FOODS

Many of you will leave your doctor’s office with questions about foods and kidney stone prevention. You will go home. You will sit down at your desk and the Googling will begin. Here is a spot for you to ask me anything you like about this topic. We already have things on this site about salt, oxalate, and calcium but this space is for specific issues for anyone who comes.

106 Responses to “FOODS”

  1. Sherry Goldstein

    I make calcium oxalate stones and watch my diet. In fact, I was a patient many years ago and printed out lists of high oxalate foods to avoid. I have avoided coffee, black pepper, strawberries, blueberries, for years. In looking at your list, it appears that I can have several of the foods I have been avoiding. Has there been new research to show that these foods are not high in oxalate? Here is a current article that still shows that blueberries and strawberries are high and should be avoided. I’m very confused.
    https://www.livestrong.com/article/155502-foods-high-in-calcium-oxalate/

    Reply
    • Fredric Coe, MD

      Hi Sherry, It is about amounts and also the nature of the patient. Do you need to limit oxalate? The lists on the site are about as good as we can get in that they were edited by a noted authority on oxalate and began at Harvard as pretty good before that. Livestrong etc is one of many sites proposing oxalate lists, many of which conflict with one another. But for you the big question: Have your been fully evaluated?. Does your evaluation point to oxalate as a main problem? How much can you do with a proper kidney stone diet? The last thing is reducing diet oxalate as a special pursuit. Regards, Fred Coe

      Reply
  2. Michele

    I need help!! Two days ago I had 4 stones removed from my left kidney 5mm, 2X7mm, and 3mm. There are smaller ones as well, and a CT Scan showed more forming in my right kidney. In 2015 I had many removed from my right kidney. I had a urine study done in 2015 and my results were:
    Urine Volume 3.33 liters, SS CaOx 2.0, Urine Calcium 160, Urine Oxalate 25, Urine Citrate 910, SS CaP .78, 24 hour Urine pH 6.912, SS Uric Acid .04, Urine Uric Acid .448 (Litholink – the 2nd report was similar)

    The lab report said my stones in 2015 were made up of Calcium oxalate monohydrate 55%, calcium phospate 30%, and Magnesium ammonium phosphate 15%

    This has been a very disheartening and painful few days. I’m not getting accurate info I feel.

    Reply
  3. Mark

    Dr. Coe,
    Is magnesium carbonate safe in terms of not promoting calcium oxalate stone formation? The product below has magnesium and citric acid in it and looks like a tasty lemonade drink, so I bought it, but now I am wondering about the main ingredient in it, magnesium carbonate. (I already take magnesium citrate and potassium citrate daily to prevent further calcium oxalate stone formation.) https://www.iherb.com/pr/Now-Foods-Magnesium-Inositol-Relax-Lemonade-16-oz-454-g/73624

    Reply
  4. Kate

    I was just told that my latest stones were again 80% uric acid and 20% oxalate. After blood work and a 24-hour urine analysis \my doctor said my citrate level was very low and my oxalate level was very high. He wants me to take potassium citrate and to follow a low oxalate diet. He said I should have blood work done 2-3 weeks after starting the potassium citrate. I could not swallow the potassium citrate tablet. It got caught in my throat and dissolved there burning as it did. I wanted to crush it but it is time-release and I was advised against it. I spoke to the pharmacist and then to my doctor and a liquid form o the medication has been prescribed but there is an insurance glitch so I haven’t received the med as yet. I am leaving the country for a 3-week stay in only 12 days and the doctor wanted me to be on the med and to have the blood work done before I leave. I don’t know if this is going to happen if I cannot get the med.

    In the meantime, I am following the low oxalate diet. I am already a picky eater and have been dieting (losing over 60 pounds in the past 16 months). The low oxalate diet has cut my food choices even more. I had been trying to eat healthier grabbing nuts instead of chips and now nuts are out too. I know that calcium is helpful but calcium is difficult for me to add. I have an issue with eating much dairy and I do not care for most other foods that contain dairy (like kale). Some other foods listed as high in calcium such as almonds are also high in oxalate. Any suggestions as to how to increase calcium intake?

    I am drinking water like crazy. My doctor has recommended that I also drink lemonade. Does it matter what kind? Some lists I have seen say lemonade should be limited or that lemonade from concentrate should be avoided. It gets very confusing.

    Kate

    Reply
    • Fredric Coe, MD

      Hi Kate, Uric acid stones have nothing to do with oxalate and everything to do with low urine pH. Low oxalate diet is almost certainly unimportant unless your urine oxalate is quite high – take a look here. On the other hand alkali matter a real lot and your physician is right to worry about travel without treatment – uric acid stones grow fast and can be large. Crystal Light contains 20 mEq of potassium citrate per liter, so you can use it until medication comes along. Low urine pH that causes uric acid stones is worsened by all forms of insulin resistance: obesity and diabetes and metabolic syndrome – points of information for you. Regards, Fred Coe

      Reply
      • jharris

        Kate,

        It is very confusing indeed. You might want to consider taking the course that I am doing to educate patients on their treatment plans. The next one is starting very soon – jillharriscoaching.com/course.
        It will help immensely. Safe travels-
        Jill

        Reply
  5. Marty Murrell

    Urine testing indicated I needed to be on the low oxalate diet. Started a week ago, and doing ok oxalate-wise. Using only “low” and “little to none” oxalate foods from your lists. So really minimal oxalates per day. I also use the App “MyFitnesPal” to track the other nutrition, including fat, sodium, sugar and calories aspects. It shows that I am getting only a tiny fraction of the recommended (300 of the 3600 mg) potassium goals. Will that become a problem? If so, I can up the oxalate counts, but which foods higher oxalate foods would you suggest that are PACKED with that nutrient and still keep me within the 50 oxalate goal zone daily? (BTW, your website and your and Jill’s passion are phenomenal!!!)

