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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C
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C

Hello, I am in my mid 20’s and have been making stones since I was 21. I have passed/had removed 9 stones in the last 5 years and nothing I do seems to work. My urologist said low oxilate and high calcium but I am very sensitive to dairy and have trouble finding other sources of calcium. Any tips ?

Martha
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Martha

Hello- I am wondering if kombucha is good or bad for someone with calcium oxalate stones? Thank you.

Fredric Coe, MD
Admin

Hi Martha, This form of sweetened green tea should have no effects at all. Regards, Fred Coe

Julie Basque
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Julie Basque

Question- high calcium diet leaves me on the constipated side. Drinking lots of water and taking colace already. Can you recommend a lower oxalate fiber cereal? Currently doing Raisin Bran or Frosted mini wheats with milk once a day but these seem too high in oxalate.

Julie Basque
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Julie Basque

Question: I’m 57 and had my first stone in my late twenties. I still make stones but realized I can do a lot more in terms of prevention. I have embraced the low sodium, high calcium diet but have a question. It was recommended to me to drink milk (a big source of my calcium) with my meals. I’m assuming this is to offset any oxalate in the meal. I do that now- whenever I can. What if I’m not eating a meal but I still need to get to my 1200 mg of calcium per day- can I drink… Read more »

Morgan Sterling
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Morgan Sterling

I have a dairy intolerance. I read somewhere on your website about the preferred type of calcium and to take it with a heavy meal, but I cannot find it. What is the best type to take and do you have a favorite brand? Does brand matter? Thanks!

Fredric Coe, MD
Admin

Hi Morgan, If you mean a calcium supplement, all are about the same. They block oxalate absorption and can provide for your bones. The best way is to take one with each of your two large meals – the ones with oxalate in them – to a total of 800 to 1000 mg daily. But do this only with your physician and with testing to be sure about stone risk. Regards, Fred Coe

Morgan Sterling
Guest
Morgan Sterling

Thank you! Should it be Calcium Citrate or Calcium Carbonate?

Fredric Coe, MD
Admin

Dear Morgan, Both are reasonable – but per pill they may contain different fractions of calcium so be sure to keep the daily total of calcium in bounds. Regards, Fred Coe

Tina Rose
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Tina Rose

I have just experienced a kidney stone too large to pass that was removed w/procedure. No prior history of stones. The stone was comprised of 50% calcium oxolate monohydrate; 40% calcium phosphate; 10% calcium oxolate dinydrate. My dr. Has put me on a low calcium, low animal protein & low sodium diet & referred me to a metabolic/endocrine dr. for a study of ur one & blood to make sure there isn’t underlying issue. I have had critically low potassium, calcium & phosphates in past since hysterectomy (3 years ago)and had low potassium again when blood work was done before… Read more »

Fredric Coe, MD
Admin

Hi Tina Rose, Of course I know nothing of your details, but can say that in general there is no place for low calcium diet or low animal protein diet in kidney stone prevention. Likewise high potassium intake protects against stones. Given what you tell me I would recommend arranging an evaluation at a university medical center that has experience with bone and mineral disorders – kidney stones are in that general category of specialty. I looked on the web and found no special facility at the university nearest you. Perhaps you might consider flying to another location to get… Read more »

Mike
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Mike

Dr Coe – Thank you so much for your dedication to helping us kidney stone suffers. I am confused by the vegetable section of this article. When you reference kale and bok choy I assume the salt content is because it is frozen? Do fresh vegetables contain the same salt statistics as frozen? I was not aware any fresh vegetable contained sodium. How do we get sodium statistics on fresh vegetables? Sounds like fresh fruit are natural low. Tough enough to understand the right amount calcium to eat during a meal to offset any oxalate, but now concerned about sodium… Read more »

Stan Blyskal
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Stan Blyskal

Hi Dr. Coe, and thank you for sharing your time and expertise so generously. After 2 Ca Oxalate stones I’ve had a very fine reduction in U oxalate from 55 to 22 and my other parameters are doing well also – but since I’m lactose intolerant I used Ca Citrate 250 with each meal to reduce oxalate absorption and increase Ca i the urine. The binding effect of the CaCitrate has become very difficult – would it be ok to substitute a dose ?30 cc of Mag Citrate for one of the Ca Citrate to keep up the Citrate at… Read more »

Vicki
Guest
Vicki

If one does have to supplement with calcium, is there a preferred form? I’ve seen advice to chew Tums with meals, and also to take calcium citrate. I’m a bit confused because I’ve also read that once the calcium binds to citrate it is not available to bind to oxalate. And that the calcium carbonate in Tums doesn’t do anything because it is not really bioavailable. I have to take magnesium and wonder if I should do that separately from calcium containing foods or supplements. I can and do have some dairy products but I can’t eat very much of… Read more »

Fredric Coe, MD
Admin

Hi Vicki, You have stones and no real plan, just shards and fragments. Here is a good start for you. It links into more detailed plans. See if it helps. Regards, Fred Coe