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!
Thank you for your comprehensive website! I have had kidney stones all my life and just got over the worst one I have ever had. I need to go on the Kidney Stone Diet for sure, but for some reason I am having trouble finding the list of foods and their oxalate levels . . .
Thank you!
Hi Lori,
Here is an excellent list:https://jillharriscoaching.com/eating-a-low-oxalate-diet/
Best, Jill
When Gluten & Dairy free diet has been prescribed, how do I follow the Kidney Stone diet and still get the proper nutrition? (I have had kidney stones through the years and have then now.)
Hi Lisa,
I consult many patients who have other dietary restrictions. There are other milk sources like flax, hemp, and coconut milk to help. Think about joining my program that will help you put it all together: jillharriscoaching.com
Best, Jill
Dear Ms. Harris:
I have a FH of Kidneystones and was Dx last year by a Dr. at a Clinic. However, they only gave me medications, they would not tell me the type, nor what to do about preventing its reaccurance.
I also years ago was Dx with Hypoglycemia, so any advice on how to prevent more Kidneystones while dealing with my Hypiglycemia which I’m trying to do so to prevent Diabetes which I also have a FH of.
Please advise.
Thanks
-Angie
Hi Angie,
Please ask your doctor to order you a 24 hour urine collection so that you can see what your stone risk factors are. Also following The Kidney Stone Diet which you can find here:https://kidneystones.uchicago.edu/the-kidney-stone-diet/ can help.
Good luck, Jill
Hi, I’m a uric acid stone former, trying to get a handle on diet. Everything I read is tied to gout, understandably, but does this translate to me in terms of diet? Like can I eat tomatoes which are low in purine but are a gout trigger? This is very hard, trying to eat low fat, low sugar, low protein and not waste away to nothing here. I’ve dropped 20 lbs in a few months and I don’t want to lose any more.
Hi Dan, Uric acid stones arise from low urine pH and are gone on the moment when you raise it with potassium citrate. Diet is not an issue for uric acid stones. If you have gout as well, most physicians use allopurinol or another drug that lowers serum uric acid, but gout is beyond the scope of this site. Bring this idea about urine pH to your personal physician and add potassium citrate if he/she is in agreement. Regards, Fred Coe
Hi I was diagnosed with uric acid stones . However my doctor stated to just drink lots of water .🤦🏻♀️
Hi , I just been diagnosed with three uric acid stones , one measuring 5mm 2mm, my primary doctor said “ drink lots of water . However I am not comfortable with the reply , I understand it is a form of gout . I have not had a gout attack . Year ago x – ray result showed mild arthritis in my right big toe . I do feel mild bruising feeling in my right elbow , I understand those are two location of gout . My question is what should be my health goal . ?
Hi Nellie, Uric acid stones arise from too acid a urine pH and are prevented with potassium citrate. Fluids are not enough. You need 24 hour urine testing to determine your urine pH response to the drug and be sure it is about 6. Ask your physician if he will do this for you, as you cannot do it by yourself. Regards, Fred Coe
I am trying to help my husband lose weight with his life long history of calcium oxalate kidney stones. He is 54 yrs old and over 100 lbs overweight. He only drinks water all day long, no tea and stays away from foods that cause them, but does like his meat and potatoes. I have searched for some kind of weight loss program that will also stay in line with preventing the kidneys stones. Any weight loss programs out there?
Hi Kim, The bests source I know of for weight loss + kidney stone prevention is Jill Harris, who writes on this site and runs online classes at a very modest price. The link is to one of her articles, and she is easy to find on the web. Let me know. Regards, Fred Coe
I take a curcumin supplement that has been very helpful in relieving my osteoarthritic knee; I would like my husband to take it, but he has a history of both kinds of kidney stones. Would it be safe for him to take the supplement if he took calcium at the same time?
Hi Sandra,
I would advise against it for your husband. It is terribly high in oxalate. Even with the calcium.
Best, Jill
Do you have the oxalate content of Uncle Ben’s Converted Brand Rice? I’m working with a nephrologist to reduce diet oxalate consumption. My web searches for oxalate contained in this particular rice have not been fruitful. Wikipedia’s article on paraboiled rice (https://en.wikipedia.org/wiki/Parboiled_rice) leave me concerned that Uncle Ben’s may have a high oxalate content similar to brown rice’s 24 mg/cup. Mars Food USA, the manufacturer of Uncle Ben’s, reports they do not measure for oxalate content. I appreciate your help!
Dan,
I do not have specific oxalate levels on the rice you ask about. No food manufacturer will report oxalate values as it is expensive and difficult to measure oxalate in foods. Keep your oxalate levels under 100/day (unless otherwise advice by your doctor), get your RDA of calcium and you can have your rice. And remember, portion matters. One half a cup of rice will have half the oxalate, so that helps too. But even if you have a higher oxalate food, pick and choose what matters to you. I have a nice article on this here:https://jillharriscoaching.com/good-oxalate-list/
Best, Jill
Do you know who has the most expertise in personalizing a stone prevention diet based on the 24 hr urine collection at Mayo in Rochester?
