If we put together everything on this site about diet for kidney stone prevention we get a reasonable and consistent image of one basic pattern. It is more or less what is ideal for idiopathic hypercalciuria and for reducing urine oxalate. It is the diet that has been used in the one major trial of diet for stone prevention. It accords with modern recommendations for the health of the American people. More or less, after all is said, there is only one diet plan that meets the needs for kidney stone prevention and we have called it ‘The Kidney Stone Diet.’
‘We’ are me and Jill Harris (pictured right).
Of course, we are speaking of the diet for treatment of idiopathic calcium stones. Stones from systemic diseases, like bowel disease, primary hyperparathyroidism, primary hyperoxaluria, are treated by treating those diseases, and that is a different matter altogether. But those are the exceptions. Of the millions of American people with stones, almost all are idiopathic.
There will be surprises. Diet oxalate always matters but less so than you might think once the full diet is in place. Calcium will seem odd to you unless you have been a frequenter of this site. Sodium will seem all too familiar.
Dissecting the Diet
Calcium
High calcium intake is essential for stone formers. They have bones and many have idiopathic hypercalciuria that can cause bone disease unless there is a lot of diet calcium intake. Oxalate absorption is greatly hampered by high calcium intake, if the calcium is eaten when the oxalate is eaten.
It is not only stone formers who need a lot of calcium. The new FDA diet recommendations include high calcium intake for all Americans.
How high is high?
More or less, throughout life, men or women, girls or boys, the range hovers between 1,000 and 1,200 mg daily. This amount of calcium is ideal for both protection against bone mineral loss from idiopathic hypercalciuria and reducing oxalate absorption. The unique part for stone formers is timing the calcium to go with the main oxalate containing foods during the day.
Sodium
Urine calcium follows urine sodium like a shadow. The lower the sodium the lower the calcium. In the one bone study that seriously looked at the matter, it was the combination of low sodium diet and high calcium diet that led to positive bone calcium balance – uptake of mineral into bone as opposed to bone loss.
So, what is ‘low sodium. The new FDA recommendations are an intake below 2300 mg (100 mEq for those of you who read lab reports). For those with high blood pressure – treated with drugs or not – 1,500 mg is ideal. For stone formers, the latter, 1,500 is ideal because it brings urine calcium of hypercalciuric people near the normal range, and also benefits those without hypercalciuria by making urine calcium as low as possible.
If 1,500 mg is the ideal for the kidney stone diet, 2,300 is the absolute upper limit, and people will more or less want to live somewhere in between, hopefully at the low end.
Refined Sugar
Refined sugar is sugar that has been extracted from plants into the white stuff you buy in bulk and add to cake and cookie and brownie recipes, and use to make candy. The sugar in plants and fruits is packaged along with fiber and released slowly so it is very safe. Once you extract it into white powder it is absorbed very fast. We are not made to use this well. Blood sugar and insulin rise a lot, fat is formed, and it is not healthy.
Jack Lemann first showed decades ago that simply eating 100 gm of glucose causes a rapid rise in urine calcium with – can you imagine worse? – a concomitant fall in urine volume so supersaturations rise extremely high. It is the perfect storm. Urine calcium of people with hypercalciuria rises a lot more than in those without it, so it is evil in family members of stone formers. Since about one half of the relatives of a hypercalciuric stone former will be hypercalciuric because of genetics, even the children are put at risk by high sugar intakes. The worst part is that hypercalciuria is silent until stones or crystals form, so no one can know.
Very reduced refined sugar intake is emphasized in the new government diet recommendations because of American obesity and diabetes. The recommendation is that less than 10% of all diet carbohydrates come in the form of added sugar which means very little sweets. This means sugars that are added to foods, not the natural sugars in fruits and some vegetables. The latter are absorbed more slowly and are safe. Obviously candy and cake and brownies and all the other good stuff is in the very bad category.
Protein
Our long and difficult review of the protein story make a main point. People absolutely need at least 0.8 gm/day per kilogram of body weight of protein and need no more than 1 gm/d/kg. WIthin that narrow range there is a measurable but modest effect of protein on urine calcium that can be neglected if sodium is controlled. So we see no physiological basis or trial evidence that ‘low protein diet’ is appropriate. By low we could only mean 0.8gm/kg/d. The one comprehensive kidney stone diet trial implies a low protein intake but in fact employed 93 gm of diet protein – which is a lot. The diet change was to make 40% of it be plant based. But there is no evidence that plant protein reduces stones or urine calcium compared to meat protein. Plant based protein sources are often rich in oxalate.
Oxalate
All things being equal we have advocated for a low oxalate intake between 50 and 100 mg daily. However Ross Holmes showed clearly that with very high calcium intakes such as 1,000 to 1,200 mg daily, absorption of diet oxalate is less and therefore the need for strict control is also less. In the one diet trial by Borghi diet oxalate was 200 mg/day but diet calcium was high and urine oxalate actually lower than in his contrast group with low calcium diet and less oxalate intake.
The ideal approach as best we can tell is to put in place the high calcium diet, aim for about 200 mg of oxalate, which is easier to accomplish than lower values, and measure the urine results. If despite high calcium intake urine oxalate is creating risk of stones then diet needs to be altered appropriately.
Some people seem to absorb oxalate more efficiently than others, so there are no fixed rules. Many have normal urine oxalate excretions without any diet change at all. Many who have undesirably high urine oxalate at their first labs will show a marked fall with the higher calcium intake and need no further restrictions.
Some will remain hyperoxaluric despite the calcium and it is for them that very restricted oxalate diets can be reserved.
