Many of you will leave your doctor’s office with questions about foods and kidney stone prevention. You will go home. You will sit down at your desk and the Googling will begin. Here is a spot for you to ask me anything you like about this topic. We already have things on this site about salt, oxalate, and calcium but this space is for specific issues for anyone who comes.
FOODS
Hello Jill,
Thank you for creating a Q&A section! I have had aggressive kidney stones since 2012 which have resulted in 1-2 percutaneous nephrolithotomy surgeries per year since that time. The stones have become more aggressive as time has gone on. I had been educated on the basics about increased fluid intake and reduced sodium in the diet but it was only recently after an appointment with Dr. Coe that I found out about the importance of reducing sugar in the diet as well. I am doing my best to drastically reduce most processed sugars from my diet. I am finding this venture to be rather difficult. I wanted to ask if there are any “safe” sugars in addition to natural sugars in fruit? Specifically I am curious about stevia, agave, and coconut sugar but I would welcome any informaiton on any sugars that can be used in moderation. I would like to find options that could be added to things like iced tea, coffee, and the ocassional baked treat. Also, is there a recommended daily limit to stay under? Is sugar like salt where if you have a bad day you can make up for it with extra water and monitoring for a few days? Thank you for taking the time to review my post!
Hi Stephanie-
Sugar is so hard to limit. I love it myself, but do indeed watch my intake. The American Heart Association says we women should not have more than 25 grams which is about 100 calories of ADDED sugar to our diets. That is about 6 teaspoons for us and 9 teaspoons for men.
Here is the thing- you will have days where you just need to have some sweets. When that days comes upon you, just have them, don’t waste time damning yourself for giving in to the craving, get on with your life and choose better next time. We were not put on this earth to shun chocolate chip cookies. Once in awhile is perfectly fine.
All of the sweeteners will raise your blood sugar levels just like normal sugar. The artificial sweeteners tend to be many times sweeter than regular sugar, which can lead to more sugar cravings. What is a girl to do?
When you lessen your sugar intake, you will lessen your cravings. In my experience it takes a week or two of really making the commitment to lowering your sugar intake and you then you will totally notice your cravings are less.
Hope this helps-
J
Hi Jill,
Thank you for providing an oxalate food list. I have been having trouble locating a safe bread source. The list suggests oatmeal bread or oat bran bread, but the brands I have found start with wheat flour, which I thought was verboten. Are there any brands of bread you could suggest?
Thank you.
Hi Meg,
It is difficult to find breads that don’t contain wheat. I am going to suggest something that goes very much against what I believe to be the healthiest choice, which is to stay away from the whole grains or wheat breads because they will contain higher amounts of oxalate. White bread has the least amount of oxalate if you can’t find an oat bread that doesn’t contain wheat. If you hunt around in specialty grocery stores that have more international brands you might be able to find a pure oat bread that doesn’t contain wheat. Also, the gluten free breads (Rudi’s is a brand I use) have not been studied for oxalate so I cannot be sure of the content but they certainly do not contain wheat. They do however contain potato starch so that might be a problem.
Here is the thing to remember. If you are eating bread every day and you cannot go without it, have it. Just remember to add it into your daily oxalate amount and watch how much oxalate you are eating for the rest of the day. Maybe have the sandwich or bread with something that contains dairy as well to absorb with the oxalate so it doesn’t get reabsorbed back into the blood stream. Also drink water with it.
I hope this helps a little. Please let me know if you need more assistance.
Happy Holidays,
Jill
Thanks Jill! I pretty much came to the same conclusion about white vs whole wheat bread, and being a nurse, going white seems so counterintuitive! I also have added milk back into my diet for the oxalate issue and so much more. I am not a huge consumer of bread. In fact I sort of do a Paleo diet (not too much protein), and used vegetables almost exclusively for my carbohydrate source. Now I have to rethink the vegetables, not go too high on protein, watch out for sugar and salt, and pound down the water. All of this just in time for the holidays…no chocolate or nuts?! Nuts! So long chocolate, bonjour creme brûlée. Sometimes it seems easier just not to eat at all!! Thank you so much for being such a great resource. I’m sure I will have more questions.
Warmest wishes for wonderful holiday.
Meg
Hi Jill,
1) So mashed potatoes are high. But what if they are made with milk, cream and butter? Will the addition of dairy decrease the overall oxalate impact? 2) I see one avocado are very high. But what if I have half? What if I have the avocado as part of a meal and drink milk? 3) My favorite thing to do is have dim sum for my birthday. They have a decadent dessert called jian due: a glutinous rice ball filled with sweetened red bean paste, deep fried and covered with sesame seeds. I take it this dessert is an oxalate bomb?
Thanks.
Meg- I love all your questions because they are right on point. Let me tell you why.
Mashed potatoes are high, but you are right if you have milk or cream you will not absorb as much oxalate than if you didn’t have the added calcium.
Yes, have half an avacodo instead of the whole one. With milk or some yoghurt will also help.
And as far as you sweet rice balls- I love them too- they may be on the higher side- but it is your birthday and why not? One rice ball is not going to send you to the ER.
My point is always this. You can still manage to enjoy your very favorite high oxalate foods- just watch portion, what you pair it with, and how many times you are having said item. When it is your birthday- all bets are off! Just go back to “watching it” the next day.
Best of health-
Jill
Hi Jill. I am second generation vegetarian (almost vegan) going from a veggie-nuts-legumes-soy diet to low oxalate. I see oat bran and oat bread are listed, but could not find anything on oatmeal. Is cooked oatmeal allowed? I have always preferred “white bread” for sandwiches (Pepperidge Farm Thin-Slice). Would like to know if white pita bread white and english muffins are better choice? This website is fantastic and thank you for taking questions!
Hi Paula,
What a transition you are having to make! Good for you! Vegetarians do have it much tougher in many cases because there diet is definitely higher in oxalate.
I would think oatmeal is ok since oats in general are low. English muffins are a bit lower in oxalate, but it is the white flour in these products that are causing the issue, not the products themselves.
Remember to not only focus on a food, but to keep in mind your overall oxalate intake per day. You have a certain amount you can have (ideally less than 50 mg/day), and you get to choose what foods you want to “spend” it on. It will feel less restricting for you if you think of it that way. If you want to have some white bread for your sandwich, choose wisely the next food choice.
Thanks for writing and if you have any special advice that you have found useful watching your oxalate and being a vegetarian, we would love to hear your suggestions!
Jill
I got my first calcium oxalate stone after 2 years of being a vegetarian, near vegan with a diet probably similar to what Paula described (fruit, veggies, beans, nuts, soy). After the first stone I felt I had to drop the vegetarian diet path all together because despite my research I just couldn’t find enough foods that I felt safe eating. It was unfortunate because I was at a much healthier weight and felt a lot better when I was vegetarian. I have since had a lot of other stones but never another one containing oxalate. I have added back in high oxalate foods but in much smaller quantities than I used to eat and I don’t eat them every day. I’m still hesitant to dive back into a full force vegetarian diet for fear of the oxalate levels getting to high and causing another stone. I would love to hear from someone that has successfully stayed the course with the vegetarian lifestyle after an oxalate stone.
Hi Steph-
Thanks for telling us your story. I feel like it really is hard to maintain a veggie diet (I was one for 10 years) without adding too much oxalate. One needs the beans, nuts, and soy for protein and we all know these foods are a killer for oxalate levels.
I am concerned about the extra weight you are carrying. Being overweight can also be a precursor for stone disease. I wonder if you are consuming too much meat and perhaps that is leading to the other type of stones you are forming. Let me know. Are your new stones uric acid stones? How are you with fluid intake? I am asking because I don’t want you to keep making new stones!
Always good hearing from you, let’s keep the conversation going!
Jill
Hi Jill,
It is only the last 2 years that I have had reoccurring kidney stones. Ironically, it was when I started a healthier diet and more exercise. I have several questions. I recently learned that that some of the things I have been routinely eating are on the foods to avoid list such as oranges, tangerines, and zucchini. What can you suggest to put in a healthy salad as spinach, kale, and carrots appear to be on the Do Not Eat list. I have heard that iceberg has very little nutritional value. Can I add cheese to offset something maybe the carrots? Also, will limiting carbs increase the levels of oxalate? I was told by my MD to avoid red meat s(which I do anyway) but they are not listed as a food to avoid on the University of Pittsburgh Medical Center oxalate diet. The Harvard diet and UPMC oxalate diets differ on quite a lot of foods. Do you know which one is more accurate and which one I should follow? Thank you. Judy
Hi Judy,
Thanks for reaching out. You can eat kale as a salad base. Take a closer look at the Harvard list. It is actually safe to eat. Iceberg lettuce does have little nutritional value, but use it as a base and decorate it with nutritional lower oxalate veggies. There are still so many you can enjoy. You can certainly add some cheese too.
Meat do NOT contain oxalate. Oxalate is only found in plant foods. Do you know what type of stone you form? He may have told you that for a different reason? Not sure. But I do know it doesn’t concern oxalate.
Remember to get enough calcium in your diet as well- around 1000 mg/day is good.
The Harvard list is the best we know of. We also consulted and added some data from Dr Ross Holmes who is an expert in the field of oxalate.
Hope this helps.
