How to Eat a High Calcium Low Sodium Diet

Many patients assume that they are forming calcium stones and should therefore limit their calcium intake. That assumption could not be more wrong. Low calcium diet won’t stop your stones and may even increase your risk. Lets not forget that our bones are in desperate need of calcium to avoid osteopenia and osteoporosis.

But, many of the best foods for calcium are also high in sodium, and sodium raises urine calcium loss and stone risk.

Now what?

How Much Calcium do We Need?

The National Institutes of Health tells us age matters. Nineteen to fifty year old male or female need 1,000 mg of calcium a day. Fifty one to seventy year olds need 1,000 mg for males and 1,200 mg for females. Those above seventy one need 1,200 mg, both sexes.

We all know that much of our calcium comes from diary products. But did you know that dairy products are very high in sodium?

When we eat a high calcium food that is also high in sodium the sodium can undo the benefits of the calcium by raising urine calcium losses. This is especially true for stone formers with idiopathic hypercalciuria whose urine calcium is much more sensitive to sodium than in normal people.

So we need to search for dairy products that are lower in sodium than usual.

We also have to find what else there is because not everyone can tolerate dairy products. This means fruits and vegetables, and they may contain oxalate.

How to Read Food Labels for Calcium

All food labels are based on a 2000 calorie per day diet. Calcium is given to us in the form of a percentage.

How do we figure out how much we are getting per serving?

Take a look at the featured picture. It shows Friendship Dairy cottage cheese no salt added.

This is a great product for high calcium and low salt. On the label it tells us that per serving you will receive 10% of your daily value for calcium.

How do we convert this to milligrams?

Since we know that every food label is based upon a 2000 calorie per day diet, and gives the percent of the recommended 1,000 mg of calcium for that diet, we can just put a 0 at the end of the percent. So 10 percent is 100 mg of calcium. In this case a serving size is half of a cup. Eat more or less and the calcium from the product will vary.

Eating a low sodium, high calcium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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We are going to continue with the example of the cottage cheese

breakstone reduced sdium cottage cheese

The low salt version of Friendship Cottage Cheese has only 60 mg of sodium per serving. The regular Friendship cottage cheese contains 260 mg/serving. This is a great sodium savings in that the ideal intake of sodium is only 1,500 mg daily.

As a contrast take a look at this product.

The label, which does not show, says a serving contains 15% of daily requirement which is 150 mg of calcium. But the sodium in that serving is 290 mg!

The Trouble with Food Labels

These Friendship and Breakstone cottage cheese products are two excellent examples of how difficult it is to distinguish between really low sodium and rather high sodium products.

The 30% less sodium label is correct, but it is 30% less than a lot of sodium. The Friendship label tells you there is no salt added, which is also true.

But the actual sodium amounts are what you want to look at. They have to be accurate by law and they are.

You have to notice the small subtleties in all food labelling. It is definitely worth the time if you want to keep sodium low while getting adequate calcium.

How to Shop for Low Sodium Dairy Products

We have to become experts at reading food labels. Don’t pay mind to the front of the package. The nutrition label is the only thing you need to look at. You want the highest calcium for the lowest sodium, and the only way to get it is by looking at the label. Sometimes this may require you to look at several brands. You may have to stop using your favorite brand.

In the beginning of this process it may seem this is a daunting task.

But before long you will become quite efficient and even a food label expert.

No Food Label?

Many of  you will shop at the deli counter or prepared food section, or eat in a restaurant. You will just have to remember that certain dairy products have a lot of salt – like cheese – and find the low sodium alternatives. When you are asking the deli counter person to cut you some cheese or the waiter to bring you a fancy cheese plate you have to ask for the low sodium varieties if there are any.

What if You Can’t or Won’t Eat Dairy Products

If you won’t maybe you should take a look at our list and reconsider. The list is ordered by how much calcium is in a serving. Dairy products win by a big margin. So if you possibly can use them, use them.

The remaining options are fruits, vegetables, fish, and supplemented foods. We have consulted the usda data laboratory charts for calcium and sodium, and our own oxalate lists to give you what we can find with modest oxalate and a high calcium per sodium ratio. We have redacted from the immense usda lists our list of the best calcium to sodium bargains adjusting for oxalate from our oxalate lists.

The list is what we think will be most useful to you. Below we highlight a few foods in each category that we specially like.

Fruits and Juices

Fruits have very little sodium when raw and fresh, so it is all about their calcium content.