One key is urine collections to see that calcium alone can accomplish for any one person.
The other key is timing. The diet calcium must come in the same meals that contain the bulk of the day’s oxalate. Without that precaution calcium might not work well in this regard.
Fluids
We have covered this topic completely. The urine volume you want is above 2.5 l/d, the amount of fluids needed is about 3 l/d and you just have to experiment to find the exact intake for you, and also allow for weather, occupation, sports. Obviously sugared fluids have always been unfavored on this site, and you need to avoid them. The other major issue is steadiness over the day and into the evening. Overnight we just take our chances in most cases.
There You Have It
The kidney stone diet is one thing: High calcium, low sodium, low refined sugar, normal protein, flexible oxalate management that depends on how high urine oxalate is once high diet calcium is achieved, and of course high fluids.
This site is rich in articles that pertain to the kidney stone diet – it was built in part for this purpose. The home page lists articles by topic and you can find there the ones you need. Here is a brief summary with links.
High calcium and low sodium: 1,000 to 1,200 mg calcium 65 – 100 mEq (1,500 to 2,300 mg) sodium and care about oxalate (50 to 200 mg/day) can be achieved using our list of foods that meet all three requirements. It is essential that calcium be taken in with the meals that contain appreciable oxalate.
Low refined sugar (below 10% of daily carbohydrate intake): This is best thought of as a major reduction in sweets – cookies, candy, sugared drinks, cake, pie. Fruits are not a problem, but smoothies that break up the fruit may liberate their sugars and overcome the ‘slow release’ properties of the intact fruits themselves. We did not write an article about this matter because it is simply to give up what many of us love.
Normal protein intake – this translates into 1/2 to 2/3 pound of meats daily for an average adult. For stones, the issue of red meat vs. fish or chicken does not matter. Vegetable protein sources such as soy are high enough in oxalate one cannot recommend them.
High fluids and how to get them are in many articles on this site.
When Do You Begin the Diet
To us there is no question it should be after even one stone. The diet accords with all modern recommendations. The only special features are attention to oxalate and to timing of calcium with oxalate containing foods. High Fluids are more of a task, but after one stone the one trial showed a marked reduction in second stone formation with urine volumes above 2.5 l/day compared to the 1 l/d of the control group.
A more subtle matter is family members. Idiopathic hypercalciuria causes both stones and bone disease, and is hereditary. About half of first degree relatives of hypercalciuric people with stones have the trait even without stones. Given this, and also that the kidney stone diet is benign and in line with what we all should be eating, why not make it the general family diet as well?
I (Jill), have recently put together a private FB page called THE Kidney Stone Diet. It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound. Come on over and join the discussion!
Hello,
I am a 32 year old female who suffers from Calcium oxalate stones and I am on my way to get a procedure to remove them all. I have stents on each side bcuz an infection brewed up. I need guidance on what to eat and how to avoid this again. I’m miserable. If you can offer any advice please do. Thank you in advance .
Hi Nina, I am sorry and hope for a speedy recovery. Indeed this whole site is about prevention. Here is my favorite starting article. This one is easier but not as detailed. The kidney stone diet is in fact the ideal US diet – the easiest part. Regards, Fred Coe
I need to know about a site as well..
I do not want to go there this again ..
Please give me some info ..
Hi Tammy, I am not so sure what you mean. This is a site and about prevention. I guess you do not want more stones. Try this article to see if it helps you. Regards, Fred Coe
Good day
I am a 34 year old male from South Africa.
On 1 April 2018, I had a huge amount of pain on my lower right back area and also groin area. I initially thought I was constipated but I also noticed that I could not urinate.
I then rushed to the hospital and received the diagnosis that my urine contains some blood and that the scan showed that I had a kidney stone near my bladder area. I was then given one day / 24 hours to see if the stone can pass through.
Unfortunately it did not. I then a had a procedure to remove the stone via a laser. I too have a stent which will be removed soon.
I tried to understand what my cause was. I did not that I drank alot of Sugar-Free Pepsi soda on 1 March 2018 until 1 April 2018. I suspect this may have caused the issue? I also noticed that I drank alot of coffee particularly nespresso or similar.
Questions I have:
1. Can Soda cause kidney stones?
2. Can Coffee cause kidney stones?
3. Is there a diet I should be following to prevent? I understand drinking enough water daily assists this.
Thank you
Hi Mr Man, Coffee is protective against stones, diet soda not ideal. But you did not form your stones in a day or week, but over months or more. Here is a good general article on stone prevention. If you want a long video on how stones form, try this one. The stone diet article is a favorite of mine – it matches the US ideal diet and probably best for South Africa as well. Regards, Fred Coe
I just passed my first stone and have 3 small calcifications. I also have interstitial cystitis so I can do no citrus and already have a very limited diet. I do very little dairy because it is so constipating. I eat zero processed sugar but have lived on spinach, sweet potatoes and meat for the past 3 years. My urology APN has me on 3g of DMannose daily (1.5g morning and evening). Is that a sugar that is ok on the stone prevention diet?
Hi Karessa, With a low calcium diet + spinach you are almost asking to make a stone. The oxalate in spinach is very high and without diet calcium absorption will be very efficient. The mannose could reduce urinary tract infection but is itself of no known value or harm to humans. Here is a very detailed article about the matter. You need a different diet – kale instead of spinach would be a good start. You have a skeleton, so low calcium diet is a worry. Regards, Fred Coe
Thank you Dr. Coe for your rapid response and the link to the article. And for the articles on the site that I am gradually making my way through. I will not be concerned about the DMannose and will continue supplementation if I understand the article correctly. It was a calcium oxalate stone that I passed. 24 hour urine and blood tests will be done in a couple weeks. I have already replaced spinach with kale, only eat 1 small sweet potato per week (had been daily) and have reduced salt and protein intake. I have increased water intake to approximately 2.5 liters a day and am still trying to increase. Your articles have been of great help! I am now trying to identify calcium sources that work with IC and are not horribly constipating. I plan to try cottage cheese this weekend.