Hi Robert, At Mayo I would suggest Dr John Lieske; he is an expert in stone disease. Regards, Fred Coe
Information on Stevia is confusing. Are there any forms of Stevia that are low oxalate ?
Also, are al teas high oxalate ?
Hi JDevenney, commercial stevia sweetener is a synthetic chemical or pure chemical and has no oxalate. Stevia leaf or any stevia plant material can be high in oxalate. So all forms of stevia but the plant material itself are free of oxalate. Regards, Fred Coe
What is the specific name and CPT code of 24 hour urine test? I am going to self order and lab says there are numerous possibilities that check many different things.
Hi Michele, I have to admit I do not know the CPT code – but if you order from Litholink, the best provider in the US – there is only one 24 hour urine panel. The analytes include calcium oxalate citrate sulfate ammonium ion, sodium potassium phosphate magnesium pH and chloride as well as calculated supersaturations for calcium oxalate calcium phosphate and uric acid. I hope this helps. Regards, Fred Coe
When I do the formula for .8 to 1 gram protein per kg per day, I get only 2 to 3 ounces as my daily allowance (144 lb=65kg, 65g/28g = 2+ oz per day). How did you come up with 1/2 to 2/3 pound?
Thanks, Judith, a very reasonable question. It is indeed 2.29 ounces of protein for you. There are about 7 gm of protein in one ounce of cooked meat – like chicken, so for your 65 gm of protein you would need 9.28 ounces of cooked meat, and given 16 ounces per pound that comes to 0.58 pound – or just under 6/10 pound cooked a day. Regards, Fred
Hello Dr. Coe,
I went to the doctor today and I’ve lost 3 more pounds since this began. Which isn’t good news for me. I’m down to 115 from 123. I’m sure some of it is from only drinking water these last few weeks and cutting out soda. But how can I stabilize and gain my weight back or at least, 5 pounds? I know I can’t drink Ensure anymore so I’m at a loss. Thank you for all you do.
Hi Natalie, The kidney stone diet matches the US ideal diet, so your weight should stabilize if you have no underlying disease. But I do not know your medical condition, so you should discuss this with your personal physician who can help you decide if this is a normal loss of excess weight or a problem. I am too far from your real life to make any serious medical comment. Regards, Fred Coe
I was eating a very high oxalate diet and suffered from kidney stones. I am now very careful in what I eat. What confuses me is why am I seeing sardines on the list of high oxalate foods to avoid? I am guessing they are high in purines and should be avoided for people with certain stones but mine were calcium oxalate stones. I love sardines and they are a staple in my diet post kidney stones. I would think even if they have oxalates they are so high in calcium with the bones in them it would not be an issue anyway. Can you explain this?
Hi Randy,
They have no oxalate as plant food only contains oxalate. They are very high in sodium.
Best, Jill
That is what I thought but it is listed on many lists as moderate levels. One showed them as 4 oxalates per 100 grams. Very confusing looking at all these lists!
Randy,
Please stick with one list. I have been helping patients for two decaded based upon the Harvard list. My patients are very successful in lowering oxalate levels. PLease read this:https://kidneystonediet.com/good-oxalate-list/
Jill
One list showed them as 4 oxalates per 100 grams. Very confusing!
Hi,
I just found out I have calcium phosphate kidney stones and wondering what kind of diet I should follow?
Thanks,
Sandra
Hi Sandra, I do not know, but here is what you should do to find out. Prevention is a process in which we need to know what is wrong and then correct it via diet and meds. Here is another introductory article of a broader reach. Do not just do diet, find out what is wrong and aim there. Regards, Fred Coe
My kidneys used to make urate stones. I am a hyperuricemia one that in a bad condition with memory loss. So I need to get more meat and fish and walnuts to touch borderline for good myelination my nerves and preventing AD. Today the lab report said both kidneys have stones about 3mm and one had hydronephrosis. What do you recommend to me?
@diet_therapy_guissou_sharifi my address on Instagram.
Hi Guissou, Given uric acid stones, the best treatment is to raise the pH of the urine with potassium citrate. In fact, it is the only reasonable treatment. One thing, though, you say urate stones, not uric acid stones. Urate stones must be with a counter ion – potassium urate, sodium urate, ammonium urate, and if you have been making one of more of these urate stones then treatment is far more complex. Your physician will know, and also knows that uric acid stones are easily prevented with potassium citrate. Ask him/her, and of course your physician is entirely responsible for your care. Never try to prevent stones without a physician supervision. Regards, Fred Coe
I have had both Uric Acid and Oxalate stones, is there a comprehensive diet that easily prevents stone formation. Items on one diet that are verbotten are okay on another diet. At 72 years of age with co-morbidities of HTN, BPH, Type 2 diabetes and CLL it is very frustrating to follow a simple path.
