Anyone who’s had a kidney stone will tell you that they’re one of the worst medical problems you can ever experience. Kidney stones are a common and painful chronic condition seen in otherwise “healthy” patients, and one of the most common disorders of the urinary tract. About a million people in the United States are treated for kidney stones each year, and the prevalence in adult men is almost 12% and around 6% in adult women. (1)
Stones are most common in caucasian adults between the ages of 20 and 50, and once someone develops a stone, they are far more likely to develop another stone in the future. Like most chronic diseases, the incidence of kidney stones has been increasing over the past 30 years. (2) This is likely due to the variety of dietary and lifestyle changes we’ve made as Americans which aren’t conducive to good health.
What Are Kidney Stones?
Stones can be formed from a variety of substances, but the most common stones are made of calcium and oxalate that has crystalized in the urinary tract. Other types of stones include struvite, uric acid and cystine. While stones themselves are painful enough, they can lead to more serious conditions such as obstruction of the urinary tract, permanent damage to the kidneys, and even life-threatening infections. I’ve seen patients in the hospital who have come in with necrotic kidneys due to obstruction from a stone, so this can become a serious condition if not managed properly.
Conventional medical professionals take a multi-pronged approach to treating kidney stones, including surgical removal, using shock waves to break up the stone into smaller, passable pieces, and various medications to prevent future stones from forming. There are a few conventional dietary guidelines for preventing future stone formation, but most of these guidelines are based on the composition of the stone, not the true pathology behind why the stone actually formed. After all, why do some people eat junk food, or foods with high calcium and/or oxalate content, drink barely any fluids, and never experience kidney stones, while I’ve had patients who eat healthy diets, drink plenty of fluids, and still develop stones?
Still getting kidney stones on Paleo? Read this for tips on how to avoid this painful condition.
While it’s difficult to know why one person is more prone to kidney stones than another, there are a few important strategies to help reduce your stone risk, whether you’ve had one before or you have a family history of stones. And not surprisingly, these aren’t necessarily the guidelines you’re going to hear from your typical nephrologist. (3) The following are my best tips for preventing kidney stones using simple diet changes.
Balance Your Fat Soluble Vitamins
This would be my top priority for any patient suffering from kidney stones, specifically calcium-oxalate stones. As many of Chris’s readers know, we require more than just vitamin D to properly metabolize calcium in our diets and in our blood, yet unfortunately, most nephrologists and dietitians never consider the role other fat soluble vitamins play in calcium metabolism. But vitamin A and vitamin K2 are two nutrients that are critical for balancing out the effects of vitamin D and making sure the calcium from our diet gets deposited into our bones and not into our arteries. (For more information about vitamin A, D, and K2, you can check out my review of a great book on the topic.)
In someone with kidney stones, vitamin A deficiency, vitamin K2 deficiency, and vitamin D excess are all prime suspects to be considered in terms of both absolute amounts and proportions between the vitamins. Chris Masterjohn, PhD has written volumes about the importance of balancing these three nutrients, and especially balancing vitamin A with vitamin D, as an excess of one will lead to a deficiency of the other. In fact, vitamin D excess is considered to be a risk factor for kidney stones in the conventional medical world, and studies show that people exposed to high levels of sunlight (such as lifeguards) are at higher risk for stones. (4, 5, 6, 7, 8) Interestingly enough, adequate vitamin A intake protects against excess vitamin D, as Masterjohn has made clear in his series on the topic.
Vitamin K2 may play an independent role in kidney stone development. As Masterjohn points out, “patients with kidney stones secrete [vitamin-K2 dependent] protein in its inactive form, which is between four and twenty times less effective than its active form at inhibiting the growth of calcium oxalate crystals, suggesting that vitamin K2 deficiency is a major cause of kidney stones.” While the research is still new, I think there’s no reason not to ensure adequate intake of these nutrients in your diet for health maintenance, and you might find it helps with preventing kidney stone formation.
