growing lemon and lime trees indoors. I ask about the meat because my wife or I don’t want to give it up(studies about eating for my bloodtype say to give up non-aquatic animal meats entirely). I feel I should be able to eat some so long as its a “safe” amount.
    Thanks.

    Reply
    • Fredric Coe, MD

      Hi Gary, Glycine is processed to oxalate but the actual slope of urine oxalate on protein intake is very modest. If one stays in the recommended range of 0.8-1 gm/kg/day protein is not a factor of importance. My question is why all the fuss about oxalate? Modern thinking would have one be sure of a few things in advance: Are stones calcium oxalate, is urine oxalate high, has increased diet calcium been put in place to lower urine oxalate? Take a look. Regards, Fred Coe

      Reply
      • Gary

        I had a stone analyzed years ago and it was a calcium-oxalate stone, I don’t recall the concentration and I am planning on having these newest stones analyzed. Thanks again for all the great info, I am discussing the low oxalate diet with my doctors as well as increased calcium intake.

        Reply
  29. Susan

    I have looked at the links above, “reliable source” and “Useful table of oxalate foods” and there is a huge discrepancy between the two with regard to brussel sprouts. Reliable source says very high at 17, and oxalate food table says very low at 2. Help! This is one of my favorite veggies and since modifying my diet I’ve been eating many little sprouts per day. Now I’m panicked that I’ve just created more stones!

    Reply
    • Fredric Coe, MD

      Hi Susan, Begin with whether you even need this diet. Take a look. If you do, how far are you from the goal? In general if you do low sodium high calcium diet your diet oxalate can be up to 200 mg/day which is avoiding only the higher oxalate foods. But I will also ask Jill Harris to answer about sprouts. Regards, Fred Coe

      Reply
    • jill Harris

      Hi Susan,

      You will note that the higher number is because we had found newer research that indicated that they are high. You can still eat them, do it within moderation and you will be fine. Do you know how high your oxalate level is? Don’t panic, limit them to a reasonable amount, get enough calcium per day, lower your salt, and of course keep your fluid intake high!

      Warmly,
      Jill

      Reply
  30. Theodore Flandreau

    im 60 yrs old.. 4 yrs ago i went vegan and i lost 50 lbs…ive been getting calcium stones since my 20’s….yesterday i had my 8th one…3 mm’s in size…of course now that im vegan all i eat is every high oxalate …smoothies..juicing..nuts…spinach…kale….i feel great…i look great..
    nothing hurts on my body….EXCEPT THESE DAMN STONES!!….i so tired of fighting this battle…and of course this article and blog you have is making me even more confused..
    my urologist told me 10 yrs ago that none of what you eat matters…he said ‘i dont care if you eat twinkies and spinach 24/7 just drink enough water and youll be fine” …well i’m guilty of not drinking enough water thats for sure…if i drink the amount that im supposed i will be peeing every half hour and i dont have time for that based on my job…christ all mighty isnt there a PILL i can take??….i do drink ACV and lemon juice water every morning but im still getting stones……..HELP ME!!!!!!

    Reply
    • Fredric Coe, MD

      Hi Theodore, First, get the stones analysed. Then get a full evaluation. Here is a nice plan to follow. It may well be that the oxalate loads matter, it may not. Be sure and collect your urine samples while eating as you always have eaten. Don’t change things and don’t assume. Just measure. Things will become obvious when the labs and stone analyses both are available. Regards Fred Coe

      Reply
    • jharris

      Hi Theodore,

      Sorry for all the trouble these darn things are causing you and have been for such a long time. That concoction of ACV and lemon juice is not the cure all for stones, although I know many people are drinking it. Have you don’t 24 hour urine collections? This will tell you what is going on. Also, I know drinking it super hard, but stones are way worse. Your pick on this choice. Shoot me an email if I can help more at jharris1019@gmail.com.

      Warmly,
      Jill

      Reply
  31. Al R.

    Hi Jill,
    I noticed that the Harvard list reports that a medium baked potato with skin has 3x the oxalate as a cup of mashed potatoes, but it seems like the weight of potato is probably in the same ballpark.
    I’m wondering whether simply skinning potatoes could reduce the oxalate by 2/3?
    Do you happen have any more data on this? Sounds too good to be true!
    Best regards, Al

    Reply
  32. BDee

    Thanks for this article.

    I was diagnosed prediabetic so I changed my diet to lower the carbs. To replace the calories from carbs I’ve been eating more protein, but also pistachios, almonds, pecans, and walnuts, along with avocados. I only eat one serving of each every day, but all these are high in oxalate, as are the oranges and several other things I eat daily.

    This morning, after about 4 weeks on this diet, I woke up and in my first trip to the bathroom my urine had small orange and shiny crystals in it. I had a calcium oxalic acid stone exactly 10 years ago and have limited my nut and spinach, etc, intake to prevent another one.

    What the heck am I supposed to eat if I can’t have the foods to replace the calories I used to get from the carbs? I don’t want another stone but I need to get to 2400 calories a day and it’s hard to do that even without removing nuts and avocados, etc from my diet.

    Will drinking massive amounts of water help me to prevent a stone if I keep eating the nuts? I don’t know what to do.

    Reply
    • jharris

      Dear Bill,

      I hear your frustration all the way here in Chicago. I understand. You need to be able to put both diets into play. You simply need education. You can still eat your healthy foods and keep stones at bay by learning how- it is indeed complicated but very doable. This website and getting help from a live person to teach you will help. Many times you do not even need to lower your oxalate if you getting enough calcium and keeping your sodium levels low. I teach a course for a very low price to actuate what Dr. Coe and I write about. Please find the course at jillharriscoaching/course and please continue reading the website. Dr. Coe will be releasing a wonderful article tomorrow, please come back and check it out.

      Jill

      Reply
  33. Eli

    I have a history of stones about every 4 years. Since my last episode in November of 2016, we did a 24 hour collection and come to find my Oxalate is high and my Calcium low. I’ve never been a dairy person so that can explain the low levels. I’ve struggled with weight the past 10 years but i’m on pace to be on the positive side. I’ve lost 30 lbs in the past 6 months and been doing Juicing and Smoothies at least once a day. I dislike taking medication and have now been put on an oral medication for 6 months and then do another collection.
    So my questions are 1) By increasing my dairy intake and being on the prescription, along with a healthy diet, can this help both levels? and 2) While having my drinks, any recommended fruits ( since i cant have much of apples, strawberries, raspberry’s, orange, black/blue-berries) not on the list?

    Reply
    • Fredric Coe, MD

      Hi Eli, Very low calcium diets surely raise urine oxalate, and juicing with high oxalate fruits will make it worse. I am not sure what prescription would be helpful in your situation, but higher diet calcium surely is important as is eating the fruits intact and not as a juice that concentrates everything so much. Fred Coe

      Reply
  34. dshino

    Thank you for the helpful info. I recently passed a stone with a combination of calcium oxalate and struvite. This doctor only says that the percentage of struvite is substantially smaller than the calcium oxalate. Should I try to try to eat more calcium (I have had a very low amount of calcium in my diet over the past several decades) and take a potassium citrate supplement (if so, how much, 100mg/day, etc.)? I am terrified of passing another stone. There are many 1mm tiny ones in both sides, doc says.

    Reply
  35. Bill Colbran

    Dr Coe
    My issue is not stones but oxylate deposition in my kidneys ( as diagnosed from a biopsy). My kidney problems began following the removal of almost all of my small intestine, only about 12″ remain. I’ve tried to stick to low oxylate foods as well as the diet recommended for short guy syndrome but my creatinine level continues to rise.
    Do you think there could be a link between short gut and oxylate deposition, and do you have any recommendations for the deposition as opposed to stones?
    Thank you.

    Reply
    • Fredric Coe, MD

      Hi Bill, I do not think, I know. You have extremely high urine oxalate levels from the short small bowel and are depositing oxalate in your kidneys not merely as stones but higher up in the proximal tubule which is producing kidney damage. Your physicians know all this, of course, and are doing what they can. Bring to them the idea of perhaps parenteral nutrition that might ameliorate matters, and also this publication – not yet on this site – by us about primary hyperoxaluria, which you do not have, but that creates similar tissue oxalate problems. Whatever they can do to stop the process they should do – and probably already are doing – as one can progressively lose kidney function – as they certainly know. Regards, Fred Coe

      Reply
      • Bill Colbran

        Dr Coe
        I am on TPN (2.5l for 12 hours a night) and doctors are carefully controlling such things as potassium via weekly blood draws. I appreciate your honesty about not knowing. There isn’t much overlap between low oxalate diet and SBS diet. All the good foods , ones I love, are high in oxalate!
        Suffering………

        Reply
        • Bill Colbran

          Dr Coe
          One thing I should have said is that my physician’s greatest concern is the speed with which this happened. Was stable with a Creatinine of about 2.4 for 5 months since the small intestine resection, then jumped to 5.6 in the course of one week! My nephrologist, and the specialist Short Bowel clinic at UC San Francisco have not seen this happen so fast.
          Don’t know if that tells you anything additional.
          Bill

          Reply
          • Fredric Coe, MD

            Hi Bill, I am sorry to hear about that. But if it is oxalate, not too surprising. You are at a fine institution and they know as much as anyone. Protection of the renal proximal tubule from oxalate, if that is the issue here, depends a lot on avoiding sodium retention. Regards, Fred Coe

            Reply
        • Fredric Coe, MD

          Hi Bill, It is surely the oxalate as a major issue. Be sure your physicians take a look at the article I linked for you. Many are not as yet aware of this corner of kidney pathophysiology. Regards, Fred Coe

          Reply
  36. Jackie

    I have a question on the lists that are provided within the article: spinach is listed as very high with a value of656mg (ok I get that ) but also on that very high list are refried beans at 16 mg, red kidney beans at 15mg and yams at 40mg!!?!? so why are foods that have 15mg -40 mg listed as being very high when the spinach level is 656 mg? I don’t see how they correlate???? Please help me understand

    Reply
    • Fredric Coe, MD

      Hi Jackie, I apologize for the semantics. We ran out of adjectives. We should have said astronomical for spinach and very high for the yams. Lazy speech. But we meant all are high enough to be careful. Regards, Fred Coe

      Reply
  37. Michele

    Hi, I have been asked to reduce oxalate due to kidney stones. I thought I was on the right track after having a stone removed in the spring 2016, but I have just found out that I have another stone. I also have interstitial cystitis, so my food list with both diets combined is rather narrow. Do you think the following items are ok: corn starch (need it for baking), instant organic oatmeal (ingredients include organic rolled oats, organic dehydrated cane juice solids, organic flaxseed, sea salt), and unsalted popcorn. Also…is it damaging to eat animal protein daily if the portion size is low? Thank you so much for the help!

    Reply
    • Fredric Coe, MD

      Hi Michele, I am sure Jill Harris can answer about the foods. Are you sure your urine oxalate is high? Are your stones calcium oxalate or calcium phosphate – so oxalate would not matter. If your urine oxalate was high have you already determined the extent to which a proper high calcium diet would reduce it? Before making your food life difficult, check out all of these issues. Low oxalate diet is added on when stones are calcium oxalate, urine oxalate is high enough to pose at least some risk, diet calcium has been raised to the US normal level of 1000 to 1200 mg, and urine oxalate remains high enough to pose significant risk. Regards, Fred Coe

      Reply
    • Jill

      Hi Michele-

      As long as you eat the above foods in normal portion sizes you will be fine. Have you done a 24 hour urine collection?

      Let us know-

      Jill

      Reply
  38. Karen

    I am getting conflicting information about what is good to eat and what is not good to eat. It is contradicting to what was said above. For instance – above it says you can have blueberries but in another article I was reading it is in a list of high Oxalate. Then above they are saying Avocados are only good in so many servings but the other website says you can have as many avacados, bananas, you want. Which website do I follow. Low Oxalate Diet | Patient Education | Materials | UPMC- Pittsburgh, PA

    Reply
    • jill

      Hi Karen,

      We use the list that is in the article you just read. It is from Harvard. I don’t look at any other list and I tell patients not to either to avoid being confused. I trust this list because I have been working with patients from it for 15 years and the patients I work with cease making stones for the most part. Warmly, Jill

      Reply
  39. Sumit Suthar

    i have calcium oxalate stone..
    I can Drive beer.. and eat agg and chicken
    and one most important thing I’m using Optimum Nutrition | Creatine Powder . stop using Creatine?? yes/ No

    Thank You

    Reply
  40. Stan Celestian

    We have an orange tree in our yard and enjoy fresh orange juice in season. However, I noticed on your list that an orange (1 fruit) is “very high” in Oxalate Category with an Oxalate Value 29mg. One cup of orange juice is “Low” with only 2 mg. Can you explain the huge difference in values? I would think they should be almost identical.
    Thank you for your comprehensive list.

    Reply
    • Fredric Coe, MD

      Hi Stan, Oxalate is in the rind, the juice more or less tries to exclude that part. Regards, Fred Coe

      Reply
      • Sarah Aston

        Is the oxalate in the orange peel or the white pith?
        I avoid eating either.
        Thank you for your advice. The site is wonderful.

        Reply
        • jharris

          Hi Sarah,

          As best we know it is the peel. Thanks for writing-

          Jill

          Reply
  41. K Matthew

    Hello, What do you suggest as a good protein substitute for tofu? I am vegan. Thank you.

    Reply
    • jharris

      Hi there,

      Why not try some coconut yoghurt or coconut milk? Can you get it with some cereals that are fortified with protein? If your oxalate is NOT high than you can try some other nut alternative milks.

      LMK-
      Jill

      Reply
  42. Jamey

    Dr. Coe,
    I have had kidney stones since I was 19 and have passed many. Thank you for the updated information on this site. I have avoided high oxalate foods for several years now. I try to avoid glueton as I feel better when I keep my consumption low. What information do you have, or know of, for oxalate content in alternate flours? Almond flour or other nut flours are often used in recipes I come across, but I have assumed since nuts are high in oxalates, the flours are as well. However, I have noticed that oranges are higher, but orange juice is not. Should I not be making this assumption? Potentially coconut flour, oat flour or flax seed meal/flour are ones that I think are ok. Your thoughts on this?

    Reply
    • Fredric Coe, MD

      Hi Jamey, I am sorry you have had so many stones, but you may be asking the wrong questions. Are your stones mainly calcium oxalate or calcium phosphate? Is your urine oxalate really high? The best course is to get a full evaluation – here is a good plan. If indeed your stones are mainly calcium oxalate and your urine oxalate is high the best initial step to lower the oxalate may well be to increase diet calcium. Check out the article and think about what might be best. Bring it up with your physician. Regards, Fred Coe

      Reply
    • Fredric Coe, MD

      Hi Jamey, I am sorry you have had so many stones, but you may be asking the wrong questions. Are your stones mainly calcium oxalate or calcium phosphate? Is your urine oxalate really high? The best course is to get a full evaluation – here is a good plan. If indeed your stones are mainly calcium oxalate and your urine oxalate is high the best initial step to lower the oxalate may well be to increase diet calcium. Check out the article and think about what might be best. Bring it up with your physician. Regards, Fred Coe

      Reply
  43. Steven Lareau

    Hi Doctor Coe,
    Stumbled across this site, it’s been a treasure trove of information. Just had my first 7.5 mm oxalate calcium stone laser blasted, so now I’m digging for information. Man, there are SO many contradictions around on this topic. One I ran across mentioned instant coffee (Like Taster’s Choice) was high, but there’s no mention of instant here. (That I’ve seen so far). Any idea on where that would fall?

    I’m thinking of the charts and data I’ve found here will be the best all around guide for this stuff. It’s pretty overwhelming, to say the least. It was depressing to see that most of the food that makes up my daily meals are high on the list, so this is going to take some time getting used to eliminating a lot of them. But, I’ve eaten anything I’ve wanted for 59 years now, so I guess it’s time to pay the proverbial piper. I sure don’t want to deal with stones ever again, it’s miserable, to say the least.

    Thanks for the time and effort you’ve put into this, it was great to have run across a site with so much in depth info.

    Reply
  44. cis

    This article is worrying.
    I am not a “stone maker” (that I know of). I don’t particularly like spinach, so that’s fine. But my serum calcium levels are low and calcium intake also probably low (dairy intolerance) and I eat TONS of dark chocolate, often lentils and beans. If I measured the amount of oxalates in my diet, I would get such an extremely high number you have not even considered it.

    What is the evidence that a high calcium consumption PREVENTS kidney stones? One of my acquired relatives eats tons of cheese and meat plus some pasta and often ends up in hospital with kidney stones. If a high calcium intake was really protective, surely he would be fine? I almost feel as if it should be the opposite (e high calcium leading to high stone formation).
    I seem to remember there are different types of stones (containing different substances), so the low oxalate diet may only help SOME of these not being formed.
    A high calcium diet may have other side effects, such as calcification of arteries, brain and soft tissue (not a nice prospect). It is important to take steps to avoid these if increasing calcium in one’s diet.

    Reply
  45. david

    I am having trouble finding any RCT that shows low oxalate diets work to prevent stone formation?
    I couldnt find any that examined the independent effect of altering dietary calcium, purine, oxalate, or potassium. on stone formation

    Reply
    • david

      one study suggests DASH diet might just work better!

      Reply
      • Fredric Coe, MD

        Hi David, there is no trial of DASH diet, just epidemiological correlations. Regards, Fred Coe

        Reply
        • cis

          May be no “highly scientific” trials but the epidemiological data is quite impressive.
          In my family, my great-grandmother did the (original) DASH diet for 30 years to keep company to her husband (a cardiac patient).
          She died at 98 (her affairs settled, family around her and in NO Pain whatsoever) after she decided it was “her time to go”.
          No disease was found on autopsy. Her death certificate quotes the following cause of death: “old age”.

          Reply
          • Fredric Coe, MD

            Hi Cis, This is an attempt to answer both comments. If you do not make stones, I have no reason why you need to avoid any foods. For someone without any disease the new US diet recommendations are probably most advisable. It calls for 1200 mg of calcium, no more than 2300 mg of sodium, lots of potassium – from fruits and veggies, and low intake of refined sugars. A lot of work went into those recommendations. There are no data showing that high diet calcium of the sort proposed will foster vascular disease. Regards, Fred Coe

            Reply
    • Fredric Coe, MD

      Hi David, There is no RCT of oxalate per se. If you read my article on treatment of idiopathic calcium stone formers, you will find the details of the one proper diet trial. In that trial high calcium diet was used to lower urine oxalate, which it did, and low sodium intake was used to keep urine calcium from rising. The result was a lower stone rate vs. a control diet much like that common in the US right now. Potassium citrate has been used in multiple trials which are detailed in the same paper, and links in that paper go to even more detailed analyses that include the primary data. Regards, Fred Coe

      Reply
  46. Netasha

    How can I incorporate more calcium into my diet when I’m lactose intolerant? Thank you for all the great info!

    Reply
    • jharris

      Hi Netasha,

      You can eat coconut yoghurts or lactose free yoghurts. Check the label and see how much calcium they offer. The brand SO DELICIOUS has a dairy free coconut yoghurt that has a substantial amount of calcium in it.
      You can also drink lactose free milk. You can get enough with these few products!

      Best, Jill

      Reply
      • Jackie

        Hello. I have to take one or two lactaid pills when eating dairy. What is your opinion on this? Does the lactaid pill stop the calcium from binding in which case I am not getting the benefits from the calcium in regards to stone formation? Thank you, Jackie

        Reply
  47. Nancy Kostyrka

    Is there a benefit to knowing blood oxalate levels as well as urine levels? I ask because my calcium oxalate stones began when I was diagnosed with IBS. From what I have read, the bowel plays an important part in oxalate absorption. My urine oxalate level is low, so could those oxalate be lurking elsewhere? Thanks.

    Reply
    • Fredric Coe, MD

      Hi Nancy, No; oxalate cannot lurk in blood and cause stones. Blood oxalate levels are about 2 – 4 micromoles/liter whereas urine is about 100 – 300 micromoles/liter, because the kidneys remove oxalate from blood at a high rate. Regards, Fred Coe

      Reply
  48. Nancy

    I am wondering if measuring oxalate levels in the urine is enough? Would it be a benefit to know the blood oxalate level as well? The reason I ask is that my stones have coincided with a diagnosis of IBS. From what I have read, the bowel plays a part in oxalate absorption, and an inflamed bowel may cause problems. My urine oxalate level was low, although I have calcium oxalate stones. Thanks!

    Reply
    • Fredric Coe, MD

      Hi Nancy, Blood oxalate is not measurable for clinical purposes as it is a challenging technique. We have measured it for research purposes. It has no role in kidney stone evaluation or treatment apart from the very rare genetic hyperoxaluric diseases in which urine oxalate is very high. Since your urine oxalate is low that is not your problem and your stones have another origin. Look at your lab reports and check which are indeed the problem and be sure they are attended to. The stuff about bowel and oxalate arose from obese rat research here at my school by a colleague. Links to people are so tenuous as to be invisible. Newspapers played it up in a silly way. In any event your urine oxalate is low. Regards, Fred Coe

      Reply
  49. Christa

    Dear Dr Coe, Thank you for this article. It was extremely helpful. I am told I have 20+ kidney stones. I first discovered this about 15 years ago while 6 months pregnant, not a fun experience at all. I few years after that I saw a urologist who performed lithotripsy on me however it landed me in the cardiac unit and several months later I had to have a cardiac ablation to stop daily bouts of an SVT. Needless to say that since that experience I have not returned to a urologist because I never had a heart issue before the lithotripsy (however the ablation fixed the issue). I did not pass stones since that time, however this month I had the pleasure of passing two. So it started me thinking that I need to look at this issue again and am concerned because I am 51 and can’t imagine passing stones in my 60s or 70s. My question for you is should I be seeing a urologist or a nephrologist? And I also believe I have a daily sensitivity so that creates other concerns. Thank you so much for your feedback!!!

    Reply
    • Fredric Coe, MD

      Hi Christa, I think this overlaps with your prior comment, so I will focus on the additions. The two links I sent detail my best offering of how to pursue prevention. Prevention arises from knowledge of causes, and if you read through and follow the articles you will find those causes. Treatments do indeed prevent stones but only if done properly and in a useful sequence. Regards, Fred Coe

      Reply
  50. Christa

    Thank you for this helpful information. About 10 years ago I had a kidney stone nightmare. I am told that I have over 20. I went in for lithotripsy and ended up in the cardiac unit. I had NOTHING wrong with my heart previously. I had to get a cardiac ablation to correct the SVT that was caused. I still have the 20+ stones. I passed one about 14 years ago and then did not pass another until this month where I passed two. I have not been to a urologist since the mishap because of my experience. I have two questions, 1) Should I be going to a urologist or a nephrologist? 2) What to do if I have a sensitivity to dairy? Thank you so much for this article! It has been VERY helpful.

    Reply
  51. Lisa

    Merry Christmas fellow stone makers. I’m happy to say this is my first Christmas out of the past three I’ve not been in the hospital with kidney stones (was for thanksgiving). I’m a researchers dream. 22 lithotripsy within 14 months. All over 8cm – largest was 16cm. I form calcium oxalate on my stints within three days. Thanks Dr. Coe for this article. I’ve shared with my nephrologist and urologist and they are impressed and gave me the go ahead to try the list. For the first time excited to take my 24 HR collection. Any additional thoughts or suggestions, I encourage you to share or reach out to me. You can only imagine how o would be willing to try anything!

    Reply
  52. Mason

    Dear Dr. Coe: I found this very informative thread while searching for information about my apparent IH,. which seems to be connected to my low BMD. I am 61 year-old male, and was diagnosed with osteoporosis in my spine via a DXA scan 4 months ago. I have subsequently had two 24-hr urine tests over the last 4 months, both in a urine-ca range of 320-340/day. I have never had kidney stones, although every decade or so I have randomly experienced blood in my urine, and the GP has never been able to figure out what caused it. The latter 24-hr test was actually higher, and was done to assess the effect of dyazide treatment. (I am awaiting a second appointment with my endocrinologist now to follow up on that test.) The only “positive” change between the tests seems to me to be that the rate per dl fell from 11 to 7. No dietary guidelines were given to me by my endocrinologist , but as I read your recommendations for stone-formers, I wonder whether such a diet (low sodium, low protein, high calcium, and potasium citrate) would also be indicated for folks like me with IH who have no history of stones, but who show abnormally high bone loss? I also wonder if oxalate limits would be beneficial — I apparently eat a lot of foods in the high-oxalate category that I consider to be otherwise very “healthy,” like spinach and broccoli and nuts, so this would be a significant dietary shift for me. (A side-note: I apparently have what is called “leaky gut,” and an internist recently put me on a breakfast diet with lots of kefir and probiotics. Has leaky gut been correlated with IH?)

