How To Wean Off Sugar

Who doesn’t love dessert?  I, for one, thoroughly enjoy cookies, cake, and ice cream, but I keep it for here and there and not everywhere.

I know that many of you love it, too, because you tell me everyday that this is the hardest thing for you to avoid.  But I am here to tell you that it is possible to lessen your sugar and still want to wake up in the morning.  Really.

I work with many clients who have a very tough time lessening their sugar intake.  It is hard at first, but it gets better over time.

It’s Important To Reduce Sugar

Another recent article makes the case. Added, or refined sugar (sucrose) can raise your risk of kidney stones. It is also bad for your health.

Kidney Stones

Just one sugared drink raises your urine calcium within 30 minutes and keeps it up for at least 2 hours more. At the same time, it lowers your urine volume. If you have hypercalciuria – a majority of stone formers have it – the effect is larger because you start higher, and your urine volume will fall more. So with every sugary treat, risk of making stones increases for hours.

The drinks have no calcium in them, so where do you think the extra urine calcium comes from? It has to be from your bones. So sugar is bad for bone health, too.

Major Disease

I know we all see kidney stones as major, but think about diabetes and cardiovascular diseases – real killers. Also, obesity that is not just from calories, but of a special and very bad kind.

The fructose in added sugars is like a poison. It causes diabetes by making people resistant to their own insulin. It forces the liver to make lipids – triglycerides – that are a serious health threat. Fat from fructose does not accumulate around the hips but in the abdomen where it causes all these problems. So sugar is not just calories – it is a specific bad thing. Bad for your health in general.

Fruit has fructose; how can I say fruit is bad?

It is all the amount.

“Only The Dose Makes The Poison”

Paracelsus (1493 – 1541) was a physician, philosopher, professor, and chemist in the 15th – 16th century who is credited for the above adage.  He was commenting on the basic principle of toxicology.  In other words, too much of anything can be a problem, and portion is always key in staying healthy.

The beautiful image of Paracelsus is by Rubens. (Pieter Paul Rubens, Portret van de geneesheer Paracelsus Brussel, Koninklijke Musea voor Schone Kunsten van België [Foto: Heule, Grafisch Bureau Geert Leferve])
So, it is all about the amounts.
The fructose in an apple is small compared to a piece of chocolate cake, or a bowl of ice cream. But think about fruit juice. I have seen where it takes 3 to 6 apples to make one 8 ounce glass of apple cider. How many of you can eat 3 – 6 apples in five minutes? You can drink it that fast.
Yes, fruit contains fructose, but no one eats enough real fruit at once to match a candy bar.

Make the Commitment

Commitment is key. You must make a conscious decision that lessening your sugar intake is something you want to do because you want to be a healthier person.  You want to lessen your risk for kidney stones, heart disease, diabetes, and obesity.

Here is a staggering fact:

“Between 1980 and 2013, the proportion of overweight and obese adults rose from 28.8 to 36.9 % worldwide, with similar trends appearing in children and adolescents. The accompanying costs of health consequences and absenteeism associated with excess weight, estimated to range from 3.38 to 6.38 billion annually in the USA alone, make obesity a pressing public health problem”.

Sugar intake paralleled that increase in obesity. Here is one of many scientific studies. In Minnesota, from 1980 through 2009 sugar intake rose in men and women (black and white bars), plateauing in 2000-2002 and perhaps finally falling a bit. BMI in both sexes rose with sugar consumption. I could show many examples of this in the US and elsewhere. If you want deeper commentary, the CDC offers this about 2005 – 2010.

That is amazing to me.  By simply choosing better foods we could lessen our obesity rate.  We could lessen the odds of us becoming chronically ill and our children, too. Just sit with that for a minute.

The sugar problem is so severe the US recommendations have changed for all of the American people. They want added sugar reduced to less than 10% of total discretionary calories. For a woman that is 120 calories from added sugar, or 30 gm/day. The American Heart Association is even lower. They want around 25 gm/day for women. For men the number is around 36 gm/day.

Educate to Motivate

What to do?  You educate yourself, like you are doing on this website.  How much sugar are you eating a day? Remember, for a woman we want no more than 25 gm/day and for a man 36 gm/day. These are the goals for added sugar.