So how can you get more vitamin A and vitamin K2 in your diet? For vitamin A you can eat plenty of organ meats like liver, egg yolks, and full fat dairy products. For vitamin K2, eat liver, grass fed dairy products like ghee, butter, and full-fat cheeses, or natto (if you’re adventurous). If you need to supplement, keep vitamin A around 5,000-10,000 IU per day and try to get these nutrients from a food-based source, such as the Extra Virgin Cod Liver Oil from Rosita. Also, try to cut down on alcohol consumption, as excess metabolism of alcohol can impair your utilization of vitamin A, leading to deficiency. (9)
Add Lemon to Your Water
This is a natural treatment that conventional nephrologists have gotten right. While lemon water is often touted as a cleansing or alkalizing drink, the main reason it is helpful in reducing stone formation is its citric acid content.
Citric acid (not to be confused with vitamin C or ascorbic acid) inhibits stone formation and breaks up small stones that are beginning to form.(10) It works in a few different ways. Citrate binds with calcium in the urine, reducing the amount of calcium available to form calcium oxalate stones. It also prevents tiny calcium oxalate crystals that are already in the kidneys from growing and massing together into larger stones. It also makes the urine less acidic, which inhibits the development of both calcium oxalate and uric acid stones. (11)
You’ll need about a half a cup (4 oz) of lemon juice added to water throughout the day to get the same benefits as taking a potassium citrate pill, which is one of the standard pharmaceutical treatments for kidney stones. You can either take this all in one shot, or spread your intake of the lemon juice throughout the day. Try adding half a cup (or more!) of lemon or lime juice to a 32 ounce bottle of water and sip on it throughout the day. If you prefer, you can also try adding apple cider vinegar, which also contains citric acid and is an alkalizing addition to your beverages. (12)
Get Your Magnesium
Sometimes it seems like magnesium might be the cure for everything: muscle cramps, headaches, fatigue, insomnia, anxiety, constipation, back pain, brain fog… it might even solve world hunger. I’m kidding of course, but magnesium is definitely one of those magic cure-all dietary supplements that seems to help with a great variety of maladies without much risk for toxicity. That’s why I, like Chris, believe everyone should take a maintenance dose of a magnesium supplement, since it’s hard to get adequate magnesium even in the healthiest ancestral diet.
However, it may surprise you to learn that there’s some research suggesting that magnesium can lower the risk of stone formation. (13, 14, 15) While scientists are still trying to figure out why magnesium has this stone preventing effect, and to determine which forms of magnesium are the most effective at preventing stones in humans, I think it’s safe to say that if you suffer from kidney stones, you’d be smart to ensure that your magnesium intake is adequate.
There are a few ways to up your magnesium intake. The easiest is to simply take at least 400 mg of magnesium in supplemental form on a daily basis. The best types to take are the chelated forms such as magnesium citrate and magnesium malate, as they’re well absorbed. You can also increase your dietary intake by eating pumpkin seeds, spinach, swiss chard, and nuts like almonds and cashews. Be sure to soak your nuts and seeds before eating them, which will help make the magnesium more available. Some people have reported benefits from taking epsom salt (magnesium sulfate) baths, as magnesium is able to be absorbed through the skin.
Whatever your method, just make sure you’re getting it daily in adequate amounts, since at least 50% of Americans have magnesium deficient diets, consuming less than 400 mg per day. (16) And coffee, a common “paleo” treat, may actually cause magnesium deficiency so be careful not to overdo it in the mornings.
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Moderate Your Salt
In Chris’s great series on salt, he explains how excess salt consumption can promote stone formation in those who are susceptible:
“Those who are prone to kidney stones may need to reduce their salt intake, as high sodium excretion also leads to a higher level of calcium excretion in the urine. Evidence on this topic is mixed, but it has been demonstrated that excess sodium intake is associated with increased urinary excretion of sodium and calcium, and subjects who consumed the highest levels of sodium tended to have the greatest urinary calcium excretion. Higher calcium excretion may lead to kidney stone formation, particularly if fluid intake is inadequate.”
So even if you’re eating a diet low in processed foods, you may still be taking in a lot of salt through food items like cured meats (e.g. bacon), canned or preserved foods, fermented condiments like pickles, sauerkraut, and kimchi, or simply by adding a lot of salt to your food. While some salt is good, eating tons of bacon and few plant foods is likely going to push you over your sodium needs without matching that sodium intake with potassium, a crucial electrolyte that can actually eliminate the negative effects of excess sodium. So make sure if you’re eating lots of high salt foods that you’re getting in plenty of good sources of potassium, such as bananas, leafy greens, squash, white potatoes, and avocado.
