I have heard this one million times from patients in my practice. Make stones? Drink water. Water, water, and more water. Drink it all day long, all night long. Just drink water.
What about other fluids? Are they safe? Are they high in oxalate? Will they count toward your daily intake? Is caffeine a problem?
Your Physician Prescribes How Much
I will be offering as much variety as I can, and encouraging you to drink, but the volume you need comes from your physician. This applies especially to my two day long examples. I made them to provide very large amounts of fluids for those who need them. If your physician prescribes less, just scale my recommendations back. Under no circumstances should you follow a fluid prescription in this post unless it fits with your physician’s specific recommendations for you.
Some Beverages Raise Stone Risk
What Did People Who Developed Stones Drink?
Perhaps the most useful study of this matter is by Ferraro and colleagues. Two large groups of nurses and one group of physicians have been followed for many years to ascertain habits and diets that appear healthy or unhealthy.
Some of the people in each group developed kidney stones. Most, as expected, did not. Because diet habits were closely monitored by well established questionnaires over the years, the scientists could determine which beverages, my particular concern here, were associated with a higher or lower risk of becoming a stone former.
The amounts are important to keep in mind. For coffee and tea it was 8 ounce servings. For juices, a small glass. For carbonated drinks and beer a glass, bottle or can. For wine a 5 ounce glass. Servings were graded from less than 1 weekly, over the range of 1, 2-4, 5-6 weekly, and more than 1 serving a day. A significant effect meant that as the amounts increased, the risk of new stones increased or decreased in rough proportion – there was a ‘dose’ effect.
Winners and losers
Sugar sweetened colas and non-cola drinks were associated with development of kidney stones. Punch was also associated with more stones. But drinks with sugar in them were not all bad. Apple juice, grapefruit juice, and tomato juice did not raise or lower risk of stones.
Coffee, decaffeinated coffee, tea, red wine, white wine, orange juice, and beer were the winners. People who used more had a lower risk of new stones.
No Special Effect on Stones
We already mentioned apple, grapefruit and tomato juices. Add to them liquor, artificially sweetened sodas – cola and non-cola (clear sodas), whole and skim milk, and water itself.
Water Is Not Your Only Option
Nothing is totally off limits when it comes to increasing fluids. The main point is that you do, indeed, increase them. If having a soda here and there helps you maintain your ultimate daily fluid goal, then by all means, treat yourself once in a while.
I am certainly not advising you to have as many Coke’s as you would like, nor am I advocating that you drink very large amounts of coffee all day long, even if coffee drinking lowers risk of stones. What I am saying is that all fluids count and water is NOT your only option. Other beverages help provide variety but my principle is to use them in moderation.
This post will help you decide which other beverages you might incorporate into your diet to help raise your total daily fluid intake. Keep in mind that you need to take into consideration other medical conditions you may have that will contraindicate some of these choices. Review your version of my plan with your physician to be sure.
Pucker Up!
Lemonade is an excellent way to increase your total daily fluid intake and raise your urine citrate level. Citrate is a molecule that binds to calcium so that calcium does not have the chance to bind with phosphate or oxalate. It also slows the formation of stone crystals. Both actions decrease your risk of forming new kidney stones. Lemonade use was not part of the large beverage study I have already quoted, but is thought to be beneficial for stone prevention, or at least not a specific risk like sugared drinks.
The Best Tasting Ones
The Huffington Post polled people on the best store bought lemonades. The winner was Whole Foods brand 365 Pasteurized Lemonade. The next two best were Simply Lemonade and another Whole Foods product, brand 365 Organic Lemonade. Read the whole article and let us know which ones you like.
Unfortunately, all three winners have extra sugar added to them. Simply Lemonade seems free of extra sugar, but comments to a review of the product document added cane and beet sugars.
Sugar in any form can raise kidney stone risk, and sugared drinks raise risk of stones – as I have already pointed out. Of course sugared drinks promote weight gain, and raise blood glucose and insulin. But if you follow my moderation principle some of these tasty treats are fine. ‘Some’ means some.
My Favorite for You
I recommend Crystal Lite™ lemonade for my patients, as it is a no calorie alternative. The other reason I love this for you is its convenience. Here is a link for “on the go” packets. Another recent post on this site points out that those who need potassium citrate treatment can use this beverage in place of some of their pills.
Make Your Own
You can also just squeeze some fresh lemons to add to your water. If you don’t have time to always buy, cut up, and squeeze fresh lemons, here is an excellent, convenient, alternative: Pre-made concentrate. I get it at Whole Foods, but you can find it at Walmart and Amazon as well. In order to increase your citrate level with a recipe that has been tested in a research experiment, you need to add one half cup of RealLemon© to 7 1/2 cups of water. The Whole Foods concentrate may work as well, but has not been tested.
Got Milk?
Adding low fat, skim or 2% milk is a great way to increase your daily fluid intake and also help you to increase your diet calcium intake. For those of us who are lactose intolerant, here are lactose free alternatives.
Lots of Calcium and Protein
Getting normal amounts of calcium into your diet (about 1000 mg/day) is necessary for your bone health. An 8 ounce glass of milk contains about 305 mg of calcium. Two percent contains 295 mg. You can check the amounts for all milks at the site. There is a lot of protein (8 grams) and other nutrients, too. The protein content is the same whether for fat free or whole milk.
Not So Many Calories As You Might Think
Milk is a calorie bargain. An 8 ounce glass of 2% has only 120 calories, and 1% 105 calories.