    Reply
    • Fredric Coe, MD

      Hi Mason, IH is an established cause of bone mineral loss and a probable reason why stone formers are prone to fractures. You de indeed have high urine calcium, but IH demands your blood calcium be normal, as well: Be sure of that. The amount of calcium per deciliter (dl) of urine is irrelevant to bone as it is simply the concentration of calcium in urine not the amount lost daily. I would think that low sodium would be invaluable as – from my work and also from scholarship of work by others – the very quintessence of IH is an excessively high slope of urine calcium loss on urine sodium loss; the latter is simply diet sodium intake. Low protein is never on the menu, for bone or stone disease. High diet calcium is recommended for all Americans to prevent bone disease. As for oxalate, since you have never had stones and will have a high calcium diet, simply measure urine oxalate – you will probably find it uninteresting and not need to concern yourself about the matter. Thiazide helps bone but low sodium diet probably is additive to the drug. Drugs oriented to bone per se – bisphosphonates etc are probably helpful in IH bone disease – no trials. Regards, Fred Coe

      Reply
  53. Misty

    I noticed Stevia is in the list. I use this in my coffee. Any suggestions for substitutions? Are splenda and equal ok? Also I drink Shakeology every day and some of the ingredients are in this list. Do you know if it is ok to drink it? Any help would be appreciated! I drink it because it has all the vitamins and nutrients in it I need as a bariatric patient. Could there be any relationship to my stones? I was just diagnosed with 3 small stones last thursday and never want to go through that pain again. Thank you in advance for your advice!

    Reply
    • jharris

      Hi Misty,

      I know Stevia is on the list. But after it gets processed there is no oxalate in it. The plant itself is high.
      As far as the shakeology, it has not been studied, so I am unclear if it is high or not. Many bariatric patients get stones because they are not absorbing nutrients as they once were so getting stones is a side effect of the surgery.

      You need to do a 24 hour urine collection to see what is the cause. Otherwise you will be putting yourself at risk for making more. You might not have an oxalate problem. Do the collection and find out.

      Best,
      Jill

      Reply
      • Misty

        Ok thank you for the info!! I will ask my doctor!

        Reply
      • John

        I use liquid stevia in my beverages. I drink organic lemonade with apple cider vinegar during the day, and organic coffee in the morning. Is the liquid considered processed i.e. “no oxalates?” I had a 5mm stone in my left proximal ureter. Asymptomatic for approx. 1 year. I am a nurse and am trying to be careful..
        Thanks!!

        Reply
        • John

          Forgot to mention that I use organic chocolate coconut milk in my coffee.

          Reply
          • jharris

            Hi John,

            I hope you are drinking water as well as these beverages (they are ok, though, watch the sugar in the lemonade). The chocolate will have oxalate. Make sure you have done a 24 hour urine collection so you can see if you even need to watch your oxalate level.

            Best,
            Jill

            Reply
            • John

              Thanks Jill! I am going to let everyone know about your site. I am very impressed. I see a lot of people that have questions that you answer. I am using the liquid stevia in my beverages, ie. lemonade/coffee, is that OK since “Hopefully” the stevia has been processed and the oxalates are low? And yep I’m drinking water as well. Thanks! They wanted to do lithotripsy, but I wanted to wait it out, to avoid any side effects on my organs. So far so good. The follow-up KUB, (originally was diagnosed with a C/T scan,) came back with a radiologist report stating; “I think there may be a very small stone, very distal now.” The other radiologist said he did not see any, just very small crystals in the kidneys. 24 hour urine collection is a great idea!! Thanks again…

              Reply
  54. Julia

    Hi Dr. Coe and Jill, have taken great interest in these publishing’s. I have decided to take matters into my own hands and try a lower oxalate diet which I’m hoping will help me. I’m 54 and have had kidney stones at least 2nd yearly since I turned 40. Most requiring EWSL. Frankly so over it, my urologist says there’s nothing I can do, i haven’t told him about this either. I’ve lost 5kg since my last surgery in November as too scared to eat, stupid I know. Just drinking at least 3L/day. My stones are composed of Calcium oxolate/calcium phosphate and calculus carbonate. Apart from following this diet restriction re high oxolate foods, is there any other advise you can offer. I’m also trying to eat yoghurt with every meal but unsure as to amount, a few tablespoons or more?
    Thanks again for any help. Kind Regards Julia.

    Reply
    • jharris

      Dear Julia,

      It is not “stupid” that you are losing weight because you don’t know what to eat. Having kidney stones is very scary and the thought of having another will send people to places they never thought they would go. Simply put, we understand.

      There are things you can do. First you need to tell you urologist that you would like to complete a 24 hour urine collection so that you can see why you are forming stones. You may know your composition of stone, but that doesn’t mean you are sure of what to do. You need to do the collection as well.

      When you have done that, I will be able to give more exact advice.

      Warmly,

      Jill

      Reply
    • Fredric Coe, MD

      Hi Julia, I agree you need proper testing and a whole approach to stone prevention. Here is a good overview of how to approach prevention. Here is a more narrow article that focuses on the technical aspects. Your stone composition is crucial – you need to determine the main components of your stones. Are they mostly calcium oxalate with minor admixtures of hydroxyapatite, or are they mainly hydroxyapatite with minor components of calcium oxalate. From your brief note I suspect it is mainly calcium phosphate so urine oxalate is a minor issue and urine calcium, citrate, and pH are crucial. Read through the two articles and see if you can make your way. Regards, Fred Coe

      Reply
  55. Tracy K

    I’m confused. In the article you say black pepper is high in oxalate but on the spread sheet it is listed as “very low”. I do understand that black pepper is used in small amounts, but is it considered high or not? Funny, I thought I was eating healthy with my huge daily spinach salad I’ve been eating each day for many years, along with avacado, grapefruit, oranges, nuts and celery, sweet potatoes. I love most fruits and vegetables and eat lots of them. I’m trying to figure out an alternative to spinach because I gag on lettuce. I just found out I have a 6mm kidney stone and I don’t want any more. So thanks for the article and list. I have some diet changes to make, replace the healthy stuff with other (low oxalate) healthy stuff!

    Reply
    • jharris

      Hi Tracy.

      It is considered high because it was measured in a 3 ounce portion. Which no one eats on any given meal. So, it is really not a concern.
      You can all eat oxalate, if you eat it with calcium, and save the really high things for every once in awhile. Moderation is key here and eating the treats with calcium foods as well.

      Best,
      Jill

      Reply
  56. J. Bosslett

    I do not get the idea of broccoli being moderate in oxalate. So many studies and broccoli seems to have very little oxalate. What is the truth? I eat broccoli every day for the fiber but I am also on a low oxalate diet because of stones. I drink alot of water when I have the broccoli but I need to know if broccoli every day is good or not. I have the broccoli steamed. I would appreciate any suggestions. Thank you

    Reply
    • jharris

      Hi J.

      Broccoli is listed as an ok food. Don’t eat large portions as it adds up, and if you can eat it with some calcium containing food that would be great. Half a cup of chopped broccoli has 6 mg of oxalate according to what we have found. We consider that moderate as for the amount that is moderate. So having a cup of chopped broccoli will have 12 mg and more even higher. So you see it depends on amount.

      Hope this helps-

      Jill

      Reply
  57. Joanna

    what about persimmons? also does soaking or sprouting beans affect the level of oxalates?

    Reply
  58. Luann Gould

    Also, how can you recommend corn chips? There are 155 mg of sodium in an ounce of corn chips.

    Reply
    • jharris

      Hi Luann,

      We don’t recommend, we just offer as a substitute to potato chips. There are many people that will have to eat a chip or they will not be able to keep it together. For them we offer a low oxalate version of something crunchy and satisfying. Being on these diets are not about being perfect, they are about being better. Trying to be perfect, for most, will lead to over doing it. So we offer suggestions to lower oxalate version of foods and it goes without saying that sometimes these things might have extra salt. Be smart, don’t over indulge and watch your overall sodium intake accordingly.

      Make sense?

      Jill

      Reply
  59. Luann Gould

    Hello,

    Like some of the others, my urologist also says to limit protein, especially from animal sources. The information I was given says “Excessive protein in your diet can increase both the calcium and oxalate in your urine. Eat adequate, but not excessive amounts of protein: A) limit milk and milk products to two servings per day (one serving equals 1 cup of milk or yogurt or 1 ounce of cheese) and B) limit your intake of fish, poultry and meats to five ounces per day.” I was also told to incorporate more fresh fruits and vegetables in my diet and to avoid restaurants and processed foods.

    My stones, which were tested in November, were of the calcium oxalate variety. I’ve increased my water intake to more than two liters per day, cut out coffee and am gradually getting used to using way less salt. The food lists and advice found on the internet are very contradictory and confusing. For instance, the list from my doctor includes cauliflower but not potatoes like your list does. I honestly do not know how I am ever going to memorize everything and avoid developing stones again, but I have to try.

    thank you,
    Luann

    Reply
    • jharris

      Hi Luann,

      I understand how confusing the “lists” are. Use the one we recommend. I have been teaching from it for many years, and my clients at the very least from less stones, if not stop for good. So I know it works. Throw the others out. You can email me at jharris1019@gmail.com and I can give you a low oxalate list that I have derived from the Harvard list to keep it easy for you.

      Best,
      Jill

      Reply
  60. Mike Babowicz

    Hi,
    Thanks for the info. I’ve been reading the oxylate data linked,and have some questions.
    Regarding white flour,listed at 17 units of oxylate per 1 cup flour. Is it safe to assume that whatever one makes with the flour will have no more oxylate total than the sum of the oxylate parts?
    Or does preparation affect the oxylate composition of the product.
    So-
    If I make pasta,from 1 cup of flour and one egg,will that total amt of pasta still only have 17 units oxylate after cooking?
    Also…Saw cornmeal at (64 units oxylate )/ cup…I presume dry uncooked cornmeal…is this right?…..if I make cooked simple polenta from that cornmeal,will I have no more oxylate in the polenta than in the cornmeal originally? (Which is relaveant because 1 cup meal makes,a fair lot of cooked polenta)
    Thanks Again!
    MikeB

    Reply
    • Jill

      Hi Mike,

      Cooking does not matter much at all. What goes in the pot will come out relatively in that amount.

      If you are adding foods to the the questionable foods, you must also add any oxalate these other foods you add might have. But I assume you know that…

      Thanks for writing-
      Jill

      Reply
  61. terry

    hi jill, any idea why the difference in levels for avacado? harvard says very high, try oxalate diet says very low. other sources also rate them very low. thanks, terry

    Reply
    • jharris

      Hi Terry-

      It bothers me that acocados are listed high here bc they are very healthy in good fats and fiber. But- I have been teaching from this list for 15 years- and I trust it as it has helped many of my clients when used properly.

      Of course have them here and there and it helps if you eat it with a calcium rich food.

      Best,
      Jill

      Reply
  62. Kris

    My doctor says to stay away from animal protein. Is this right

    Reply
    • Fredric Coe, MD

      Hi Kris, Once adjusted for size, there is little relationship between urine oxalate and diet protein intake, so that is not very important. Diet calcium is very important, and so is diet oxalate. Regards, Fred Coe

      Reply
    • Jill

      Hi Kris,

      Maybe the doc told you that for another reason. Perhaps your urine caclium is too high, or you have a low pH? Check with him/her and find out the reason for that treatment suggestion. Not to question, but to make sure you understand and can be better compliant with your treatment plan.

      Knowing the why’s and how’s is what keeps you motivated and educated.

      Warmly,
      Jill

      Reply
  63. Lois Defelici

    Is corn flour, corn and oat bran the only carbs available for breads. Would still appreciate a more complete list of most veggies and fruits that are allowable for a low oxalate diet. Thank you again. I have reread the above info many many times, there’s just a bit more clarity I could benefit from. Thank you,

    Reply
    • jharris

      Hey Lo-
      Here is the deal. The carbs are tough, but it doesn’t mean you can’t have them. Eat them here and there. You can still have a couple pieces a day, without worrying. It also helps, as you know, to eat it with a calcium containing product. This is the list. I do not have anything more to add or take away. There are still plenty of fruits and veggies you can eat, and the high ones just eat in moderation.

      It really is that simple. If you eat a diet that has around 1,000-1,200 mgs of calicum you can safely eat 100-200 mg of oxalate per day. That is why it is so important to eat calcium. Less so for oxalate.

      Best,

      Jill

      Reply
  64. Romey Moore

    Thanks for the information. I am at a borderline for needing a low oxalate diet recommended by my urologist. This seems to be one of the more trustworthy lists so I will see how much I can get out of it, and if it seems consistant. I get really, really frustrated when some trys to get information about what to do then get blasted in the face with meaningless numbers(yes, one of the reasons this page was born). I still see some of it in your spreadsheet. A really high amount can be 13mg or 750mg???? When there this much range, its almost meaningless. I wish you had explained how this is ok or try to get the other authors on sites to edit their info by explaining how something like can be true. I would create a new scale that provides the warning by going from 1 to 10 or 1 to 5. A one is as much as you want, a 9 or 4 is measure carefully/once a day, a 5 or 10 is proceed at your own risk/never…etc. treat the other numbers similarly. Would help format the ideas of ok to veryhigh. One thing that may or may not been answered: are the amounts per meal or per day. If I eat 2 meals per day, how should I treat the amounts? Can I eat 2 cups of spinich (universally very high) on monday the first, not want any more until the 15th and be ok? I think that it could be a good idea to supply this information so a better nutritional experience can be had.

    Good article. Provides the type of information that is actually usable instead of wondering how an article could be published in such a confusing manor.

    Reply
    • Fredric Coe, MD

      Hi Romney, Adjectives are a mess and you are right about them. Here is something useful that needs to be better said in the article. If you eat a properly high calcium diet – 1,000 top 1,200 – as is recommended for all otherwise healthy Americans, a total daily oxalate intake can be between 100 and 200 gm daily and you can use the numerical data on the list to make the budget work. It is also not the same as running a spaceship: More or less oxalate will be absorbed, depending on the mix of food in any one meal so everything is approximate. Re-testing is crucial and the goal is a reasonable urine oxalate and reasonable depends on the other things in urine like calcium and citrate, and volume. For some better perspective, take a look at how treatment of idiopathic calcium oxalate stones – I presume this is your situation – actually works. Diet oxalate is really only a minor part of the effort. Regards, Fred Coe

      Reply
      • Romey Moore

        Thank you very much. Knowing how to apply the numbers helps a lot. Gotta increase calcium and be wary of the things that can put me overlimit (with reason) in one meal or so. I guess spinach is out for a while until im back in check. Its ok though, I usually really only crave spinach when I broil lambchops. Guess I’ll replace the spinach with kale or other safe green vegatable. Another question (may be explained when I read through the link), does the body process oxalates over time or does it peak like someone that has to manage their sugar intake? This would allow me to better understand what is happening when I eat, so may consider eating something like yogurt before I eat the main meal.
        It all makes better sense now. I can eat olives again, I just have to be aware that I dont do it everyday and not unlimited. Its ok though, I just used to snack on them until I got tired, then forgot about them for weeks at a time. There is still spinach though 🙁

        Reply
        • Fredric Coe, MD

          Hi Romey, Do without spinach; you will not adapt or something, it will always be a hazard. Oxalate is not metabolized, but urine oxalate excretion does go up with meals, so that is oxalate absorbed from food. You want the yogurt WITHIN the meal, the calcium needs to mix in with the oxalate to precipitate it so it is not absorbed into you. Regards, Fred Coe

          Reply
          • Romey Moore

            Thanks. Guess I will have to get my spinach from old popeye cartoons 🙂
            Nothing major, as I stated before. Will kinda miss it though. The perplexing part is that quite a few foods that have proven benefits need to be carefully assesed in a low oxalate diet. Imagine a parent telling her kid “NO SPINACH” for you mister. Had I been a child it would have been good news. Lastly, would that mean that I should also consider iron supplements? Multi-vitamin?
            Thanx again.

            Reply
            • Jill

              Hi.

              I would not recommend doing that before talking to your doc. I don’t eat spinach and my iron levels are fine. Taking iron pills can lead to constipation and you don’t want that either. You can always get a blood test at your annual to keep an eye on our iron levels and other levels as well before making that decision. And talk to your doc to help make that decision.

              Thanks for all your great comments-
              Jill

              Reply
  65. Lois Defelici

    Are their any dried beans or beans in cans i.e.: garbanzos, white beans,pinto beans that we can cook with? Can we turn any of these canned beans into hummus. What natural spices can we use, which ones must we stay away from? Can we use corn meal flour versus white or whole wheat flour. Which fruits are yes, which ones are absolutely no?

    Reply
    • jharris

      Hi Lois,

      Please read the article on how to eat a low oxalate diet and you will find the list of oxalate foods. It will help you in figuring out what foods are high and low.

      Best,
      Jill

      Reply
  66. Lois Defelici

    Which veggies can I eat either raw or cooked? Which fres fruits and berries can I eat? Should I give up almond milk for coconut milk or organic cows milk? Are there nuts or seeds that can work with this low oxylaye diet?

    Reply
  67. Pam M

    What about peanut powder? I’m trying to find an easy, quick and on the go breakfast and would like to try a shake. Many people are using this but I figure its just as bad as eating peanuts. And how do I find out oxalate levels in plant based multi vitamins? I need to find a way to get nutrients in me. I’m not 20 anymore 🙁

    Reply
    • Jill

      Hi Pam-

      I would assume powders made with peanuts would be high on oxalate. Don’t know the oxalate levels in vitamins but I would not worry about it. They will not add to your oxalate levels. High doses of vitamin C can be a problem, but a normal multi won’t cause issues.

      Be well-
      Jill

      Reply
  68. Lois Defelici

    Just been diagnosed with oxalate stone removed ten days ago. Now trying to clarify the foods that I can eat. Seems a bit overwhelming at this moment. My doctor recommended your site only. Will be doing 2 24 urines over next two months. Will keep reading it, I have hope!

    Reply
  69. Kellie

    I am confused I just found out after having two surgery’s to remove a 8 mm stone about the calcium intake. I do not drink milk, should I be taking Calcium?? I am now on a low oxalate diet, which seems to be ok since I have been eating low carb. I have also started drinking lemon water daily.

    Reply
    • jharris

      Hey Kellie,

      Did you do a 24 hour urine collection? If not, please get one ordered so you can see WHY you are forming stones. If you are not getting enough calcium from foods, which is how the body like it best, please talk to your doctor about calcium supplements. If you take too much it could actually increase your risk of new stones, so you don’t want to play around with supplements without discussing with your doc.

      You are making major dietary changes, make sure they are warranted by doing the urine collection.

      Thanks for writing-

      Jill

      Reply
  70. Elizabeth

    Hi, I’m getting really confused. Some reports say coffee is high in oxalates , This one says I can drink it . Some other foods are confusing too. Please help.

    Reply
    • jharris

      Hi Elizabeth!

      You can have some coffee. Keep it at no more than 2 cups a day, normal sized cups, not 32 ounce cups. Here is what I have to say about all the dreaded lists on the internet. Stop looking at them. Use this one. I have used it with patients for nearly 15 years, my patients tend to decrease if not erradicate their stone production. I know it works.

      Warmly,
      Jill

      Reply
  71. Leona

    The list includes cornmeal in the very high category while listing corn flour in the low category (one cup of each). Can you clarify.
    Thank you

    Reply
    • jharris

      Hi Leona,

      The only thing I can think of for the discrepancy is that corn meal has a higher concentration of corn thus leading to the higher amount of oxalate.

      Thanks for your question-

      Jill

      Reply
  72. Guillermo Reyes

    I found your webpage incredibly chocked full of data. Thank you for that! I am a medical student, 2nd year, preparing for my Step 1 medical board exam, and during a routine medical checkup, microscopic hematuria was found. When it was repeated, same findings. My father died of prostate cancer, and my brother currently has bladder cancer. A quick trip to the medical school teaching hospital, cystoscopy, followed by CT Urogram, and my Urologist told me I had small kidney stones that did not need further intervention. He did tell me to avoid oxalate foods. I have no trouble with eliminating nuts, french friends, black tea, spinach and others. But I think it unrealistic to lower my protein intake. I enjoy bodybuilding as a sport, no anabolics or supplements, but I do consume protein to increase muscle mass. I have no comorbid conditions and take no medications.

    There must be a way to reduce oxalate levels systemically other than avoiding spinach, nuts, bran, potato chips, etc. It seems to me the question is how do we reduce this chemical if we already eat a clean healthy diet? I drink 3 L of water daily to keep my kidneys healthy.

    Thanks

    Reply
  73. Shayna

    I’m perplexed that you say to be careful with stevia because a teaspoon has 42 mg of oxalate. Is that a teaspoon of pure stevia powder? I *love* sweets, and less than 1/16 teaspoon of powder is plenty for sweetening a cup of lemonade or any other beverage. Liquid stevia? 4 or 5 drops, max.

    Reply
    • jharris

      Hi Shayna,

      Stevia before it is processed into the little packets you use has that much oxalate. After processing it is safe for you to use- at least regarding oxalate content.

      Best,

      Jill

      Reply
      • John Farquhar

        A related question: Do sugar substitutes increase Calcium loss just as sugar (which you so delightfully called “… the demon in all eyes, dreadful to behold”) does? Specific guidance about Sucralose, aka Splenda, would be helpful. I love it–but find it so sugar-like it’s sure to be bad.

        And thanks so much for all your thoughtful efforts on this site. It’s really a treasure!
        John

        Reply
        • Fredric Coe, MD

          Dear John, Thanks for the compliment. I believe Jill has answered about sugar substitutes – there is no reason they should behave like real sugar. Regards, Fred Coe

          Reply
  74. Paula

    I have one kidney. I have been told I have hyperoxaluria. My nephrologist has instructed me to stop all supplements with Vitamin C and Calcium. I have also been on a low calcium diet. I have 24 hour urine tests every 4 months. My current oxalate level is 100. My counts have been as high as 121. I have been using the Harvard List of Foods as a guide. I am on 6 potassium citrate (1080mg per tablet) a day. I also drink 8 oz. glass of lemonade per day. I would appreciate a suggestion as to what you would think could bring my counts down.

    Reply
    • Fredric Coe, MD

      Hi Paula, I am a bit alarmed by your story. If your urine oxalate is really 100 mg/d – units are missing, and has been as high as 121 – same units, either you have an amazingly high oxalate diet, a form of malabsorption with enteric hyperoxaluria or primary hyperoxaluria. Given the low calcium diet, it is possible that extremely high diet oxalate loads could cause such high urine values but I doubt it. If you have transcribed the number correctly and the units are indeed mg/d (milligrams per day) then you have a dangerous and alarming problem that your nephrologist must surely want to remedy as fast as possible. Regards, Fred Coe

      Reply
  75. Kevin

    Oxalate Lists are confusing, this is the only list I have seen with Avocados as Vey High Oxalate, there are even sites suggesting eating them to prevent kidney stones. They are listed high in Salicylate but so is Blueberries so unclear if food high in Salicylate should be avoided? I try to avoid regular oxalates due to minor but somewhat regular stones, I do have Avocados regularly the last few months.
    Also how long does it take to form a kidney stone, I ate a ton of blueberries one day and had a kidney stone the next, of course mentally with them being High or so I thought, I tied the 2 together and have since avoided but unclear if there was any relation whatsoever?

    Reply
  76. Carlos

    My urologist, after removing an oxalate kidney stone from my left ureter, told me the best prevention for oxalate kidney stones is lemonade. I happen to have a lemon tree in my backyard, so nowadays, two or three times a week, I squeeze one or two lemons to yield about 1.5 inches of lemon juice at the bottom of a regular size glass. Then I top it off with sparking water and drink it (with food in my stomach) without adding any sugar. Also, I have added apple juice to sweeten it a bit. At my six month follow-up visit, no kidney stones were found by radiology. I also try to eat all things in moderation, because I know that my oxalate kidney stone was caused by eating excessive amounts of cashews.

    Reply
    • jharris

      Dear Carlos,

      That is exactly what to do. Except for the fact that you make no mention of doing a 24 hour urine collection. Make sure you get one so you can see WHY you are forming stones. Follow the kidney stone diet that Dr. Coe and I have written about here on the website.

