Many patients assume that they are forming calcium stones and should therefore limit their calcium intake. That assumption could not be more wrong. Low calcium diet won’t stop your stones and may even increase your risk. Lets not forget that our bones are in desperate need of calcium to avoid osteopenia and osteoporosis.
But, many of the best foods for calcium are also high in sodium, and sodium raises urine calcium loss and stone risk.
Now what?
I run an online education program to help, but here is my best advice in the form of an article.
How Much Calcium do We Need?
The National Institutes of Health tells us age matters. Nineteen to fifty year old male or female need 1,000 mg of calcium a day. Fifty one to seventy year olds need 1,000 mg for males and 1,200 mg for females. Those above seventy one need 1,200 mg, both sexes.
We all know that much of our calcium comes from diary products. But did you know that dairy products are very high in sodium?
When we eat a high calcium food that is also high in sodium the sodium can undo the benefits of the calcium by raising urine calcium losses. This is especially true for stone formers with idiopathic hypercalciuria whose urine calcium is much more sensitive to sodium than in normal people.
So we need to search for dairy products that are lower in sodium than usual.
We also have to find what else there is because not everyone can tolerate dairy products. This means fruits and vegetables, and they may contain oxalate.
How to Read Food Labels for Calcium
All food labels are based on a 2000 calorie per day diet. Calcium is given to us in the form of a percentage.
How do we figure out how much we are getting per serving?
Take a look at the featured picture. It shows Friendship Dairy cottage cheese no salt added.
This is a great product for high calcium and low salt. On the label it tells us that per serving you will receive 10% of your daily value for calcium.
How do we convert this to milligrams?
Since we know that every food label is based upon a 2000 calorie per day diet, and gives the percent of the recommended 1,000 mg of calcium for that diet, we can just put a 0 at the end of the percent. So 10 percent is 100 mg of calcium. In this case a serving size is half of a cup. Eat more or less and the calcium from the product will vary.
Eating a low sodium, high calcium diet can be overwhelming and difficult to incorporate into your daily life.
We are going to continue with the example of the cottage cheese
The low salt version of Friendship Cottage Cheese has only 60 mg of sodium per serving. The regular Friendship cottage cheese contains 260 mg/serving. This is a great sodium savings in that the ideal intake of sodium is only 1,500 mg daily.
As a contrast take a look at this product.
The label, which does not show, says a serving contains 15% of daily requirement which is 150 mg of calcium. But the sodium in that serving is 290 mg!
The Trouble with Food Labels
These Friendship and Breakstone cottage cheese products are two excellent examples of how difficult it is to distinguish between really low sodium and rather high sodium products.
The 30% less sodium label is correct, but it is 30% less than a lot of sodium. The Friendship label tells you there is no salt added, which is also true.
But the actual sodium amounts are what you want to look at. They have to be accurate by law and they are.
You have to notice the small subtleties in all food labelling. It is definitely worth the time if you want to keep sodium low while getting adequate calcium.
How to Shop for Low Sodium Dairy Products
We have to become experts at reading food labels. Don’t pay mind to the front of the package. The nutrition label is the only thing you need to look at. You want the highest calcium for the lowest sodium, and the only way to get it is by looking at the label. Sometimes this may require you to look at several brands. You may have to stop using your favorite brand.
In the beginning of this process it may seem this is a daunting task.
But before long you will become quite efficient and even a food label expert.
No Food Label?
Many of you will shop at the deli counter or prepared food section, or eat in a restaurant. You will just have to remember that certain dairy products have a lot of salt – like cheese – and find the low sodium alternatives. When you are asking the deli counter person to cut you some cheese or the waiter to bring you a fancy cheese plate you have to ask for the low sodium varieties if there are any.
What if You Can’t or Won’t Eat Dairy Products
If you won’t maybe you should take a look at our list and reconsider. The list is ordered by how much calcium is in a serving. Dairy products win by a big margin. So if you possibly can use them, use them.
The remaining options are fruits, vegetables, fish, and supplemented foods. We have consulted the usda data laboratory charts for calcium and sodium, and our own oxalate lists to give you what we can find with modest oxalate and a high calcium per sodium ratio. We have redacted from the immense usda lists our list of the best calcium to sodium bargains adjusting for oxalate from our oxalate lists.
The list is what we think will be most useful to you. Below we highlight a few foods in each category that we specially like.
Fruits and Juices
Fruits have very little sodium when raw and fresh, so it is all about their calcium content.
The most calcium in this category will be found in one cup of calcium fortified orange juice – 366 mg. Calcium supplemented grapefruit juice gives 350 mg of calcium in 8 ounces. The oxalate in grapefruit is modest and will fit into most diets. Apple juice fortified with calcium has little oxalate and is a good choice. We emphasize that these are calcium supplemented juices, otherwise they will not do.
Some useful foods have too little calcium to make our list but are good, Pineapple juice, 6 ounces gives 84 mg of calcium. Plums and apricots are very low in oxalate and a cup gives about 70 mg of calcium. Blueberries and pears are low in oxalate and give about 60 mg for a cup. Peaches give about 50 mg of calcium/cup.
Fish and Seafood
Sardines, no salt added, have about 150 mg of calcium and 50 mg of sodium in a serving. Three ounces of canned salmon provides 212 mg of calcium and 64 mg of sodium. Most other fish, even fresh, have about 80 mg of sodium for every 120 mg of calcium, which is not a great ratio. Crustacea have very high sodium levels even when fresh.
Vegetables
From the list, here are a few highlights.
Kale, frozen, boiled, and drained without salt has 179 mg of calcium, 20 mg of sodium and little oxalate – a great bargain. Mustard greens, frozen, are low in oxalate and have 152 mg of calcium with 38 mg of sodium. Chinese cabbage (bok choy) has 158 mg of calcium and 58 mg sodium in 1 cup, and very little oxalate.
