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.
My husband had a kidney stone 35 years ago and then just a few weeks ago another one. He changed his diet recently because of prostate cancer, trying to become a full on vegan thus increasing – you named it – spinach, beets, nuts and tofu….and then the second kidney stone. What recommendations do you have for vegans – where to get that food based calcium and protein without nuts and soy. Thanks so much.
Hi Joyce, It may be as you say or otherwise. Is the stone calcium oxalate? In later life it could be uric acid, altogether different. If he has not passed it his physician can measure its CT density. 24 hour urine studies are important because the assumption that food oxalate caused the stone may be wrong. As for diary products, I know of no data anywhere showing that they contribute to cancer risk, and absent dairy it is very hard to maintain bone health. Regards, Fred Coe
What do I do if I can’t eat dairy? I have a casein intolerance.
Hi Becci,
Plenty of non dairy sources of calcium. Go to my blog to read about it: kidneystonediet.com/blog
j
Hi,
I have never passed a stone but I have 4mm and 8mm stones in both kidneys. In my attempt to ensure they don’t grow, I started drinking more water and taking magnesium citrate, Vit B6 and apple cider vinegar as supplements ( based on my physician’s recommendation ). Also drinking lemonade twice and cut back on tea and chocolate. After about a month, My first 24 hour urine numbers are all in the normal range (oxalate 34, citrate 663, calcium 125, ) but urine ph was High (6.765). Should I be concerned with the high PH given other numbers in in range ? I have read that high PH can contribute to Calcium Phosphate stones. If my high urine pH can lead to these stones , should I make other dietary changes and/or scale back on any supplements I am taking ?
24 Urine results
Vol24 2.91
SSCaOx 2.15
Ca 24 125
Ox 24 34
Cit 24 663
SSCaP 0.75
pH 6.765
SS UA 0.11
UA24 0.737
Na24 116
K24 116
Mg24 145
P24 0.876
CR24 1709
-Sunny N
Hi Sunny, I suspect the pH is high because of alkali from the lemonade and cider but you have high levels of urine citrate which is protective. SS with respect to calcium phosphate (SSCaP) is <1 so there is no obvious risk there. I wonder why you formed stones given these values. Perhaps things were different in the past when the stones formed. Regards, Fred Coe
Thank you Dr Fred for the response. Things might have been different in the past as I was drinking less water and consuming enough nuts and dark chocolate . I have given up on those and added 2L of water a day.
Do you still think it makes sense to go back on the old diet and repeat the 24 hour test to see if I can find the root cause of what might have caused my stones ?
I am determined to not have a stone again and would do anything to make the ones in my kidneys from growing bigger . I have read digestive issues can contribute to stones. How can I be sure that is not the case here ? Any other testes you recommend that I should ask my physician about ?
Hi Sunny, It depends on how much curiosity you have vs. the effort and expense. The information you sent showed a low stone risk on that one urine sample. Whatever your GI tract was doing that day the urine stone risk was low. If I were you I might repeat the 24 hour urine in a while to see if results stay so benign, but I would stay on the diet used for the first one. Ask your physician what she/he thinks. Regards, Fred Coe
Hi,
Thank you for all the great info. It’s been tough to choose what to eat as part of my current kidney stone analysis. What types of food should I avoid for prevention?
My 24 hour urine sample results below. It’s high for calcium urine, uric acid urine, and brushite
Component
Latest Ref Rng & Units
3/10/2022
Total Urine Volume
>2.00 L/day
2.55
pH, Urine
6.7
Calcium Urine
418 (H)
Oxalate Urine
29
Uric Acid Urine
737 (H)
CITRATE URINE
619
Sodium Urine
102
Sulfate Urine
12
Phosphorus Urine
515
Magnesium Urine
150
Ammonium Urine
29
Potassium Urine
33
CREATININE URINE
1,504
Calcium Oxalate
1.93
Brushite
3.11 (H)
Sodium Urate
1.06
Struvite
2.50
Uric Acid
0.29
The Patient Has:
Hypercalciuria Hyperuricosuria
Supersaturation Index With Respect To:
Brushite (Ca phosphate)
Suspected Problem Is:
Hypercalciuric Nephrolithiasis Hyperuricosuric Nephrolithiasis
Hi Carlos, Oxalate is certainly not your problem. You have very high urine calcium. If your blood calcium is absolutely normal (below 10 mg/dl fasting in the morning) it is presumably idiopathic (genetic) in origin You already have a rather low urine sodium so the very high urine calcium is perhaps complex in origin. Your physicians should consider possible specific causes and measure your serum 1,25D and PTH as well as calcium – preferably in the same fasting am sample. Your urine is alkaline, too, which may reflect a high intake of fruits and veggies – healthy – or reflect other systemic issues for your physician to consider. I have too little to go on to say much more. Regards, Fred Coe
Hi, I would love to get some direction. A little background 29yo female, bilateral kidney stones, biggest one 4mm left kidney, pre-diabetic (A1c 5.7) , IBS-d, high stone forming genes (both parents have kidney stones) recently turned vegan to try to prevent further stones and improve overall health. After reading your post I am now greatly concerned and confused as to what should I do next with regards to my diet and medical steps.