      Thanks for writing-

      Jill

      Reply
  77. Leigh Kramer

    This is very helpful. Thank you for compiling it! I’m not sure about the cause of my kidney stones but it was recommended I decrease my oxalate intake. I’m stumped by the calcium recommendations, however, because I’m dairy-free to keep my eczema in check. If it’s not one thing, it’s another! Back to researching I go.

    Reply
  78. Katherine Fines

    Foods-to-avoid questions:
    I assume all nuts and seeds are high in oxalates, so pine nuts would be not good? Sounds like I could have some occasionally on breakfast yogurt or mixed with corn or rice. Or, should I just give up pine nuts along with my cashews, almonds, macadamia nuts, walnuts, pistachios, etc.? (I always put walnuts on my breakfast oatmeal, but am now trying meat for substitute protein. Smoked turkey in oatmeal is interesting.)
    Cooked oatmeal is not high in oxalates, right? I eat three dried prunes (and two apricot halves) cooked with 1/3 cup of oatmeal and oat bran in 1 cup of water…and recently switched walnuts with smoked turkey. This, along with my other breakfast dish of yogurt and fresh fruit should mitigate the dried prune oxalates, correct?
    A diet with no dark chocolate is just wrong. What’s the best way to mitigate eating 1/8 (2 sections) of a Ritter Sport dark chocolate/hazelnut bar? Drink more liquids, maybe tawny port? Pair it with cheese? Switch to a nut-free bar?
    Thanks for providing such a carefully prepared and practical website for those of us new to dealing with this oxalate business. There is a lot of conflicting info out there on the web about foods.

    Reply
    • jharris

      Hi Katherine,

      It is very confusing I know. My greatest wish is that people worry less about oxalate and more about getting enough calcium into the diet. With getting your daily recommended amount of calcium and if eaten with the high oxalate product it would help a lot for stone disease and bone disease.

      You can eat that amount of dark chocolate. That is a reasonable amount. I would really stay away from nuts and when you do eat them add them to your yoghurt. It will help a lot. Smoked turkey sounds yucky to me, but we are all different! Do what makes you happy.

      Always keep your liquids up, do 24 hour urine collections to make sure your oxalate levels are staying low and keep me posted on how you are doing.

      Warmly,
      Jill

      Reply
      • myra clayton

        Hi Jill,
        How does one go about doing urine oxalate tests at home?
        Thank you

        Reply
        • Fredric Coe, MD

          Hi Myra, there is no home testing for 24 hour urine risk factors. Oxalate by itself is worthless even if it could be done as it is merely one contributor to stone risk. Regards, Fred Coe

          Reply
  79. Dave Frieder

    Hi! I am using “Bone Strength” Slim Tabs made by New Chapter as a natural plant based calcium intake. Its supposed to be better then other types of calcium supplements. Do you know of this product? I had a full body scan (Forgot the type) and its telling me I have some bone loss. I am 63. This is in addition to my Calcium Oxalate stones. Thank you.

    Reply
    • jharris

      Hi Dave,

      I do not know the product. If you have stone AND bone issues, I would seriously look into getting more calcium from foods I eat, as the body absorbs it better from food. Also, make sure your doc approves the amounts you are taking. Too much supplementation could also result in stone production and make sure you take supplements with a large meal.

      Thanks for writing in-
      Jill

      Reply
  80. Tracy M Sweet

    there is a lot of misinformation about concord grape juice, is it high in oxalate or not?

    is there a difference between concord and regular grape juice?

    Reply
    • jharris

      Hi Tracy,

      I have read it is low, but do not have a source that I find as 100% reliable. Therefor, I will have to say that I am unsure and proceed with caution. I also don’t love the product as it is VERY high in sugar.
      Best, Jill

      Reply
  81. awaneesh pathak

    few months ago ; both kidney have 32 33 mm stones ‘ they removed by operation
    8 stones are still present largest one is 13 mm. Please suggest me what I do

    Reply
    • Fredric Coe, MD

      Hi Awaneesh, So many stones means that prevention is critical. Take a look here, and see if you can get through the steps needed. There is only one way to good prevention that I know of, and it is this way. Regards, Fred Coe

      Reply
    • Da_Mess

      Awaneesh,

      Just got over an out-patient ESWL (sound wave treatment) for a 15mm stone. Take guidance from your urologist, but since stones are not usually passable over 6mm, sounds like ESWL (lithotripsy) is in the cards. The procedure itself is not a big deal (i’ve had it 2x now), however, i know know that for stones over 10mm, you will should get a urinary stent. Discuss with your urologist. The stent is not fun but prevents blockage while you pass fragments (of which you’ll have plenty). The stent runs from the kidney to the bladder and can cause symptoms that similar to that of passing a stone (narcotics may be required to kill pain). in my case, i was given numerous medication: Pyridium (to minimize uninary tract burning while passing fragments), something i can’t recall to minimize spasms from the stent, and flowmax which can help promote passing of large fragments. The pyridium causes urine to be bright orange with super staining power and the stent causes uncontrollable urinary leakage which is a bad combo. As a male, i eventually got “male leakage shields” that go in your underwear and allowed me to get back to work. The drugs do make you tired and it can be a frustrating ride. i was not able to do any physical activity with the stent in place (which for me lasted 18 days from the ESWL). i got the stent removed yesterday and while it wasn’t something i’d want to do every day, it was cake next to stone pain. 24 hours later and free of drugs, i feel like a real human again! Hang in there. It ain’t fun, but be thankful we live in an age where procedures exist to rid our bodies of these devilishly painful stones.

      Reply
  82. Dave Frieder

    Hi! I have been forming calcium oxalate stones for many years. The last BIG one was 1.5 cm! The doctor had to go in with a laser to pulverize it! Now I have some small ones, maybe 1-2 mm diameter in BOTH kidneys. I have had so may procedures the ureters are large enough to pass some without pain. I eat a fairly healthy diet and I take 15 mg Potassium Citrate 2X daily as recommended by my doctor. I STILL get stones! Is there ANY over the counter pill or supplement I can take to help eliminate them? I have a “Paper” stomach so some of the items I saw online won’t work and I can’t have too many citrus drinks. ANY help would be greatly appreciated! Dave

    Reply
  83. Vijay

    does pomegranate and it’s seeds cause any type of Kidney stones

    Reply
    • jharris

      Hi Vijay,

      I don’t have a good resource for them so unsure. Eat them sparingly…
      I will keep searching though and report back if I find something.

      Jill

      Reply
  84. Michael Rioux

    Hi Jill, I just passed my second kidney stone in a little over a year (not quite sure on the time.) The last time I believe drinking gatorade did it. Now I eat a lot of peanut butter. I also eat baked potato chips by lays. I usually have a ham cheese lettuce tomato bacon sandwich for lunch with a ginger ale. I try to drink water but went for a long walk on Sunday in bad weather and did not hydrate enough. Not sure what else to say. If you have questions please feel free to ask.

    Reply
    • jharris

      Well my friend, I am pretty sure your diet is not helping your stones! Please make sure you get a urine collection ordered by your doctor and you complete it. This will tell you WHY you are forming stones. Then you can also get on preventative treatment based upon those results. This will most likely dietary changes, sometimes meds. Drinking enough water to produce a least 2.5 liters of urine a day will also help tremendously.

      Good luck and let us know how you are doing.

      Warmly,

      Jill

      Reply
  85. Asha Chhablani

    Hi Jill,
    I am vegetarian and have asymptomatic Calcium oxalate stones and osteoporosis.
    I use hemp protein powder and nutritional yeast as protein supplement, but am concerned about the oxalate content of both. Are hemp protein powder and nutritional yeast high in Oxalates?
    Thank you
    Asha Chhablani

    Reply
    • jharris

      Hi Asha,

      I do not have sufficient evidence to say one way or another. Hemp is made from seeds, so it most likely has some, but really not sure. I use both these products as well. They are healthy items, but if they add to stone risk, I can not say. Are you getting enough calcium? Are you paying attention to your sodium intake? If you are not, this could be increasing your risk. Many vegetarians do not get enough calcium so let me know.

      Jill

      Reply
  86. Sammy

    I am confused about regular lemonade high oxalate
    Diet lemonade low oxalate
    What about fresh homemade lemon aid with sugar substitutes

    Or squeezed lemon on food ?

    Reply
    • jharris

      Hi Sammy,

      Many people use Crystal Lite, and some just add fresh squeezed lemons into their water. You can do either without increasing your oxalate.

      Thanks for writing-

      Jill

      Reply
  87. Sammy

    I am confused about regular lemonade = high oxalate
    Diet lemonade = low oxalate

    What about fresh homemade lemon aid with sugar substitutes

    Or squeezed lemon on food ?

    Reply
  88. Angie

    I have had stones for the past 6 years. Surgeries twice to three times each year, even ruined my honeymoon with a 5mm stone stuck. They always get stuck!!! My questions are I have the calcium oxalate stones and some of the things they are telling me not to eat it seems you are saying its ok. The eggs, coffee, strawberry’s. I just want to know what will truly help me. If I cant get rid of the stones completely how do I get them to not get so big so quickly to where I can pass them on my own. I have never been able to. Seem they go from 0 to 100 in seconds in size. I have tried the water intake of 2 liters or more a day, the changing of the diet, the low carb way. I honestly have gained since this all started and just want some true honest answers that we cant seem to get from a doc. Like the gentleman above I also went to a dietician and they had no idea how to help and only wanted me to pay to join their weight loss program. Its very frustrating to go to doctors and specialist and get no where. Any help or advice would be greatly appreciated.

    Angie

    Reply
    • jharris

      Hi Angie,

      I hear the frustration through your well written words. I am sorry to hear your story, but so glad you told it. Please read THE Kidney Stone Diet on the site. It will help you. It is also the way we should all be eating to remain healthy (except not worrying about the oxalate and drinking sooo much water- this is specific for stone formers).

      We feel Dr. Ross Holme’s list is the best for oxalate content of foods, and we use it in the article you read. I have found my private clients like a list that contains only the OK oxalate foods. This proves to be less confusing to them. I am happy to give it to you, but it is long so please write me at jharris1019@gmail.com if you think you might like it. You can also find it at my private Facebook group- THE kidney stone diet. I have just started it and people go there to ask about diets regarding calcium oxalate stones. If you would like to join please do so. I moderate it to keep it clinically sound.

      I will tell you this. Please drink enough water to produce at least 2.5 liters of urine a day. Also have you done a 24 hour urine collection? Let me know. It is the very first step in stone prevention.

      Your friend,

      Jill

      Reply
  89. Holly

    I had bilio-pancreatic bariatric surgery with duodinal switch about 13 years ago. I am also lactose intolerant. I have lost over 170 pounds by sticky to a low carb diet. My stones started about 5 years ago. The results of my last 24 hr. urine test shows Urine oxalate at 121 mg/day and Urine citrate 289. How do I work with both diets? I went to a dietian who simply looked at me and said she had no idea how to combine the diets. Now what do I do?

    Reply
    • jharris

      Dear Holly,

      Congrats on the weight loss. That was a very big surgery you had and as you well know can have side effects with malabsorption issues. This is most likely the reason for your high urine oxalate and low citrate levels. Not everyone in the nutrition field has studied the problem of kidney stones, so I am not surprised by your experience. That being said, this situation is complex and you would benefit from direct help. If you would like to email me at jharris1019@gmail.com, I would be happy to advise you about how best to obtain such help. Very Best, Jill

      Reply
  90. William Eggers

    Thank you both for a very informative presentation and the Q&A follow-up. I am a 67 year old male who has had recurring calcium oxalate kidney stones for the past 25 plus years. I was told by both of the Urologists who have provided me with care to drink at least 8-12 ounce glasses of water (or more) per day. Typically, I drink in excess of two (2) gallons of water each and every day. I add fresh squeezed lemon juice to each glass I drink. At one time I had a vrry nice vegetable garden…then was told to pass on growing/eating the fresh leafy veggies, etc. Long story short: I stopped eating almost all of the high content oxalate foods (moderate consumption of some on rare occasions). My digestive system has suffered from the lack of fiber/roughage and, though fewer in numbers, my kidney stiones have grown larger quicker. Prior to the change in diet, stone production averaged 3 or 4 stones 2-4mm every 2 years or so. For the past 4 years, I have averaged one (1) large stone (10-12mm) per kidney every 12-18 months. Suggestions on diet change/supplements/additions? Thank you!

    Reply
    • jharris

      Hi William-

      I am happy to hear that your stones are less frequent. I am unhappy to hear they are large. I am also unhappy to hear about your fiber intake.

      Please look at the list again, and notice all the fruits and veggies you can eat. Spinach is the biggest no-no, but after that not too many others. Nuts too can be eaten in small quantities. If you can tolerate yoghurt put some nuts or berries on top and the calcium in the yoghurt will help absorb extra oxalate.

      I would rather you be more diligent with your salt intake (1,500mg/day and calcium intake, 1000mg/day) then avoiding all roughage bc of oxalate. Does that make sense?

      Thanks for writing us. Hopefully you have done a 24 hour urine collection and you know for sure that you have high oxalate. Let us know-
      Jill

      Reply
  91. Patrick

    Hello. Questions. On the list of foods,spaghetti is listed as high, but mac n cheese is low. Is the spaghetti made with tomato sauce and the mac with cheese? What about plain pasta made with semolina flour? Should/could food manufactures include oxylate content like they do for sodium,fat etc? Also found this list: http://www.denvernephrology.com/wp-content/uploads/2012/12/Oxalate2008.pdf
    Thanks

    Reply
    • jharris

      Hi Patrick-

      Unfortunately food manufactures will not be adding oxalate content anytime soon. It is just too hard to measure in every food and it varies depending upon the very many factors needed for each plant to grow. Soil, sunlight, etc effect the oxalate content.

      I would assume that all pastas being measured would NOT have the sauce on them already, but the mac and cheese would. Pasta noodles in general are high. Eat them with a glass of low fat milk, and in smaller quantities and you can eat it here and there.

      Hope this helps-

      Jill

      Reply
      • Patrick

        Ok thanks for the quick reply. I’m Italian and having pasta withdrawals! I just have to cut way back.

        Reply
        • Jill

          I am Italian too, and feel your pain in cutting way back. But it will help.

          Jill

          Reply
  92. Marion

    I am so relieved to find your article, today. My husband has been having a lot of issues with his liver, kidney stones, gout, and arthritis. He goes to several different doctors and finally has woken up to the fact that he needs to take the bull by the horns and change his diet. So, last month we both changed to a low purine (for gout) and low carb diet. We are both losing weight, and he hasn’t complained of any ache or pain since. He went to the kidney doctor today who told him that he has lost 10 pounds and more importantly his kidneys look better and no kidney stones.

    But, the doctor told him to stay away from brightly colored foods, like spinach and strawberries. I couldn’t figure out what he meant and was feeling very discouraged. I admit I cried. After all, we thought we were doing so good on our low carb diet. Almost everything we eat now is brightly colored! So I turned to the internet and found your article. Now I understand. The doctor must want him to stay away from foods that are high in oxalates. I printed out the full list and added it to my growing binder of things to know for this new adventure my husband and I are on of eating healthier. I no longer feel discouraged. Now, I am just annoyed at that doctor for telling him something so irresponsible. “Stay away from brightly colored foods.” Really??? (Years ago my husband gave up on understanding what it meant to be on a low carb diet because of not getting good information from the doctor and nutritionist.) Now, because of your article, we won’t be discouraged, we won’t give up, and we will be able to easily change our new diet to include low oxalate too. We are more determined than ever to continue to eat healthy foods!

    Thank you so much!

    Reply
    • Fredric Coe, MD

      Hi Marion, A reduced oxalate diet is only relevant in someone who maked calcium oxalate stones. I would have thought your husband made uric acid stones from the story. Also, it matters when urine oxalate is at least above the low end of normal. So be sure he has had a proper evaluation = here is a good overview. Regards, Fred Coe

      Reply
    • Jill

      Hi Marion,

      I am so glad you wrote to us. Has he done a 24 hour urine collection and has your husband had his stone analyzed? I agree with Dr. Coe, with all the other symptoms, you want to make sure it is oxalate that he has to be careful of.

      Even if your husband is supposed to lower his oxalate, as you can see by the list, there are still plenty of colorful veggies and fruits he can eat. Making sure he has enough calcium in his diet will also help, even negate higher oxalate foods.

      Thanks for writing to us and sharing your story. It gives us real pleasure and gives others real motivation to keeping on the road to good health.

      Keep us posted on everything-

      Jill

      Reply
  93. Lauren

    I am 56 year old woman and had my first stone 3 years ago. Had uteroscopy and lithotripsy and doctor NEVER told me about stone prevention. Learned about metabolic testing on my own and am currently waiting for results. ALL urologists should be educating patients on stone prevention. Luckily, I have now found a PA who gets it. Question is: I have gone dairy free due to stomach issues. How do I get the calcium I need? Perhaps dairy free Ben and Jerry’s is looking good despite the price!!!!

    Reply
    • Fredric Coe, MD

      Hi Lauren, We have tried to find a good list of high calcium low sodium foods and here is our best. You need both because the low sodium will keep the urine calcium from rising overly and the high calcium will greatly lower urine oxalate. But I sense a lack of a complete program in your notes, so take a look here and be sure you cover all the bases – to use a baseball metaphor. Regards, Fred Coe

      Reply
      • Jill

        Hi Lauren,

        It is very hard to get enough calcium when you are lactose intolerant. I am also lactose intolerant so I personally know how hard it is to accomplish this task. Ben and Jerry’s non-dairy ice cream is excellent for people who cannot tolerate dairy products, but be careful, it is made with almond milk so can be very high in oxalate. It has not been studied, but I trust that it is high.

        Try using coconut milk to help support your calcium needs along with coconut yoghurt. Look at the links Dr. Coe wrote about as well. If you need more help, we are here-

        Jill

        Reply
  94. Barrie Pedersen

    I am 77 yrs old, had my first kidney stone 10 yrs ago, 9mm!
    In the last two years, I have had
    4 attacks and 4 lypotripsies! Did the 24 hr test, examined everything I was eating, etc. I had to eliminate all the nuts except pistachio and macadamia, as well as the no-no’s like spinach, rubarb, etc. I take 500 mg/day of calcium citrate and milk in my cereal (Nature’s Path organic Pumpkin Flax Granola). Eat tuna/cheese/cranberry sandwich for lunch on homemade bread ( 3 cups w, 1 cup ww) and dinner is usually something other than beef or pasta. Doctor told me to include lemon juice with my liquid intake, which is the first thing I do when I get up. Having said all of this, I think was has kept me stone free is that I eliminated all the various health pills that contained artificial vitamin C. Read article about research in Sweden on 25,000+
    men (re artificial C) and found that most of the kidney stones where in the group taking the artificial C! I follow the “oxalate”
    diet, also.

    Reply
  95. Maria

    I’m confused. If yams are at the bottom of the list, why avoid them?

    Reply
    • Fredric Coe, MD

      Hi Maria, I will let Jill answer this one. Regards, Fred Coe

      Reply
    • jill

      Hi Maria,

      The level or position of the food is not indicative of the high or low value. They are high and to be eaten here and there in lower portions and perhaps with a glass of low fat milk if you can tolerate it.

      Thanks for writing-

      Jill

      Reply
  96. Christina V

    Hi Dr. Coe,

    I am 27 years old and have passed 10 kidney stones already and 1 of them was an 8mm Calcium Oxalate stone. I somewhat understand what I need to eat and what I should not eat. I feel like on a calcium oxalate diet I am gaining weight when I am actually trying to loose weight since I also have Gullstones and my weight gain is just making it more painful. I have considered getting the stones removed from my Gullbladder. With that said… How can I not gain weight in taking all the dairy and carbs. Also, my urologist told me to minimize protein in take except for maybe fish here and there and when I do eat protein to drink excessive water. I drink about 2-3Liters of water a day. Also, the past 10 stones have been within 9 years. I guess the low carb dieting is what caused all the stones. Now I just would like to know, which carbs would be okay for me to have yet less of a problem for gaining weight. This is just such a struggle. Is there any specific diets I can refer to and look at? I have many different low oxalate cook books and some of them say don’t eat this and some say you should eat it. Is there a list of foods that you recommend to eat? Also, should I basically eat dairy with all my meals to avoid the building of calcium stones? Thanks in advance.

    Reply
    • Christina V

      This is also for Dr. Jill Harris, sorry didn’t mention it in the beginning. Anyone’s help would be great

      Reply
    • Fredric Coe, MD

      Hi Christina, I am sure Jill will answer you. Be sure about what is wrong in your urine tests. Is your urine oxalate high enough to be producing risk? Are there other factors in the urine that are also a problem. Here is an organized approach. High calcium low sodium diet is the basic diet for stone prevention, and protein intake should more or less simply follow WHO and US government recommendations. I leave the rest to Jill. Regards, Fred Coe

      Reply
    • jharris

      Hi Christina-

      I am sorry you are suffering with not only kidney stones, but gallstones as well. As Dr. Coe has stated- make sure you do need to be on a low oxalate diet. Did you complete a urine collection? If not, you may be pulling your hair out for no reason concerning the oxalate. Only way to know if your oxalate is high is to complete a 24 hour urine collection.

      As for the carbs, eat less. Many people are very good at eating healthy foods, they are just eating too big a portion. So are there carbs you can eat without gaining weight? Sure. Eat whole grain- (look at the ingredients) low sugar, high fiber, whole grains. Yes, they will be high in oxalate. Eat them with a glass of lower fat milk or low salt cheese and you will be ok.

      I watch people look at the bread basket when it comes to the table as if the server has just laid down a weapon of mass destruction. As with all “diets” too much or too little of something will create problems going forward. So how do you stop gaining weight? You eat less. Eat healthy whole grains, veggies, fruits, dairy, and lean meats. I wish it were more complicated than this but it isn’t.

      We all know what is healthy or not healthy to eat (pretty much). The problem is we lack discipline, not knowledge. It is difficult to constantly shy away from your favorite foods. This is why I suggest that you don’t. More days than not, do not eat more than a couple of slices of good whole grain bread (for lunch), step away from the cookie jar, don’t go near the mac and cheese offered on the menu.

      MORE DAYS THAN NOT. NOT NEVER!!! When we deprive ourselves of foods we love, we wind up not being able to keep that deprivation up. There is a difference between discipline and deprivation. When you don’t eat a piece of bread for 3 months, guess what you keep craving? BREAD. It doesn’t work.

      Eat a healthy diet rich in whole grains, veggies, fruits, lean meats, and dairy. Once in a while you have a bit of a sweet, and on special occasions of course you will eat cake. When you do, do not fret. Just pick a healthier choice next meal.

      As we go on in Dr. Coe’s site, more discussion will be given on how to implement diet and lifestyle changes. I don’t mean to be glib, I know it is hard, but it is very doable.

      Let me know if I can be of more help and thank you for sharing your story-

      Jill

      P.S. Keep up the great work on drinking water!

      Reply
  97. howiem

    Dr. Coe, I am a 77 year old male, and recently had a urine tract infection. I was given Ciprofloxacin500mg twice a day and Harnal 0.4mg before sleeping, and did a PSA test which resulted in a reading of 2.9. The doctor said it should be less than 4, but a week later had me take another PSA test and the reading was 3.3. He said that the increase was not a good sign, so he changed the medication to AMOKSIKLAV 1000mg twice daily plus the same Harnal dosage. I am supposed to get a 3rd PSA in a couple of days. Here are my questions:
    1. Are the oxalates that cause kidney stones different from the oxalates that might cause prostate cancer?
    2. I have read that a PSA reading of 0.0-6.0 is normal for men of my age, so is the doctor making me take PSA tests unnecessarily or is he looking for a trend?
    3. While he did not give me a diet list, he told me specifically to stay away from dairy products and chicken because they have high oxalates. Yet, the tables on this web site show chicken as low in oxalates. Yes, it is confusing.

    Reply
    • Fredric Coe, MD

      Hi Howiem, I gather you are not a stone former and your questions are about effects of oxalate on the prostate. There is no link between oxalate and cancer of any kind. Dairy products do not contain oxalate and neither do the meat products. It is true that oxalate is produced via amino acid metabolism but that is inconsequential for intakes of meat in the normal range. Your present drug is a combination of amoxicillin and clavulanic acid and presumably aims at your urinary infection. With respect to the PSA testing, I am not an expert and leave that to your physicians. Regards, Fred Coe

      Reply
  98. Jacques

    One more question: Is there a kit to test for oxalate in the urine that you can do your my self each day or one a week?
    So I’ll know immediately if what I eat is OK.