Several foods are too low to make the list but are tasty and can be used. Winter squash gives 80 mg calcium and 8 mg sodium in one cup. Raw onions have little oxalate but 72 mg of calcium and 8 mg of sodium in a cup. Cowpeas, if you find them, also known as black eye peas, have 184 mg of calcium, and 27 mg sodium in a cup.
So Now What?
You may not like what I am about to say but that’s not going to stop me from saying it. For people who choose to avoid dairy products by choice or because of lactose intolerance or food allergy, it is difficult to get enough calcium into the diet without an excess of sodium and in the case of fruits and vegetables too much oxalate. There is one usable alternative milk and yogurt product: coconut. Soy and almonds are too high in oxalate.
That leaves supplements. We have already mentioned calcium supplemented juices. Pill supplements can be used – check with your physicians – but only with substantial meals. Taken without food they can raise urine calcium a lot and it is not clear that bone cells will use the calcium. So used improperly supplements can increase stone risk. With meals, supplements can and do lower urine oxalate.
Thanks so much for this food list. I’ve twice had kidney stones, and was looking at dietary options from a “legit” 🙂 site such as yours. I am lactose intolerant so it’s very useful info for me. Thanks much!
Hi Kris, Thanks. The article is actually not finished – Jill and I had hoped to finish it weeks ago and things got in the way. What is on it is correct but there is more to come. Regards, Fred Coe
Hi Chris,
As Dr. Coe said, we are not finished with this article but everything on it as of today is of course correct. I am lactose intolerant and casein intolerant so getting enough calcium by food for me is difficult. Lowering salt is such a big factor in controlling calcium levels as well, so really try to get your sodium intake to around 1500 mg/day (more days than not). No one is perfect, but have that be your goal.
Thank goodness there are so many dairy free options these days. Kite Hill makes great products (cheese and such) and I love them, but they are made with almonds so that is a problem for many stone formers b/c of the oxalate. Super annoying.
Dr. Coe and I will finish this article soon. Look for it and thanks for writing.
Warmly,
Jill
I sent a question regarding having hypothroidism, fibromyalgia and kidney stones…and the diet restrictions for each “issue” leaves basically nothing to eat. Please advise…
Hi Lisa, Jill answered on the article you first replied to – on oxalate. You are now on the calcium article – not even finished yet!! – so her comment is not apparent. She sent you a reference and a an answer. Put another way you have lots to eat. Let us know if you need more. Regards, Fred Coe
Thank you for your and Jill’s and colleague’s information and care. Including care enough to say what we need to hear. It helps me reduce my risk of stone forming accurately.
A question: I am taking Allegra as needed (the antihistamine) which has significantly helped me get past bronchitis — even today. I am trying to take more water to compensate for the dehydrating effects and possible stone formation. Any thoughts or recommendations? Thanks again!
Hi Michael, antihistamines cause mouth dryness but do not affect urine volume. Regards, Fred Coe
Thanks so much for this list. I continue to follow a low salt, high calcium diet. I have found that Kroger makes a
low carb yogurt, low in salt and sugar. I thank you for your continued research, it has been a great help to me.
Hi Midge,
Your compliment is kind. Thanks for it. Also thanks for sharing your find at Kroger. Maybe you could share the name of it so that everyone might gain from your knowledge?
Warmly,
Jill
Perfect timing! Really working on this with Jill. Any and all info regarding this topic is helpful. Looking forward to part two.
I have had several stones, some very large, but are uric acid stones rather than oxalate stones. Should I be concerned about consuming foods with high or moderate oxalate values?
Thank you for all your hard work. I am juggling a low oxalate and diabetic diet and I have seen so many differences in the oxalate findings. Knowing your diligent work for all of us I am confident when I follow your recommendations. Looking forward to Part II.
Hi Lisa, I am glad the materials are helpful for you. Regards, Fred Coe
FYI – Tropicana Trop 50 calcium fortified orange juice provides 350mg calcium, 10 mg sodium and only 50 calories in one cup (8 fluid ounces). Some people with dairy issues might like having this option?
Thanks Anita, The fortified juices are good. But the sugar load is a bit high so they are not ideal long term. Regards, Fred Coe
Anita, Hi!
As Dr. Coe states, OJ can be a good source of a non-dairy, calcium fortified drink but can be high in sugar. Make sure you get the low sugar version and then it will be a better choice.
Thanks for writing-
Jill
I have been looking for the cheeses you list on the spread sheet that accompanies this article. I cant find any brand that has calcium as high as these and/or as low in sodium. Do you have a list of some brands / products that have these levels?
1175 247 CUP – SWISS CHEESE
965 21 1 CUP – MOZZARELLA LOW SODIUM CHEESE
963 63 1 CUP – PARMESAN LOW SODIUM CHEESE
928 28 1 CUP – CHEDDER OR COLBY LOW SODIUM CHEESE
Hi Randy, Jill and I did and I will ask her to respond separately. Regards, Fred Coe
That’s great! Thanks!
Hi Randy- I think it is because of the quantities of these products that the calcium is so high. You are most likely seeing the calcium levels not as high bc the serving size is not the equivalent to our chart-
Thanks for writing-
Jill
Thanks so much for your response. I am so grateful to have an authoritative resource like you and Dr. Coe. I understand what you are saying about the serving size, however, the serving size should not affect the ratio of calcium to sodium.
For example, you list that 1 cup of CHEDDAR OR COLBY LOW SODIUM CHEESE has 928 mg of calcium and 28 mg of sodium. So the ratio of calcium to sodium is about 33 !!! I cannot find any cheese brand that makes any cheese (with the exception of Swiss) that has a ratio over 1.4 (see below).