My recent 24hr urine LithoLink stone study exam findings:
Stone Risk Factors /Cystine Screening:
Vol 24 – 2.01
SS CaOx – 7.24
Ca 24 — 265
Ox 24 – 31
Cit 24— 461
SS CaP—2.45
pH 6.590
SS UA – 0.16
UA 24 – 0.517
DATE SAMPLE Serum
Calcium – 9.9
Phosphorus – 3.9
Creatine- 0.76
eGFR – 109
Cr Clearance — 123
Uric Acid – 4.4
Mg – 2.2
Na – 141
K – 4.2
CO2- 28
Cl- 104
Interpretation Of Laboratory Results (also worried about this my urologist is referring me to a Nephrologist + Endocrinologist)
Hypercalciuria. Exclude hypercalcemia, Vit D excess, sarcoidosis, hyperthyroidism and malignant neoplasm.
Mild hypocitraturia. If this is the only metabolic defect consider treatment with potassium citrate 20 to 60meq per day in 2 to 3 doses. If pH is above 6.3 monitor SS CaP, hypercalciuria may need to be treated to avoid
CaP stones. Hypokalemia can cause hypocitraturia.
High urine pH. High urine pH can promote calcium phosphate stones. When coupled with low urine citrateconsider distal renal tubular acidosis. When using alkali supplements (citrate or bicarbonate) manage urinevolume and urine calcium to maintain SS CaP less than 2.0.
Moderate CaOx stone risk. If stones are calcium oxalate and actively forming, manage urine volume, calciumand oxalate to lower SS below 4.
High CaP stone risk. If stones contain >15% calcium phosphate and are actively forming, manage volume andcalcium to lower SS below 1.2.
Hi Natalie, Oxalate is not your problem, it is your high urine calcium. With such an alkaline urine (pH 6.59, common in young women) calcium phosphate may be a main part of your stone. I would consider the kidney stone diet as a first move and see what happens with your urine calcium. Regards, Fred Coe
I have been told by my physician to eat a low oxalate diet. I have researched and searched and am really confused. One list will have this food as being high in oxalate and another list will not. After the searching I have done, I am wondering now if my problem is just simply not getting enough calcium. I have always been told to avoid calcium due to the calcium/oxalate stones that I produce. The latest 24 urine was completed in 2018. Results are listed below. My liquid intake has improved since this study. My potassium citrate was increased another 10 meg.
Urine volume .63
SS CaOx 13.95
Urine Calcuim 127
Urine Oxalate 21
Urine Citrate 198
SS CaP 2.42
24 hr Urine Ph 6.019
SS Uric Acid .99
Urine Uric Acid .324
Any guidance would be appreciated.
Hi K Cabe
Not getting enough calcium through food sources will increase kidney stone risk and bone disease risk. We stick with the Harvard oxalate list bc we trust the researchers. I have guided my patients with that list for decades and it has proven to be accurate. BUT/ It is all the other advice that goes with the oxalate list like what to do if Harvard didn’t study it. Go to my website to find out what we do in that case or my YouTube channel which you can also find on my site: kidneystonediet.com/start
Is it possible for a 55-yr old male runner (running 35-40 miles a week) with a tendency to form calcium stones to maintain a vegan diet? In other words, a vegan kidney stone diet that still supplies the electrolytes lost through exercise, as well as proteins for recovery. Nuts used to be a key source of nutrition for me, but now with stones I am not sure what to do about the diet. Currently my diet includes natural protein supplements like Orgain Simple (which is also nut-based). I also feel my diet is lacking enough potassium.
Hi Cyba,
I have many patients that are vegans. They all lower their stone risk once they are educated. Here is my website to get all your free resources! kidneystonediet.com/start
Jill
Hi there,
I live in Toronto, Canada and am 38 years old. Been a type 1 diabetic since I was 25. For the past month I started experiencing tingling in my feet and lower legs and fluid build up around my ankles. My arms also tingle and itch. Those are my only symptoms. But it’s constant. I got my blood work done and it showed that creatinine urine was high at 29.7 mmol. The normal range says it will be between 2.0 – 20.0 mmol.
Given my symptoms and the high creatinine level, what does this mean? Is this the first stage of kidney disease and do I need to be on a low oxalate diet?
Thank you kindly,
Casey
Hi Casey, Urine creatinine does not measure kidney function. Serum creatinine does this. From your symptoms one might expect diabetes is affecting your kidneys. I am sure your physicians have already informed you if that were true. The fluid around your ankles suggests abnormal protein loss in your urine. Unfortunately this site is not aimed at renal disease per se. Oxalate would have no immediate bearing on diabetic renal disease. Regards, Fred Coe
Hello,
Thank you for all the great work you do at this website.
I would like to know, please, the amount of oxalate in Hungry Jack Mash Potatoes. (Or any brand of instant potatoes.)
On another topic, what’s the formula for the amount of reduction in oxalates in the boiling of white or Russet potatoes?
Thank you,
Michael
Hi Michael,
Get your Harvard oxalate from my website to find out about levels. Mashed potatoes are higher, but you can certainly fit them into your diet within moderation.
kidneystonediet.com/start
jill
Thank you very much for your reply, Jill.
Hi,
See under fruit section says:
“On the other hand, people do not realize avocado, oranges, dates, and even grapefruit and kiwi are very high and need caution.”
But the later…
“Here are some juices that are low in oxalate and better substitutes: Apple juice, apricot juice, orange juice, grapefruit juice, grape juice.”
Is the juice of a high Oxalate fruit lower?