    Reply
  99. Jacques

    I had many kidney stones over the years with more than 20 surgeries in about 30 years! Each time the urologist gave me a list of things I not suppose to eat containing oxalate. I still the list on my refrigerator. I look at it and try to be careful but my wife does have practically the opposite diet that contain a lot of oxalate. She’s a better cook than me hence my many kidney stones OK my fault!

    I’m now 67 and would like to be able to not make kidney stones anymore.

    By the way this is the best ever report I red on the subject I’m glad I found it.

    I do have a couple questions. There is no way I can shop for the right food each time and cook this recommended low oxalate meals for me each time.
    So I’m asking if someone know a business that can prepare low oxalate meals that can be purchase online?

    Why only my left kidney is making those stone called calcium/oxalate and not the right one?

    Thank you

    Jacques
    Grants Pass, Oregon

    Reply
  100. Beth

    Hi – I am a 50-year-old healthy female (5’7, 120 pounds) who experienced what I believe to be kidney stone pain on June 23. I had pain in my left flank that radiated to the front and down into my groin area. I got up for work and the pain was very intense so I drove myself to the ER. As soon as I walked in to ER and showed them where my pain was – the nurses and ER doc all said kidney stone. They did a catscan and found no hyronephrosis or ureteral dilatation. But did find a 7mm non-obstructing calculus in the midportion of the left kidney, (“probably in an upper pole infundibulum). No other renal, ureteral, or urinary bladder calculi identified. I had microscopic hematuria and was sent for an ultrasound of abdomen which found nothing. I was loaded up with IV fluids, Dilaudid (which after the first dose made me extremely nauseated) and Toradol. A Urologist examined me and said your pain is not coming from the stone. They kept me for observation and sent me home following day. From start of the intense pain to finish I’d say it lasted about 48 hours or so. It would come in waves and was like nothing I’ve ever felt before. I will also mention that many years ago a former doctor ran a catscan on me (I forget why) and saw a tiny stone, he said I’d likely pass it without ever knowing. That is my only history with a stone. My older brother had a uric acid stone 20 years ago, he is now 55.

    I saw a Urologist after I was discharged from hospital (2 days later) and the blood in my urine continued. He also believed the 7mm stone was not the issue but discussed the small possibility that I had passed a tiny stone without it being picked up on catscan by the ER. He ordered an xray and the report said “a 7 mm calcification overlies the medial aspect of the left renal outline. A questionable tiny calcification overlies the lower portion of the left renal outline, no calcifications are noted overlying the right renal outline.” Based on the blood in the urine I had a Cystoscopy performed 2 weeks later – and nothing was found, though he did have to dilate my urethra (I was sedated) as he could not get the scope in. Next we did a 24-hour urine collection via Litholink with the following results:

    Urine volume: 2.70

    SS CAOx: 1.50

    Urine Calcium: 109
    Urine Oxalate: 17
    Urine Citrate: 782
    SS CaP: 0.58
    24 Hour Urine pH: 6.751
    SS Uric Acid: 0.08
    Urine Uric Acid: 0.520

    Interpretation: High urine ph. High urine pH can promote calcium phosphate stones. When coupled with low urine citrate consider distal renal tubular acidosis. When using alkali supplements (citrate or bicarbonate) manage urine volume and urine calcium to maintain SS CaP less than 2.0.

    Stone Risk Factors/Cystine Screening – Negative
    Dietary Factors:
    Na24: 147
    K 24: 53
    Mg: 59
    P 24: 0.555
    Nh4 24: 20
    CI 24: 141
    Sul 24: 23
    UUN 24: 7.04
    PCR: 1.0

    Normalized Values:
    CR 24: 1210
    Cr 24/kg: 21.9
    Ca 24/kg: 2.0
    Ca 24/ Cr 24:
    90

    I returned to my Urologist who was not concerned about the mention of distal renal tubular acidosis. He’s had me order a supplement called Theracran (cranberry supplement) to take twice day for a few months to try to acidify my urine. And I will take another 24-hour urine test end of October.

    Lastly – I had an ultrasound done of my kidneys last week as I was asked to fly/travel for work and I’m concerned about the stone moving. The results are confusing though! It says “There is no hyronephrosis bilaterally. There is a small right extra renal pelvis measuring 1.5cm AP dimension. There is a small echogenic focus in the lower pole of the left kidney measuring 5 mm. Demonstrates variable shadowing. Impression: Suspected small calculus lower pole left kidney. Suggest CT or KUB imagining for conformation if not performed previously.

    My questions are: Due to my low urine oxalate content, should I still be vigilent about low oxalate foods all the time? Is my urine oxalate level only indicative of what I ate in the past 24 hours or is more cumulative?? I’ve increased my water intake – which is obvious due to my test results. I never watched my salt previously but had no reason to and rarely salt my food – nonetheless I have cut back on salt. I am not a big red meat eater, eat small portions of animal protein. My doctor really hasn’t advised me on any main dietary factor to prevent stones – and doesn’t even recommend removing the stone.

    But the latest ultrasound concerns me. I know they are not as accurate as catscan – but is it possible I now have a 5mm stone in my lower kidney and they did not pick up the 7 mm stone in the upper pole? Or is it possible the 7mm stone dropped and the size reading is off?

    I’m so concerned about having a kidney stone attack. And I swear I always have this lingering dull ache in my lower flank and sometimes I get a sharp pain. Docs say it can’t be the non-obstructing stone. I’m seeking a 2nd opinion at the end of the month. I want to consider lithotripsy – but if the 7mm stone is now in the lower pole – I have read that can be more of a challenge to blast and then pass the fragments?

    I am told it is unlikely I can pass stone of that size – so I just wait for it to cause me all this excruciating pain people talk about? That isn’t really something I think I can do. But the other concern for me is do I now have TWO stones? I really don’t want the radiation of another catscan. Can MRI pick up on the stone just as well? Do I get a KUB?

    I’d appreciate any feedback you can provide.

    Reply
    • Fredric Coe, MD

      Hi, I believe this replicates your other comment, so I will just leave it as is. Regards, Fred Coe

      Reply
      • Beth

        Thanks Dr. Coe – was there a response? If so, I can’t locate it.

        Reply
        • Fredric Coe, MD

          Hi Beth, YOu posted the same question to two different article and I answered one and did not answer it again. The other article was Types of Kidney Stones a Primer. I answered you in detail there. Take a look and let me know. Regards, Fred Coe

          Reply
  101. lee

    It’s so confusing. Some reputable sources say the tahini in hummus is super high in oxalates and to avoid it, while others don’t even include it on their list. Some list graham crackers and popcorn as being low in oxalates, while others say they are high. How can someone which to believe or go by?

    Reply
    • jharris

      Lee,

      Darn right it is confusing. We use the list from Harvard and don’t bother with anything else otherwise we, too, would be pulling out our hair. We trust their list and also realize that none of these lists are perfect. Plants studied under different growing conditions might vary. Use the Harvard list and if you find your favorite food really high from a reputable source elsewhere (not many of those btw), then eat it with a calcium containing food, or drink with milk, to counterbalance the oxalate.

      Hope that helps-

      Jill

      Reply
  102. Connie

    Thanks for all the info – I have been struggling to find answers; perhaps you have some ideas….

    My situation is perhaps unique (?)
    I began having occasional (calcium oxalate) kidney stone episodes 20+ years ago, after first using Imitrix (a vasoconstrictor for migraines)

    I elected to continue the medication because up until that time I had suffered with severe debilitating migraines for 20+ years, increasing in number to the point where I literally was never without the pain, nausea, photophobia, etc….this constant pain lasted for approx. 12 years!

    I tried everything! (ergotamines, narcotics, anti-inflammatories, muscle relaxers, beta blockers, calc channel blockers, etc., massage, PT, bio feedback, yoga, etc., …multiple anything! that multiple doctors and therapists suggested, I tried it….. add to that my own research and trial of various methods and herbs, etc…..)

    The imitrix (and later similar meds such as Maxaalt) works! !!
    (I only have 2-4 migraines a month now, lasting several days each, the meds take the edge off, allowing me to have a “normal” life.)

    I have been more than willing to put up with kidney stone pain and/or passing now and then, in order to keep the migraines in tow.

    HOWEVER – in the past 3 years, kidney stone production has increased drastically!
    A year ago I ended up in the ER with malignant hypertension, due to severe pain of 5 stones….4 of which thankfully passed on their own (with help from fluids and muscle relaxers)
    (And then it got worse…….3 weeks ago I underwent surgery on my kidneys for removal of 35 stones!, some very large, spread throughout R and L)

    Since the surgery, I am drinking TONS of water, increased my dairy intake; have cut back on salt, pepper, and have eliminated all the high-oxalate foods; ….and stopped my vegetarian diet
    (about 3 years ago I adopted a vegetarian diet, simply because of compassion for animals being treated so badly)…….I have now discovered Kosher meats (very compassionate processing)…..I am aware now that the veg diet could very well be the “culprit” for the drastic increase in stone production…

    Minus multiple stones, I was feeling better… until this weekend …..I had a severe migraine…..I took the meds….and within 24 hours, experienced that all too familiar kidney pain.
    I am sitting on a heating pad as I write this letter – my head feels better, but my left flank is miserable!

    I can’t even imagine going back to the life of excruciating migraines every day! (if you have ever had even one, you can understand)….

    On the other hand, 35 kidney stones!! I am concerned about the pain yes….but primarily my concern is that my kidneys will be eventually scarred, and damaged to the point of compromising not just my comfort, but all the possibilities that kidney damage might entail, including shortening my life expectancy.

    I head back to the doc in 2 weeks…..she says medication may be necessary.
    I am assuming she probably is talking about orthophosphates or thiazides…and I am beginning my research on those.
    I am desperately looking for alternatives, ideas, insight, wisdom….anything to help me make a decision about what to do next

    Reply
    • Fredric Coe, MD

      Hi Connie, I am sorry to hear about so much trouble. I did not find in your writeup anything about the causes of your stones – just a conjecture about your recent diet change. Why don’t you consider this approach – it is organized and will lead to the causes of stones in most cases and thence to efficient treatment. This site has a lot about treatment for idiopathic calcium stones – no systemic disease as a cause of stones – and thiazide is at the end of the list. Phosphate is not a proven treatment and I would not use it. Let me know, Regards, Fred Coe

      Reply
    • Stacey A Zappacosta

      Could you be sensitive to histamine. Too many histamine rich foods cause intense migraines for me. Surprisingly, high oxylate foods are also high histamine foods

      Reply
      • Fredric Coe, MD

        Hi Stacey, I do not know about histamine from high oxalate foods. But I have no reason to believe histamine plays a role in stone production. Regards, Fred Coe

        Reply
  103. Kim

    I’ve been reading the oxalate content of foods from the Harvard link you provided at the beginning of this article. On line 179 it states pancakes (4, from mix) have 10 mg oxalate. However, on line 507, it shows 37 mg oxalate for the same item. Could you please clear this up for me? Thanks!

    Reply
    • jharris

      Hi Kim,

      Thanks for picking this up. The only plausible answer is that it was different mixes and unfortunately they did not clarify. Suffice to say pancakes do have some oxalate in them, eat them here and there and when you do try to eat with milk or another calcium rich food.

      Thanks again,

      Jill

      Reply
  104. Ian Thomas

    Hi there, i hope you don’t mind me commenting on here, i live in Wales – part of the United Kingdom. I was searching for information on diets for high Oxalate/Urate stones and came across your page.
    I’ve had 2 occasions where i have been admitted to hospital because of stones, the first when i was 19 or so, which passed naturally. The second was in 2013 when i was visiting Disney land Florida, when i returned to the UK i had 2 operations – the first involved a stent insertion and the second to remove a large stone – approx 5-6 mil.
    I’ve had no advice from my docs regarding diet, only to drink lots of water.
    How much would diet affect the forming of stones? As i said the only advice i have received is to drink fluids.
    I feel as though i’m just waiting for another episode.

    I’m taking allopurinol tablets daily to reduce the uric acid build up.

    Any advice would be greatly appreciated.

    Regards

    Ian Thomas

    Reply
    • Fredric Coe, MD

      Hi Ian, Everybody is welcome. I gather the stones contain both calcium oxalate and uric acid. This latter is due to an unduly acid urine and potassium citrate is usually prescribed. Perhaps your physician might want to consider this. Allopurinol will not treat uric acid stones, and as I am the person who first suggested it for calcium oxalate stones I am free to say it is a minor and rare treatment alternative. So potassium citrate would be important. Likewise 24 hour urine testing is critical as we have no compass – just a map. Regards, Fred Coe

      Reply
  105. Jim

    I’ve started forming stones that are a mix of oxalate and phosphate. The 24-hour urine test revealed that I have hypercalciuria but my oxalate level was not even detectable. I’m also on the lower side of normal for citrate. I can justify cutting out high oxalate foods as a precaution, but do I really need to go down the road of a super restricted low oxalate diet?

    Reply
    • Fredric Coe, MD

      Hi Jim, If you have hypercalciuria and little urine oxalate why bother with oxalate in your diet. How about treating what is wrong. Idiopathic hypercalciuric requires a low sodium reduced sugar, high calcium diet and the latter will lower urine oxalate all by itself. Be sure to cover all the bases in your evaluation. Regards, Fred Coe

      Reply
      • Jim

        Thank you for your reply–especially over a long weekend!
        I wish I lived closer, as I am finding it hard to get proper advice/care up here in Canada (I’m an American transplant). The only thing the ER urologist tentatively suggested to me was possibly increasing the acidity of my urine and suggested either citrate tablets or just adding lemon juice to my diet. However, the problem is that I also suffer from severe acid reflux and lemon juice and/or citrate would be too harsh on my stomach. I’m beginning to wonder if being on a low acid these past few years for reflux/ GERD has somehow contributed to the stone formation. I’m also wondering if the kidney stones are at all related to having had bone loss for the past several years (i.e. osteopenia and even osteoporosis in some places) possibly due to either HIV disease or the HIV medications I take (I have previously been on Tenofovir, which has been implicated in bone loss). Also I read that stress can cause kidney stones, but who doesn’t have stress in life, right?
        At this point, I am upping my dietary calcium through food (I’m not sure about calcium supplements and stone formation) and I am also restricting my sodium intake and really trying to limit my sugar. I’m not someone who eats fast food or lots of processed items. I also don’t drink soda or sugary drinks (or even alcohol), but I do have to watch the other sweet stuff i.e. cakes, cookies. After thinking I would have to also eliminate oxalate in my diet, I am now relieved, as it seems everything has oxalate in it.
        Any other advice would be appreciated, as I am not really able to follow up with anyone here. Socialized healthcare might be free in Canada, but it often means wait lists of over a year to see a specialist.

        Reply
  106. Lara Windsor

    Since 1978, I’ve had nearly a dozen bouts of calcium oxylate kidney stones. Some have been removed, some passed. I conscientiously restricted my diet to very low oxylate intake, but continued to have stones. In 2011, I had a parathyroidectomy; one bad gland was removed. The surgeon said the other 3 were good, and that I would now feel better, have no more stones, and could eat whatever I want, which I have. I live in a hot dry climate, but do drink a lot of water. Since January, my doc has me on 5,000 units VitD daily and Calcium 600mg because my Vit D level is below normal and bone scan shows beginning osteopenia. Three days ago, another attack. CT shows 5 stones, all in the right kidney, largest 4.7mm, blocking the kidney. My question is, why why why after the surgery am I again making stones??? What should I do??

    Reply
    • Fredric Coe, MD

      Hi Lara, You need repeat 24hour urine testing. Not rarely urine calcium stays high after cure of hyperparathyroidism. Also, are these five stones new or leftovers from when you had that disease?? Be sure and analyse all of these stones that pass, and take a look to be sure calcium oxalate is all that is there. I suspect more phosphate than you report. Regards, Fred Coe

      Reply
    • jharris

      Hi Lara,

      First get blood and 24-hour urine samples done to see why you are forming stones. Have you done this yet?
      Secondly, even though you had a partial parathyroidectomy doesn’t mean that you don’t have to watch what you eat and drink.

      You may still have high calcium levels in your urine and this could be why you are still forming stones. But we don’t know until you do testing, right?

      Do that and come back here and tell us what is going on if you wish. We are here!

      Jill

      Reply
  107. Lisa

    I also have hypothyroidism. If you read about diet restrictions for this, they suggest not eating cruciferous vegetables as well such as broccoli, cauliflower and kale. I am having difficulty balancing all the diet restrictions with what I can actually eat to avoid kidney stones AND to help my metabolism work…add Fibromyalgia into this recipe and I am confused what to eat!

    Reply
  108. Barbara Jo Kingsley

    I just recently had a kidney stone blasted and am now trying to figure out what to eat. Every one of my favorite foods (spinach, chocolate, raspberries, whole wheat everything, lots of tofu, and lots of raw nuts, etc.) is very high in oxalate, probably what caused the stone. I am a vegetarian, so leaving out tofu will be hard, but I can switch to milk from soy milk, and increase dairy food. One big question I have – are endive and escarole low in oxalate?? Thank goodness kale and romaine are low. Also, what is a good carbohydrate to eat? Is popcorn and corn on the cob o.k.? The list you have shows corn flour o.k. but corn grits and corn meal very high. How is that? Thanks for your help.

    Reply
    • Fredric Coe, MD

      Hi Barbara, Your big issue is to figure out if you even need a low oxalate diet and, if so, how much of an oxalate problem is there. Save your anguish about lost foods until you know you really need to sacrifice. For this you need your stone analysis and 24 hour urine studies. Take a look at this and see what you think. Also, remember that a high calcium diet will lower urine oxalate and is always a first step. Regards, Fred Coe

      Reply
    • jharris

      Hi Barb,

      Sorry to hear about your stone troubles. It is always hard to figure out what to eat and what to sub for your fav foods. I highly recommend you doing a urine collection so you can be sure of what the cause is. Perhaps you can eat your favorite foods without cutting them out entirely. Maybe it is more a hydration problem then oxalate. Problem is you don’t know what it is until you complete a collection.

      From what I have read, endive is lower in oxalate and escarole is higher. The only answer I might suggest is that there are different levels of concentration in the corn products above, it is a good question and I do not have a good answer.

      Ask for the collection, you might not have to put yourself through this!

      Thanks for writing,

      Jill

      Reply
  109. Sandy

    My dilemma is that I have very severe lactose intolerance, IBS-D, a gut that is hyper sensitive to acidic foods and I am a teacher who has long stretches of the day without the possibility of a bathroom break, so I limit water intake for much of my day. I’ve had extensive difficulty with calcium oxalate stones and my 24 hour urine showed high levels of oxalate so I’ve been told to follow a low oxalate diet. I am anemic and have always eaten a fair amount of spinich each week to help with that. My favorite things are now taboo – black tea, peanut butter, spinach, sweet potatoes, carrots, etc. My list of foods I can eat is very short. I’ve had five lithotripsy procedures in the last ten years and have passed many stones. I also have a familiy history of kidney stones on both sides of my family. Any suggestions?

    Reply
    • jharris

      Oh Sandy, I am sorry that you are going through this but very happy you have found us.

      So, yes. Your favorite foods are very high in oxalate so you will have to avoid them, but not totally give up on them. I, too, am lactose intolerant which is so annoying, but nowadays there are so many alternatives. Of course many of those alternatives are made with almonds and since you must watch for oxalate you cannot have them. I use coconut milk and coconut yoghurt for my dairy alternatives. Give those a try.

      You can have some green tea to sub for black tea and less oxalate. Substitute kale for spinach.

      Drink enough water to pass at least 2.5 liters of urine a day. This is tough with your job, I understand. The only thing I can say to this is it is worse to have to take off from work bc you are making more stones or having more lithos. I do not mean to sound glib, I realize that it is very difficult or nearly impossible to leave your classroom. But, there is not much of an alternative I can give you there.

      Limiting your water is probably your biggest factor, not the oxalate. Give that some thought. Changing your diet won’t matter much WITHOUT increasing your water intake. The driving force of stone formation is super saturation. This means that if you don’t drink enough water your urine will be super saturated with stone forming crystals- in your case- calcium oxalate. When you drink enough fluids your urine becomes less saturated with crystals and you will form LESS stones. So although very hard, you really will have to concentrate on getting your urine less concentrated with these crystals. If you change your diet but don’t drink enough water you will still make stones.

      Stay healthy and write if you have more questions-

      Jill

      Reply
  110. C

    I have had two bouts with kidney stones; the first about 8 years ago and the second a year ago. MRI’s taken during each occurrence revealed I had multiple stones but, thankfully, each time, the largest stone passed on its own. I have done extensive research on identifying foods high in oxalates, but there is so much conflicting information. To compound my dietary restrictions further, I have celiac disease, osteoporosis and am lactose intolerant. Any help you can offer will be very much appreciated.

    Reply
    • jharris

      Hi!

      Have you done a 24 hour urine collection? Is your oxalate high? Your conditions contradict each other so that is why it is so difficult. Let us know if you have done a urine collection to see if you really need to restrict your oxalate. Worth checking for your stone disease and with your already complicated diet restrictions.

      The oxalate list in this article is reliable and one that I and Dr. Coe would use for ourselves and our families. Check it out, but again, please don’t limit oxalate if you have not been tested. Even when you make oxalate stones, high oxalate may not be the reason.

      Please email me personally at jharris1019@gmail.com when you get those values. I can help you if you like, but it might take more than just one reply.

      Thanks for writing-

      Jill

      Reply
    • C

      Thank you!

      Reply
  111. Jade Bonica

    Hi Jill and Fred,

    I’m a stage 2 breast cancer survivor (5 years this December). I had surgery for kidney stones last week (my urologist removed two, one was 2cm, the other was 1cm). I try to stay away from dairy and soy in general but I like almond milk. I also like freekeh (and I know I need to stay away from bulger). Do you have any suggestions for an alternative to almond milk? Can I still eat freekeh?

    Thanks,
    Jade

    Reply
    • Fredric Coe, MD

      Hi Jade, Jill will answer about the milk but allow me to add that prevention of more stones is really important and there is no reason to believe that a low oxalate diet is what you need or enough for you. Take a look at a path to prevention. Regards, Fred Coe

      Reply
    • jharris

      Hi Jade,

      Being a stage 4 cancer survivor, I know how good it feels to write that, huh!!! Congrats to you!

      Almond milk will be high in oxalate, as you know. Coconut milk is a good alternative and so it coconut yoghurt. I just ate some myself. Staying away from dairy might increase your stone risk, so unless you are lactose or casein sensitive I might ask you to add some dairy into your diet. LMK.

      AHHHH, the new super grain Freekeh. It is wheat so assume it has a lot of oxalate in it, no studies on it but one can assume safely it is high in oxalate.

      Congrats again on your remission. Here is to continued good health-

      Jill

      Reply
      • Jade Bonica

        Thank you both for your quick responses…

        Hi Jill, I’ll mix in some dairy here and there, stoneyfield actually makes a great non gmo plain yogurt. I’ll try coconut milk and yogurt too. Have you ever heard of tiger nuts (not a nut at all if you have)? I thought of using tiger nuts and tiger nut milk as well.

        Hi Fred,

        I was sent a 24 hour urine test yesterday, and I have an appointment with my urologist to figure out what my next move should be. The low oxalate, low sodium diet was given to me when I left the hospital.

        Reply
        • jharris

          I know about Tiger Nuts. Not sure about oxalate content as it is considered a root vegetable. I would assume it is most likely high. Let us know what your oxalate level is once you do the 24 hour urine collection. Write us when you know more about your 24 hour values.

          Jill

          Reply
      • Jade Bonica

        Hi Jill, It does feel good to say “survivor” it’s changed my life for the better. One other thing I wanted to mention, I’m taking vitamin D3, CoQ10, Women’s one a day, and a powder probiotic.

        Reply
  112. Raeshae

    Hello! I am being put on a low oxalate diet for kidney stones and me physician said that this is a reliable list to base my diet off of, but there are some interesting, confusing things on this list. 1) It says I am allowed cornbread but i am not allowed cornmeal. 2) I am not allowed to eat oranges but I can drink orange juice 3) It says on the list that kale is low in oxalates but my urologist said to avoid eating kale. I am just extremely confused by all of this. Also, the list does not mention anything about pumpkin and coconut. I have been substituting flour for coconut flour and pumpkin is an all time favorite of mine. Please, if you could help me on some of these clarifications that would be wonderful. Thank you!