Dear Karessa, The ideal is the entire kidney stone diet – all five parts. Otherwise you will be forever overdoing one or another part – like too much attention to oxalate. Regards, Fred Coe
Hi Dr. Coe,
I eat a very health-conscious diet, and I have been able to lower Ca 24 significantly by carefully following your dietary recommendations. But SS CaP I still too high. I’ve noticed that P 24 varies quite a lot between 24-hr urine tests, so I suspect that it may have to do with what I eat. But I haven’t been able to figure out a pattern.
Can you please suggest how I can reduce P 24 and therefore also SS CaP through diet or something else? Thx!
Hi Kenny, that SS CaP stays high means urine pH is too high, or volume too low, or calcium too high; the urine phosphate plays little role. So try to push volume up as best you can, lower sodium the same; in the worst case, if SS CaP is not 1/2 of less of what it was when you started and a bit more effort cannot achieve such a goal, perhaps your physician might want to add a very low dose of chlorthalidone – 12.5 mg/d if indicated. Regards, Fred Coe
Hi Dr. Coe,
Thx for the help! Learning a lot from this site. Drinking gallons of water, slashed sodium, cut protein, and added Chlorthalidone. No Potassium Citrate pills due to high pH, but I do need to eat a lot of fruits and veggies keep my K up.
The good: Ca 24 dropped by one-third. The bad: pH went even higher, and SS Cap remained virtually unchanged. Feels like I’m stuck in a game of ‘Whac-A-Mole’ where another just pops up when one goes down. That’s why I’m looking for others knobs to turn.
Sorry, I don’t understand why the “P” in “SS CaP” only plays little role in this case. The difference in SS Cap between a low P24 day and a high P24 day looks to be around 15%, so it feels like it might be an opportunity.
Do you have any ideas what dietary factory might make P24 swing so much? Other ideas to optimize SS CaP when pH is stuck high, Ca is as low as my Dr. can get it, and volume is high?
Hi Kenny, phosphate is a fundamental part of all living cells so just eating gets it into you. Cola drinks are a special high source. The best plan is to look at how much more you can drop your urine sodium – are you at 1500 mg (65 mEq/d) yet? If not, that will lower calcium a lot more and SS CaP, too. The fruits and veggies raised the pH, no doubt. I always so as much with sodium as possible; urine phosphate is very hard to change for the above reasons. Regards, Fred Coe
My husband has been plagued by recurrent kidney stones. Passed another one this morning. Is there any imaging that can be performed to see if he has other stones in his kidneys? We will work on the dietary suggestions in your article.
Hi Gayle. CT scanning is nearly perfect but involves radiation; ultrasound is the common way to track if obstruction is present. Plain KUB x rays are poor but usable in some patients. Do pursue prevention; it works. Regards, Fred Coe
Hi Dr. Coe,
I’m told that I’m probably a Ca hyperabsorber, and as a result Ca is absorbed to quickly to bind enough oxalate, and too abruptly to be used optimally by my bones.
I found a time release “slow Ca supplement”, but 1200 mg is way too much Ca/day on top of my healthy diet for one with IH.
Do you have any ideas for supplements or foods with nice slowly absorbed Ca that binds oxalate well? Ideally something that I can take in a bag lunch.
Hi HB, I know of no such phenomenon as too fast a calcium absorption to permit blocking of oxalate absorption. People with hypercalciuria absorb a higher fraction of diet calcium but rarely more than 30%, and with high calcium diets usually less. Ideally, put food calcium with meals that contain oxalate. Use supplements to bring the day total to 1,000 or 1,200 mg likewise spacing them into meals with oxalate. SLow release has no relevance I know of. Regards, Fred Coe
Thank you, Dr. Coe. Great article.
Sorry, I’m confused though. I also read your reply to a poster’s question about the Tums in case study #2, and it sounded like it was absorbed to fast to bind oxalate well.
I’m having trouble finding really good sources of Ca. Cheese has a lot of bad sodium, yogurt a lot of bad added sugar, and milk is harder to carry with a lunch. And pills take time to dissolve so I’m not sure how to time them.
Any additional ideas?
Hi H.B., Tums is just a convenient calcium supplement one can take with meals to block oxalate absorption. Food calcium is better and safer. If you have no systemic or bowel disease and just calcium stones, the ideal is a high calcium diet where the calcium is placed with the meals that contain oxalate. Yogurt need not have sugar – that is an additive. Milk is ideal, and there are many kinds of milk in case of sensitivities. Here are more diet calcium low sodium sources. As for dissolving, Tums and other calcium carbonates dissolve fast in the stomach acid. Regards, Fred Coe
Dr. Coe,
I’ve been dealing with stones for about 15 years. What I’m going through now is epic, like when I got my first. I’m approaching desperate to find some doable answer. Now, please forgive my ingnorance, but in many of these Q & A’s, folks are referencing information and terminology that suggests they’ve dug deeper and analyzed urine, etc. How does that happen? Does that come through a urologist, or are they going to a kidney specialist or what? I quit counting years ago, so I don’t know how many stones I’ve passed (dozens), but I’m getting too old for this. I can tell by reading this stuff that I’m behind the times, and I can probably do better than simply cutting my calcium and sodium and guzzling Crystal Light lemonade. I get the regrettable feeling that the family physician has, over these years, seriously let me down. – Mark, Indiana
Hi Mark, No problem. Perhaps you might be best off beginning at the beginning – I have a whole book up on the site and here is chapter one. If you read along the evaluation and treatment options all are there – or mostly, this site is large and seems never to be done! Diagnosis precedes treatment, and treatment for stone prevention is generally focused and particular. Let me know, Regards, Fred Coe
Mark,
I had to respond when I saw your Crystal Light comment- that should never be an option. The sugar is opposite what you’re seeking. You need to make it yourself without sweetner. You’ll get used to it, and not put chemicals I you creating other health problems
So no additional need to specifically reduce purine intake, other than by addressing total protein? Are high dietary purine sources a non issue? Can you send a reference for this?
