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.
Hi Dr. Coe,
I am 27 years old and have passed 10 kidney stones already and 1 of them was an 8mm Calcium Oxalate stone. I somewhat understand what I need to eat and what I should not eat. I feel like on a calcium oxalate diet I am gaining weight when I am actually trying to loose weight since I also have Gullstones and my weight gain is just making it more painful. I have considered getting the stones removed from my Gullbladder. With that said… How can I not gain weight in taking all the dairy and carbs. Also, my urologist told me to minimize protein in take except for maybe fish here and there and when I do eat protein to drink excessive water. I drink about 2-3Liters of water a day. Also, the past 10 stones have been within 9 years. I guess the low carb dieting is what caused all the stones. Now I just would like to know, which carbs would be okay for me to have yet less of a problem for gaining weight. This is just such a struggle. Is there any specific diets I can refer to and look at? I have many different low oxalate cook books and some of them say don’t eat this and some say you should eat it. Is there a list of foods that you recommend to eat? Also, should I basically eat dairy with all my meals to avoid the building of calcium stones? Thanks in advance.
This is also for Dr. Jill Harris, sorry didn’t mention it in the beginning. Anyone’s help would be great
Hi Christina, I am sure Jill will answer you. Be sure about what is wrong in your urine tests. Is your urine oxalate high enough to be producing risk? Are there other factors in the urine that are also a problem. Here is an organized approach. High calcium low sodium diet is the basic diet for stone prevention, and protein intake should more or less simply follow WHO and US government recommendations. I leave the rest to Jill. Regards, Fred Coe
Hi Christina-
I am sorry you are suffering with not only kidney stones, but gallstones as well. As Dr. Coe has stated- make sure you do need to be on a low oxalate diet. Did you complete a urine collection? If not, you may be pulling your hair out for no reason concerning the oxalate. Only way to know if your oxalate is high is to complete a 24 hour urine collection.
As for the carbs, eat less. Many people are very good at eating healthy foods, they are just eating too big a portion. So are there carbs you can eat without gaining weight? Sure. Eat whole grain- (look at the ingredients) low sugar, high fiber, whole grains. Yes, they will be high in oxalate. Eat them with a glass of lower fat milk or low salt cheese and you will be ok.
I watch people look at the bread basket when it comes to the table as if the server has just laid down a weapon of mass destruction. As with all “diets” too much or too little of something will create problems going forward. So how do you stop gaining weight? You eat less. Eat healthy whole grains, veggies, fruits, dairy, and lean meats. I wish it were more complicated than this but it isn’t.
We all know what is healthy or not healthy to eat (pretty much). The problem is we lack discipline, not knowledge. It is difficult to constantly shy away from your favorite foods. This is why I suggest that you don’t. More days than not, do not eat more than a couple of slices of good whole grain bread (for lunch), step away from the cookie jar, don’t go near the mac and cheese offered on the menu.
MORE DAYS THAN NOT. NOT NEVER!!! When we deprive ourselves of foods we love, we wind up not being able to keep that deprivation up. There is a difference between discipline and deprivation. When you don’t eat a piece of bread for 3 months, guess what you keep craving? BREAD. It doesn’t work.
Eat a healthy diet rich in whole grains, veggies, fruits, lean meats, and dairy. Once in a while you have a bit of a sweet, and on special occasions of course you will eat cake. When you do, do not fret. Just pick a healthier choice next meal.
As we go on in Dr. Coe’s site, more discussion will be given on how to implement diet and lifestyle changes. I don’t mean to be glib, I know it is hard, but it is very doable.
Let me know if I can be of more help and thank you for sharing your story-
Jill
P.S. Keep up the great work on drinking water!
I’m confused. If yams are at the bottom of the list, why avoid them?
Hi Maria, I will let Jill answer this one. Regards, Fred Coe
Hi Maria,
The level or position of the food is not indicative of the high or low value. They are high and to be eaten here and there in lower portions and perhaps with a glass of low fat milk if you can tolerate it.
Thanks for writing-
Jill
I am 77 yrs old, had my first kidney stone 10 yrs ago, 9mm!
In the last two years, I have had
4 attacks and 4 lypotripsies! Did the 24 hr test, examined everything I was eating, etc. I had to eliminate all the nuts except pistachio and macadamia, as well as the no-no’s like spinach, rubarb, etc. I take 500 mg/day of calcium citrate and milk in my cereal (Nature’s Path organic Pumpkin Flax Granola). Eat tuna/cheese/cranberry sandwich for lunch on homemade bread ( 3 cups w, 1 cup ww) and dinner is usually something other than beef or pasta. Doctor told me to include lemon juice with my liquid intake, which is the first thing I do when I get up. Having said all of this, I think was has kept me stone free is that I eliminated all the various health pills that contained artificial vitamin C. Read article about research in Sweden on 25,000+
men (re artificial C) and found that most of the kidney stones where in the group taking the artificial C! I follow the “oxalate”
diet, also.
Hi Barrie, Thanks for sharing your experience. Regards, Fred Coe
I am 56 year old woman and had my first stone 3 years ago. Had uteroscopy and lithotripsy and doctor NEVER told me about stone prevention. Learned about metabolic testing on my own and am currently waiting for results. ALL urologists should be educating patients on stone prevention. Luckily, I have now found a PA who gets it. Question is: I have gone dairy free due to stomach issues. How do I get the calcium I need? Perhaps dairy free Ben and Jerry’s is looking good despite the price!!!!
Hi Lauren, We have tried to find a good list of high calcium low sodium foods and here is our best. You need both because the low sodium will keep the urine calcium from rising overly and the high calcium will greatly lower urine oxalate. But I sense a lack of a complete program in your notes, so take a look here and be sure you cover all the bases – to use a baseball metaphor. Regards, Fred Coe
Hi Lauren,
It is very hard to get enough calcium when you are lactose intolerant. I am also lactose intolerant so I personally know how hard it is to accomplish this task. Ben and Jerry’s non-dairy ice cream is excellent for people who cannot tolerate dairy products, but be careful, it is made with almond milk so can be very high in oxalate. It has not been studied, but I trust that it is high.
Try using coconut milk to help support your calcium needs along with coconut yoghurt. Look at the links Dr. Coe wrote about as well. If you need more help, we are here-
Jill
I am so relieved to find your article, today. My husband has been having a lot of issues with his liver, kidney stones, gout, and arthritis. He goes to several different doctors and finally has woken up to the fact that he needs to take the bull by the horns and change his diet. So, last month we both changed to a low purine (for gout) and low carb diet. We are both losing weight, and he hasn’t complained of any ache or pain since. He went to the kidney doctor today who told him that he has lost 10 pounds and more importantly his kidneys look better and no kidney stones.