    Reply
    • jharris

      Hi Raeshae,

      Unfortunately many doc bunch up the green leafy veggies and say that they are all high in oxalate. Not true. Kale is ok to eat. The other foods you mentioned are confusing but not really if you look into it. Orange juice vs one orange makes sense bc the juice is diluted with water and the corn meal also is more concentrated with corn than the corn bread. Make sense?

      Pumpkin and coconut tend to be lower in oxalate.

      Thanks for writing!

      Jill

      Reply
      • Raeshae

        Thank you for your quick response! I do not buy oranges from concentrate, we buy simply orange juice which is just orange juice, no water. When you say “tend to be lower” do you mean they are lower or that certain varieties of pumpkin are lower in oxalates than others? I ask because I have been substituting anything I would eat with regular flour for coconut flour and I want to make sure that the coconut flour is ok so when the holidays come I can enjoy homemade coconut flour crust pumpkin pie.

        Reply
        • Jill

          Hi Raeshae-

          Here is a piece I found about pumpkin seeds (http://www.ncbi.nlm.nih.gov/pubmed/3799495). I have no reputable or reliable information on what type of pumpkin.

          Everything I have read on coconut and coconut flour indicates that it is low in oxalate. However, I do not have a reliable source on this information.

          When I do not have definitive answers I like to caution patients that they use the product in moderation. I do not want to say that coconut flour is for sure low, because that generally means that patients will use it and eat it constantly. So, within moderation should be fine.

          I cannot say this enough. Unless your oxalate levels are in crazy land, you can eat your favorite foods that contain oxalate. Just watch the portion size, eat high oxalate foods less frequently, and when able, pair them with calcium rich foods (almonds and yoghurt for example). You want to stay under the 50 mg/day level. It is very doable if you follow this advice.

          In regards to eating your favorite foods that are high in oxalate, some people like the “within moderation” way. Some say they “can’t have it in the house”. You are all different, so do what works for you. All require discipline, and that is what is hard.

          In all of this diet stuff, please know that none of you will be perfect. It is when we aim for perfection that we fall off the wagon. Eat and drink well most days and on the days that you don’t, get up the next day and start all over again.

          Hope this helps-

          Jill

          Reply
  113. sunita

    Hi Jill and Fred, thanks for the info. I was just wondering when you say lentil soup, which lentils are you referring to- yellow, red or something else? There are so many “daals” in Indian food. Which ones should be avoided? Do you have number as to how much oxalate is in the lentils or other daals? Also, oxalate stone patients are advised to reduce intake of dairy and meat products. What should one eat?
    – Sunita

    Reply
    • jharris

      Hi Sunita!

      No one should be told to avoid dairy when instituting a low oxalate regimen. That is wrong information as dairy does not contain oxalate, and it is good to get the calcium as it will LESSEN calcium oxalate stone formation! So, please eat dairy, but watch the sodium content when you do.

      As far as the lentils they are high in oxalate. It is doubtful that every type has been tested, but in general, they are high. If this is a staple to your diet, please reduce the frequency and the portion size when you do eat it. Please remember that you need to know how high your oxalate level is before you go banning foods from your diet. Also, if you eat some dairy when you have the higher oxalate foods it will help lessen the amount of oxalate your body absorbs. Calcium is important to maintain normal levels of 1000 mg/day. More days than not.

      Hope this helps-LMK if it doesn’t.

      Jill

      Reply
  114. Shari Richburg

    Just wanted to say Thank you. I have found this article very helpful and encouraging. I have passed 10 stones since March this year and I am currently working on number 11. The stones that have been captured and tested were all calcium. However, my current Doctor has not been helpful in respect to diet changes. And I have asked. I do understand that you are not offering a cure, you are offering me a path to improve my situation that is manageable and it gives me some hope for relief. I am also looking into the benefits of Magnesium Citrate. And will be dicussing or with a new Docter soon.

    Reply
    • Shari Richburg

      Sorry.. Last comment should read I am looking into the benifits of Potassium Citrate.

      Reply
      • Marilyn L Anquetil

        Hi Shari, I also found this very informative and was told I need to follow a low oxalate diet to pervent any other kidneys stones, I have past stones which are very painful! What deit is helping you? I need some advice from someone that can relate to what I am going through, I really appreciate your input and want to know do’s and don’ts !

        Reply
    • Fredric Coe, MD

      Hi SHari, Calcium can mean calcium oxalate or calcium phosphate and there is a world of difference. For example, diet oxalate is not so relevant for the latter as it is for the former type of stone. Treatment requires one know the reason for stones and I do offer a path, a rather good one; take a look. I would not advise trying this or that remedy until you know for sure what the stones really are and why you form them. Regards, Fred Coe

      Reply
  115. Pat hayes

    I need a diet that I can eat that does not form stones. I love cheese, eggs, and some bread. I was raised on meat, potatoes and veggies. This was a balanced diet for me. It is hard for me to cut out potatoes. I love tomatoes, green onions, pasta, meat and green beans, and all Mexican food. I am not a sweet eater but I do like ice cream. I have passed 9 stones in the past 6 months. I’m 76 years old and I’ve never had stones until now. I drink nothing but water and I drink 15 glasses a day. I am seditary and I don’t do much to exercise. What can I do to help myself and stay away from stones?

    Reply
    • Fredric Coe, MD

      Hi Pat, You may indeed need a diet but stone prevention is very uncertain and cumbersome if one just tries to somehow avoid all possible factors that might cause stones. Every person has some few specific causes for stones, sometimes not amenable to diet. Take a look at a way to obtain rational prevention, rather than trying to do all things with diet alone. Regards, Fred Coe

      Reply
    • Jill

      Hi Pat,

      The diets will work but only if you need to be on them and if you do it right. Have you done a 24 hour urine collection to see if your oxalate is high? If not, you should. That is a lot of stones in a short time and you don’t want to continue down this path.

      Take a look at Dr. Coe’s link he shared with you. See what still needs to be done and then we can talk diets. If your oxalate has been tested and you know that it is high, then unfortunately you will need to limit the potatoes for sure. Doesn’t mean you can never eat them but in moderation is fine. Eat them less days and less quantity each time.

      Great job with the water. No matter what you do with diet, won’t matter much if your’e not drinking enough water. So keep that up.

      Hope this helps-
      Jill

      Reply
  116. terry

    hi, terry here again. this process of deciphering the multitude of sites and information, often conflicting, is perplexing. i joined the yahoo group and accessed the extensive and formidable oxalate food list, as well having its own contradictions. on the “how to read spreadsheet” instruction page it says:

    “5. Column E – Total oxalate in mg (insoluble and soluble) per 100 g. Insoluble oxalate- oxalate that can be bound by the calcium/magnesium. Soluble oxalate- gets absorbed in the body and isn’t available for binding.”

    either this is poorly or incorrectly written or i am misinformed about what soluble vs insoluble means. i think correctly stated it would read:

    insoluble oxalates found in food sources are already bound to another atom and cannot be absorbed into the body. soluable oxalates are those that are available to be absorbed into the body and are available to bind with calcium to form an insoluble oxalate that will be excreted rather than absorbed.

    am i on track with this? thanks.

    Reply
    • Fredric Coe, MD

      Hi Terry, Are you referring to the lists on my site? If so, where did you find the confusing comment? I will fix it. If it is on another site, I would not know off hand. The issue of available food oxalate is complex scientifically. Insoluble oxalate in food is irrelevant as you appear to say. That which can be absorbed will be unless the amount is limited or diet calcium is provided to complex with it and prevent absorption. Let me know where the confusing text – if it is on this site. I agree there are a multitude of sites, and of variable reliability. This one tries to adhere to contemporary science and bases its articles on references from PubMed – the peer review literature. In general, we work at the same standards for the site as we would in a scientific paper or review. Even so there are a lot of confusing areas and I would like to improve them. Regards, Fred Coe

      Reply
      • terry

        hi and thanks for the reply. no, not on your site, but on the yahoo oxalte group site that has a 180 page pdf of food oxalate contents by per 100 g samples and also by serving sizes. the list is composed of results from the *autism oxalate project* and the *vulvar pain foundation*. also, serving sizes are helpful, as they put things into a real world perspective similar to glycemic index vs glycemic load does.

        Reply
        • Fredric Coe, MD

          Hi Terry, Yes I am familiar with these lists. I am not an expert on diet oxalate, my expert colleague is Dr Ross Holmes and he is not completely satisfied with these lists. You do make a good point about serving sizes, however, which are not perhaps as good as we could do. Our lists arose from the Harvard group and we modified them to bring the data up to best modern standards such as one can. Creating serving sizes may be too much work right now as this site has no support, and is simply run by a few of us volunteers. Regards and thanks for the thoughtful comments, Fred Coe

          Reply
  117. michael

    First time suffering with Kidney stones…Terrible feeling..went to e.r..ran tests and found 2 mm…stone…Holy crap. ..something so small…so much pain..i can’t imagine the other guys pain…with cm size stones. ..As I’m in pain now looking for remedies…is there anything you can suggest to help me pass stone faster or home remedy for pain…I’m on hydrocodone…and ibuprofen..flomax? But…looking for more faster methods of relief…took pills this morning and just vomited them up along with water..ugh…heeeeelp.

    Reply
    • Fredric Coe, MD

      Hi Michael, the acute attack is managed with fluids and with the drugs you are taking, so your physicians are doing what they can. When it passes the pain will go away. If it does not your physicians can go in and get it, but usually that is not needed. If there is persistent vomiting let your physicians know so they can arrange for hydration. The real problem is to prevent more. Take a look at a good plan. Regards, Fred Coe

      Reply
  118. Brent Clay

    Are there calcium supplements you can take with meals to offset the oxalate in your meal? Something like the chewable Viactiv or calcium capsules etc? What and how can you do this? Please help !!!

    Reply
    • Fredric Coe, MD

      Hi Brent, Calcium supplements can be taken with larger meals and can prevent oxalate absorption. Before doing all this be sure you know exactly what stones you have formed, and what is the reason you form them. This is an orderly plan for you that will assure safety and that you are doing what is actually of benefit. Regards, Fred Coe

      Reply
  119. STEVEN YOUNG

    Such a Marvelous Article!!! Many of us Kidney Stone Sufferers aren’t aware of the massive amounts of Oxalates waiting to sabotage us! You have brilliantly listed these offenders, so now I can shut them out. But something that would be of major help in this article is a day to day diet recommendation. Yes, you briefly touch on the positive foods to eat, but we need more specifics.
    A detailed one week clear cut list showing what to specifically eat for Breakfast, Lunch and Dinner Sunday thru Saturday. From there, I can do variations on this theme. —- LET’S MAKE IT HAPPEN, DR. COE AND JILL.

    Reply
    • Fredric Coe, MD

      Hi Steven, We will try. Regards, Fred Coe

      Reply
    • Jill

      Hi Steve,

      One of the reasons I have not given a sample diet is bc many patients don’t like the same foods. So what I might say to you is not what I would say to perhaps a vegan. It is much more complicated than that. I don’t know if you eat meat or have diet restrictions, other medical conditions (like diabetes) or what you like and don’t like. Make sense?
      Here is some generic advice: Meats and dairy do NOT have oxalate so you are safe with them. As far as fruits, veggies, and grains, look what is on the list and eat the ones that have less oxalate. When you eat higher oxalate foods, combine them with calcium containing products to absorb the oxalate.

      In order to really give good advice I need specifics on each individual and then we can create a daily diet that works for each person.

      I am afraid this reply is not going to make you happy so perhaps you might like to email me personally and I can be of better service. Just really tough to make a generic meal plan when there are so many other factors that are involved.

      Very Best,
      Jill

      Reply
  120. Tom Kloster

    This is a very helpful article! I’ve suffered kidney stones for 25 years (very prone due to “sponge kidney” condition, per my nephrologist). I have had good success with maintaining calcium levels (as you recommend) with supplements while limiting oxalates. I also take vitamin B-6, per my nephrologist. However, I’ve had a spike in stones in the past few months that I think may be tied to adding Citrucel to my diet — with methylcellulose as the active ingredient. I’ve looked extensively for information on oxalate content for Citrucel and Metamucil, with no luck. Do you have any leads on this? Thanks — it’s always a challenge to find fiber sources that don’t have high oxalate content!

    Reply
    • Fredric Coe, MD

      Hi Tom, I doubt the agent increased urine oxalate, but it may have affected urine volume by increasing stool water losses. I would consider getting a new 24 hour urine while on the agent to see if there is really any oxalate effect. See what your physician thinks. Regards, Fred Coe

      Reply
  121. Mark

    What about turmeric? I’ve read it’s very high in soluble oxalate, but it’s also meant to have many health benefits. Would you advise avoiding turmeric? Or perhaps taking it with a bit of calcium to form insoluble oxalate?

    Reply
    • Fredric Coe, MD

      Hi Mark, I am going to leave this one to Jill. I don’t like turmeric much. Regards, Fred Coe

      Reply
    • jharris

      I hate to say it but yes, it is high in oxalate. Check out this link (http://ajcn.nutrition.org/content/87/5/1262.full)

      I take turmeric as a supplement as I have had cancer and it a great anti-inflammatory agent. Eat it with some dairy product for the calcium. But, yes, if you are watching your oxalate consumption, I would go for lower doses of it.

      Thanks for writing.
      Jill

      Reply
  122. Patsy Catsos

    I am curious to learn more about the oxalate content of stevia. In the section about sweets, you note that one teaspoon of stevia contains 42 mg of oxalates. Is that pure stevia leaf or something else? Stevia leaf and extract are so strong that it would be unusual to consume more than a pinch of crumbled stevia leaf, or a drop or two of extract; can you point me toward the primary data source for the oxalate composition of stevia so I can look into this? Thank you!

    Reply
    • Fredric Coe, MD

      Hi Patsy, I looked on Pubmed and found nothing. I will write to my colleague Ross Holmes who is the real food oxalate expert and ask him where the number came from. Given the stevia alkaloids are themselves not likely to metabolise to oxalate – they do not, it must be leaf preparations, and leaves contain oxalate variably depending on the source. Thanks for the valuable question. Regards, Fred Coe
      Professor Holmes shared the source with me: ‘The value for Stevia was included in the Low Oxalate Cookbook – Book 2, published by the VP Foundation. Assays performed by Mike Liebman. I noted quite a few Stevia products on the supermarket shelf. I imagine the oxalate load in a teaspoon (5 g) is around 150 mg, so it should be avoided. There are plenty of non-oxalate choices.’
      Regards, again, Fred Coe

      Reply
  123. Gretchen

    This article is really helpful! The prospect of finding things to eat was daunting with the short list I got from my doctor, but your updated/more comprehensive list and all of the helpful hints about how to work things in makes the task much easier. Thank you!

    Reply
    • jharris

      Hi Gretchen,

      Thanks for taking the time to write us. We know that eating a low oxalate diet can be -at the very least- a bit overwhelming. Let us know if you have any questions.

      Enjoy the rest of summer-

      Jill

      Reply
  124. Gary

    I am 57 years old and have had kidney stones twice in the last 5 years. Both times were within 2 weeks of starting to take chewable tablets containing calcium. One was a fiber supplement that also contained calcium and the other was antacids. I have not read anywhere about a connection between chewable tablets and stones, but it sure seemed to be there for me. I have taken vitamins containing calcium for years and never had a problem. When I stopped taking the chewable tablets each time there were no more stone problems.

    Reply
    • Fredric Coe, MD

      Hi Gary, If you have, as an example, idiopathic hypercalciuria, a sudden burst of calcium can raise urine supersaturation and promote crystals and stones. That seems likely. As for calcium supplements they are safer taken with meals, never alone. Be sure and get at least one CT so you know what is there. Regards, Fred Coe

      Reply
  125. Micaela

    Husband (22) just came back from Dr after 24 hour urine analysis. Told to limit calcium, sodium, and red meats. What is he supposed to eat?! I feel like what I read is contradicting. His Dr. said to limit calcium, but lots of articles say that it’s okay?

    Reply
    • jharris

      Hi Micaela,

      I know it sounds like a ton of information, but it is very doable. Calcium should NOT, I repeat, NOT be limited. Normal amounts of calcium, about 1,000 mg/day by food is best. Most adults come nowhere near that. Limiting sodium and meats (all animal meats) is not too hard to do if you have the right guidance (and of course discipline). If you need help just reach out. I am happy to give a complimentary call to start him off if you would like. Email me at jharris1019@gmail.com and we can set up a date and time.

      Jill

      Reply
  126. Jerry

    Long time kidney stone sufferer. Since 1999, I’ve had 16 surgeries for stones. The stones continue to grow in size with the last 2 episodes producing stones 2-3cm each which are causing blocked ureters. I am trying yet another urologist due to insurance changes. The latest 24 hour urine test for stone risks show hyperoxaluria, marked hypocitraturia and mild hyperuricosuria. My urine citrate measures 450 for males, urine oxalates measure 69 (range 20-40)urine uric acid 0.867 (range ,0.800 males), sodium 335 (range 50-150), chloride 332 range 70-250) and urine creatinine 31.4 (range 18-24 males).

    I make different stones. I have been advised to increase mu Urocit-K from 10 mEqs BID to 15mEqs TID, a low oxalate, low calcium, low sodium diet. I was advised NOT to drink lemonade to acidify my urine.

    The conflicting information on what I should eat or dink is driving me crazy. Can you give me any guidance?

    Reply
    • jharris

      Hi Jerry,

      Sorry to hear about all your trouble with kidney stones. They are a terrible thing. I can understand your frustration with diet and fluids. I would like to offer you the opportunity to have a complimentary call with me to help sort it out. Feel free to write me at jharris1019@gmail.com. You have much going on and it would be difficult to get all info needed to give best advice.

      I will tell you this- with the right advice you do NOT have to suffer like this anymore.

      Write me to set up the call if you like-

      Jill

      Reply
      • Carole Early

        Hubby,67…stones since 29 years old…defy diets…stones anyway
        Help,
        Carole

        Reply
        • jharris

          Give me a bit more Carol. Has he had 24 hour urine collections done? Does he have any other medical conditions? What types of stones does he make? The more you give me, the better I am to you…

          Talk to us!

          Until then,
          Jill

          Reply
    • Fredric Coe, MD

      Hi Jerry, The high urine oxalate is probably dietary, and perhaps Jill Harris can help you with it. Certainly the low calcium diet will worsen the problem and is not advisable. But your stones – are they in fact calcium oxalate, or are they calcium phosphate? You do not mention a urine calcium; is it high? Your urine sodium is massive meaning you eat a lot of salt; this might be raising urine calcium losses in the face of a low calcium diet, which is not ideal. Take a look at a way to help you organize your care so you can fill in the missing pieces and make it easier for your physicians to reduce stone formation. Regards, Fred Coe

      Reply
  127. Heather Mylin

    Hello Dr. Coe, I had my first bout of kidney stones in 2007. The urologist said that the stone analysis showed that it was a Calcium Oxalate stone made of about 98% Calcium. If I remember correctly, it measured somewhere between 4mm-5mm in diameter. He suggested drinking a couple of liters water, especially first thing in the morning and before bedtime. He also suggested taking ‘Citric K’, (not sure if that is the right name for the prescription, as I ended up not taking it). He said I could drink Lemonade and even a Coke to try and get some citric acid into my system. At that time, a clump of ‘kidney stone forming’ masses were detected resting in the bottom inner folds of each kidney. Nine years on, now 2016, I had an x-ray of my spine done by my chiropractor. Many white stones were seen in those x-rays in each kidney. Depending on the gray lines running between the white stones, there look to be about 8 stones in each kidney; the largest measuring 6mm in diameter. My question is should I return to the urologist or should I try and find a nephrologist? Secondly, until I find a doctor, could I continue to take supplemental Iron, (my recent blood work shows that I am slightly anemic), Magnesium Citrate, SAM-e, Glucosamine, and Zinc. Do these play a role in raising urine oxalate or promote stone formation? Thank you for your time.

    Reply
  128. terry

    hi. concerning increased calcium consumption vs oxalates, which of the several calcium compounds available respond most effectively in tying up oxalates in the gut? and recent studies have suggested a correlation between calcium supplements and prostate problems. can you comment to that? thanks, terry

    Reply
    • Fredric Coe, MD

      Hi Terry, Once again, thank you. It is not which calcium produce or high calcium food it is that the calcium be eaten when the oxalate is eaten. Just as calcium mates with oxalate in the urine, it mates with oxalate in the bowel lumen, and the result – calcium oxalate crystals, makes oxalate absorption go down and urine oxalate with it – or at least this is current teaching by my colleagues who study oxalate. My favorites are to use a high calcium food in every substantial meal, preferably within the meal. A calcium supplement 350 – 500 mg is probably alright but needs to be with the other food. As for prostate problems, I have never heard of a calcium supplement issue. Warm regards, Fred Coe

      Reply
  129. terry

    first of all, thank you for this important site and your dedication to informing people about kidney stones.

    i have two questions, and i’ll use another form for the second one. i remember reading some time ago, but have forgotten the source, that of the high oxalate foods, only several actually contribute to stone formation. perhaps this is due to how they are digested. do you know of this study and can you respond? thanks, terry

    Reply
    • Fredric Coe, MD

      Hi Terry, You have asked a fine question in that it raises important issues. Oxalate is a risk factor for calcium oxalate stones – that is accepted medical information. But, why do we say so? The stones are made of it, so that makes the case, sort of. But oxalate makes calcium oxalate stones with calcium, meaning in some – perhaps many – people calcium is at fault. At fault seems a good way to put things: Stones can know about only supersaturation, which is – roughly speaking – the product of the calcium concentration multiplied by the oxalate concentration. The concentrations are the amounts of each in the urine daily divided by the volume of the urine. So if you eat more oxalate, and raise your urine oxalate – both are necessary, for any given amount of calcium in the urine and, by the way, any given urine volume, the product of the calcium by oxalate concentrations will be higher and therefore the supersaturation will be higher. This should put diet oxalate into some perspective. Three factors set urine calcium oxalate supersaturation – the only thing crystals can ever know about – urine volume, urine calcium excretion, and urine oxalate excretion. Urine citrate also plays a role, because citrate binds calcium so it cannot mate with oxalate. It should therefore come as no surprize that urine volume, and urine excretions of calcium, oxalate, and citrate are the four factors that are epidemiologically well linked to new stone onset. So, diet oxalate matters by indirection. No study has proven that diet oxalate itself causes calcium oxalate stones though it surely is important, and no trial has shown that reducing diet oxalate reduces new calcium oxalate stones – although common sense would make that point obvious. As for specific foods, given what I have said, I guess it is more or less that the foods with the most oxalate – spinach is a prime one – are the most risky. Also potentially risky is low calcium diet. Urine calcium may not fall so much as urine oxalate rises, so one can possibly make matters worse. Thanks for asking – warmest regards, Fred Coe

      Reply
  130. Stoner

    This was very informative and written in a non-technical way AND the comments were recent. I just got thru my 2nd bout of stones within 2 yrs. This last one required 1 month off and on in the hospital and surgery. So yesterday I got the analysis of my stones back-the 2 similar but different oxalate stones. The diet boggles my mind that the doc included. While I am not a strict vegetarian, I’ll eat a burger maybe every couple months, my diet consists of mainly everything on the “avoid” list-requires me to drink “at least 2 glasses of milk a day” Ewww-I cannot stand milk. So milk, pop(specifically colas) and water and was told to limit water as it has no nutritional value. Most veggies are to be avoided-everything in my garden is to be avoided except small quantities of cukes.
    The 1st time I had stones, my (now retired) urologist took me off calcium supplements, I had had another doc have me on 8K mg of Vit D a day. The uro doc took me off everything-then I understood the massive VitD may have played a role, also the parathyroid came into the pic. In the last less than 2 yrs, my calcium level is normal to slightly low, and my PHP (parathyroid) has been close to normal-down by almost 1/2 from when I had the 1st stone issue, and my Vit D is in the low range in the normal numbers.
    So I am confused as to-why stones again? Or why the 1st time? All my numbers are normal now. The 1st time nothing was said about the low oxalate diet-although it was the oxalate stone then, too. They went off on the D and parathyroid. I am currently seeing an internist, urologist and endocronlogist, then they wanted me to see my family doc every week “just to check in” I feel they’re milking me and my insurance-no pun intended. But the difference in treatment/diet within the 2 yrs makes me wonder. Are there other causes for oxalate stones than high oxalate? Why was I told to limit calcium the 1st time and now have to drink 2+ glasses a day? I am more confused having gone thru this twice now. If this diet is correct-no way can I drink milk and eat meat like they suggest-are there any alternatives? I’ve eaten this way 40+ years and only had stones within the last 2-in my late 50’s. Sorry to ramble… Thanks

    Reply
    • Fredric Coe, MD

      Hi Stoner, I fully understand the confusion, and hope I can be of help. Try this article and see if you can follow it from beginning to end asking the questions and lining up the answers. Likewise, as a second one, this summary. It is do hard to do prevention without a clear method, and this is mine – it will get you there. Regards, Fred Coe

      Reply
      • Stoner

        Thanks for your prompt response. I do have a urine save and blood work coming soon. The internist got me into the endocronogist within days after my last hospital release-telling her I had extreme hypercalcemia, which confused her as my calcium had been low to normal in the hospital. I held up on the tests, as I was wiped from all the runaround (I had been initially admitted with septic shock, which they said was due to the stone blockage.) Besides the usual nausea, all they would give me was 7 up-which I can’t drink. The food was horrendous, no matter what you ordered-pop, cinnamon rolls, lunch meat sandwich etc. was what they brought. I was begging for something good-like veggies and was refused. They also push Flomax for passing stones, which my former retired uro doc said was nonsense. During urine saves/bloodwork and the PTH tests that my 1st endroconlogist ordered 2 yrs ago, on my return visit, when I asked the results, he told me “let me worry about it-you don’t understand” I wanted my PTH number-I know what normal range is and I had been in the 130 range. My DIL, who’s a nurse, suggested (other than that was wrong) to ask my family doc, who also refused “because he didn’t order the tests”, although he had sent me to his buddy the endro doc. Finally I went off on a rant at my ob-gyn’s nurse several months later, she talked to my ob-gyn, who accessed the “other hospitals” records and printed out my test results. As far as I can tell, everything looks reasonably normal, my PTH had dropped to the 80 range-although the 1st endro doc told me I needed surgery-either 1 Dr at Uof I, 1 in Madison, WI or Mayo-in that order. Yet my PTH dropped. They did all the tests in the hospital, but for a patient to get-it’s impossible. And I’m confused why I have been told to quit drinking so much water since there are no nutritional benefits. I had been under the impression that the parathyroid had caused the stones 2 yrs ago and to just finally hear about the oxalate-that wasn’t even brought up thru several weeks of in and out in the hospital.

