LISTS – AND LISTS
I know you are all looking for THE list. Here is one from a reliable source I have have downloaded on my site to a separate document so it opens with one click.
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.Fred Coe and I have updates and annotated the list for those with a tendency to perfectionism: Updated table of oxalate foods. Set it at 50% for easier reading. Get yourself acquainted with the lists. They 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 177 high oxalate foods we 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.
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.
LET’S DIVIDE AND CONQUER
FOODS TO WORRY ABOUT
A List of Concerning Foods
We have created two graphs for this article. Of the 177 foods on our master list, many are of concern but can be used in your diet if you control the portion size and how often you use them. There are 30 of them that are worrisome enough to deserve special attention.
Here are the 30. The graph shows mg of oxalate in a common portion. The details of the portions are in the complete list. The foods have in common that all contain at least 40 mg/serving. All other foods for which we have reliable data have less oxalate per serving.
Your budget is about 100 mg/day.
What does this graph mean? Does it mean you can never have chocolate, or a baked potato?
No.
It means if you want to use your whole budget on a treat, do it, but keep track and make sure you do not overspend in any meal or in any one day. Have your baked potato, but maybe share half with your partner. Or, have some hot chocolate but make it with milk because calcium helps reduce oxalate absorption. Eat your cashew nuts, but pay attention to how many. If one handful leads to ten, you cannot have them.
FOODS TO AVOID
The graph to the left is of the very few dangerously high oxalate foods.
There are only six foods, but spinach, being worst of all, has two entries. Be careful of this plot because of its range. It begins at 100 mg/portion and rises to 755 mg/portion in only 7 steps, so the distance from miso soup to spinach is about a 7 fold increase.
Rhubarb and spinach are so high you just cannot eat them. Rice bran is something few will miss, the same for buckwheat groats.
People like almonds but have a hard time controlling portion size. If you can keep it to 11 almonds a day – the portion size that gives 122 mg of oxalate, alright. Otherwise stay away from them.
If you have to eat any of these foods, caution is hardly a strong enough word.
Are you sure you need to eat them?
Why?
WHAT ARE WE SAYING?
We are saying that oxalate is common in foods, and that you have to be careful, but care is a scarce resource. How much care can you give every bite? The graphs say if you eat moderately high oxalate foods – the first graph – be careful.
Watch portions.
If you are eating one of the six dangerously high oxalate foods, stop eating it.
It is too hard to be careful with those six foods. They have too much oxalate for most of you to handle. So, just say no.
WHY BELIEVE OUR DATA?
These data arose from a major effort at the Harvard School of Public Health. A world class expert has curated it twice. Harvard can be wrong and so can Ross Holmes, but both will tend to be wrong less often than the average persons who attempt to put complex data into the public domain. We have always appreciated comments, and if anyone has a peer reviewed publication with different food oxalate levels than ours, we will read the paper and see if it warrants our making a change.
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. 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?
Sure, a list is nice. But we helping you here. Lists can run on to hundreds of foods. The picture is meant for focus. Here are the ones to focus on.
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!
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.
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.
As 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 
people 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 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 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.
For those who need special help, I run an online course: The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.
Are fiber supplements safe for stone formers (like Benefiber, Metemucil, Miralax, etc.). Thank you.
Hi arj,
Yes.
Best, Jill
Hi,
I passed a number of calcium oxalate stones and am restricting dietary oxalates. I know that powdered peanuts are available and wondered if the processing to remove fat and moisture would result in a reduced oxalate content in the product. I read that processing of some foods does change the soluble oxalate content.
Hi Kevin,
Can’t be sure and therefore would not take a chance in using this product or any product that has this ingredient.
Best, Jill
Just passed naturally 4mm Kidney stone, here are the lab results:
CA OXALATE DIHYDRATE 20 %
CA OXALATE MONOHYDR. 70 %
DISCLAIMER: Comment
SIZE Comment mm
CALCIUM PHOSPHATE 10 %
I use to eat those trailmix Costco bags within about 2 weeks. – No More!
Drink less than 12oz water/day – Now try to drink at least 30 oz.
This is a start….any other suggestions?
Note, 63 yr old male with no history or any other family member having this!
Hi Ken, the calcium oxalate monohydrate component suggests that urine oxalate may well be part of the problem, but that is guessing. You should get fully evaluated as to the cause of the stones. Here is a good start. Prevention is planned from what is found as causes. Regards, Fred Coe
Hi Jill. What about protein shakes? Or protein type supplements such a BCAA mix’s? I am a 50 year old male that enjoys weight training and am concerned about not intaking enough protein in my diet. Thank you.
Hi John,
Many of the patients that come to me do so because they were taking in too many protein shakes or supplements. I don’t mind if you have one here or there in a pinch, but it is best to get your protein by food if you can. Even though you weight train, I do too and love it, you do not need extra protein. Read this to calculate your protein needs per day for your weight:https://kidneystonediet.com/how-to-calculate-your-protein-needs/
Best, Jill
Hi Jill, I have allergies to gluten and dairy and corn and soy and canola oil and understand that nuts are not a great choice for people who constantly form kidney stones. Is there a diary substitute available to me. Also, the only bread and pasta substitute I have found that i can eat is made with brown rice and water. Any suggestions for me are greatly appreciated.