Hi Jon, Uric acid stones are not treated with diet but rather with alkali to raise urine pH above 6. Diabetes is a common cause of low urine pH and uric acid stones. Given the multiple additional diseases, I am sure your physicians will want to do 24 hour and serum testing appropriate for stone prevention. The uric acid component is – as I said – preventable with potassium citrate or – if potassium is not advisable for you – a sodium citrate or bicarbonate salt. The calcium component may have causes apparent on serum and 24 hour urine testing. The kidney stone diet is not itself organized for uric acid stones. Regards, Fred Coe
I am not crazy about drinking a lot of water and have been looking for other CA oxalate stone appropriate drinks. Are cider vinegar drinks appropriate? I have found a brand in glass bottles (important non-plastic issue for me) that is made with various flavors – like cherry and cinnamon.
Hi Ginger, I see no special issues with cider unless it contains a lot of sugar. Regards, Fred Coe
I have just learned I have large Ca oxalate stones in left kidney; several small ones in right kidney. I am very confused about diet discrepancies amongst what most would consider reliable sources – like Kaiser Permanente, Cleveland Clinic, NIH etc. It would be helpful if lists would include specific portions or amounts when they say things like, “eat less protein”, “watch sodium intake”, “drink citrus based drinks, but don’t overdo Vitamin C”, “eat SOME dairy with each meal”, etc. And also when such amounts are given – that it is in a format that is useful. Most product labels list nutrition in a percent of a 2,000 calorie diet. I have no way of converting that percentage into a mg amount !!! These genial statements are just not helpful at all. Given the number of people who suffer from kidney stones, I am astounded that the medical field and food industries have not addressed this issue in a helpful, meaningful way.
So please advise for an older woman how much of these per day ( in a useful format)…???
Sodium
Calcium
Vitamin C
Protein – and is this just for meat or does it include dairy protein too?
Amount of calcium per amount of oxalate intake / per meal
Total oxalates / per day
Medications that are conducive to Ca oxalate stone formation
Thanks you!
Hi Ginger, The kidney stone diet is more complex than it seems. Here is the science behind it. For sodium, amounts are in mg and mEq; labels are all ini mg. For calcium, the ideal diet is taken as 1200 mg/d for an adult, so fractions refer to that. You have to convert percentage into amounts because the law has not yet forced producers to list amounts directly for calcium and they prefer vagueness. For you, as a woman, 1000 – 1200 mg of calcium is an ideal for US citizens. Using calcium foods with main meals reduced oxalate absorption, giving exact amounts is futile as people cannot be so exact while living their lives. I would suggest you read through the link, and that may help clarify the strategy and the science. As for discrepancies, sites vary. This one is rather detailed because I have the time to detail it. I think the people at Kaiser, Cleveland, NIH will not disagree with me most of the time. As for being genial, I am not. Here is your list: sodium – below 2000 mg/d, calcium 1000 – 1200 mg/d, vitamin C – the amount in a once a day vitamin, protein 1 gm/kg/day (shown as PCR on routine 24 hour urine reports), oxalate 200 mg/d or less. medications causing stones – too numerous and too vague a question. Warm regards, Fred Coe
Hello Dr. Coe:
I was wondering if there might be a weekly or monthly meal plan – menus – that might help to avoid kidney stones. I thinking of something along the lines of a schedule for breakfast, lunch, dinner and snacks maybe that suggests in detail some menus with the best foods. I’m thinking of the kind of thing that Atkins or Nutrisystem publishes only targeted explicitly to kidney stones instead of primarily weight loss. Thank you very much.
Hi Bill, Making up a meal plan is hard work and expensive to produce. Do you think there is a market large enough? Atkins etc do well, but are very broad in their reach. Fred
In June 2019, I discovered that I form kidney stones. I moved to a PLANT BASED diet exclusively since Jan 2018.
After some nagging pain returned to the kidneys in the fall, I took the 24Hrs urine test and was just told by my urologist that I make Calcium Oxalate stones. He wants me to increase the intake of calcium based food and off dark green leaf vegetable, nuts, legumes. So far, it is consistent with your recommendations.
With the help of the Harvard list of Oxalate foods, I was able to identify the culprits in my diet that may have contributed to creating stones for the first time at the age of 69+.
Unfortunately, most of the plant based foods that are rich in calcium are also rich with oxalate. I’m in search of a list that will point me to PLANT BASED food that are low in Oxalate and rich in Calcium. Thanks.
Hi Irit, Stone prevention is not ideally done quite this way. You assume your recent diet caused the stones, and that is not a bad idea, but you may have other factors at work. I would hope you get fully evaluated for cause – here is a good article on the subject. The kidney stone diet is like a house, the various parts – low sodium, high calcium, moderated protein, avoidance of very high oxalate foods, reduced sugars complement each other and the science is good. Plants have little calcium to offer, it being bound with oxalate. There are no foods that do what you describe. One uses milk products to provide calcium or else calcium supplements. Having stones late in life is a special issue, and this article may be of use. An emphasis on oxalate is usually not enough. Regards, Fred Coe
I had my first kidney stone 25 years ago and several more oxalate stones in the next few years. Within the past 15 years or so, I’ve had a only few small stones. But, 8 years ago, at the age of 51 I was diagnosed with osteoporosis caused by hypercalciuria. I was put on a thiazide which seemed to fix the urine calcium problem. Very recently, I repeated the 24 hour urine test and the result was 420 mg of urine calcium even though I took my thiazide during the collection period and consumed about the same dietary calcium I have been all along. All other tests were normal, just as they were 8 years ago. I have not taken any medication for the osteoporosis but I have pretty much maintained my bone density levels over the past 8 years.