Jill
Jill, Thank you so much. I appreciated all the information and learned also from your response to Georgene as I had also did the same thing! Dr. Coe, I recently passed a stone (Jan 18) in which I had the typical symptoms….RIGHT flank pain severe, gross hematuria, and nausea and vomiting. I called by MD but delayed going to the ER due to a snow storm. I think I passed the stone as I collected all the urine but did not see even a small pebble. I had a CT KUB this past Sunday (Jan 24) and was shocked when I heard I have a 6 mm stone in the LEFT ureter…20-25% from the kidney pelvic junction. They wanted me to have a lithotripsy asap. I called the hospital and requested that another radiologist verify the results of the scan. He conferred with size and location. I have NOT had any pain what so ever since passing the stone (I thought on the right side) and refused the lithotripsy. I will have a KUB xray in 1 month. After having stones for 30 years I have never not had a moderate to large stone that I was unaware of that has not caused pain. I have already had two lithotripsys and will need them in the future due to other stones seen in both kidneys. How can this be and how common is this? What do you think of my chances for passing a stone of this size? This has caused me much concern these last five days. Please, any more information you can provide is deeply appreciated. Thank you. Judy
Hi Judy, I am a bit concerned here. Is the kidney obstructed? Since there is no pain I would advise ultrasound checkup in a week or so to be sure the stone is moving. One cannot leave an obstructed kidney! Why lithotripsy at all? Ureteroscopy is more direct, no danger to the kidneys. With all these stones have you been checked for the cause, are you following a good prevention regimen? It does not sound like it. Regards, Fred Coe
Dr. Coe,
The radiologist who initially read the scan said mild to minimal hydronephrosis. The Chief of Radiology who also viewed the CT scan said he did not seen any. I am able to void and do not have any pain on the left side. The right side at times aches but not often; there is a 7 mm medullary stone. My urologist wanted to lithotripsy the stone and had be scheduled… he does not do ureteroscopies. I do not want another lithotripsy unless it is absolutely necessary. I have been seeing a nepthrologist for approximately one year and have been Rx HCTZ 12.5 mg and K Citrate 10 meq 5 days out of 7. I have increased my fluids and have been on a low Na diet and low oxalate diet. The stones keep forming but they said they do not appear to be growing as fast. I thought the three prong approach was working until I had an ultrasound in Nov which showed multiple stones (same stones as Feb 2015)but also included a new one in the right kidney of 7 mm after I had a lithotripsy in May 2015 to remove a 9-10 mm stone. I was shocked with the results of the ultrasound and more shocked when I had the kidney stone attack Jan 19 as that appears to be a new stone in the right kidney…the 7 mm is still there. The left kidney has a cluster of stones in the mid-to-lower pole. I do not know where the 6 mm stone is from…new or if if moved out from the cluster. I have no pain. The left 6 mm stone is considered to be a proximal ureteral stone. Yes I have been following the prescribed treatment plan. The only good thing is I passed the stone from the Jan 19 attack as the CT KUB Jan 24 did not show a stone in the ureter. Everyone keeps asking me if I have any pain but I do not. I will tell my urologist I want a ultrasound in a week or so as you have recommended. Why do you think I have no pain and do you think I can pass this 6 mm stone? Thank you and you owe me an apology! Judy
Hi Judy, I do, you are receiving treatment but stones continue. How low is your urine calcium and sodium? What are your stones made of? How high are your urine volumes? You make stones so there are things still wrong and it would be best to change them. If you need potassium citrate, your dose is rather low – perhaps it might be better higher depending on your lab results. I also wonder if perhaps your urologist might not be able to identify another urologist for you in case ureteroscopy would be preferable given the situation. Warm Regards, Fred Coe
I will review my medical records and those on the portal and get back to you. If I recall correctly, all lab and serum WNL. You still have not answered my questions. Do you have any theories as to why I don’t have pain and if I can pass a 6 mm proximal ureteral stone?? Thank you. Regards, Judy
Dear Judy, Silent stone passage is not rare in people with diabetes, which you have not mentioned as your problem. Sometimes stones are indeed silent and, being unwatched, obstruct the urinary tract and lead to kidney damage. In those cases the silence is often of unknown cause. Regards, Fred Coe
Monday Feb 1
Dear Dr. Coe, My 24 Supersaturation test on Nov 2015 results were:
CaOx crystals 1.10
Brushite crystals 0.05
Hydroxyapatite crystals 4.28 H
Uric acid crystals -1.25
Sodium urate comment 0.33
Collection period 1440
Volume 24 1800
Sodium 24 hour 99
K 24 hour 54
Calcium measurement 194
Mg 78
Cl 24 79
P 774
Sulfate 19
Citrate 774
Oxalate 0.18
Oxalate 24 hour 15.8
pH 6.2
Uric acid 414
Creatinine 342
Osmolality urine 358
Nov 2015 A1C 5.7
Past stone analysis…x3-4 over the years with most recent March 2014 Rt and Lt kidney (Perc and ureteroscopies) all were Calcium Oxalate
Past stones that were obtained were visible and hard…pebble/rock
Had stone in Nov 2014 existed body but crumbled w only one hard section
Unable to find stone Jan 2016 in urine…forgot to check for sand
Have requested urologist med assistant to contact MD to obtain ultrasound for next weekend (14 days p CT scan) and to provide list of urologist in his group who do ureterescopies or outside of group.
Still no pain and able to void w/o problem. Researched massage of 6mm stone to be approximately 50% ? Thank you. Warmest regards, Judy
Hi Judy. Your 24 hour urine has a total creatinine of 342 mg in 24 hours which is very low and almost certainly indicates under collection. Is it indeed the amount in mg/24 hours? Your urine calcium is high given the creatinine value is low, as 194 is just at the stone forming threshold. Your urine oxalate is frankly low which is compatible with the low creatinine. Likewise for your urine sulfate. If I allow for under collection you have a good urine volume, marked hypercalciuria, and what is probably slight elevation of your urine oxalate. Your urine sodium of 99 is also being underestimated and is probably a lot higher. Given your strong family history and these admittedly uncertain results I suspect you have idiopathic hypercalciuria, which is inherited and probably has accounted for your stones all these years. Low sodium diet and a thiazide type diuretic are common treatment approaches. But because this urine is very suspicious I would get another one and be sure to collect it exactly. Possibly the urine creatinine value you posted is not mg/24 hours and if so let me know the right value. Take a look at the article on how to read 24 hour labs as a cross check. If you indeed have IH as I suspect, treatment is very effective, but you would need to be sure. Regards, Fred Coe
Also, can I assume that if my Ca serum and urine levels are WLN that I am consuming enough calcium in my diet? I think it would help you if I mentioned my history. The past 30 years I would have intermittent kidney stones every two or three years and always would be able to pass them. I think I was up to seven stones by Jan 2013. Nov 2012 I went back to a more healthy lifestyle and started an exercise program and went on a high protein and low carb diet. Jan 2013 CT showed two small kidney stones, I passed one that summer and had lost 25 pounds by June 2013. Jan 2014 had another kidney stone attack and thought it was the other stone…but it was on the wrong side. I was shocked to hear I have 5 stones in each kidney….some too large to pass! One was identified to be a staghorn thus I had PNL in March on rt kidney and ureteroscopies x2 on left kidney. Had complications from surgery; left hospital on day 8 or 9. Had stone analysis…questioned MD and did not have staghorn (struvite) no infection. I changed my diet again and exercise regiment, no sweating and drank more water, but still producing multiple stones. Could this possibly be due to age, a more sedentary lifestyle, hormones, stress, hereditary (all siblings, father, and some cousins have produced stones but only 1 or 2)?? I thought I would resume producing a stone every 2 or 3 years but not multiple stones in one year. I find this very confusing and I am very concerned about future PNLs and lithotripsys due to long term affects on kidneys. Thank you. Judy
Hi Judy, as I wrote I am not at all sure that your 24 hour urine calcium is at all normal, but may be high. Serum calcium is tricky, even a slight elevation above normal can indicate primary hyperparathyroidism, so be sure. The high protein diet could be raising your urine calcium and promoting stones, which might be why things seem more active. Are you sure the staghorn was calcium oxalate – that is not the common situation. I am quite willing to look at more. Of course, remember that I am far away and all of my opinions are simply from these numbers and what you are saying. Your personal physicians may have a lot more information, so most of my value to you is suggestions to bring to them. Regards, Fred Coe
I did not have a true staghorn….possibly only in shape but now they say it could have been a close cluster of stones. It was not a struvite…it was calcium oxalate and I did not have an infected stone my urologist told me. My creatinine results are always low and that has been attributed to less muscle mass. I have SMA Type 2 and advanced osteoporosis, no hypertension or other dx. Only meds are to prevent stones and alendronate sodium 35 mg once weekly for OP. Supplements fish oil and Vit D3. In 2010, I transitioned from a walker to a wheelchair. I am able to walk more (with a walker) when my weight is approximately 125 pounds or lower. With both my children I could not walk the last several months of the pregnancy but then lost the weight and continued to walk. I currently weight 135 and that with a 1 to 10 pound ratio makes it feel like I have gained 100 pounds and it is now extremely difficult to walk. That was the reason why I lost the 25 pounds in 2013….it worked and I felt better and was able to walk more but I changed my diet after the PNL and ureteroscopies to a moderate one as I thought it was contributing to the stone formation. I gained most of the weight back. I continued to eat moderate levels of oxalate due to the nutrients provided in the vegetables and fruits. I was unaware until this past fall of some of those food being on the Harvard oxalate list. My diet has mostly been a low sodium diet as my Dx of osteoporosis (of almost 15 years) placed me on a low sodium diet….I never put salt on my food (I don’t like the taste) and I seldom eat packaged or canned food. I at times wondered if I was getting enough sodium in my diet. I eat cheese (1-2 oz daily for calcium) but no other diary and no bread, potatoes, pasta, rice, etc. I eat mostly vegetables and a few fruits. I try to keep my weight low to increase my weight bearing and mobility. I am aware that my health conditions (dx) make me a somewhat of a complicated case but until the last two years I was able to lead a normal life and travel but it is the kidney stone formation that is disrupting my life and causing me concerns for the future. We have the opportunity go abroad again, this time on a Baltic cruise this summer for 2.5 weeks but I am not sure if I should take the chance or confine myself to Hawaii. I do not feel confident in knowing what is causing the stones as I use to drink less, eat whatever I wanted except the spinach, chocolate, nuts, etc. and not have constant formation of kidney stones. Something has changed in the recent past. Other variables must be considered as to why I am forming stones. I appreciate you taking the time to review my case. Thank you. Regards, Judy
Dear Judy, It is indeed complex. As I am a professor here, I would be glad to do a proper review of your records as a courtesy to you and your physicians, if you would like to send all of the relevant ones to me. In that event, please call Kathleen at 773 702 1475 and she will make arrangements. Regards, Fred Coe
Dr. Coe, Thank you for your very generous offer. I have left a message with Kathleen. Warmest regards, Judy
I had my ultrasound this past Saturday. Results show “kidneys are normal re position, morphology, and echogenicity. Very mild hydronephrosis noted in the left kidney. No hydronephrosis on kidney has 7 mm stone in mid-lower pole id in CT exam of 1/24/2016. Multiple stones are seen in lower pole on the left compatible with the large number of stone fragments seen on the recent CT exam. Unable to trace ureter to evaluate 6 mm ureteral stone on left. No cystic or solid renal masses are id. The bladder is wnl and bilateral ureteral jets were identified.” MD agreed beginning of last week to order KUB approximately 30 days..1 month…from CT scan of Jan 24. Urologist office called on Friday, Feb 5, and said MD would not perform ureteroscopy…med assistant wanted to schedule it for this week before results of ultrasound. I declined. Your thoughts? Thank you. Judy
Hi. Of course at such a distance I cannot be sure at all about the significance of the left hydronephrosis. It is important to followup with your doctors about this matter and be sure it resolves, and I am sure you will do that. If your urologist is satisfied that there is no important obstruction, then I am sure you are fine. The decision not to perform ureterosscopy is a complex surgical matter I cannot comment on further. Regards, Fred Coe
Regarding Monday, Feb 8, email entry. Right kidney has 7 mm stone but no hydronephrosis. Med assistant did say my urologist would NOW do a ureteroscopy on me as I refused lithotripsy which he had scheduled for me on Thursday, Feb 4. Sorry I was writing too fast. Judy
Oh, so there is no hydronephrosis – that is good. Likewise I am glad about the ureteroscopy – It is the most direct approach to the stones. Regards, Fred Coe
Dr. Coe, I do not have hydronephrosis in the right kidney but there is very mild hydronephrosis of the left kidney which is where the 6 mm ureteral stone is/was located. Again, bilateral ureteral jets were identified. I will wait two weeks and then have a KUB to determine if the stone has moved or passed. Would I need to have a stent in place if I did not had one for a lithotripsy for a 10 mm stone located in the kidney? Thank you. Regards, Judy
I started forming calcium stones about 4 years ago when my diet changed to a low carbohydrate diet. I increased nuts, spinach, chocolate (no sugar) and other high oxalate foods without knowing it. I just did another 24 hour urine test and it is still showing that my oxalate rate is 48 (they want it smaller than 45). Would a low carbohydrate diet alone (without eating high oxalate foods) be considered a dehydrating diet?