Hi Barbara,
Many of my patients do well with unsweetened flax milk to get their calcium needs met. Or coconut milk if they don’t have to worry about saturated fat. Personally, eating pasta and bread here and there and not as a main staple in your diet (meaning like once a week for pasta, and a sandwich a few times a week or toast) is fine. It will have oxalate in it but read this article to help explain how to count up your oxalate: https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Hi Barbara,
Think about joining my course online to figure it all out. It can be complicated and overwhelming to manage when you have food allergies. For dairy, you can try unsweetened flax milk or pea milk called Rippl. Read my safe oxalate list. You can have a few nuts and some seeds. Go here:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
As a 64-year-old male, I follow a vegan diet to lower my cholesterol (successfully). Passed a stone recently (Ca oxalate mono 90%, di 7%, phosphate 3%) with several others in my kidneys though all are below 2.7 mm. Urine oxalate of 62 tested well after I passed the stone and increased my later intake to 80 oz per day. My vegan diet included lots of nuts and beans. Now, I am trying to balance sources of calcium and protein while keeping oxalate low without consuming meat, fish or dairy. This is all new to me and have seen too many conflicting lists online. Do you have recommendations of a list of foods that I can eat to get sufficient calcium and protein while avoiding the dreaded oxalate?
Hi Max,
Use unsweetened flax milk for your calcium if you like. Don’t eat handfuls of nuts anymore. I have a safe oxalate list on my website. Read the article that goes with it so you understand how it differs from the original Harvard list. https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Hi there. Thanks for this article. very informative. Can you tell me more about almonds? Are oxalates only found in the skin, so, therefore, the blanched almond flour is a good choice or no? We eat a low carb diet because my husband has Celiac Sprue 1 and almond flour is a big base for our baking.
Hi Summer,
That almond flour has led many patients to me. Very high in oxalates. Try gluten-free oat flour or coconut flour as a substitute. I help patients continue low carb diets without all the high oxalate foods. Think about joining our online prevention course at kidneystonediet.com. I also moderate a facebook page on the diet as well. The page is called the Kidney Stone Prevention Diet.
Best, Jill
Hi Sandra,
The kidney stone diet would help in all of these medical conditions. Lower sodium, lower sugar, get enough fluids, get calcium and moderate amounts of protein. Think about joining our online course so that I can help you lower your stone risk. Each person is so different and putting a diet together that works for YOU is more than an email can handle! Kidneystonediet.com
Best, Jill
Need to understand I suffer with kidney stones had a lot of surgery please help also suffer with sugar levels are high need help
Hi Caroline, I gather you have stones and diabetes – too much sugar. The diabetes complicates matters and often leads to uric acid stones, but I would start here as an introduction. Regards, Fred Coe
Hello, thank you for your very useful informative website. I don’t (as far as I know) have kidney stones, but I do have massive food intolerances, the main ones are oxalates, fructose, histamine promoting foods, nightshades, and possibly salicylates. Do you think your course might be helpful for me, bearing in mind I am not just intolerant to oxalates? Many thanks
Hi Sue,
The course is specific to kidney stone formers, but perhaps just as important, it teaches you overall healthy eating and what that means for each person based upon their allergies, medical conditions, etc. That being said, with all you have going on and not having stones, I think it might be best for you to speak to a naturopath or other medical professional specifically versed in the myriad of intolerances you are experiencing.
Thanks for writing, Jill
Thank you for all the useful information.
Why does it seem as though some oxalate lists contradict each other? For instance, I love grapefruit. I have seen it on the low lists and on the high lists. Which is right?
Hi Roberta,
Good question and one I answer on a daily basis for patients. Oxalate is very hard to study. Depending upon the growing conditions of the plant, numbers will vary. Dr. Coe and I (and many other health professionals) use the Harvard list bc our patients do lower their urine oxalate using it. Remember though, getting the correct amount of calcium is just as important for lowering your oxalate levels.
Best,Jill
Hi Jill,
Thanks a lot indeed! I have just understood how important this oxalate ‘thing’ really is…
On other websites about oxalate I have read that broth is oké and healthy. But isn’t there a lot of gelatin in broth, or am I mistaken?
Hi Linda,
There have been studies that show that collagen can increase oxalatehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268952/
Bone broth in normal amounts should not be a problem.
Best, Jill
Hi, I’m still struggling with finding a source of fiber that I can stand to eat (anything in the cabbage family gives me awful gas) and I came across this table https://veganhealth.org/calcium-part-3/ that shows Bok Choi oxalate levels of 20mg/half cup shredded boiled and 0mg/1cup shredded raw. I’m really holding out for something green on my plate. I’m also under all the usual cardiac diet restrictions so I have to go very light on meat and dairy.
Help most appreciated and I love your calm and sensible approach.
Thanks
Carol
Hi Carol,
Please stick to one list. We use the Harvard list which you found in the article you wrote from. Our patients stick to one list so they are not confused. There are so many veggies and fibrous fruit that you can enjoy. Bok choy is one of them. Remember to vary your fruits and veggies as a variety is so important to stave off boredom and gain different nutrients. Remember to get your RDA of calcium too to help get rid of oxalate that you consume.
Best, Jill
Please can you tell me if I can eat cooked oat bran? I see on the list that raw oat bran is ok but every day I make and eat oat biscuits that are made with oat flour, rolled oats and oat bran. It is my staple ‘bread’ alternative! Thanks :o) And also, here in Spain we eat roasted chestnuts but I cannot find out if I am allowed to eat these, I love them :o)
Hi Wendy,
Make sure you are getting your calcium intake each day as this is as important as lowering oxalate. Also, you can have oat bran, but be careful. It is always best to eat a variety of foods, not the same source over and over. So depending on how much bread you are eating each day it may or may not be an issue.