But, the doctor told him to stay away from brightly colored foods, like spinach and strawberries. I couldn’t figure out what he meant and was feeling very discouraged. I admit I cried. After all, we thought we were doing so good on our low carb diet. Almost everything we eat now is brightly colored! So I turned to the internet and found your article. Now I understand. The doctor must want him to stay away from foods that are high in oxalates. I printed out the full list and added it to my growing binder of things to know for this new adventure my husband and I are on of eating healthier. I no longer feel discouraged. Now, I am just annoyed at that doctor for telling him something so irresponsible. “Stay away from brightly colored foods.” Really??? (Years ago my husband gave up on understanding what it meant to be on a low carb diet because of not getting good information from the doctor and nutritionist.) Now, because of your article, we won’t be discouraged, we won’t give up, and we will be able to easily change our new diet to include low oxalate too. We are more determined than ever to continue to eat healthy foods!
Thank you so much!
Hi Marion, A reduced oxalate diet is only relevant in someone who maked calcium oxalate stones. I would have thought your husband made uric acid stones from the story. Also, it matters when urine oxalate is at least above the low end of normal. So be sure he has had a proper evaluation = here is a good overview. Regards, Fred Coe
Hi Marion,
I am so glad you wrote to us. Has he done a 24 hour urine collection and has your husband had his stone analyzed? I agree with Dr. Coe, with all the other symptoms, you want to make sure it is oxalate that he has to be careful of.
Even if your husband is supposed to lower his oxalate, as you can see by the list, there are still plenty of colorful veggies and fruits he can eat. Making sure he has enough calcium in his diet will also help, even negate higher oxalate foods.
Thanks for writing to us and sharing your story. It gives us real pleasure and gives others real motivation to keeping on the road to good health.
Keep us posted on everything-
Jill
This is a long overdue note. I want you to know that your sound advice and words of encouragement helped so much. My husband, Larry, did have the uric acid type of stones. So, we stayed on our low carb diet. We have both been steadily losing weight and feel more energetic. But, most importantly, Larry’s health is dramatically improved. He has not had any more stones and the kidney doctor says his kidneys are fine. Larry, has not had a gout episode since starting the diet, and his other health issues are improved requiring less medication.
I honestly feel that this diet change saved Larry’s life. And would like folks to know that whatever you need to do for your health, whether it is to go low oxalate, go low carb, give up gluten, whatever it is, just do it. Just pick a weekend and throw out everything you shouldn’t be eating, go to the store and buy the ingredients for the things you should eat. The hardest part for us was adjusting/replacing the meals we had eaten all the time with new meals. Once we had done that the day to day diet became easy.
Your kind words and information helped us to understand and get a better diagnosis and to not give up on our dietary changes that were so very important to my husband. Thank you!
Hello. Questions. On the list of foods,spaghetti is listed as high, but mac n cheese is low. Is the spaghetti made with tomato sauce and the mac with cheese? What about plain pasta made with semolina flour? Should/could food manufactures include oxylate content like they do for sodium,fat etc? Also found this list: http://www.denvernephrology.com/wp-content/uploads/2012/12/Oxalate2008.pdf
Thanks
Hi Patrick-
Unfortunately food manufactures will not be adding oxalate content anytime soon. It is just too hard to measure in every food and it varies depending upon the very many factors needed for each plant to grow. Soil, sunlight, etc effect the oxalate content.
I would assume that all pastas being measured would NOT have the sauce on them already, but the mac and cheese would. Pasta noodles in general are high. Eat them with a glass of low fat milk, and in smaller quantities and you can eat it here and there.
Hope this helps-
Jill
Ok thanks for the quick reply. I’m Italian and having pasta withdrawals! I just have to cut way back.
I am Italian too, and feel your pain in cutting way back. But it will help.
Jill
Thank you both for a very informative presentation and the Q&A follow-up. I am a 67 year old male who has had recurring calcium oxalate kidney stones for the past 25 plus years. I was told by both of the Urologists who have provided me with care to drink at least 8-12 ounce glasses of water (or more) per day. Typically, I drink in excess of two (2) gallons of water each and every day. I add fresh squeezed lemon juice to each glass I drink. At one time I had a vrry nice vegetable garden…then was told to pass on growing/eating the fresh leafy veggies, etc. Long story short: I stopped eating almost all of the high content oxalate foods (moderate consumption of some on rare occasions). My digestive system has suffered from the lack of fiber/roughage and, though fewer in numbers, my kidney stiones have grown larger quicker. Prior to the change in diet, stone production averaged 3 or 4 stones 2-4mm every 2 years or so. For the past 4 years, I have averaged one (1) large stone (10-12mm) per kidney every 12-18 months. Suggestions on diet change/supplements/additions? Thank you!
Hi William-
I am happy to hear that your stones are less frequent. I am unhappy to hear they are large. I am also unhappy to hear about your fiber intake.
Please look at the list again, and notice all the fruits and veggies you can eat. Spinach is the biggest no-no, but after that not too many others. Nuts too can be eaten in small quantities. If you can tolerate yoghurt put some nuts or berries on top and the calcium in the yoghurt will help absorb extra oxalate.
I would rather you be more diligent with your salt intake (1,500mg/day and calcium intake, 1000mg/day) then avoiding all roughage bc of oxalate. Does that make sense?
Thanks for writing us. Hopefully you have done a 24 hour urine collection and you know for sure that you have high oxalate. Let us know-
Jill
I had bilio-pancreatic bariatric surgery with duodinal switch about 13 years ago. I am also lactose intolerant. I have lost over 170 pounds by sticky to a low carb diet. My stones started about 5 years ago. The results of my last 24 hr. urine test shows Urine oxalate at 121 mg/day and Urine citrate 289. How do I work with both diets? I went to a dietian who simply looked at me and said she had no idea how to combine the diets. Now what do I do?
Dear Holly,
Congrats on the weight loss. That was a very big surgery you had and as you well know can have side effects with malabsorption issues. This is most likely the reason for your high urine oxalate and low citrate levels. Not everyone in the nutrition field has studied the problem of kidney stones, so I am not surprised by your experience. That being said, this situation is complex and you would benefit from direct help. If you would like to email me at jharris1019@gmail.com, I would be happy to advise you about how best to obtain such help. Very Best, Jill
I have had stones for the past 6 years. Surgeries twice to three times each year, even ruined my honeymoon with a 5mm stone stuck. They always get stuck!!! My questions are I have the calcium oxalate stones and some of the things they are telling me not to eat it seems you are saying its ok. The eggs, coffee, strawberry’s. I just want to know what will truly help me. If I cant get rid of the stones completely how do I get them to not get so big so quickly to where I can pass them on my own. I have never been able to. Seem they go from 0 to 100 in seconds in size. I have tried the water intake of 2 liters or more a day, the changing of the diet, the low carb way. I honestly have gained since this all started and just want some true honest answers that we cant seem to get from a doc. Like the gentleman above I also went to a dietician and they had no idea how to help and only wanted me to pay to join their weight loss program. Its very frustrating to go to doctors and specialist and get no where. Any help or advice would be greatly appreciated.