Most of you don’t even realize how much you are eating, but I will tell you that it is more than likely that you are eating too much.  Everyone is too busy watching calories and fat. I would rather people focus on salt and sugar because if you do that you will be naturally cutting out all the junk foods and lose weight from these two things alone.

Look at what we are doing as Americans today compared to so many years ago.

I really like this graphic as it depicts nicely our sugar consumption epidemic. The article is very daring because they make it look like a Coke bottle. 

In 1822 Americans consumed 45 gm of added sugar every five days – one soft drink. That comes to 9 grams of sugar a day.

In 2012, we consumed 765 gm of sugar in the same five days – 17 sugared soft drinks. That comes to 153 gm/day! Can you grasp that?

We should consume – a woman for example – less than 150 gm in five days or 25 gm/day. These amounts are shocking, are they not? We really eat too much sugar.

The Many Faces of Sugar

Sugar is has many different names and can be disguised in the ingredient list on the nutrition label.

Here is a sample list of the names added sugar may be called according to the U.S. Dept. of Health and Human Services:

Dextrose, brown sugar, cane crystals, cane sugar, corn sweetener, corn syrup, corn syrup solids, crystal dextrose, evaporated cane juice, fructose sweetener, fruit juice. 

The New Label

All this confuses people, and, finally, big government has faced off with Big Sugar. The new labels that phase in during 2018 make an end to confusion.


The old label is at the left. Total carbohydrate is in grams – 37 in this case. But where is sugar? Only 1 gram. Where did the sugar go?

Here is where it went. Sugar is a carbohydrate. So is pasta that has glucose as its sugar – the one that causes only fat to accumulate on your hips not in your liver. But refined sugar seems to be absent here – very healthy.

The same food, the new label on the right. Total carbohydrate – the same, 37 grams. But sugar is back – 12 grams of it. Not only that, 10 grams are added sugar, and labeled that way. That 10 grams is 20% of what you should eat all day if you eat 2,000 calories a day. The added sugar is sucrose, the one with fructose in it. The one that causes diabetes and heart disease.

But remember a woman eats 1400 calories or so, so her sugar is much less – 25 gm added sugar a day. This 10 gm is nearly half of her day’s intake.

Serving Size and Calories

There is a lot more, too. The serving size is bolded and large so you do not have to guess, and it is harder for you to keep spooning out more into your bowl. The calories are very large, so you can tell what you are eating, and no longer need your readers.

Fats and Fiber

DId you notice about fats? The 8 grams are now 10% not 12% of your calories – same calories. The fat  – heart disease link was fostered by Big Sugar to cast blame elsewhere. Ansel Keys, a famous scientist, did much to advance the low fat diet. But he was wrong, and the whole idea overblown. Links to news reports and science about the Big Lie are in another article. 

FIber is the stuff that fruits and veggies give us. The amounts we need are increased so the 4 gram on the left goes from 16% of a day’s needs to only 14%. A prompt to eat more of it.

Special for Stone Formers

We love it so much, here is a pretty vision highlighting all the new treats just for us.

Vitamin D and Calcium

Vitamin D has been added in place of vitamin A. That is useful for us, because we want enough and not too much.

Calcium content is now given in mg so we can eat the amount needed for each person – 1000 to 1200 mg/day. The old label was not clear.


Potassium is easier to find. This is a big deal for stone formers. But it also matters for everyone.

We said this already elsewhere, but here it is again. Potassium lowers blood pressure. Potassium salts that convert to alkali – like potassium citrate – are not only good for stones but also for bones. So government interests are mainly about the big diseases – stroke and heart disease from high blood pressure, and osteoporosis.

Stone formers specially need high urine citrate levels and to get them use pills with potassium citrate in them. But one does not need citrate in the pills. Does that sound silly? No. It is not.

The liver turns citrate into bicarbonate, and the bicarbonate signals the kidneys to release citrate into the urine. The citrate in the urine binds calcium – old story for anyone who reads this site.

But the liver can make bicarbonate out of many other molecules from fruits and veggies like malate, for example. The potassium in fruits and veggies almost all comes with these kinds of molecules. So if you eat what the government recommends – high intakes of fruits and veggies – you may never need the pills in the first place. A long article about potassium citrate and its costs already made this clear. The articles on the kidney stone diet are filled with information about potassium from these foods. The new label will let you keep track.