Best, Jill
Hi again, please can you explain why white rice is good to eat, but not white rice flour? Thanks :o)
I want to thank you for the list. I do not have stones, at least not yet, but am am breast cancer survivor and know that there is a connection between oxalates and breast changes. It was very hard to find a consistent and complete list; I did read the article and enjoyed it very much and learned from it.
Hi Jill,
This is such a great resource, thank you. Just wondering if pastas made of red lentils, chickpeas, & mung beans are okay? Also, sunflower seed butter? I eat eggs or chicken or turkey or salmon with a big salad for dinner so I prefer to have a lunch with lentils or beans with veggies. I’m also lactose intolerant so I have oatmeal with unsweetened coconut milk & fruit in the morning. I was eating a lot of dark chocolate, almond milk, nuts & spinach before which is how I think I developed the stone. Thank you for your help!
Hi Samina,
I do not have a reliable source on the foods you ask. When this happens I tell my patients this, “have the food once a week in normal portion size and get your RDA of calcium.”
Best, Jill
Hi Jill
I have been keeping my ox count down, drinking 2.5 litres of fluid a day. I’ve cut down on how much I’m eating as Im over weight. I have little sugar and am incorporating fruit and veg into my day, as well as having a salad each evening. I’m drinking 8oz of milk 4 times a day to get my calcium count for the day. My fiber seems low though because my meals are smaller and it seems no matter how much fiber I eat it’s not enough because I have constipation. I didn’t have milk for 20 years and since drinking the milk I’m having bathroom problems. I don’t want to increase my food intake because I’m eating 1200
Calories a day and that is sufficient for me, and healthy. Is there another way to get calcium? I don’t want to take calcium supplements, I do take magnesium though. Can I drink another kind of milk? How do I get more fiber in this diet as I’m kind of at a loss. Thank you
Hi Maureen,
You can try pea milk, or unsweetened flax milk. See if that helps!
Best, Jill
I too see many contradictions. However, a couple of items there seems to be little info on are: hemp products/milk, chia seeds, and avocados. Kindly advise on these. Thank you.
Just noticed a recommendation in the current Consumer Reports to avoid cranberry juice to prevent kidney stones– did not know that was an issue. Any information?
Hi Katherine, If you mean this article, I did not find cranberry juice mentioned. The advice was fine, except the point about reducing meats – they have almost no effect on stone risk. Regards, Fred Coe
I’ve read about how oxalate toxicity can cause many health challenges beyond kidney stones, such as digestive issues, fibromylgia, joint issues, autoimmune challenges etc. What are your thoughts on this? Also, I have an allergy to dairy, can you suggest foods that are high in calcium that are low in oxalates, other than dairy products? Thanks so much!
Hi Andrea, I have noticed comments about oxalate causing problems beyond crystal formation and – to be frank – doubt those claims. Oxalate has no apparent receptors, nor any enzymes to convert it to anything else. Serum levels are 2 – 4 umol/liter so if it were to cause symptoms it would need a specific receptor – chemical level is too low to affect cells directly otherwise. Without desiring to be bold I believe the stuff about oxalate as a disease agent apart from crystal formation is nonsense and ask those who speak about it to publish in reputable peer reviewed journals that establish their claims using standard scientific methods. Fred
I am a76 yr old woman who forms LIVER STONES instead of kidney stones. More precisely, my kidneys and bladder are easily irritated, but I have never passed a kidney stone. Through widely spaced, successive liver cleanses over approximately 20 years, my liver has expelled at least 2;700 stones, some larger, some definitely calcified. In the past few months, over 750 more stones due to repeated bile duct obstruction, and a surprising # of these are large and calcified. (This is only mildly painful due to successive layers of bile coating these stones.) Now I believe this is my bodies response to an extremely high oxylate, spinach and nut based diet, which, ironically, has helped a triple threat to my vision. Bottom line,I suddenly see myself very damaged by oxylate. Please comment and direct me to any research or advice that might be specific to gall bladder/liver stone formers, short of surgery.
Best, Madeline N.
Hi Madeline, If you mean that you are passing biliary stones there is no known role for oxalate. Gallstones are typically cholesterol, bile duct stones often calcium bilirubinate, but oxalate is not a component when analyses are done properly. Here is an excellent and recent review of the subject. Although food oxalate may lead to kidney stones, kidneys remove oxalate so well from blood that levels in blood are exceedingly low and I know of no systemic consequences of oxalate unless either from rare genetic diseases or severe kidney disease. Regards, Fred Coe
Hi Madeline, If you mean that you are passing biliary stones there is no known role for oxalate. Gallstones are typically cholesterol, bile duct stones often calcium bilirubinate, but oxalate is not a component when analyses are done properly. Here is an excellent and recent review of the subject. Although food oxalate may lead to kidney stones, kidneys remove oxalate so well from blood that levels in blood are exceedingly low and I know of no systemic consequences of oxalate unless either from rare genetic diseases or severe kidney disease. Regards, Fred Coe
What about pregnancy and breastfeeding, are those factors for stone formation? Do people ever go back to not being stone formers after they’re done having babies – or is it once a stone former, always at risk?