Angie
Hi Angie,
I hear the frustration through your well written words. I am sorry to hear your story, but so glad you told it. Please read THE Kidney Stone Diet on the site. It will help you. It is also the way we should all be eating to remain healthy (except not worrying about the oxalate and drinking sooo much water- this is specific for stone formers).
We feel Dr. Ross Holme’s list is the best for oxalate content of foods, and we use it in the article you read. I have found my private clients like a list that contains only the OK oxalate foods. This proves to be less confusing to them. I am happy to give it to you, but it is long so please write me at jharris1019@gmail.com if you think you might like it. You can also find it at my private Facebook group- THE kidney stone diet. I have just started it and people go there to ask about diets regarding calcium oxalate stones. If you would like to join please do so. I moderate it to keep it clinically sound.
I will tell you this. Please drink enough water to produce at least 2.5 liters of urine a day. Also have you done a 24 hour urine collection? Let me know. It is the very first step in stone prevention.
Your friend,
Jill
I am confused about regular lemonade = high oxalate
Diet lemonade = low oxalate
What about fresh homemade lemon aid with sugar substitutes
Or squeezed lemon on food ?
I am confused about regular lemonade high oxalate
Diet lemonade low oxalate
What about fresh homemade lemon aid with sugar substitutes
Or squeezed lemon on food ?
Hi Sammy,
Many people use Crystal Lite, and some just add fresh squeezed lemons into their water. You can do either without increasing your oxalate.
Thanks for writing-
Jill
Hi Jill,
I am vegetarian and have asymptomatic Calcium oxalate stones and osteoporosis.
I use hemp protein powder and nutritional yeast as protein supplement, but am concerned about the oxalate content of both. Are hemp protein powder and nutritional yeast high in Oxalates?
Thank you
Asha Chhablani
Hi Asha,
I do not have sufficient evidence to say one way or another. Hemp is made from seeds, so it most likely has some, but really not sure. I use both these products as well. They are healthy items, but if they add to stone risk, I can not say. Are you getting enough calcium? Are you paying attention to your sodium intake? If you are not, this could be increasing your risk. Many vegetarians do not get enough calcium so let me know.
Jill
Hi Jill, I just passed my second kidney stone in a little over a year (not quite sure on the time.) The last time I believe drinking gatorade did it. Now I eat a lot of peanut butter. I also eat baked potato chips by lays. I usually have a ham cheese lettuce tomato bacon sandwich for lunch with a ginger ale. I try to drink water but went for a long walk on Sunday in bad weather and did not hydrate enough. Not sure what else to say. If you have questions please feel free to ask.
Well my friend, I am pretty sure your diet is not helping your stones! Please make sure you get a urine collection ordered by your doctor and you complete it. This will tell you WHY you are forming stones. Then you can also get on preventative treatment based upon those results. This will most likely dietary changes, sometimes meds. Drinking enough water to produce a least 2.5 liters of urine a day will also help tremendously.
Good luck and let us know how you are doing.
Warmly,
Jill
does pomegranate and it’s seeds cause any type of Kidney stones
Hi Vijay,
I don’t have a good resource for them so unsure. Eat them sparingly…
I will keep searching though and report back if I find something.
Jill
Hi! I have been forming calcium oxalate stones for many years. The last BIG one was 1.5 cm! The doctor had to go in with a laser to pulverize it! Now I have some small ones, maybe 1-2 mm diameter in BOTH kidneys. I have had so may procedures the ureters are large enough to pass some without pain. I eat a fairly healthy diet and I take 15 mg Potassium Citrate 2X daily as recommended by my doctor. I STILL get stones! Is there ANY over the counter pill or supplement I can take to help eliminate them? I have a “Paper” stomach so some of the items I saw online won’t work and I can’t have too many citrus drinks. ANY help would be greatly appreciated! Dave
Hi Dave, Calcium oxalate crystals are forming despite treatment and that means urine supersaturations with respect to calcium oxalate are too high for you to tolerate. Check out the article on treatment of calcium stones and this one on how to be sure you have checked off all of the boxes in workup and planning of treatment. Hunting around for a remedy never works, and you are not getting the treatment you need. Let me know after you take a look. The potassium citrate must be 10 mEq or 1080 mg each, 15 does not fit. Regards, Fred Coe
My urologist said my Urin PH is about 7 which is neutral. Should it me more acid or alkali?
Hi Dave, If your stones are calcium oxalate, urine pH will have no important effect. But pH of 7 is high and you should be sure your urine calcium phosphate supersaturation has not risen as mixed stones are common. I mentioned this, and do so again, to be sure and check off a complete list of things you need to get proper prevention. Regards, Fred Coe
How much water are you drinking? Rule of thumb is enough that you urinate every 3-4 hrs and have clear to pale colored urine.
few months ago ; both kidney have 32 33 mm stones ‘ they removed by operation
8 stones are still present largest one is 13 mm. Please suggest me what I do
Hi Awaneesh, So many stones means that prevention is critical. Take a look here, and see if you can get through the steps needed. There is only one way to good prevention that I know of, and it is this way. Regards, Fred Coe
Awaneesh,
Just got over an out-patient ESWL (sound wave treatment) for a 15mm stone. Take guidance from your urologist, but since stones are not usually passable over 6mm, sounds like ESWL (lithotripsy) is in the cards. The procedure itself is not a big deal (i’ve had it 2x now), however, i know know that for stones over 10mm, you will should get a urinary stent. Discuss with your urologist. The stent is not fun but prevents blockage while you pass fragments (of which you’ll have plenty). The stent runs from the kidney to the bladder and can cause symptoms that similar to that of passing a stone (narcotics may be required to kill pain). in my case, i was given numerous medication: Pyridium (to minimize uninary tract burning while passing fragments), something i can’t recall to minimize spasms from the stent, and flowmax which can help promote passing of large fragments. The pyridium causes urine to be bright orange with super staining power and the stent causes uncontrollable urinary leakage which is a bad combo. As a male, i eventually got “male leakage shields” that go in your underwear and allowed me to get back to work. The drugs do make you tired and it can be a frustrating ride. i was not able to do any physical activity with the stent in place (which for me lasted 18 days from the ESWL). i got the stent removed yesterday and while it wasn’t something i’d want to do every day, it was cake next to stone pain. 24 hours later and free of drugs, i feel like a real human again! Hang in there. It ain’t fun, but be thankful we live in an age where procedures exist to rid our bodies of these devilishly painful stones.
there is a lot of misinformation about concord grape juice, is it high in oxalate or not?
is there a difference between concord and regular grape juice?