What about Oxalate?

Oh, what about oxalate?

If you do what we say and eat your calcium – you have a skeleton to protect – the calcium so reduces oxalate intake that common fruits and veggies are quite safe. The main high oxalate foods are a problem but no one needs to eat a lot of them. There are so many other choices. Give up all the silliness about squeezing lemons, and drinking lemon juice. Just eat a proper amount of fruits and veggies as a part of your diet.

While We’re Waiting, Look at Labels We Have Now

As illustrations, we use what we most love. You can think about your own desires and find the labels for them.

Ben and Jerry’s ice cream contains 26 gm of sugar in 1/2 cup, and I have never eaten less than 1.5 – 2 cups for dessert.

You know sugar has been added (3 different times) by looking at the ingredient list. For example, sugar is the third item, meaning more important, and also the fifth and later as cane sugar. So of the 20 gm, much is added.  I have nothing against Ben or Jerry, many ice creams are high in sugar, I picked it as Dr. Coe loves it, and I too when around him, have it on occasion.

Your Everyday Foods Might Be A Problem

I know sometimes when you read my articles you must be thinking, “she sure knows how to ruin my fun”.  I understand that uncovering the truth about what you might be eating is a bummer at times, but so is being sick. Being sick is so much worse than being mindful of the foods we are eating.  So let’s take a look at some very common foods you are eating that could be really high in sugar.


Yoplait Original has 27 grams of sugar—more than five teaspoons! And at 170 calories, 108 of which come from sugar, it is hardly a health food. When you look for yogurt, always check the label and pick the one with lowest sugar.

By contrast, Fage yogurt – same quantity – has 190 calories but only 8 grams of sugar, none of which is added. You may not love it, but it is the better choice. You could add fresh fruit to get the sweetness factor back if you like.  Some of you will be daring enough to just rough it and do without.  I for one, need the bit of sweetness and it is also a good way to get some fiber into my diet.  

Blueberries, even a few raspberries, can be added here because the calcium in the yoghurt will soak up the extra oxalate they contain.  And we all need our calcium as it is an important part of your kidney stone prevention plan and good bone health.


Meaning no special criticism of any one brand, here is an example of a healthy looking cereal. If you were picking this cereal based

upon what the front of the box shows you, you would think you were choosing wisely. If you take a closer look and read the nutrition label, you will see that health is not the prime virtue.

Look first at sodium – 180 mg for one cup. Who actually eats a cup of cereal? A whole day’s ideal sodium intake is 1500 mg.

Now, sugar. See the 17 grams in the one cup?

Sugar is listed three times in the ingredient list: Sugar, corn syrup filled with fructose, and brown sugar (and its syrup) all are added. This is a sugar festival in only one cup. If you eat two cups you are already past the daily allowance!

Canned Soups

Sugar is used in this product to help preserve shelf life. This can contains over two servings, but how many of you will fail to eat all it as one serving – the whole can?

Look at the nutrition label. If you eat the whole can, which most of us do, than you will be getting 30 grams of ADDED sugar!  Would you ever think that?  That is over your whole daily limit if you are a woman.  Many canned soups will have high fructose corn syrup added.  Please read labels and pick another with less added sugar.  They are also high in sodium, as I have said many times before, so look for low sodium ones too. The 450 mg of sodium is almost 1/3 of a whole day’s intake with one serving, and almost the whole 1500 mg (1,125 mg) if you eat the whole can.

Dried Fruit

Many of my patients use this as a go to snack when on the run.  They choose it because they assume it is healthy.  Please read the label as many of them are NOT healthy at all and it is a very easy way to accumulate your added sugar for the day.

Make sure they do not have added sugar in the ingredient list.  Also remember that since the water is taken out of the fruit the sugar content is higher per serving than if you were to eat whole fruit.

All of what follows about fructose content comes from the USDA database. You can look things up, too.