Soda Pop
The Skinny on Diet Sodas
Having a diet soda a few times a week will add to your overall fluid intake and, as I have already pointed out, does not increase risk of forming kidney stones to a significant extent. But, unlike milk and lemonade, most sodas offer you no health benefits.
There May be Real Risks
There may indeed be drawbacks. For example, in one study, risk of hip fracture seemed related to diet soda intake in women.
There is Risk By Association
Among diabetic young men, use of diet, but not sugared, sodas was associated with higher average blood glucose. This was ascribed not so much to the beverages as to the generally unhealthy life style of those who consumed larger amounts of such beverages. Likewise, in another study, diet sodas were associated with new onset of type 2 diabetes in men. But with full adjustment for other factors that might predispose to diabetes, the effect of diet soda disappeared. It seems as if men who were trying to lose weight, or compensate for high diabetic risk, preferentially used diet sodas.
Cola vs Uncola
Given that there are drawbacks to sugared sodas and no benefits to diet sodas, what about the clear sodas – the non-cola drinks, as a special case?
The clear sodas have citric acid instead of phosphoric acid. We have already presented the chart of citrate levels in clear soda and you can read it over yourself: Higher is better. Likewise, in the same post, this site has presented the case for the use of beverages as a source of citrate in place of expensive potassium citrate pills.
7UP and Sprite have no caffeine which may be an advantage for some people.
The Final Verdict
Think of diet sodas as a treat, probably not a good protection against stones. The higher urine volume is offset by what else is in the soda. It is not something to have all the time. Diet soda may increase hip fracture risk in older women. Sugared sodas raise risk of stones, so just avoid them except for a special treat once in a while.
Given the high price of potassium citrate pills, many patients may need to use high citrate beverages, which are clear sodas, as a supplement. For those who do not need supplemental citrate, and there are very many stone formers in this category, the clear sodas serve no special purpose except for variety and taste.
Unless you are using high citrate beverages to replace potassium citrate pills, limit how many times a week you are choosing soda as an alternative to water. I would recommend no more than 3 cans a week. If you’re somebody who drinks it every day, start weaning yourself off of it.
Try substituting a LaCroix for each can of soda. It is carbonated and flavored, but without the calories, sugar, and yucky stuff that soda has in it.
Wake Up and Sip The Coffee
I drink one cup of coffee every morning. Not the 72 ounce cup you can get at Dunkin’ Doughnuts, just one true cup. I need it, I love it, and I will not do without it. There is no doubt that coffee can contain considerable oxalate. Instant coffee has even more oxalate per gram than the regular coffees. The question is whether drinking coffee increases urine oxalate, which has not been determined.
I suspect it does not because coffee drinkers have a lower, not a higher kidney stone risk. In the same prospective study I quoted for sodas, caffeinated coffee drinkers had a 26% statistical reduction in new stone onset compared to people who did not drink coffee and there was a graded reduction in risk as the amount increased from none, through 1 cup per week, up to 1 cup or more every day. The decaf drinkers had a 16% reduction.
These coffee drinkers were not using coffee as a form of stone prevention. I presume they used it as a pleasurable beverage. So there is something about coffee drinking that offered a protection.
The issue is therefore not about kidney stone risk but about how much coffee people should drink every day. That is something you need to discuss with your physician. But, I cannot imagine anyone will use coffee, even iced coffee, as more than a small fraction of the many liters of fluid needed daily for stone prevention.
Terrible Teas?
Every patient I have worked with (thousands at this point) has told me that they have been told NEVER, EVER, to drink tea. Tea is known to be high in oxalate. It is true that tea is a higher oxalate beverage, but if you drink it in moderation, a cup here and there will not increase your risk of forming new stones and does add to your total daily fluid intake. In support of what I just said, in the same study I have already quoted in the prior paragraph, tea drinkers had an 11% reduction in stones.
Even though a cup or more of tea every day appears to decrease stone risk, tea, and iced tea, are not a reasonable source for the majority of the large quantities of fluid used in stone prevention. Tea is like coffee: A source of some fluids and variety.
Lovely Libations
The very important epidemiological study on beverages which I have been quoting offers perhaps a little surprise: Wine drinkers (5 ounce glass between 1 per week and 1 or more a day) had a progressive reduction in stones of 31% to 33%. Beer drinkers (1 can between 1/week and 1 or more daily) had an even higher reduction of 41%.
None of these quantities are like the scale of water drinking, or even milk drinking. These are like coffee and tea: Pleasure drinks.
Overall, your alcohol intake is between you and your physician; drinking in excess is never advisable. One glass of wine, or one can of beer a day may confer real benefits for stone reduction.
In between rounds, remember to raise a glass to your old friend water. Your body will thank you the next day.
Sport Drinks
I have not encountered very many patients who use sport drinks in important quantities. Maybe I travel in the wrong circles. Sweetened sport drinks all have the obvious disadvantages of their sugar in relation to stones, and, of course, for weight control. None were remarkable sources for citrate. They are like the sodas: Occasional treats to break up monotony.
Juicy News
If you want risk reduction specific to a juice, orange juice, 1 or more small glasses a day, was effective (12% reduction). Apple, grapefruit, and tomato juices had no effect.
But the lack of an effect is not critical here. The study refers to a small glass daily and did not test larger volumes for urine dilution. Given that none of the juices increased risk, I see no reason larger volumes cannot be used as part of the day’s fluids, apart from the problem of calories – from sugar.
Although cranberry juice may help in protecting you from recurrent UTI’s, no studies have shown it reduces kidney stone risk.
A Day In The Life
How do these suggestions play out in normal day life? Let’s take a look at an example weekday and weekend day. For those of you who are trying to increase urine citrate, we have a whole post to help you.