        Reply
        • Fredric Coe, MD

          Dear Stoner, I am as confused as you are. The serum PTH can be high because of low calcium diet, vitamin D deficiency and many other disorders. Primary hyperparathyroidism generally raises serum calcium above normal, and serum PTH is not suppressed below normal, and urine calcium excretion is not extremely low. I cannot tell what is wrong in your case, so much information missing. Perhaps you do indeed need to gather up all of your lab results from all sources and compile them by date as a help to your physicians. The university medical school in Madison WI and the Mayo Clinic deliver a very good level of medical case, so I also a bit uncertain as to why things are so uncertain. Try doing your own compilation and sharing all of the results with someone in these institutions who is taking care of you. As for stone prevention, which is your obvious goal, here is a good reference as to how to organize things to get it done. Regards, Fred Coe

          Reply
  131. Mick Bolvin

    In the “useful table of oxalate foods”, my question is on pancakes. When listed under bread, the pancakes are listed as (mix), (home made), they are listed 10 mg and 11mg respectively, then lower on the list under Breakfast, they are listed at 37mg and 22mg. Could you please let me know which is accurate. Thank you.

    Reply
    • Jill

      Hey Mick-

      Even though we stand by this list and know that it comes from the highest level of scrutiny, it can also be confusing. I assume that although they did not list what pancake mix they tested it was different in each case. Depending on the list of ingredients, it would vary. Not very helpful, huh?

      Personally, pancakes are not the healthiest item in the world, so I would just eat them when I wanted a “treat”. I would also just consider them a higher oxalate product and if you are limiting oxalate, limit pancakes.

      Also, just because something is on the high list doesn’t mean you can NEVER eat it. The easiest way to lower the oxalate is to just lower the quantity you are eating during a sitting.

      Thanks for writing and I can only hope this wasn’t a dreadful reply.

      Jill

      Reply
  132. Alex

    Sorry… Fred!

    Reply
  133. Alex

    Frank: please don’t be sorry. Both comments were a big help.

    At the end of this article you mention the study where gelatin raises urine oxalate. If there is gelatin (or kosher gelatin) in yogurt and a stone former eats two small Yoplait containers a day, can that raise urine oxalate also? Or would those amounts of gelatin be too small?

    Thanks,

    Alex

    Reply
    • Fredric Coe, MD

      Hi Alex, it is possible if someone is very sensitive to food oxalate and absorbs a high fraction of it. But if the amounts are small, as you describe, it is unlikely to be a contributor. Regards, Fred

      Reply
  134. Alex

    The article and your website are very helpful. Can you tell me if sunflower lecithin or soy lecithin contain oxalates? They’re in a lot of protein powders. Thanks.

    Reply
    • Fredric Coe, MD

      Hi Alex, here is the truth. What we know is on those lists. What is not on them is so far as we can tell not known. Oxalate contents of food materials are hard to come by and no one wants to pay for the measurements. Sorry I have not more for you. Regards, Fred Coe

      Reply
    • jill

      Hi Alex,

      Since we know that soy lecithin does indeed have soy in it, I think it is safe to say that protein powders made with it would be a higher oxalate item.

      Warmly,

      Jill

      Reply
      • Jason

        There’s no real way of knowing. However, given the fact that soy lecithin is tolerated by the majority of people with soy allergies, I would venture to guess that there’s probably very little actual soy in the protein powder and, therefore, very little oxalate per serving.

        Reply
  135. nena

    im looking for a complete listing of all foods that are low in oxalate and high my niece 31 yrs old has had stents put in kidneys hospital twice surgery twice has major issues cause of kidney stones where can we find a complete listing at

    Reply
  136. Natali

    You write that the goal is 50-100 mg of oxalate per day. How much for a child of 8 years?

    Reply
    • Fredric Coe, MD

      Hi Natali, This is an important question because children do not usually require low oxalate diets. Is there evidence that your child has a high urine oxalate? If so, are your physicians sure it is from diet or is it from primary hyperoxaluria. Please be very careful about this matter. I do not know the correct figures for so small a child, and would suggest that your child be seen by someone very expert in this area if there is a urine oxalate elevation. Regards, Fred Coe

      Reply
      • Natali

        My daughter was in the hospital. She has been diagnosed with Tubulointerstitial Nephritis. She has a high urine oxalate. The doctor said that we need a low oxalate diet. But did not give clear recommendations. In this article I understand everything and I want to follow these recommendations. But I’m not sure what goal to deliver. Whether 50 normal goal for child?

        Reply
        • Fredric Coe, MD

          Hi Natali, I am concerned your daughter may have primary hyperoxaluria which can cause what appears to be interstitial nephritis but is due to calcium oxalate crystals. I would contact the Mayo Clinic – Dr. John Lieske – and bring her to his attention. They have a rare disease consortium there and a vast experience with this specific disease. Regards, Fred Coe

          Reply
          • K. Holley

            Thanks for the Google sheet list of foods and oxylate content. It will be very useful but I did wonder how a serving of cake could have as much oxylate as a cup of AP flour. A typical layer cake takes 3 cups and makes 8-12 servings. Thanks.

            Reply
            • jharris

              Hi.

              I see your confusion. I am afraid I do not have an answer for you. Who knows how big the piece of cake was, who exactly what kind of flour was used? Perhaps Dr. Coe has an insight.

              Best-

              JIll

              Reply
  137. Liz Jones

    It seems that every 3 months I’m having 10mm and 11 mm stones shocked. My urologist tells me it’s just a “heredity” thing. I should drink lots of lemon water and cut out protein such as meat. I no longer believe this after reading your article. I have changed my diet according to your list, which I hope helps. My question is this: I am Type II diabetic, so I’m wondering how to incorporate a low oxalate diet, including 1000 mg of calcium per day, along with 10+ glasses of plain water, without messing with my sugar levels too much. Orange juice would be a prime example – low in oxalate, high in sugar. Any help you could offer would be greatly appreciated! Thanks so much for such a thorough, proven article.

    Liz

    Reply
    • Fredric Coe, MD

      Hi Liz, I guess my question would be whether you know what the stones are made of. Are they really calcium oxalate? Diabetics often make uric acid stones. If calcium oxalate, what do your 24 hour urine tests show. Diabetics often have very high urine calcium levels and oxalate is not the problem. Take a look at this plan and see if you have really had a full evaluation. If you have a high urine oxalate and need to lower it, and also to watch your sugar intake I think you might just contact Jill Harris – who wrote the article. She often speaks with people and helps them personally. Regards, Fred Coe

      Reply
    • Jill

      Hi Liz,

      I get this question all the time. it is tricky but certainly very doable. I am happy to help. Write me at jharris1019@gmail.com and I can give you advice specific to you and perhaps you can hop on a call with me which might be easier.

      Very Best,

      Jill

      Reply
  138. Lisa M Viviano

    Yikes! Please help. I’ve seen a handful of lists rating oxalate amounts of foods and many are in contrast from this one. This lists looks very complete, which is wonderful, but for example, your list says blueberries are low, in moderation. The other lists I’ve seen place blueberries, along with other berries, as very high and to be avoided. Please help my confusion. Thanks!

    Reply
    • Fredric Coe, MD

      Hi Lisa, These lists arose from the Harvard Public Health school and were then vetted and edited by Dr Ross Holmes who in fact made many of the measurements currently available. It is the best we can make of all of the available data. We know about the many divergent lists and believe they are simply not always based on reliable measurements. I am not myself a primary investigator measuring food oxalate but Ross is, and I don’t know how else to offer better right now. One list, from the Oxalosis Foundation was pulled down by them because it had faulty data, indicating a high level of responsible behavior from that organization. Others who offer lists should be sure their offerings are indeed accurate. We are not so sure they all are. Regards, Fred Coe

      Reply
  139. Colleen Rockliff

    Diagnosed with ‘secondary oxolosis’ 4.7.16. Help! All information and suggestions gratefully recieved. Creatinne level 325 & climbing.

    Reply
    • Fredric Coe, MD

      Dear Colleen, I do not understand the word secondary. Do you mean high levels of oxalate in the urine due to bowel disease? Is it instead primary hyperoxaluria? These are both very serious especially when kidney function is impaired. My suggestion is that you consult at the nearest medical school as these conditions are uncommon enough that even the finest practitioners are not likely to have managed very many patients. Regards, Fred Coe

      Reply
      • Colleen Rockliff

        Hi & thanks for responding.
        Diagnosis from kidney biopsy. Creatinne levels from bloodtests. I’ve started low oxalate diet. 6 week pelvic radiation treatment begins 20.7.16, so I’m a bit of a challenge!

        Reply
        • Fredric Coe, MD

          Hi Colleen, You really do have a very complex situation and I am sure your personal physicians are doing the right things. I gather the oxalate disease was diagnosed by kidney biopsy showing calcium oxalate crystals in your kidney tissue. Given the radiation there is clearly more wrong and I hope for a good outcome for you. It might be important to measure the amount of oxalate in the urine – routine kidney disease can cause some crystal deposits in kidneys but usually not large amounts of calcium oxalate crystals. Regards, Fred Coe

          Reply
  140. Payam

    Hi Tim, Jill,

    Thank you for this great article and the wealth of information on this site. I passed my first stone last week, ouch! I put together a quick web app to make searching/viewing the list of foods you provided easier from a mobile phone, or desktop. I hope you and/or your viewers find it useful.

    http://oxalates.site44.com

    Best Regards,

    Payam

    Reply
    • Fredric Coe, MD

      Hi Payam, I am a bit confused. If you have copied the data from the tables on my site and made them into a web source, you have an obligation to make clear their provenance, which is mixed. The lists arose from the Harvard school of public health and were modified by Dr Ross Holmes. They are meant as a complement to the article Jill wrote on who should use them and why, and to what extent. To place them into an app of your own may be a nice service to others but it is not your work and it isolates the mere measurements from the cognitive source of the article with its references. Have you assured that you have copied the results without errors? Without a link to the original article, how will people know the best ways to use it and how to determine if these lists are important in their individual treatment? If, long term, results put up on a site like mine seem to wander off without proper links back, is it certain the site will remain available? Regards, Fred Coe

      Reply
  141. Holly nealis

    Dr Coe. What are your thoughts on chance piedra for kidney stones?

    Reply
    • Fredric Coe, MD

      Hi Holly, I have been asked this before and looked. I can find no studies reported in PubMed – the national repository of science articles. So, no data. No data means could be good, could be bad, could be nothing at all. Take a look yourself, it is free to everyone. Let me know if you find anything. Regards, Fred Coe

      Reply
  142. Lisa

    Hi,
    I just had lithroscopy last fall. Today went for a followup to my last week’s ulstrasound.-my procedure was done on my left with one left at the very bottom at 2mm. It appears I have 2 new stones in my right kidney, one at 3mm and one at 4mm. I know this is due to my high oxlate diet, however, I have been trying very hard to restrict some of the good foods that are high. I no longer eat spinach, kale, potatoes (any of the high items)! I love all fresh fruit and veggies, very little salt or process foods. I love coconut milk, greek yogurt as well for calcium intake. I am frustrated at what I can continue to eat without enlarging these stones. I am also trying to drink my 10 glasses of 10ounces of water!
    Any other suggestions? I want to continue eating clean and healthy but feel I am at a point where I can not eat anything!
    Thank you!

    Reply
    • jharris

      Hi Lisa,

      There are plenty of fruits and veggies that you can eat and of course lean meats as well. Please look at the list in the article and use the high oxalate products sparingly, and the low oxalate products more. You can eat kale.

      Have you had a 24 hour urine collection? If so how high was your oxalate levels. Let us know.

      Jill

      Reply
  143. D.

    Hi,
    Thank you for this thoughtful and comprehensive post.
    As often is the case I see discrepancies in online lists that are confusing.
    Hummos LOW / Tahini – HIGH
    “Here are some low oxalate options in this category: White rice, hummus, corn flour, corn bran, flax seed, and oat bran are popular and safe.” Hummos is made with tahini so I am confused. And I really want to have hummos. Blueberries and yogurt are mentioned here as a good breakfast – but I have a bewilderingly bad reaction to nice seasonal organic blueberries (listed elsewhere as confirmingly HIGH).
    Any further thoughts on this?
    Many thanks,
    D.

    Reply
    • Fredric Coe, MD

      Hi D. The lists here are by the best experts in the field – I am not one of them. Ross Holmes went over the oxalate contents and he is really the authority. I trust him and the list. The origin of the list was the Harvard Public Health people, and Ross made additions and corrections. So it is what it is, and I know many online lists differ – from us and from each other. This is an odd site; it is from a stone program at a university and I and those I work with are – if imperfect, certainly, at least careful and bound by the best science we can find. If better data become available, we will certainly seek to publish them. Regards, Fred Coe

      Reply
    • Samantha

      Hi D,
      I think you will be ok with hummus, as it’s mainly chickpeas…the reason tahini is high is because it’s just ground-up sesame seeds, which are very high. You could make your own hummus and just leave out the tahini altogether, there isn’t a lot of it in hummus anyway. I don’t know about the blueberries though :(.

      Reply
  144. robert bentley

    I’ve had 2 lithotripsy procedures in the last 2 months. I had a mini gastric bypass in 2001 and cruised along pretty good for 8 or 9 years. Then the stones kicked in and I’ve had so many I couldn’t begin to count them all. I just saw my first urinalysis test today and it reads like this. Volume 253, ss CaOx 749, urine calcium 94, urine oxalate 144, urine citrate585, sscap 0.47, 24 hour urine ph 6.258 ss uric acid 0.20 urine uric acid 0.419. For the last 5-6 years I’ve been passing a stone a month sometimes 2or3, Needless to say lots of pain and even more worry about when the next one might come. when I started the lithotripsy 2months ago I had 6 stones that were 7mm to 11mm (2 were 11mm). I’m not a drinker and have been making an effort to drink a lot more water, I’ve looked at high oxalate foods and other than potatoes and peanut butter maybe a few others on the list I don’t eat a lot of high oxalate foods. My urologist told me today to drink 2 glasses of milk a day and try to cut back on the higher oxalate foods. what are your thoughts on this, thanks Bob B

    Reply
    • Fredric Coe, MD

      Hi robert, I guess the very high urine oxalate catches one’s eye. The volume you quote is surely incorrect, I imagine it is 2530 ml, and the ss CaOx looks odd but is probably 7.49. Your physicians must be very concerned about the oxalate and will surely want to lower it. Not only can it cause stones but also there is a real risk of kidney injury. It is not the foods it is the bypass procedure, surely, and there are approaches to treatment. Be sure the oxalate is lowered as much as possible. Regards, Fred Coe

      Reply
  145. Roxanne Forey

    I have a question, does flax milk have less oxalate levels than almond milk?

    Reply
    • Fredric Coe, MD

      Hi Roxanne, I hope Jill answers this one. I do not know. Regards, Fred Coe

      Reply
    • jharris

      Roxanne,

      In our article on how to eat a low oxalate diet we speak of flax and that is is one of the safe seeds. Enjoy the flax milk. It is on the lower side, much lower than almond milk.

      Jill

      Reply
  146. Tim

    What are the studies of adding Magnesium to ones diet through the way of Magnesium Citrate supplements? I hear they can help somewhat in preventing Calcium based stones.

    Reply
    • Fredric Coe, MD

      Hi Tim, although I have not published them, there have been magnesium trials – negative I am afraid. It does not appear to work. Regards, Fred Coe

      Reply
  147. Jacqueline

    Hi all! I’m 25 years old and have just had my 3rd kidney stone (first ones started about 4 years ago). This last one required litho to break it up and flush it out, and that stent was no walk in the park. All stones have been calcium based but different types. The latest one, I believe, was oxalate. Doc gave me ‘the list’ of foods to avoid and consume. I’ve been upping my water intake and am waiting for things to go back to normal before starting blood and 24 hour urine tests. I know in the past, I have had a blood test with my calcium levels in the normal range for my age group. I’m a little worried it could be a parathyroid issue, and it’ll get overlooked if my calcium levels are normal. I’ve read that they can appear normal if the body is leaching calcium out of the bones to make up for it? I just want to cover all bases because I am so tired of all these stones. I feel like I have a lot of symptoms that come with parathyroid issues, but self-diagnosis is pointless without test results. Fingers crossed for some results that give me answers!

    Reply
    • Fredric Coe, MD

      Hi Jacqueline, Primary hyperparathyroidism virtually always produced an elevated serum, sometimes the increase is very subtle, and sometimes ionized calcium measurements help. Always have the blood drawn fasting, and if there is a suspicion the measurements are inexpensive so many can be made. If normal all the time, the disease is not at all likely. You should have 24 hour urine testing; PHPT almost always raises urine calcium, and perhaps you simply have idiopathic hypercalciuria. It is best to follow a plan for evaluation; here is one I like. Regards, Fred Coe

      Reply
    • jharris

      Hi Jacqueline,

      It sounds like you are doing a really great job of getting yourself educated about your stones. Good for you. I see your doc gave you a list of foods to avoid, but remember, we don’t know the values yet from your lab results, so that list may not apply to you.

      Great job on drinking more water, no matter what the results say, you will always have to be an avid water drinker.

      For now we await the results. Let us know what they say!

      Jill

      Reply
  148. Denita

    Hi, I am 59 and had my first kidney stones 18 months ago, which required three operations and stents. I was laid up in bed for 3 months in pain form the stents and unable to work. I changed my diet to avoid the very high oxalate foods immediately and have been drinking 2- 3 litres of water a day, no tea or coffees. The xrays then taken after the operations showed already new crystals were formed, ( between the first and second ops ) ,much to my urologists surprise. The tests results on the stones removed showed they were calcium, but the further tests done on them showed all was normal. So I was sent for blood tests and urine tests. Again all results showed totally normal. I then had more xrays in Feb this year, and they showed that the crystals from last year are now indeed new stone – three are 1mm and one is 4 mm. My urologist is totally puzzled and all he has said is to keep drinking the 3 litres of water a day. ( which I had done anyway all along). So now I have to have more xrays in August to see if these current stones have grown further. If yes, then I have to go back to hospital for those dreadful stents and three operations. As my internal plumbing is so narrow, then I am required to have stents in for 3 months. I totally beside myself at the prospect of being so sick and bedridden for another 3 months, and cancelling work, and then another month for post recovery. I was so weak from loss of blood from the stents and in such pain for all those months. I am usually a very fit person and naturally very lean.
    I do not want to spend each year now potentially having to have kidney stone ops. By the way, my grandmother had kidney stones and died from the operation. I have seen a dietician and am very careful with what I eat and my body/urine is normal and alkaline. So why am I still forming stones when all tests show all normal?
    Thankyou for reading this.

    Reply
  149. Claudia

    Hi,
    I am so impressed with this website! I have a question about turmeric use. A medical study done in India showed that turmeric 1 g 2x/d (with black pepper supplement to boost the absorption of the turmeric) was as effective as ibuprofen 800 mg for the treatment of knee arthritis. This has been very effective pain control for me.
    I had my first episode of kidney stone in Feb /16 at age 49. It was a 9 mm calcium oxalate stone that required laser ablation and stent placement. Original CT scan only showed 1 stone. I am in the midst of the 3 month follow up and kidney ultrasound showed multiple stones on the same side as the original with the largest being 8 mm. I wonder why I have all these stones when I have been drinking more and made diet changes. I have used turmeric for about 2 years but only added the black pepper supplement around 6 months ago when I read that turmeric is poorly absorbed when taken alone. An unscientific Internet search yielded differing opinions re turmeric with some suggesting it should not be used. I stopped using it with subsequent return of knee pain. I don’t want to return to long term NSAID use due to possible consequences re renal function. I just completed my 1st 24 h urine collection while off the turmeric. Results are pending. I’m wondering if I should restart the turmeric before the 2nd collection and see the result. Any thoughts re this and turmeric?
    Thank you ( sorry this is so long) .

    Reply
    • Fredric Coe, MD

      Dear Claudia, The pepper is a possible source of oxalate, about the turmeric I do not know but your idea of testing before and after sounds worthwhile. More important, with all these new stones, what else but oxalate is wrong in the 24 hour urine?? Are your blood tests normal? Stones are rarely from one thing, but usually a compound of several. REgards, Fred Coe

      Reply
      • Claudia

        Blood tests are normal. Just submitted the 2nd 24 h urine….no word re results of the 1st yet so I can’t comment re urine oxalate levels ( yet). Stone composition was 100% calcium oxalate.
        I was given 3 liter containers for urine collection but my 1 st sample was 4100 ml and the 2nd was 5475 ml. Is that an unusual amt? Also, I have been adding 1/2. squeezed lemon to fizzy water ( soda stream) because I thought lemon is supposed to help. Is that correct or should I not use so much lemon? By the way…no sweetener is used.

        Reply
  150. Chris

    I am so confused and frustrated. No two lists of oxalate foods are the same! One says you can eat spinach and another says no spinach…and there are other foods too. Like no one agrees! Even my urologist says diet doesn’t affect stones. So this is where him and I disagree. So how does one choose a diet list? Take a chance? It is also hard because I am dairy and gluten free….thanks. I am hungry all the time!

    Reply
    • jharris

      Hi Chris-

      You are confused and frustrated because it IS confusing and frustrating. Please know that spinach is one of the highest containing oxalate items. Since you are dairy free and gluten free I can see how frustrated you must feel.

      First question for you. Have you done a 24 hour urine collection to see how high your oxalate is? If so, how high is it? Before I make suggestions it is best I know those two answers.

      After that I can help-

      Jill

      Reply
      • Chris

        Hi Jill. This is a new journey. I had severe kidney stones and an e coli infection 5 yrs ago and the urologist removed with litho. In January 2016 I was back in the er and again the kidneys were full of stones. 3 surgeries, 4 stents and I have been dealing with this since January! After these last surgeries, I figure that it is more than just water consumption. My urine was clear even on the day I went to the ER. There has to be something diet related. On the other hand my urologist says that diet does not contribute. I’ve asked him several times. So I am searching and reading on my own. I will call and ask if they do a urine collection to check the oxalates. Thanks for your quick reply.

        Reply
        • Nancy Nash

          Hi Chris..have you had your parathyroids checked out? My endocrinologist says that because my blood calcium level is high that one or more of my parathyroids can be the culprit. Once the parathyroid is removed my stones should not be an issue.