Hi Chad, “Is the juice of a high Oxalate fruit lower?” is hard to answer because you did not say in regard to what. Can you rephrase it?? Fred
Thank you for such an informative and helpful article! It is really terrific and I am very grateful to you.
I do not suffer from kidney stones. I have been diagnosed with Lichen Sclerosus, and one recommended lifestyle change is to eat a low oxalate diet. Your charts and your explanations are very helpful. Thank you so much.
Jeri Massi
Great info,thx. Have a question, is wheat pasta better than regular white pasta when it comes to kidney stone prevention?
Hi Becca, I do not believe there is any major difference between them. Regards, Fred Coe
Excellent info. Many thanks for sharing. I went overboard trying to transition to a healthiet mediterannean diet. I started earing more spinach and nuts to fit my macros and ensure adequate calorie intake. Nor suprsingly, I landed in the emergency department with so much pain, only to have a CTA scan reveal I had a kidney stone. That was the first time ever I had fathered a kidney stone. When the attending physician told me I needed to increase my fluid intake, I was surprised as I was already consuming on average so much water, on average 18 to 24 plus glasses of water. I was literally p*ssing like a race horse from consuming a lot of water. I followed up with my physician to insist on a referral to a urologist to get a 24 hour urine test to try and get at the root of why I formed this stone. I suspect it was a calcium oxylate form that materialized in the absence of a dietary calcium deficiency combined with a maasive increase in high oxylate foods. Since finding Jill’s articles and site, I have learned so much and am using that info to modify my diet until I see the urologist for a 24 hour urine test. Last thing I want to do is land in the hospital due to the unbearable pain of giving birth to a second kidney stine monster. And talking about food lists, I cannot seem to find anything anywhere about oxylate amount if white rice crackers. I recently bought these on to snack on in moderation. 1 serving of 14 crackers contain 130 calories, 2 grams fat, 0.6 as saturated, 25 grams carbs, 2 grams protein, 150 mg sodium, 30mg potassium, and 0.4 grams iron. Ingredients list only: Organic rice, Sunflower Oil, and Sea Salt.
Is this safe to incorporate into a low oxylate diet? Many thanks
Hi John, Your problem is with the lag in testing. You are right and need 24 hour urines (2) and bloods with them to get at the cause of your stones. I would not assume diet did it, that may be right but is no basis for prevention. The stone needs to be analyzed. From that and the urine and blood tests one can figure out the cause and get you a rational treatment program. IN the meantime, I would argue against any major changes in diet as one can cause other problems. Regards, Fred Coe
I have just completed surgery in both right and left kidney. The stage horn in my left had been there a good while. I’m left with only 1/2 of that kidney.
The right kidney had a group of hard stones.
Your information is so needed. I was afraid to put anything in my mouth 😂
I’m trying hard to come up with a plan, but it is really difficult. Is there a site where I can find suggested menus. Maybe you even have some.
It be most appreciated.
Thank you again .
Sincerely,
Charlotte
Hi Charlotte, I would not jump to the idea that diet caused your large stone and that diet is sufficient to prevent more. You need a full evaluation to find the cause and treatment directed there. Here is my best effort at how to go about all this. Once you have your stone analysis and lab studies, I would be happy to take a look on the site. I would not make large changes in diet in advance of the proper studies. Regards, Fred Coe
I thought coffee depletes calcium from your bones. I was just diagnosed with osteoporosis, and have to watch both my calcium, sodium and oxylates. Any suggestions? Thank you.
Hi Donna,
It does but a very small amount. Salt depletes much more so have a cup or two of coffee per day. Get your calcium needs met. Lower added sugar and sodium to the kidney stone guidelines which can be found here: kidneystonediet.com/start
j
Thanks Dr. Coe. Appreciate all you do!
Thanks very much for the work put into these lists and suggestions. I am a fairly new Kidney Stone producer aged 73 and in good general health. I have a question that I have been unable to find any data on.
I take one tablespoon of whole husk Psyllium a day to keep my stools regular and easier to pass. I started this about a year ago. Being that this is plant based, is there any concern about Oxalate content?
Hi David, Metamucil, which is made from this plant has no oxalate. Perhaps that is a fair answer. Fred
What about soy sauce? I lost 70 lbs largely because of my epiphanous discovery of the joys of cooking Chinese food. The typical serving size is 1 tbsp but I’d say a typical serving of one of my dishes clocks in under 1 tsp (sometimes as little as 1/2 tsp). I would find it amazing to learn that half a globe’s worth of cuisine is off limits because of soy sauce. What do stone formers in Asia do if they can’t have soy sauce?
Hi Steve,
With soy sauce, the bigger problem is with the high sodium content. Not so much the oxalate. You are eating a low portion of it, and that matters. The kidney stone diet is all about portions. You can have many higher oxalate foods if you eat within regular portion sizes and get your daily calcium needs met. Get the lower sodium soy sauce if you are not already. Great work on your weight loss, as it too is a precursor for stone disease!
Jill
Another question: if tomato sauce is in a dish with cheese (calcium) such as manicotti (stuffed with ricotta and covered in mozzarella) would that mitigate risk? ALSO: my urologist said I could take some extra-strength Tums with a high oxalate meal and it would bind to the oxalate and the oxalate would be passed instead of being absorbed, thus reducing risk. Is this true?