Hi Tracy,
I have read it is low, but do not have a source that I find as 100% reliable. Therefor, I will have to say that I am unsure and proceed with caution. I also don’t love the product as it is VERY high in sugar.
Best, Jill
Hi! I am using “Bone Strength” Slim Tabs made by New Chapter as a natural plant based calcium intake. Its supposed to be better then other types of calcium supplements. Do you know of this product? I had a full body scan (Forgot the type) and its telling me I have some bone loss. I am 63. This is in addition to my Calcium Oxalate stones. Thank you.
Hi Dave,
I do not know the product. If you have stone AND bone issues, I would seriously look into getting more calcium from foods I eat, as the body absorbs it better from food. Also, make sure your doc approves the amounts you are taking. Too much supplementation could also result in stone production and make sure you take supplements with a large meal.
Thanks for writing in-
Jill
Okay, Thank you!
Foods-to-avoid questions:
I assume all nuts and seeds are high in oxalates, so pine nuts would be not good? Sounds like I could have some occasionally on breakfast yogurt or mixed with corn or rice. Or, should I just give up pine nuts along with my cashews, almonds, macadamia nuts, walnuts, pistachios, etc.? (I always put walnuts on my breakfast oatmeal, but am now trying meat for substitute protein. Smoked turkey in oatmeal is interesting.)
Cooked oatmeal is not high in oxalates, right? I eat three dried prunes (and two apricot halves) cooked with 1/3 cup of oatmeal and oat bran in 1 cup of water…and recently switched walnuts with smoked turkey. This, along with my other breakfast dish of yogurt and fresh fruit should mitigate the dried prune oxalates, correct?
A diet with no dark chocolate is just wrong. What’s the best way to mitigate eating 1/8 (2 sections) of a Ritter Sport dark chocolate/hazelnut bar? Drink more liquids, maybe tawny port? Pair it with cheese? Switch to a nut-free bar?
Thanks for providing such a carefully prepared and practical website for those of us new to dealing with this oxalate business. There is a lot of conflicting info out there on the web about foods.
Hi Katherine,
It is very confusing I know. My greatest wish is that people worry less about oxalate and more about getting enough calcium into the diet. With getting your daily recommended amount of calcium and if eaten with the high oxalate product it would help a lot for stone disease and bone disease.
You can eat that amount of dark chocolate. That is a reasonable amount. I would really stay away from nuts and when you do eat them add them to your yoghurt. It will help a lot. Smoked turkey sounds yucky to me, but we are all different! Do what makes you happy.
Always keep your liquids up, do 24 hour urine collections to make sure your oxalate levels are staying low and keep me posted on how you are doing.
Warmly,
Jill
Hi Jill,
How does one go about doing urine oxalate tests at home?
Thank you
Hi Myra, there is no home testing for 24 hour urine risk factors. Oxalate by itself is worthless even if it could be done as it is merely one contributor to stone risk. Regards, Fred Coe
This is very helpful. Thank you for compiling it! I’m not sure about the cause of my kidney stones but it was recommended I decrease my oxalate intake. I’m stumped by the calcium recommendations, however, because I’m dairy-free to keep my eczema in check. If it’s not one thing, it’s another! Back to researching I go.
Dear Leigh, A key to lowering urine oxalate is high calcium intake. If dairy products are a problem perhaps other sources than cow milk might work. If all else fails, perhaps calcium supplements – but always taken only with the main meals that contain oxalate. But low calcium diet apart from oxalate, is not good for health. The US diet recommendations are excellent and specifically call for calcium. Take a look. Regards, Fred Coe
My urologist, after removing an oxalate kidney stone from my left ureter, told me the best prevention for oxalate kidney stones is lemonade. I happen to have a lemon tree in my backyard, so nowadays, two or three times a week, I squeeze one or two lemons to yield about 1.5 inches of lemon juice at the bottom of a regular size glass. Then I top it off with sparking water and drink it (with food in my stomach) without adding any sugar. Also, I have added apple juice to sweeten it a bit. At my six month follow-up visit, no kidney stones were found by radiology. I also try to eat all things in moderation, because I know that my oxalate kidney stone was caused by eating excessive amounts of cashews.
Dear Carlos,
That is exactly what to do. Except for the fact that you make no mention of doing a 24 hour urine collection. Make sure you get one so you can see WHY you are forming stones. Follow the kidney stone diet that Dr. Coe and I have written about here on the website.
Thanks for writing-
Jill
Oxalate Lists are confusing, this is the only list I have seen with Avocados as Vey High Oxalate, there are even sites suggesting eating them to prevent kidney stones. They are listed high in Salicylate but so is Blueberries so unclear if food high in Salicylate should be avoided? I try to avoid regular oxalates due to minor but somewhat regular stones, I do have Avocados regularly the last few months.
Also how long does it take to form a kidney stone, I ate a ton of blueberries one day and had a kidney stone the next, of course mentally with them being High or so I thought, I tied the 2 together and have since avoided but unclear if there was any relation whatsoever?
Hi Kevin, The list here is a curated and lightly edited version of the one from Harvard, and more or less the best available in terms of adherence to available science. There are many lists on the web, but only so many scientifically reliable reports of food oxalate, so in principle there is only one list possible if you stick to analyses from such papers. I would not obsess over occasional oxalate variations. In fact, since a proper calcium intake will greatly lower urine oxalate on average a good step is to review your whole diet. Take a look at what it should be. Calcium oxalate stones do not appear in a day and the stone you might pass has probably grown over months or more. Take a look at this video about how stones really form – it is long but you can view it in chunks. It gives a sense of how chronic a process it is. Regards, Fred Coe
I have one kidney. I have been told I have hyperoxaluria. My nephrologist has instructed me to stop all supplements with Vitamin C and Calcium. I have also been on a low calcium diet. I have 24 hour urine tests every 4 months. My current oxalate level is 100. My counts have been as high as 121. I have been using the Harvard List of Foods as a guide. I am on 6 potassium citrate (1080mg per tablet) a day. I also drink 8 oz. glass of lemonade per day. I would appreciate a suggestion as to what you would think could bring my counts down.