Even the best fruit snacks are not a good idea. For example Kind Fruit Bites Cherry Apple has no added sugar but 11 gm of ‘natural ‘ sugar from the fruit. All of that will be fructose. We have already figured out that a woman can have less than 25 gm of added sugar (36 for a man) which is 1/2 fructose. So that means 12.5 and 17 gm of fructose are the whole day’s allowance. A pouch of these bites has 11 gm of fructose in just that one snack. That is just too high for one snack. You could have a lot of apples for that much fructose and you get the fiber.


Healthy, right? One cup of raisins contains 49 gm of fructose. There is a reason you love them on your oatmeal. That is the fructose in 100 gm of table sugar – 20 tsp filled with it. Remember table sugar is 1/2 fructose, 1/2 glucose and it is the fructose that causes disease.


A great ‘natural’ sweetener, right? A cup of dates, chopped, is 29 gm of fructose.


One cup of dried apricot halves contains 16 gm of fructose.


Dried cranberries contain 11 gm but in 1/4 cup, so a cup would contain 44gm. Remember they are always sweetened. How else could you eat them?

Canned Fruit

All of these are bathed in syrup and syrup is made of sugar in water. The sugar is all added and mostly dextrose – 1/2 fructose. So these are bad choices altogether.

Fresh Fruits

This is an easy win.

Bananas are relatively high, so one cup of mashed banana – about one whole one – has 11 gm of fructose. Whole pears range from 8 to 10 gm of fructose each. An apple or a cup of blueberries is about 5-7 gm of fructose depending on the variety. Strawberries are even lower at 4 gm per cup. And watermelon, honeydew melon, plums are about 4 – 5 gm per cup.

In other words, the fresh fruits have fructose in them but they have a lot of fruit, bulk, water, fiber. No one eats that much of any one of these on a regular basis to worry about fructose or, frankly, anything else at all. There is the oxalate problem, and you have your lists. But if you are eating the proper amounts of calcium, and portions are in the cup range, it is not a major issue.

The Afternoon Meal, Luis Egidio Melendez Spain, ca. 1772 belongs to the Met.

Dressings and condiments

Notice the sugar levels in each portion size.  Fat free dressings are notorious for having more sugar added to make up for lack of flavor in fat free versions.  Also, there is much sodium in these products too.  The best thing is to watch your portion size.  I am not saying you cannot have ketchup on your burger, but do you need as much as you are using?  Cut down on the condiment and dressing portions and you will lessen your added sugars and sodium.


Many are high in sugar and again, remember the portion size.  More of it, more sugar in it. When dining out you can always ask for your sauces on the side this way you can control the portion size.  Also, why not skip the sauce altogether and have your chicken grilled and sautéed in olive oil instead?

Granola bars

This product makes me want to cry many times.  Please look at the label of your favorite granola bar and notice how much sugar is in it.  You will be shocked.  Sometimes these products are just as bad as a candy bar. Here is a popular and reasonably representative granola bar for you to think about

Two bars is a serving size. They contain 190 calories and 12 gm of sugar. All of it is added, obviously. The second item is sugar. Later on, honey is mentioned – pure sugar. This is another ‘100% Natural’ product, but added sugar is not natural. Don’t let the labels on the front of the box fool you. Read the nutrition label.

Oats have no added sugar, but have starch which is pure glucose. If you subtract the 12 gm of added sugar from the 28 total carbohydrates you get 16 gm of glucose from starch. Remember, glucose can make you fat but not insulin resistant.

By now I must sound like a scold and also a critic of everything. But no. The people who make these products tell you what is in them. They are not dishonest. It is up to you to read what they say. They make what people want and buy. If you do not want the sugar, buy something else – like fresh fruit, or yogurt.

Gluten free products

Everyone is gluten free these days and I certainly don’t understand how this has become such a thing.  Many of you will be tested and find out that you are indeed gluten sensitive, even worse may have celiac disease and you must be gluten free. Most of you have fallen prey to the hype of gluten free and think it is healthy so you are doing it.  For the record, most  of these items have extra sodium and sugar in them to make up for the taste of gluten free foods. They also tend to be overpriced.  Look at your label and if you don’t need gluten free, don’t buy it.

A recent report raises questions about the health drawbacks of a low gluten diet. Remember, it is a low grain diet. People in the highest gluten intake groups, after adjustments for confounding factors, had a definite reduction in cardiovascular disease. This was observation, not a trial, but even so these diets are not ideal unless medically necessary.