I love colby and cheddar cheese. Do you know the brand that your chart is based on? Otherwise, it seems that Boar’s Head or Tillamook swiss are the only real options
Helluva Good Cheese Ca Na Ratio Ca=Calcium Na=Sodium
Extra Sharp cheddar 1 oz 200 180 1.11
Colby 1 oz 200 190 1.05
Monterey Jack 1 oz 200 170 1.18
Colby-Jack 1 oz 200 170 1.18
Muenster 1 oz 200 180 1.11
Boar’s Head
44% lower Sodium provolone 1 oz 200 140 1.43
Canadian Cheddar 1 oz 200 170 1.18
Colby Jack 1 oz 200 180 1.11
Longhorn colby 1 oz 200 170 1.18
Swiss 1 oz 300 60 5
Mozzarella 1 oz 150 150 1
Sargento
Reduced sodium Colby-Jack 21 gm 150 105 1.43
Extra Sharp chedar 21 gm 150 140 1.07
Land O Lakes
Swiss 1 oz 200 140 1.43
Baby swiss 1 oz 250 115 2.17
Provolone 1 oz 200 200 1
Tillamook
Medium cheddar 1 oz 200 170 1.18
Colby 1 oz 200 190 1.05
Reduced Fat Monterey Jack 1 oz 200 200 1
Swiss 1 oz 300 60 5
Just wanted to say “Thank you so much” for all that you both do. I have been through 3 urologists that gave me incomplete and inaccurate information. I have had several lithotripsies and ureteroscopies. The urologists don’t seem to care and I am now extremely pro-active and research, research, research. I have not been placed on a diet but only told to stay away from nuts and tea. My current urologist never mentioned magnesium and B6 supplements and, when I brought it up, said not to bother. My last two (at the same time) 24 hour urine analyses show that I drink plenty of water and citrate and I just got cleaned out (again) and am determined never to go through the pain and expense of more stones. I did not even know I should be drinking things like Crystal Light to help me (although I was drinking it anyway in the last few months) as I can no longer drink lemon juice due to stomach upset. My sister got a referral for me for a new urologist and after some research on her I will be changing urologists again.
My point being that one has to be their own advocate and I was very pleased watching Jill’s video that she said this. I’ve learned so much from both of you as none of my doctors have ever mentioned high-sodium as a reason calcium can be leached from my bones into my urine (I am post-menopausal and have osteoporosis that runs in my family). Most everything I know about prevention of kidney stones comes from my own research. So everyone out there – do your own research – try Google Schoolar – and, if you do use Google, look up the doctor’s name because if it’s some place like South America, or they have ads on their page, you can’t trust what they are saying. And if your gut tells you that your health and well-being is not in your doctor’s best interest – keep changing doctors until you can find one that does care about your health. Surgery should be a last option – not the only resort.
There is a special place in Heaven for both of you and, again, I can’t thank you enough for giving me more information that corresponds to my own research and what I have found in the last couple of months. Bless you both for getting this information out to the world!
Hi Susan,
Glad that you are finding all the info helpful. We know that the missing link is education. You are not getting enough of it and we plan on truly doing all we can to get it to you. But, yes, you are your own best advocate. If it doesn’t seem right, it probably isn’t. Thanks for writing. It is always helpful to know that we are.
Your friend,
Jill
Why are calcium supplements frowned upon for people with calcium stones and yet dairy products and fruits/veggies that contain calcium are not? Are they absorbed differently?
I’m really in a bind here because I have mixed calcium oxalate and phosphate stones and suffer from osteoporosis, so I need my calcium and have always had dairy in my diet, however, since finding out about the stones, my doctor and dietician wanted me to ramp up dietary calcium intake and I’m finding the increased amount is too much for me–it’s actually making my stomach turn. I also suffer from IBS and severe acid reflux, so excess dairy is causes symptoms and I cannot drink acidic orange juice (yes, I know…my whole body’s a mess). I’ve looked into lactose free milk, however, most people don’t realize that the potassium levels in it are astronomical (I’m not sure why), and, as we know, potassium is not great for the kidneys either. Is it ok just to take a calcium supplement and if so, what’s the best ratio?
Hi Jason,
I am sorry to hear of your troubles. It is very hard to adhere to a treatment plan when that treatment plan stirs up trouble with other medical conditions. I would discuss with your doctor about switching over to supplements, but you can do this. It is true that the body does like its nutrients from food best, but sometimes that is not possible. Supplements should be taken with meals and split throughout the day.
Thanks for writing-
Jill
Hi, Jason, I do not know of any reason to say that the potassium in lactose free milk poses any dangers to your kidneys. There is no evidence for your belief and you can indeed use the product. One glass of this produce contains 4120 mg of potassium, which is just over 10 mEq. A common dose of potassium citrate for stone prevention is 20 mEq twice daily. US diet recommendations for normal US citizens is 4,500 mg of potassium daily from fruits and veggies in addition to whatever is in other foods. Regards, Fred Coe
Dear Dr. Coe, Thank you for your wonderful resources! I was wondering if you have any thoughts concerning Vitamin D supplementation for IH patients? My vitamin D is quite low and I do now have osteoporosis. My nephrologist has given his blessing to 10,000 IU/day for 10 weeks followed by 2,000 IU/day thereafter as prescribed by my endocrinologist. The general recommendations from my Litholink report advise against Vitamin D supplementation excess, however no upper limit is given. Thank you.
Hi Linda, I would simply achieve a normal vitamin D level. The Litholink algorithms were written by me and Dr John Asplin, and we meant by excess enough to produce abnormally high serum levels, which are not your problem. One might ask why your levels are so low. People with hypercalciuria tend that way and also develop bone mineral loss. If you have idiopathic hypercalciuria be sure and follow a high calcium low sodium diet. Regards, Fred Coe
Thank you so much!