Hi Paula, I am a bit alarmed by your story. If your urine oxalate is really 100 mg/d – units are missing, and has been as high as 121 – same units, either you have an amazingly high oxalate diet, a form of malabsorption with enteric hyperoxaluria or primary hyperoxaluria. Given the low calcium diet, it is possible that extremely high diet oxalate loads could cause such high urine values but I doubt it. If you have transcribed the number correctly and the units are indeed mg/d (milligrams per day) then you have a dangerous and alarming problem that your nephrologist must surely want to remedy as fast as possible. Regards, Fred Coe
I’m perplexed that you say to be careful with stevia because a teaspoon has 42 mg of oxalate. Is that a teaspoon of pure stevia powder? I *love* sweets, and less than 1/16 teaspoon of powder is plenty for sweetening a cup of lemonade or any other beverage. Liquid stevia? 4 or 5 drops, max.
Hi Shayna,
Stevia before it is processed into the little packets you use has that much oxalate. After processing it is safe for you to use- at least regarding oxalate content.
Best,
Jill
A related question: Do sugar substitutes increase Calcium loss just as sugar (which you so delightfully called “… the demon in all eyes, dreadful to behold”) does? Specific guidance about Sucralose, aka Splenda, would be helpful. I love it–but find it so sugar-like it’s sure to be bad.
And thanks so much for all your thoughtful efforts on this site. It’s really a treasure!
John
Dear John, Thanks for the compliment. I believe Jill has answered about sugar substitutes – there is no reason they should behave like real sugar. Regards, Fred Coe
I found your webpage incredibly chocked full of data. Thank you for that! I am a medical student, 2nd year, preparing for my Step 1 medical board exam, and during a routine medical checkup, microscopic hematuria was found. When it was repeated, same findings. My father died of prostate cancer, and my brother currently has bladder cancer. A quick trip to the medical school teaching hospital, cystoscopy, followed by CT Urogram, and my Urologist told me I had small kidney stones that did not need further intervention. He did tell me to avoid oxalate foods. I have no trouble with eliminating nuts, french friends, black tea, spinach and others. But I think it unrealistic to lower my protein intake. I enjoy bodybuilding as a sport, no anabolics or supplements, but I do consume protein to increase muscle mass. I have no comorbid conditions and take no medications.
There must be a way to reduce oxalate levels systemically other than avoiding spinach, nuts, bran, potato chips, etc. It seems to me the question is how do we reduce this chemical if we already eat a clean healthy diet? I drink 3 L of water daily to keep my kidneys healthy.
Thanks
Dear Dr Reyes, Who says your stones are calcium oxalate? They may be calcium phosphate. Likewise, your 24 hour urine oxalate may be low and your calcium high. Take a look at a decent protocol for workup and think about whether all of the steps have been climbed. Get a proper workup and then plan long term treatment instead of guessing and then making life difficult for yourself bothering about food oxalate levels. Regards, Fred Coe
The list includes cornmeal in the very high category while listing corn flour in the low category (one cup of each). Can you clarify.
Thank you
Hi Leona,
The only thing I can think of for the discrepancy is that corn meal has a higher concentration of corn thus leading to the higher amount of oxalate.
Thanks for your question-
Jill
Hi, I’m getting really confused. Some reports say coffee is high in oxalates , This one says I can drink it . Some other foods are confusing too. Please help.
Hi Elizabeth!
You can have some coffee. Keep it at no more than 2 cups a day, normal sized cups, not 32 ounce cups. Here is what I have to say about all the dreaded lists on the internet. Stop looking at them. Use this one. I have used it with patients for nearly 15 years, my patients tend to decrease if not erradicate their stone production. I know it works.
Warmly,
Jill
I am confused I just found out after having two surgery’s to remove a 8 mm stone about the calcium intake. I do not drink milk, should I be taking Calcium?? I am now on a low oxalate diet, which seems to be ok since I have been eating low carb. I have also started drinking lemon water daily.
Hey Kellie,
Did you do a 24 hour urine collection? If not, please get one ordered so you can see WHY you are forming stones. If you are not getting enough calcium from foods, which is how the body like it best, please talk to your doctor about calcium supplements. If you take too much it could actually increase your risk of new stones, so you don’t want to play around with supplements without discussing with your doc.
You are making major dietary changes, make sure they are warranted by doing the urine collection.
Thanks for writing-
Jill
Just been diagnosed with oxalate stone removed ten days ago. Now trying to clarify the foods that I can eat. Seems a bit overwhelming at this moment. My doctor recommended your site only. Will be doing 2 24 urines over next two months. Will keep reading it, I have hope!
What about peanut powder? I’m trying to find an easy, quick and on the go breakfast and would like to try a shake. Many people are using this but I figure its just as bad as eating peanuts. And how do I find out oxalate levels in plant based multi vitamins? I need to find a way to get nutrients in me. I’m not 20 anymore 🙁
Hi Pam-
I would assume powders made with peanuts would be high on oxalate. Don’t know the oxalate levels in vitamins but I would not worry about it. They will not add to your oxalate levels. High doses of vitamin C can be a problem, but a normal multi won’t cause issues.
Be well-
Jill
Which veggies can I eat either raw or cooked? Which fres fruits and berries can I eat? Should I give up almond milk for coconut milk or organic cows milk? Are there nuts or seeds that can work with this low oxylaye diet?
Are their any dried beans or beans in cans i.e.: garbanzos, white beans,pinto beans that we can cook with? Can we turn any of these canned beans into hummus. What natural spices can we use, which ones must we stay away from? Can we use corn meal flour versus white or whole wheat flour. Which fruits are yes, which ones are absolutely no?
Hi Lois,
Please read the article on how to eat a low oxalate diet and you will find the list of oxalate foods. It will help you in figuring out what foods are high and low.
Best,
Jill
Thanks for the information. I am at a borderline for needing a low oxalate diet recommended by my urologist. This seems to be one of the more trustworthy lists so I will see how much I can get out of it, and if it seems consistant. I get really, really frustrated when some trys to get information about what to do then get blasted in the face with meaningless numbers(yes, one of the reasons this page was born). I still see some of it in your spreadsheet. A really high amount can be 13mg or 750mg???? When there this much range, its almost meaningless. I wish you had explained how this is ok or try to get the other authors on sites to edit their info by explaining how something like can be true. I would create a new scale that provides the warning by going from 1 to 10 or 1 to 5. A one is as much as you want, a 9 or 4 is measure carefully/once a day, a 5 or 10 is proceed at your own risk/never…etc. treat the other numbers similarly. Would help format the ideas of ok to veryhigh. One thing that may or may not been answered: are the amounts per meal or per day. If I eat 2 meals per day, how should I treat the amounts? Can I eat 2 cups of spinich (universally very high) on monday the first, not want any more until the 15th and be ok? I think that it could be a good idea to supply this information so a better nutritional experience can be had.