Frozen yogurt

There is an excellent Seinfeld episode called Ed’s Non-Fat Frozen Yoghurt where Elaine joins millions who start eating non fat FroYo.  There is so much added sugar in those items that if you eat it, you will definitely be adding a lot of sugar to your day.  This particular episode speaks about non-fat FroYo and during that time in NYC there was a chain that said they had no fat in their yoghurts but they actually did.  Elaine and pals do indeed gain weight and soon after put their plastic spoons down.  Have this item as a treat here and there.  And watch the toppings.  As far as I am concerned, they defeat the purpose of you trying to choose healthier.

Energy drinks

Some of them are WORSE than soda.  I hate them, you don’t need them.  Get more sleep, eat well, exercise, and save your money.  I just got really mad writing about them and may need a FroYo to get over myself. Enough said. If you read the labels you will find massive sugar loads.

Here is one of many. Monster. Once again, I am not singling out any one product. This one is popular so it depicts what people buy and drink.

The serving size is 1/2 can, but do we think most people drink 1/2 can and put the rest in the fridge for tomorrow? Really? So, a serving is a can, 54 gm of sugar. All of it is added. Now, all is glucose, not fructose. Glucose can make you fat, but it does not have the creepy fructose toxicity with insulin resistance and all.

So, strangely enough, although these drinks are silly from a nutrition point of view, they can be better than, for example, binging on raisins.

Red Bull – sounds bad. And, it may be. It has 39 gm of sugar in a 12 ounce can – larger can than Monster.

But sugars are listed as sucrose, then glucose, meaning that it must contain a lot of fructose as part of the sugars. Not good. Of course the labels still do not tell us exactly what we are drinking. Even so, this is not a good choice for any reason.

Frozen meals

Sugar and sodium reign supreme in many frozen dinners.  These items are to be used when you simply have no other options.  Most people may say, “But Jill, I have lost much weight eating them”.  The reason is the serving size.  They are made for baby dolls.  There is nothing miraculous about these products, and much of the time, nothing healthy in them either.

Let’s Talk About Starbucks

I have been known to go to Starbucks here and there to work and sip coffee.  I have also been known to glance up from my computer and look at the people in line ordering what might as well be an ice cream sundae for breakfast and muffle the scream that is about to come from deep inside me.  You may not realize how much sugar is in your favorite coffee drink from this popular place.  Look at the sugar in these common Starbucks drinks and see if what you order is a total sugar bomb? Remember, this is all added sugar which means 1/2 fructose. 

OK Party Pooper, What The Heck Am I Supposed To Do About Dessert?


I know you expect me to say just eat fruit.  This is one way that I take care of my sugar tooth (that is what I call it).  But what else?  Sometimes an apple is not going to cut it.

Other Stuff

Kettle Corn Pipcorn. This product has four versions. The one I suggest is the sweetest of the four: ‘Kettle’. It has 4 gm of sugar added in 2 cups, and only 95 mg of sodium. The other three versions have almost no sugar, and are high fiber. Their problem is high sodium 190 mg, and they will not be sweet. I eat the White Truffle. There is no oxalate – corn lacks it.

Annie’s Cinnamon Bunny Grahams. Two full sheets are 9 gm of added sugar. Total carbohydrate is high – 25 gm because it is made out of wheat flour. But this sugar is glucose not fructose. Safe but fattening. 

Fruit based smoothie (made with milk or coconut milk base or water). These are a great nutritious way to get your sweets with calcium and fiber. But you need to be very careful of the amounts. My smoothie is one cup of frozen fruit with enough milk to make it drinkable. That’s it. You will get about 4 –  7 gm of fructose. You cannot make it much bigger because 2 cups will give 8 – 14 gm of fructose, a day’s worth. Watch your portion size. Remember, fructose is not just about stones. It is about serious diseases.

Low sugar cereal and milk. Cheerios plain has only 1 gm per cup of added sugar. It has 20 gm of total carbohydrate because it is oats, but that will all be glucose. One cup with milk is a nice sweet treat.