In reading all the valuable information on your site, I believe that I should start following your recommendations for the kidney stone diet. I’m assuming the same diet would help to preserve my bone density. My question is whether or not it would be appropriate for me given that I’m producing very few stones these days?
Thank You
Hi Janet, The kidney stone diet, as it happens, mimics the US ideal diet, so we all should be eating it! One key for you may be diet sodium. If not low enough, thiazide will not work well. So, of course use the diet. As for the bone disease, if BMD is stable, perhaps things are reasonable as is, but I am sure your physicians will want to keep a close watch and if needed add bone active meds. One issue with hypercalciuric bone disease is that bone density does not closely predict fragility and fracture. That is merely an observation we have made, and not published. Perhaps a low sodium diet is of real importance for you – 24 hour testing is crucial, no one can tell how much sodium is being eaten. Regards, Fred Coe
Hi I might have asked this before, but I am unsure. Is psyllium husks high in oxalate? I need extra fiber in my diet and I have been taking it for quite awhile. I was pretty sure I read somewhere it was low oxalate, but cannot find the source anymore. Was it ever tested?
Hi Jason,
You have and I replied saying it was fine. I love getting enough fruits and veggies to help with my fiber intake but if you just cant get to the recommended 30grams per day it is safe to bump it up with psyllium husk.
Best, Jill
Thanks Jill 🙂
Has anybody asked about plant sterols (for heart health)?
I know that the majority of the “sterols” come from soy, but because it’s processed, would this lessen the oxalate?
Hi Jason, a PubMed search for oxalate in soy sterols revealed no papers. Likewise a search for oxalate in heart healthy diets. This rather old article appears to be a major one on the soy oxalate topic, but not concern heart disease prevention nor sterol extracts. The bests approach is to measure 24 hour urine oxalate on the diet needed and see if it is above the risk threshold. Regards, Fred Coe
Hello, I’m thrilled just to read what I’ve read here. Even though I’m a nurse, I did not know how important taking calcium is in my diet. My first stone was passed at age 28. The stone was found to be calcium oxilate, so as you mentioned, I thought less calcium was really better in my case. The urologist gave me a diet restricting oxilates. I kept passing stones. Stopped drinking sodas, switched to water. I tried another urologist; he basically dismissed me, said there was no need to keep bringing in the stones when I’d pass one, we knew it was calcium oxilate. Discouraged, I tried urologist #3 who, after I passed a 6.9mm stone put me on thiazide. My b/p has always been on the low side, and the thiazide bottomed me out at 90/50 ish. Not only was I prone to fainting, I was having leg cramps. So I quit taking the thiazide and quit going to the doctor.
Age 51, went through normal menopause and no ERT. Also , developed type 2 diabetes controlled by metformin.
After a particularly difficult episode with a stone, (age 56) thankfully I went to see urologist #4 at a big hospital in a big city. Within 1 month after testing (24 hr urine & IVPs) he told me my body made no citrate. Put me on potassium citrate and a low oxilate diet. He did lithotripsy on the larger stones, which didn’t break any of them up. My kidneys completely cleared out of stones (they looked like the stars in the sky on the IVP). I thank God for that man! He retired, I didn’t follow up with another dr, I thought I was cured as long as I took potassium citrate.
I took low dose antibiotics since age 28 (coincidence?) for cystic acne until age 62 when I went on an anti inflammatory diet because my daily fbs was elevated to 140 and I did not want to get on insulin. My acne disappeared in 3 days. It was the gluten. So I totally eliminated gluten, which eliminated all acne, lost some weight (180 down to 160), lowered my fbs somewhat. A side note, I was diagnosed with leaky bowel syndrome; which did improve some by eliminating gluten.
Now I’m 67. I’ve always drunk a lot of water. I have always taken a multivitamin w 500mg calcium, and a vitamin D daily. Last summer I cut down a bit on water, because of work we were doing in Mex and lack of restrooms. I also stopped eating supper, just ate once daily. I thought since I wasn’t eating supper I only needed postassium citrate for the noon meal.