Hi Georgene,
No, a low carb diet without any high oxalate foods would not by itself cause a problem. High protein diets can indeed cause and increase in uric acid stone formation, but you don’t mention that you had that type of stone.
I would like you to really take a good look at the oxalate list we have posted on the site and see if you find something that you missed and are eating that is causing the higher oxalate readings.
Sometimes it is not necessarily that you are eating more oxalate, but that you are not eating enough calcium. This could lead to any oxalate you are eating to be reabsorbed back into the blood stream and cause higher readings. If you get your daily intake of calcium (about 1,000 mg/day) it would help. Let me know if you getting enough calcium is a problem.
Thanks for participating in the conversation!
Warmly,
Jill
What type of calcium citrate is best to use if one has had kidney stone? There is so much confusion on even the .edu sites of well renown.
Thanks,
Diane S
Hi Diane, I presume you are using it as a calcium supplement. In general one needs 1000 mg of calcium daily for bones, and you need to figure out about how much you are getting from your foods and add supplements to make up the difference. The secret is to take the supplements with meals – so it will seem as if it were food, never by itself. Calcium citrate, calcium carbonate, I know of no difference. One does not use calcium citrate as a source of alkali. There is no special type of this material; shop for price. Regards Fred Coe
Dear Dr Coe, your site is incredible. I have a question. 2 years ago I lost 30 lbs very quickly on a super lowcarb diet (nearly ketogenic) and I was taking metformin and Invokana for diabetes. (At that time, my a1c was in the 7.5 range.) After a few months, pain developed on both sides in kidney area and I told my doctor that I thought the Invokana was causing problems because I started noticing a jolt of more severe pain, often about 1/2 hour of taking the Invokana, so I stopped taking it for a week before my doc visit. She said Invokana wasn’t the problem and given pain location, wanted to do a lung xray…pain was on both sides down near where my rib cages end. I went home that night feeling silly, and took the Invokana again, 1/2 hour I got quite a painful jolt in kidney area again, so I went back and she said OK, stop the Invokana and monitor the pain.
Fast forward, I did not do so well adhering to my low carb diet…I was very mindful, but not diligent and slowly, the kidney pain went away on both sides and I gained my 30 lbs back over 6 months.
Now, here is my current issue…the pain is back on the back right. It’s pretty bad but tolerable through a day. I have been adhering greatly to a ketogenic diet for about 1 month, and have lost 10 lbs. (About 20-30 carbs a day…even with that on metformin, I often have readings around 120) But, the pain is back, about 20 days into the diet and seems to be getting worse. Almost all of my food has been high fat, moderate protein and lots of high oxalate foods (which I learned about on your site.) Specifically, I have been eating A LOT of nuts, spinach, celery, avocado a long with many other very low carb veggies, like chayote squash and nopales (cactus pads). Also, I do make bone broth…chicken and beef, and eat that a lot, so I’ve been getting A LOT of gelatin and collagen in my diet, daily.
This last week, I started putting baking soda in water, as I learned about the dangers of ketogenic diets related to uric acid. But I realize I don’t know what’s causing the pain and I need to get to the doctor so that I don’t take the wrong things, thinking that I’m helping. I know I’m eating a lot of acidifying foods, and oxalate foods….but I certainly don’t know if I have a stone (I’ve never had kidney pain except for on these diets/meds. I’m 300 lbs, also with family history of heart disease and thought the keto diet would help me. I’m disappointed to be having this issue….wanted it to be the Invokana, and be able to do this keto diet.)
Question is this….before I go to the doctor and get tests, should I stop taking baking soda (1/3 tsp- 3 times a day)…been doing it for 1 week now, or stop drinking Crystal Lite (just drank 2 liters yesterday), my pharmacy and walmart didn’t have the potassium citrate tablets or the bicarbonate tablets. What should I or should I not consume in the days before the test? Ironically, I’ve been addicted to fresca for more than 15 years, often consuming 1-6 cans in a day…it may have been helping me , but since it has splenda, I was trying to get rid of that from my diet! Lastly, I don’t have a clue how much calcium I get…I do that bone broth and do eat quite a bit of cream on this keto diet.
Thank you for advising me, I know I should be scolded for self medicating, but I’ve decided to take a risk and be upfront, so that I can get the most success from my doctor visit and medical testing.
Correction…fresca has aspertame. And also, I sure hope I didn’t post this in the wrong forum?
Hi Mary, Do you have kidney stones? I do not see it in your note. The drug Invokana works by inhibiting glucose reabsorption by the kidneys and would lead to rapid increase of urine flow rate which may be causing the pain syndrome. The FDA has released a warning about this class of drugs because some cases of ketoacidosis have been reported with serious consequences. Since you are following a ketogenic diet the drug may be specifically not ideal at all. I suggest you mention my comments and this link to your physicians, and that perhaps the drug needs to be stopped. The pain with increased flow may signal stones so you should have either an ultrasound or CT scan – kidney stone protocol to be sure what is in your kidneys. There is an ongoing lawsuit about the drug. Regards, Fred Coe
I have a dilemma. I would like to modify my diet to eliminate the foods that are high in oxalates. My situation is this: since I am diabetic, some of the foods that are low in oxalates are bad for my blood sugar for instance: white rice. Nothing raises my blood sugars faster than white rice. Additionally, I have cancer and the chemo causes me to lose my appetite and I need to make sure the foods I eat matter because of that. Add to it the many list of low, moderate and high oxalate foods and many of the lists conflict on what is low medium or high. I have been to several nutritionists who do not seem to be able to help me in deciding what to eat. Add to that the fact that according to what I’ve read, it depends on how the food is prepared. None of the websites list the many ways food can be prepared so there is no way of knowing if the oxalates are being increased by the way the food is prepared or not. This has been a very frustrating process for me and I would really like some real guidance on how to proceed with eating. Also, I would like to make my own bread but I’m not sure what grains I can have so I don’t know what to make. Any suggestions?
Dear Val,
This is an all too common dilemma unfortunately and nutritionists are not well versed on kidney stones and oxalates. Many times nutritionists like nurses and doctors have special concentrations of expertise.
With all the conditions you have going on it is understandable that you feel frustrated. I, too, am going through cancer treatments and know how food is not as pleasurable as it once was. The metallic taste in one’s mouth is only relived by sugary items and that is a disaster. I would like to know what foods are causing you distress, or is it eating in general?
As far as oxalates, please use our list on Dr. Coe’s website. It is the best that is available and one you can trust. Do not worry about cooked or not. If it the product is high, eat it very sparingly.
Check this out for bread: http://www.mynewroots.org/site/2013/02/the-life-changing-loaf-of-bread/
I have made it several times and it is great. Made psyillium fiber instead of flour. Totally paleo. Lots of fiber to keep your blood sugar happy and stable. You can have the flaxseeds, oat bran, sunflower seeds (although they have some oxalates, use less of them) Almonds are high so you can sub pistachios and pecans or pumpkin seeds. Yes- some of these nuts will have oxalate but it is so much less. Use the list that is on this site so you see safer options.
DO YOU KNOW HOW HIGH YOUR OXALATE LEVELS ARE? DID YOU DO A 24 HOUR COLLECTION? Let me know. This tells me how strict we really need to be with your oxalate intake has to be.
You need to eat foods that you can tolerate now due to treatment, keep your blood sugar down, and watch oxalates. I get it and can help. Give me that info and we can go from there.
It might be worth a phone call to me too, as this is complicated and it is hard over email. You can email me at jharris1019@gmail.com if that sounds like something you would like to do.
Write back or call-
Very best,
Jill
I had kidney stones and I am.listcregarding the diet I have to have from now in
what kind of breads can I wat??
tk you
sylvie
Dr. Fred Coe, Jill Harris: Thanks, For your help in understanding the pathway to Kidney Stone Prevention. I came across your articles after a random Internet search. After having various “kidney stone” incidents over a 15 yr. period. It became evident, no one, was helping me understand how to “prevent” future kidney stone incidents, (primary care doctor, urologist, nutritionist). Aside from giving me conflicting dietary restriction handouts, I received mainly “crisis intervention” With out a doubt, there is a lot of info. to digest in your articles. I am just now, understanding how to be a “successful patient” I am currently working with a nephrologist, We are in the process of understanding the “cause” of kidney stones in my case, through (urinalysis), So I can work toward “prevention”. My nephrologist was very encouraged, when I mentioned your name, He asked me “is Fred Coe a friend of yours?” I replied “no” “I have been reading the info. on his website” Things instantly started to “click” between myself and the Dr. at that point! I plan on using the info. you have provided, in the future, as a “guide” to work toward “stone prevention” For now I have three specific questions: Is “Wheatgrass” a known “high oxalate” food source? Should it be avoided? What is the best info link to access the “Harvard” list of low-oxalate foods? Thanks a Million, James J.
Hi James, The article by Jill Harris on how to eat a low oxalate diet links directly into the two spreadsheets. But it is not just oxalate, as the successful patient article mentions. Be sure and read this one. Regards to you and your nephrologist, Fred Coe
Hi, that list does not contain wheatgrass and I have scoured the web to try to find the oxalate level. It seems like it’s never been tested. Do you have any idea about this? I ask because I like fresh wheat grass chopped up on salads, etc. Thanks!
Hi Lori, You must be referring to a comment to Jill Harris as ‘FOODS’ is one of her domains. I am sure she will respond. I do not know which list you refer to but she will. Regards. Fred Coe
I know this is an old thread but I was wondering about whey protein. There seems to be some controversy surrounding whey. Im a personal trainer so I recommend it a lot to my clients and I was wondering what the downsides of if are and if perhaps something like pea protein might be a better choice.
Hi Scott,
There is no real evidence saying that whey protein increases risk of kidney stones. But I push back on trainers (I lift weight and o eat protein, but the amount I need and not over) for asking patients to eat super high amounts of animal and seafood protein as that CAN increase risk of stones. Here is one of many studies done on high protein diets and kidney stone formers.https://pubmed.ncbi.nlm.nih.gov/12936953/
Thanks for writing. I am about to start the ISSA program to get certified. I love training so much and figured why not!
Jill
Hi Lori,
I do not have a reputable source to give me good values for wheatgrass. I would use it here and there and lessen the portion. If you have it with a glass of skim milk, then that will help too.