Hi Lori, How thoughtful a comment! It was I first brought up the uric acid – calcium oxalate stone link, and here I omit all mention of it. Purine and protein sources are very close linked – not identical, certainly. The former comes from cell nuclei the latter from cytoplasm – as a rule. One can get nuclei enriched protein sources – high nuclear to cytoplasmic ratios – in some seeds, as an example. But the protein uric acid link is good enough. Moreover, I have no epidemiological evidence for purine alone, or even uric acid excretion alone, as a risk predictor for new stones. Even so, there is the allopurinol trial and I certainly bring it up in the overall treatment of idiopathic calcium oxalate stones. Warm regards and thanks, Fred
Just read an article that listed Stevia Sweeteners as high in oxalate and to be avoided for stone formers. Do you agree with this?
Hi Just, No. Chemical stevia has no oxalate. Stevia plants do, but you can buy the commercial chemical that is oxalate free. Regards, Fred Coe
Are Stevia Sweeteners high in oxalate and to be avoided for stone formers?
Hi Just, I answered this – No; the chemical stevia is free of oxalate. Only the plant has it, so avoid ‘natural’ stevia in favor of the pure chemical. Regards, Fred Coe
I have had kidney and bladder stone and they are of the uric acid variety do oxalates paly a role in their formation? what is the best ways to help prevent uric acid stones?
Hi Larry, Here is my best on uric acid stones. It works. Regards, Fred Coe
the report on my recent kidney stones that block my kidney were 80 percent uric acid and 20 percent calcium oxalate how and what plan do I need to follow for this combination ?
Hi Barbara, Uric acid stones are treated one way only; take a look. But you need 24 hour urine testing and blood as well to be sure you know all that might be present. The calcium component is separate. These articles should help you make a plan; here is a nice planner. Regards, Fred Coe
Hi I have had 8 kidney stones in 7 months. They are calcium stones and my urologist and pcp can’t figure out what’s causing them. Blood work showed calcium levels are normal. Urologist think parathyroid glands are causing them. Pcp is urging me to change diet and referring me to nephrologist. If it’s not my diet or parathyroid glands what is causing them? Help please?
Hi Erin, I gather bloods and 24 hour urines have been done and people – and you – are confused. Here is a good starting place. Here is what primary hyperparathyroidism is all about. Here is a good plan for evaluation. Let me know if things do not get straightened out. Regards, Fred Coe
hi Dr. Coe. I asked you a question a couple of days ago but I don’t know on which of your pages I asked it. Is there a simple way of finding where I asked my question? Thank you for your brilliant and thorough information.
Hi Arno, You put it here. Let me know if you cannot fine my answer. Regards, Fred
Dr coe, I have chronic Uric acid kidney stones. Cannot swallow k citrate tablets. Smaller tablets 5 meq, I might be able to swallow, but more expensive. What do you think about liquid or effer k, but not FDA approved. Am drinking 12 glasses water and 8 ounce lemon juice a day and totally changed my diet. Thanks
Hi Janine, You need to raise your urine pH. Beverages like Crystal Light have a lot of potassium citrate and will do this for you. Effer K is fine, 10 mEq per dose of potassium citrate. You can mix and match. This article is full of workarounds for potassium citrate pills. Just be sure the 24 hour urine pH is above 6, and uric acid will not crystallize anymore. Regards, Fred Coe
Doctor Coe,
I am post menopausal and have high testosterone levels. My OB/GYN physician has put me on Spironolactone 100 mg. 1x daily in evening to reduce testosterone. I have been on this for 2 weeks and I am urinating constantly at night 6 to 7 times easily. I am concerned I know it is a diuretic but off label is used to lower high levels of testosterone. Could this cause kidney stones?
Thank you for your time and attention to my concerns.
Joan
Hi Joan, I know of no link between this medication and new onset of kidney stones. I found lots of articles on the web about increased urine flow with the drug but on PubMed – a reliable scientific locale I found nothing. But this review from Google but of a scientific article does mention polyuria. Be sure and check your serum potassium, as it can rise, especially at the 100 mg dose and in an older person. Such monitoring is always recommended for safety. Regards, Fred Coe
Hello,
I wonder if you know of or recommend a veterinary equivalent to these articles? My German Shepard will have surgery for Calcium Oxalate stones in his bladder and because of IBD the prescription diet perscribed is causing a flare up of those symptoms. I wonder if dogs and people are similar. I’d like to research how to adjust his diet after the surgery because at 10 year old and with IBD he may not tolerate repeat surgery…Thank you
Hi Gayle, veterinary medicine is a deep specialty and I am not in it. You need to consult with an expert in dog biology and medicine. This site may be altogether bad if used for animals, and I would advise against it. I know stones should be stones wherever they are, but not true when we get into another whole branch of medicine. Regards, Fred Coe
So I’ve been having cramping in lower abdomen for about 8 months now, had just recently found out going thru menopause. Plus had a cyst on right ovary. Had that removed. Had a ultrasound from OBGYN and plus a ultrasound of abdomen. Stomach doctor now telling me I have kidney stones. Now I’m wondering, wouldnt the OBGYN doc be able to see that I have kidney stones?