Hi Steve,
We know that Tums can increase stone risk. There are plenty of different ways to get calcium. And you only need 1000 mg/day as a man so a couple glasses of dairy or non dairy milk will get you where you need to be. Make sure to get the Harvard list and HOW to use it from my website. You certainly can eat your pasta. kidneystonediet.com/start
Jill
Your dedication is unmatched. Thank you so much! I have questions about the oxalate content of corn. Most lists say that corn on the cob and corn flakes are low, but corn grits and cornmeal are high. You also say above that corn chips, popcorn, and corn flour are low and that grits are high. What is the reason for the difference? Also, is there any difference between yellow corn and white corn, or between nixtamalized corn (hominy grits, masa harina) and non-nixtamalized (regular grits, polenta)? I miss cornbread as a side and grits for breakfast, so I’m hoping to find out which type of corn and method has the lowest oxalate content.
Hi Joe,
Cornmeal is high because of its concentration. But. You can certainly incorporate cornbread into your diet. This is a portion game and also getting your calcium each day is very important. Go get your Harvard list from my website and also learn how to use it so you can see you can eat way more than you think. kidneystonediet.com/start
jill
Hello, thank you for explaining the intricacies of navigating a low oxalate diet. I do have a concern. I am either allergic to dairy or lactose intolerant. Which one is the case i’m not 100% certain. Basically, I can’t digest dairy properly. How do I balance this out, and what alternatives could I use to replace dairy?
Monica
Hi Monica,
My site’s blog has the latest research on non dairy ways to get your calcium needs met. Kidneystonediet.com/blog
Jill
Hi, what about stevia as a sweetener in coffee? I am confused because I thought it was ok was processed. I use a packet of organic stevia in my coffee every morning. which is .8g of stevia according to the packet. ALso, I thought hummus was bad because it has tahini in it. Is hummus ok or is it high in oxalate?
thank you
Hi Ellen,
You see, we asterisked stevia to show that while the plant itself is high, once processed, there is no oxalate. One can have hummus. Just eat all foods (except spinach and almonds) within portion size. Most important is to get your calcium needs met each day as this lower urine oxalate. Also, go to my start page so you can get all your tools and oxalate list0 including the safe oxalate list: kidneystonediet.com/start
Jill
Hi there, this info has been quite helpful as my daughter has been found to be incredible oxalate sensitive as far as neuro and GI reactions go, not so much stone formation. My question is – I have read that taking a calcium supplement with meals can help bind the oxalates (even if eating low levels) and remove them from the system. Is this true? And if so, which type of calcium is best to supplement? Her calcium level has been consistently on the very low end, if not the last last number before the cut off of “normal range”, so if not using as a binder, it may be helpful for supplementation anyway. Thanks!
Hi Amanda, In general the normal 1000 to 1200 mg of calcium from foods will lower diet oxalate absorption. Food calcium is the right thing. But I must say I have found little support for the theory that oxalate causes systemic reactions apart from stones (excepting the rate over production states). Regards, Fred Coe
I would just like to add my input here. At only 40 years old, I have 29% function on one kidney, and 80% on the other. I have my entire adult life lived “healthy” with lots of whole grains, beans, and TONS of fruits and vegs, and nuts. Lots of daily exercise. And of course, dairy free (as that is supposed to be healthy). I have also Endo stage 4, which basically exploded when I switched to a high veg diet. No kidney stones, just poor kidneys.
My diet was also VERY high in oxalate.
After stopping all oxalate and eating very low, the pain I started getting in my “good” kidney has disappeared, but, also, my brain fog is getting better, my dry skin is improving, my chronic back pain is gone, the “sand” i had in my joints is gone, the muscle stiffness is gone. And it’s only been 3 months.
I have pretty much eaten white rice, white bread, chicken, a bit of meat, cheese, cornflakes and milk/yoghurt. And the occational banana.
I don’t know about my kidneys or endo, I guess time will tell. But I am quite chocked to have discovered that so many ailments I never thought could be tied to oxalate, has gotten better by basically living on gluten and dairy.
Science doesn’t prove, or disprove everything or anything. It merely looks at an overview of a group of people, not individuals. If an ailment cannot be stasticially proven in a study (and this depends on which formula is being used), it doesn’t mean individuals are affected. And that I think is the biggest flaw in science.
Hi Liz, You are not alone in concerns that diet oxalate can have systemic effects. And I am a scientist as well as physician so I take science for what it is and can achieve. A reasonable way to view the problem you raise would be to say you and not a few others favor the statement that diet oxalate causes kidney pain and brain fog. That is not an unreasonable thing to say, but how does one test its validity? In this case it is not to study a group in general but to study those who have the problem and ask if one can test effects of diet oxalate on a subjective item like perceived pain or brain fog. It is possible via a double blind trial of foods with and without added oxalate, for example. Perhaps that is worthwhile, and if so one could imagine organizing it and getting NIH to fund it. So science is not the limitation, it is the initiatives of scientists who might want to undertake what may indeed be a significant issue. In your case, I would suggest it is possible that diet oxalate mostly removed by one kidney may be causing crystal formation which is painful and also not easily detected unless the urine is studied for crystals. Regards, Fred Coe
I use himalyian pink salt. Is it forbidden also? I have several foods being taken away from me because of all my issues. So I would like to be able to put this salt on my food. Bland is hard to eat. I am also High in Salicylates and their list is not herbs and spices. Just mainly salt for seasoning.
