Basic kidney stone diet:
Almost all kidney stone patients will benefit from simple dietary changes which include increasing their fluid intake and limiting certain types of food. Together, these simple steps have been shown to decrease the risk of forming another stone by 50% or more and will also improve overall health and well-being. A handout outlining these steps is available for download below. For more detailed information on dietary prevention read on further.
A high fluid intake is one of the most important cornerstones of kidney stone dietary prevention. A sufficiently dilute urine will prevent the individual chemical components of stones from becoming concentrated enough to precipitate out of solution, keeping them instead in their dissolved state. A high urine output also may reduce stone from forming through “flushing” out of stone components and prevention of urine stagnation. In addition to stone benefits, increased water intake has been shown to have a multitude of other benefits, including improved alertness, better skin appearance, enhanced physical performance, reduced constipation, and enhanced weight loss.
The average daily urine output of normal healthy adults is 1.2 liters a day, ranging from 1 to 2 liters in most individuals and varying with body weight and gender. In stone formers, however, a higher daily urine output is required for stone prevention and achieving a daily volume of at least 2.0 to 2.5 liters a day can significantly reduce the recurrence of future stones. In a randomized study of stone formers who were given specific instructions to increase their fluid intake compared to stone formers told to not change their diet, those given specific fluid instructions achieved a high urine output of 2.6 liters a day versus 1.0 liters a day in those not given dietary instructions. Over a period of five years, the high fluid intake group was half as likely to form new stones as compared to the normal fluid intake group (Borghi et al, J Urol 1996).
We recommend that most stone formers increase their daily fluid intake by one liter (an additional two 16 oz water bottles or two tall glasses a day) in order to achieve a urine output of 2.5 liters a day. (One liter = 4.2 8-oz glasses or 34 oz).Alternatively, a 24 hour urine collection can be performed to guide fluid intake to achieve 2.5 liters of urine output in a specific patient.
Type of fluid intake
The type of fluid intake is generally less important that the total intake. While drinking water is our preferred recommendation because it is inexpensive and contains no calories, for stone patients who do not enjoy drinking water, any beverage will be beneficial in reducing stone risk.
Contrary to popular belief, studies have found that an increased intake of tea, coffee, and alcoholic beverage actually reduces the risk of stones, possibly because of an associated increase in urine output (Curhan et al, Am J of Epidemiology, 1996). While tea contains high levels of oxalate, this does not appear to result in increased stone formation for the reasons discussed below in our discussion on oxalate.
Soda intake (including colas) and milk intake also do not appear to increase the risk of stones.
Citrus juices, including lemon juice and orange juice, contain citrate, which acts as a stone inhibitor for calcium based stones. Citrate seems to do this by binding calcium, making it unavailable to combine with oxalate or phosphate: a necessary first step in the formation of stones. Citrate also seems to make it more difficult for stones to grow once they’ve formed.
Drinking citrus juice in the form of concentrated lemon juice mixed with water has been shown to effectively increase urinary citrate levels and reduce urinary calcium levels, both of which will reduce stone risk. Orange juice will similarly increase urinary citrate levels. However, orange juice appears to also increase urinary oxalate levels (a stone promoter). Other sources of citrate, including grapefruit juice, have had less research completed confirming their beneficial effects on urinary citrate levels. Therefore, lemon juice is typically favored over other citrus juices as a natural method to increase urinary citrate levels. Many patients find drinking citrus juices to be an attractive alternative to pharmaceutical treatment with potassium citrate.
We recommend that stone formers consider supplementing their daily fluid intake with a mixture of 60 ml of concentrated lemon juice in one liter of water to increase their urinary citrate levels.
A high sodium intake increases the risk of stone formation by increasing calcium levels and decreasing citrate (a stone inhibitor) levels in urine. Additionally, high sodium intake will impair the ability of medications such as hydrochlorothiazide to effectively reduce calcium levels in urine. A study of stone formers who were kept on a strict diet with a maximum daily sodium intake of 50 mmol (1200 mg) in addition to a reduced protein diet demonstrated that the low sodium diet was effective in reducing stone recurrence by 50% as compared to the low calcium diet.
We recommend that stone formers aim to follow the FDA’s guideline of limiting salt intake to 2300 mg of sodium a day in the general population and 1500 mg of sodium a day in those with hypertension, African Americans, or middle aged and older adults. 2300 mg is equivalent to about 1 teaspoon of table salt.
The best way to determine the salt content of your food is to read the nutrition label. Processed foods tend to contain higher amounts of salt. Choose low sodium options whenever possible.