Eat More Carbohydrates
Another problem that people on a run-of-the-mill Paleo diet might encounter is an inadequate intake of carbohydrate. While carbohydrate is not an essential macronutrient in the most basic biochemical description, a very low carb diet can lead to profound health problems in certain individuals, such as depressed thyroid function, nutrient deficiencies like scurvy, and even insulin resistance. Many people eating a Paleo diet tend to eat lower carb simply because of the nature of the ‘banned’ foods being higher in carbohydrate, such as grains and dairy.
While eating Paleo does not equal low carb, it’s a common situation, especially if someone is new to the diet and doesn’t understand that foods like white potatoes are okay for most people to eat. (In fact, it might be good to alternate sweet potatoes with white potatoes regularly, since sweet potatoes are very high in oxalate which could contribute to stone formation!)
Paul Jaminet, PhD has written a great deal of information about the dangers of carbohydrate restriction, and kidney stones is one of them. While I won’t go into the great detail about why very low carb (VLC) diets can increase the risk for stones (you can read Jaminet’s article for that), the issue is likely due to the fact that VLC diets (<15% of calories from carbohydrate) make the urine more acidic due to the excessive amount of protein metabolism, potentially leading to uric acid stone formation. Generally, this is more of an issue on ketogenic diets, but is a risk for anyone whose diet and exercise routine requires a significantly high level of gluconeogenesis (i.e. forming glucose from amino acids/protein). A high protein diet with adequate carbohydrate intake, contrary to popular belief, will not necessarily increase your risk of stones, unless you already have underlying kidney disease. (18)
In addition, per Jaminet, the degradation of oxidized vitamin C is a likely contributor to the development of stones by increasing oxalate excretion. So if you’re not getting enough vitamin C in your diet and your vitamin C needs are increased on a low carb diet, you may be unintentionally contributing to stone development.
Jaminet recommends a minimum of 20% to 30% of energy intake coming from carbohydrates. (18) For a moderately active woman eating 2,000 calories per day, that’s 100-150 grams of carbohydrate from fruits, starchy vegetables like potatoes and sweet potatoes, white rice, and some dairy if tolerated. For a moderately active male eating 2600 calories, they might need more like 180-200 grams of carbohydrates per day.
As activity level and calorie needs increase, you’ll need to increase carbohydrates appropriately to support glycogen stores and activity levels. If you’re eating a low carbohydrate diet (less than 15% of calories per day) and getting kidney stones, I would reconsider your carbohydrate intake and try bumping it up. If you’re eating low carb and have never dealt with kidney stones, then you might be alright staying low carb – it’s up to you to decide!
On the flip side of eating enough carbohydrates, make sure you’re not getting the majority of your carbohydrates from fructose. As Chris mentioned in his article about gout, research has shown that higher intakes of fructose may mediate many of the abnormalities seen in the metabolic syndrome, including elevated triglycerides, due to increases in uric acid production. (19) High levels of fructose intake not only produces excess uric acid, but it also reduces its excretion in the urine. (21)
While fructose in naturally occurring amounts is relatively benign, fructose is commonly found in our food supply as a sweetener, and is often touted as a natural additive to certain foods. One of the biggest culprits in someone eating a “natural” diet is agave syrup, which is advertised as a low glycemic, naturally occurring sweetener derived from the agave plant. However, its fructose content can range to as high as 90%, compared to high fructose corn syrup which contains about 45-55% fructose!
So while fructose from fruit is generally fine, make sure you’re not using high fructose sweeteners like agave or drinking high quantities of fruit juice. And it should go without saying that soda and other HFCS-sweetened beverages should never touch your lips, regardless of your kidney health!
As you can see, eating a comparatively healthy Paleo or ancestral diet does not guarantee you won’t be immune to kidney stones. While the standard American eating big macs and drinking a liter of cola every day might be at a much higher risk, it’s easy to miss out on some of the key nutrients you need to prevent stones from forming if you’re not eating a varied diet with emphasis on nutrient dense foods. If you do have kidney stones, try following the tips above and see if your stones reduce in size or possibly even disappear!