These are Examples; Your Physician Sets The Amounts
I have already said this and say it again. These examples are for very large volumes of fluid. They show you how you can achieve such large volumes with variety. Your physician will tell you how much to drink. Scale back these examples to match what you are told.
Perfection Is Not a Realistic Goal
You may notice that depending on your day you may drink less than your goal. You may not reach your intended goal every day. It is OK. You are not going to be perfect every single day. Try your best on most days, and if you have a really bad one, just make up for it on the following day.
Monday – A Weekday Fluid Plan That Provides 120 ounces (~1 gallon)
Here is a weekday example for your sunny, early riser with a job and a lot to do. The plan provides 120 ounces – one gallon – of fluids a day and aims for modest front loading so you do not have to get up at night. It includes a treat – diet coke – which could be any diet drink. It does not favor milk because many people do not like it or cannot tolerate it. If you can, milk can substitute for water whenever you wish.
Wake Up – 6 am
1 cup of coffee or tea (5 ounces).
5 ounces of milk with cereal
One 8 oz glass of water with lemon
Mid-morning
Three 8 oz glasses of water
Lunch
One 8 ounce glass of fresh lemonade or diet lemonade beverage
One 8 ounce glass of water
Mid Afternoon
Two 8 ounce glasses of water
One (5 ounce) cup of tea
Dinner
One 8 ounce glass of water before dinner
One 8 ounce glass of water during dinner
One can of diet soda — 12 ounces toward the end
After dinner / before bed
One 8 ounce glass of water
One cup (5 ounces) of herbal mint tea
Saturday – A weekend plan that provides 148 ounces
No work for most of us but a lot of chores. Weekends may be a time to up the ante and go over a gallon. Even if you fall short on the weekdays a bit, and likewise on the weekends, these plans are large enough to give you some margin. But it would be ideal to stay on the high side more days than not. You are buying insurance by the day, after all.
Wake Up – 8 am
1 cup of coffee or tea (5 ounces)
One 8 oz glass of water with lemon
5 ounces of orange juice
Mid-morning
Three 8 ounce glasses of water
Lunch
12 ounces of iced tea
8 ounces of water
Mid Afternoon
One liter of water with workout at gym (about 34 ounces)
5 ounces of green tea
Two 8 ounce glasses of water
Dinner
Two 8 ounce glasses of water
Two 5 ounce glasses of red wine
One 5 ounce decaf
The Wrap Up
My intention was to convey that water does not have to be the only thing you choose when calculating your daily fluid intake. All fluids DO count toward the total.
I think this is important to note, as many patients tell me they hate drinking so much water everyday and then wind up not drinking at all. You can safely add items like diet soda, fruit juices, tea, and alcohol if you do it sparingly throughout the week along with your best friend: water.
Personally, I choose water most of the time. It is free, without any calories, supposedly good for my skin, and does a great job of quenching my thirst during the day and after exercise. As a middle-aged woman, it checks all my boxes.
Need more support getting in fluids or changing your diet?
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. I moderate it to keep it clinically sound. Come on over and join the discussion!
Dr. Coe, I was recently prescribed potassium citrate to prevent recurrence of kidney stones. But, as you indicate, the drug is relatively expensive so I began searching for a natural option. I read your article regarding Crystal Light lemonade and started drinking it. However, I recently read the following article which claims “that orange juice provides an alkali load, promotes hypercitraturia, and reduces the propensity for crystallization of calcium oxalate and uric acid, whereas lemonade does not.” Here is a link to the article: https://cjasn.asnjournals.org/content/1/6/1269. So, now I’m confused…which is correct? Thanks.
Hi John, thanks so much for the link. The paper is a wonderful example of good technique applied to a very flawed hypothesis. Crystal light was chosen because at the time we made measurements it contained the highest amounts of citrate. Lemonade concentrate contains citrate but I suspect mainly as citric acid because it is more acidic than orange juice or Crystal light. That may be why the analysis of the concentrate revealed little potassium to go with the measured ‘citrate’. Citrate assays measure citric acid whether protonated or not, and if protonated by an acid juice the resulting molecule will not raise urine citrate or pH – as happened here. I never have recommended lemons or their juice for this reason, and the work hold no surprise, novelty, or even vague interest for me. Orange juice provides sugar we do not need, and I avoid it, too. So, that is what confused you and you had every reason to be confused. But not now. Thanks again! Fred
This is very confusing. If Jill Harris wrote the article, why is Fred Coe responding to comments, and more importantly–why are you providing contradictory advice? Fred, you state here that you have never recommended lemons or their juice, and in a later comment say it’s because you believe that lemon juice has no efficacy for stone prevention. Yet Jill’s article above has an entire section recommending lemonade from a variety of sources, including fresh squeezed and concentrates.
This is contradictory and does not serve your patients. Please agree on a consistent message and revise for clarity. Thank you.