Hi Leann, The OBGYN probably focused on your pelvis, the other physician higher up where kidneys are. Regards, Fred Coe
Hello, I’ve been taking Lasix for a year and Acetazolomide (low dose) for the last three months for some stubborn IIH symptoms. I’m starting to feel pain in my right abdomen and back. In an effort to be healthy I was eating low carb. I read kidney stones are possible with these meds. The prescribing doc is a neuro opthamologist. What should I do? Quite concerned. Thanks for any help.
Hi Jessica, the acetazolamide is a known culprit. If you fear stones get a renal ultrasound or even CT to be sure. Given stones, your physicians will need to find other ways of treating you. The stones from this drug are calcium phosphate and can be large and numerous. Regards, Fred Coe
Diagnosed with extremely low ViT D level. I have been prescribed 50,000 IU one tab/ week for a couple of months. Will this increase my chances of forming another calcium oxalate stone
Hi Sondra, No; but your low levels need explaining. Is your diet deficient? Hypercalciuria can lower vitamin D stores, is your urine calcium level high? Regards, Fred Coe
Dear Dr Coe and Ms Harris,
I am greatly impressed by the thorough and dedicated job done on your site. I have roamed it and am most amazed and it is a great help. Thank you.
I live in Mexico, on the kidney stone-endemic Yucatan Peninsula, and have had my second bout of kidney stones in 13 years. So it is not that bad, I say, but this time there were several stones—all quite small, luckily.
Here the basic diet is corn tortillas and beans—be they black, red or white. (I guess the black ones are what you call navy beans stateside? Sounds like they are a problem as to oxalate intake…)
I see on your site references to corn meal and corn flour: I am not sure that the dough used for corn tortillas is either of these??
The corn in the homemade tortillas I eat (not the commercial ones) is cooked in limewater which increases calcium by 750% making it 85 % available for absorption, then my question is: does that calcium off-set the oaxalate intake of corn enough to eat the tortillas peacefully and pleasurably?
Thank you for your answer and wonderful job.
Spyros
Hi Spyros, It may indeed. Given several stones I would invest in 24 hour urine testing while eating as you do and thereby find out about the urine oxalate and calcium and other stone risks. Easier to measure than guess. Regards, Fred Coe
Adding to my previous question: I worked as a health worker in disastrously poor war torn regions of Centroamerica and never saw a case of rickets despite having seen other forms of malnutrition. I would attribute this to the tortillas even though there, for the levels of poverty, they were not cooked in limewater but in wood ash lye. For whatever that be worth…
Dear Spiros, The wood ash lye is potassium hydroxide, so it provides potassium and alkali, the latter would raise urine citrate and lower urine calcium losses. Maybe that is part of the answer – good for bones. Regards, Fred Coe
Im have a kidneys stone, im taking medicine as pres by my Doctor, potassium citrate1200meqs 3x a day, for 3mos, but it didnt disolve the stones, my doctor tells me that maybe the stones are two hard to break. And he concluded its a calcium oxalate stones,.and now its getting bigger from .40 CM TO .5CM. I would like to ask if what diet am i going to follow? Thank u very much, godbless
Hi Kem, Potassium citrate can dissolve only uric acid stones. Calcium oxalate stones will not dissolve. I suggest you might want to read a bit more about treatment. The article you are posting is the ideal diet for stones, and it is the one you want. But perhaps a larger perspective would help. Try this. Regards Fred Coe
I’m an ethical vegan with three kidney stones. I was assigned a wonderful doctor in the emergency room in Hershey, Pennsylvania (who went to U Chicago). Your article was very helpful but I’m still s bit confused about what to eat. Animal products are not an option. Any suggestions would be greatly appreciated. Thank you.
Hi Teresa, This is a question for Jill Harris, who has studied a lot about diets for stone formers. I would contact her; she helps patients via the internet. Regards, Fred Coe
Thanks for putting this together! I have been attempting to follow this. I am finding the oxalate, calcium, added sugar and sodium restrictions to be doable. However, I am far exceeding the top of the protein range (about 2.6 g of protein per kg of body weight) and am about 700 calories below where I’d like to be (2,500) given my activity level and weight. Any recommendations for foods to add?
Example:
Breakfast: Oatmeal, Blueberries, Skim Milk, Banana
Lunch: Turkey Burger on thin Bun, Salad, Skim Milk
Dinner: Boneless Skinless Chicken Breast, Cooked Vegetables, Cottage Cheese, Brown Rice
Oxalate: 60
Calcium: 1,170
Protein: 170
Added Sugar: 30
Sodium: 1,560
Calories: 1,800
Hi Dennis, This is a complex diet question, and the ideal person to help is Jill Harris. She works with patients on the web, and could also just answer your question. Regards, Fred Coe
I would like to join a private group but not on Facebook or Google for security (and political) reasons as neither of these can be trusted, a software engineering fact.