A couple weeks ago, I passed a stone, about 4mm. I was surprised; my primary doc did an mri of my kidneys, they found multiple stones both sides, and one is 8mm. I was referred to a urologist who said the former urologist did the right thing putting me on potassium citrate. I’m scheduled for lithotripsy next week. I got results of my first bone density (gyn) and it shows I have osteopenia T score is -1 left femur neck. After reading your article, I realize my usual diet has been high protein (avoid hunger) and too much salt, too many carbs that turn into sugar. Not enough fruit, I do love veggies and eat salads daily, but I try to snack at supper so I won’t gain more weight. I will talk to the new urologist about my diet, and the osteopenia. I’m just nervous about the lithotripsy and upset over the osteopenia. I thought I was doing a pretty good job eating meat for the calcium, curbing my appetite, and taking the multivitamin w some calcium & extra D. I’ve been washing all the calcium out with salt and carbs. I don’t even smoke, so I thought I was at low risk for bone problems as I get older, and never even asked about having a bone density.
Is there anything else I should ask about? Not sure on which calcium is best absorbed, but I will be changing my diet today and ordering some calcium to take with meals. Thank you so much for getting this info in our hands. You will make a big difference in many lives.
Hi Janice, The diet calcium protects your bones and also blocks oxalate absorption but high diet calcium will raise urine calcium unless diet sodium is reduced to below 2000 mg and often one needs to go even lower, to 1500 mg/d. Also, the calcium is useless for oxalate blockade unless taken with meals that have oxalate in them, and it is probable that it is best taken with nutrients so bone will best use it. These principles led me to develop the kidney stone diet out of the research we had available. Here is a good review of the science and the diet. Regards, Fred
Hello, I’m on a low oxalate diet and take Potassium Citrate and Hydrochlorothiazide daily to prevent kidney stone formation. I recently starting taking taking Tumeric/Curcumin supplements to help my knee/joint inflammation, but noticed in a search online that Tumeric has high levels of oxalate and may be detrimental to reducing stone formation. What is your recommendation regarding Tumeric/Curcumin supplements? Thanks, Lars
Hi Lars. I would suggest measuring 24 hour urine oxalate before and during use of the supplement. That is the only way to know, the rest is conjecture. If you added the normal diet calcium of 1000 – 1200 mg/d and normal diet sodium of below 100 mEq (below 2300 mg) – justified in the article you are posting on – , urine oxalate would not rise as much from food. Regards, Fred Coe
Hello! How informative. I have just passed a small stone and a 2mm is sitting in the top lobe of my kidney – is there a cookbook type with details of the diet? Something very specific?
Hi Bianca,
What we do have is an online course helping patients implement the diet. It has been very helpful for kidney stone patients: kidneystonediet.com
Best, Jill
Dr. Coe,
I was a patient of yours in 2010 following a diagnosis and surgery for hyperparathyroidism. After your review of my CTs, bloodwork and two 24 hour urine collections, I followed your recommendations for lowering my sodium intake and increasing my water intake before bedtime, as stone formation typically occurs overnight. I have faithfully followed your advice but unfortunately, have just passed two small kidney stones in the past 6 weeks. My internist suggested I have a scan of my 3 remaining parathyroid glands, as I could still have a parathyroid issue without elevated serum calcium. What do you recommend?
Hi Colette, I wish I had done better for you! Are you sure these are new? Here is a way to count them. As for hyperparathyroidism, diagnosis begins with serum calcium, and it must be measured fasting in the morning. If your serum calcium values are normal, the diagnosis is not tenable. You need a 24 hour urine to go with the blood because urine calcium is rather high in PHPT. Be sure and have the stones analysed, as their composition matters and can change with time. In 2010 we may have still relied on abdominal flat plates to count stones, whereas now we use CT. Possibly the two stones you passed were there. Regards, Fred
Dr. Coe – in regards to calcium that is excreted in urine (during a 24 hr urine collection) – where is that calcium coming from? our bones? I do take calcium supplements (600mg – twice daily and with food), and have over 200 mg of calcium showing in my urine. Reading many of your articles, I understand that elevated sodium causes calcium loss in the urine, but again, just curious as to where this calcium is being pulled from. Thank you in advance for your time and answer.
Thanks,
Molly
Hi Molly, What a fine question, and so well stated! The urine calcium comes from diet when diet is high in calcium and low in sodium, but the higher the sodium the higher the fraction of urine calcium that can come from bone. If you are a stone former, you may have idiopathic hypercalciuria, and if so a higher than usual fraction of urine calcium will be from bone. Best, Fred
Thank you Dr. Coe. I am a stone former, calcium-oxalate. I read another one of your articles where you state that it is possible to keep oxalate levels low, with high calcium intake (upwards of 4000 mg/day). Since I take my calcium with food (to bind the oxalate), is it better to take calcium carbonate or calcium citrate? (If both types of calcium work in the same manner, then I’d rather take 2 pills of carbonate VS 4 pills of citrate at each meal.) My recent Litholink lab showed my oxalates at 79 (and that is with me following a low oxalate diet, and previous value was 114), so the recommendation is to take 1 g calcium with each meal. My urine citrate is 49, so I am taking potassium citrate, 20 mEq-2x daily to help raise it. Thank you again for your thoughts.