Hi Whitney, Sorry for the apparent contradictions. Jill are I are partners and we wrote the article together. Neither of us have recommended lemons per se. Lemonades contain potassium citrate without the citric acid excess and sugars in lemons. Use of fresh lemon to make water less dull is not unreasonable but also not a prevention. The reason for lemons and lemonades is to get potassium citrate without using expensive pills. Potassium citrate can be obtained by fruits and veggies in the diet, if in proper proportion. But all this is not quite exact. For you or anyone else the issue is whether potassium citrate – however obtained – is of value and that depends on the cause of the stones as ascertained by 24 hour urine and blood measurements. If it is needed, a basically good diet is probably the best way to get it Lemon slices, lemon juice, add some flavor to water to make high fluids less boring, and that was what we meant when we wrote the article. I hope this helps. Sorry for any confusions. Regards, Fred Coe
Dr. Coe- My urologist did a 24 hour urinalysis and when I returned for a follow up, he handed me the same pamphlet that they handed me previously. When I said I need help in choosing foods and that the pamphlet contradicts itself on every page, he said I need to see a nephrologist. This is Dr Bird in Gainesville(UF) a highly respected urologist. Interact change my diet but don’t know how. The pamphlet is comical. On page 1 it says limit meat intake to a max of 6oz per day. On the last page it lists foods that you can have all you want, moderate amounts, and avoid completely. Well, under ‘no limit’ is Meats! All of them. Soda as well.
Help please.
Hi Greg, If diet is an issue, I think this might be a decent starting place.Best, Fred Coe
Why not mix orange juice with Chrystle Light lemonade to get any / all effects in one drink?
Hi Tanialee, You can. I am sorry I missed this question and am so late!! Best, Fred
So many people use lemon for stone prevention it could help protect their teeth. Lemon is actually not an ideal way to get potassium and citrate; -Fredric Coe MD.
I find this odd since the acid would help break down the oxalate. I’ve been told by several Urologists and nurses to drink water with lemon. So I find it hard to believe ONE doctor that I don’t personally know.
Plus, since having to drink so much water it’s more convenient to add lemon to the water. Just makes sense to me.
Best regards,
Jamie
Hi Jamie, I am not sure which article you are quoting, but I cannot find the comment in the one you have posted on. I believe the ‘it’ concerned using a straw to drink lemon juice which can damage tooth enamel if used chronically. The citric acid in lemon has no effect on oxalic acid whatever. It is that if the lemons are not too acid, the citrate species in the fruit will include a predominance of citrate vs. citric acid, the latter will do nothing for stone prevention. The former is metabolized as citric acid and thereby creates alkali for the body that will in turn raise urine pH and urine citrate. But lemons are variable, and not very reliable as a source of citrate compared to medication or even some commercial beverages. Adding lemons to water is a nice taste treat, and why not, but no evidence at all for efficacy in stone prevention. Urologists and their nurses are perhaps encouraging one to drink more by adding a piquant flavor, and no harm in that, but it is not a stone prevention treatment. I am sorry to be the one outlier, but professors are apt to be that way because we are paid to study things. Warm regards, Fred Coe
I’m confused on this, don’t lemons go in the body as being acidic and later turn alkaline? I was under the impression too to add lemons to your water to help raise your urine PH? So all my lemon water drinking has been done in vain…
Only crystal lite will do?
Hi Lindsey,
It can raise it a bit, but upping your fruits and veggies, in general, will def raise it and that is what I would advise you to do. Try that instead. Also, have you done a urine collection to find out if you need to raise your pH?
Best, Jill
I wonder if the authors have considered that whether coffee is good or not for kidney stones depends on the elimination rate. Dr Greger of nutrition facts has gathered the research for fast eliminator of caffeine coffee is good for them which has good cancer effects and for slow eliminators coffee is bad for them increasing their cancer and other ill effects.
Hi Mark, the only reliable science we have is the epidemiology Gary Curhan did linking coffee drinking to a reduced risk of stones – quoted in the article. I do not know anything about Dr Greger’s work, but know of no scientific data that caffeine will have no obvious effects to cause or prevent stones. Regards, Fred Coe
I’m totally confused. Reputable internet sites don’t seem to agree on what is or isn’t good for stones. My urologist listed coffee as a top 3 to cut out but this article says coffee is fine. Urologist also listed lemons to go with but here it seems maybe/maybe not.
Oy
Hi Phil, Well, here is a reputable site and I have found lots of confusion – among patients and others. The problem is the question. How do you determine a mode of prevention sans knowledge of cause? Most medical process goes from diagnosis, so you might be happier getting a full evaluation for cause via 24 hour urine and serum testing so you can aim your prevention efforts. As for coffee, the main evidence is from the work of Dr Gary Curhan at Harvard. It is that work leads us to exonerate coffee as noted in the article. As for lemons, that remedy was put into public view by my friend Dr Marshall Stoller at UCSF, and I am not enthusiastic about it because there are so many alternatives in the event that potassium alkali – what lemons offer – is the right thing for you. So, I would find out the problem and treat it. Regards, Fred Coe
I am in the process of trying to make alterations to my diet, and recently realized that I pay for insurance to include access to a nutritionist, so I should work with them to make changes to my diet. That said, I had been attempting to make such changes myself. One thing I read about was that ascorbic acid (vitamin C) breaks down into oxalic acid in the body, but citrate helps the body prevent the formation of stones. So I thought about it and began to add lime juice to my water. Limes are relatively low in ascorbic acid compared to other citrus fruits, but high in citric acid; classically this is why, although they were good enough in the navy to prevent scurvy, they would have been far more effective had lemons been used instead.
I would value your thoughts on using lime juice in lieu of lemon to the water. I am not looking for “natural” “holistic” blah blah blah, I am trying to work with what is scientifically justified, but there is a terrifying amount of misinformation and contradictory information out there. I found a urology center who recommend eating spinach to prevent formation of stones because of the high magnesium content. Some places report some fruits and veggies are containing insignificant quantities of oxalate while others contain high amounts; I even found a paper which decided to search google to determine oxalate concentrations and found the reported concentrations varied wildly. For me, this is a huge step, trying to bring my health under greater control. It is upsetting, frustrating, scary, and difficult to navigate.