Hi Doug. An interesting point. How would patients form a private group without a platform?? Fred
What is the exact play by play diet for a male to follow to get a kidneystone that is lodge I’m his kidney and needs the stone to by through right away asap?? Tyia
Hi Nickie, Diet will not affect a stone that has formed, only prevent more of them from forming. The diet on the page of your comment is the right one, but full prevention takes a bit more work. Here is my best on how prevention – diet as one part – works. Regards, Fred Coe
When will you confirm that oxalate neutralizing microbiome species are increased when eating the oxalate foods, while also consuming calcium to protect the kidneys from excess oxalates (along with the other factors of the University of Chicago Kidney Diet)? My post, “Kidney Stones, food” shows a Litholink (24 hour urine testing for kidney protection) chart over time. It repeatedly show higher oxalates with lower dietary calcium. As well, it demonstrated great solutions when eating your diet at home vs worsening with return to college cafeteria foods. I’m sure you have this effect demonstrated in your patient records as well!?! Have you published this?
Hi, I really should not allow this post on the site as it is advertising a product. Multiple studies have documented falling urine oxalate with higher diet calcium, so rising urine oxalate with falling diet calcium is predictable – in fact the same thing. I know of no oxalate neutralizing species; I know about microbes that metabolize oxalate, that they do not flourish unless one provides oxalate, and that the few trials have been bleak failures so far. I do not endorse your products. Fred Coe
I am so happy to have found this site! My husband had three kidney stones. He did not change his diet until the third one which was the largest. He was able to pass each stone thankfully by drinking lots of water with apple cider vinegar. The last stone was three and a half years ago. It started with blood in his urine and we were terrified that it was something worse. That is what finally prompted his diet change. He was vegan for a year after the stone and has gradually introduced some animal products back into his diet. He drinks approximately 2L of water per day and has cut back on refined sugary sweets in his diet. My concern is that he still has virtually eliminated dairy, substituted milk for almond milk in cereal and smoothies (fructose?), and eats a lot of cashews for snacks and beans instead of meat. Going forward, what changes if any, should he make to his diet? Are meat/fish/chicken ok or should he avoid them? Should he add more dairy? What type of dairy – cheeses or yogurt or milk? I don’t want to see him suffer another stone ever!! Thank-you for any advice!
Hi T, He needs evaluation to see what is wrong, and that involves 24 hour urine and serum testing. You just cannot guess and get a good result. Here is a good source article to help, and right now confusion is a possible problem in his care. Regards, Fred Coe
I forgot to add that kidney stones strongly run in his family on his mother’s side.
Hi T, More reason to pursue full evaluation before trying treatments. Regards, Fred Coe
I have been dealing with kidney stones going on 7 years. The first kidney stone almost took my life in 2013. It set up sepsis and attacked all my organs and left me on a ventilator for eight- ten days. After finding medicine to get the sepsis out of my system. Moving forward I had to get All my toes and finger tips cut off, with the exception of my thumbs. I’m very Grateful to God to be alive. I still have problems with kidney stones. I have been trying to find the kidney stone diet. I need to know what exactly I need to stay away from.
Hi D.H. Given all this, you need comprehensive study to determine the cause of stones and serious prevention. This may include diet and meds. I would suggest you read beginning here and running through the chapters. You simply cannot make more stones, and there is no reason to. Regards, Fred Coe
Hi I hace a question.
Dahlite stone, can be from any other thing besides uti?
Hi Ana, Dahlite is simply the form of calcium phosphate common in bone, tooth enamel and kidney stones. They are not due to infection at all, but rather to high urine pH from the biology of the kidneys. Here is an article about people who produce calcium phosphate stones. The stone mineral is called hydroxyapatite, but often it contains a lot of carbonate whereupon its name is Dahlite. Not a distinction of direct relevance to treatment. Regards, Fred Coe
I am suffering from kidney stones more than 7 years. I had two surgeries (ureteroscopy) between 2016 and 2018 in the same kidney (right one).
I did all the blood tests needed, I went to see a diet professional but I still produce kidney stones and have renal colic sometimes three times a week and I can’t have a normal life anymore.
They told me that I have oxalate calcium stones; I still have 6 kidney stones until now in both kidneys and I don’t know what to eat and not to eat to be in a good shape and this is complicating my life.
By the way I am from Morocco.
Hi Ifri, Blood testing will not disclose most causes of calcium oxalate stones – you need 24 hour urine testing for that. The testing will point to what you need to do, diet, meds or both. Proper testing must be available in Morocco, but I do not know where. You need to find it and get it. Regards, Fred Coe
Good Morning!
I’ve been exploring this site and reading many of the linked articles since about 6 am this morning.
I have history with kidney stones, just recently had a stone event that included a severe case of sepsis.
24 hour analysis revealed calcium oxalate stones and proteinuria.
I am a 64 year female. 5’4 and 190 lb generally active and community and socially engaged.
Last year I was recommended to begin water pills and calcium
I chose to wait as I was concerned about the heavy meds.
I live in rural area and have had little access to what information I need to navigate these stones.
First stone at age 34
No recurring stones until mid 50s when I seemed to get them every 15-18 months.
Had 3 lithotripsies at that juncture
Tried many diet changes based on my own research
Lost confidence in medical doctor as he missed an 8mm stone and consequently I hemmoraged needing yet another surgery and stent.
Changed urologist and had to travel 2 hours to largest city in our state.
Had one more stone and than found a mineral called Milk Thistle.
Took that faithfully from 2008 until last year 2017 with absolutely NO stones!
SADLY last year in October 2017 I was rushed to surgery with 8 large stones….4 on each side.
As I stated earlier i declined the meds. Being transparent my reasons were concern about reaction and distrust of medical process
I admit I could have done better due diligence and researched more options but I did not.
NOW I find myself forced to give these meds a trial.
