RECIPES FOR KIDNEY STONE PATIENTS

As much as diet causes kidney stones, diet change prevents them.

Not diet in general, of course, too vague to matter.

Thus far decent science identifies only seven components of diet as affecting stone formation: calcium, sodium, refined sugars, potassium, protein, oxalate and high fluids of the proper kinds.

A diet correct for the first five components corresponds with present day healthy diet recommendations for all people in the US. Everyone should eat it. Oxalate control and high fluids are specific to stones, however, so all seven components combined is properly named the “kidney stone diet”. 

The featured picture shows a new collection of recipes by Melanie Betz that address, excluding fluids, all components of the kidney stone diet. It is well enough to tell patients what a correct diet contains, but quite another to give recipes for actual foods that do the work of it. Here is the link to get the recipes. 

I will say something about Melanie later on in this article, but first a review of the diet to provide a perspective on what she has given us.

The Kidney Stone Diet

Calcium

The US population eats too little calcium for ideal bone health. Because of idiopathic hypercalciuria and probably other factors not as well established, stone formers have an abnormally high risk of bone mineral loss and fractures. So adequate diet calcium is especially important, above 1000 mg per day or more.

Most kidney stones contain calcium oxalate, and oxalate absorption is reduced by high calcium intake. The powerful effect of high diet calcium to lower urine oxalate and prevent calcium oxalate kidney stones is seen in the one diet based stone prevention trial.

Sodium

Because urine calcium tracks with sodiumlowering diet sodium below the US “tolerable upper limit” of 100 mEq (2300 mg) per day, ideally below 65 mEq (1500 mg) per day, can prevent high diet calcium from increasing urine calcium and stone risk. In fact, the combination of low diet sodium with high diet calcium was the only one that produced positive bone mineral balance among menopausal women.

Reduced diet sodium is especially valuable for stone formers. It helps lower blood pressure and they have a higher than normal frequency of hypertension.

Sugar

Refined sugar is a world menace. One half of the molecule is fructose, metabolized directly to fat and capable of inducing insulin resistance in healthy people over as little as 8 weeks. After a dose of sugar, fructose or glucose, urine calcium rises and volume falls, so stone risk rises – all this within a hour or so. Your chocolate bar in mid afternoon is risky! Nationally, sugar is a main cause of obesity and diabetes. Stone formers need to limit it, and so does everyone else. I have – as best I can. 

Protein

Skilled scientists have debated if protein excess reduces bone mineral, but all agree it raises urine calcium. Not the commonplace 0.8-1 gm per kg body weight per day recommended for all US people, but values much above that range.

Potassium

Food potassium parallels food anions that when metabolized produce alkali. Good for bones, alkali also signals kidneys to release filtered citrate into the urine where it inhibits formation and growth of stone crystals. Low urine citrate is a recognized stone risk, and before adding potassium citrate supplements one should certainly bring diet potassium up to the US recommendations in hopes that will remedy at least part of the deficit, leaving less for expensive and unpleasant capsules of potassium citrate powder. We generally eat much less than the recommended 120 mEq (4700 mg) per day of diet potassium.

Oxalate

Even high calcium diet will not protect calcium oxalate stone formers against excessive oxalate intakes, so moderation is very important. This site has massive oxalate lists, and our article on low oxalate diet is perhaps the most popular of the over 100 articles here. I have inveighed against a compulsive search for every mg of oxalate in food. It overly constrains diet choices. But diet oxalate matters a lot when stones are calcium oxalate and 24 hour urine oxalate is high enough to convey risk of stone despite that diet calcium has been raised to the US normal range. For this reason, recipes for stone formers need to address oxalate excess.

Melanie’s Offerings

What They Are

Melanie’s collection includes 4 appetizers, 7 breakfast items, 3 soups, 7 salads and dressings, 7 entrees, and 3 desserts. Her recipes meet all requirements of the kidney stone prevention diet but focus specially on dairy products – the main source of calcium. Seeing patients struggle to meet the requirement of 3 servings of dairy per day, she sought unique ideas for incorporating it into a dish rather than a simple glass of milk on the side.