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How can you recommend adding spinach to the diet to get magnesium, when spinach is the vegetable that has the highest level of oxalate of any vegetable out there?
My thoughts exactly!
For calcium oxalate stone formers, spinach has a skull and cross bone on it … LOL
How abourt red palm Oil (sustainably harvested) for Vitamin A?
I have heard that on keto diet salt intake should be inceased to 3-4 grams a day. Does this increase risk for kidney stones.
Any suggestion for resources that cover the pros aand cons of keto diet?
Also, this link – (For more information about vitamin A, D, and K2, you can check out my review of a great book on the topic.) – is not working in your article.
I take Garden of Life Raw Meal in a smoothie with green tea. So far nothing bad has happened in two years. Should I continue
I suffered with kidney stone 2 years past till that i am well, but past few months i feeling little pain during urination some times found little drops of blood too. is this trouble is somewhere related to kidney stones or is it something else
I had that happen., You passed or are in the process of passing the stone to your bladder and it’s just cutting up either your uriter or bladder. Nothing to worry as long as it doesn’t last more than 2 days or so. What I did was make a heavy stream every time i urinated to make sure if the stone was coming out it got pushed out fast. I had one get stuck in my penis and has to drink alot of water and wait 2 hrs before i was able to force it out.
I have been taking Potassium now for about 2 months after have a CT of my kidneys reveal I have 6 stones. Yea 6, one is 5 mm in size and the others are smaller. I had already passed one 5mm by 1 cm and it was a bitch!! but I am a single dad and can’t go to the hospital as I have no one to watch my 2 children. I quit eating Spinach and high Oxalate foods, I always drank alot of water but started mixing it with lemon juice and after doing all this, The 6 stones formed. I am hoping the Potassium stops the future formation and these others that are already in my kidneys just waiting to make my life miserable (one of these days) pass without any major issue. I have passed others as well in the past and what I can say is, If you are active doing strenuous activity when a stone decides to leave the Kidney and make its journey to your bladder, you really don’t have much pain. The doctors told me that’s because your ureter is dilated when your are active and sweating. So I asked the doctor what did they give me in the hospital to artificiality dilate my ureter to help the stone pass and she gave me a prescription for Flomax (tamsulosin). I was told at the first indication that the stone dropped and is ready to travel to my bladder to take 2 pills (double the normal prescription) along with some pain meds and make the best out of the several hours it may take. So, I suggest you all talk to your doctor about getting some Flomax along with the pain meds to help you pass the stone.
Can I get a little bit more information about kerogenic diet and the effect of it on kidney stone.
What about if person drink enough fluids will still may be able to cause the stones?
I’m 16 years old and i have atleast been in the hospital for kidney stones about 4 times. At a young age, its hard for me to walk away from soda and salty foods, any suggestions?
Please stop drinking soda. It will make a big difference. Drink water with lemon. Afer a while you will find soda very sweet and not like it.
I totally know how you feel. I have had 2 bouts with stones, the last one putting me in the hospital over Thanksgiving. And really stones cannot form if you stay really, really hydrated. It’s only when our urine gets super concentrated that we are at risk. What we eat can either give us some wiggle room to avoid a kidney stone, or put us over the edge. If you just have to have a soda, follow it with the same amount of water. Not that I am a big fan of the extra sugar in your diet from soda, but sometimes you want a soda, right?! Same with salty foods. Salty foods are going to make your urine too concentrated and stones will form. Push the fluids. The University of Chicago has a stone prevention website run by nephrologist Frederick Coe. He’s a great guy who will answer your questions for free. Check it out. They also have a registered dietitian who will also answer your questions at not cost. They are a great resource. Hang in there girl!
No hydration helps but dies but stop kidney stone I know for a fact
Once you get In the habit of drinking water you actually crave it . give it time you will prefer water over soft drinks which are so unhealthy. the garbage in soft drinks and diet drinks actually make you crave for more of the garbage in those drinks
Drink 1 tbsp of Bragg’s Apple Cider Vinegar in am and 1 tbsp at pm. Put lemons in your water. Drink 100% juice, preferably orange and Cranberry. If you drink soda, limit to 1 a day and make it a light color.