Hi Kelly, Pregnancy is not a clear risk factor for stones, although urine calcium rises markedly. But when pregnant stones are a special risk. Lactation as well poses high supersaturations but is not known to cause stones. I do not know of data showing that pregnancy reduces stone events, either. The most correct statement is that for a stone former pregnancy is higher in risk for complications and such patients warrant special extra care. Even so, a majority of stone formers have perfectly normal pregnancies and babies. Regards, Fred Coe
One of the studies cited above states that increased animal protein increases stone risk, I believe due to lowering urine pH, despite that increased protein in general does not increase urine oxalate levels – am I correct in that? Yet dairy – an animal protein – is pushed as the best source for food derived calcium. The search to get enough calcium from food that is not animal protein is difficult, and it appears a lot of people feel the same way. I don’t mind some dairy and meat, so I’m not vegan, nor vegetarian, but I also want my intake of these to be minimal. AND I don’t want to take calcium supplements. Is that even possible and meet the DRV??? (and I’m breastfeeding, so my DRV is even higher) As a side note, I read somewhere that Crystal Light is recommended instead of lemon juice (correct?), and I remain confused on this, but might True Lemon brand dried citrus powder packets be as good as Crystal Light for helping prevent stones? THANK YOU FOR ALL YOUR HELP!!! I plan to take your course after I save up for it. 🙂
Hi Kelly,
You can get your calcium from non-dairy sources such as coconut or flax “milk” (unsweetened is best). But cow’s milk does not lower a person’s pH like meats and will not increase your risk for uric acid stones.
Best, Jill
I have oxalate triggered vulvadynia so I follow a low-med oxalate diet and have always known it’s a matter of amount and frequency of consumption of a food that determine a problem starting or not. I take 1,500 mg of calcium citrate throughout the day – to bind to oxalate and I know enough not to take it with magnesium / which can bind to it and prevent it’s binding to oxalate. I too am looking for a list of low / mod oxalate foods that are either high in calcium and/or high in magnesium. I’m low in magnesium and need to supplement that too/because all high magnesium foods are also high oxalate (but I do eat bananas which have some magnesium) and green peas and kale). Still I’d appreciate the lists requested above or where I can find a list. Thanks. Hypnogal
Hi Hypnogal,
You can find the list in the oxalate article here:https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Best, Jill
Where and how can I find a list of all foods and there oxalate level
How can I read a food label and figure out how much oxalate I will get
Thanks Mike
Hi Mike,
Oxalate will never be found on a food label. You can find a list of oxalate food in the article you sent your comment on here:https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Best, Jill
HI,
This is an amazing resource thank you!! Can talk about quinoa? I have not seen anyone talk about the oxalate levels in quinoa. Thank you!!
Eric
Hi Eric,
We don’t have a reliable source for oxalate and quinoa. When that happens I tell my patients to eat the food once a week and in normal portion sizes. Don’t forget to get your daily allowance of calcium. Read about that here:https://kidneystones.uchicago.edu/how-to-eat-a-high-calcium-low-sodium-diet/
Best, Jill
I thought it might help to know that quinoa is in the same botanical family as spinach, beets and chard.
Hi
I came across your site and was interested in what you had to say.I am now rather confused, because your list of foods differs from ,Sally K Norton, she was interviewed by Dr Mercola, about Oxalates . For example, she say’s, you can eat avocado if they are ripe and soft but you put them as being high. Rutabaga,which I know as swede, & turnips, Sally, say’s these are low in oxalates, you seem to be saying they are high. This is just a few differences you have on your list, which is saying the opposite to her.
Sally, say’s all her findings are by scientific testing, which she lists, one of them being by the,Vulvar Pain Foundation.
I now am unsure what is high in oxalates and what is low.
Can you help with this confusion.
Regards
Heather Ungless
Hi Heather, Our list originated at Harvard School of Public Health, and you can find the original lists through this article. We had that list curated by Dr Ross Holmes who is a world authority in oxalate research. We believe the amounts of oxalate per amount of food is reasonably accurate and that published data are in accord with these amounts. The eaten amounts are the product of what is in the food and how much you use as a portion. Frankly only spinach, rhubarb, rice bran and buckwheat groats are so high as to cause notice and put up a red flag. A long second list – also in the article you comment on – has modest amounts of oxalate but portions need not be excessive. Below that level, one simply needs to be sensible. Most important, if diet calcium is adequate – US recommendation is 1000 to 1200 mg/d, and calcium is placed with meals that contain oxalate, urine oxalate will not be very high in most circumstances. Regards, Fred Coe
Please send me a list of high , low and moderate oxalates foods . All if these paragraphs on maybe. Because perhaps are good but I want a list for shipping and consuming . Thank you
Hi Cathy,
Here is your list.https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Hi, so I’m trying a carnivore diet which entirely avoids oxylate. I’m doing this as a test for trying to improve my hypo thyroid condition( non hashimoto). I’m concerned that oxalates might be competing w my iodine or possibly lodging as stones in thyroid though that is pure conjecture on my part. I’m wondering what you think of this approach for kidney stone ( calcium oxylate) formers? My husband has had 3 of them and they were all calcium Oxylate. He is taking calcium citrate per his urologist. I’m wondering if putting him on an all meat and broth diet would w just a few other foods on occasion could just solve the issue. I’m actually quite content eating this way most of the time though I know that sounds surprising as it did to me before I tried it.
Another question though and I can’t find info on this is if kelp and seaweed is high in oxalates? Thanks for any info you have. I’m very curious to hear if other kidney patients have tried this w any luck?
