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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.’

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


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.


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.


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.


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.


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!

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Thank you so much for this well-sourced and footnoted site. I have been reading many many of its pages and footnotes studies over the last 72 hours. After a few years of my hisband’s urologist taking a very laissez-faire approach to his kidney stones (except for being pro blasting), I finally started doing research 3 days ago after this week’s appointment showed new stones on an ultrasound. We had been given very minimal (“stay hydrated and don’t drink coffee”) drinking instructions and NO dietary instructions. Only 18 months AFTER surgery did he put my husband on a Potassium Citrate supplement,… Read more »

David Swanson
David Swanson

My 63 y.o. wife was recently diagnosed with kidney stones. With her substandard health insurance we are unlikely to find out what kind of stones she has. While she awaited an ultrasound I found Chanca Piedra online and her nurse practitioner said that is interesting, probably okay, give it a try. What is your take? Also, on another site while looking for dietary tips, I found on one site that beets and spinach were good for one kind of stone and bad for another. Confusing to say the least.


I need a site that can show me a meal plan I can follow..all of this is too overwhelming to me to figure out..


Hello, do you think that intermittent fasting or the omad diet ( one meal a day ) could reduce calcium oxalate kidney stones ? And what about the ketogenic diet or carnivore diet ?

Thank you for the reply.


Is there a snack or protein bar that is low in oxylate. To carry with you if no time to stop to eat?
The rest of the diet is understandable. Thank you


Hi Jan,
I hate bars in general as they are typically filled with unnecessary amounts of sugar and protein. I often suggest to patients to have a lower sugar yogurt or hard-boiled eggs to carry them through to the next meal. Also, fiber is very helpful to aid in weight loss, curbing appetite, and general good colon health. How about a pear or an apple to tide you over? Good 4 grams of fiber in each.
Best, Jill


I’m a 35 year old female with one kidney stone. I have had two procedures in the last six months, to break up the 6mm stone I was diagnosed with. It’s down to 2mm but it has moved back up into the kidney and hasn’t moved. I have been drinking 2-4 liters of water, occasionally adding lemon juice, with no change. I have done bloodwork and 24 hour urine collection, all coming back normal (which is great!). I’m feeling frustrated and wondering now what? Just keep drinking tons of water? My dr said to do low sodium, but I’m still… Read more »


Good Morning! I’ve been exploring this site and reading many of the linked articles since about 6 am this morning. I have history with kidney stones, just recently had a stone event that included a severe case of sepsis. 24 hour analysis revealed calcium oxalate stones and proteinuria. I am a 64 year female. 5’4 and 190 lb generally active and community and socially engaged. Last year I was recommended to begin water pills and calcium I chose to wait as I was concerned about the heavy meds. I live in rural area and have had little access to what… Read more »


Do you study Fabry disease?


I am suffering from kidney stones more than 7 years. I had two surgeries (ureteroscopy) between 2016 and 2018 in the same kidney (right one). I did all the blood tests needed, I went to see a diet professional but I still produce kidney stones and have renal colic sometimes three times a week and I can’t have a normal life anymore. They told me that I have oxalate calcium stones; I still have 6 kidney stones until now in both kidneys and I don’t know what to eat and not to eat to be in a good shape and… Read more »


I have been dealing with kidney stones going on 7 years. The first kidney stone almost took my life in 2013. It set up sepsis and attacked all my organs and left me on a ventilator for eight- ten days. After finding medicine to get the sepsis out of my system. Moving forward I had to get All my toes and finger tips cut off, with the exception of my thumbs. I’m very Grateful to God to be alive. I still have problems with kidney stones. I have been trying to find the kidney stone diet. I need to know… Read more »


I forgot to add that kidney stones strongly run in his family on his mother’s side.

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