-Molly
Hi Molly, You appear like people with bowel disease = so low a citrate, so high an oxalate. Calcium carbonate is fine but you need to time it with the meals. The alkali should raise your citrate. But are your physician sure why your urine oxalate is so high, citrate so low? Is it bowel disease? Regards, Fred Coe
Hi, in January 2019 I was diagnosed with type 2 diabetes. At the time., CT scans showed clusters of stones in both kidneys. I was 273 pounds, with a blood sugar reading of 43.6 my old. Today through the help of diet and exercise, I am 170 pounds with an average of 5.3mmol, and an A1C of 4.6 I was admitted recently to the hospital in severe pain and scans showed I had 9 stones in the tracts, I had 2 double j stents put in and was diagnosed with Nephrocalcinosis. The doctor wants me to give up meat, and watch my oxalates.. When looking over the foods that are high in oxalates, it removes a lot of the healthy foods (whole grains, spinach, almonds, beans…) that were the basis of my diabetic diet. Is there a common ground? Giving up meat is not really an issue, but giving up all the healthy carbs (whole grain, quinoa, lentils) are more of an issue.
Hi Allen, As you might note the kidney stone diet does not make much of oxalate, it rather focuses on lower diet sodium, higher diet calcium and reduction of diet sugars. A persistent emphasis on oxalate is a holdover from prior years. Take a careful look at the diet and judge for yourself. Also, you must have serum and 24 hour urine testing to determine what is causing stones, and analysis of any stones removed – even crystals will do. Given diabetes uric acid stones are common, and your physician can determine the radiographic density of the stones – UA has a low HU value in the 300 range, calcium stones are usually over 1000. So your diabetic diet can probably stay in place – low sodium and high calcium intake are part of all healthy diets, and so is low refined sugar. Regards, Fred Coe
Hi,
I was wondering if you could “refine” the definition of refined sugars. Do sweeteners like natural maple syrup, honey and raw sugar (the brown crystals) constitute refined sugars that should be avoided?
Thanks,
Robert
Hi Robert, I can. Table sugar is a dimer of glucose + fructose. The fructose is unhealthy. Starches are just glucose – fattening but not especially unhealthy. Honey, maple syrup, all these are like table sugar – which is simply an extract from sugar plants. Fruits are full of fructose but in such small concentrations you cannot get too much eating them. But juices can concentrate a lot of fructose so you are better off dropping them. The big menace is just sugar itself, the dimer, white and deadly. Regards, Fred Coe
Hi,
Thanks for the wealth of information. I have “elevated” pressure and am an occasional stone former. The last one was a year ago and before that about 8 years ago.
I was hoping that you could “refine” the definition of refined sugar. In particular I was wondering if products like natural maple syrup, honey and “raw” sugar (the brown crystals) are considered to be refined sugars or if they could be considered as refined sugar substitutes.
Robert
Hi Robert, I believe I answered part of this, here is the rest. Brown sugar is the same dimer of glucose and fructose as white sugar. Honey is filled with fructose and maple syrup is 67% sugar. No hope. Fred
I apologize for posting the same questions twice. I did not notice the
“being moderated” when I posted the first time and thought I had made a mistake. Feel free to keep the version you prefer. If possible, I would appreciate it if you do not use my last name when you respond.
Robert
Oh! I found this after the other two. Too late! Sorry. Fred
I had a 45 mm calcium stone that was removed in pieces through my back in 2017 and a 14 mm stone that was blasted by lithotropsy last year. The whole thing about how much calcium and how much sodium is confusing. After all, they’re calcium stones and I raise my calcium intake? And sodium seems to be nearly impossible to avoid.
Hi Jeff,
Knowing what to eat and how to eat are things we learn. Eating whole foods and staying away from processed foods is key in lowering sodium. I have good articles right here on this site or on mine at kidneystonediet.com
You must have calcium in your diet to help rid your body of oxalate and to nourish your bones. Here is another article on that:https://kidneystonediet.com/why-you-need-calcium-and-how-to-get-more-of-it/
Best, Jill
Hi Dr. Cole, I am really very naive when it come to this topic. I have presently having an issue that is making me feel I have kidney stone. Sometime last year I had lots of acid in my tommy and back pain. I went to the doctor and she had me checked and said I was ok. She did a scan and discovered my neck didn’t look alright and sent me for mri scan. After I did the scan she sent me to see a neurologist because I had some dislocated disc neck, middle and lower back. The neurologist sent me to physical therapy which I did for months and felt better. Fast forward to this year, sick with pain in my stomach, and a pain that seemed to radiate from my back, sides and circles around my stomach. Someone recommended I should see a gastroenterologist and after explaining he said it was acid reflux, gave me medications which didn’t help. Went back after some days explained that the pain seems to come from my back to my waist and sides and he said some stomach pain comes from the back he said I needed colonoscopy and endoscopy which I did February 2020 and the analysis showed I had erosive gastritis and unspecified colitis. I have been taking medications like food for months but the back and sides pain remain. But i noticed i always had pain below my tummy every morning which seems to relieve once I peed.one night in March after riding my bike I came back home went to the use the restroom, came out and immediately felt an urge to pee again and it was weird because I felt so strange in my and around my waist. I had just a drop and seconds later I went back and peed blood, very nervous with the experience I rush to hospital and after hours of waiting I was finally attended to and from the pee analysis they told me it was chronic uti gave me some iv and antibiotics which I took for 10days but instead of getting better the sides pain increased. I did a culture pee test but before test had Ciproflox DM 5 and after pee test showed bacteria resistant to Ciproflox doctor recommended another and although the pain dialed down a bit but the sides pain subsided and the came back couple days later. Went to see another doctor who asked for pee culture and gave me gentamicin injection 5 days which will end today 13/5/20. I am really stressed out and frustrated and I want to know does it take this long to treat UTI or is this a kidney stone. By the way I live in Mexico I do not know how to read the test because everything is in Spanish but it keeps mentioning staphylococcus. Please help, I am sorry my comment is too long
Hi Mary, An ultra low dose CT scan is about 98% sensitive for stones, so a negative scan more or less can settle the matter. I would suggest this to my physician if I were you and see if she/he would agree. Regards, Fred Coe
Thanks 🙏
What is your thinking re vitamin/mineral supplements and pharmaceuticals as contributing factors in someone who has formed calcium oxalate stones?