Hi Amely, No data of any calibre would support the idea of oxalate within the body affecting your thyroid gland. As for your husband, the idea is not good. Firstly, do you know if his urine oxalate level is even high enough to raise risk of stones? Second, an all meat diet will provide excessive metabolic precursors for oxalate production by the liver so urine oxalate excretion could rise. Do not do this, as it is likely to cause poor nutrition and will not solve any oxalate problem he has – if he has one. Regards, Fred Coe
What about peeling carrots and potatoes? Is the oxalate concentrated in the peel, or throughout the vegetable? What about pico de gallo or other fresh salsa? What about couscous (which is apparently a wheat pasta produce)? How much couscous would be ok daily (like ½ cup, or 1 whole cup)? What about fresh herbs? How do you feel about low-salt vegetable broth if I buy it? Also, on that theme, what about those white Marcona almonds – I always thought maybe they were peeled – would that make any difference?
Thank you so much!!! What a wonderful website you have written!
Randi
And what about oats, for oatmeal (as breakfast) and in a blueberry/blackberry crumble dessert?
Hi Randi,
My patients eat oats without issue. I would not think peeling anything will help oxalate levels. Any food not on the list should be eaten within moderation. Once a week within normal portion size. Please remember, that even more important than oxalate is getting your calcium needs met. Also on my website is the safe oxalate list which you might find helpful. Read the article that goes with it.https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Can you comment on the high protein drinks & powders like Ensure 350, Isolate, Vega, Nido, & Klim?
My Dad suffers kidney stones but also suffered a tremendous weight loss fighting bladder cancer.
We are using these to increase his daily calorie intake over 3K.
Hi Juan, Given weight loss from cancer, stone issues take a very far back seat. Perhaps his physicians might want to obtain a 24 hour urine to see if the protein has increased his urine calcium or, possibly oxalate – from glycine loading. Even if they do, cancer takes all priorities. If he can tolerate a high fluid intake, his physicians might choose that as some protection. Regards, Fred Coe
Gracias. It does seem that the protein powdered mixes like Nido/Klim, etc. did greatly help in his gaining 19# over the last 3 weeks. Unfortunately a 1.5cm stone became problematic & dropped his kidney function to 30%. He lost the ability to swallow food, went 5 days with no food, & has been fed liquid food & drink via a PEG tube for 3 nights now. I do believe
with 24 hr feedings he is generating at least 2L urine/day. I remind them often to test it via your specifications.
I will ask about calcium content in his feed today.
What I really need from you though is oxlate numbers for these protein drinks.
While they are rich in protein they are also rich in calcium as 1 cup of Nido/Klim is 35% RDA calcium & the rest
are typically 30%. So I’m wondering If that calcium offsets any potential harm from the protein.
Hi Juan, Oxalate production can rise from glycine loads, so it is not absorption from food but liver production that matters. Diet calcium cannot alter this. Regards, Fred Coe
Hello,
Nutritional yeast flakes (not active baking yeast) are often used as a source of B vitamins and other nutrients. Do you know if these contain Oxalates?
Best. Kevin
Hi Kevin, Yeast flakes are not likely to contain important amounts of oxalate, but to be sure – as this is an odd additive – get a 24 hour urine after you begin eating them and see if your urine oxalate has risen. Regards, Fred Coe
Hi Kevin,
I do have many patients use yeast flakes. I like them too. I do not think they have higher oxalate, but do as Dr. Coe suggests. Eat them during your next 24 hour urine collection and see how it effects your urine oxalate. Best, Jill
I’m not sure if my problem is oxalates or the beginning stages of kidney disease, but it looks like the diets recommendations are opposite. What tests should I be looking for?
Hi Roberta, I am not sure either. Do you have stones? Is your measured kidney function below normal? These are independent issues and your physician can distinguish them. If it is stones, oxalate is just one tiny part of prevention. Here is a good overview you might find useful. Regards, Fred Coe
Can you explain the differing oxalate ratings shown between corn meal (high) & corn flour (low)? The information available indicates they are the same material except for particle size.
Thanks!
Hi Nicholas, Confusing names. Corn meal is ground up corn. Corn flour is variably used as the name of either corn starch or finely ground corn meal. So the name is not a good one> I presume the corn flour name in the table refers to corn starch that is devoid of oxalate. But I beg of you to avoid being too compulsive about diet oxalate. Given adequate diet calcium, it is rarely necessary to parse out the finest details of food oxalate. Moreover, urine oxalate is often a minor contributor to stone risk compared to volume, calcium, or citrate. Regards, Fred Coe
Is it not true that any healthy diet containing a reasonable amount of unrefined plant foods will have sufficient calcium without dairy? That said, I have recently had a kidney stone after having spinach, berry, walnut and almond milk (or oat milk) smoothies for over a year. Not sure if related and I did not do a 24 hour urine test. Regardless, I would like to reduce oxalate intake. Instead of introducing dairy into my diet is there a calcium and magnesium supplement that will work? Thank you!