Warmly,
Jill
I have recently re-adopted a lowfat, low sodium, vegetarian diet after emergency gallbladder surgery on 2/14/16, and passing a kidney stone 2 weeks later. I have lost 12 lbs., my cholesterol levels look better, and I have cut my blood pressure med in half (under dr. care). I have been a stone former for at least 30 years. The stones are calcium oxalate. My most recent 24 hour urine oxalate levels are 41 (2015), 33 (2014), and 27 & 34 (2009). Calcium levels are 188 (2015), 185 (2014), and 254 & 286 (2009). I am anticipating that the new nephrologist I am seeing tomorrow will order a new 24 hr. urine. I have adopted my current diet plan for several reasons – post surgery I have had a harder time digesting animal fat, I had been reading Dr. Joel Fuhrman, Dr. Michael Greger, and Dr. McDougall who say that a plant based diet is best for all types of stones, I feel better eating this way, and I wanted to improve my heart health (family history of heart disease). I am lactose and gluten intolerant. I have looked at the oxalate list and noted that I am eating very high oxalate foods daily, such as beans, brown rice, nuts, and some veggies and fruits. Is it possible to eat the way I am eating in a healthy manner and eat low oxalate? Also, since I am lactose intolerant, can I get enough calcium on heavily plant based pescatarian diet? I do eat salmon, and have some kale every day in a smoothie. Additionally, is it safe for kidney stone formers to supplement with vitamin D3? My last two labs have shown levels to be low – 247 and 24 – and my doctor wants me to supplement D3 with K2 1000-2000 IU daily.
Thank you for your help!
*my vitamin D level should say 27 and 24, not 247!!!
Hi Carla, I gather your diet was adopted because of food intolerances and issues after gall bladder removal. If this diet suits you, I see no reason to not use it. No trials support vegetarian diets for stones, but certainly some forms of vegetarian diets may benefit urine stone forming factors like calcium and oxalate. To get adequate absorbable calcium from all plants is not necessarily easy. I think your urine calcium may be high – given the results you send along, and low sodium diet should be beneficial. Given 30 years of stones, perhaps your new nephrologist might want to offer more than just diet. A new 24 hour urine is a good idea, and you should look at the supersaturations now compared to prior years and ask if they are falling; you will need to lower them, one way or another, if stones continue. Regards, Fred Coe
Hi,
The next step for me to try to reduce calcium excretion and supersaturations is to lower protein intake. Some sources specifically recommend limiting animal protein (e.g. NIH), others speak of limiting total protein. Frankly, substituting plant-based protein for a part of the animal protein would make a large reduction much more palatable.
Protein seems to have to be a myriad of impacts. E.g. excretion of calcium, phosphorous & citrate, absorption of calcium, effects on urine pH, and the effects of sulphur-containing amino acids.
Question…Can you please tell me about the differences between consumption of animal and plant-based proteins when it comes to calcium stone risk?
Also, do you have dietary guidelines for each?
Thank you. I will greatly appreciate any help you can offer to sort this out!
-Al
Hi Al,
The difference between animal and plant protein is that the plant protein will not produce an acidic urine and animal protein does. Why do you care about that? Stones love forming in your urine when it is acidic.
You should aim for meeting this equation for your protein needs: 0.8 to 1.3 gm/kg/day. Many people who are doing high protein diets are increasing their risk of forming new stones. There is also the problem of eating a high salt diet. This will definitely increase calcium consumption, so please be aware of this if you are not already. You want to aim for about 1,500 mg/day of sodium.
Hope this helps-
Jill
Hi Jill,
Thank you very much for your reply. Actually, urine pH is a big concern for me. My doctors have no explanation for this: My urine pH was 6.8 in my baseline supersaturation test. Then it rose to 7.1 when we tried 20 mEq of potassium citrate, and 7.3 when we tried 40 mEq. That coupled with Olympic-class calcium excretion raised my SS Cap to 2.44 even when passing nearly 4 l/day! Chlorthalidone has helped a bit. I have also been reducing salt, but unfortunately that hasn’t made a dent in this. So I’m working on protein and salt together now-Dr. Coe’s helpful suggestion.
I’m starting to wonder if animal protein could possibly be better than plant in my odd case…?
-Al
Hi Al, I gather you have a very high urine calcium excretion and an alkaline urine pH. Potassium citrate may not be an ideal treatment. Chlorthalidone is indeed an excellent treatment if combined with low diet sodium. But if these together do not work, perhaps you have something more complex. Be sure and do followup measurements: If urine sodium is as low as 65 mEq daily and you are taking chlorthalidone and protein intake is not more than 1 gm/kg/day (PCR gives this) and your urine calcium remains very high along with a high supersaturation for CaP you need expert consultation to rule out some systemic causes. I am sure your personal physicians are already aware of all this, and they will be able to do what is needed. Regards, Fred Coe
Jill:
Dr. Coe has told me about a website for low sodium, but high calcium dairy products (Cheeses). Can you point me to the right web site? Thanks.
Hi Bob-
I am not quite sure of which website he told you to go to. He will reply to you, but I do know that you must go “low salt” on all your dairy products. Many dairy items now come in “low salt” versions. When you go grocery shopping look for items that say low salt, but also make sure they really are. Many claims that you find on packages are false. You want to eat meals that contain around 500 mg/sodium/meal. This divides your sodium throughout the day nicely. Of course I realize that life is not perfect. You may eat more salt at lunch, but then watch it for dinner…..
Let me know if you have more questions-
Jill
Jill,
I’m Diabetes Type 2 and last tests showed too much Oxalates in my system. I’m cutting way in high Oxalate foods in the chart and I’ve eliminated nuts as a snack. I also saw that Shredded Wheats were high in Oxalates. I’d been eating it for breakfast because of no sodium, sugar. I have 2 questions: 1) Should I switch breakfast to Cherios or Special K. (Low Sugar and Sodium, lower Oxalates? 2) Do you have an idea of how many oxalates there are in Matzo? I’ve been eating it with a cream cheese spread to boost Calcium.
Hi Bob,
Good to hear from you again. I would definitely switch to the other cereals. Wise choice. Also, if you are talking about Matzo crackers they must be on the higher side as they are made of white flour and water. That is it. So I would eat them sparingly.
Let me know what value your oxalate level was and we can see how low you really have to go on your oxalate foods.
Warmly,
Jill
My number was 140. I’m increasing Calcium intake with sour cream, cream cheese, and various low to medium sodium cheeses in salads. I’ve cut out nuts as snacks and am switching cereals from Shreaded Wheat to Cherios.
I’m also cutting back on sweet potatoes from once or twice a week to every few weeks. I let myself eat whatever I want within reason once a week. Should I do more? We’re testing again in a month.
Thanks for getting back. That oxalate level is very high, so you need to cut back as best you can. You sure the oxalate was 140? Jill
Hi Jill,
I have a bit of a puzzle here. I’ve painstakingly calculated the sodium, calcium, and protein in everything that goes in my mouth the day before and day of two recent supersaturation tests. I even know where our tap water comes from, how much salt it reportedly contains, and how much I drank.
But when the supersaturation report comes back, the Na 24 has been a full 1/3 higher than my calculated intake for the day. I was expecting a much closer match. By the way, the creatinine variation from test to test (as a sanity check on the tests) is just 6%.
For example, I calculated 90 and 100 mEq intake for the day before and day of, and the Na 24 result was 134 mEq. I’m not sure how long it takes for sodium to make its way out, but although I didn’t calculate sodium for the week before, I hadn’t eaten out and would not expect a wide variation.
Thank you in advance for any ideas on what I may be missing, or suggestions you may have!
Best regards,
Al
Hi Al, calculated sodium and urine sodium of 100 vs 134 is pretty good! Sodium balance integrates over a 4 day average, so it is possible you saw a bit of carryover from the day before your last calculation (day -3). I am pretty happy with your calculating, given the general averaging in the system. Regards, Fred Coe
Hi Dr. Coe,
Thank you for the helpful info and encouragement! It’s good to know that just one, possibly unknowingly, very salty meal isn’t going to dump out all the sodium at once, hopefully limiting the stone risk somewhat. I also read “Control of Urine Oxalate Excretion” with interest. And although much of it was over my head, there were plenty of precious nuggets. For example, the point that with sufficient daily dietary calcium, a single high oxalate meal is not likely to affect stone risk.
As you might guess, I am also very interested in how the effects of intake of calcium and protein are averaged. These are probably don’t only have an effect in the hours immediately following a meal either.
Question – Do you happen to also have any data on the period of time over which calcium and protein intake have their effect on supersaturations?
In other words, are the greatest effects of calcium and protein intake seen in the hours immediately following a meal, or is there more of an averaging through the day, across several days, or something more complicated?
Best regards,
Al
Hi Al, You are a great reader! Thanks. Calcium losses rise immediately with food whether there is calcium in the food or not. So if there is no calcium in the meal, bone must donate it to keep the blood calcium constant. Raw calcium, like in supplements, but without nutrients, raise urine calcium immediately but it is not clear that bone will use that calcium. It is a real stone risk. We do not advise using supplements except as part of a meal. Protein raises urine calcium immediately, like any other nutrient. So there is no averaging over days, just a peak with meals, and a general decline over a few hours. It is very complicated but not in terms of time averaging like sodium. The message: Get your diet calcium when you eat food. Best, Fred
Thank you so much, Dr. Coe. That is incredibly helpful!
While we’re on a roll…Any thoughts on what side effects drinking an extra liter of water per day might have on both 24-hour Ca excretion and urine pH?
(I’m guessing there may be significant variability depending on the kind of IH.)
Best regards, Al
Hi Al, water has no known effect on urine calcium excretion but may increase urine pH. These are not certain comments, as our newest research has uncovered some odd effects of water – but all in a direction that would reduce stone forming. Regards, Fred
Hi Dr. Coe, Stumped again! I thought testing the benefits of a low protein diet would be easier. I did a pair of new supersaturations – one with my current typical diet, and one with low protein vegetarian meals the dinner before and all day during the test. I worked hard to keep other factors such as volume, Na 24, etc. constant.
The normal diet with 1.35 g/kg protein yielded a PCR of 1.4. The low protein vegetarian diet with 0.85 g/kg of protein only dropped PCR to 1.2.
I was expecting a much smaller PCR. Any idea what I may be missing?
Thx again, Al
Hi Al, many vegetable sources have a lot of protein. PCR is derived from measurement of urea nitrogen, and if you had suddenly reduced your caloric and protein intake you might have been catabolizing your own protein stores which will produce urea, in other words it is as if digesting protein but really using up your own. Hard to tell which. REgards, Fred Coe
Hi Jill,
Before CaOx kidney stones began, I looked for healthy high protein snacks with a minimum of empty sugar calories, trans fats, and saturated fat. ½ oz of low salt peanuts offered a long lasting, high energy snack. But nuts pack a lot of protein (Dr. Coe explained I need to limit protein), as well as oxalate.
“How To Eat A Low Oxalate Diet” is exceedingly helpful. However, do you happen to have a few healthy, kidney-stone-friendly snack suggestions beyond the every faithful apple up your sleeve?
Thanks in advance, Al
Hi Al,
Considering the time of year I think low oxalate fruits might be a good fit for you. Take a look at the list and pick a banana, some berries, or melons. Ditch the apples til fall!