Dr Coe and Jill,
The calcium list is incorrect, the Total Cereal only has 2 % calcium and not 100 % calcium as listed. This list can be misleading as I was fooled for a while thinking that Total Cereal was providing me with all the calcium I needed until I read their label on the box !
Hi Sheila,
Here is a link to show the label from their page on the internet. I will have to go to the store to double check. Perhaps it is a different type of Total, one not fortified with calcium? http://www.fooducate.com/app#!page=product&id=1E92CD36-E106-11DF-A102-FEFD45A4D471
Hope you are well- Jill
Hey there, Gidday from Australia.
Have purchased your kidney stone program, but haven’t had a chance yet to look through it as so busy with work. In saying that I have been researching some thing which are important to me.
I have had 3 kidney stone attacks, the last one being the last as far as I am concerned.
Problem is I am following a ketosis diet right now to lose weight (9kg in 4 weeks so far) which means, high good fats, medium protein and 20gram carbs in one day.
Due to the kidney stone I obviously have to be wary of HIGH Oxolate foods, as have felt the wrath off too much spinach before I realised it.
All my studies have shown to have god calcium foods with the moderate or so oxolate foods, so am trying to get a good list of everything. High Calcium foods also can mean high oxolate and so on. making lists of everything.
1. Do you have a list of High Calcium, Low Oxolates (I mostly eat fresh foods, not packet or canned except will try the sardines and tuna)
2. If I have to eat moderate to high oxolate foods will these calcium foods stop stone formation (ie: lots of liquid and lemon water during the day to keep the urine flowing as well)?
Obviously once I finish this ketosis diet which is the first thing in my life to help me lose weight finally, I can be a bit more picky with food rather than watching the carbs etc, and then I want to lessen the meat as not a big meat eater.
3. Also I have been making protein bread, and products, is this as bad as meat for kidney stones or better.
hope this all makes sense and you can answer me thanks
serypeta
Hi Serypeta, The list in the article was screened for oxalate so you can use it. High calcium intake with meals will reduce oxalate absorption a lot. Protein loading will raise urine calcium, and that can raise stone risk, so keep up yout fluids. Best, Fred Coe
I have just had surgery to remove a calcium oxalate stone. Hopefully my one and only. My doctor just told me to avoid cheese, yogurt, red meat eat less salt, more fresh fruits and vegetables and drink a ton of water. In reading all of your material (which is so helpful, by the way) I saw where it said to avoid Vitamin D? I also have Multiple Sclerosis and take 5000 mg of Vitamin D a day. It’s necessary for MS and I can’t stop taking it. Will it cause a problem?
Also, I drink a glass of sweet tea almost every day. I’ve read tea is OK and I’ve read that it’s not. Which is right?
Thank you so much for all your information, explanations and encouragement!
Hi Kate, Of the advice, I like the less salt, but cannot agree with low calcium diet – you need lots of calcium and low sodium together, just as the article says. Here is a good article on how to go about prevention. Here is my most definitive article on what I presume is your kind of stone forming. Just be sure from the first article that you have been fully evaluated for a systemic disease causing stones. The vitamin D is fine, and the tea likewise. But I would have some calcium with the tea – perhaps time it with some food or add milk. Regards, Fred Coe
I have calcium oxalate stones and the consensus seems to be that calcium supplements are not good to take and may contribute to the formation of kidney stones. I took calcium supplements for many years until I had my first kidney stone a couple years ago. I’m now trying to increase dietary calcium in my ‘plant based’ diet, but am confused with why fortified foods like plant milks, orange juice, and cereals are considered good sources to get calcium when they are not truly natural food sources, such as kale, broccoli, cauliflower, dairy milk, etc. Isn’t the calcium carbonate added to fortified foods just as bad as in the supplemental form? I’ve read conflicting viewpoints on how well the body is able to utilize the calcium from fortified food sources, so this concerns me. And if calcium fortified foods are indeed a good way to obtain calcium, wouldn’t taking calcium supplements along with a meal serve the same purpose? My doctor has told me it’s ok to take calcium citrate, one capsule twice per day with meals (1 capsule is 160 mg). What is your take on this and what do you recommend, especially for those of us that would like to avoid dairy? The only way I see to get my recommended 1,200 mg calcium per day is to eat these fortified foods and/or get some of it met via the supplements.
Hi Kathy, The big issue with diet calcium – supplements or foods is timing. If you eat high calcium foods they are foods and the calcium is absorbed more slowly. Most importantly, you want the calcium eaten where the oxalate is – with meals that have oxalate from plants. If you just take supplements away from meals the calcium goes into the urine and does not block oxalate which comes in with meals. If supplements are timed exactly with meals they will block oxalate absorption. We need a trial of this, so I am presently assuming based on research. Regards, Fred Coe
I really appreciate all your information about low oxalate and a good level of calcium since I’m having trouble with too much oxalate. However, I noticed your spreadsheet showing best calcium to sodium foods has whole grain Total cereal mislabeled. The box says one serving (3/4 cup) provides 2% of the daily requirement for calcium, which would make that 20 mg. based on your formula, not 1.000! mg. Since I have high cholesterol despite a low dairy, low meat diet, I could really use better calcium sources that don’t also contain cholesterol. I am a small person so I’m looking for high calcium sources that don’t require me to eat more calories than my small frame needs. Any ideas?