Good article. Provides the type of information that is actually usable instead of wondering how an article could be published in such a confusing manor.
Hi Romney, Adjectives are a mess and you are right about them. Here is something useful that needs to be better said in the article. If you eat a properly high calcium diet – 1,000 top 1,200 – as is recommended for all otherwise healthy Americans, a total daily oxalate intake can be between 100 and 200 gm daily and you can use the numerical data on the list to make the budget work. It is also not the same as running a spaceship: More or less oxalate will be absorbed, depending on the mix of food in any one meal so everything is approximate. Re-testing is crucial and the goal is a reasonable urine oxalate and reasonable depends on the other things in urine like calcium and citrate, and volume. For some better perspective, take a look at how treatment of idiopathic calcium oxalate stones – I presume this is your situation – actually works. Diet oxalate is really only a minor part of the effort. Regards, Fred Coe
Thank you very much. Knowing how to apply the numbers helps a lot. Gotta increase calcium and be wary of the things that can put me overlimit (with reason) in one meal or so. I guess spinach is out for a while until im back in check. Its ok though, I usually really only crave spinach when I broil lambchops. Guess I’ll replace the spinach with kale or other safe green vegatable. Another question (may be explained when I read through the link), does the body process oxalates over time or does it peak like someone that has to manage their sugar intake? This would allow me to better understand what is happening when I eat, so may consider eating something like yogurt before I eat the main meal.
It all makes better sense now. I can eat olives again, I just have to be aware that I dont do it everyday and not unlimited. Its ok though, I just used to snack on them until I got tired, then forgot about them for weeks at a time. There is still spinach though 🙁
Hi Romey, Do without spinach; you will not adapt or something, it will always be a hazard. Oxalate is not metabolized, but urine oxalate excretion does go up with meals, so that is oxalate absorbed from food. You want the yogurt WITHIN the meal, the calcium needs to mix in with the oxalate to precipitate it so it is not absorbed into you. Regards, Fred Coe
Thanks. Guess I will have to get my spinach from old popeye cartoons 🙂
Nothing major, as I stated before. Will kinda miss it though. The perplexing part is that quite a few foods that have proven benefits need to be carefully assesed in a low oxalate diet. Imagine a parent telling her kid “NO SPINACH” for you mister. Had I been a child it would have been good news. Lastly, would that mean that I should also consider iron supplements? Multi-vitamin?
Thanx again.
Hi.
I would not recommend doing that before talking to your doc. I don’t eat spinach and my iron levels are fine. Taking iron pills can lead to constipation and you don’t want that either. You can always get a blood test at your annual to keep an eye on our iron levels and other levels as well before making that decision. And talk to your doc to help make that decision.
Thanks for all your great comments-
Jill
Is corn flour, corn and oat bran the only carbs available for breads. Would still appreciate a more complete list of most veggies and fruits that are allowable for a low oxalate diet. Thank you again. I have reread the above info many many times, there’s just a bit more clarity I could benefit from. Thank you,
Hey Lo-
Here is the deal. The carbs are tough, but it doesn’t mean you can’t have them. Eat them here and there. You can still have a couple pieces a day, without worrying. It also helps, as you know, to eat it with a calcium containing product. This is the list. I do not have anything more to add or take away. There are still plenty of fruits and veggies you can eat, and the high ones just eat in moderation.
It really is that simple. If you eat a diet that has around 1,000-1,200 mgs of calicum you can safely eat 100-200 mg of oxalate per day. That is why it is so important to eat calcium. Less so for oxalate.
Best,
Jill
My doctor says to stay away from animal protein. Is this right
Hi Kris, Once adjusted for size, there is little relationship between urine oxalate and diet protein intake, so that is not very important. Diet calcium is very important, and so is diet oxalate. Regards, Fred Coe
Hi Kris,
Maybe the doc told you that for another reason. Perhaps your urine caclium is too high, or you have a low pH? Check with him/her and find out the reason for that treatment suggestion. Not to question, but to make sure you understand and can be better compliant with your treatment plan.
Knowing the why’s and how’s is what keeps you motivated and educated.
Warmly,
Jill
hi jill, any idea why the difference in levels for avacado? harvard says very high, try oxalate diet says very low. other sources also rate them very low. thanks, terry
Hi Terry-
It bothers me that acocados are listed high here bc they are very healthy in good fats and fiber. But- I have been teaching from this list for 15 years- and I trust it as it has helped many of my clients when used properly.
Of course have them here and there and it helps if you eat it with a calcium rich food.
Best,
Jill
Hi,
Thanks for the info. I’ve been reading the oxylate data linked,and have some questions.
Regarding white flour,listed at 17 units of oxylate per 1 cup flour. Is it safe to assume that whatever one makes with the flour will have no more oxylate total than the sum of the oxylate parts?
Or does preparation affect the oxylate composition of the product.
So-
If I make pasta,from 1 cup of flour and one egg,will that total amt of pasta still only have 17 units oxylate after cooking?
Also…Saw cornmeal at (64 units oxylate )/ cup…I presume dry uncooked cornmeal…is this right?…..if I make cooked simple polenta from that cornmeal,will I have no more oxylate in the polenta than in the cornmeal originally? (Which is relaveant because 1 cup meal makes,a fair lot of cooked polenta)
Thanks Again!
MikeB
Hi Mike,
Cooking does not matter much at all. What goes in the pot will come out relatively in that amount.
If you are adding foods to the the questionable foods, you must also add any oxalate these other foods you add might have. But I assume you know that…
Thanks for writing-
Jill
Hello,
Like some of the others, my urologist also says to limit protein, especially from animal sources. The information I was given says “Excessive protein in your diet can increase both the calcium and oxalate in your urine. Eat adequate, but not excessive amounts of protein: A) limit milk and milk products to two servings per day (one serving equals 1 cup of milk or yogurt or 1 ounce of cheese) and B) limit your intake of fish, poultry and meats to five ounces per day.” I was also told to incorporate more fresh fruits and vegetables in my diet and to avoid restaurants and processed foods.
My stones, which were tested in November, were of the calcium oxalate variety. I’ve increased my water intake to more than two liters per day, cut out coffee and am gradually getting used to using way less salt. The food lists and advice found on the internet are very contradictory and confusing. For instance, the list from my doctor includes cauliflower but not potatoes like your list does. I honestly do not know how I am ever going to memorize everything and avoid developing stones again, but I have to try.
thank you,
Luann
Hi Luann,
I understand how confusing the “lists” are. Use the one we recommend. I have been teaching from it for many years, and my clients at the very least from less stones, if not stop for good. So I know it works. Throw the others out. You can email me at jharris1019@gmail.com and I can give you a low oxalate list that I have derived from the Harvard list to keep it easy for you.