Hi Brok, The web is variable thence I wrote this site to as high a scientific rigor as possible. But I am not clear about your goals. Do you know your stone type? Have you had 24 hour urine studies? Do they point to a need for altered diet oxalate. Juices can provide citrate, but have limitations; is your urine citrate low? I would hope you have been or will be fully evaluated with serum and 24 hour urine studies to define the cause of your stones, and also find out what crystals comprise the stones. Regards, Fred Coe
I appreciate all the work and advice on these pages. I have not had a urine study done, but my most recent stone was analyzed (after ten years of stones and my arguing with doctors that I wanted them tested rather than them just assuming without even looking at the stones what caused them). It was Calcium Oxalate Dihydrate (Weddellite) 20%, Calcium Oxalate Monohydrate (Whewellite) 80%. So, okay, dietary changes are a must. I am trying to do that and to put together a careful dietary plan which takes all the info I have read into account so that I can go over it with my nutritionist and get her approval.
The biggest thing I have been tripping over has been the 1984 data from USDA, which keeps being 10-1,000x higher than studies before and since. There is no explanation for this anywhere that I have found. Dr. Duke’s info seems good but for 19 items has “oxalate” as a separate category than “oxalic acid” where the numbers are astronomically higher. I am trying to do my best here, but I do not have the background to evaluate truth from nonsense. Do you have an explanation for the USDA and Duke numbers?
Hi Brok, That the stone was calcium oxalate means nothing about urine oxalate or a need to alter it. High urine calcium, low urine citrate can cause the same stone with urine oxalate being normal. So you really are not best advised to begin diet change without urine study. I like at least 2 24 hour samples one at work one on weekends. If urine oxalate is indeed high the main thing is to increase diet calcium, as that will lower oxalate. If urine calcium rises from that calcium intake, the next step is to lower diet sodium to reduce the calcium. Here is a good article on what the kidney stone diet looks like – it is the science version, but it links to the more general one. As for lists and lists, we used the one compiled from Harvard, and asked an established authority on food oxalate, Dr Ross Holmes, to curate it for us. Our lists are probably as good as we presently can get. Older data sets used methods of questionable accuracy. I know nothing about the USDA data set as the Harvard group did all the original sifting of prior data to create their list. In point of fact, very few foods create the greatest fraction of risk, and they are highlighted on the graph in this article. Regards, Fred Coe
Thanks for writing the article. As noted Tea is high in oxalate, would that negate the benefits say in Green Tea?
Hi Rhys, Green tea is not so high in oxalate, but do make it a treat not your main beverage. Regards, Fred Coe
With all due respect, the recommended liquid intake volumes shown in the examples are utterly unrealistic for most people. Would they produce well-diluted urine? Sure. But trying to gulp down that much fluid in one day would amount to becoming obsessive about it. Which, I suppose may be ideal for preventing stones, but is, if I may be so bold, unnatural. Something doesn’t add up here. Why would nature not instill in us the desire to consume three liters of fluid a day, if that was what the body required to achieve a kidney and urine solute homeostasis? I have no natural desire to consume more than a liter of fluids in one day, sometimes much less. And I am an active person. I am a stone-former, and I have modified my diet to increase dietary calcium intake and lower oxalate intake. I have recently and successfully eliminated added sugar from my diet. But I simply cannot conceive of drinking anywhere near the amount of fluids recommended here. I have tried, and it feels as if I am becoming a fluidaholic. Everything revolves around trying to flood my body with fluids. Seriously? It’s just not natural.
Hi Gerald, Here is the problem. Evolution fitted us for water conservation under conditions of very low diet sodium availability. With really low diet sodium stone risk is not present as calcium losses become very tiny. The entire thirst/vasopressin axis is very complex and aimed, as I said, at water conservation under conditions of variable and often slight water availability. So you are right. We are fighting against a disease due entirely to our modern ‘dietscape’ – If I may use such a neologism. We cannot go back to where we started, and stone prevention tries to accommodate. Reduced diet sodium, high diet calcium reduced diet sugar – there never was abundant sugar until about 400 years ago – will take you long way. If you are one of the many people who cannot stand high fluid intake, and the diet does not lower stone risk enough, meds are a reasonable answer. Lots of us like water, for example I do, but that is certainly not a rule. Regards, Fred Coe
Evolution? Seriously? God made us in HIS own image!
If we came from apes, and evolved, then why are there still apes?
God was never an ape! Let me ask you this. Do you believe in God, Jesus Christ? Son of God?
Hi Rhonda, Evolution and Christian religion are not really at odds. Presently the Catholic Church accepts evolution and special creation as alternatives for the faithful. Highly orthodox christians and Jews reject evolution, however. Best, Fred
Rhonda,
Nowhere in Dr. Coe’s response dud he say that we evolved from apes. The word Evolution isn’t always used as the opposite of creation.
Thank you, Angie. Fred
I totally agree with you!
There is also a problem when people drink TOO MUCH water!
Hi Sharon, The problem of hyponatremia, though rare, is very serious. Ideally one will take in the fluids steadily over the whole day, and also be wary if taking drugs that affect the nervous system as they can foster hyponatremia, as can diuretics. Regards, Fred Coe
I have had Lupus all my life, kidney function has always been something my doctor and I have monitored – every 6 months. while oxalates in the urine are mentioned here, I am interested in creatine levels in the urine and what less oxalates will do for creatine levels. The “leaking” of protein from my kidneys is also an issue. foods high in phosphate, high in potassium, and diet high in animal protein are thought to make the kidneys work harder..your thoughts??