Decaf or reg coffee and milk with cinnamon stick and dusted cinnamon on top. I know you’re thinking ‘she’s lost her mind’ on this one. But I do drink it after dinner and it really satisfies my sugar tooth. And, its pretty, festive, looks like a treat.

Frozen greek yoghurt drops. This is a darling site and worth a visit for you and your kids. Here is a picture of her frozen yogurt covered blueberries. Aren’t they pretty? Use low sugar Greek yogurt and you will have yourself a fine treat.

Frozen banana. (push a popsicle stick into the bottom of a peeled banana and put it in the freezer)

Halotop Icecream is one of a group of low sugar products. I eat it. The vanilla is my favorite and contains 60 calories for 1/2 cup, 5 gm of added sweetener in the form of erythritol and five grams of added sugar. It also contains stevia as a minor additive. Chemical stevia has no oxalate. This ice cream tastes best when you let it sit on the counter for 15 minutes. It is made with real milk and cream and eggs.

This little gem came from my Facebook page

Dark Chocolate. Also, eat a square or two of dark chocolate, if you can limit yourself.  I know it has oxalate, but have it here and there and you will be ok.  If you can drink it with milk that will help too.  You can even have a glass of chocolate milk if you just put a tiny bit of chocolate in there- just to satisfy your sugar tooth.

Jill, You Know Not What You Say.  I AM AN ADDICT!

You may recall in Dr. Coe’s article he confided in you that he was a sugar addict-  that he was not the type that could have a little bit as that would open the flood gates to SA (sugarholic anonymous).  I told him what I am going to tell you.  You cannot deprive yourself of never having sugar again.  You will only want it more.  We humans are not made that way.  Those of you who have taken The Kidney Stone Prevention Course are aware that I always say, “deprivation leads to temptation”. Almost always!

There will be a couple of you (Dr Coe is one) who will really go cold turkey and never eat added sugar again. To you I say “God bless- you are better than I”.  Most of you will not be able to do that and to you I say; live, love, laugh, but limit.

Try your best to stay under 25 grams of added sugar for women and less than 38 grams of added sugar for men.  Here is how I do it.  When I find myself going overboard on sugar, I say this to myself:  ‘Rein it in sister.  Get it together’. The more I have, the more I want.  So in reverse, the less I have, the less I want.  It is true.

Start weaning yourself off of added sugars. Use the above substitutes to help you through the withdrawal period. Use healthier snacks as your staples and the brownies and chocolate as rare sweet treats.

Will a frozen banana ever be as good as a Snicker’s bar? I’m not going to lie, it won’t. But you get used to the substitutes. The reward to all of this is less kidney stones, less obesity, less heart disease, less diabetes, and more health.

How sweet is that?

75 Responses to “How To Wean Off Sugar”

  1. Bridget Wright

    In the stevia debate. I found product containing steviosides extract powder. Is this the synthetic form that is low in oxalates?

    • Fredric L Coe, MD

      Hi Bridget, I think so. It is annoying that we have to guess. The chemists who do the extracting know the answer. Fred

  2. John Lamont

    Not sure what is left to eat after reading your site – low sugar/carbs, low protein, low fat, low salt, oh and by the way, only those vegetables low in oxalate

    • Fredric L Coe, MD

      Hi John, It is not so bad as it seems. Low sugar is 15% of calories or less from refined – table – sugar, an important US health matter. Our articles do not say low protein, merely 1 gm/kg/day of protein, which is the US recommended for all adults. Low sodium is simply below the US tolerable upper limit for sodium of 2300 mg/d. I have never mentioned reduced fat intake as it is unrelated to stone disease, and as for vegetables our site has strongly endorsed the US recommended calcium intake of 1000 to 1200 mg/d at which urine oxalate tends to be rather low and diet oxalate not so crucial an issue. So the kidney stone diet is mostly in accord with US diet recommendations for all Americans. Regards, Fred Coe

      • John Lamont

        Hi Fred, thanks for getting back to me. I was only being facetious. My Scottish humour, I’m afraid. Your are right there are still lots of options in terms of diet and your site is a wealth of great information. One thing I have noticed in myself, however, is a real inability to handle all carbs, which is strange. I really have to watch my intake. Any ideas on why this might be? Salt has exactly the same effect. After immediately eating these two ingredients, I can really feel my skin drying out, and despite drinking lots of water. Can hypercalciuria cause dry skin?