Hi Shari, Thanks, and we will fix it. Low calcium diet is not a good idea and without dairy products it is hard to get enough calcium. If you cannot use them, then calcium supplements are a difficult second: they must be taken with the main meals to avoid sudden calcium loss in the urine. But ‘too much oxalate’ may not be all that is wrong. Take a careful look at your own reports to be sure that is all. Jill and I exhausted ourselves finding the foods on the list, and do not know any more. Regards, Fred Coe
Hi Dr Coe,
I was diagnosed with a PUJ obstruction in my left kidney and was operated in 2007 by under going a pyloplasty. Now after 10 years I experienced a sudden unbearable pain that I had to be rushed to the emergency where they finally diagnosed that I have a cluster of Kidney stones in my left Kidney. I was then operated for Stone removal and then a procedure called endopylotomy was performed. After which 15 stones were removed and a stent was placed to be removed after 3-4 weeks. The stones were tested and were confirmed as Calcium Oxalate stones. The entire process was so painful the second time around that I cannot think of being operated ever again. The shape of my kidney is always swollen and thats why the stones found a place to rest in the base. The doctor mentioned I had an obstruction as well due to which urine was stagnant a lot of times in my Kidney. Quite honestly I use to not drink 2-3 liters of water too. Please help me understand how can I avoid stones in the future as 15 stones is way too much and I must be doing something wrong. Do you think we can also analyze the age of the stones? Is there a medicine that I can take to clear or flush my kidneys?
Hi Hinda, Perhaps simple stasis explained the stones but I would be sceptical. Instead of guession, I would pursue a complete evaluation. Regards, Fred Coe
Hi Dr. Coe. I have idiopathic hypercalciuria and an asymptomatic 8 x 8 x 12 mm kidney stone. Blood serum Calcium 8.9. 24 hour Litholink urine collection results: volume 3.85, SS CaOx 2.03, Urine calcium 227, Urine Oxalate 21, Urine Citrate 945, SS CaP 0.31, 24 Hour Urine pH 5.911, SS Uric Acid 0.32, Urine Uric Acid 0.492. Today I also was diagnosed with osteopenia. My internist said I should take over the counter calcium pills 500 mg three times a day with a 2,000 unit Vitamin D3 pill. Am I correct that taking calcium supplements in pill form will increase stone risk, especially if you take it with Vitamin D? What do you do in this situation? Also, do the above results indicate that I have a calcium phosphate stone and therefore do not need to eat a low oxalate diet? Thank you so much for your help.
Hi Lois, Your urine calcium is marginally high, blood oxalate low normal, and you have bone disease. I agree that diet calcium should be high but if diet sodium is not also lowered urine calcium will rise and bone disease may not benefit. Here is an overview of the proper diet. The article on high calcium low sodium diet conveys the key sodium information. Pill supplements will do only if taken exactly with the larger meals; otherwise urine calcium might rise too briskly. But what about foods with calcium in them? Regards, Fred Coe
Hi Dr. Coe. I will follow your advice– low sodium, no sugar, and lots of water. I don’t want to risk increasing urine calcium by taking calcium pills, so I have decided to make sure that I eat foods that will give me 1,500 mg of calcium every day instead of taking calcium pills. I also will take a 2,000 unit Vitamin D3 pill. Thank you for your invaluable help.
Hi Linda,
Just want to make sure you are not too restrictive. It is advised that you eat less than 25 grams of ADDED sugar per day. Don’t try to do no sugar as when we deprive ourselves that much we inevitably “fall off the proverbial wagon”. You can tell if it is added to a product as you will see it in the ingredient list. So milk is fine even though it has sugar in it. It is naturally occurring, just like fruits. But if you are looking at a cereal label and it has high sugar, take a look at the ingredient list. You will undoubtably find sugar hidden a few times within it.
Read the article on this website called: How to Wean Off Sugar- it will help a lot.
Hope this helps-
Jill
I am on a no salt, no sugar, low carb, low potassium diet and just found out I have osteopenia. What’s left for me to eat!?!
It’s challenging!
If one does have to supplement with calcium, is there a preferred form? I’ve seen advice to chew Tums with meals, and also to take calcium citrate. I’m a bit confused because I’ve also read that once the calcium binds to citrate it is not available to bind to oxalate. And that the calcium carbonate in Tums doesn’t do anything because it is not really bioavailable. I have to take magnesium and wonder if I should do that separately from calcium containing foods or supplements. I can and do have some dairy products but I can’t eat very much of them.
Stones run in my family and I have already had two huge ones that obstructed my ureter. I really want to do good for bones and kidney. Doctors have offered sound general advice but I’m still at a bit of a loss. “Push fluids” is not exactly an action plan with measurable goals! On my own, I’ve cut out all nuts, chocolate, tomato sauce, tea without milk, potatoes, whole grains, beans, soy products, peanut products, lentils, and many other healthful foods I used to eat because of oxalate content because of oxalate stones.
Any advice would be welcome!
Hi Vicki, You have stones and no real plan, just shards and fragments. Here is a good start for you. It links into more detailed plans. See if it helps. Regards, Fred Coe
Hi Dr. Coe, and thank you for sharing your time and expertise so generously. After 2 Ca Oxalate stones I’ve had a very fine reduction in U oxalate from 55 to 22 and my other parameters are doing well also – but since I’m lactose intolerant I used Ca Citrate 250 with each meal to reduce oxalate absorption and increase Ca i the urine. The binding effect of the CaCitrate has become very difficult – would it be ok to substitute a dose ?30 cc of Mag Citrate
for one of the Ca Citrate to keep up the Citrate at least and ease the GI problem?
Dr Coe – Thank you so much for your dedication to helping us kidney stone suffers.
I am confused by the vegetable section of this article. When you reference kale and bok choy I assume the salt content is because it is frozen? Do fresh vegetables contain the same salt statistics as frozen? I was not aware any fresh vegetable contained sodium.
How do we get sodium statistics on fresh vegetables? Sounds like fresh fruit are natural low.
Tough enough to understand the right amount calcium to eat during a meal to offset any oxalate, but now concerned about sodium within vegetables.