Hi Christine, This is not a kidney stone issue but one of kidney disease from an immune disease. Urine creatinine arises from muscle metabolism and can be raised by large intakes of muscle – meat – but proof is lacking that meat damages kidneys except perhaps with large extremes. Phosphate and potassium are issues when kidney function falls, and urine protein losses are a very important gauge of kidney disease, but these are matters for your nephrologist and outside the range of this site. As for oxalate, our group has offered evidence that it might affect kidney disease, but in cases when its losses in urine are far above normal. Right now I am not able to say that reduced diet oxalate is advisable in kidney disease patients whose urine oxalate is unremarkable. But one recent article does implicate oxalate in progression of kidney disease, so the matter is unsettled. Regards, Fred Coe
There’s a mention of orange juice, drinking a small glass each day is good for you. Yet I have 3 doctors and all have said, stay away from orange juice because of the vitamin C…Vitamin C causes kidney stones.
I also cannot drink a lot of fluids…I am just not thirsty. But to drink the amount listed on this page just seems unrealistic. I have tried drinking a lot and end up constantly in the bathroom. I’m also taking Hydrochlorothiazide twice a day so that makes me go as well. I do like soda on occasion. I like wine but don’t drink much of it…reading this article, maybe I should start having a glass each day? I’m mostly a skim milk and water with lemon drinker, I just don’t drink more than 2 quarts of fluid a day.
Thank you,
Kim
Dear Kim,
As a nurse I will not override a doctor’s order, but I will tell you that the little bit of juice you are inquiring about does not exceed the limit of vitamin c. Vitamin C in excess of 2,000mg/day converts to oxalate. The normal amount you ask about does not come close.
Best, Jill
Question, since I’m nearing surgery for my kidney stones what beverages besides water can help to reduce the stones so they can pass?
Hi Pamela,
All fluids count, water is best!
Good luck, Jill
Very helpful and beneficial information. I would like others to read this article. It really helped me a great deal. It is also nice that it does not have a catch to try to make you buy something or listen to a video that is not helpful at all. Thank you so much. It is well written and it is made simple so everyone can understand and will have a guideline to follow.
Hi Heather,
I am happy you enjoyed it. My website has a bunch of easy articles to read too. kidneystonediet.com/articles
Best, Jill
My husband loves a cup of hot tea in the morning but was told not too. Do tea bags or hot tea have the oxalates too?
Hi Laura,
You can certainly fit a cup of tea into your diet and still lower oxalate. Please read this and also get your searchable oxalate list here to learn more: https://kidneystonediet.com/oxalate-list/
Best, Jill
I took care of a 9 mm kidney stone that was stuck at the bottom of the ureter tube, and my left kidney was not functioning to full capacity. Stent was in place for 6 weeks after surgery, and I had that removed. I have to wait another 4weeks for an abdominal ultrasound to check kidney function and most likely a bladder scan. The CT scan also came back with a dilated pancreas, and I’m reading that because of that you have malabsorption which can cause oxalate kidney stones. Maybe I should’ve seen the GI doctor first, instead of the urologist? Any suggestions? I’ve had digestive issues, I.e. constipation for a very long time and have to take a product called ez-go. I hope this isn’t a problem with staying low oxlate, but I have to take it. I’ve been on a fodmap diet for bacteria in the large intestines, which most likely means it’s also in the small intestines as well SIBO. But now need to be on a low oxalate diet, I don’t mind the restrictions on food, but just wanna get better. The cost of all this is unreal, and I’m just reaching out for help
Hi Petrina, You do not say what your stone was made of, so be sure it is analysed. The pancreatic issue is separate from the stones. For the stones you need 24 hour and serum testing, which may reveal high urine oxalate or not. If not, your pancreas can be considered separately from the stones. If urine oxalate is high, perhaps you have malabsorption with enteric hyperoxaluria. :png time laxative use can cause stones by reducing urine volume because of increased bower fluid losses. As for low oxalate diet, that will only matter if your urine oxalate is high and other measures fail to lower it. Regards, Fred Coe
Do you have any experience with Swerve. Does it effect oxalate levels.
Hi Peter,
No, swerve does not have oxalate.
Best, Jill
Dear Jill…
I cannot thank you enough for your articles, posts, your course, and your videos. I greatly appreciate all the knowledge that you pass on to us! I ran into your FB page quite by accident and have told so many people about it.
Again, thank you!
Kaki
Hi Kathryn,
It is my privilege.
Hope you are doing well,
Jill
Hi I get nausea a lot of the time, & mild pain in left flank. I’ve heard nausea can occur even if the stone is not in the ureter. Such an uncomfortable symptom. I will up my lemon in water any other ideas for the nausea. When I have nausea microscopic blood shows on a urine dip stick Thankyou for the information
Kerri
Hi Kerri, Do you actually have stones? Nausea is indeed common when a stone obstructs urine outflow, so if you have a stone, even one not passing, your nausea may reflect on and off obstruction and signal a need for its removal. Bring this to the attention of your physicians, as they are responsible for your care. Regards, Fred Coe
Hi thanks so much for the information you freely give it is much appreciated. Are there any herbs to stay away from? I drink a lot of herbal teas to help with my fluid intake.
Hi Jillian,
Tea is fine to drink, but we say to keep it to a true cup or two a day. Water is best for the base of your fluid intake, but all fluids do count. This is a portion game, so eat and drink within normal portions.