I’m searching for options that include diet and perhaps even a move to another location closer to more medical choices.
As I was near heavens door during the most recent incident 9/16/18, I am motivated to do whatever is necessary to avoid stones and thereby any further damage.
Thank you for your comprehensive articles. I will continue to educate myself and make changes.
I only wish I learned this information when I was in my 30s.
Blessings
Diane M
Hi Diane, Do pursue prevention. Try reading from here, and just doing it. You need to know the cause and reverse. Regards, Fred Coe
Do you study Fabry disease?
Hi Diane, No; I have no special expertise for this disease. Sorry, Fred
I’m a 35 year old female with one kidney stone. I have had two procedures in the last six months, to break up the 6mm stone I was diagnosed with. It’s down to 2mm but it has moved back up into the kidney and hasn’t moved. I have been drinking 2-4 liters of water, occasionally adding lemon juice, with no change. I have done bloodwork and 24 hour urine collection, all coming back normal (which is great!). I’m feeling frustrated and wondering now what? Just keep drinking tons of water? My dr said to do low sodium, but I’m still not sure why if all my results came back fine. I was drinking protein shakes and the drs believe this was the cause of my stone formation.
Hi Barbara, You are almost there but a bit mired down. The stone analysis is crucial, and surely some fragments were tested. Second, I am sceptical that results were really normal. Ask your physician to review them with you in terms of what more one could do. Protein shakes will raise urine calcium and stone risk, so if urine calcium is below 200 mg/d and you stopped the shakes, and nothing else is wrong, and the stone is mere calcium oxalate, well and good. But be sure. Regards, Fred Coe
Is there a snack or protein bar that is low in oxylate. To carry with you if no time to stop to eat?
The rest of the diet is understandable. Thank you
Hi Jan,
I hate bars in general as they are typically filled with unnecessary amounts of sugar and protein. I often suggest to patients to have a lower sugar yogurt or hard-boiled eggs to carry them through to the next meal. Also, fiber is very helpful to aid in weight loss, curbing appetite, and general good colon health. How about a pear or an apple to tide you over? Good 4 grams of fiber in each.
Best, Jill
Hello, do you think that intermittent fasting or the omad diet ( one meal a day ) could reduce calcium oxalate kidney stones ? And what about the ketogenic diet or carnivore diet ?
Thank you for the reply.
Hi Lagmari, I think one meal a day might worsen stones by imposing a massive urine loss of materials in a short time. Ketogenic diets can promote stones in theory by raising urine calcium. I am not a fan. Regards, Fred Coe
Thank you for the reply . I am doing intermittent fasting . I fast from 8.00pm till 4.00 pm the next day but I drink water. 2 liters at least .With some apple cidar vinegar. And I add 5g potassium citrate and 3g Mg citrate in my 2 l bottle of water. I also have some black coffee and tea, without sugar. And I feel better. No pain in my kidneys. Is my recipe dangerous or safe ? I don’ t eat that much in the evening but I try to have some meat, bread, fruits,dairy…And I am testing my urine ph, trying to keep it between 6 and 7,4.
Hi Lagmari, I gather you really eat one meal a day, and if sounds superficially alright. But I urge you check this with your physicians as they are responsible for your care and I am simply an outside commentator. If they are satisfied, I would be. Regards, Fred Coe
I need a site that can show me a meal plan I can follow..all of this is too overwhelming to me to figure out..
Hi Deborah, Jill Harris – on this site – runs an excellent course online and can help you. Regards, Fred Coe
My 63 y.o. wife was recently diagnosed with kidney stones. With her substandard health insurance we are unlikely to find out what kind of stones she has. While she awaited an ultrasound I found Chanca Piedra online and her nurse practitioner said that is interesting, probably okay, give it a try. What is your take? Also, on another site while looking for dietary tips, I found on one site that beets and spinach were good for one kind of stone and bad for another. Confusing to say the least.
Hi David, Chanca has little data to support its cost – to me it is likely worthless. The kidney stone diet is the common ideal for all US people, so your wife should adopt it without concern. Spinach is never good for stones – uniquely high in oxalate. The site has a complete oxalate list you can check out. But most people do not need such a diet if they follow the high calcium intake of the kidney stone diet. If she can get 24 hour urine testing, she should. If not, the diet in this article can do no harm and probably will help. Regards, Fred Coe
Thank you so much for this well-sourced and footnoted site. I have been reading many many of its pages and footnotes studies over the last 72 hours.
After a few years of my hisband’s urologist taking a very laissez-faire approach to his kidney stones (except for being pro blasting), I finally started doing research 3 days ago after this week’s appointment showed new stones on an ultrasound.
We had been given very minimal (“stay hydrated and don’t drink coffee”) drinking instructions and NO dietary instructions. Only 18 months AFTER surgery did he put my husband on a Potassium Citrate supplement, and never told us of his partial renal tubular acidosis diagnoses from his calcium phosphorus stones until I brought it up.
Needless to say we will not be returning to him.
Your site is a God-send. Thank you.
Hi Theresa, Renal tubular acidosis is an uncommon condition. Here is something about it for further reference. Regards, Fred Coe
It is very help full page for all.
Have a ? So I’m curious to know if I have kidney stones is it ok for me to eat a pice of cake with butter cream icing on it or no
Hi Bryant, a piece here and there is no problem. Sugar matters when in significant excess of US recommendations. Regards, Fred Coe
I found the website to be of great benefit after being told by urologist to begin a low oxalate diet due to kidney stones. The list of foods with their ratings has helped me tremendously. I keep it in my kitchen and reference it when making my grocery list.