Mike
I have just experienced a kidney stone too large to pass that was removed w/procedure. No prior history of stones. The stone was comprised of 50% calcium oxolate monohydrate; 40% calcium phosphate; 10% calcium oxolate dinydrate. My dr. Has put me on a low calcium, low animal protein & low sodium diet & referred me to a metabolic/endocrine dr. for a study of ur one & blood to make sure there isn’t underlying issue. I have had critically low potassium, calcium & phosphates in past since hysterectomy (3 years ago)and had low potassium again when blood work was done before stone procedure on 2/23/2018. I am finding extreme difficulty w/this diet & I find a ton of conflicting information (I.e. He has me on low calcium & things I read say I need to increase calcium when oxolate is high). I am 60 yr old female w/ generally good health until post hysterectomy 3 years ago. I have no gall bladder, 2 bulging discs, stenosis of spine (none of these bad enuf for s/x), lots of numbness/tingling (neuropathy) & neurosurgeon (2) have both recommended metabolic. I am looking for direction with this diet or recommendation on what type of physician to see or where a good dietician for this type diet might be located in the southeast. I live in tupelo, MS
Hi Tina Rose, Of course I know nothing of your details, but can say that in general there is no place for low calcium diet or low animal protein diet in kidney stone prevention. Likewise high potassium intake protects against stones. Given what you tell me I would recommend arranging an evaluation at a university medical center that has experience with bone and mineral disorders – kidney stones are in that general category of specialty. I looked on the web and found no special facility at the university nearest you. Perhaps you might consider flying to another location to get an opinion. Regards, Fred Coe
I have a dairy intolerance. I read somewhere on your website about the preferred type of calcium and to take it with a heavy meal, but I cannot find it. What is the best type to take and do you have a favorite brand? Does brand matter? Thanks!
Hi Morgan, If you mean a calcium supplement, all are about the same. They block oxalate absorption and can provide for your bones. The best way is to take one with each of your two large meals – the ones with oxalate in them – to a total of 800 to 1000 mg daily. But do this only with your physician and with testing to be sure about stone risk. Regards, Fred Coe
Thank you! Should it be Calcium Citrate or Calcium Carbonate?
Dear Morgan, Both are reasonable – but per pill they may contain different fractions of calcium so be sure to keep the daily total of calcium in bounds. Regards, Fred Coe
Question: I’m 57 and had my first stone in my late twenties. I still make stones but realized I can do a lot more in terms of prevention. I have embraced the low sodium, high calcium diet but have a question. It was recommended to me to drink milk (a big source of my calcium) with my meals. I’m assuming this is to offset any oxalate in the meal. I do that now- whenever I can. What if I’m not eating a meal but I still need to get to my 1200 mg of calcium per day- can I drink milk alone? My hips are fine but my spine is osteopenia. I need the calcium to stay near the 1200 mark. So can milk also be taken alone? Thanks. Love your website!
Hi Julie,
I am happy to hear you are ready to take your kidney stone prevention seriously. We all need calcium, stoners or not. Of all the thousands of patients I have worked with for nearly 20 years, most do NOT get enough calcium. It is key for stone prevention and as you stated, bone disease as well. Yes, you need your RDA of calcium and it is best to pair it with your higher oxalate products but even if you are not eating you should be drinking your milk to get (in your case) 1,200mg/day.
Take care,
Jill
Great news. I will do both- milk with main meals and extra milk if I haven’t yet hit 1200mg!
Thanks for your thorough and quick response!
Question- high calcium diet leaves me on the constipated side. Drinking lots of water and taking colace already. Can you recommend a lower oxalate fiber cereal? Currently doing Raisin Bran or Frosted mini wheats with milk once a day but these seem too high in oxalate.
Hi Julie,
I have worked with many patients that experience constipation from introducing more dairy into their diet. I would rather you incorporate more fruits and vegetables that are higher in fiber and lower in oxalate. There are so many options. We should be getting between 25 and 30 grams of fiber a day, most of us get around 12 gm/day. Exercise also helps to get you moving (pardon the pun) and lots of water. You cannot and should not raise your fiber to the recommended amount overnight. You will be bloated if you do so. Please slowly incorporate higher-fiber fruits and veggies into your day. Oatmeal can be used for breakfast instead of sugary cereals.
Hope this helps- Jill
Thank you. I will look at my fruit and vegetable intake and also try some oatmeal!
Hello- I am wondering if kombucha is good or bad for someone with calcium oxalate stones? Thank you.
Hi Martha, This form of sweetened green tea should have no effects at all. Regards, Fred Coe
Hello, I am in my mid 20’s and have been making stones since I was 21. I have passed/had removed 9 stones in the last 5 years and nothing I do seems to work. My urologist said low oxilate and high calcium but I am very sensitive to dairy and have trouble finding other sources of calcium. Any tips ?
Hi C,
There are plenty of milk subs now like flax milk and coconut milk. Also, google non-dairy sources of calcium (like salmon) and you will find many foods that have calcium in them. If you have an oxalate problem use the foods listed that will also be lower in oxalate.
Good luck,
Jill
my husband produces stones since he was in his teens, he is now in his 60’s. Anyway, he lost over 100lbs on keto diet and his dr. suggests he change his diet. His acid counts are 5.
Hi Susan, a 100 pound weight loss is very impressive and also a bit heroic at age 60; I presume his physician is keeping watch. I do not know what the 5 refers to, I presume urine pH, but that is a guess. I agree with his physician; enough may be enough. Likewise, muscle can be lost along with fat, and that is something his physician may want to keep an eye on. As for stones, this kind of diet has many ways to worsen them. Regards, Fred Coe
Hi Steven,
You sound like you are an excellent candidate for the kidney stone prevention course I run. Come to read about it. You can prevent stones you just need to learn HOW to make the changes necessary to do it. Read about the online course here: jillharriscoaching.com/course
Best, Jill
I am a bit confused about tuna vs tuna salad. Is it the mayo that puts tuna salad in the moderate category? Thanks!