Best, Jill
Dear Jill,
Thank you so much for all of your important information. I had a 9-10mm stone removed two mths ago, it was discovered when I had gross bleeding. Now I am doing the urine test by mail and next week I go for a Rental Ultrasound. Can you tell me what they are searching for in a Renal Ultrasound. I did have a CT before my surgery for kidney stone removal and thought that would give them all the info they would need. ($$$)😥 The result of the stone says it’s Cal. Oxylate so why then do I need to do the Lipto urine 24/he retrieval? This is so confusing and just want to get better and not have anymore stones!. I was told that I also have a 3mm stone in the kidney as well (the 9-10mm stone that was removed was in the ureter) Should the Urologist have also removed the 3mm stone? I certainly don’t want it to enlarge and cause the same problem. Thank you for all of your free information and I am so glad you are well. Please, any response will help ease my worries. Sincerely, Cheryl W.
Hi Cheryl, The 24 hour urine is crucial for finding the cause(s) of your stones. They are many and cannot be found otherwise. The ultrasound following a CT is not clear to me, either. But your physicians are responsible for your care and may have reasons. I suspect your surgeon removed the ureteral stone but did not go up into the kidney – a more involved procedure – as the stone there was so small. It can grow, so the 24 hour testing is crucial for prevention of growth or another stone as well. Regards, Fred Coe
I had this argument with my dad for years: is true herbal tea without any real tea from a tea plant off limits? Since herbal teas don’t contain tea, aren’t they a good source of hydration for folks who have kidney stones?
Hi Jill,
You can safely have a cup or two of teas per day as the articles stated. I would use water as your primary hydration!
Best, Jill
Do drink flavorings have oxalates? For example, the Mio brand sweet tea flavor?
Thank you!
Hi Laura,
Only plant foods have oxalate.
Best, Jill
I turned to a plant based (with fish) diet and my bloods have come back better than ever and my MSK seems stable. I am concerned about calcium though. The link to that lactose free section doesn’t work (I’m in New Zealand so wonder if that’s why).
Hi Mary,
Just google some lactose free options to get your calcium intake. I am lactose free too and have an article on this for you on my site:https://kidneystonediet.com/calcium/
Best, Jill
Hi! I received a list of oxalate content from you in an email. It was from Harvard University.
In it, it says that coffee has 1 mg of oxalate, but in the above article, it says that “coffee can contain considerable oxalate”.
I am confused. Could you please explain this to me?
Hi Michael,
You can certainly have a cup or two of coffee each day. We need to update the article.
Best, jill
Does anybody know if this Starbucks green tea is moderate to high in oxalates?
Emperors Clouds & Mist Hot Tea.
Thanks
Hi Troy,
Teas and coffee are only a problem bc people overdo it. Have a true cup or two per day and get your recommended calcium intake in!
Best, Jill
Hi Jill,
Question on lemon water/lemonade. You mentioned here and another one of your sites that it can be good to bring up your urine citrate levels to prevent stones which mine is 325 but I’m a Calcium Phosphate stone former and my urine PH is 7 which is high so is this still advised for my type of stone and high urine PH, won’t that increase my PH more? Does the benefit outweigh the risk of higher urine PH?
Also I’m increasing my diet calcium with dairy which I love but for my type of stone how much should I have, 51 year old woman at 120 pounds. Some places say 1000, some 1200, and others say you need more. The labels are so confusing now with percent, milk from what I remember use to be 30% in one cup now it says 10%. Also how much calcium can be absorbed at one time or each meal? Is it 500mg whether it’s food or supplement and if so how many hours in between do you have to wait to have more calcium in food? Also does dairy raise urine PH?
Another question, I know I should have around 50g of protein and I eat very little meats but with all the dairy to get my calcium it’s very hard to keep this low and to have some protein other than all dairy. I will have eggs or tuna as my other protein during the week. I keep a log and I get between 70-90g and noticed even hint of salt triscuits and breads have protein! I do have peanut butter Wegman’s organic 2 measured TBS a day because I love it and that has 8g. My last two oxalates were 23 and 35 and oxalate sats were 1.33 and 1.22. Should I limit the PB? My stone was 70% phosphate and 30% oxalate.
One last question, I eat greek yogurt and my understanding is that it has more protein and less calcium than regular yogurt, is it advised to switch so I get less protein.
Thank you so much for the work you do and your time,
Carol
Hi Carol,
These questions are a bit complicated and need more than a reply here. Perhaps schedule a short consult with me if you like:
Best, Jill
Hi Jill –
I am having difficulty finding oxalate data on herbal teas. Do you have any data that you can share? Specifically Raspberry Leaf or Tulsi teas.
Thanks in advance,
Hi Lisa,
All teas in moderation. You can imagine that not all teas have been studied as there are hundreds of them. Have a true cup or two a day and you will be fine. Getting your calcium needs met are even more important for you.
j
What is the oxilate content of Diet Peach Snapple? I got off sugary drinks to this beverage but am wondering if I need to dump this one too?
Hi Mike,
I would think there is little to none.
j
Does the caffeine in my energy drinks (150mg/2 fl oz) also contribute to formation of kidney stones?
Hi Kevin,
Too much caffeine can be dehydrating. Also, notice the sugar and sodium in these drinks. They are known to be high.
Jill
I put some manuka honey in my container of hot lemon water. Is that safe?
Hi Moi, Yes. Fred
This is a long shot. Put on a low oxalate diet for kidney stones, I cannot find out whether the popular UK drink of (alcoholic) cider contains oxalates. Can anybody help? Thanks. ps
Hi Peter,
It may but not enough for you to worry about unless you are drinking in large amounts. Not sure unless it is studied.
jill
Hi. I was wondering if you may know where I can find information on exactly how much potassium citrate is in a serving of diet lemon lipton tea. I buy the jar of instant and Im hoping it contains a good amount but I’d like to know for certain. Thanks!