Hi Ira, No, it is not true. Plants can contain a lot of calcium but often not available for absorption. That is the reason that the US diet calls for milk products for calcium. You describe a very high oxalate load, and it may possibly have caused stones. You should not add calcium supplements without urine testing as you do not know what is really the prime cause of your stones. If you have genetic hypercalciuria and add considerable calcium supplement urine calcium might rise and cause more stones, especially if diet sodium is not controlled. Whether or not you find my comment useful, at least discuss the matter with your physicians, so as to reduce the possibility of worsening things. Regards, Fred Coe
I saw on a list that Stevia is high. Is there a guide for other artificial sweeteners for a type II diabetic. we are just learning about this and trying to balance Oxalate and Diabetic. Thanks for any guidance you can share to help others too.
Hi Sherry, Synthetic stevia has no oxalate, stevia from the plant extract has oxalate. Regards, Fred Coe
Thank you Fred for your reply. How do I know what I’m buying – or what brands. I have “Pure Via” and it says it has Stevia Extract, along with dextrose, Reb A. I will research it also, but wondered if you have an easy answer. My husband is the diabetic and I’m trying to “train” him…. not an easy task!!
Hi Sherry,
Any brand is just fine. The plant itself is the problem. Once processed and put on the shelf, no stevia product has oxalate.
Best, Jill
Jill, I’m confused. You say any stevia sweetener is free from oxylates, yet the safe oxylate food list I just downloaded from your website indicates Stevia Sweetner* 1 tsp 42mg.
Hi Charla,
If you notice on that list, there is a disclaimer for the Stevia (it is asterisked). You can have it.
Jill
Hi Charla,
Notice the * next to the Stevia. There is a disclaimer at the bottom of the page on that list explaining that it has no oxalate.
Best, Jill
I began a vegan diet about 6 weeks ago & have seen wonderful effects. I have a horseshoe kidney. I now have stones likely due to the increase of spinach & nut intake. How do you maintain a vegan diet and still lower your oxalate intake?
Hi Sherry SS, I do not think the 6 weeks of Vegan diet caused the stones – too rapid. But vegan diets can impose an oxalate load so you need to be careful. I will ask Jill Harris to add a more detailed answer, as she is the diet expert. Regards, Fred Coe
Hi Sherry,
I work with many, many vegans and help them stay vegan but also minimize stone risk. To learn how come join the kidney stone prevention course. Go to read about it here: kidneystonediet.com. It is the “handful of almonds” and so much spinach that causes the issues. But 6 weeks is much to short to form a stone. Could be you had it and it never caused an issue or moved until recently. That would be my guess. Best, Jill
Hello
I am celiac and dairy intolerant plus avoiding oxalates to try to prevent further stones.
Is there a good source of non dairy milk or gluten free bread oxalate levels?
Is oat milk ok?
Thank you!
Emily
Hi Emily,
There are many non dairy milks that have good calcium. Flax milk, oat milk, coconut milk, pea milk to name a few. Stay away from the nut milks if you have an oxalate issue. I am not worried about the oxalate level of bread unless you are eating a loaf a day (which I know you are not). Read this article from my website on how to use the oxalate list:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
So I recently started a low oxalate diet as my Oxalates were “off the charts” . I’ve kinda replaced chocolate now with grapes and am eating a lot of grapes, is that OK? I have CKD and also had Gastric Bypass Surgery 18 years ago and need to make sure I eat enough calories and do not lose any more weight.
Hi Ira,
Grapes are pretty high in sugar, so when you say “a lot of grapes” I worry. Are there other fruits you can eat that at least have some fiber in them to help with the sugar issues? Please make sure you are getting calcium too so you can rid yourself of excess oxalate.
Best, Jill
I had my first kidney stone when I was 35 1/2 weeks pregnant and was told that it formed due to “metabolic changes of pregnancy”! Over the last 15 years I have had numerous stones. My 16 year old daughter began showing signs of a kidney stone on Thanksgiving Day. She has not passed it yet so it hasn’t been tested (the doctor thinks it is still in her bladder). The doctor wants us both to be on a low oxolate diet. We have to be gluten and dairy free due to celiac disease and food allergies. A lot of gluten free cooking uses brown rice flour, does brown rice flour have a lot of oxalate? Also, how can we get enough calcium? Are there good calcium supplements? This is all a bit overwhelming to add to our already limited diet. Thanks for any help you can give me.
Hi Amy,
Have you both done urine collections to see if your oxalate is indeed high? There are other reasons you might be forming stones.
Let me know- Jill
how about blueberry, strawberry fruit compote? if I heat the fruit over the stove would this cause higher oxalate content?
Hi Kimya,
You can eat the compote, but heating it will not cause issues. Just have this here and there. Neither of these fruits is high in oxalate.
Best, Jill
I just got out of the hospital this is my 5 th bout with kidney stones . They are calcium stones . I had a 24 hour urine study two years ago. Everything was in normal range except citrate.Was prescribed citrate for my stones unfortunately my insurance will not cover it anymore. $360.00 a month is a lot. I eat healthy apparently that’s a problem . I’m so confused and afraid to eat . The list I received for the low oxilate diet is crazy. Help! My dr is suggesting I drink like a gallon of lemonade every 4 days plus my normal water I drink every day.