Best,
Jill
Also, how can you recommend corn chips? There are 155 mg of sodium in an ounce of corn chips.
Hi Luann,
We don’t recommend, we just offer as a substitute to potato chips. There are many people that will have to eat a chip or they will not be able to keep it together. For them we offer a low oxalate version of something crunchy and satisfying. Being on these diets are not about being perfect, they are about being better. Trying to be perfect, for most, will lead to over doing it. So we offer suggestions to lower oxalate version of foods and it goes without saying that sometimes these things might have extra salt. Be smart, don’t over indulge and watch your overall sodium intake accordingly.
Make sense?
Jill
what about persimmons? also does soaking or sprouting beans affect the level of oxalates?
I do not get the idea of broccoli being moderate in oxalate. So many studies and broccoli seems to have very little oxalate. What is the truth? I eat broccoli every day for the fiber but I am also on a low oxalate diet because of stones. I drink alot of water when I have the broccoli but I need to know if broccoli every day is good or not. I have the broccoli steamed. I would appreciate any suggestions. Thank you
Hi J.
Broccoli is listed as an ok food. Don’t eat large portions as it adds up, and if you can eat it with some calcium containing food that would be great. Half a cup of chopped broccoli has 6 mg of oxalate according to what we have found. We consider that moderate as for the amount that is moderate. So having a cup of chopped broccoli will have 12 mg and more even higher. So you see it depends on amount.
Hope this helps-
Jill
I’m confused. In the article you say black pepper is high in oxalate but on the spread sheet it is listed as “very low”. I do understand that black pepper is used in small amounts, but is it considered high or not? Funny, I thought I was eating healthy with my huge daily spinach salad I’ve been eating each day for many years, along with avacado, grapefruit, oranges, nuts and celery, sweet potatoes. I love most fruits and vegetables and eat lots of them. I’m trying to figure out an alternative to spinach because I gag on lettuce. I just found out I have a 6mm kidney stone and I don’t want any more. So thanks for the article and list. I have some diet changes to make, replace the healthy stuff with other (low oxalate) healthy stuff!
Hi Tracy.
It is considered high because it was measured in a 3 ounce portion. Which no one eats on any given meal. So, it is really not a concern.
You can all eat oxalate, if you eat it with calcium, and save the really high things for every once in awhile. Moderation is key here and eating the treats with calcium foods as well.
Best,
Jill
Hi Dr. Coe and Jill, have taken great interest in these publishing’s. I have decided to take matters into my own hands and try a lower oxalate diet which I’m hoping will help me. I’m 54 and have had kidney stones at least 2nd yearly since I turned 40. Most requiring EWSL. Frankly so over it, my urologist says there’s nothing I can do, i haven’t told him about this either. I’ve lost 5kg since my last surgery in November as too scared to eat, stupid I know. Just drinking at least 3L/day. My stones are composed of Calcium oxolate/calcium phosphate and calculus carbonate. Apart from following this diet restriction re high oxolate foods, is there any other advise you can offer. I’m also trying to eat yoghurt with every meal but unsure as to amount, a few tablespoons or more?
Thanks again for any help. Kind Regards Julia.
Dear Julia,
It is not “stupid” that you are losing weight because you don’t know what to eat. Having kidney stones is very scary and the thought of having another will send people to places they never thought they would go. Simply put, we understand.
There are things you can do. First you need to tell you urologist that you would like to complete a 24 hour urine collection so that you can see why you are forming stones. You may know your composition of stone, but that doesn’t mean you are sure of what to do. You need to do the collection as well.
When you have done that, I will be able to give more exact advice.
Warmly,
Jill
Hi Julia, I agree you need proper testing and a whole approach to stone prevention. Here is a good overview of how to approach prevention. Here is a more narrow article that focuses on the technical aspects. Your stone composition is crucial – you need to determine the main components of your stones. Are they mostly calcium oxalate with minor admixtures of hydroxyapatite, or are they mainly hydroxyapatite with minor components of calcium oxalate. From your brief note I suspect it is mainly calcium phosphate so urine oxalate is a minor issue and urine calcium, citrate, and pH are crucial. Read through the two articles and see if you can make your way. Regards, Fred Coe
I noticed Stevia is in the list. I use this in my coffee. Any suggestions for substitutions? Are splenda and equal ok? Also I drink Shakeology every day and some of the ingredients are in this list. Do you know if it is ok to drink it? Any help would be appreciated! I drink it because it has all the vitamins and nutrients in it I need as a bariatric patient. Could there be any relationship to my stones? I was just diagnosed with 3 small stones last thursday and never want to go through that pain again. Thank you in advance for your advice!
Hi Misty,
I know Stevia is on the list. But after it gets processed there is no oxalate in it. The plant itself is high.
As far as the shakeology, it has not been studied, so I am unclear if it is high or not. Many bariatric patients get stones because they are not absorbing nutrients as they once were so getting stones is a side effect of the surgery.
You need to do a 24 hour urine collection to see what is the cause. Otherwise you will be putting yourself at risk for making more. You might not have an oxalate problem. Do the collection and find out.
Best,
Jill
Ok thank you for the info!! I will ask my doctor!
I use liquid stevia in my beverages. I drink organic lemonade with apple cider vinegar during the day, and organic coffee in the morning. Is the liquid considered processed i.e. “no oxalates?” I had a 5mm stone in my left proximal ureter. Asymptomatic for approx. 1 year. I am a nurse and am trying to be careful..
Thanks!!
Forgot to mention that I use organic chocolate coconut milk in my coffee.
Hi John,
I hope you are drinking water as well as these beverages (they are ok, though, watch the sugar in the lemonade). The chocolate will have oxalate. Make sure you have done a 24 hour urine collection so you can see if you even need to watch your oxalate level.