Hi Lynn,
For kidney stone formers it is recommended you keep your sodium between 1,500-2,000. You may use salt, just watch the portion.
Jill
Could powdered collagen protein be contributing to my calcium oxylate stone formation?
Hi Patricia, Indeed. Collagen contains abundant hydroxyproline which is metabolized to glycols which convert to oxalate, so you are best advised to stop using the powder. Of course, 24 hour kidney stone testing is also important as it may not be oxalate or the collagen that has promoted your stones. Regards, Fred Coe
Thanks so much for this article. I can’t describe how miserable I’ve felt reading other, more ominously presented information (at times inaccurate, misleading, or downright foolish), or how relieved I was while reading your much more thoughtful and sensible assessments.
Virtually every oxalate table I’ve seen lists “baked potato with skin.” How about *without* the skin? Or peeled & boiled? Similarly, many articles mention raw carrots but not cooked, which has gotta be at least as common. Any insight there? Thanks again for such an encouraging discussion.
Hi Mark,
We ask patients not to be too overwhelmed by the oxalate part of this diet. Most people simply ate foods super high in oxalates like spinach and almond products without getting their calcium needs met each day. You can have a potato here and there, with or without skin. Just get your calcium needs met and don’t over eat them. Read more about the oxalate food list here: kidneystonediet.com/start
j
I have a horseshoe kidney with 100 percent calcium oxalate stones. I went to Mayo in Jacksonville to get a lipotripsy. The dr. could only get small part of the stones. She said it is tortuous to try it again I have put myself on a low oxalate diet. What do I do now?
Hi Janice, I suspect Dr Wolber was your urologist. She has a good training and professional background. I would ask her about prevention of more stones. There are a number of nephrologists on staff at Mayo Jacksonville, so perhaps she might want to send you to one. Here is my view about how to evaluate for causes and pursue prevention. Perhaps she or others there might share similar views to this one. I would presume that given the complex anatomy prevention would be a high priority, especially for Mayo physicians who are rather an elite group. Regards, Fred Coe
Thank you!
Hello,
What is your take on consuming fish oil (omega3) as a daily supplement ? Do they inhibit or cause kidney stones to grow/form ? Also I have borderline high cholesterol and my PCP recommend statins which I have been trying to avoid and rather incorporate lifestyle changes. Recently I came across articles suggesting statins can inhibit kidney stones.
Given that I have a 9mm kidney stone , I am now feeling more inclined towards statin therapy. What are your thoughts ?
https://www.goldjournal.net/article/S0090-4295(18)30083-9/fulltext
Hi Rajan, It is not an unconvincing article, and thanks for it. Since your physicians favor a statin anyway, perhaps this is an additional benefit. Pure empiricism can identify causal candidates (came before stones, could prevent stones in this case). I may well do a new site article on this topic as it intrigues me. Best, Fred
Thank you for all your research on oxalate.
I don’t think I have kidney stones. But I was experiencing a flare up of arthritis
pain in my hip. So I began thinking about what I had been eat a lot of lately. And it was canned greens, avocados and nuts (especially almonds). Thinking that I was eating something healthy. So I began looking up what they contained. And began to find out that they all contain high amounts of oxalates.
So I appreciate your information on oxalates.
I thought I might mention, they friend of mine that lived in Las Vegas often would have kidney stones. The doctor told her if she would eat five cherries a day it would prevent the crystals in her urine from developing into kidney stones.
I drink about 2-3 oz. of unsweetened tart cherry juice not from concentrate each day. And about the same amount of unsweetened cranberry juice not from concentrate per day.
Hi Cornelia, I wonder at the not uncommon information that oxalate causes systemic problems in people with normal kidney function. Blood levels are extremely low and more or less indifferent to diet because kidneys are so efficient at oxalate removal. I do not believe any serious evidence favors an oxalate – arthritis link. As for cherries and stones, the physician seems to know something I have never read about. I do not believe any serious science connects cherries to stone prevention.
Wow – I do seem negative, and apologize for so seeming. But I do science, read science, and depend on it for everything I do. Here is my paean to science, the engine of modernity. Regards, Fred
Thanks for this informative and detailed article. One question:
How is it okay to have 122mg of oxalate in the form of almonds if the budget for the whole day is 100mg? Did I miss something?
Hi Dawn, Almonds are among the worst of all, and I see nothing good about them for stone formers. Frankly, I do not have stones and fear almonds enough that I avoid them – like spinach. Regards, Fred Coe
One more Q: If cornmeal has twice the oxalate content, by the list at the top of this article, as cashews and french fries, how are corn chips an okay substitute for potato chips? Aren’t corn chips made from cornmeal? Does turning the cornmeal into corn flour remove oxalates? -Would especially love to know if corn tortillas are okay. -will avoid corn chips due to the salt and fat.
Thanks for any clarification.
Hi Dawn,
Corn not corn meal is what corn chips are made of. But like you said, other reasons to limit these snacks, not just the oxalate.
j
I am a “mostly vegan” who, after having a big stone removed last year, takes a “calcium chaser” with each meal, consuming all of the following three products daily:
1. 1 Cup Unsweetened Coconut Silk (460mg calcium)
2. 1 Cup Unsweetened Good Karma Flaxmilk (310mg calcium)
3. 3/4 Cup Unsweetened So Delicious Coconutmilk Yogurt Alternative (390mg calcium)
Vegans need to be told first thing about oxalates. I never heard of oxalates until I researched kidney stones. We are encouraged to consume lots of spinach and almonds. Check out Liam Hemsworth’s painful kidney stone surgery story in Men’s Health where he stated: “Every morning, I was having five handfuls of spinach and then almond milk, almond butter, and also some vegan protein in a smoothie,” he said. He chose to stop being a vegan, but I think I’ve found a way around it. What do you think about my solution?