          Reply
        • jharris

          Chris-

          This is a journey I wish you did not have to take. Please get a 24 hour urine collection done so that you can see what is causing your stones. It could be many things. You need to do that before you ask for diet changes or blood tests. When you get that done you will be able to find out WHY you are forming them. No point in changing diets if you don’t have to, but many times that is indeed the case. The results of the urine test will show what diet changes, if any, will need to be made.

          Also, do drink more water. That is something all stone formers must do in order to keep your urine less saturated with stone forming crystals.

          Let us all know how it goes once you get that test ordered and the results come back-

          Best to you.

          Jill

          Reply
          • Chris

            I have an appt with the urologist in July. He will check the xrays and see how the stones look. Then he might have me do the 24 hr urine testing. See you all later! Thanks for all the help.

            Reply
            • Meekah

              Hi Chris,

              My father battles with reoccurring calcium oxalate kidney stones and has tried following a low oxalate diet since his last occurrence (needing surgery) back in 2014. He’s found it easier to stay away from his favorite high oxalate foods (chocolate, beans, potatoes, cereal) by following a low oxalate, semi-paleo diet. Obviously avoiding the big threats like spinach and rhubarb. I know it’s incredibly frustrating and difficult to make radical changes to your diet. Being dairy and gluten free, maybe you can also look into this if your stones are also calcium oxalate.

              Jill, what are you thoughts on semi paleo diets for calcium stone formers?

              -Meekah

              Reply
              • jharris

                Hi Meekah,

                It all depends on what your 24 hour urine collections say. Meaning, it just depends if your oxalate and protein levels are really high on your test, then I would say to watch how much proteins you are eating. When the values are known from your testing, discussing what to limit and why stems from testing.

                If you are not eating too much protein, then typically it is ok. If you are not eating too much high oxalate foods, then it is ok. Has your father been tested?

                Jill

              • Meekah

                Hi Jill,
                He has been tested, but I can’t get a hold of his urine test results. However, his stone components were tested at:

                61% calcium ox monohydrate
                35% calcium ox dihydrate
                1% calcium phosphate (carbonate form)
                1% calcium phosphate (hydroxyl form)
                2% protein

                another at:
                50% calcium ox monohydrate
                40% calcium ox dihydrate
                7% calcium phosphate (hydroxyl form)
                3% protein

                It will be interesting to see what his urine looks like after following this diet. I’ll ask that he follows up with this.

  151. EDWARD NIESHOFF

    Great synthesis of a ton of papers, thanks!

    Any comments on vit D? Am told that pharmacologic doses are associated with hypercalciuria, lower doses not so.

    Also would appreciate a comment on vit B6 to lower oxalate, and using extra citrate to decrease risk (lemon juice).

    Finally, here’s an interesting option – adjusting microbiome. Insufficient data, but why not? VSL3 is available mail order (used in this study – http://www.ncbi.nlm.nih.gov/pubmed/20224931); see also http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396938/

    Reply
  152. Josh

    Sorry – I had a follow-up question. I just had surgery to remove a kidney stone and my doctor told me to wait 4-5 months to do the 24 hour Litholink Test – he recommended to do the Two, 24-hours collections. I’m already planning to change my diet. Should I just do the test now before I change my diet? He said not to schedule a follow-up until 2-3 weeks after my test, so I’ll be seeing him late October…

    Reply
    • Fredric Coe, MD

      Your doctor wants you to have recovered from the surgery and is prudent. Two are ideal. Do the diet you think is wonderful and see what it does for you. Regards, Fred Coe

      Reply
  153. Josh Hersh

    Thank you SO much for this website and putting together this information — having it in a Google Doc is especially helpful. I’m 30 years old – had a kidney stone in college and just dealt with another one over these last two months. Not. Fun. My stone was primarily made of oxalate, so I’m just now digging into all of this oxalate food research. I was vegan for the last 4 years, so I’m definitely having to change things up. Anyway, thank you for what you do. It is greatly appreciated!

    Reply
  154. NASRINE

    I would like to know if quince has high Oxalate levels or not ? How about squeezing fresh lemon juice on some foods you eat or squeezing it in your water? Lastly some articles say it is good to drink lemonade and some say it is not, what do you suggest? Thank you.
    Nasrine

    Reply
    • Fredric Coe, MD

      Hi Nasrine, I do not find quince on the lists, so I do not know its oxalate content. Lemon juice on food will be neither good nor bad. Lemonade has some citrate which is good but usually not enough to matter, so it is not a serious treatment. Regards, Fred Coe

      Reply
    • jill

      Hi Nasrine,

      Not sure if you meant quinoa. If so, we do not have it on the list, but since it is a grain I would presume it does have some levels of oxalate. It has not been studied as it is a relatively newer grain people have been eating. Eat it in small portions.

      Best,

      Jill

      Reply
  155. Jim Hildebrand

    I eat a lot of bread and have some questions on oxalate content: a) does sprouting grains before making breads change the oxalate content? Ezekial Bread is an example of a commercial sprouted grain bread. b) any data on spelt, black beans or lima beans? or Hemp and Chia seeds that stores carry these days. c) your list has 8 oz of grapefruit juice as low, but a 1/2 fruit of grapefruit as very high?

    Reply
    • Fredric Coe, MD

      Hi Jim, As you might have guessed, what is not on my lists I do not know. Anything I find out I put there, The juice has less oxalate than the fruit itself which I presume is because the oxalate is in the linings and rind. Regards, Fred Coe

      Reply
  156. Dina Rappette

    I have been looking at 4 Apps available for keeping track of the oxalate content in my diet to help me stay within the 50-100 mg/day. Do you have recommendations? if not an app other ways to easily track it on they fly during the day?
    Thank you,
    Dina

    Reply
    • Fredric Coe, MD

      Dear Dina, I am afraid I have not checked any of them out. My concern is always the lists they use, which are not easy to track – inside the app. Sorry! Regards, Fred Coe

      Reply
    • jill

      Dina,

      I suggest patients track by looking at the list and understand what is really off limits (like spinach) and must be eaten sparingly, and then the other foods that have some oxalate just eat in smaller portions.

      Unless you have a really high oxalate content you don’t have to be exact. It is more knowing to limit portion size and the quantity of times you eat higher oxalate products. If you have a day where you eat a lot of oxalate see if you can combine those foods with calcium foods for oxalate binding effect.

      Let me know if this helps.

      Jill

      Reply
  157. Josh svoboda

    Curious on all this..am trying a low oxalate diet but have a few questions?
    Is ezekiel bread high on oxalate? Are oats? Is broccoli? These things r in my diet and trying to figure out if I need to eliminate them. I am also a big coffee drinker but I read that coffee is ok….organic brewed.
    Thanks,
    Josh

    Reply
    • jharris

      Hi Josh,

      Thanks for writing. Ezekiel bread has not been studied, but I assume that it does have oxalate in it as it is made with a bunch of grains. Having a piece will not throw you over the edge, but be mindful. If you look at our list in the oxalate article, you will find links to all the high oxalate foods.

      Very Best,

      Jill

      Reply
  158. Yvonne

    I am watching Oxalate amounts for an itchy rash my daughter has had for several years. In one day of omitting Almonds from her (anti-candida diet) she is much better. Several of hi amt. foods on the list trigger her rash. They are what you eat with that diet veggies, greens, no dairy, nuts etc.. So thank you for adding stevia because it is a go to for those who fight Candida, now I see why she is not improving . There is definitely a connection.

    Reply
    • Fredric Coe, MD

      Hi Yvonne, I am quite sure that foods can cause skin reactions but also sure that the simple chemical oxalate is not the culprit. It is something else in the foods that cause difficulties. Regards, Fred Coe

      Reply
    • Yvonne

      Thank you for your reply, but why else would a food cause an allergy or reaction if not for it’s toxins? One mans food is another mans poison correct? Isn’t that what oxalate is? a crystal forms in the body, the body tries to rid itself of it, maybe it can, maybe it cant depending on the overall toxic overload. it binds with calcium to try to move it through the body? Isn’t the skin a means of detoxification?

      Reply
      • Fredric Coe, MD

        Hi Yvonne, Items in foods that cause reactions are usually larger than oxalate and susceptible to recognition by the immune systems. Oxalate itself is rather inert. Crystals of calcium oxalate are not removed through the skin. But in fact in the bowel lumen calcium is thought to bind with oxalate to prevent its being absorbed into the blood stream, so your image works in the other direction. Regards, Fred Coe

        Reply
        • Yvonne

          Thank you, as one desperate to find the cause of this rash, I appreciate narrowing down the possibilities. Anyway, it’s a great list I will share with those who have kidney stone problems.

          Reply
  159. Judy

    Thanks you so much for this information.

    Do you have any more specific advice for protein choices for vegetarians who have calcium oxalate kidney stones? Are all beans and all nuts high in oxalates?

    Raw brussel sprouts are in the top 179, but cooked brussel sprouts are not listed. Are cooked (roasted, sauteed, steamed) brussel sprouts ok? I have the same question about carrots. Are cooked carrots ok?

    Is corn bran ok, but corn grits and corn meal, not ok?

    Thanks,
    Judy

    Reply
    • Fredric Coe, MD

      Hi Judy, I will leave this fone for Jill to answer. Regards, Fred Coe

      Reply
    • jharris

      Hi Judy,

      All beans and nuts are high in oxalate according to the list. What you see on the list is what we know. If the products you ask about are not on the list they have not been studied and we cannot know for sure.

      Some vegetarians eat dairy, if you do I suggest you add some to your diet for the calcium and protein. Also let me know if you eat fish. Some do, so let me know what specific vegetarian diet you are following.

      Very Best,

      Jill

      Reply
  160. Kate

    Hi there –

    Every website I’ve seen says avocados and lemonade are fine, including the list from this site (from March 2016): https://groups.yahoo.com/neo/groups/Trying_Low_Oxalates/info

    You also say hummus is fine, but it’s traditionally made with tahini, which is not ok.

    I’m just concerned because I love avocados. I have oxalate kidney stones and feeling like everything I like is a no-go, as well as conflicting information from one place to the next is so frustrating. I hate living on a low oxalate diet. If I stayed away from everything I’d be miserable. So I stay away from the big time baddies (Spinach, soy, nuts, seeds, multi-grain stuff) and eat everything else on the naughty list (chocolate, potatoes of any kind, tomato sauce, etc.) in moderation and try to drink 68 oz of water every day. I haven’t had a stone in almost 2 years, and the last ones were because I accidentally ate a lot of something that had soy in it (non-dairy creamer) for a few months. I do have stones in my kidneys presently, but they’re staying put at least for now. Sorry to ramble, just feeling frustrated at the moment!

    Reply
    • Fredric Coe, MD

      Hi Kate, The list here is good, so avocados are probably alright. Are you sure it is high urine oxalate that is causing your stones? There are a lot of causes. Be sure you have been fully evaluated and treated for all of your abnormalities – they need not all be about oxalate! Regards, Fred Coe

      Reply
      • Kate

        Thanks Dr. Coe. I appreciate your reply! I had the Litholink urine analysis done a few years ago and was told they were calcium oxalate stones, and they told me to be careful of oxalates. This was about 5-6 years ago.

        So, re: avocados, the article and list here on this site is not correct, the list I linked to is correct, and I can continue eating avocados without fear? I just want to make sure I’m clear!

        Again, thank you for taking the time to answer these questions. Its greatly appreciated.

        Reply
        • Fredric Coe, MD

          Hi Kate, Did I misspeak? Avocados are number 96 on the list and classified as very high in oxalate, as noted. They did not make the chart on page one of the article which cuts off at 40 mg of oxalate per serving but 19 mg is a lot in a diet that is to contain no more than 50 mg of oxalate a day. Perhaps I wrote carelessly, but I just checked the list and am quite sure this is not a good food for you. Sorry if there has been confusion on my side. Regards, Fred Coe

          Reply
  161. Myra Hutchens

    I’ve been trying to use stevia as much as possible in lieu of aspartame. I see it is listed as a high oxalate food. What “sweetener” do you recommend? I use it mainly in my coffee.

    Reply
    • jharris

      Hi Myra,

      I know you all might get mad at this reply, but I’m going to say it anyway. I find that sweeteners are always being researched and found out to be unhealthy for us in some way. I used to be a sweetener queen, but found that I craved sugar products even more. So one day I went cold turkey and started substituting real sugar for the sweetener. I only use a tiny bit for my coffee and although it was tough at first I now like my coffee less sweet. So yes, I am advocating that you might want to try just a bit of regular sugar….I am hoping one day soon I won’t even have to put the small amount of sugar and just drink it black. Crazy, huh?

      Thanks for writing,

      Jill

      Reply
  162. Eric

    Hi, love your site, article and supporting lists and data! Being a sufferer of calcium oxalate stones for many years (a 6mm stone currently in left kidney), this is what I have been searching for – thanks so much! Sorry to see though that many of the foods I have been eating thinking they were low in oxalate are actually high. The list I have been using was given to me by my urologist and is based on research from AstraZeneca back in 2002! I guess a lot has changed since then. So, needless to say, I will be structuring my meals based on your list.

    Also, your site focuses mainly on prevention. Do you plan to research and publish on the many treatments (more importantly, non-surgical) of existing stones? And if so, do you have an opinion on chanca piedra as a stone treament?

    Thanks again!

    Reply
    • Fredric Coe, MD

      Hi Eric, so many lists are wrong! Partly things have changed. Partly, the lists are hard to put together and maintain. I focus on prevention because of what I do, but I have a brilliant young surgical colleague – Mike Borofsky – who writes on surgery. I am sure you have seen his articles. As for non surgical management of existing stones, there is not a lot of reliable data. Uric acid stones can be dissolved with alkali, of course, and cystine stones with fluids and cystine binding drugs. Such dissolution is by no means easy as the surface to volume ratio of visible stones is very low compared to the initial nuclei so it takes a lot of time and steady reduction of saturation to below solubility. As for chanca piedra, PubMed shows only 3 articles; none have to do with stones. WebMD shows a lot of unsupported hype about it which tells me it is not a reliable professional site despite the ‘MD’ name: Professional gets its data from PubMed, not advertisers. For example the link to the claim about this material and kidney stones takes one to the WebMD kidney stone health center that does in fact offer a few vanilla nostrums about the disease, but does not mention this treatment. PubMed is open to the world for free, and I would check out proposed stone treatments there. Regards, Fred Coe

      Reply
  163. Natasha

    Hello! Why would diet lemonade be okay and not frozen from concentrate? Is it because very little lemon juice is actually used? The frozen from concentrate is still high, even after water is added, correct?

    I don’t see unsweetened ice tea on the lists and I see that sweetened is okay . . . I presume that unsweetened would be okay also?

    Thanks!

    Reply
    • Fredric Coe, MD

      Hi Natasha, You are right, it is that lemon juice has oxalate in it, and less of it is safer from an oxalate point of view. Unsweetened tea will no doubt be the same as sweetened. Measurements of food oxalate are hard to do, no one want to pay for them, and the lists try to stick to what has been measured, so sugar or not is assumed to be the same. Regards, Fred Coe

      Reply
  164. David K

    Hi, I have calcium oxalate stones. 24hr results: Ca 86, Citrate 613, Oxalate 59, Tot Vol 1.9, Uric Acid 2.9. I’m want to try the advice to increase calcium and fluids to see how much that helps before making major diet changes. However, I am trying to figure out how “large” a meal should be in order to take supplemental calcium at the same time. The generic version of Citrical I have is 315 mg calcium per pill. Is it better to space these out by taking them with small meals/snacks so I take 3-4 separate smaller doses a day? Or would I be better served by taking 1-1/2 or 2 pills each at lunch and dinner? I don’t eat much at breakfast time.

    Reply
    • Fredric Coe, MD

      Hi David, Your urine calcium is low, urine volume a bit low, and oxalate is high. I gather that you do not have bowel disease. The best start is to add calcium containing foods rather than supplements. They should provide 1,000 mg daily and can be apportioned among your two main meals. If you do not want to eat such foods, then 1,000 mg/day of supplements are alright, divided between your main meals, never alone. The purpose of the calcium is to bind oxalate and prevent its absorption and also to provide for your bones. When you have your new regime, retest. Regards, Fred Coe

      Reply
  165. Miriam

    Hi. Thanks for the great site. I have 2 questions. I noticed only 2 beans listed on the high oxalate pages, kidney and navy. Are there any dry beans that are low oxalate ? My first stone was calcium oxalate, I’m currently trying to pass another stone. I did have a 24 hour urine test but I wasn’t specifically given the results but I was handed a food list of high oxalate foods to avoid. Can you make calcium oxalate stones and have a normal level of oxalate a in your urine ? Thanks in advance.

    Reply
  166. angelica

    I was just prescribed a low oxalate / low calcium diet. But, I have a history of bowel obstructions and have a suggested restricted diet to combat that. It appears that one diet cancels out the other. Can you advise?

    Reply
    • jharris

      Hi Angelica,

      Sorry to hear about the bowel obstructions. I have had bowel surgery myself and understand how frightening and real they are. As a nurse I never override doctor’s order, but in your case I just have to say that everyone should be eating a normal calcium diet. Getting around 1,000 mg/day is best for all of us and very importantly stone formers as a low calcium diet may increase your stone forming risk!

      If you can be more specific I know I can help. Tell me the other diet you are on and we can go from there. I don’t want to assume!

      Warmly,

      Jil

      Reply
  167. Nigel Whittaker

    I have been advised to go on a low oxalate diet as I had been hospitalised due to raised calcium levels in my blood and the diagnosis was hypercalcaemia secondary to sarcoidosis. I was a big crisp eater, loving to snack on these when watching late night tv. Now I can obviously not do this on a low oxalate diet so I was eating corn chips/tortilla chips as I thought that this was lower because of the corn. Now I am not so sure after reading the list of foods. Also I was snacking on rice cakes. Is there anything at all I am able to munch on?!

    Kind regards,

    Nigel

    Reply
    • Fredric Coe, MD

      Hi Nigel, Although oxalate is certainly a factor in stones, it sounds like you have a significant systemic disease as a cause of increased serum and I presume urine calcium – Sarcoidosis. Usually urine oxalate is the least of the problems in treatment. Our oxalate lists are as accurate as one can make them, so you can feel confident in their use. But I would hope more is being done in terms of treatment for both the stones and the sarcoidosis itself. Regards, Fred Coe

      Reply
    • jharris

      Hi Nigel,

      Low oxalate versions of crunchy snack can include popcorn (air popped has the least amount of oxalate- about 4 mg/), triscuits, saltines and graham crackers. If it were up to me I would pick pop corn. Most satisfying with the least amount of calories and oxalate.

      Hope that provides a bit of relief-

      Jill

      Reply
  168. Betty lomax

    I want to loose weight can you help me thank you

    Reply
    • Jill

      Hi Betty-

      Of course I can but we would need to talk a bit before starting. Generically I can tell you and anyone else that wants to lose weight that you should get rid of all white foods and limit sweets. Limit your portion sizes, do not go back for seconds during meals and limit in between meal eating.
      Do that and you are off to a good start-
      For more jharris 1019@gmail.com is where you can find me!

      Very best-
      Jill

      Reply
  169. Ted Dennison

    I am a cancer patient (neuroendrocrine carcinoma) along with other issues I have only 28″ left of my intestines so absorption of anything is poor. I have fast forming kidney stones that are always a big problem almost daily (hospitalized many times, had kidney stents etc) I was told to avoid lots of the same as you list (potatoes, nuts etc and add calcium) and to drink lemon water as much as possible. Do you have any other suggestions for me? Always looking for more food options as it is hard to maintain weight and energy levels.
    Thanks

    Reply
    • jharris

      Dear Ted,

      First off, I am sorry to hear about your cancer. I am also a cancer patient and understand how daunting that diagnosis and treatment can be to you and your loved ones.

      Because you must have a hard time absorbing and keeping up with calories I am going to suggest a few things. Because of your shortened bowel I assume drinking or eating too much at any one time might lead to problems with absorption. So keeping this in mind we need to get you low oxalate foods that are high in calories and nutrient dense to keep your weight and nutrition levels up. For patients like you I recommend smoothies made with milk if you can tolerate milk. Bananas, blueberries and other low oxalate fruits are wonderful to use. Make smoothies for snacks as they can increase your calories count by a few hundred calories.

      You must eat and drink small amounts but many times during the day. You can write me at jharris1019@gmail.com to get more specified info. I would need to know a few more things about how you are handling food right now to better help you.

      Jot me a line and we can connect-

      Jill

      Reply
      • Ted Dennison

        Jill,

        Thank you for the advice. I love smoothies, would you recommend adding frozen yogurt to the smoothie as well to add calories, bulk and more calcium. Yes you are correct that if I eat or drink (especially drink) too much at any one time it leads to problems. So a basic smoothie of frozen yogurt, fresh banana, blueberries etc. and whole milk would be a good meal/snack option. What about a bagel (plain or raisin) with Cream cheese, will the cream cheese be enough to offset the oxcilates in the bagel (for the morning when I don’t have time to do eggs and bacon?

        Reply
        • jharris

          Hi Ted,

          Please, if you can tolerate the lactose add milk or yogurt for sure! I had an ileostomy for 5 months while I was healing from a bowel surgery due to cancer and I know that if I drank too much at one time it was never good. So when you are making your smoothies, please drink it slowly so your body can absorb what you are trying to put into it.

          I think that if you put cream cheese it will help. Other hints might be: just eat half a bagel so that alone will cut the oxalate. Maybe couple the bagel with low salt cottage cheese for even more calcium or a yogurt.

          Continue writing if you need more help. Besides me loving my family and friends it is the main reason I am here on this earth.

          J

          Reply
  170. David

    Many thanks for this amazing article, plus the spreadsheet. Been suffering from stones for over 15 years (Had to go to the hospital 3 times already!) and I always got very general instructions, and never the basic: Avoid high-oxalate foods. I just noticed I did so many things wrong (Like eating nuts, I love them to death) for so long, so I’m very optimistic that starting today, my kidney stone problems will start to go away.

    Thank you!

    Reply
  171. murray marr

    Many thanks for your excellent information.
    I’m a bit dismayed at the oxalate levels in wholemeal wheat. It looks like I’ll have to make my own bread from now on.
    But from what? Can I use wholemeal oat and rye flour with say 20% strong refined wheat flour?

    Reply
    • jharris

      Hi-

      Sure you can. All grains will have oxalate, but you can lower it by managing your recipes in a way that lessens the oxalate content. You can also eat the bread with some dairy and keep your water intake up.

      Thanks for writing-

      Jill

      Reply
  172. Camille

    Hello,

    I just wanted to say the information I found here has been a revelation. I have been plagued with kidney stones for 8 years. The cause of the stones I I now realize has been my diet which was suggested by my doctor to lose weight. A quick question, is Greek yogurt high in oxalates? I need a protein option for breakfast. I used to eat Peanut Butter because I have egg allergies.

    Thanks.

    Reply
    • Fredric Coe, MD

      Hi Camille, I am glad the site is valuable for you. There is little oxalate in yogurt – none probably in common with most dairy products. About your stones, be sure you know their cause. Are they calcium oxalate? Have you been evaluated fully? Regards, Fred Coe

      Reply
      • Camille

        Hi Dr. Coe,

        My first bout of stones in 2008 turned out to be Calcium Oxalate. The repeated episodes until now were protein based. I was advised to eliminate dairy from my diet and up the protein. Protein being soy, nuts, etc… The stones seemed to occur more and more and now I know why. I’m seeing my doctor within the next week to chart out a better diet plan that won’t result in more stones.

        Thank you again.

        Camille

        Reply
    • Jill

      Hi Camille-

      As Dr. Coe said- perfect solution for breakfast! Also- we always say before you start changing your diet be sure to know if your oxalate level is high. You can find this out by doing a 24-hour urine collection. If you have not done one ask you urologist about ordering one for you-

      Warmly-

      Jill

      Reply
  173. Natasha

    Hello, thank you for the very helpful information! I am wondering why OJ, grapefruit juice or okay, but not the whole fruits themselves? It seems like the juice would be a higher concentration than the whole fruit? Also, do you have any recommendations for low oxalate breakfast cereals? And lastly, are there any breads or pastas that you would recommend made from a different low oxalate grain? Thanks in advance!

    Reply
    • jharris

      Hi Natasha,

      Glad you are finding the info helpful. We always appreciate your feedback. It is a bit odd that the fruit is higher, but I believe that is because the fruit juice has so much added water (which people often are surprised to find out)- as much as 88% added water.

      The cereals NOT on the list can be eaten or go for something like eggs if you eat dairy. The pastas are high and so are your grains. There are no subs for them.

