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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!

348 Responses to “THE KIDNEY STONE DIET”

  1. JDevenney

    Information on Stevia is confusing. Are there any forms of Stevia that are low oxalate ?

    Also, are al teas high oxalate ?

    • Fredric L Coe

      Hi JDevenney, commercial stevia sweetener is a synthetic chemical or pure chemical and has no oxalate. Stevia leaf or any stevia plant material can be high in oxalate. So all forms of stevia but the plant material itself are free of oxalate. Regards, Fred Coe

      • Michele Gerard

        What is the specific name and CPT code of 24 hour urine test? I am going to self order and lab says there are numerous possibilities that check many different things.

        • Fredric L Coe

          Hi Michele, I have to admit I do not know the CPT code – but if you order from Litholink, the best provider in the US – there is only one 24 hour urine panel. The analytes include calcium oxalate citrate sulfate ammonium ion, sodium potassium phosphate magnesium pH and chloride as well as calculated supersaturations for calcium oxalate calcium phosphate and uric acid. I hope this helps. Regards, Fred Coe

  2. Robert Coates

    Do you know who has the most expertise in personalizing a stone prevention diet based on the 24 hr urine collection at Mayo in Rochester?

    • Fredric L Coe

      Hi Robert, At Mayo I would suggest Dr John Lieske; he is an expert in stone disease. Regards, Fred Coe

  3. Dan Sossamon

    Do you have the oxalate content of Uncle Ben’s Converted Brand Rice? I’m working with a nephrologist to reduce diet oxalate consumption. My web searches for oxalate contained in this particular rice have not been fruitful. Wikipedia’s article on paraboiled rice ( leave me concerned that Uncle Ben’s may have a high oxalate content similar to brown rice’s 24 mg/cup. Mars Food USA, the manufacturer of Uncle Ben’s, reports they do not measure for oxalate content. I appreciate your help!

    • jharris

      I do not have specific oxalate levels on the rice you ask about. No food manufacturer will report oxalate values as it is expensive and difficult to measure oxalate in foods. Keep your oxalate levels under 100/day (unless otherwise advice by your doctor), get your RDA of calcium and you can have your rice. And remember, portion matters. One half a cup of rice will have half the oxalate, so that helps too. But even if you have a higher oxalate food, pick and choose what matters to you. I have a nice article on this here:
      Best, Jill

  4. Sandra Fischer

    I take a curcumin supplement that has been very helpful in relieving my osteoarthritic knee; I would like my husband to take it, but he has a history of both kinds of kidney stones. Would it be safe for him to take the supplement if he took calcium at the same time?

    • jharris

      Hi Sandra,
      I would advise against it for your husband. It is terribly high in oxalate. Even with the calcium.
      Best, Jill

  5. Kim

    I am trying to help my husband lose weight with his life long history of calcium oxalate kidney stones. He is 54 yrs old and over 100 lbs overweight. He only drinks water all day long, no tea and stays away from foods that cause them, but does like his meat and potatoes. I have searched for some kind of weight loss program that will also stay in line with preventing the kidneys stones. Any weight loss programs out there?

    • Fredric L Coe

      Hi Kim, The bests source I know of for weight loss + kidney stone prevention is Jill Harris, who writes on this site and runs online classes at a very modest price. The link is to one of her articles, and she is easy to find on the web. Let me know. Regards, Fred Coe

  6. Nellie

    Hi , I just been diagnosed with three uric acid stones , one measuring 5mm 2mm, my primary doctor said “ drink lots of water . However I am not comfortable with the reply , I understand it is a form of gout . I have not had a gout attack . Year ago x – ray result showed mild arthritis in my right big toe . I do feel mild bruising feeling in my right elbow , I understand those are two location of gout . My question is what should be my health goal . ?

  7. Dan

    Hi, I’m a uric acid stone former, trying to get a handle on diet. Everything I read is tied to gout, understandably, but does this translate to me in terms of diet? Like can I eat tomatoes which are low in purine but are a gout trigger? This is very hard, trying to eat low fat, low sugar, low protein and not waste away to nothing here. I’ve dropped 20 lbs in a few months and I don’t want to lose any more.

    • Fredric L Coe

      Hi Dan, Uric acid stones arise from low urine pH and are gone on the moment when you raise it with potassium citrate. Diet is not an issue for uric acid stones. If you have gout as well, most physicians use allopurinol or another drug that lowers serum uric acid, but gout is beyond the scope of this site. Bring this idea about urine pH to your personal physician and add potassium citrate if he/she is in agreement. Regards, Fred Coe

      • Nellie

        Hi I was diagnosed with uric acid stones . However my doctor stated to just drink lots of water .🤦🏻‍♀️

  8. Angie

    Dear Ms. Harris:
    I have a FH of Kidneystones and was Dx last year by a Dr. at a Clinic. However, they only gave me medications, they would not tell me the type, nor what to do about preventing its reaccurance.
    I also years ago was Dx with Hypoglycemia, so any advice on how to prevent more Kidneystones while dealing with my Hypiglycemia which I’m trying to do so to prevent Diabetes which I also have a FH of.
    Please advise.

  9. Lisa

    When Gluten & Dairy free diet has been prescribed, how do I follow the Kidney Stone diet and still get the proper nutrition? (I have had kidney stones through the years and have then now.)

    • jharris

      Hi Lisa,
      I consult many patients who have other dietary restrictions. There are other milk sources like flax, hemp, and coconut milk to help. Think about joining my program that will help you put it all together:
      Best, Jill

  10. Lori

    Thank you for your comprehensive website! I have had kidney stones all my life and just got over the worst one I have ever had. I need to go on the Kidney Stone Diet for sure, but for some reason I am having trouble finding the list of foods and their oxalate levels . . .

    Thank you!


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