Hi Debbie,
I am sorry you are going through a tough time right now. Think about taking our course. You can learn about it here: kidneystonediet.com or come join my facebook page that will help if you like: kidney stone prevention diet (on fb). We use the Harvard list but most importantly, getting your calcium is needed. You can eat many healthy foods, you just can’t eat lots of high oxalate food like almond and spinach. Read about HOW TO USE your list and all the safe oxalate foods here:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Hi Debbie, Things are getting confused and you are not getting ideal prevention. I see where my partner Jill Harris answered you and I agree with her. But as well, there is a basic medical issue here. Normal ranges are not a good estimate of stone risk, but rather legal limits on lab reports. You do not say if the stones are calcium oxalate or phosphate. Here is an article that introduces proper stone prevention. Take a look and see how it is done. Diet change with Jill may well be ideal. Here is another deeper article that gives an idea of what you might expect from your physician. Regards, Fred Coe
Hi Jill. Your list has avocados as being high in oxalate. There are several sites that list/state them as “low” in oxalate. Please advise. Thank you.
Hi Joyce,
Glad your wrote this question. I get it a lot. And this is exactly why I made the “safe oxalate list” derived from the Harvard list. Go here to read the article and get the list that gives you all the safe foods you can eat. The problem with the original Harvard list is that they label foods “high, medium, or low” when in fact foods that they say are “high” ARE NOT. Like avocados. Read this article to understand what I am trying to write:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Thank you!
The link you included to your own web site about coffee says “There is no doubt that coffee can contain considerable oxalate.” and cites an NIH study. Do you have a source for your claim here that coffee is almost oxalate-free?
Hi Moses, Thanks for the careful note. The link is to a page saying that coffer can have oxalate and the article concerns Polish brewed coffee as an example. But it also points out that in the massive cohort studies by Curhan et all drinking coffee as a habit was associated with a substantial reduction of stone risk. So coffee has oxalate but coffee drinkers have a lower risk of stone forming. Regards, Fred Coe
High quality organic instant coffee ( German, powdered) is in my opinion, very high in Oxalates. Trouble. I moved to organic French press long time ago.
Thanks, Marinko. Fred
Dr. Coe,
When does someone throw in the towel on trying this low oxalate diet?
I’ve been following it for a few years now, and I still am producing mixed calcium oxalate and phosphate stones.
I’ve also been limiting my sodium and drinking at least 4L water a day.
Quite honestly, I’m not sure I ever really needed to follow it. I’ve had four separate 24-hr urine tests over the last three years and the only thing that is high is the calcium on every single test. When testing I’ve always have had oxalate containing foods to see if it would increase my levels, and three out of four times the levels of oxalate in my urine were too low to even calculate. One test was higher, but still within normal range, because I had quite a bit of peanuts.
I really feel at the end of my rope here and my doctor is not providing much guidance.
Hi Jim, You are a sensible person. One attends to diet oxalate when urine oxalate is above the risk level >25 mg/d both sexes and stones are calcium oxalate. The main approach is to increase diet calcium taking care to use the calcium with meals that may contain oxalate, The low diet sodium is to lower urine calcium despite the higher calcium intake. Some people are remarkably sensitive to diet oxalate, or cannot or will not eat sufficient calcium or times it to oxalate containing meals, and for them more care is needed. Thanks for the comment! Regards, Fred
Hello,
First off, thank you for taking the time to do all of this.
I’m curious; has the Harvard list actually been updated, as in food being re-tested or is this just changes regarding portion sizes? I do know that the person testing for the original list was Dr. Michael Liebman from the University of Wyoming. I don’t know of anybody else who has tested food other than him. However, it gets confusing because there’s so much discrepancy between websites and even medical authorities regarding levels of oxalate in foods. For example, the VP (investigate at your own risk) Foundation has a list as well of foods tested by Dr. Liebman, however this list greatly conflicts your list. Turnips (just one example) high on your list…low on theirs, but same tester? Low Oxalate Groups (via Yahoo), while not exactly Harvard, does point back to the original testing of Dr. Liebman, but their list wildly differs from yours and from Harvard’s. And even Harvard says that there really is no established daily oxalate limit and to only limit foods containing more than 75mg per 100g. See article “The kidney stone diet: Not as restrictive as you may think”.
Again, I want to absolutely commend you for all your work into oxalate and kidney stone research, however, who to believe?
It might also be helpful to one day condense your body of information. I find that there are too many separate pages regarding kidney stone info for both the University of Chicago and your own personal site. All pages seem to have comments (thank you for allowing btw), but info can get lost or repeated among all this and I’m sure you get tired of answering the same questions as well.