      As a reminder to everyone, what is concerning is your daily consumption of high oxalate foods. Meaning- if you want to have some pasta, watch your oxalate consumption for the rest of day and drinks lots of water. You can have higher oxalate foods here and there if you eat a small portion, can combine it with a calcium rich food (like cereal and milk), and be mindful of the choices you make for the rest of the day.

      Best I can offer you and hope that it helps.

      Fondly,

      Jill

      Reply
  174. Megan

    Hello! So I am new to all of this and am trying to create meal plans. I usually make smoothies in the morning: banana, strawberries, orange, greek yogurt, skim milk, and peanut butter (I use protein powder or the real stuff) for the protein. Will this still be okay or what do I need to substitute out?

    Thank you for your help! Also, do you know of any sites that have meal plans that are low in oxalate?

    Reply
    • Fredric Coe, MD

      Hi Megan, The article links to very good oxalate lists, and you can use them as your guide. The big figure at the top of the article highlights the really high oxalate foods, too. I have asked Jill Harris to add an answer, as she is expert on diet plans. By the way, do you have a high urine oxalate excretion? Before you undertake all this be sure you do. Likewise, are your stones calcium oxalate? Prevention is not hard, but also is specific to the individual, so take a look at my summary of the matter. Regards, Fred Coe

      Reply
    • Jill

      Hi Megan,

      As Dr. Coe has asked, it is important to know your oxalate values before you start limiting healthy foods from your diet. Let us know if you have done a 24 hour urine collection which will provide you with the values we are seeking. Your breakfast smoothie, although healthy, is high in oxalate. But this may not be of concern to you unless your oxalate levels are high.

      I can definitely help you more specifically once you find out how high your oxalate is- that help will include meal plans too.

      Thanks for writing and let us know if you have completed a 24 hour urine collection.

      Jill

      Reply
  175. Karen Roberts

    What if you are unable to eat dairy, due to casein/whey (and, in my case, histamine) sensitivity? Can supplemental calcium citrate (paired with magnesium citrate 2:1) compensate for low dietary calcium intake? Does adequate (supplemental) K2 intake have any known impact on the rate of absorption, accumulation or excretion of dietary oxalates? Thank you.

    Reply
    • Fredric Coe, MD

      Hi Karen, Lets assume you need a low oxalate diet – your 24 hour urines show an oxalate high enough to confer stone risk, and your stones contain calcium oxalate crystals. You can add a calcium supplement to your larger meals – the ones that contain higher oxalate content foods. Typical size would be 500 mg calcium. The supplement needs to be eaten with the food so the calcium can combine with oxalate in the bowel and prevent oxalate absorption. Vitamin K has no known effects on oxalate absorption. Regards, Fred Coe

      Reply
  176. Nancy Shorter

    First of all thank you for the very helpful information. I’ve been battling kidney stones & a severe infection since entering the e.r. in december. My most recent 24 hour urine collection showed my oxalate level was 201, with the normal range between 20- 40. Is that as frightening a number as it looks? And my next question is regarding Crystal Lite peach tea. I drink a lot of it all day. Any ideas how high it would be? I’m not sure if it would be considered an “actual” tea. Since I drink a gallon of this daily & use it as a means to get my water in I’m very concerned . Thank you so much. I don’t know who else to ask.

    Reply
    • Fredric Coe, MD

      Hi Nancy, Indeed a value of 201 is worrisome. If you have this as a real and consistent number – it needs to be checked in a high quality laboratory!! it requires expert attention as it might reflect significant disease and high risk of kidney injury. Do not delay in getting attention for this. Litholink is a very accurate laboratory source, and multiple measurements are indicated to be sure of the value. The main concern is primary hyperoxaluria which can be managed by experts. Regards, Fred Coe

      Reply
    • Meekah

      I also have a hard time drinking enough water, but personally, I’ve found that adding a lemon slice to my glass makes a world of a difference!

      I see tea listed as very high on the list, but it doesn’t say what type. Jill, is it good to avoid all brewed teas (green, black)?

      Reply
      • jharris

        If your oxalate is high, it is best to really limit your tea consumption. Green is better than black and makes a good substitute and also has healthy benefits.

        Jill

        Reply
  177. Marc T.

    Thanks. And, also thanks for this site. This is the most comprehensive, educational and informative site that I have found. I’ve had 5 stones to date and currently have one in my right kidney. Also, any thoughts on Beeltith, coconut milk or coconut water? Some ” unofficial studies” i have read about on line suggest that taking beelith, and/or drinking this (not tied together though – 2 independent things i have read) can reduce the actual size of existing stones or prevent stones. I’m suspect but thought I’d ask anyway..

    Reply
    • jharris

      I am suspect too, but have forward to Dr. Coe to see if he agrees. We will wait on what he has to say. There are no scientific studies on either one. But I am happy you asked. He may know something I don’t.

      j

      Reply
    • Fredric Coe, MD

      Hi Marc, vitamin B and Beelith have no trials. Just examples of treatment ideas that have come and gone. B vitamins are thought to lower urine oxalate excretion but in most people they have little effect. Coconuts are outside of my knowledge – but taste very good! I doubt anything can reduce the size of calcium stones – the crystals are usually too insoluble. Regards, Fred Coe

      Reply
  178. Marc. T

    Anyone have any feedback on Beer. I read what was mentioned above but some sites suggest dark beer and draft beer should be avoided but most bottled beer is ok. Also, any thoughts on coconut water?

    Reply
    • Fredric Coe, MD

      Hi Marc, Beer is associated with reduced risk of stones. All are the same so far as we know. Fred Coe

      Reply
    • Jill

      Hi Marc-

      I don’t have a reliable source of coconut and oxalate content. What I have read says it has a moderate amount. Have one a day and call it. The key to eating less oxalate is really you can have what you want in MODERATION, drink lots of water and a have your oxalate goodie with some milk if you are able. If you decide to have a food that has a lot of oxalate watch what you have for the rest of the day. You are not going to form a stone by eating a spinach salad for lunch. It is what you are doing day to day and over time that matters.

      I write this knowing that everyone is concerned about oxalate. But if you follow my rule of everything in moderation and make sure you are getting enough calcium, watching your protein amounts, you will all be ok.

      Also, drinking water is always key. ALWAYS.

      Best,

      Jill

      Reply
  179. Sherry

    After my fourth lithotripsy—this one for an oxylate 11 mm stone just 8 months after another lithotripsy for a 7 mm stone in the same kidney—my doctor gave me, for the first time, a sheet on foods to avoid. 25 years of stones treated by three doctors, and no one had thought to mention this.

    I am a vegetarian as a matter of conscience, and have been getting my protein from soy. I just learned that this is one of the worst foods I can eat. (Perhaps this is how I came up with an 11 mm stone in just 8 months.) What can I do to obtain complete protein without meat, soy, meat, and most legumes?

    Reply
    • Fredric Coe, MD

      Hi Sherry, It may well be that urine oxalate is your problem and food oxalate your treatment but that would usually not be the complete story. Take a look at how prevention is supposed to work and be sure you are getting all of it. If you need a reduced oxalate diet, the article offers a lot of alternatives for veggies. Now, for the protein problem you are outside my expertise. Perhaps Jill can answer you. Can you use eggs, for example. Regards, Fred Coe

      Reply
      • Sherry

        Thank you so much for the response, Dr. Coe. I am trying very stay vegan; I do not want to eat animal protein in any form. Thus my quandary. Going through the posted oxalate-content list, I don’t see any way to get complete protein in a low-oxalate, vegan diet. Perhaps Jill or another reader might respond to this. I feel lost and would sure appreciate any help I can get.

        In the meantime I will go through the recommended material from the “Take a look at how prevention is supposed to work” link.

        Oh–one technical comment re the website and this page: The use of purple for links makes them nearly indistinguishable from black text for red-green colorblind people. My husband is helping me and he didn’t even know there was a link there.

        Thanks again.

        Reply
        • jharris

          Hi Sherry,

          I see your problem. Do you know how high your oxalate actually is? Have you done a 24 hour urine collection? If so, tell me how high the oxalate level(s) are. We can then go from there. You may be able to eat more oxalate then you think in order to get the protein you need and also we can figure out ways you can safely incorporate oxalate without making new stones. Please post your oxalate values and if you don’t want to do it here, email me at jharris1019@gmail.com if you like.

          Warmly,

          Jill

          Reply
  180. Larry Schuh

    Most sites I check list strawberries as high in oxalate your list does not which is right?

    Reply
    • Fredric Coe, MD

      Hi Larry, Many sites say things that are not consistent with available scientific data. The listings here originated at Harvard as a compilation of best available data. The copy on this site has been corrected and updated as noted in the text. I curate at the level appropriate to a scientific review. That means I do not propose the articles and lists here are ‘right’, merely that they are as consistent as possible with measurements that have been made in a scientific manner. So, strawberries are – so far as one can tell – not so high in oxalate. Regards, Fred Coe

      Reply
  181. Barry

    Thank you so much for this article! My doctor gave me minimal information about my new diet to reduce the chance of more kidney stones and the conflicting information on the Web is almost impossible to wade through.

    Reply
    • jharris

      Thanks for writing Barry. We are happy to help and glad you found the piece helpful.

      Warmly,

      Jill

      Reply
  182. Lauren

    Are any artificial sweeteners okay to use? I really enjoy homemade lemonade. I’ve been using Truvia in my lemonade and coffee but on the ingredient list it has Stevia leaf extract. Is Truvia or another artificial sweetener low in oxalate? I really don’t need the extra calories using sugar when add.

    Thanks!
    Lauren

    Reply
    • Fredric Coe, MD

      Hi Lauren, Unless it is on the lists attached to the article the oxalate content is not known. There is only so much available. Regards, Fred Coe

      Reply
  183. lawrence marcus

    Keeping calcium high helps but magnesium and pomegranate juice seem to help as an insurance policy…..

    Reply
  184. Matt

    Having recently been through my second episode of kidney stones, and learning that my healthy diet is very high in oxalates, I have been trying to educate myself on what foods to avoid. I have seen at least a half dozen lists, all from “reliable sources,” and am very overwhelmed. How is one to know which list from a “reliable source” is actually the most reliable?

    It wouldn’t matter if they were all in agreement, but unfortunately they aren’t. For example, avocados and pumpkin seeds are high on the list linked in this article, but low on most others that I have seen. Blueberries, raspberries, kale, fig bars…all low or very low on this list, but high to very high on others. I think I have seen oat meal, which I eat every day, rated in every category on one list or another.

    Thankfully there are some foods that are low on all lists, so I suppose I will have to make do with a well-rounded diet of alfalfa sprouts, meat, cheese, and melon.

    Confused and frustrated,
    Matt

    Reply
    • Fredric Coe, MD

      Hi Matt, I guess perfect knowledge is hard to obtain. The lists here began at Harvard with a lot of effort at measurement and collecting data. Professor Ross Holmes, who is about the best modern expert in food oxalate then helped me update the Harvard lists with what he thought were the best available measurements. So, for what it is worth, he and I would say we did about as well as available data allow. Other sites are known to us, and we believe most disagreements reflect errors on those sites. This is not arrogance, but simply that between him and I we have access to most of the measurements, and have put them here. There is no hidden cache of other measurements one can draw on to make alternative lists. We wish there was more funding to allow more food oxalate measurements, but there is not. It is not attractive to funding agencies and food companies have no reason to do this. Regards, Fred Coe

      Reply
      • Matt

        Thank you for the response. Yes, perfect knowledge is likely impossible, though something we all want. It’s a little demoralizing to discover that some foods that I thought I could still enjoy, such as avocados, pumpkin seeds, and oranges, should probably be avoided. On the other hand, it may be okay to consume kale, blueberries, and oatmeal, which I thought I needed to eliminate.

        Unless I am missing it, I do not see coconut on this list at all. Most studies that I have read indicate that it falls into the low oxalate category. Should I be skeptical?

        Reply
  185. Kate Conaboy

    It seems like the low oxylate diet is good for the kidney but not very good for the bowel or heart. Is a fiber supplement ok? Also does this same thing go for MSK people like me?Thank you for all of this great info. I wish I lived in Chicago. I’d go over there and give you all hugs.

    Reply
  186. Anita

    Can drinking lots of water overcome some dietary oxylate? Can soaking in excess water reduce oxylate in cut up plant foods?
    I expect the beet tops or greens are high in oxylate, but what about beet bottoms? The list just say “beets” but not the plant part.
    Chicken Enchiladas are confusing – corn tortillas are moderate for oxylate, chicken and cheese are not a problem, main ingredients for salsa verde are not on the list (tomatillos, serrano peppers) – why on the naughty list?
    On stevia, I am not a big user, but the packets I have noticed do not contain a teaspoon and have been cut with maltodextrin or similar bulking powder, as is common for high intensity sweeteners. Was it retail powder that was tested or 100% stevia, because these are not identical.
    Thanks for the great website – it is a jungle out there, trying to do the right thing, often in the face of disparate advice.

    Reply
    • Fredric Coe, MD

      Hi Anita, I do not know about beets; the history of the list is as in my article, and I do not do this kind of research. I suspect the enchiladas are high in fact and those who measured did not take them apart to see why. Stevia is not a big issue because amounts – as you are pointing out – are not large. As for water, the only problem with oxalate is in calcium oxalate stone formers, and the only desire is to lower the urine oxalate concentration to lower the urine calcium oxalate supersaturation. So lots of water is always useful as it dilutes the calcium oxalate salts. As for soaking vegetables, I am doubtful as the oxalate is usually stored as calcium oxalate with is very insoluble. Boiling might help but I have no data. I believe Jill will also answer this, and she may have more to say. Regards, Fred Coe

      Reply
    • Jill

      Hi Anita,

      I concur with Dr. Coe as far as no one has tested or deconstructed the ingredients of the enchilada. That being said, having a couple is not going to cause chaos. Have a few here and there. Drink extra water when you do and the cheese will add some protection by providing you with some calcium to bind with oxalate in the small intestine.

      Beets- eat them sparingly… all parts. I don’t think the oxalate particular likes one part of it and not the other. If it is on the higher side, than it is the whole beet.

      Having veggies soak in water is not going to lower the oxalate level. Choose ones that are lower more and eat the ones that are higher less. Not rocket science, but always bears repeating.

      I am not sure which they tested, the packet or pure stevia. I would lessen my use of it either way. It is high, but a tiny bit will not hurt. If you must use sweetner, go for real sugar. Calories yes, but oxalate no.

      Hope this helps a bit, if not we are here.

      Yours-
      Jill

      Reply
  187. Robert Weeks

    I have been having stones since 1995 approx. two a month. I have tried all kind of diets from low O.xalate, low calcium and so on. My question is why does the low Oxalate lists keep changing with different Doctors I receive a new list and it will be totally different from the last list I received, why is this? Whom should I believe? lately my stones have been quicker to pass since I started potassium citrate

    Reply
    • Fredric Coe, MD

      Hi Robert, First of all, be sure you need a low oxalate diet. Your stones need to have appreciable amounts of calcium oxalate in them and your urine oxalate should be in a region that confers risk of stones – above 25 mg daily. If so, the lists on this site are perhaps the best curated. The primary source is from the Harvard School of Public health, as noted in the article. Professor Ross Holmes, who has devoted a lot of his career to measurement of food oxalate added to and modified the list from other newer sources. A review of lists on the web indeed confirm your concerns about variability, which is why we have worked as well as possible to produce these present ones. The National Institutes of Health has not been very enthusiastic about funding food oxalate measurements, and they are not mandated by Federal law, so it is a bit hard going. Regards, Fred Coe

      Reply
  188. AB

    In the list of foods by type, a number of items are marked with an asterisk (raw carrots, for example). I’m wondering what the asterisk signifies. I’m particularly concerned about what the asterisk means with regard to stevia, because I use a small amount of stevia in my water and lemon juice mix. Thank you

    Reply
    • Fredric Coe, MD

      Hi, In the article I mentioned that these tables are updated with the newest values available. Asterisks show updated values. I had to make this annotation because the source tables are from Harvard – also mentioned in the article – and I could not alter their data without a notation. I will make a note on the tables about the asterisks, Regards, Fred Coe

      Reply
  189. Mary Miller

    looking for healthy meals for my husband he needs a low oxalate diet , low calcium diet , low uric acid he also has high blood pressure please , please help thanks so much

    Reply
    • Fredric Coe, MD

      Hi Mary, For reduced oxalate diet, try this article by Jill Harris. I do not think you mean a low calcium diet; there is no reason ever to follow such a diet. I think you meant a lower sodium diet – good for stone prevention and lowering blood pressure. Low uric acid diet means lower intake of meats; it is hard to combine that with low oxalate diet, and if this is for stones, I would concentrate on the oxalate first. Regards, Fred Coe

      Reply
    • Jill

      Hi Mary,

      Thanks for the awesome question. When a patient is asked to incorporate all the dietary changes your husband has been asked to do, it can be confusing and frustrating. Let me see if I can help a bit.

      First off, as Dr. Coe has said, lowering oxalate and meat intake can be daunting. I, too, would start with limiting the high oxalate items from his diet. Did you find some on the list that he has been eating and are really high?

      Secondly, when lowering meat consumption, the first thing you should do it lessen the portion size. Typically we eat way more than we should. That deck of card analogy that everyone points too when serving meat is very little. Most people are eating three times that. Ask him to eat less meat at each sitting and see if that helps. People I have helped never have to give up meat, but they do have to cut down on portion size. What is a average portion size for him?

      Thirdly, no one should be limiting calcium. If your husband is eating too much meat, he is also probably eating too much sodium. If you can, give a bit more details and lets go from there.

      Hope this helps,
      Jill

      Reply
  190. Jim W

    Just had my first brush with a kidney stone. After reading through the big list of foods and their oxalate levels, I’m a little disheartened. Turns out that some staples in my diet for the past couple of years – raw spinach, nuts, avocado, and stevia, among others – are real culprits according to that list. I added nuts and avocados into my diet, since they are otherwise supposed to be very good for people. And I turned to Stevia in order to avoid sugar (personal issue with it) and artificial sweeteners, because of so much controversy around them. In addition, I have trouble getting enough fluids, because if I drink water or other liquids that require little or not breakdown in the body with my meals or too soon afterward, I get some nasty indigestion. SO…..let’s start with the Stevia. If I don’t want to or can’t use much “real” sugar and want to avoid artificial sweeteners, what on earth is left? Xylitol? Or is that bad too?

    Reply
    • jharris

      Dear Jim,

      I hear the frustration in your words- I am sorry you have stones and also that the foods you enjoy so much are high on the list. First off I must ask if you did a 24 hour urine and are you sure you have an oxalate issue? Meaning- did the results come back with high levels of oxalate? Many stone formers start limiting foods without ever doing a 24 hour urine collection.

      If you know you have high amounts of oxalate in your urine, then yes, you must limit those foods that you are enjoying most. But Jim, remember, it doesn’t mean you can never have them. Incorporate them into your diet here and there. Stevia is a problem. At 42 mg for one teaspoon, you MUST limit. If your oxalate needs to be limited I would rather see you have it with a healthy avocado, then taken all up at once with stevia. I understand that you have a “personal issue” with table sugar, but it does not increase urinary oxalate and you might want to reconsider using it.

      Xylitol is derived from Birch trees and may be high in oxalate.

      Let me know if your urinary oxalate levels are known and if so, how high are they? You may not have to limit as much as you think.

      Thanks for writing-
      Jill

      Reply
  191. Robert Howard

    Does Crystal light Lemonade qualify as “diet lemonade is low in oxalate”?

    Reply
    • Fredric Coe, MD

      Hi Robert, A great question. I hope so. No data that I know of. But the sweetener may be stevia which is high in oxalate. I will ask my colleague Dr Ross Holmes who is a food oxalate expert and see if he knows. Best, Fred PS Dr Holmes never studied this beverage but Jill Harris points out that aspartame is the sweetener. FLC

      Reply
    • Jill

      Hello Robert,
      The sweetener in Crystal Lite is aspartame. Not plant derived, but lab derived. So there should be NO oxalate in it.

      Reply
  192. Ludwig Wolf

    The oxalate content of most foods pales in comparison to that of SPINACH. Much as I like it, I will try not to ever eat it again

    Reply
  193. Tracy

    My partner is getting kidney stones regularly. Mostly Calcium hydrogen phosphate. He has had 24hr urine analysis and nothing showing as out of the ordinary. Aside from drinking “lots of water”, what else can he do to try and reduce the number of stones he is producing? Low Salt, High Calcium?

    Reply
    • Fredric Coe, MD

      Hi Tracy, Calcium hydrogen phosphate sounds like brushite – calcium monohydrogen phosphate, and if so such stones are special. Firstly they respond poorly to shock wave lithotripsy so other surgical means are best should he need management of stones. For prevention, I doubt his urine chemistries are really normal. Usually urine calcium is high – above 200 mg daily – and the pH of the urine likewise a bit high 6.3 or more. Brushite stones are nasty in that crystals can plug the kidney tubules, and the numbers of stones can be large. Yes, high fluids are important and given the kind of stones 3 liters of urine – 3.5 to even 4 liters of intake worthwhile. Yes, very low sodium is worthwhile, 1500 mg daily. Brushite stone formers are enough of a problem I often use thiazide type diuretics if fluids and low sodium are not enough to stop their forming. Modern 24 hour urine testing shows supersaturations with respect to brushite – calcium phosphate – and the goal is to drive that supersaturation below 1. Likewise fluids need to be even throughout the day leaving few or no dry spells when urine becomes concentrated. Fred Coe

      Reply
  194. Laura bousada

    Dear Dr. Coe and, and Jill Harris,

    Thank you for the article and thorough information on eating to reduce oxalates. I came prepared today to ask a couple of questions regarding the type of stones that my body produces but have had a few of them answered in responses to Kathleen Tega’s questions.

    I was told by my nephrologist to take 1200mg of elemental calcium a day and also some calcium with every meal. Would this still help my bone calcium, even while producing calcium phosphate stones?
    And in the future, is it a possibility for lists and information on what to eat to reduce phospates in ones diet? I will go back to the article and read more on having calcium in your diet. As you might remember my stones are calcium phosphate (brushite & apatite).

    Thank you for your consideration in this matter.

    Sincerely, Laura Mac Donald -Bousada

    Reply
    • Fredric Coe, MD

      Hi Laura, 1200 mg of total calcium is very ideal and you use it this way. About 400 mg with each meal, never between meals. The total should be food calcium to the best extent possible then add in supplements only as necessary. Excessive phosphate in the diet is largely from cola drinks. All living things have a lot of phosphate, so you will get about 600 or so mg/day just eating. Perhaps we need an article on high phosphate. Certainly we need one on how to get food calcium with a minimum of food sodium. Your big problem will always be the higher urine pH which cannot be changed that I know of. Low diet sodium – 1500 mg, very high urine volume – 3 liters spread out over the day – and medications as needed to lower urine calcium further are compatible with the high diet calcium you need for your bones. Regards, Fred Coe

      Reply
  195. Kathleen

    Dear Dr Coe, I found my test results and they were on the low end of normal for oxalates so I guess I’m ok there 🙂 . The only “high” levels were brushite and monosodium urate so I’ll check your articles for info on them. Thank you again for all the wonderful information , in this article and your other ones, Sincerely, Kathleen

    Reply
    • Fredric Coe, MD

      Hi Kathleen, I wish I already had a proper article on the special problem of calcium phosphate stones, but basically they occur because of idiopathic hypercalciuria and too high a urine pH. High fluids, high calcium diet, low diet sodium, and perhaps thiazide diuretics will often be very effective, and that is what your physician has probably already considered. Regards, Fred Coe

      Reply
  196. Kathleen

    Thank you so much for this information. Years ago I was handed a pamphlet but it was so obscure I couldn’t tell what I could eat and what I couldn’t, to be honest I just gave up in frustration. I have MSK with non-obstructing calculi so stones have only been a problem that one time…Would avoiding oxalates slow the production of the calculi?

    Reply
    • Fredric Coe, MD

      Dear Kathleen, you are clever to have even found this article which is a draft and not even linked to the front pages of the site! It is not so hard to eat a moderated oxalate diet, as Jill Harris points out. Whether or not you should do this depends on the crystals in your stones. If they are all calcium phosphates, it is not so important; if they are calcium oxalate it is. Likewise for your 24 hour urine studies: Is your urine oxalate above normal?? If not, why bother? Finally, there is the matter of diet calcium. If your urine oxalate is high, to me the first step is a high calcium diet – 1000 mg daily. If that lowers your urine oxalate, perhaps other diet changes are not needed. Regards, Fred Coe

      Reply

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