Other snacks that you may enjoy would be yoghurt if you like it. You could even sneak a few higher oxalate fruits on top of it as you are getting calcium with the yoghurt that would balance the oxalate in it.
Lower salt cheese (including cottage cheese) would be good as well. I know you are watching proteins, but remember you just have to watch your portion sizes on your food, not so much the food itself.
Nuts are such an easy portable snack, it is a shame to totally go without. If your oxalate levels are totally high really avoid them, but if not, have a few here and there. Drink lots of water, eat them with some other food that contains calcium and you CAN still enjoy them.
Hope this helps, even a little-
Jill
i have a history of kidney stones. I have had surgery 4 times. Someone recently recommended taking liquid magnesium daily to dissolve the stones. I have 3 right now. What is your opinion of liquid magnesium for kidney stones?
Hi Sara, Magnesium oxide has been tried as a stone prevention with negative results. I cannot recommend it. Try a more organized approach and see what is wrong then what can be done about the problem. Regards, Fred Coe
For a patient with a high urine uric acid (0.983), high UUN (19.68) and PCR of 1.8, what would you recommend they limit their protein consumption to? I seem to remember reading 1.2 gm/kg somewhere on this site, but I can’t find that now. And, that is just in reference to animal protein, correct? Thank you!
Hi Natasha, Protein loading raises urine calcium. The article is not quite finished but it is good enough to answer your question. I think 1 gm/kg/day of protein is recommended as ideal – see the article. Plant proteins seem to impose less of an acid load but frankly looking at the data it is very hard to see much difference from animals. You eat a lot of protein and perhaps might want to discuss less – unless your physicians have a special purpose in mind. Regards, Fred Coe
Sorry, along with my earlier question, is there somewhere you can direct me to read about why excessive protein consumption leads to kidney stones in some? Thanks again!
Thanks for all this info.
I have had 2 kidney stones. One was tested, it was oxalate. My Dr has me taking TUMS twice a day as a prevention to stones forming. I haven’t read this anywhere. Any thoughts ?
Dear Miriam, Although you are posting in the foods area that Jill runs, I thought I would respond. There are several reasons for Tums, the most obvious being that your urine oxalate is high and your physician seeks to lower it. High calcium intake will lower urine oxalate, but the calcium must be timed with the main meals that would contain the oxalate. I imagine that this treatment was preceded by a complete evaluation; ask your physician if I am right or there is another reason for the calcium supplements. Regards, Fred Coe
Thank you Dr. Cole as this website has made a significant difference in my diet. You have provided much information and comfort in the past. have not had any stones in the last six months; I had four stones the first 4 months. I have increased my water intake this last year and take my meds (HCTZ and K Citrate) but it is my diet that has changed the most. So I am hopeful that the stone fragments (MD also mentioned dust/particles) will not grow into full size stones. Also, I hesitated to have another lithotripsy (this summer) and was surprised to hear my MD state in October that the KUB (using a new machine) shows the 5-7 mm stone to be an ovarian vein phlebolith! For the first time this year no procedures were recommended and for that I am very grateful. My question, do you have any special tips for the Thanksgiving holiday weekend regarding diet? I do plan on having the traditional meal of turkey, stuffing, sweet potatoes, cranberries, and pumpkin pie. I have avoided these foods including potatoes, beans, breads, oranges, raspberries, etc. for the last six months. I would like to enjoy the day. Is there a way to pair these foods with a diary product? Thank you so much. Judy C
Hi Judy,
Many congrats to you doing an excellent job on your dietary changes. It is hard, but you did it. WOW! For Thanksgiving, eat whatever you want, just watch the portion sizes. Enjoy the day and when you get up on Friday go back to your regular routine. You will be just fine and also happy you enjoyed your holiday treats!
Happy Thanksgiving!
Jill
Jill, are cranberries and pumpkin high in oxalate? My daughter wants to make cranberry bread, muffins (using oat flour), and cookies. Also, can ice cream or whip cream lower the affect of eating the pumpkin pie if is high in oxalate? We are actually eating three Thanksgiving meals…a lot to be thankful for but I want to reduce the effect of oxalate. I am trying to pair them as mentioned by this website. Thanks, Judy
Hi Judy,
Eating ice cream with your pumpkin pie would help oxalates. There is a PubMed study regarding cranberry juice that says it increases risk of CaOx stones, so we can safely assume that cranberries themselves would pose a risk. I am not sure of pumpkin as there are contradictory pieces.
I understand that you have three Thanksgivings. I would eat very gingerly, and be mindful of portions at each of them.
Jill
Thank you Jill. I will avoid cranberries and limit my pumpkin pie/ice cream consumption. Regarding fast foods on the list, Pizza with Cheese is considered very high. I was surprised as I thought the cheese (calcium) would offset the crust/tomato sauce (oxalate). Would Margarita pizza (thin crust) be acceptable if I had more cheese on it? I noticed that Dr. Cole said we could have a half of tomato. Also, I would remove the basil as I am not sure if it is high or not. How about Canadian bacon and pineapple? Is there any kind of pizza you can recommend? This is for the one day a week when I am off my low oxalate diet. Thank you. Judy
Having a piece of pizza is not going to send you to the ER. Have it and enjoy! Remember that you can eat some oxalate, just keep it under control.
Jill
Hi,
Can you please tell me if it is feasible to alter urine pH significantly, say by 0.25 or more, with diet alone in order to help optimize for bone health and stone risk?
I found a list of foods that promote acid or alkaline urine in Davis’s Drug Guide. Prunes, for example, reportedly acidify. But there is no indication of the relative effect of a serving of, for example, acidifying meat, or corn vs. a serving of alkalinizing milk or squash. Any idea where I could find that info?
Thanks in advance!
Al
Hi!
I am not sure of where you could find that info. I think you are asking if there is a source that could tell you how much per portion is a food going to lower or increase your pH level. Is this right? If not please let me know but if it is my answer is- not that I know of. I definitely think you could alter your pH by .25 by food alone. Dr. Coe will correct this if I am wrong…
Thanks for writing-
Jill
Ideally, yes. But really any clues about how acidifying or alkalinizing various common foods are could be useful. I can’t imagine that the effect of a serving of prunes would be close to that of a serving of chicken, for example. I agree that info is hard to find, but thanks for trying!
Just closing the loop in case anyone is interested: I did find study with a great deal of information to start from, “Potential Renal Acid Load of Foods and its Influence on Urine pH”, Remer and Manz, J. Am Diet Assoc. 95: 791-797, 1995.
Thanks again for your help!
Al
Thanks, Al, I know this paper and many more like it. For patients with too alkaline a urine pH I have no published experience using diet successfully, although in principle it should work. Regards, Fred
Hi Al, there is no real way to lower urine pH effectively. Is your urine pH too high? That would mean you are forming calcium phosphate stones. Regards, Fred
Thank you for your reply! Yes and yes. Innately high (7.0-8.0). Maybe I’m over simplifying, but how about this as a research idea? Prunes reportedly acidify and bananas alkalinize. Both are low in protein and sodium, high in potassium-all good. So it seems that urine pH should be reduced if one substituted a couple servings of prunes for bananas. Of course the question is by how much.
Then one could measure the effect on both pH and Ca24 and check the net effect on Cap SS. And if Ca24 shot up, that would seem to be a red flag for bone risk. Thoughts?
Best regards, Al
Hi Al, I do not know if that will work. I presumed before and now that the high pH is a direct cause of stones meaning your stones are calcium phosphate. Usually such stones are prevented by means other than lowering urine pH, and if I am right about the nature of your stones I would be sure my treatment regimen was lowering calcium phosphate supersaturation enough to prevent more stones. I do this all the time and have no magic way to lower urine pH. Warm regards, Fred
Thanks for such an informative and helpful website. I have a comment and a question. Comment: I changed my diet last year to include more almonds (my stepson grows them) and sweet potato chips (instead of potato chips) only to have some of the worst kidney stones of my life. It turns out both almonds (and many other nuts) and sweet potatoes are very high in oxalates. Needless to say, I’ve removed those almost completely from my diet. Question: This experience led me to the work being done on Oxalobacter formigenes. I’ve looked everywhere for a commercial source of this probiotic. Can you direct me to a source? Thanks!
Hi Dave, Sorry! Oxalobacter has not proven much of a treatment, nor am I totally sold on the oxalobacter story as science. One can take it but the bacteria die off right away as they have to have oxalate to survive and we do not eat enough for them to compete against more capable bacteria. In fact, if you raise your diet calcium, and do even reasonably with diet oxalate you will have reasonably well controlled urine oxalate, so be sure to do this and get 24 hour urine followup measurements. Regards, Fred Coe
OMG….I’m so lost with this. I have diabetes 2 and now with the kidney stone things that ci could have such nuts I can’t with those darn stones. For 2 years I have been telling my doc something is bothering me on my left side . Pain would come so strong that I could not breath but then time passed and now the uncomfortable pain come and go nothing major. Doing some blood test I was asked to see a kidney doc , then ultrasound and ct scan done. the ct scan shows left kidney with within the renal pelvis 2.2×1.3×2.3 cm ( what hag is this measurement !!!) 3 adjacent 4 to 5 mm calculi in the lateral midpole cortex. Several calculi in a lower pole calyx largest measuring 10×3 mm( another crazy measurement ..what this mean ? 10 times 3mm?. saw a urologist he said the stone is too big for the shock wave …..need to do a ureteroscopy. I’m not in pain , is there anything I can do to remove it naturally? for me doc saw dollar sign…..sorry doc I’m just so confused and afraid
Hi Renata, It sounds like you have stones with a large one in the left renal pelvis and smaller ones as well, but none you mention on the right. There are plans for removal because of pain. The big issue is proper evaluation for the causes of these stones and a proper prevention plan. This should precede the surgery if possible because if you have major stone forming abnormalities new ones may form before treatment can be put in place. After surgery you must wait until you recover fully before you can be tested properly. Here is an overview of how to proceed, and here is a more detailed plan. Regards, Fred Coe
Urine testing indicated I needed to be on the low oxalate diet. Started a week ago, and doing ok oxalate-wise. Using only “low” and “little to none” oxalate foods from your lists. So really minimal oxalates per day. I also use the App “MyFitnesPal” to track the other nutrition, including fat, sodium, sugar and calories aspects. It shows that I am getting only a tiny fraction of the recommended (300 of the 3600 mg) potassium goals. Will that become a problem? If so, I can up the oxalate counts, but which foods higher oxalate foods would you suggest that are PACKED with that nutrient and still keep me within the 50 oxalate goal zone daily? (BTW, your website and your and Jill’s passion are phenomenal!!!)
Hi Marty,
Do me a favor. Get a copy of your results and see how high your oxalate is. Maybe you don’t need to eat such a low oxalate diet. AND!!! You also can eat more oxalate if you get your calcium requirement. Adding yoghurt, coconut water, and a banana can add up to about 1,500 mg/potassium with just those three low oxalate items.