Hi Lane, I do not know. Coconut Silk, flaxmilk etc sound great but what are their oxalate contents? As a stone former you need to insist your physicians be sure to make a complete evaluation of cause, which will tell your – among many other more important matters – your 24 hour oxalate loss (which must balance your net oxalate absorption from food). I would do it eating as you say, and it will disclose everything you want to know. Prevention without 24 hour urine measurements is sailing without a map or compass. Best, Fred Coe
From your oxalate lists it says triscuits are very low oxalate but spoon size shredded wheat is very high. They both are whole grain wheat for ingredients so why the difference in oxalate amount. It would be about the same serving if you had 6 lower sodium triscuits or a cup or under of the shredded wheat. Thank you-
Hi sb, These lists are from measurements on the products as made and sold. Differences arise during manufacturing, and are nigh impossible to identify. Regards, Fred Coe
Thank you so much for this information, I initially thought I would not be able to eat any food again but thanks to you. The thing is my breathing sometimes changes whenever I take milk, do I still continue?
Hi Funke, oxalate matters but do not let it distract you from other stone risk factors that may well matter a lot more. Be sure you have been evaluated fully, and that prevention focuses on what is really causing your stones – very often it is NOT oxalate. Regards, Fred Coe
Hello — Thank you for this excellent article! My partner was diagnosed with genetic predisposition calcium oxalate kidney stones at 27 (he is now 32). Because of the complexity of this condition, he has to watch oxalate content as well as purines and sodium. I am trying to compare the content in a number of common foods, so the lists you have provided are helpful. I was wondering if the Harvard group or others have standardized the measure of oxalate content to some common measure (like per 100g or some standard mass) as well as the servings that are indicated? Thanks!
Hi Michelle, I know of no genetic predisposition that fits your partner apart from the general familial nature of stones, and idiopathic hypercalciuria. Neither concerns itself with purines or oxalate. I suspect his physician offered a set of diet guidelines not unlike those promulgated on this site but possibly too overarching. The key is the 24 hour urine and serum studies. If they point to high urine and normal serum calcium, then reduced diet sodium is valuable. If urine oxalate is high, then higher diet calcium will help provided sodium is controlled to keep urine calcium from rising. All that is in this article.An excessive attention to oxalate can lead to pointless restrictions and miss the main problems present, so take a look at this article on the basic evaluation. The lists on the site are per portions that are given there. Regards, Fred Coe
Does the British Medical Association still recommend vitamin B to reduce or prevent Kidney Stones?
Thank you
Hi Bob, On Google I found no evidence one way or another. Here is an off topic massive review of all studies of vitamins etc for heart disease and cancer mainly of use here as a clue to the extreme difficulties of showing a benefit or not in healthy populations for smaller gauge diseases like kidney stones. Even with these big diseases it is hard to be sure, but mainly results are negative. Here is a review about a wide range of supplements in stone disease which points out the problem of small studies and uncertain conclusions. Best, Fred Coe
What would be the best low oxalate food options (especially veggies & fruits) that is also ok for diabetic people? Thanks for the help, Doc!
Hi Layla, Given the complexities of diabetic diets I would opt to eliminate the main high oxalate foods (large graph of 7 main culprits) in the article. A better answer is to be sure you have been properly evaluated for causes of stones, so prevention can focus on what is actually wrong. It is often not oxalate. Diabetics frequently form uric acid stones that have nothing to do with oxalate and can be cured. Regards, Fred Coe
Other sources report completely diferent results: https://e-cnr.org/ViewImage.php?Type=TH&aid=487614&id=T9&afn=9994_CNR_4_3_137&fn=cnr-4-137-i009_9994CNR
What is your opinion about the big differences ?
Hi CT, Oxalate lists have variability. I put up the Harvard list because it was well done, and before his retirement a noted oxalate expert vetted it. Even so I am sure for any given food one might fine divergent results for oxalate content depending on the food origin and perhaps degree of ripeness. Oxalate is used by plants as an energy store unlike in humans for whom it is an end product of metabolism with no apparent purpose of its own. I do emphasize that the top 10 or so oxalate foods are agreed upon and that given a proper calcium intake food oxalate need not become an object of excessive anxiety. So variations among the lower oxalate foods has little bearing on stone prevention – to my mind. Regards, Fred Coe
Some of the vegetables contain also big amounts of calcium, which may link with a part of the oxalate content during digestion. It could be possible that these vegetables to have smaller excretion ratios for oxalate in urine than other vegetables with less oxalate but also smaller amounts of calcium ?
Hi Daniel, In fact this is very clear thinking. Calcium may be abundant and not available from the food. That is one reason why so much of diet calcium must from from dairy. Best, Fred Coe
Hello. And thanks for all the great information. I’m vegetarian. You mentioned that tofu and veggie burgers were high in oxalates. I was wondering what you think about some of the other vegetarian proteins. Specifically ones that are gluten-based and also a relatively new one made from pea protein.
Best Regards.