In particular, is there good clinical evidence that the use the of magnesium glycinate or the drug gabapentin should be avoided?
Hi Will, apart from excess vitamin C, I know of no special hazards. The two agents you mention are not known – to me – as causes of stones. Regards, Fred Coe
Thank you for your response and for the wealth of information you’re providing on this site!
Will
I am confused about soy products. I do not eat meat (other than fish and sardines for calcium) but I do eat tofu for protein. I have soy milk a few times a week with cereal. I am wondering if in Asia where tofu, soybean pastes, sprouts are eaten daily and even several times daily, whether there is a high incidence of kidney stones? They also traditionally do not use dairy products and thus don’t get calcium from dairy. Thanks!
Hi Rae,
Barley flour is more concentrated so will be higher in oxalate. You can have your barley, potion not perfection applies here and make sure to get your daily recommended amount of calcium.
Best, Jill
? Not sure about your response: I didn’t mention barley, just soy. Maybe you were answering another person’s question?
Hi (again) Rae,
Sorry, must have answered the wrong question. Soy can be higher in oxalate. Find another non dairy milk like pea or flax unsweetened that you switch to so that you get your calcium needs met. Can you eat other non soy foods for your protein?
Best, Jill
This article is great and exactly what I’ve been looking for in terms of all items in one place! I have Crohn’s Disease and follow the Specific Carbohydrate Diet (SCD) as well. For about a year, I’ve been looking to find a sweet spot of foods/amounts of food that fit between the 2. One question that i have regarding increased calcium intake along side of high oxalate foods. Is any ratio of calcium:oxalate that should be considered? Also, when making nut based bread, is their any value in adding calcium to the recipe? I have calcium citrate capsules (200mg) and was wondering if adding some of that to a recipe would have any benefit. Thanks and have a great day.
Hi RCB, No ratio. The diet calcium is best from food and should be present with meals apt to contain oxalate. Adding calcium to foods is fine, as it is an atom and therefore immortal. The idea of adding calcium to nut bread – high oxalate potential – is ingenious! Very original. Does it taste good? Regards, Fred Coe
I had a few stones in 2017. Been free since. I am now starting intermittant fasting and read it can cause stones.
Is that true and how? If I drink my 3 litres of water daily and don’t eat oxalates how will it create stones?
thank you you were so helpful when I had the stones AND DO NOT WANT THEM AGAIN!
Hi Rob, It will be alright if you drink a lot and avoid oxalates. But be sure the lot is 3 liters/d of fluids at least. Fred
Thank you SO MUCH for this information. Seriously, I cannot express how incredibly valuable your website is to me! I was wondering if you have any advice on how to get THE BEST dietary oxalate list available. Many sources have contradictory information, and many foods are missing from these lists. In particular, I am looking for carbon bean. Some say it has no oxalates, others say it is very high. I use it as an alternative to high-oxalate chocolate. Apparently the testing to determine if foods are either high or low in oxalates has changed significantly in the last few years, so that some foods that once showed low oxalate (like carob) are now testing high. I am using only lists that show actual evidence and cite their sources (so much on the internet does not cite sources). Any advice?
Thank you, Mica
Sorry, I meant “carob” bean, not carbon.
Hi Mica,
Please get this extensive list and why we use it and most importantly HOW to use it:https://kidneystonediet.com/oxalate-list/
Best, Jill
Where is the guidance on complete list of foods for kidney stone diet . Frustrated that I can’t access the info now .