- 1 cup of canned chicken noodle soup contains 870 mg of sodium
- A fried chicken drumstick contains 310 mg of sodium
- A serving of shrimp contains 240 mg of sodium
- 2 slices of white bread contains 200 mg of sodium
- 15 potato chips contain 180 mg of sodium
- 1 container of strawberry yogurt contains 85 mg of sodium
- 1 tomato contains 20 mg of sodium
- 1 apple contains 0 mg of sodium
In addition to lowering the risk of stones, a low sodium intake helps to control or prevent high blood pressure, which can lead to heart disease, stroke, heart failure, and kidney disease.
Animal protein in meat products increases the risk of stone by increasing calcium, oxalate, and uric acid levels in urine. All three of these changes increase the risk of stones. In studies comparing high meat eaters versus low meat eaters, high meat eaters were found to be at increased risk of forming stones. A randomized study of stone formers restricted to a low meat intake of 52 grams a day (equivalent to 8 0z of beef) in combination with sodium restriction found that the combination reduced stone recurrence by 50% compared to calcium restriction alone (Borghi et al, NEJM 2002).
We recommend that most stone formers try to reduce their meat intake to 6 oz a day. This includes all types of meat: beef, pork, poultry, and seafood.
The USDA recommends a daily allowance of 5-6 oz of protein intake among adults. They also recommend choosing non-meat protein foods such as nuts and beans instead of meat sources. Protein from non-meat sources does not appear to increase the risk of stones.
- A small steak contains about 3-4 oz of protein.
- A quarter pound hamburger with cheese contains 4 oz of protein.
- A chicken breast contains about 5 oz of protein, a chicken thigh about 2.5 oz, a chicken drumstick about 1.5 oz.
- One 5 oz can of tuna contains 5 oz of protein.
- 1 medium egg contains 1 oz of protein.
Lowering your animal protein intake and eating more fruits and vegetables also benefits your overall health by limiting the amount of saturated fats and cholesterol in your diet. This helps to reduce your risk of cardiovascular disease.
While oxalate plays an important role in the development of calcium oxalate stones, dietary restriction does not appear to be effective in reducing the risk of stones in the majority of patients. About 40% of urinary oxalate comes from dietary sources while the remainder is naturally made within the liver. Therefore, reducing oxalate dietary intake does not always have a significant impact on total urinary oxalate levels.
Oxalate is found in many vegetable and fruits, including many healthy dietary choices often making it difficult to achieve a low oxalate diet. Because of these issues, oxalate avoidance is beneficial primarily in those individuals with specific abnormalities that lead to high oxalate urinary levels.
We recommend that most stone formers should maintain a normal oxalate intake without the need for oxalate restriction. High oxalate intake should be avoided in individuals found to have high urinary oxalate levels on metabolic evaluation. Oxalate restriction may be beneficial in certain individuals with high urinary oxalate levels.
Oxalate rich foods
- Tea (black)
- Spinach
- Mustard greens
- Chard
- Beets
- Rhubarb
- Okra
- Berries
- Chocolate
- Nuts
- Sweet potatoes
Kidney stone formers often question whether to stop or reduce their calcium intake. Despite the fact that calcium is a major component of 75% of stones, excessive calcium intake is very rarely the cause of stone formation. In fact, several studies have shown that restricting calcium intake in most stone formers actually increases the number of stones they develop. This appears to happen because when less calcium is ingested, it becomes easier for oxalate (which normally binds with calcium in the gut) to be absorbed. Higher levels of oxalate in the urine then lead to an increase in stone risk. Calcium obtained from dietary sources appears to be better than calcium from supplements in regards to lowering stone risk because supplements can actually increase your risk of stones slightly (by 17%) while dietary calcium intake is instead associated with lower stone risk. If you need to take supplements, taking them during meals appears to be better in terms of stone risk.
We recommend that stone formers maintain a normal calcium intake, preferably from dietary sources. Female stone formers taking calcium supplementation to prevent osteoporosis experience a slightly increased risk of stones (17%) which needs to be balanced against their risk of osteoporosis.
For more on calcium intake and stones, see: Should I stop my calcium?
Editors note: Oxalate and calcium sections updated on 5/23/12 to reflect information presented at the 2012 American Urological Association Meeting.
I see this at the bottom of the article: “Editors note: Oxalate and calcium sections updated on 5/23/12 to reflect information presented at the 2012 American Urological Association Meeting.” 2012 is 10 years ago. Would you please update the article and/or provide recommendations about high-oxalate foods and calcium from the latest evidence-based research?
Drinking a lot of lemon juice to get citrate is terrible for your enamel and can get quite expensive. Look at KSPtabs that you can dissolve in your water and will give you all the citrate you need plus other alkalinizing agents. I’ve been taking them for years and never had another stone.