Get your daily requirement of calcium, typically between 1,000 and 1,200 mg/day (depending on age), and you can eat much more oxalate. Of course you must eat the foods together, don’t forget that. You can’t eat some yoghurt and then two hours later eat some almonds. You must eat them together, so the calcium and oxalate will bind together in your gut and leave through the stool.
Get your results, look at your oxalate 24 hour values and go from there. We are here if you need us.
Jill
The stone was Calcium Oxalate.
SS CaOx = 10.39
Urine Calcium = 396
Urine Oxalate = 41
Urine Citrate = 784
Thoughts?
SS CaP = 1.72
24 hr urine = .44
Urine Uric Acid = 0.721
Hi Marty, I am also answering. You have markedly increased urine calcium, borderline high oxalate and high SS CaOx and CaP. If there is no systemic cause for the high calcium then it is a perfect fit for the treatment approaches for idiopathic calcium stone formers. Take a look. Regards, Fred Coe
I was just told that my latest stones were again 80% uric acid and 20% oxalate. After blood work and a 24-hour urine analysis \my doctor said my citrate level was very low and my oxalate level was very high. He wants me to take potassium citrate and to follow a low oxalate diet. He said I should have blood work done 2-3 weeks after starting the potassium citrate. I could not swallow the potassium citrate tablet. It got caught in my throat and dissolved there burning as it did. I wanted to crush it but it is time-release and I was advised against it. I spoke to the pharmacist and then to my doctor and a liquid form o the medication has been prescribed but there is an insurance glitch so I haven’t received the med as yet. I am leaving the country for a 3-week stay in only 12 days and the doctor wanted me to be on the med and to have the blood work done before I leave. I don’t know if this is going to happen if I cannot get the med.
In the meantime, I am following the low oxalate diet. I am already a picky eater and have been dieting (losing over 60 pounds in the past 16 months). The low oxalate diet has cut my food choices even more. I had been trying to eat healthier grabbing nuts instead of chips and now nuts are out too. I know that calcium is helpful but calcium is difficult for me to add. I have an issue with eating much dairy and I do not care for most other foods that contain dairy (like kale). Some other foods listed as high in calcium such as almonds are also high in oxalate. Any suggestions as to how to increase calcium intake?
I am drinking water like crazy. My doctor has recommended that I also drink lemonade. Does it matter what kind? Some lists I have seen say lemonade should be limited or that lemonade from concentrate should be avoided. It gets very confusing.
Kate
Hi Kate, Uric acid stones have nothing to do with oxalate and everything to do with low urine pH. Low oxalate diet is almost certainly unimportant unless your urine oxalate is quite high – take a look here. On the other hand alkali matter a real lot and your physician is right to worry about travel without treatment – uric acid stones grow fast and can be large. Crystal Light contains 20 mEq of potassium citrate per liter, so you can use it until medication comes along. Low urine pH that causes uric acid stones is worsened by all forms of insulin resistance: obesity and diabetes and metabolic syndrome – points of information for you. Regards, Fred Coe
Kate,
It is very confusing indeed. You might want to consider taking the course that I am doing to educate patients on their treatment plans. The next one is starting very soon – jillharriscoaching.com/course.
It will help immensely. Safe travels-
Jill
Dr. Coe,
Is magnesium carbonate safe in terms of not promoting calcium oxalate stone formation? The product below has magnesium and citric acid in it and looks like a tasty lemonade drink, so I bought it, but now I am wondering about the main ingredient in it, magnesium carbonate. (I already take magnesium citrate and potassium citrate daily to prevent further calcium oxalate stone formation.) https://www.iherb.com/pr/Now-Foods-Magnesium-Inositol-Relax-Lemonade-16-oz-454-g/73624
Hi Mark, Magnesium carbonate is an alkali much like magnesium citrate. It has never been tested as a prevention agent. PLease be sure you need citrate, and that you know all that is wrong. Here is a good plan you might consider. Regards, Fred Coe
I need help!! Two days ago I had 4 stones removed from my left kidney 5mm, 2X7mm, and 3mm. There are smaller ones as well, and a CT Scan showed more forming in my right kidney. In 2015 I had many removed from my right kidney. I had a urine study done in 2015 and my results were:
Urine Volume 3.33 liters, SS CaOx 2.0, Urine Calcium 160, Urine Oxalate 25, Urine Citrate 910, SS CaP .78, 24 hour Urine pH 6.912, SS Uric Acid .04, Urine Uric Acid .448 (Litholink – the 2nd report was similar)
The lab report said my stones in 2015 were made up of Calcium oxalate monohydrate 55%, calcium phospate 30%, and Magnesium ammonium phosphate 15%
This has been a very disheartening and painful few days. I’m not getting accurate info I feel.
Hi Michelle, Your older stone contained struvite 15% that forms only because of infections. A lot is calcium potassium phosphate and your urine pH is very high. Your SS CaP is low only because of the enormous volume and I suspect that volume is not how you always are. So I would lower my urine calcium from what it is to lower with low sodium diet. Take a look. You already have a high veggie fruit intake – alkaline urine, but be sure about high calcium and very low sodium. If needed, thiazide can be added. You are not stone free despite the urine finding meaning you need to do more and probably gaps in hydration let stones form. Water alone is rarely enough. Best, Fred Coe
I make calcium oxalate stones and watch my diet. In fact, I was a patient many years ago and printed out lists of high oxalate foods to avoid. I have avoided coffee, black pepper, strawberries, blueberries, for years. In looking at your list, it appears that I can have several of the foods I have been avoiding. Has there been new research to show that these foods are not high in oxalate? Here is a current article that still shows that blueberries and strawberries are high and should be avoided. I’m very confused.
https://www.livestrong.com/article/155502-foods-high-in-calcium-oxalate/
Hi Sherry, It is about amounts and also the nature of the patient. Do you need to limit oxalate? The lists on the site are about as good as we can get in that they were edited by a noted authority on oxalate and began at Harvard as pretty good before that. Livestrong etc is one of many sites proposing oxalate lists, many of which conflict with one another. But for you the big question: Have your been fully evaluated?. Does your evaluation point to oxalate as a main problem? How much can you do with a proper kidney stone diet? The last thing is reducing diet oxalate as a special pursuit. Regards, Fred Coe
Hello, thanks so much for such a comprehensive dedicated site> I eat a lot of other foods not listed and wondered about things such as coconut cream and Indian flour such as chick pea flour and herb teas. I note hummus is fine so I presume so is chickpeas, but given orange juice is ok but not oranges themselves I am a bit confused as well !!
kindest thoughts
Jude
Hi Jude,
Hummus is listed as low, but notice the amount and portion size. If you eat enough hummus it will add up so be careful. Chick peas as long as eaten in normal portions should be fine. I would assume that the pith will have oxalate in the orange and also the juice may be diluted as well so that all matters.
If you eat things in normal portion sizes (normal being the key word) there are so many fruits and veggies one can still eat. Do you know if your oxalate is high? Have you done a urine collection to see?
Let me know-
Jill
Thanks so much Jill…I am on my 4th admission to emergency with Kidney Stone attack (over about 4/5 years) …I haven’t been given an oxalate test but I go back to the drs tomorrow and hoping, now I have looked at your site , to get better information and tests.
I’ll come back when things are clearer thank you
kindest thoughts
Jude
How much oxolate is in black eye peas
I will hope Jill will answer this one. Fred Coe
Hi Nino,
I don’t have a reliable source for this food. When I don’t, I give this advice and it has been without a problem for many years: Eat the food in normal portion sizes and once a week!
Best,
Jill
how many oxalates are in oatmeal?
Thank you so much for the help. I haven’t been able to find anything on Google to give me an oxalate value
Dear Lisa, Essentially none. Regards, Fred Coe
What a great site! I have been a past patient of Dr. Coe. (many years ago) He diagnosed me with medullary sponge kidney complicated by idiopathic hypercalciuria after 2 episodes of stone formation. I currently take Indapamide 1.25mg along with Vitamin D 1000iu. I am having a problem getting my daily requirement of calcium. Could I take a calcium supplement to help me reach my daily total. I understand this supplement has to be taken with a meal. I am a 64 year old postmenopausal female who has osteoporosis. Once I get this sorted out I will need to work on my sugar intake. I had no idea sugar mattered in stone disease! Any advice would be greatly appreciated.
Hi Melanie, How nice to hear from an old patient and gather that she has been stone free all these years. Supplements are a mediocre swap for foods, but if you need them use with meals, never alone. Low sugar is wise and also against stones. Hypercalciuria can cause bone disease, incidentally, something I did not understand as fully when you knew me. Proper calcium intake is most critical, and as low a sodium intake as possible. Regards, Fred Coe
I am slowly and carefully making my way through this priceless site. I am 80 yoa, just had my second stone in 5 years (80% oxalate monohydrate, 10% uric acid and 10% calcium oxalate dihydrate). I got the message: proper hydration, avoid totally those food items you have identified as Very High in oxalates and, per my doctor’s suggestion, I take 500 mg of calcium citrate each evening at dinner when I am most likely to ingest food items with oxalates. If I occasionally have something which is high in oxalates, I’ll accompany it with a 6oz glass of milk. My question is, does the advice to drink cranberry juice for general kidney health, which one finds everywhere, an old wive’s tale or is there any validity to it?
Thank you
Hi Carl, cranberry juice is not a known benefit and can lower urine pH. Given uric acid in stones your pH is already too low. So, no. I would repeat a 24 hour urine on your new regimen and if the pH is below 5.5 consider additional alkali – perhaps more fruits and veggies. Regards, Fred Coe
Many sources say that Special K Red Berries is a lower oxalate cereal alternative, but I was wondering how some of the newer Special K varieties rate on oxalate (e.g. Blueberry w/lemon clusters, fruit and yogurt, protein-cinnamon brown sugar, nourish-peaches and berries w/yogurt pieces, etc…).
I’m trying to keep my daily oxalate <100 (or weekly <700 if I have a day when it is too difficult to avoid without significantly increasing my sodium intake-I travel frequently). I also aim to drink 100+ oz of water/day (I'm 5'1, ~130lbs).
Also, I love the Chobani Greek yogurt flip cups, but the only kinds without chocolate or nuts seem to be the key lime crumble (it does have while chocolate) and peach cobbler flavors. Did you think there is enough calcium in the yogurt to cancel out the oxalate in the varieties that do have chocolate/nuts?
Thanks in advance for your guidance!
Hi Toni,
We don’t have recent studies discussing the new cereals. But if you have a normal portion size with milk you should be fine. As far as those yogurts go, they are filled with sugar (the flip ones). Yogurt winds up being as bad as a candy bar in many cases. Can you do a low sugar yogurt like Siggi’s and add your own whole fruit? That would be best.
Be well,
Jill
Hello, thank you for this website, it is an invaluable resource.
I’d like to clarify the oxalate content of berries and their risk factor for stone formers. Almost every website lists them as a major “no no”. However, the oxalate spreadsheet offered on your website (featured here: https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/ ) would indicate they aren’t very high in oxalate at all. I am curious to know – who’s right, and why such a large discrepancy on the topic? Is this a case of old/new studies in contrast, differing mechanisms of testing/metrics, or are their other factors besides oxalate that make berries “dangerous”? Thank you.