Hi Jason, What I did was ask Ross Holmes, a working scientist who is an accepted authority on food oxalate, to curate the Harvard list as it appears on this site. He knows Dr Liebman, although I do not. A PubMed search: ‘Liebman m AND oxalate’ yielded 13 papers, from 1992 to 2015, all rather specific to either probiotics or special food types. Divergences as you describe them are hard to resolve as he has not published comparisons in peer reviewed journals so we do not have his original lab data to compare to those data he presumably obtained many years ago and under other circumstances. None of this is criticism, just the business of getting science data into some semblance of use in practice. Frankly, to me, minor amounts of food oxalate are of minor consequence if diet calcium is high – as the US food recommendations recommend, about 1000 mg /d or more. I have written about this in several articles. With such a high calcium diet, managing food oxalate should not require too detailed a parsing of food contents – the worst offenders are in the large and bold second graph in this article. As for the sites, I did not know the UC had another kidney stone site, as this is not mine but a UC site I created and run as a professor of that school. Perhaps the Urology department has one, but I did not know. If you mean that this site is already way too big, I agree, but it grew over the past 4 years and I have not had the time to redo it and condense articles. Warm regards and thanks for the thoughtful comments, Fred
I’m completely new to this but have stumbled upon it because, recently having had a CT scan to check my pancreas (found to be OK), small stones were seen in my kidneys, (the largest one 3cm). 18 months ago, I found I had higher than normal blood sugar, despite being very slim, with a low BMI. I immediately went on to a very low carb diet which had no effect whatever on my HbA1c hence the CT scan. But guess what – my move to a low carb diet had taken me to eating a lot of nuts, avocados, green salad (including spinach), berries and 85% dark chocolate plus other items on this list so all of this is bad news for me (except that I eat a lot of calcium in the form of milk, yogurt, kefir and cheese). I’m twixt a rock and a hard place – stones or diabetes or such a restricted diet no-one else can ever cook for me! I don’t know what types of stones these are and am unlikely to find out but I speak to the GP about the test results in a week or so,
Hi Carol, I am not sure that your story evolved as you hypothesized. The stones may have been present before the new diet – especially one so large as 3 cm! -, and oxalate may have nothing to do with them. Here are some thoughts you might want to share with your physicians. Firstly, she/he can measure the radiographic density of your stones on the CT scan – conventional measurement; low values speak for uric acid, higher ones for calcium based. If a stone is really 3 cm (not mm) that should be very easy. Your physicians know these numbers. Second I would think 24 hour and serum testing are appropriate to see what is wrong with your urine chemistries. Third, your blood glucose confuses me. Did it suddenly rise? Were you diabetic? Are you young or early middle age – speaking for unusual forms of diabetes. Is your HbA1c really high? Some stone patients with hypercalciuria have elevated blood glucose levels and not not diabetic. See if any of this interests your physicians. Regards, Fred Coe
Oh so curious here and learnt something. About 3 -4 years ago at the age of 56 – 57 I went through 6 months of having 3 kidney stone attacks. So the hospital said, but no stone was ever released or found, in face I dont think they did anything to fine one. The also didn’t tell me what sort of stones etc, only that I would suffer for the rest of my life (the nurse wheeling me for a scan said he had 19 attacks already – What The?)
Anyway, I wasn’t going to suffer again, so did a lot of research and changed diet etc, did keto then found my back right side was aching cos i was eating a lot of greens (spinach) so reduced. Anyway, havent had an attack since, occasionally find i get an ache but could be when i play with bad sugary food, and doing a 9 day liver detox at the moment so lots of greens, spinach of course and had no problems. I used to think it was oxolate, and partially still do so am aware, and know calcium helps it to go straight through, but not counting anything, watching what I eat.. eating everything good for a liver…. (this is not the apple juice, olive oil epson salts detox)
Everything has been okay. Should I still have that urine oxolate test? Is it too late to tell me if I am in that quota of oxolate be aware group??? Don;t want to ever go through that again, but eating a lot of plant base is working for me right now
thanks for any advice.
sery
Forgot to mention also, I don’t do milk, cheese is limited due to aluminium content in normal chedder slices etc.. usually eat Gouda cheese, yoghurt seems to be a required taste.. what other things can i take in high doses if I need to? As i have learnt a calcium supplement on its own doesn’t work. I do take magnesium regularly. thanks for the information
Hi Sery, I think anyone who has had stones should be tested, and here is a proper list of what one is best doing – so far as we know at this time. Oxalate is one of a number of measurements of use. The link is to a chapter introducing the topic, and has links to all of the rest of what you would want to know. Regards, Fred Coe
I started drinking Spring water some years ago because there
were questions about the purity of the tap water in my area. During treatment for herniated discs, some time ago it was discovered that I had numerous calcium deposits in various organs including my kidneys seen on mri. This past summer I experienced n/ v & excoriating
pain in right flank and was hospitalized with kidney infection &obstructed rt ureter. A stent was placed for month then removed. Was calcium seen earlier on x- ray cause or minerals fr spring water consumption?
Hi June, Your physicians can easily tell if the calcifications seen earlier were stones. But MRI does not show stones reliably, so in that sense I suspect they will tell you they do not know if there were stones. Having formed a stone, you should have it analysed to find out what the crystals in it are, and have yourself evaluated for cause. Regards, Fred Coe
I have been told to use a low oxalate diet by my urologist after a large stone was removed and a 24 hour urine test. I have large amounts of calcium in my urine and a high amount of oxalate in my urine. I am dairy free, not by choice! So many solutions revolve around using dairy with other foods. Not a solution for me. I am confused by the oxalates need for calcium to bind together and leave my body. Seems I have the calcium present in abundance, but no bonding. Weight gain is beginning to be an issue. Osteopenia is present. Confusion and frustration are at issue.
Hi Doris, It is a confusing matter, but in reality very straightforward. No doubt you have either idiopathic hypercalciuria – if your serum calcium is normal – or primary hyperparathyroidism if it is high. Your low calcium diet leaves no calcium to bind diet oxalate so any in food enters the body and can leave mostly via the kidneys. So you have little calcium in your bowel for binding oxalate and a lot of calcium in your urine, and the latter is in significant part arising from bone mineral loss. That is why you have osteopenia. The correct approach is a very low diet sodium, to keep calcium out of the urine, and ample diet calcium – from dairy products or – if needed – supplements timed with your larger meals that might contain oxalate. If you cannot manage low enough diet sodium, a thiazide diuretic will work, lowering urine calcium. Here is the strategy. Of course, your physicians are entirely responsible for your care, so I would suggest sharing these comments with them to see if they are in agreement. If not, always follow the advice of your physicians or seek another opinion. Regards, Fred Coe