Each recipe comes with the expected ingredient list for shopping, preparation instructions, and hints for serving. A professional Registered Dietitian certified in kidney nutrition, Melanie has carefully defined what a portion is and has analyzed portions for nutritional content, so calories, sodium, calcium, oxalate, and other nutrients can be counted.

She created all of the recipes, tested them, and made up her collection all by hand without any help. It is a downloaded PDF. She asks we pay for it given her time and effort in doing all the work of the foods themselves and making up the book. I never endorse products for sale except when they seem of unique potential value and reasonably priced, as here.

My Judgement of Them

Unknown as yet.

Thirty one recipes all aligned with kidney stone prevention is a trove to take notice of. They are a start, some real entries on a blank slate.

But I have not eaten them, nor made them myself – a metaphor as I do not cook – though they look attractive and seem enjoyable – on the page, at least.

Melanie tells me her husband, Eric, likes them, especially the Mac and Cheese and Burrito Bowl. She most likes the blueberry Panna Cotta dessert.

Your Judgment of Them

You will say if they matter.

Do you like them? Your family, will they happily eat them? Do you find them delicious, or at least acceptable? How hard are they to use? Are they a help in reality or just an ideal too difficult for a busy world. Given what they added to your stone prevention, is the price a fair price?

Please comment on the article. Without your feedback, how can Melanie know what to do beyond what she has done? How can I know if I am right in putting her recipe collection forward as useful. Melanie and I look forward to your comments.

Because of her training I know the recipes accord with the goals of the kidney stone diet. Her knowledge is sound.

But food is in the eating.

Melanie As Colleague

Melanie works in the Nephrology Section as our dietitian, so is part of our team. Her high level of credentials outlined in her recipe collection, and her 10 years of experience are why we recruited her.

She mainly cares for kidney disease patients in whom an error of diet can be dangerous. Many require dialysis, or have such impaired kidney function that diet is a fine balance between nutrition and the need to limit sodium, and potassium, and protein.

Melanie has counseled a number of our kidney stone patients, and I believe that led her to create these recipes. She is a fine clinician.

Since age 3, Melanie has cooked, she told me,  and she is a foodie. Monthly, she organizes a group of 6 women friends who choose a new ethnic restaurant and eat there to sample the cuisine.

Being at a university she has begun doing research, and I have had the pleasure of collaborating a bit with her.

33 Responses to “RECIPES FOR KIDNEY STONE PATIENTS”

  1. JoAnne

    Thank you for all the amazing information you provide here. I am so grateful to have found your site.

    I eat a nutrient dense vegan diet, consuming only things I make and sprout. I had an accident that resulted in many broken bones and a TBI that prevents me from tasting, smelling and I have NO hunger and remember to eat breakfast in the afternoon. I have never consumed much salt but all my surgeons who implanted the titanium in my body told me that my blood pressure was so low that I needed to consume more salt.

    To help the healing process of my brain I was advised to consume a lot of cacao/almond mild, turmeric/almond milk and blueberries as well as many other superfoods that have a high oxalate content. Hmm, it seems everything I was told would heal my brain caused my kidney stone.

    After recently passing my first kidney stone (age 62), I am eager to avoid a recurrence of that painful experience and am in search of any lists that contain the oxalate levels for plant based potassium and calcium rich foods. I am grateful for anything you can provide. Thank you again for all the information that has given me hope.