Ksp tabs contain citric acid. No different then lemons
I have not had to add another stone to my kidney stone necklace since I followed the Harvard Medical School recommendation from: https://regepi.bwh.harvard.edu/health/Oxalate/files
see the Excel file.
hope this helps
Dubg
Please Help! I had lithotripsy on a large stone that turns out to 80% uric acid and 20% calcium oxalate. I see that diets conflict if I try to reduce forming uric acid stones and the 20% oxalate stone. Is there any good information on how to eat with both types in treating both types of stones? Some foods are ok with uric acid but not for oxalate. I don’t want to feed either and go through the severe pain again. Thanks
Is there information available on how much oxalate is in nutritional supplement products? My mother received treatment for head and neck cancer. Her current diet is 90% Boost Very High Calorie. She was diagnosed with kidney stones as an incidental finding on a surveillance CT. She has had 2 stents and shockwave lithotripsy x1.
Nice post thanks for sharing
yes, thank you
potasium citrate, lemon juice, low oxalate foods
Have there been any articles published on lactose intolerant people and kidney stones?
I have been unable to consume dairy for the past 35 years and have had kidney stones sporadically for the past 30 years. I struggle to get enough calcium in my daily diet but follow all the other guidelines.
you can get enough calcium from dark leafy veggies
I’ve had no problems with lactose free milk – it is a little more expensive, but tastes exactly the same as normal milk. Great in coffee, cereal, etc.
I have kidney stones oxlate ones, I remember very well 11 yrs ago I got my 1st stone.. it was excruciating, I am into my 12th year of having them and I am addicted to pain killers. I get lithotripsy once a year and key hole surgery at least twice a year. The stone have been really a terrible Bain on my life. Can u plz list the foods ( greens , fruits carbs that I can’t eat and I might get a bit of relieve. As I write this the pain is in the 6-7 on a ten scale. I am 46 and I would consider myself. 40% healthy on a 100% scale. If I could get some sort of advice I am willing to listen and take action. I am a chocolate eater and my sugar intake is big. Tea, coffe , cereals and sweets are big in my diet. I also eat the normal intake of greens fruit and meats that the average person will eat daily. I am a smoker (20) per day and when the pain is around the 3 out of 10 mark I like to get active. Walk the dog and do some sports. I don’t drink alcohol and drink 3 ltrs of water daily. Can you point out to me what I can do to improve my life style. I am slowly reducing my cigarette intake and soon I will be a none smoker… thank you ANTHONY Ireland
Try Chandra Piedra tea or pills…read up on it….stonebreaker,
Helps many according to what people write….
Chanca Piedra.
You should see a dietician. You could probably see great relief by dietary changes alone. Sorry to hear about your pain.
Here is a very good site that lists the foods you can eat, and those to avoid https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Cut way back on the chocolate. Cut back on sweets in general and on drinks with caffeine (coffee, tea, sodas). Start reading food labels. Aim to keep your daily intake of sodium to 1500 mg or less.
I have been getting Kidney stones for over 40 years. I have been to multiple doctors, been on the operating table, lithotripsy, etc. Every doctor over the years seems to have had an opinion on the cause & what to do that has resulted in an opposite opinion from another doctor in most cases. Usually I pass at least one smaller stone (apx. 5mm) annually that I pass on my own. About every 5 years on average it is back to the operating table or lithotripsy or something. I drink lemon water until it seems like it eats my insides out some days, even though I actually like the taste of lemons. I have tried every diet that I have been advised of religiously over the years to find that it did not work. Now I really make an effort to not go to the hospital though, because it has gotten ridiculously expensive & unaffordable, so I try to pass them all on my own. To make it worse, contrary to the old days when they would beg you to take a prescription to help lighten the pain & allow you to relax, they will now rarely give you a prescription unless you go to the hospital. I would just like to find the answer & stop this madness. I am wide open to real ideas that work.
Have you tried Stonebreaker drops or pills.
Many people say it has helped them….buy on amazon…..there is stonebreaker tea to . These products contain Chandra Piedra …good luck
have you had urine testing for citrate, calcium oxalates, uric acid?
Everybody tells you something different. Maybe you could find a book online, written by a nutritionist or Naturopath, but specifically contracting on kidney stones. Most Urologists, and other MDs, are taught very little about the amazing curative powers of diet. And most Nutritionists don’t know THAT much about stones. If a Nutritionist writes a book about stones, or a Urologist writes a book about diet’s affect on stones, then these are people who probably are up on the most current research on diet and stones.
Just diagnosed with MSK. Age 57. I eat little animal protein, probably why it took so long to show up. I had a mass of stones lithotripsied at age 45 and now I have one large one which apparently isn’t blocking anything. I do have occasional side pain and chronic UTI’s. Drinking a ton of water and frequent trips to the bathroom. My sister is insisting that I try nettle leaf tea for kidney treatment. Has anyone tried it?