Hi Justin,
Most list agree that raspberries are high. Harvard (the one we use and cite here) says that blackberries and blueberries are lower. I can assure you that one of the reasons we promote and use the Harvard list is because our patients do indeed lower their urinary oxalate when they follow this list and all the advice on how to use the list and eating enough calcium.
Hope this helps-
Jill
Thank you for this website. I am learning so much. However, I do have a couple of questions. I haven’t seen much about oatmeal or steel oats…are either of these low in oxalate? Also, I am very confused after reading your lists as to what flours are low in oxalate? I find they conflict and am frustrated when grocery shopping. Occasionally, I would like to to have a sandwich. Is there a bread made with the correct flour and/or do you have a recipe to make a sandwich bread?
Hi Ann,
Make sure you download the oxalate list we use here from Harvard. They list the foods you are asking about. You can certainly have a sandwich, pair it with some calcium and you are fine.
Be well,
Jill
I am a new kidney stone patient who is trying to maneuver this world on my own. I have seen a urologist and done the 24 hour collection but was sent away with vague instructions. I will see a new doctor once I pay down some medical bills from the trip to the ER but for now, I have two main question…my treatment plan based on the urine analysis was to 1) increase fluids 2) start K-cit 15 for low citrate (454) and high pH (6.484) and 3) reduce animal protein. I am finding mixed information on whether milk and yogurt are considered “animal protein” and am also wondering if I HAVE to take pills, they are expensive! Would lemon water suffice? Desperately wondering. Thank you so much.
Hi Daniela, the 24 hour urine is just part of the planning. Here is a good overview of what to do. Animal protein is not relevant, just eat what is commonly recommended for everyone. There are lots of alternatives to the pills. The easiest is to eat the right amounts of fruits and veggies – 5 servings a day; your urine citrate is only slightly low. Finally, as you seem confused, this article may be of help. Regards, Fred Coe
I have question about being on a low oxalate diet and a Gluten free (or Gluten reduced diet).
Many of the flours used in GF baking are made with brown rice flour (high oxalate) or white rice flour (moderate oxalate).
Do you have articles, references, or advice how to combine both diets?
Thank you
Hi Gail, Because low oxalate diet is often not needed, be sure you need it. Prevention is a lot more than low oxalate diet – take a look. Gluten sensitivity is rare – almost no one needs a gluten free diet according to gluten experts, and such diets are poor nutrition. Be sure you have a real need for it. Regards, Fred Coe
Dear Dr. Coe,
Thank you! I have found your website to be a wealth of great information! I am a 44 yr. old, male and suffered two calcium oxalate kidney stones (same event) from following an extreme Atkins diet for 3 weeks back in 2003. One dropped in 2003 at that time and second in 2006. Never had stones prior. 2006 event caused trip to hospital due to the pain.
Recently, I had been eating a higher protein to carb ratio (approx. 1 month) and drinking solely alkaline water (ph of around 9.0 – EvaMor water), 48 oz per day for about 10 days. I then started to pass small stones (less than 2-3 mm); composition: 55% calcium phosphate; 25% calcium oxalate monohydrate; and 20% ammonium acid urate. For diet during this time, I would have a ½ cup of cottage cheese for breakfast, along with 2-3 hardboiled eggs. For lunch, a very large 4-6 cup salad of mixed greens, 1-2 Tablespoons of olive oil (without vinegar due to acid reflux) and maybe a 2/3 to 1 breast of chicken. For dinner, usually about 6-10 oz of protein, side salad and a side vegetable like steamed broccoli. On occasion, I would have a little more carbs. Urinalysis indicated my urine pH was 5.5 with trace amounts of ketones. My recent blood test serum creatinine was 1.19 mg/dl (I have more muscular build), but my BUN levels were 23 mg/dl. Last summer, my BUN was only 12. I am thinking the higher protein ratio diet has something to do with this. In total, so far over three weeks I maybe passed around 5-6 of these small stones. I had mild lower back and flank side pain, but I have since switched to a more normal pH water (Deer Park) at around pH of 6.3 and began to eat more carbs. I have not kept track of my sodium, but it would not seem to be too high now. Over the years, I would eat a lot of sodium and had cloudy urine often—but would not get stones. It seems, for me, the protein and possibly the alkaline water have something to do with my recent stones. I am concerned about ammonium stones (due to their being so rare) and phosphate stones. I read how calcium phosphate stones are much worse than oxalate as per the potential to damage the kidneys. What does the composition of my recent small stones tell you? Is the potential for phosphate stones to damage kidneys the case with even very small 1-3 mm stones or usually with larger stones? Can isolated events still have a lot of potential to damage the kidneys? Or, does this usually occur over time with repeated events? I have no idea how the ammonium stones formed. I have not abused laxatives, did not have diarrhea, digestion seemingly normal—my diet as per above was only thing different in last 15 years.
Hi Tom S., I believe you performed an enviable experiment. Of course the protein loading raised your urine calcium and your urine ammonia production. Normally your urine pH would have been lower but you kept it up with the water just enough to form the ammonium acid urate stones (of course your urine uric acid would have been very high with such a diet, as well). Likewise you were able to form CaP stones, for the same reason: High urine calcium and high pH. The urinalysis pH is useless as one needs the 24 hour average. I think you may have underlying genetic hypercalciuria and your cloudy urine with salt loading reflects the rise in urine calcium from sodium. More important, you need a full evaluation so you know what is really going on, and you need to have a less immoderate diet approach as you do not seem to tolerate extremes. Stones can damage kidneys, so let’s be prudent. Regards, Fred Coe
So appreciative of your response Dr. Coe! I’ve learned so much from you over the last few weeks. Thank you. I am going to dig into the other links you provided above and take them to my urologist so more testing can be done. Two items I did not mention above in my first posting. 1. First, I suffer from GERD/LPR, so I had been on both Nexium and Zantac (150 mg), beginning the month prior to passing the small stones mentioned above. I’ve recently read that some studies show an increased rate of stone formation with acid reducing medications, especially Zantac. Do you believe these studies are solid? I’m wondering whether these acid reducers could potentiate increased stone formation in those who may be susceptible genetically (e.g., generic hypercalciuria). Any thoughts? 2. Second, since switching my diet to more carbs and lower pH water (Deer Park at 6.3) around 2 weeks ago, I have not passed any more stones until yesterday, where I again passed two small stones (same creme color, and likely similar composition mentioned above 55% CaP, 25% CaO, and 20% ammonium acid urate). The thing is that I recently stopped both the Nexium and the Zantaz cold turkey after having been on them both for a month (due to the research I read on increased stone formation from these). However, the last few days, I had suffered bad acid reflux and so I again began the Zantac two days ago (without the Nexium). And after two days of Zantac, I again passed two small stones (after the 2 weeks of not passing stones). Again, these stone events are the first reoccurrence since 2006. I’m wondering if these two new stones may be due in part to the Zantac? Since my diet was much better and since I eliminated the alkaline water, the only two conclusions I could draw are that either these two stones were produced within my body much earlier when i produced the other stones–and they are simply now passing, or these are two new stones that were formed due to my taking the Zantac. Any thoughts on this? If I altered the chemistry and balance of my urine/blood due to the higher protein diet/high alkaline water, does it take a long time to re-balance to baseline? Based on a potential genetic hypercalciuria, would potassium citrate be helpful for the high calcium and uric acid? I do notice I get peripheral “stings” on my fingers occasionally (more rare), and I am thinking this may be the higher uric acid (gout-like) condition. I am going to begin following your stone prevention/ DASH diet and eat lower protein, lower sodium, higher potassium via veggies/fruits. Incidentally, my great uncle was a “farm” for stones and would pass them every month until I believe he went on the potassium citrate and then he never got another stone.
Hi Tom, I think you need comprehensive 24 hour urine collections – perhaps 2 – with matching bloods to really figure out the chemistry in your urine. On reading both of your comments I do not find any evidence of these. Without them it is impossible to work out prevention. I doubt the acid blockers are a large part of your problem. Regards, Fred Coe
Hi all, I’ve been dealing with awful kidney stones and mostly live in a developing country where I can’t access good medical care or do any modern testing.
I do know, however, that my diet has been EXCEEDINGLY high in oxalates as most of those “chief offender” foods were my staple foods. I am reducing oxalates because I have had a lot of other awful symptoms which may be related as well. It’s also hot here so I’m sweating out my fluids/electrolytes as quickly as I replenish them, and I am dairy intolerant so I probably haven’t been getting enough calcium. I am also allergic to fish/shellfish and gluten intolerant (possibly celiac but we’ll never know; I can’t tolerate gluten long enough to find out), and have had low Vitamin D levels due to this (I assume).
I’m wondering if supplements could balance me back out nutrition wise and prevent stones with sufficient electrolytes??
I’ve also seen this enzyme which claims to break down oxalate and seems to have been very recently developed, and am wondering if you all have tried it or if you have any thoughts about whether it actually works and is safe. There was a study done (here: https://www.ncbi.nlm.nih.gov/pubmed/28322893 ) but I’m still wondering why it’s not recommended for pregnant women or children if it’s considered perfectly safe. And it is actually effective? It would be wonderful if it were! Thanks for any thoughts. I’ll be back in civilization for a visit soon, but as an overseas volunteer, I’ll want to first think really hard about spending any money on something which may or may not work.
Hi CiCi,
It’s wonderful you are that you are volunteering your time overseas! The climate along with the dietary issues you describe are more than likely causing your stones. The first line of defense is to keep your fluids up, even more so since you are losing fluid in sweat. Use the oxalate list we give on this website and continue to lower the highest oxalate foods. Please try your best to seek out foods that have calcium in them and you can “Google” nondairy sources of calcium and see what you can do to get enough into your diet. We do indeed know about the enzyme you speak about. We can not endorse it at this time as it has only been tested in a “simulated gastric environment”. One still needs to follow a low oxalate diet when taking these. If there are further developments in the product we will inform you.
Be well,
Jill
Hi CiCi, As my colleague mentioned oxalate treatments are all in testing phase and not actual drugs one can use. More important, you seem to be an active stone former and chose to live in a world sans testing and advanced medical care. Perhaps you could have proper testing when you come back for a break and establish what is really wrong with you. As for long term management and prevention under the conditions you mention, possibly a proper knowledge of cause will help. Right now, everything is vague and therefore unlikely to work. Your link is to a toxicity study in rats – very distant from patient care. Regards, Fred Coe
If one develops kidney stones only in one kidney and none in the other, does this imply the stones are not caused by one’s diet?