Hi Suzanna,
Please read this for all your guidance and all lists:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Where is the guidance on complete list of foods for kidney stone diet . Frustrated that I can’t access the info now . I need to have paper copies of the list so I am not always having to check things out on my iPhone
Hi Suzanne,
Read this and find lots of guidance:https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Thank you for the excellent overview and this new timing ” tums” with protein meal will be difficult to initiate, but I m onboard, glad this binder type option exists. Is one type of calcium preferred gummies vs tums vs calcium citrate. So With a 2 egg breakfast, 500 mg Ca adequate? Please address liquid oxalate uptake vs lambchop.
Is it the same 500 mg Ca w Tea and diet cola? This is my Achilles heel
Tx for organizing the info… No Hospital visit since 2012 and counting…3 before then!
Hi John, The idea is this: low diet sodium is the anchor that lets you increase diet calcium. The diet calcium needs to be where the oxalate will be – not protein, but plants have most of the oxalate. Here is an article that focuses on the strategy. Regards, Fred Coe
I would like to know exactly which types of food I can eat with kidney stones, please?
Hi John,
You can eat most foods within the portion. Please read this so you know exactly what matters:
Best, Jill
May i ask what will be the best foods to eat fo a person experiencing gastritis and acide reflux with kidney stones? We are having a hard time looking for the best way to handle it.
Hi Leslie,
You may need some extra help putting this together, I encourage you to go here: kidneystonediet.com
Best, Jill
Hi Jill,
I’m really struggling here. Oatmeal is listed as a 0mg cereal choice but i’m struggling to understand something. The following website https://tastessence.com/porridge-vs-oatmeal, states,
“Oats used for making oatmeal are derived from ground oat groats with bran removed. Porridge, on the other hand is made from cracked but whole oats. Oats used for porridge can also be steel cut or steamed and rolled”
Ok I get that
But then this site https://www.bda.uk.com/resource/wholegrains.html says,
“A huge variety of cereal crops are grown for food throughout the world including wheat, rye, barley, oats and rice. Grains are the seeds of these cereal plants. The entire grain or ‘wholegrain’ is made up of ‘three’ elements:
a fibre-rich outer layer – the bran
a nutrient-packed inner part – the germ; and
a central starchy part – the endosperm.
During the milling process, the bran and the germ are often removed to give a ‘whiter’ cereal ”
Which suggests that even with the bran removed you are still left with the germ and the endosperm which still appears to be defined as a wholegrain! but I thought wholegrains were bad!
Is it sufficient for the bran only to be removed for the remaining constituents i.e. the germ and the endosperm to be regarded as ‘Oatmeal’ and hence have zero oxalate or does the germ need to be removed as well?
Hello, I would like to know the answer to this question, also, please.
Is oatmeal, OK to eat to reduce kidney stone formation, and if so, what type of oats/oatmeal?
Thank you very much for considering and answering this question.
Hi Omar,
Yes you can eat oatmeal.
Jill
Hi, I’m vegan and recently had my first (hopefully last ever) stones.
I feel like the lack of calcium in the vegan diet contributed. Is there a way to replace calcium without diary?
Hi Anya, Don’t guess. Get the stone analyzed and get fully evaluated. Urine oxalate is very often not the main reason for stones, even if calcium oxalate. Regards, Fred Coe
Hello, Dr Coe,
First, I wanted to extend my deepest thanks for you and your associate’s efforts: as a practicing chiropractor, I see many patients who had or who’re suffering with stones, and point them ALL to your work.
Personally, I’m a chronic oxylate former, and have eGFR below 60 for >10 years. I like the promise of ketodiet slowing decline, and agree with lowering protein. Should I have any concerns about the increased calories ( 140Kg x 30Kcal = 4,200!!) and increased fat?
I plan on getting menus from a kidney-smart nutritionist next month.
Great work!
Bradley
Hi Bradley, You do not give your age, but that you have calcium oxalate stones and reduced eGFR. Is your urine oxalate very high by chance – in the range of 80? Be sure it is not. As for lowering protein, I mean to the normal mean of 1 gm/kg/d or so, not below. Low CHO diets end up converting amino acid nitrogen to glucose and losing significant calories as ketones, so do not increase body fat stores or weight. Regards, Fred
What can you tell me about medullary sponge kidney? I am a 60 year old female and was diagnosed when I was in my 20s. I did not have issues with stones until I was 34. Just had a cat scan and shows approx 10 stones in each kidney average size 3 mm. How can anyone possibly get rid of all these stones?
Hi Patty Jo, I answered you on the Chapter One article. Fred
Are the allowed values in the above areas the same for children?
Hi Kristy, Children diets are special in terms of amount and balance. In general the diet mirrors the ideal US diet, so children are encouraged to eat it but I would recommend his/her pediatrician play a role in adjusting nutrient levels. Fred Coe
Dr. Coe
Does the body absorb one form of calcium better than another, for instance is dairy absorbed better by the body than calcium from breads, vegetables, fruits, or other nondairy foods? Thank you for all your work.
Hi C, I do not know absorption from all foods. IN general it is the dairy products that have reliable amounts of calcium and I would rely on them. Calcium from veggies is often not very well absorbed. Regards, Fred Coe