        • Fredric L Coe, MD

          Hi John, Sugar is addictive. Salt is adaptive – more salt and your ability to taste it wanes. Salt causes drying out everywhere. I hate them both in excess, the one causes weight gain and stones, the other raises blood pressure and causes stones. Both are evils of high culture that can provide so much of what should be minor diet constituents. Fred

          • John Lamont

            I hear what you are saying about salt and sugar. I get most of my calcium from diary and I do eat vegetables and fruit higher in calcium and lower in oxalate such as Kale and blueberries. I have also stopped adding salt to my meals. However, as you point out, there is quite a lot of salt in diary and to get enough calcium I am still getting too much salt for me – not loads, but enough. Any ideas on how I can get my calcium through diary or other foods and manage to lower my salt? I have been looking for low salt diary such as low salt cottage cheese but can’t find any at my supermarket (plus not a great fan of cottage cheese). Also, calcium supplements do not agree with me. Thanks

            • Fredric L Coe, MD

              Hi John, Milk is ideal in its balance of calcium to sodium. Other foods like it are in the article. The work on lower diet sodium higher diet calcium has mostly relied on adding milk because of the high calcium/sodium ratio. Supplements are useful but complex to time right. Regards, Fred Coe

  3. Maureen Vear

    Having trouble finding a synthetic Stevia – I have checked with Whole Foods and other organic markets in my area – can you recommend brands that would apply?

    • Fredric L Coe

      Hi Maureen, Most products have the synthetic chemical unless the ingredients say plant based or organic. I see your problem in that Google search for chemical stevia synthetic yielded up a lot of plant junk. You just have to sieve through labels in the store and filter out all the organic, leaf, plant, and stuff. It is a mess! Fred

  4. Conni

    I am so confused about what kinds of stevia are safe and what are not. I do not understand what the phrase “synthetic stevia” means. Synthetic implies fake, but stevia is made from stevia plants. Can you please please comment on Sweetleaf Stevia in particular? The ingredient label says Inulin soluble fiber and organic stevia extract. Does that contain oxalate or not?

    • Fredric L Coe

      Hi Conni, the plant has lots of oxalate, and the organic extract is from the plant. Synthetic stevia is the pure chemical, which has no oxalate – being pure. Synthetic means the chemical was made in the laboratory and has no oxalate. Regards, Fred Coe

      • Conni

        Thank you for your reply Dr. Coe, although I am still struggling to understand. Are you saying that the Sweetleaf Stevia brand DOES have oxalate, because it is an organic extract from the plant? Or are you saying that the extraction process eliminates the oxalate, and the only way to be exposed to oxalate is by chewing on an actual stevia leaf?

        • Fredric L Coe

          Hi Conni, Yes: plant extract may well have oxalate or not depending on how well the ‘extraction’ has separated the stevia and oxalate molecules. So, if you want surety use synthetic stevia – no oxalate. Best, Fred

  5. Jason

    What’s the deal with Stevia? It seems like there’s some conflicting info between you and Dr. Coe.
    Does Stevia leaf contain oxalate vs chemical Stevia?
    A supplement I take for my gut lists in the non-medical ingredients Stevia rebaudiana leaf.

    • Fredric L Coe

      Hi Jason, I believe you are writing this to Jill, but we do not disagree about stevia. The plant has oxalate, the pure chemical does not. Stevia leaf contains oxalate chemical stevia does not. Regards, Fred Coe

      • Jason

        Hi Dr. Coe,
        I was just confused regarding a statement Jill made in a thread from July 23, in which she stated that once the stevia leaf is processed, it contains no oxalate.

        • Fredric L Coe

          Hi Jason, One can purify stevia from plants, and when purified the chemical contains no oxalate. I think that was what Jill meant by processed. Fred

  6. Anne Ventura

    This is the best information I have seen. Thank you so much for it.
    My husband has been diagnosed with CKD and his body forms those nasty oxalate stones. He also has high cholesterol as well, which makes it difficult to come up with meal plans. I bought a lite lemonade from Whole Foods, their brand, 395. It is sweetened with organic cane sugar and Stevia to a 9gm of sugars per 8oz. Short of making my own, this was the best one I had found. I know lemons are good for stones. Would you be able to tell me where I could find some recipes or meal plans the address this combo problem of cholesterol and oxalate stones. I was shocked to see how many food items has high to moderate oxalates. Avocados was a real surprise.