The most calcium in this category will be found in one cup of calcium fortified orange juice – 366 mg. Calcium supplemented grapefruit juice gives 350 mg of calcium in 8 ounces. The oxalate in grapefruit is modest and will fit into most diets. Apple juice fortified with calcium has little oxalate and is a good choice. We emphasize that these are calcium supplemented juices, otherwise they will not do.

Some useful foods have too little calcium to make our list but are good, Pineapple juice, 6 ounces gives 84 mg of calcium. Plums and apricots are very low in oxalate and a cup gives about 70 mg of calcium. Blueberries and pears are low in oxalate and give about 60 mg for a cup. Peaches give about 50 mg of calcium/cup.

Fish and Seafood

Sardines, no salt added, have about 150 mg of calcium and 50 mg of sodium in a serving. Three ounces of canned salmon provides 212 mg of calcium and 64 mg of sodium. Most other fish, even fresh, have about 80 mg of sodium for every 120 mg of calcium, which is not a great ratio. Crustacea have very high sodium levels even when fresh.

Vegetables

From the list, here are a few highlights.

Kale, frozen, boiled, and drained without salt has 179 mg of calcium, 20 mg of sodium and little oxalate – a great bargain. Mustard greens, frozen, are low in oxalate and have 152 mg of calcium with 38 mg of sodium. Chinese cabbage (bok choy) has 158 mg of calcium and 58 mg sodium in 1 cup, and very little oxalate.

Several foods are too low to make the list but are tasty and can be used. Winter squash gives 80 mg calcium and 8 mg sodium in one cup. Raw onions have little oxalate but 72 mg of calcium and 8 mg of sodium in a cup. Cowpeas, if you find them, also known as black eye peas,  have 184 mg of calcium, and 27 mg sodium in a cup.

So Now What?

You may not like what I am about to say but that’s not going to stop me from saying it. For people who choose to avoid dairy products by choice or because of lactose intolerance or food allergy, it is difficult to get enough calcium into the diet without an excess of sodium and in the case of fruits and vegetables too much oxalate. There is one usable alternative milk and yogurt product: coconut. Soy and almonds are too high in oxalate.

That leaves supplements. We have already mentioned calcium supplemented juices. Pill supplements can be used – check with your physicians – but only with substantial meals. Taken without food they can raise urine calcium a lot and it is not clear that bone cells will use the calcium. So used improperly supplements can increase stone risk. With meals, supplements can and do lower urine oxalate.

Eating a low sodium, high calcium diet can be overwhelming and difficult to incorporate into your daily life. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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104 Responses to “How to Eat a High Calcium Low Sodium Diet”

  1. Andrea Petitte

    Hi Jill and Dr Coe,

    Although I my bone density test cam back normal, I am losing bone mass. I have broken two toes and am up to three broken teeth since July. I only have one kidney so I can’t take a calcium supplement. I also can’t take Iron and do not assimilate any of the B Vitamins well. I take 50,000 iu of Vitamin D twice a week. And, just to make things even more interesting, I am bone on bone arthritic in most of my body and am not a candidate for hip replacement where the arthritis is the worst. I take medical marijuana, in tincture form, for the pain. What would your suggestions be to help these issues. These are the questions that run through my head at 3:15 am.

    Reply
    • Fredric L Coe, MD

      Hi Andrea, If the toe fractures were pathological – injury is not at all sufficient as a cause – and bone mineral density normal, you have a very complex problem that needs to be evaluated by an expert in bone disease. Usually such experts work at universities. If the toe fractures were from sufficient force that one would expect a fracture, then it is just trauma. I do not believe that one kidney precludes a proper calcium intake of 800 to 1000 mg/d, unless that one kidney is functioning below normal. The arthritis would be a separate issue from bone or kidney disease. As for pain management for the arthritis – I gather that is the main issue – I am not an expert in use of marijuana for that purpose. I am sorry I cannot be more specific. Regards, Fred Coe

      Reply
  2. Jon

    Hello, I produce calcium oxalate stones. One recommendation to help remove oxalate from my body is to increase my dietary calcium. Great, I love and tolerate dairy very well. However, my Nephrologist said that added vitamin D, as in milk, should be avoided. Is this correct? If so, what calcium rich dairy products do not contain added vitamin D?