Hi Kim,
Depends what was in the tuna salad, could have been celery…
Best, Jill
Hi Jill,
Is there any information, or maybe just a general guideline on how much calcium I should consume when eating high Oxalate foods to help absorb the Oxalates?
Hi Rus,
I just ask my patients to spread their calcium intake throughout the day. Limit oxalate to less than 100mg/day (unless your doc has said otherwise). Use dairy or nondairy milk. It is easiest. There will be enough calcium in these products to help. Read this article to help you
understand:https://jillharriscoaching.com/why-you-need-calcium-and-how-to-get-more-of-it/
Best, Jill
I’m 39m who is currently experiencing kidney stones. The pain is incredible. I’m trying to find a list of food to help that would make grocery shopping easier. Any help is greatly appreciated. Thank you
Hi Christopher,
I am so sorry you are going through this. Prevention is key going forward. Please read about the kidney stone diet on this website and you can find a good list here: jillharriscoaching.com. But please do a urine collection to see if you need a list. You may not need to watch oxalate!
Best, Jill
I am 28 and i am recently experiencing calcium oxalate stones. Im striving hard to find high calcium low sodium foods
Hi Jan, Good. Be sure to get 24 hour and serum measurements so you know what is causing stones. One can be surprised.
Is Oatmeal low in oxalate?
Hi LJ,
My patients eat oatmeal without raising their urine oxalate. They do eat it with a calcium-containing beverage and adhere to our other advice of getting their RDA of calcium. Here is a good article on oxalate and it also contains a safe oxalate list based upon the Harvard oxalate list. https://jillharriscoaching.com/good-oxalate-list/
Best, Jill
Thank you Jill!
Contrary to common belief, Kale is actually high in Oxalate, almost as high as Spinach. I stopped spinach and introduced Kale but still faced a lot of issues and then after doing some research found this:
https://doi.org/10.1080/09637486.2018.1482530
Hi Sujay, Even with my UC credentials I could not get the article, just the abstract. It says the ratio of oxalate to calcium is <2, meaning that the absorption of oxalate from kale will be poor. In an accessible source, the oxalate content of cooked kale vs spinach were oxalic acid (mmol) 6·6 (SD 0·2), vs. 0·11 (0·01 SD) spinach vs. kale, cooked alike and matching weights of 300 gm each. So the kale contained 0.11/6.6 or 1.66% of that of spinach. The article you cite may have actual oxalate contents, but all I could get was the low value for oxalate to calcium ratio. In a separate article, ‘The OA content of cooked spinach was 848 mg/100 g, of which 271 mg were soluble oxalates. Cooked kale OA content amounted to 8 mg/100 g, with 3 mg being soluble.’ I see no evidence that kale has any appreciable oxalate. Perhaps the one article I cannot access has different data, but even if it does we have to measure out the quality of their work, impossible given the journal makes access impossible. Regards, Fred Coe
Please could you send me your food list so I can see what is high, medium and low oxalate foods
Hi Gillian,
Here is it in searchable form. Also, that link will provide you with the “safe oxalate list” too!
Best, Jill
Do you have a Dr you recommend in the San Diego Ca area for a woman?
Hi Maggie, I presume it is for her kidney stones. The university in San Diego has a kidney stone center, and the physicians are excellent. Regards, Fred Coe
Hi Jill,
I am on a low sodium diet (800-1000 mg) for controlling Meniere’s disease and I need high calcium for bone health. I don’t know if oxalates would be a factor for me or not. Do you know of any program similar to yours that would address my combination of needs. I’m not a beginner and I follow the diets well. This amount of sodium is new and more restricted than what I’ve done previously and it’s hard to do low sodium,high calcium, as you said. Thank you
Hi Denise, Nothing prevents shopping for low sodium foods – labels have sodium content – and using adequate dairy product to maintain a proper diet calcium intake. This article is not bad for such a diet. Oxalate is irrelevant as you are not a stone former, and a high calcium diet will in fact lower urine oxalate. The big problem is prepared foods, all kinds of packaged foods – sodium is very high in them. Although you do not have kidney stones, the 24 hour urine stone test is excellent for marking sodium intake and also estimating calcium intake. Litholink is the best vendor. Regards, Fred Coe
Hello and thank you for considering my questions.
Confused on this article about adding a 0 to get the amount of calcium in a product, you say if 10% add 0 and you get 100mg. My milk/yogurts have both listed, 2% milk says 290mg and 20%, one yogurt has 230mg and 20%, another yogurt says 160mg and 10%. This makes it very difficult to know the true amount.
Also have Ca Phosphate stones, does all this dairy make the urine more alkaline than it already is?
My Uro Phosphorus is 940, is that important when it comes to Ca Phosphate stones? Does large amounts of dairy cause this to increase meaning should I not have all my calcium from dairy?
Thanks,
Lisa
Hi Lisa, Labels for calcium are not ideal. The % are of ideal intake and that ‘ideal’ varies among food producers. Use the Mg as noted and all will be a lot easier. Regards, Fred Coe
I had a bout with Kidney stones a few years ago and my doctor told me to cut back on oxalates, which I had no idea what they were, so he gave me a pamphlet with listings by food category with oxalate levels. On the vegetable listing, Kale was listed as the HIGHEST in oxalate level as well as other greens, so he told me to not eat them. Yet in the article above, it is recommended! Why the difference?
In fact, most of the foods that I had considered to be the best for you (almonds) were high on the oxcalte list.