Thank you so much for this site. Having just experienced my first stone, I’m naturally doing a lot of research and have found there’s so much more than the little your site has. For instance, Pogue’s video is great, except he says we have to eliminate leafy greens, which is not true. Some of them, yes, spinach is definitely out, something I was eating a lot of, and I believe was the primary cause of my stone. Kale, however, has low oxalates and higher nutrition, although it’s more work to prepare. Also important to consider is bioavailability of oxalates. For example, I learned that while tea is high, little is kept in the body. Here’s a link to about the best source I’ve found, with links to charts, too, and it’s from the University of Chicago: http://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Good luck to all of us.
I believe I have kidney stones. My lower back is killing me. Got the LB massaged over two weekends. It temporarily stopped pain for an hour. I have been doing a lot of exercise in the heat and not drinking much fluids. Urine is dark yellow and skin has salt deposits on it so much that the wasps want to land on me and eat it. I have discovered a product called Chanca piedra. I got the capsules and the fluid. I have started to drink ten tall glasses of water a day. In each glass, I use one lemon. I squeeze the lemon out with this juicer thing that I twist it on and the juice goes in a jar. I pour that in the cup, squeeze some honey on top of that and fill the glass with cold water. Then stir with spoon and put an eye dropper squirt of Chanca piedra. My back has been hurting bad for two weeks, but after just one day of drinking ten glass of squeezed lemons, honey and Chanca piedra, almost half the pain is gone. I can actually lay in my bed and sleep now. It’s a pain drinking all this water. I keep a record and drink one glass every hour. As soon as I drink a glass, I prepare another one and place in the refrigerator. I tell you this, passing a kidney stone is like going to hell. It delivers a grinding pain you can’t run from. One must never forget to drink a lot of water. No beer, no alcohol, no sodas, just plain old water! Lemonade or orange juice is a close second substitute. Good luck!
Dude–go to the doctor! If something hurts like that for two weeks, you’re crazy not to go have it taken care of. The stone pain doesn’t last long when you’re passing it. If it does, you have a bigger problem and need it taken care of.
Is there a cook book for people like me. I need help I’m getting so small because
I’m trying to watch what I eat. I’m just about to be anorexia. If you think about it
everything has things in it that’s not good for people with kidney stones. And I
know watch what you eat and how much you, but all the good healthy foods are
not good for you. I’m having a very hard time getting good healthy food.
I have been dealing with kidney stones since 1977. In my experience, Citrus, parsley, strawberries, chocolate, and Vitamin C, have given me stones. I recommend drinking distilled water, and taking Magnesium Malate, Taurate, Threonate or Orotate with activated B complex daily, and cranberry juice when stones are present.
In the main text, you recommend “concentrated” lemon juice. Do you actually mean the juice as squeezed from a lemon? If so, then “concentrated” should be removed as redundant. If not, you will need to specify the actual degree of concentration. I suspect the former, rather than the latter.
HFL
Exactly. I have never heard of “concentrated lemon juice.”
I am 26 years old already operated in2013, but repeat paining madem, food protein means dal,pototos,green veg ,rice not take.
Dear Sir/Madam,
My husband is diagnosed with kidney problem. He has stone and leakage of protein in his urine. Please advice me what to cook for him and prevention. He is a diabetic and have pressure. He is 54 years old. I am very scard. Doctors also told him that he has a cyst on the kidney and his kidney are in different sizes. Please help.
From Malaysia
I am looking for advise. After having my 1st child I constantly felt unwell visited the doctors repeatedly (“you must be post natal” was the advise at the time) when she was 3 I had a heart attack, doctors still unhelpful. 12months after the heart attack I was rushed into hospital with severe pain and upon scans they found several stones in both kidneys that were “huge” and was advised that this is more than likely why I had had the heart attack (3 years of being miss diagnosed) but there was no advise given and the doctor retired 2 weeks later – I was left to figure it out on my own. Well my daughter is now 12 and I have had about 16 operations on stones raging from 12mil to 31mil in size (I have nearly died on the operating table, lost all my teeth that had fillings and quite frankly been through hell) 2 weeks ago I passed a stone at home and have just found out that I have 3 small stone forming again. I noticed that before passing the recent stone I had a very very strong urge to drink lemon water and I drank 2 litres in one day on top of my normal water intake for the day. The following day I passed the stone. Today I discussed this with my doctor and he said “clever you have listened to your body” and it appears that the lemon water has high level of potassium citrate which helps me get rid of the stones. I would love to know more about this and if I can get tablets etc of potassium citrate in Australia. advise on Brands etc with the right level of potassium citrate would a great help.