Hi Belle, I doubt there is much. I do not have specific information. It is certainly not a remedy for stone prevention, although tasty. Fred
You might consider trying TruLemon, TruLime, and TruOrange powders. They consist of citrus juice and oils dried onto citric acid powder. Nice fresh tart flavor for making “lemon water”. They come in small packets which can be added to water or sprinkled on foods (e.g. melon or fish) More convenient for the office than keeping fresh lemons around.
I have just become aware of True Lemon this week. I squeeze a couple wedges of lemon and lime in my first water every morning. I’d love to replace that with TrueLemon since it would be so convenient, but I can’t find any information on whether it’s as beneficial as real lemon. I use lemon for my urinary tract, and for the vitamin C. The container only states that it gives you lemon “taste”, although it is made from real lemons. Have you found any further information on it?
Great information. I have recurring kidney stones alot. You don’t mention pineapple juice. I usually drink 8oz for breakfast. I was drinking a lot of cranberry juice, a lot! But stopped a month ago when the kidneys stones came back in Jan after a Sept surgery
Hi Sherry, If you have recurring stones, you need proper evaluation and treatment based on causes. Here is my best summary about how to. Regards, Fred Coe
you did not mention distilled water from water distillers, I have been drinking 2 liters and have a slightly lower body calcium now. is this good or bad for stones. I could take calcium to increase but will that cause stones then? please help…
Ryan,
Get your calcium by food and drink, not pills. If you must take pills you need to take them with food for better absorption.
Jill
what about distilled water?
Hi Ryan,
You can use distilled water if that pleases you.
Jill
I was recommended a tea, called kumis kutjing, also known as Java tea. Originally from Indonesia and presumably a very old remedy against kidney stones. Plant: orthosiphon aristatus. Can you comment about this?
Hi Roy,
Watch this on tea from my YouTube channel:https://youtu.be/Qbr6jRlwZUo
Jill
Any truth about Apple cider vinegar shrinking calcium stones?
Hi Barry,
No, no truth at all. You can watch my YouTube video on this topichttps://www.youtube.com/watch?v=KnTaZdRn_SA
Jill
My urologist did recommend a lemonade crystal light. How Many servings do I drink per day to get the benefit? I drink 5 servings a day but I’m starting to get really bored of it. If I can drink Less servings and still get the benefit that would be great.
Hi Angela, it has (or had when we measured it) 20 mEq of potassium citrate per liter. I do not know why you need alkali, nor how much, but your physician does and that one equivalent should make it easier for him/her to tell you how much to drink. Be sure you have been fully evaluated for causes of stones, as alkali in general is not a panacea for stones and can worsen things in some cases. Regards, Fred Coe
My doctor told me to avoid dairy and calcium rich foods, because it will help the stones grow. Is this true?
Hi Katja, No. That is not a good idea based on what we know. Take a look at a more reasonable kidney stone prevention diet. REgards, Fred Coe
Are plain or flavored seltzer waters (i.e. Bubbly, La Croix, or Waterloo) as safe to drink as plain water? No sugar or sweetener. The ingredients just state “carbonated water and natural flavors”.
Thanks!
Hi Eric, If they also contain no added sodium, no problem. Regards, Fred Coe
I’m old – 85 – and in relatively good health despite having Factor V, hypertension, insulin resistant and about 25 pounds overweight, MGUS, and diagnosed in the last couple of years with kidney stones – one nearly 9mm the rest small – and osteoporosis.
I see some specialists for these issues and they often give contrary advice. Dr. Coe, I’m stunned by your grasp of the entire body, never mind your mastery of your field and especially your ability to cut through the confusing underbrush so that dogs and cats can probably benefit from what you have to say.
I am most concerned about the kidney stones, hypertension and osteoporosis. In the past I’ve been able to control my hypertension, which is familial, with lots of exercise but that doesn’t seem to be working anymore. During the pandemic I thought, good chance here to lose the weight, and I lost close to 40 pounds on a keto diet I loved. I’ve been eating low-carb for a very long time but I’m also a food writer, which makes things difficult.
I have a few other issues: mysterious diarrhea that appeared violently and intermittently starting in 2006, diagnosed after unsuccesfully consulting about five top doctors at top university clinics plus a functional medicine doctor of great renown. A PA suspected bile overproduction about a year ago – though gall bladder removal in 1980 produced no such symptoms.
She was right and now I take cholestipol, which means I have to get my important fat-soluble nutrients in early in the day.
I had gout for a while after seriously dieting in the late 80s and was prescribed allopurinol for life, which I refused to take after looking it up. A different doctor told me your uric acid levels always go up after serious dieting and I stopped worrying about it. No more problems…
My kidney stone PA tells me my problem is not enough liquids, now that I’ve reduced the oxalate levels to good levels. Before that, I ate spinach at least twice a week and raspberries as well plus rhubarb and lots of tea and a daily couple of squares of dark chocolate – LOVE my oxalates. I hate drinking anything except tasty things. But I’m at 10 cups and up now, thanks to your site.
I’m longing to return to the strict keto diet but I hesitate to do that. I’m wondering if anything else in my details screams out at you? I have a third Litholink and a CT scan coming up before the end of the year.
Fran
Hi Fran, You do not say what the stones are made of. If uric acid, treatment is certain. If calcium and of recent onset, I would be most concerned about primary hyperparathyroidism, curable and slithy. There is not enough in your note for me to go further. Best, Fred Coe