Hi Joe,
Honestly, I am more concerned with the sodium in these products, have them once a week or so. Make them fit into your kidney stone diet goals (found here: kidneystonediet.com/resource-list).
Hope that helps-
Jill
Have been dealing with kidney stones for many years, cutting certain things out of my diet entirely, while dialing down the intake of others. Still having to go in for SWL every so often. Really getting tired of it…
First time I have been to this site in a while. Looking much better now than previous. Data emphasis and inclusion has changed: Why is Swiss Chard no longer on any bad lists? I seem to remember that it’s oxalate numbers made it practically radioactive.
Thanks & Regards,
Mike
Hi Mike, If stones keep coming, have you been evaluated completely? Here is a good summary. The problem may ne other than oxalate – that is usually the case – so you may not be attacking the real causes. I am glad the site looks better, it is a solo act, no help and no money, so it never has been glamorous. Fred
Super helpful article, and sure appreciate your responsiveness to questions. I have one that I’m running into difficulties in researching on my own: Several articles refer to collard greens as a vegetable that has low bioavailability of its oxalates, but there was no real data presented. I have a little ‘forest’ of tree collards and would really like to know. I passed a kidney stone two years ago, but don’t know what kind it was. Can you direct me to a resource on the bioavailability issue? Thank you kindly!
Hi Annely,
So many foods don’t have any real data. For the past 24 years, I have been working with people, I have not had one follow up report that came back with high oxalate (unless the patient had malabsorption issues). What am I saying? That once you take away spinach and almond products, you can eat most foods, just get your calcium each day and eat food within portion size. You can go to my YouTube channel https://www.youtube.com/watch?v=x15qBiHzwOc to hear more about what to do if there are no studies on food you might like to eat. But I will tell you that this advice has never steered one of my patients wrong! Have your collard greens within portion size and eat calcium-containing food or drink with it. You will be just fine.
Jill
Thank-you for this helpful information. I eat a gluten free diet to help control acid reflux and inflammation. I have noticed brown rice syrup and brown rice flour listed as ingredients on granola bars, crackers etc.., although towards the end of the ingredient list. Are they safe to eat occasionally?
Hi Marie,
I am known around town for this motto: “Portion not perfection.” You can eat pretty much all foods if you eat normal amounts, get your calcium each day, and stay away from spinach and almond products. Go to kidneystonediet.com for more!
jill
Hello Jill,
I have watched a few of your videos. You’re great! The problem I’m having is that I can’t seem to eat enough and my weight has dropped 15 pounds in a few weeks! I love the way I look, but trying to live with 50 mg. of oxalate per day will keep driving my weight down. After I eat a tablespoon of hummus, I drink fat-free milk. Oh, by the way, I have calcium oxalate stones and have had numerous lithotripsy “surgeries.” This diet is insane. For breakfast I have Cheerios and blueberries with milk and a few walnut pieces. For lunch I may have a rice cake with a tablespoon of peanut butter and 1/2 teaspoon of strawberry jelly. I will eat an apple during the day and chopped salad for dinner with chick peas.My calorie intake is nill. How the hell am I supposed to live on such a diet??? Thanks.
Jeff, I am just beginning to learn about oxalates, but as for calories, A few years back I learned to eat only bananas during the day, and a salad to get nutrients in the evening. A semi-professional athlete was my guide along with The 80/10/10 Diet by his coach.
I no longer eat all raw food, but I still eat around eight or ten nam wah bananas a day (I live in Thailand) along with healthy vegetarian food, now adjusted for no spinach. I stay thin as a result, but I initially had to ramp up my intake because I was disappearing.
Stop drinking fat-free milk. Why are you drinking fat free milk if you want to gain weight? Studies show fat is healthy for the brain. You need fat, healthy fats. Don’t listen to anything fat free. That is old news that hurts the brain and brings on early dementia . Stay away from hummus, chickpeas, walnuts and peanut butter. Oxalates. Eat pecans. Also stop eating cheerios! They have absolutely no nutrition and are high carb. They will make you hungry. Try oat bran in the morning with ground flax, banana, pecans & some blueberries. Top it off with some half n half or full fat milk. Mid morning have a yogurt (look for low sugar) full fat. Calcium reduces chance of stones. Calcium helps prevent colon cancer too. Eat cheese! Cheddar, etc. I had a kidney stone history. And I haven’t had them in years now, I drink spring water. Take Magnesium citrate and they won’t form. 400 mg daily. I hope I have helped you. Btw, you need to get some chicken, fish and grass fed meat in your diet. I’m not sure why you are on this deprivation diet? Start eating 🙂
Jill,
I forgot to mention that I also eat bananas. Nothing feels filling. I also drink 96 oz of water per day. Thanks again.
Hi Jeff.
Why are you restricting your oxalate to only 50? Have you had a bariatric surgery or suffer from other malabsorption issues? Oxalate is so little of the problem once one stops eating spinach and almonds all day long. I have been educating patients on this diet successfully for 24 years. It is NOT as restrictive as you think. Watch this video from my YouTube channel for more detailed info on oxalate and weight loss.https://www.youtube.com/watch?v=DE9xyHh1tyg&t=512s
Jill
Thank you, Jill.
I’m just playing it safe, and I’ve seen your video – it’s great! It’s all just a bit depressing keeping track of everything that goes in my mouth. I do appreciate your help!
Give yourself a break. EAT DAIRY! You are getting very little protein! Are you vegan?