Hi Brad, Kale looks dangerous, being dark green and all but has no oxalate in it. Almonds look great but have lots of oxalate. Regards, Fred Coe
Can I realistically get all my calcium on vegan diet. I am lactose intolerant. Vegan diet works for me. So kale and coconut milk products good options?
Hi Andrea,
Yes, they are fine. There are many non dairy milk products now from flax to pea.
jill
At 54, I have both osteoporosis and recurring kidney stones. I also no longer have a thyroid and take a synthetic hormone for that. I’ve been trying to change diet to find the sweet spot between all those variables. Much of the advice for kidney prevention conflicts with osteoporosis prevention diets. I thought I’d try doubling my calcium food intake such that I’d eat calcium rich foods with my meals (which are high in whole grains, beans, low-fat unprocessed meats and very little sodium), plus calcium snacks between meals such as yogurt. That way the calcium at meals could cancel out the oxalates and I’d add more boost to calcium between meals. Does that sound right? Also I’ve come to love barley ‘tea’ since I *thought* my habit of green or black tea is not good?
Hi Whitney, The advice to eat a high calcium low sodium diet – this article – is in line with what will preserve bone mineral. Here is a more general article on the value of this diet pairing for stones. No one lowers diet calcium or raises diet sodium for stone prevention, it is high calcium and low sodium we want – high calcium reduces urine oxalate, low sodium reduced urine calcium loss. As you say at the end of your comment. Regards, Fred Coe
Hello,
Regarding canned fish. I love canned salmon with bones. Most (all) companies add a lot of salt though as you’ve noted. But. I think a solution to this would be to rinse the salmon with water a few times. There may be some loss of other nutrients in doing this. But I think it could significantly reduce the sodium content. Making for a fantastic option to get in dietary calcium. Your thoughts?
Also, for those who avoid dairy because of lactose intolerance. This is solved very simply. Lactaid or any generic brand of Lactase tablets. Problem solved. Along with that. There is always aged cheese which is naturally lactose free. Yes, sodium may be an issue here. But there are low sodium brands.
Have you already put together a list of brands for high calcium / low sodium foods?
Thank you for all the work you do!
Hi Douglas, Rinsing out the sodium is a good idea – I do it too. Likewise, you are right about Lactaid etc. Brands are just too much for this kind of site and would not help much as we wrote the article scanning the whole FDA food directory for our present food candidate classes, and sodium content is by law shown on all products. Regards, Fred Coe
hai, is 100% fresh cow milk is ok for calcium intake? is fresh cow milk high on oxalate? thanks for the reply
There is no oxalate in milk. Fred Coe
Hello, I produce calcium oxalate stones. One recommendation to help remove oxalate from my body is to increase my dietary calcium. Great, I love and tolerate dairy very well. However, my Nephrologist said that added vitamin D, as in milk, should be avoided. Is this correct? If so, what calcium rich dairy products do not contain added vitamin D?
Hi Jon, No data support omission of vitamin D so dairy products are fine – to me. You might discuss this with your physician. Fred
Hi Jill and Dr Coe,
Although I my bone density test cam back normal, I am losing bone mass. I have broken two toes and am up to three broken teeth since July. I only have one kidney so I can’t take a calcium supplement. I also can’t take Iron and do not assimilate any of the B Vitamins well. I take 50,000 iu of Vitamin D twice a week. And, just to make things even more interesting, I am bone on bone arthritic in most of my body and am not a candidate for hip replacement where the arthritis is the worst. I take medical marijuana, in tincture form, for the pain. What would your suggestions be to help these issues. These are the questions that run through my head at 3:15 am.
Hi Andrea, If the toe fractures were pathological – injury is not at all sufficient as a cause – and bone mineral density normal, you have a very complex problem that needs to be evaluated by an expert in bone disease. Usually such experts work at universities. If the toe fractures were from sufficient force that one would expect a fracture, then it is just trauma. I do not believe that one kidney precludes a proper calcium intake of 800 to 1000 mg/d, unless that one kidney is functioning below normal. The arthritis would be a separate issue from bone or kidney disease. As for pain management for the arthritis – I gather that is the main issue – I am not an expert in use of marijuana for that purpose. I am sorry I cannot be more specific. Regards, Fred Coe
Dr Coe, I noticed breads seem to have more calcium these days like some English muffins contain 90mg a muffin or some breads I eat have 50mg a slice. Is this considered the same type of calcium as dairy or is it more like a supplement type calcium they are adding to these breads? Is it just as good getting these from breads as it is from dairy?
Hi Lisa, the calcium is just that, and will do the same as if in dairy products. Regards, Fred Coe
I know this is going to sound very spoiled and whiny. I just got preliminary results back and have oxalate crystals in urine, and am supposed to limit intake of those foods/increase calcium until they get more results back. I have lifelong sensory processing issues and am honestly panicking because most of the “safe” kidney stone foods are the few things I just can’t handle: eggs, milk, anything “creamy” like… basically all dairy! The dairy I am okay with, hard cheeses, are apparently too salty to be “safe” in larger quantities. I’m also supposed to limit my meat/fish intake, so it truly seems like I’m only allowed to eat things like eggs and yogurt and cottage cheese, which are the foods that are most challenging for me to eat. It sounds stupid, but I become very anxious, even panic, and become nauseated if I try.
I know changing diet is tough for everyone but would love resources on how to deal with this specific problem. I’ve gotten a lot better since I was younger but this specific texture issue is the one I still really struggle with.
Hi Chris, I presume you have stones, or perhaps pain attacks from crystals. If so, you should have your physicians pursue a full evaluation as to cause. Here is my best effort at this. Diet need not be overly constrained. A reasonable kidney stone diet, which may be fine for your depending on your results and your physicians is rather well balanced and includes most foods. Regards, Fred Coe