    Reply
    • Fredric L Coe, MD

      Hi Jon, No data support omission of vitamin D so dairy products are fine – to me. You might discuss this with your physician. Fred

      Reply
  3. anwar syahman

    hai, is 100% fresh cow milk is ok for calcium intake? is fresh cow milk high on oxalate? thanks for the reply

    Reply
  4. Douglas

    Hello,

    Regarding canned fish. I love canned salmon with bones. Most (all) companies add a lot of salt though as you’ve noted. But. I think a solution to this would be to rinse the salmon with water a few times. There may be some loss of other nutrients in doing this. But I think it could significantly reduce the sodium content. Making for a fantastic option to get in dietary calcium. Your thoughts?

    Also, for those who avoid dairy because of lactose intolerance. This is solved very simply. Lactaid or any generic brand of Lactase tablets. Problem solved. Along with that. There is always aged cheese which is naturally lactose free. Yes, sodium may be an issue here. But there are low sodium brands.

    Have you already put together a list of brands for high calcium / low sodium foods?

    Thank you for all the work you do!

    Reply
    • Fredric L Coe, MD

      Hi Douglas, Rinsing out the sodium is a good idea – I do it too. Likewise, you are right about Lactaid etc. Brands are just too much for this kind of site and would not help much as we wrote the article scanning the whole FDA food directory for our present food candidate classes, and sodium content is by law shown on all products. Regards, Fred Coe

      Reply
  5. Whitney

    At 54, I have both osteoporosis and recurring kidney stones. I also no longer have a thyroid and take a synthetic hormone for that. I’ve been trying to change diet to find the sweet spot between all those variables. Much of the advice for kidney prevention conflicts with osteoporosis prevention diets. I thought I’d try doubling my calcium food intake such that I’d eat calcium rich foods with my meals (which are high in whole grains, beans, low-fat unprocessed meats and very little sodium), plus calcium snacks between meals such as yogurt. That way the calcium at meals could cancel out the oxalates and I’d add more boost to calcium between meals. Does that sound right? Also I’ve come to love barley ‘tea’ since I *thought* my habit of green or black tea is not good?

    Reply
    • Fredric L Coe, MD

      Hi Whitney, The advice to eat a high calcium low sodium diet – this article – is in line with what will preserve bone mineral. Here is a more general article on the value of this diet pairing for stones. No one lowers diet calcium or raises diet sodium for stone prevention, it is high calcium and low sodium we want – high calcium reduces urine oxalate, low sodium reduced urine calcium loss. As you say at the end of your comment. Regards, Fred Coe

      Reply
  6. Andrea Lloyd

    Can I realistically get all my calcium on vegan diet. I am lactose intolerant. Vegan diet works for me. So kale and coconut milk products good options?

    Reply
    • jharris

      Hi Andrea,
      Yes, they are fine. There are many non dairy milk products now from flax to pea.
      jill

      Reply
  7. Brad

    I had a bout with Kidney stones a few years ago and my doctor told me to cut back on oxalates, which I had no idea what they were, so he gave me a pamphlet with listings by food category with oxalate levels. On the vegetable listing, Kale was listed as the HIGHEST in oxalate level as well as other greens, so he told me to not eat them. Yet in the article above, it is recommended! Why the difference?
    In fact, most of the foods that I had considered to be the best for you (almonds) were high on the oxcalte list.

    Reply
    • Fredric L Coe, MD

      Hi Brad, Kale looks dangerous, being dark green and all but has no oxalate in it. Almonds look great but have lots of oxalate. Regards, Fred Coe

      Reply
  8. Lisa

    Hello and thank you for considering my questions.
    Confused on this article about adding a 0 to get the amount of calcium in a product, you say if 10% add 0 and you get 100mg. My milk/yogurts have both listed, 2% milk says 290mg and 20%, one yogurt has 230mg and 20%, another yogurt says 160mg and 10%. This makes it very difficult to know the true amount.
    Also have Ca Phosphate stones, does all this dairy make the urine more alkaline than it already is?
    My Uro Phosphorus is 940, is that important when it comes to Ca Phosphate stones? Does large amounts of dairy cause this to increase meaning should I not have all my calcium from dairy?
    Thanks,
    Lisa

    Reply
    • Fredric L Coe, MD

      Hi Lisa, Labels for calcium are not ideal. The % are of ideal intake and that ‘ideal’ varies among food producers. Use the Mg as noted and all will be a lot easier. Regards, Fred Coe

      Reply

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