Hi, I’ve had kidney stones off and on since 1979 when I got food poisoning on our honeymoon. I ended up in the ER yet again mid October. I have been straining tribe since and was told the 6 mm stone was near passing. My urologist and my cardiologist are at odds. I was on a keto diet since 1/1/22 at the recommendation of my cardiologist due to being about 50 pounds overweight (5’6” tall and was 195). I lost 30 pounds so far and then got stones. I didn’t even think that the high animal protein could be at fault like my urologist thinks. The cardiologist says that new data debunks this myth and that I should rather watch my oxalates and salt. I had a CT scan yesterday to see where I am with stones as the ER said I have the one 6 mm stone I was trying to pass in my right kidney near the bend of the ureter, but, also a 2 mm sitting in my left kidney. I’m also taking Stone Breaker that I began two days after ER. Since taking it, there’s been no pain. Urologist said that will do nothing for stone but, won’t hurt to take it. I love potatoes in all forms and was eating a lot of them, as well as, nuts for the Keto. My question is, I’m a little confused in that some food is high like oranges but then orange juice is ok? Is it the preparation of food that makes it bad? I’ve never been told or even had measured the oxalates in my urine. They just tell me if it’s concentrated or has blood in it. Is this something routinely done? Is this creatine levels?
Hi Mindi, I gather stones are not a new thing but more of an on and off thing as though you have some predilection to form them and actually do form them when stressed – dehydration from food poisoning and perhaps an odd diet. Since there are several in play it seems time t find out why you do this. Here is my best take on an evaluation plan and what it points to. Guessing about diet oxalate never works – you need to know if urine oxalate is your problem, and it is usually not the main one. So right now you are wandering in a sea of bafflement because the causes of your stones are not known – do a complete evaluation and see what comes next. REeards, Fred Coe
Having had many kidney stones over the years this is my advice. Get a yearly ultrasound for stones. Immediately make an appointment for lithotripcy for your stone. It’s pretty painless. A 6 mm stone is going to hurt. I ask for a lithotripcy for any stone. My urologist says there is no issue having this procedure. Stone breaker will do nothing.
Mindi,
As your urologist to request a 24-hour urine test be sent to you. This is a good starting point.
I haven’t eaten spinach, almonds, or rhubarb for years, and also stopped peanut butter three years ago. Last month a 13mm stone was seen in ct after blood in my urine. Had nephrostomy tube for over a month to drain swollen kidney, stone was zapped Monday. Lab said it was calcium oxalate. I had been eating Greek yogurt with walnuts, string cheese with sunflower seeds, lots of broccoli, cabbage, and cauliflower, and drinking lots of flax milk. Also canned salmon, egg whites, and some ketogenic bread made from sprouted wheat berries. Now I’m trying to figure out where I went wrong and what to eat. I am not overweight but am slightly prediabetic. I don’t want any more kidney stones.
Hi Wendy, Although stones are calcium oxalate, quite possibly oxalate per se has no important role in their cause and there is another treatable problem not so far detected. Here is a good place to orient oneself about a full evaluation, and perhaps it will lead you to better treatment. Regards, Fred Coe
Hi Dennis, I would not be so extreme. But the kidney stone diet was designed (by Jill Harris and I) around a full evaluation. For example, some people have no reason for diet oxalate management, some no need for sodium or calcium changes, etc. So I would certainly advocate for people evaluation as to cause. Regards, Fred Coe
Sounds like your doing everything right. By any chance do you drink well water. My well water was the main culprit. I now only drink store bought spring water. Although I still stick to a low oxalate diet.
Wendy, have you had a 24 hour urine test? A urologist can order one.
In August, I was in the hospital with several stones in my left kidney. I had to have a nephrostomy tube for two months because of a blocked kidney. Had a lithotripsy at the end of October with a stent. When the stent came out, I told the doctor I didn’t want another emergency of being rushed to the hospital. I also had sepsis and a urinary tract infection.
In January, I will be having an ultrasound and x-rays along with doing a 24-hour urine test so the urologist and his team can monitor my making more stones.
The bread may be doing you a disservice! Wheat berries are super high in oxalate.
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Hello and Happy Holidays, Jill!
If I eat one tablespoon of peanut butter, how much non-fat milk would you recommend I drink right after? I think I’ve been drinking too much with three “gulps.
Many thanks as always!
Hi Jeff, Honestly for so little a helping one gulp or even none would do. It is all in amounts, isn’t it? Regards, Fred
Thank you, Doc!
I would like to add fresh ginger to my diet to help with sinus issues. How much fresh ginger would be too much a day?
Hi Dee,
Ginger pills are high in oxalate. Adding a tiny bit of FRESH ginger to your food shouldn’t be a problem. It has NOT been studied, but again, portion not perfection. Getting your calcium needs met will help with all oxalate issues. Go to kidneystonediet.com/resource-list to learn more.
Jill
Thank you, Jill!
If I feel a kidney stone attack coming on,what fluid should I drink excessively to try to pass it? Lemon juice? Beer? Thank you
Hi Michael, Water is best. Lemon juice in high volume is not very palatable, beer is not advisable. Regards, Fred Coe
Question what’s the best water to drink if you have an oxalate ossue
Hi Kay.
Dr. Coe and I just drink tap. There is more to it than just water. Make sure you know where to start: kidneystonediet.com/resource-list
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