Using no seasoning was difficult initially. I have increased my water intake, drink one glass of lemonade (sugar free) daily and a cup of hot water with lemon slice the first thing in the morning. My blood pressure has decreased, A1C is lower, and liver functions down with weight loss. I will be interested in seeing the results of a 24 hour urine in September. Also decreased and avoid canned products, prepared foods.
My urologist scared me to death. Thank goodness I found your website!
Hi Nikki, the kidney stone diet is actually the ideal US diet, and should lead to improved A1C, weight and BP. If you eat the higher amounts of calcium oxalate will generally fall, and the low oxalate diet be rather a simple matter. Regards, Fred Coe
Hello Dr. Coe ! Question, I have been told that Barley Water is very good for kidney stoners ????
Hi Christina, I know of no data supporting use of barley water in stone prevention. If it is a way to get you to drink that would be good. But the kidney stone diet – that you have posted on – is not really about fluids so much as all of the separate parts taken together. Regards, Fred Coe
I’ve seen a small Polish study implicating black tea and coffee as important sources of oxalate. Black tea is often said to be ill advised, but coffee is widely credited with lowering the risk of CaOxalate stone recurrence. I wondered if the Polish experience might have been influenced by brewing technique, such as using a French press to prepare a “sludgier” cup.
Hi Rob, We did what we could about the data concerning tea and coffee. Tea is a stone risk, coffee is protective. Regards, Fred Coe
Two questions: 1) I was under the impression intake of lemon juice on a daily basis (in addition to 3L of water) was helpful in breaking down stones before they form and 2) many athletes report issues with protein supplements and stones. Is it possible vegan protein supplements will circumvent this?
Hi K, There is not a shred of data supporting lemon juice. It is a popular nostrum that is easy to like but likely useless – as all random treatment attempts end up being. Vegetable use is protective against stones, animal protein has little effect on stone occurrence, but that is for diet protein, not supplements. Vegan protein supplements are not easy to assess, but probably would be less problematic than supplements from animals. Ideally, food is not taken apart, so you get the mixture we evolved on. Regards, Fred Coe
After kidney surgery and stones in the remaining one, I am on a low oxalate diet. Your site is the most comprehensive and up-to-date. Two questions:
1. I have trouble getting enough fiber and can’t find any oxalate data on metamucil/psyllium husk. Can I use it to increase my fiber content?
2. The only way I can get enough calcium is dairy but then I have a high sugar level. You’ve written about fructose and sucrose. How does lactose effect sugar levels?
Thank you for the site and the help you’re providing all of us.
Hi Ann, Milk products are ideal. Lactose has no malign effects on blood sugar levels. If you eat a high calcium diet, urine oxalate will be a lot less of a problem, so I would consider it. Regards, Fred Coe
Like Ann, I am trying to maintain a high fiber, low oxalate diet, so I’m also interested in psyllium husk intake. I also have not found any information regarding the oxalate content of psyllium husk supplements, so I’m reluctant to take it on a daily basis. Any insights into oxalates in psyllium husk supplements?
Hi Russel, If you are using the high diet calcium as part of your kidney stone diet – the article you post on concerns that diet – these details of oxalate rarely matter. Is your urine oxalate high?? Did it remain high despite following the kidney stone diet?? A lot of the oxalate issues arise from the low calcium diets prevalent in the US, and it is better to fix that than struggle with matters of diet oxalate that might not matter at all if diet calcium were at the recommended level for the US. Take another look at the article. Regards, Fred Coe
everybody talks about oxalate, but nobody says what it is. I am clueless. What foods have it, and how do I know if I’m getting any of it?
Hi Cal, It is a simple two carbon fatty acid that plants use for energy storage and our cells do not use at all. Unfortunately we do produce it as a metabolic end product. This article shows a picture of the molecule. Regards, Fred Coe
sir,i had gone through PCNL before 7 weeks but i heard that kidney stones can reccur and i am bodybuilding loving boy so i want atleast 150-170 gms of protien to full fill my balanced diet plan so for this i include chicken and eggs as a source of lean protien so i want to know that in how much quantity should it be safe to eat AND i am also drinking atleast 4-5 litres of water regularly
Hi Aman, If you raise diet protein a lot, urine calcium will rise and with it risk of more stones. About 1 – 1.2 gm protein/kg body weight is tolerable, above that have your physician obtain 24 hour urine testing to see how high your urine calcium is. One trick is to keep diet sodium low, as that will help keep urine calcium losses down. But, very high protein diet is a risk. Regards, Fred Coe
Dear Dr.
I have spent the last 6 weeks and 2 ultra-sonic treatments dealing with my first stone ( Ca-Ox). Needless to say, it has been uncomfortable but also concerning giving the level of effort required to treat it. Your websites have been the most helpful to me, by far.
I have a dietary question: For the last 15 years I have eaten as a vegetarian and some-time vegan. My usual diet contained soy milk and soy products at its center along with spinach and nuts. Reading through your sites I seem to be concluding that : 1. A vegan diet is problematic if I’m now a stone former; and 2. That even a vegetarian diet is challenging because of losing so many regular vegetarian protein sources.
Am I correct in my reading or is there a way to craft a vegetarian ( lacto-ovo) diet forward that is reasonably stone protective? Is there a good source you can point me toward that addresses, authoritatively, kidney stones and vegetarianism?
Many, many thanks,
Joe
Hi Joe, The diet on this page is a good one, and the protein can come from plants as well as milk and eggs. Just be sure you have proper testing before and during the diet so you know your stone risk – it is not ideal to sail without a compass or map. Regards, Fred Coe