    Reply
    • jharris

      Hi Marty,

      Do me a favor. Get a copy of your results and see how high your oxalate is. Maybe you don’t need to eat such a low oxalate diet. AND!!! You also can eat more oxalate if you get your calcium requirement. Adding yoghurt, coconut water, and a banana can add up to about 1,500 mg/potassium with just those three low oxalate items.

      Get your daily requirement of calcium, typically between 1,000 and 1,200 mg/day (depending on age), and you can eat much more oxalate. Of course you must eat the foods together, don’t forget that. You can’t eat some yoghurt and then two hours later eat some almonds. You must eat them together, so the calcium and oxalate will bind together in your gut and leave through the stool.

      Get your results, look at your oxalate 24 hour values and go from there. We are here if you need us.

      Jill

      Reply
  6. Dave Burger

    Thanks for such an informative and helpful website. I have a comment and a question. Comment: I changed my diet last year to include more almonds (my stepson grows them) and sweet potato chips (instead of potato chips) only to have some of the worst kidney stones of my life. It turns out both almonds (and many other nuts) and sweet potatoes are very high in oxalates. Needless to say, I’ve removed those almost completely from my diet. Question: This experience led me to the work being done on Oxalobacter formigenes. I’ve looked everywhere for a commercial source of this probiotic. Can you direct me to a source? Thanks!

    Reply
    • Fredric Coe, MD

      Hi Dave, Sorry! Oxalobacter has not proven much of a treatment, nor am I totally sold on the oxalobacter story as science. One can take it but the bacteria die off right away as they have to have oxalate to survive and we do not eat enough for them to compete against more capable bacteria. In fact, if you raise your diet calcium, and do even reasonably with diet oxalate you will have reasonably well controlled urine oxalate, so be sure to do this and get 24 hour urine followup measurements. Regards, Fred Coe

      Reply
    • Renata Wong

      OMG….I’m so lost with this. I have diabetes 2 and now with the kidney stone things that ci could have such nuts I can’t with those darn stones. For 2 years I have been telling my doc something is bothering me on my left side . Pain would come so strong that I could not breath but then time passed and now the uncomfortable pain come and go nothing major. Doing some blood test I was asked to see a kidney doc , then ultrasound and ct scan done. the ct scan shows left kidney with within the renal pelvis 2.2×1.3×2.3 cm ( what hag is this measurement !!!) 3 adjacent 4 to 5 mm calculi in the lateral midpole cortex. Several calculi in a lower pole calyx largest measuring 10×3 mm( another crazy measurement ..what this mean ? 10 times 3mm?. saw a urologist he said the stone is too big for the shock wave …..need to do a ureteroscopy. I’m not in pain , is there anything I can do to remove it naturally? for me doc saw dollar sign…..sorry doc I’m just so confused and afraid

      Reply
      • Fredric Coe, MD

        Hi Renata, It sounds like you have stones with a large one in the left renal pelvis and smaller ones as well, but none you mention on the right. There are plans for removal because of pain. The big issue is proper evaluation for the causes of these stones and a proper prevention plan. This should precede the surgery if possible because if you have major stone forming abnormalities new ones may form before treatment can be put in place. After surgery you must wait until you recover fully before you can be tested properly. Here is an overview of how to proceed, and here is a more detailed plan. Regards, Fred Coe

        Reply
  7. Al R.

    Hi,
    Can you please tell me if it is feasible to alter urine pH significantly, say by 0.25 or more, with diet alone in order to help optimize for bone health and stone risk?
    I found a list of foods that promote acid or alkaline urine in Davis’s Drug Guide. Prunes, for example, reportedly acidify. But there is no indication of the relative effect of a serving of, for example, acidifying meat, or corn vs. a serving of alkalinizing milk or squash. Any idea where I could find that info?
    Thanks in advance!
    Al

    Reply
    • jharris

      Hi!

      I am not sure of where you could find that info. I think you are asking if there is a source that could tell you how much per portion is a food going to lower or increase your pH level. Is this right? If not please let me know but if it is my answer is- not that I know of. I definitely think you could alter your pH by .25 by food alone. Dr. Coe will correct this if I am wrong…

      Thanks for writing-
      Jill

      Reply
      • Al R.

        Ideally, yes. But really any clues about how acidifying or alkalinizing various common foods are could be useful. I can’t imagine that the effect of a serving of prunes would be close to that of a serving of chicken, for example. I agree that info is hard to find, but thanks for trying!