Best,
Jill
Thanks Jill! I am going to let everyone know about your site. I am very impressed. I see a lot of people that have questions that you answer. I am using the liquid stevia in my beverages, ie. lemonade/coffee, is that OK since “Hopefully” the stevia has been processed and the oxalates are low? And yep I’m drinking water as well. Thanks! They wanted to do lithotripsy, but I wanted to wait it out, to avoid any side effects on my organs. So far so good. The follow-up KUB, (originally was diagnosed with a C/T scan,) came back with a radiologist report stating; “I think there may be a very small stone, very distal now.” The other radiologist said he did not see any, just very small crystals in the kidneys. 24 hour urine collection is a great idea!! Thanks again…
Dear Dr. Coe: I found this very informative thread while searching for information about my apparent IH,. which seems to be connected to my low BMD. I am 61 year-old male, and was diagnosed with osteoporosis in my spine via a DXA scan 4 months ago. I have subsequently had two 24-hr urine tests over the last 4 months, both in a urine-ca range of 320-340/day. I have never had kidney stones, although every decade or so I have randomly experienced blood in my urine, and the GP has never been able to figure out what caused it. The latter 24-hr test was actually higher, and was done to assess the effect of dyazide treatment. (I am awaiting a second appointment with my endocrinologist now to follow up on that test.) The only “positive” change between the tests seems to me to be that the rate per dl fell from 11 to 7. No dietary guidelines were given to me by my endocrinologist , but as I read your recommendations for stone-formers, I wonder whether such a diet (low sodium, low protein, high calcium, and potasium citrate) would also be indicated for folks like me with IH who have no history of stones, but who show abnormally high bone loss? I also wonder if oxalate limits would be beneficial — I apparently eat a lot of foods in the high-oxalate category that I consider to be otherwise very “healthy,” like spinach and broccoli and nuts, so this would be a significant dietary shift for me. (A side-note: I apparently have what is called “leaky gut,” and an internist recently put me on a breakfast diet with lots of kefir and probiotics. Has leaky gut been correlated with IH?)
Hi Mason, IH is an established cause of bone mineral loss and a probable reason why stone formers are prone to fractures. You de indeed have high urine calcium, but IH demands your blood calcium be normal, as well: Be sure of that. The amount of calcium per deciliter (dl) of urine is irrelevant to bone as it is simply the concentration of calcium in urine not the amount lost daily. I would think that low sodium would be invaluable as – from my work and also from scholarship of work by others – the very quintessence of IH is an excessively high slope of urine calcium loss on urine sodium loss; the latter is simply diet sodium intake. Low protein is never on the menu, for bone or stone disease. High diet calcium is recommended for all Americans to prevent bone disease. As for oxalate, since you have never had stones and will have a high calcium diet, simply measure urine oxalate – you will probably find it uninteresting and not need to concern yourself about the matter. Thiazide helps bone but low sodium diet probably is additive to the drug. Drugs oriented to bone per se – bisphosphonates etc are probably helpful in IH bone disease – no trials. Regards, Fred Coe
Merry Christmas fellow stone makers. I’m happy to say this is my first Christmas out of the past three I’ve not been in the hospital with kidney stones (was for thanksgiving). I’m a researchers dream. 22 lithotripsy within 14 months. All over 8cm – largest was 16cm. I form calcium oxalate on my stints within three days. Thanks Dr. Coe for this article. I’ve shared with my nephrologist and urologist and they are impressed and gave me the go ahead to try the list. For the first time excited to take my 24 HR collection. Any additional thoughts or suggestions, I encourage you to share or reach out to me. You can only imagine how o would be willing to try anything!
Hi Lisa, I am happy for you. Be sure that your evaluation has been complete – here is another guide. Be sure there is not more wrong than oxalate. Warm regards, Fred Coe
Thank you for this helpful information. About 10 years ago I had a kidney stone nightmare. I am told that I have over 20. I went in for lithotripsy and ended up in the cardiac unit. I had NOTHING wrong with my heart previously. I had to get a cardiac ablation to correct the SVT that was caused. I still have the 20+ stones. I passed one about 14 years ago and then did not pass another until this month where I passed two. I have not been to a urologist since the mishap because of my experience. I have two questions, 1) Should I be going to a urologist or a nephrologist? 2) What to do if I have a sensitivity to dairy? Thank you so much for this article! It has been VERY helpful.
Hi Christa, Given recent stones a full evaluation is appropriate. Here is my best at a good program, and here is a broader overview. Those new stones are priceless; get them analysed so you know what you are dealing with. Your urologist should be a good place to start. As for diet issues, save them until you know what it is you have to do for prevention – read the linked articles. Regards, Fred Coe
Dear Dr Coe, Thank you for this article. It was extremely helpful. I am told I have 20+ kidney stones. I first discovered this about 15 years ago while 6 months pregnant, not a fun experience at all. I few years after that I saw a urologist who performed lithotripsy on me however it landed me in the cardiac unit and several months later I had to have a cardiac ablation to stop daily bouts of an SVT. Needless to say that since that experience I have not returned to a urologist because I never had a heart issue before the lithotripsy (however the ablation fixed the issue). I did not pass stones since that time, however this month I had the pleasure of passing two. So it started me thinking that I need to look at this issue again and am concerned because I am 51 and can’t imagine passing stones in my 60s or 70s. My question for you is should I be seeing a urologist or a nephrologist? And I also believe I have a daily sensitivity so that creates other concerns. Thank you so much for your feedback!!!
Hi Christa, I think this overlaps with your prior comment, so I will focus on the additions. The two links I sent detail my best offering of how to pursue prevention. Prevention arises from knowledge of causes, and if you read through and follow the articles you will find those causes. Treatments do indeed prevent stones but only if done properly and in a useful sequence. Regards, Fred Coe
I am wondering if measuring oxalate levels in the urine is enough? Would it be a benefit to know the blood oxalate level as well? The reason I ask is that my stones have coincided with a diagnosis of IBS. From what I have read, the bowel plays a part in oxalate absorption, and an inflamed bowel may cause problems. My urine oxalate level was low, although I have calcium oxalate stones. Thanks!
Hi Nancy, Blood oxalate is not measurable for clinical purposes as it is a challenging technique. We have measured it for research purposes. It has no role in kidney stone evaluation or treatment apart from the very rare genetic hyperoxaluric diseases in which urine oxalate is very high. Since your urine oxalate is low that is not your problem and your stones have another origin. Look at your lab reports and check which are indeed the problem and be sure they are attended to. The stuff about bowel and oxalate arose from obese rat research here at my school by a colleague. Links to people are so tenuous as to be invisible. Newspapers played it up in a silly way. In any event your urine oxalate is low. Regards, Fred Coe
Is there a benefit to knowing blood oxalate levels as well as urine levels? I ask because my calcium oxalate stones began when I was diagnosed with IBS. From what I have read, the bowel plays an important part in oxalate absorption. My urine oxalate level is low, so could those oxalate be lurking elsewhere? Thanks.
Hi Nancy, No; oxalate cannot lurk in blood and cause stones. Blood oxalate levels are about 2 – 4 micromoles/liter whereas urine is about 100 – 300 micromoles/liter, because the kidneys remove oxalate from blood at a high rate. Regards, Fred Coe