    • Fredric L Coe

      Hi Anne, Why does your husband have CKD and how bad is it? Do you know how high his urine oxalate might be? You do not mention 24 hour urine levels, so I cannot tell what might be causing his stones. But CKD and calcium oxalate stones always raises the specter of a high urine oxalate state and these are so dangerous one must know about them. If he has had 24 hour urine testing, be sure his oxalate excretion was not high. If he has not had such testing it is imperative he get it. As for sugar, it raises urine calcium. Is his urine calcium high? Regards, Fred Coe

  7. Judith Gibbs

    I tried a new Lemonade it says it is sweetned with stevia on the very bottom is that ok to drink

    • Fredric L Coe

      Hi Judith, Stevia is without risk unless it is the plant itself. In lemonade it surely is synthetic and no risk at all. Regards, Fred Coe

      • sylvie tab


        I just had an episode of kidney stones and I am a sugar addictive. I need something to replace the sugar I am not taking right now What can I take when I have those cravings. Tks

  8. Jolie

    Hi Jill & Dr. Coe,
    So I am totally confused about plant vs. synthetic stevia. Isn’t all stevia plant-derived? Please clarify, maybe include a photo or name brand of an oxalate-free choice for us coffee lovers, (one cup a day of course!)

    • Fredric L Coe

      Hi Jolie, Stevia chemical is free of oxalate; it is purified from plant material or synthetic, in either case, no oxalate. Stevia leaf – the plant – has oxalate in it. The label will say stevia, not stevia leaf or plant. The plant forms are advertised as ‘natural’ etc but are indeed not a good thing for stone formers. Regards, Fred Coe

      • Jolie

        Hello again Dr. Coe. My Stevia label says: Organic Stevia Leaf Extract 45mg. It is sold by Trader Joe’s and is a white powder. Is this safe? Kindest Regards, Jolie

        • Fredric L Coe

          Hi Jolie, I am afraid this is plant material, not synthetic stevia and is apt to contain oxalate. I would avoid it. Regards, Fred Coe

      • Laurel Cunliffe

        Hi, the discussion on Stevia is very informative but I am still having trouble working out if the Stevia in a drink is leaf extract or synthetic. In Australia there is a brand of low calorie drinks called NEXBA. They are really nice and include flavoured Kombuca, Tempache and Switchel but use Stevia as a sweetener. I have tried to find out more details from the company and all they can say is that the Stevia is less than 1% of the product and that they use a Stevia extract made by steeping the leaves before filtering and drying them. Does this mean that the Stevia may have leeched out of the leaf before using as a sweetener in the drink.

        • Fredric L Coe

          Hi Laurel, Plant stevia will contain oxalate, and it sounds like they use plant material in this drink. So I might want to avoid it. Regards, Fred Coe

    • jharris

      Hi Jolie,
      You can have stevia with your coffee. Once the plant is processed it contains no oxalate!
      Best, Jill

  9. Sid Colton

    I see one somewhat confusing comment on Stevia. In general, can Stevia play any role in “weaning” me from the results of stopping to use table sugar? Or, if not … what is the reason for not transitioning away from table sugar by using some Stevia for example in seltzer water or such, since the traditionals soft drinks are now “out” for me. I have had a friend had huge negative results from aspartame (12 Diet Cokes per day for 30 years … and a grapefruit sized non-malignant brain tumor and 13-hour-surgey to remove it), so I will not have anything with Aspartame. Oh … apparently one kind of Stevia is better than another … which is the “better” kind?

    • jharris

      Hi Sid,
      No one should be drinking a 12 pack of diet soda every day. Let’s just start there. I try to limit all foods that contain artificial sugar as well only bc anything sweet whether artificial or not can increase my sweet tooth. Always look for the lowest amount of sugar in your foods, real or artificial. Eat foods that are not processed when you can.
      Best, Jill


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