Hi Lucy, No. Stones form by chance given risk – like car theft if you park in the wrong neighborhoods. So, prevention is the same. Regards, Fred Coe
Question. I am a nurse just diagnosed with kidney stone. I am type 2 DM, was not eating well or drinking water well, drinking a lot of caffeine coffee and tea, and diet ice tea. Diagnosed with a kidney stone. As a nurse, I reach out to many professionals in health care. One of the oncologists I work with looks at nutrition studies and practices vegan. He listens to nutritionfacts.org which is a physician who looks at all nutrition research and summarizes and for kidney stone prevention the two common themes is decreasing animal proteins and salt. ER doctor told me to stop drinking caffeine-coffee, tea and add lemon to my water as it helps to prevent kidney stones. Thirdly, I was just diagnosed with erosions in my stomach (would get upper abdomen distention, sudden nausea, and belching and epigastric tenderness, not burning-placed on protonix) had an overactive bladder and spasms and was told acid again a culprit and can coincide with acid reflex (put on uribel that improved QOL) and now two weeks later a kidney stone. Not sure if all interrelated. Thank you for any information. Trying to read and learn can be very confusing and I have cleaned up my diet. See urologist for first time tomorrow.
Hi Lizzie, The facts you are getting are partly right; sodium is a problem, animal protein is not much of one. Coffee is not a stone risk, lemon is not a treatment, and the stone you passed might have formed a year ago. Being diabetic you may be forming uric acid stones that have their own special treatment unrelated to diet. You need a strategy and here is a good one. Take a look. Here is another. Regards, Fred Coe
Hi,
I’m having trouble forming an opinion on Chanca’s Piedra’s effectiveness in dissolving calcium oxalate stones.
Although there are almost endless online testimonials of its ability to dissolve stones, occasionally I see a comment that says “you can’t dissolve calcium oxalate stones; only uric acid stones”. Yet, 80% of stones are calcium oxalate and there are hundreds of reviews saying that it absolutely does dissolve them, even if it doesn’t specifically call out calcium oxalate.
Can you help me understand which side of the story is likely true?
Thank you for your help.
Josh
Hi Josh, You are a good thinker. There are a lot of articles that say Chanca dissolves kidney stones but they are not scientific. Scientific is not a snobby idea but a practical one. A study to believe tests the stuff against some control with proper means for counting stones in kidneys and measuring changes in size. The readers and counters and patients all know nothing about whether they take the Chanca or a placebo. No one has done anything like that. What you read is anecdote and/or sales materials. This kind of study is how you might decide which refrigerator works better, so it is really important we get it right about a matter of our bodies. I know of nothing to dissolve calcium oxalate crystals in humans. I am willing to change my tune when I see a real study. A good criteria is PubMed; those studies are all at least acceptable science. Check out the Chanca – I did already. Regards, Fred
I have had calcium oxalate stones four times over about 20 years, from several years to more than five years apart. They have all been all around 7mm. I don’t seem to get multiple stones, just one at a time.
Reading your list of foods, I see I could remove some from my diet, like almonds. I had no idea. One you don’t seem to endorse, where others do, is putting lemon juice in your water? Am I correct that you don’t feel this is beneficial?
I’ve always been interested in eating well, and try hard, but it seems everything is bad for you according to someone. I’m also concerned about cardiac health and have read Dr. Esselstyn’s book on preventing heart disease in which he promotes a vegan diet. It seems impossible to follow a vegan diet and avoid high oxalate foods. It’s all very confusing.
Thanks,
Tim
Hi Tim, Having calcium oxalate stones does not mean that diet oxalate matters to you. You need serum and 24 hour urines to be sure what is the cause, and one treats based on what is really wrong. You are a good reader, I despise nostrums and remedies like adding lemon to water as being distractions from actual preventions that work. One needs to find the abnormalities and treat them, that is now possible and practical. Regards, Fred Coe
Hello all. I’m a 60 yr old female. Last year I had 6 stones removed from my left kidney (ranging from 1mm to 9mm in size). The stone analysis report shows they are comprised of 40% calcium oxalate monohydrate, 20% calcium oxalate dihydrate, 40% calcium phosphate. When the ureteral stent was removed a week later, I was advised that my ua showed a slightly low citrate level, so just drink lemon in my water. Now, one year later, a ct scan shows 2 more stones in that same kidney! I have hypothyroidism (have taken armour thyroid for years). No other health issues. I’m perplexed as to why my body is making these stones. I’m left to do my own homework on this and would really appreciate some guidance here. The scientific information about the stones is interesting, but I really don’t understand it. Can you suggest changes I should be making in food, etc., or anything I should be looking at along with diet changes, please? Thanks much. Suzanne.
Hi Suzanne, The high phosphate content of your stones means that prevention is perhaps more urgent than usual as this type recurs easily, the stones can be large, and crystals can plug kidney tubules. I doubt that your only 24 hour urine abnormality was a slight reduction of citrate, and as for lemons they have no proven role at all in treatment. I would advise an organized evaluation with serum and 24 hour urine testing, and a careful look to see what is the cause of stones so they can be prevented. The science is unavoidable, but your physicians are supposed to cope with it, not you. Here is a good article on the evaluation; here is a good general review of the topic. Regards, Fred Coe
I have hypercalciuria – 350 on my first one. After that I found this website and changed my diet to your recommendations. I declined the doc’s prescription for thiazide until trying dietary efforts first. My next 2 -day 24 urinalysis showed 350 again (on both). My one giant stone was over 50% calcium phosphate. My urine pH is always about 6.7, so not surprising. However, my urine output is over 4 L on all 3 urinalysis (I started drinking more water after the first stone occurred in 2015). My SS CaP is, on all 3 urinalysis, between 1.10 and 1.55. Therefore, I am wondering if my high fluids can prevent future CaP stones. All that said, I’m nervous about osteoporosis but yet I do not want to take thiazides (my diet has corrected my prediabetes, but I don’t want to risk the thiazides in this case). Your thoughts? Other data you may want: SS CaOx between 2 and 4, SS UA .05, citrate between 600-1000, urine oxalate ~28,
Hi Susanna, You do indeed have hypercalciuria. I presume your blood calcium is normal. You followed my advice and your urine calcium did not fall, but what was your urine sodium at the start and with treatment? DId your urine sodium really fall below 100 mEq/d and your urine calcium not fall? Fluids are rarely enough, and you are right to worry about your bones. Take a look at this article on idiopathic hypercalciuria and the sodium effect. If your urine calcium is not sodium dependent you may have a genetic variant, so it matters. Regards, Fred Coe
Thank you for replying!!! Yes, my serum calcium is normal. YES, my sodium DID fall!!! It went from Na 24 (190) before dietary treatments all the way down to 53 and 70 after changing my diet. I now eat zero processed foods. Yes, I have read the sodium effect and I was very optimistic that my calcium excretion would improve itself once I changed my diet. With the understanding that my sodium did fall, am I doomed to have to take thiazides to prevent stones and protect my bones? I am concerned my prediabetes will reassert itself with a vengeance with thiazide treatment. I feel like I have to choose my poison – stones/bones or the many dangers of diabetes. Thank you again for your time!
Hi Suzanna, WHen your diet sodium was 53 and 70, was your urine calcium still high?? If so, how high. Were your supersaturations reduced? Thiazide is when diet fails and supersaturations are still too high (CaOx > 3, CaP >1) or all are fine but new stones form. Maybe you do not need the ‘poison’?? Regards, Fred Coe
Thank you once again for your time. Yes, sadly, my urine calcium was still 350 (on two separate 24 hour urinalysis) AFTER my very religious dietary changes. And sadly, my supersaturations of CaP stayed the same (1.10 – 1.55) and my CaOx actually went up (2.85 – 3.6). Urine volume was high before and after dietary changes (over 4 L). What is your best guess as to the issues with scenarios like this? Vitamin D hypersensitivity? An inborn distal convoluted tubule issue that didn’t cause problems until my 40’s? Or, as a nephrologist suggested, things like ibuprofen may have compromised kidney function (despite me considering the use quite normal and within guidelines)? I guess I keep wondering if I did something to damage my kidneys or if this is primarily genetic. And, for goodness sake, I have seen numerous studies that indicate thiazides can worsen kidney function! Yikes! I have this sneaking suspicion my kidneys are already on the fragile side, so to speak. Alas, I feel like your painting would be a Milton for such a situation – stuck between a rock and a hard place.
Hi Susanna, If your urine calcium remains at 350 despite low urine sodium of 50 – 70 mEq/d, a low dose of chlorthalidone would be a good idea. No, thiazide does not cause kidney disease; millions of patients have used this drug for management of hypertension, and kidney function does not decline from the drug. NSAIDS like Ibuprofen do not raise urine calcium. Is your kidney function really reduced?? As for the high urine calcium it is probably genetic and due to multiple genes. Another possibility is a CYP-24 error, but that would cause abnormally low serum PTH – below the normal range – and your physicians would have seen it already. I suspect routine idiopathic (genetic) hypercalciuria. Regards, Fred Coe
Dr. Coe, You’ve been so generous with your time already, but I will impose one more time to ask another question! I went ahead and tried the thiazide, but my blood pressure plunged to 75/59 and I had horrific vomiting and diarrhea. The nephrologist said not to take it again. So, here I am, with mild chronic kidney disease (GFR ~59mL/min and creatinine about 1.1). I have two upcoming urinalysis and I’d like to do two experiments: 1. FAST with normal water intake. I figure this will either show me for sure that I lose 350mg/Ca/day no matter what, or it may help. If Ca excretion actually increases while fasting, well….. I guess I’ll snack more or something. Experiment 2: K2 supplementation while following my regular kidney stone diet. I found a study from 1985(!) on rats(!) that showed a reduction in hypercalciuria with vitamin K supplementation. Can you point me to any other studies regarding hypercalciuria and either fasting or Vitamin K? Thank you. PS I also joined the great facebook page for the kidney stone diet, but Jill sent me right back to the idiopathic hypercalciuria article that you wrote (and which I have previously read with great interest several times). In closing, thank you for your amazing website and your passion and dedication to helping improve the lives of countless people.
Hi Susan, The high calcium is almost certainly idiopathic hypercalciuria; fasting will lower urine calcium, but low calcium diet would be inadvisable because of risk of bone mineral loss. Jill is right to send you back. Given thiazide did no good, try to lower urine sodium as much as possible – 1500 mg *65 mEq) or less. That should lower urine calcium. If you can do this, a tiny dose of chlorthalidone – for example 1/2 tab every other day – might make up all the remaining difference. Vitamin K has no proven role in stone prevention. Regards, Fred Coe
Jill – I heard that black eyed peas are low in oxalate. I was interested in expanding my horizons by making black eyed pead salads. What info do you have on this?
Hi Jill,
Is it safe to add a little honey to my low fat, low sugar yogurt (5 grams).
Hi Gary,
Yes, it is. Just make sure your definition of “a little” really is just that! I would rather you use higher fiber blueberries or other low oxalate fruit with higher fiber.
Best, Jill
Great. Thanks.
Hello, My doctor has advised me to take enough potassium citrate to keep urinary citrate over 600. Can you advise best ways to do this both through foods and supplementary tablets? Thank you
Bi Brian, Laudable goal, if a bit high. The kidney stone diet provides enough fruits and veggies to raise urine citrate if everything is normal. If that is not enough – the diet I mean – one needs extra citrate and that is potassium citrate in its many forms. I would start with the diet and add meds as needed. Regards, Fred Coe