        Reply
        • Al R.

          Just closing the loop in case anyone is interested: I did find study with a great deal of information to start from, “Potential Renal Acid Load of Foods and its Influence on Urine pH”, Remer and Manz, J. Am Diet Assoc. 95: 791-797, 1995.
          Thanks again for your help!
          Al

          Reply
          • Fredric Coe, MD

            Thanks, Al, I know this paper and many more like it. For patients with too alkaline a urine pH I have no published experience using diet successfully, although in principle it should work. Regards, Fred

            Reply
    • Fredric Coe, MD

      Hi Al, there is no real way to lower urine pH effectively. Is your urine pH too high? That would mean you are forming calcium phosphate stones. Regards, Fred

      Reply
      • Al R.

        Thank you for your reply! Yes and yes. Innately high (7.0-8.0). Maybe I’m over simplifying, but how about this as a research idea? Prunes reportedly acidify and bananas alkalinize. Both are low in protein and sodium, high in potassium-all good. So it seems that urine pH should be reduced if one substituted a couple servings of prunes for bananas. Of course the question is by how much.
        Then one could measure the effect on both pH and Ca24 and check the net effect on Cap SS. And if Ca24 shot up, that would seem to be a red flag for bone risk. Thoughts?
        Best regards, Al

        Reply
        • Fredric Coe, MD

          Hi Al, I do not know if that will work. I presumed before and now that the high pH is a direct cause of stones meaning your stones are calcium phosphate. Usually such stones are prevented by means other than lowering urine pH, and if I am right about the nature of your stones I would be sure my treatment regimen was lowering calcium phosphate supersaturation enough to prevent more stones. I do this all the time and have no magic way to lower urine pH. Warm regards, Fred

          Reply
  8. Judy C

    Thank you Dr. Cole as this website has made a significant difference in my diet. You have provided much information and comfort in the past. have not had any stones in the last six months; I had four stones the first 4 months. I have increased my water intake this last year and take my meds (HCTZ and K Citrate) but it is my diet that has changed the most. So I am hopeful that the stone fragments (MD also mentioned dust/particles) will not grow into full size stones. Also, I hesitated to have another lithotripsy (this summer) and was surprised to hear my MD state in October that the KUB (using a new machine) shows the 5-7 mm stone to be an ovarian vein phlebolith! For the first time this year no procedures were recommended and for that I am very grateful. My question, do you have any special tips for the Thanksgiving holiday weekend regarding diet? I do plan on having the traditional meal of turkey, stuffing, sweet potatoes, cranberries, and pumpkin pie. I have avoided these foods including potatoes, beans, breads, oranges, raspberries, etc. for the last six months. I would like to enjoy the day. Is there a way to pair these foods with a diary product? Thank you so much. Judy C

    Reply
    • jharris

      Hi Judy,

      Many congrats to you doing an excellent job on your dietary changes. It is hard, but you did it. WOW! For Thanksgiving, eat whatever you want, just watch the portion sizes. Enjoy the day and when you get up on Friday go back to your regular routine. You will be just fine and also happy you enjoyed your holiday treats!

      Happy Thanksgiving!
      Jill

      Reply
      • Judy C

        Jill, are cranberries and pumpkin high in oxalate? My daughter wants to make cranberry bread, muffins (using oat flour), and cookies. Also, can ice cream or whip cream lower the affect of eating the pumpkin pie if is high in oxalate? We are actually eating three Thanksgiving meals…a lot to be thankful for but I want to reduce the effect of oxalate. I am trying to pair them as mentioned by this website. Thanks, Judy

        Reply
        • jharris

          Hi Judy,

          Eating ice cream with your pumpkin pie would help oxalates. There is a PubMed study regarding cranberry juice that says it increases risk of CaOx stones, so we can safely assume that cranberries themselves would pose a risk. I am not sure of pumpkin as there are contradictory pieces.

          I understand that you have three Thanksgivings. I would eat very gingerly, and be mindful of portions at each of them.

          Jill

          Reply
          • Judy C

            Thank you Jill. I will avoid cranberries and limit my pumpkin pie/ice cream consumption. Regarding fast foods on the list, Pizza with Cheese is considered very high. I was surprised as I thought the cheese (calcium) would offset the crust/tomato sauce (oxalate). Would Margarita pizza (thin crust) be acceptable if I had more cheese on it? I noticed that Dr. Cole said we could have a half of tomato. Also, I would remove the basil as I am not sure if it is high or not. How about Canadian bacon and pineapple? Is there any kind of pizza you can recommend? This is for the one day a week when I am off my low oxalate diet. Thank you. Judy

            Reply
            • jharris

              Having a piece of pizza is not going to send you to the ER. Have it and enjoy! Remember that you can eat some oxalate, just keep it under control.
              Jill

              Reply
  9. Miriam Alweis

    Thanks for all this info.

    I have had 2 kidney stones. One was tested, it was oxalate. My Dr has me taking TUMS twice a day as a prevention to stones forming. I haven’t read this anywhere. Any thoughts ?

    Reply

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