    Reply
  2. Andra

    For me, stones are becoming larger in size and are forming quite often. I have had several stones over 10mm that have completely blocked my kidneys and were cause for long hospital stays. These formed in a matter of months. I pass stones often at home and two or three at a time. We have examined three 24-hr collections and so far, the nephrologist cannot find any specific reason for my stones issue. I am excited to try these recipes as I have been struggling with Calcium Oxalate stones for 20+ years. Same song as others: several ESWL and several laser lithotripsies. Many stents and I am concerned with scarring. I have purchased the recipe book. It was stated that I would receive an email and I have not yet received anything however, I was able to download through the final purchasing page. I have always been told to eat foods low in oxalate however, my doctors (urologist and nephrologist) did not provide a lead to finding any recipes. They did provide three lists that included foods to avoid, foods to limit, and foods that were lowest in oxalate. I have just recently began to adhere to these lists and have received Rxs for HCT and Potassium Citrate. All three together may help reduce the number of stones. (?) After reading most of the recipes in the book I purchased, a question comes to mind that I hope you can answer. Some of the foods highest in oxalate are included in these recipes. Blueberries, celery, kale, nuts (walnuts & pecans), and black pepper are all on my “Foods to Avoid” list so I was surprised to see them included in these recipes. Please help me understand if my lists are incorrect.

    Reply
    • Fredric L Coe, MD

      Hi Andria, I sent your specific question about the recipes to the author of the book. I am surprised that you have so many stone and 24 hour urine studies yield no reason – perhaps there is a combination of mild abnormalities. Are your stones calcium oxalate or high in calcium phosphate? I know you gave their name but many times ‘calcium oxalate’ is not so much determined as found in a few stones and assumed in the rest. With a lot of procedures I suspect stones now have calcium phosphate or even brushite – a special kind of calcium phosphate – and need special care for prevention. Regards, Fred Coe

      Reply
      • Fredric L Coe, MD

        Here is the response from the author of the recipe book:
        “You should have received an automated message immediately after purchasing the cookbook to download the book. Please let Melanie know if this was not the case and I’m glad you found another way to get the recipes. Melanie uses the Harvard list to calculate the oxalate content of the recipes. This list is known as the gold standard, and we use it because we know it has worked to prevent stones for our patients. Unfortunately, there are many incorrect oxalate lists out there. You can find the Harvard list with standardized portions here. Blueberries, celery and kale are low in oxalate per the Harvard list. There are some “high/moderate” oxalate foods in the recipes in smaller portions. This is intentional to show that some nuts are lower in oxalate and can be included in smaller portions. For most patients, we aim for no more than 100mg of oxalate per day. This allows for some medium oxalate foods. A healthy diet is all about balance, rather that total avoidance of most foods.”
        I hope that answers your question. Regards, Fred Coe

        Reply
      • John

        Hello, I have had a kidney stone in the past. I use a small amount of Stevia Extract in my morning coffee (usually 2 or rarely 3 cups in the morning. The bottle says it is standardized 90% steviosides. Just wanted to make sure it is OK to use the Stevia on a daily basis. Thank you so much for your reply!!! I will sleep better knowing the answer LOL!!

        Reply
        • Fredric L Coe, MD

          Hi John, Oxalate is in the plant, the chemical stevia is without oxalate. Yours seems that. Fred

          Reply
  3. Jacques

    Dear Mr. Coe, Is there a diet proposal created by Melanie as part of your team?
    How many urine tests will I need to provide your team to get a specific kidney stone diet tailor to my need?
    How much this type of service will be?
    Over the last 40 years, I probably got more than 40 kidney stone surgery. I’m more than ready to change my diet but so far it’s easier to have surgery.

    Reply
    • Fredric L Coe, MD

      Hi Jacques, Treatment is based on cause and diets cannot be made intelligently without proper evaluation which is a medical matter. We can help you via telemedicine if your insurance company covers my university. Alternatively your personal physicians should do it. Here is my best article on that. With so many procedures, evaluation and medical management, including diet is obviously important. Regards, Fred Coe

      Reply
  4. Jane Olivia

    I am a patient of PCOS. A few days ago I was diagnosed with kidney stones. Can I follow this recipe?

    Reply

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