I have been taking Kidney Stone Formula supplement from Bio Essence as it has all the ingredients recommended by a urologist with some additional herbs. It says you will get 90% protection and in 3 years since last attack my oscillate levels have not increased. He mentioned 2 others but they don’t seem to be in business any more.
Like I told my sons. Switch from soda, to iced tea. Then you can slowly move down to unsweetened ice tea. Also being overweight will contribute, and not exercising and laying around encourages formation of stones.
There is very helpful information in the following article.
It worries me to see this sort of characterization of keto diets: “VLC diets (<15% of calories from carbohydrate) make the urine more acidic due to the excessive amount of protein metabolism, potentially leading to uric acid stone formation. Generally, this is more of an issue on ketogenic diets, but is a risk for anyone whose diet and exercise routine requires a significantly high level of gluconeogenesis (i.e., forming glucose from amino acids/protein)."
Ketosis is not achieved through a high-protein diet (which should have been implicitly apparent in the above — obviously if you are using a "significantly high level of gluconeogensis" you are getting glucose from protein gluconeogenesis, rather than using fat for fuel (i.e., ketosis), so you aren't even ketogenic). I see this misunderstanding a lot in mainstream medicine, and I am surprised to see it here.
True keto is HFLC and adequate protein — NOT high protein.
Would you say then that if I stay in Ketosis with a moderate amount of protein (60-80gr for 117 lbs and very active 14hrs running a week) I shouldn’t worry about gluconeogenesis and stones? I switched to Keto after a whole life of high carb and kidney stone history hoping it will make it better and not worse. Feel so good now that would hate to add more carbs, can stay in Ketosis with 50-60gr a day.
Good Day! I want to know if lemon juice is safe to use for kidney stone treatment even if the patient has ulcer.
Need your advice.
spinach,chard,almonds,nuts. High in oxcalates?
I am 22. Recently i was affected by kidney stones i would like to know if i can eat bakery foods like cakes, fruit cakes etc.. please do reply ..
Sorry you are dealing with stones at such a young age. You would probably be better off limiting the amount of the foods you are asking about. It depends on what type of stone you form, though. Most common are calcium oxalate stones.
Flour tends to be high or medium oxalate, and excess fructose (from the fruit) can convert to oxalate in the body.
The most comprehensive list of the oxalate content in different foods that I have found is at the Trying Low Oxalates Yahoo group. Members there have lots of experience and are really helpful. There is a huge amount of information regarding diet, supplements and about anything else you can think of.
One of the easiest and best things you can do, is to increase your water intake. 2 to 2 1/2 liters of water per day is a common recommendation.
Boron Deficiency Kidney Stones http://cheflynda.com/2015/03/the-inexpensive-arthritis-osteoporosis-cure/
Boron Deficiency causes kidney stones, Boron can lower uric acid by 50% – Benefits of Boron Lecture Jorge Flechas, MD https://www.youtube.com/watch?v=TJp7SW1pY2I#t=159
Kidney stone part starts near minute 23, but be sure to watch all of it!
Fluoride blocks magnesium and causes kidney stones http://fluoridealert.org/studies/kidney09/
Borax rids the body from fluoride, helps prevent kidney stones by removing calcium from organs(kidneys) and works with magnesium Read article http://www.health-science-spirit.com/borax.htm
I have a large uric acid stone as well as gout. Dr. has prescribed potassium citrate as well as colcrys. I have low vitamin D under 20. I had been taken vitamin d supplement on and on in recent years. I have had other stones as well. How can I dissolve this stone with food and help the gout as well. I have high uric acid levels over 8-8.5 for many years?
I have been reading a lot of comments from many ppl all over the internet. I found that I am truly lucky that I have had not had a problem with my stones in over 5 years.
I truly feel bad for these people. I have tried to tell them how I have basically kept myself out of the Drs. office and or the hospital. No one will listen, so I am going to repeat it since I just want someone to take my advice and get the relief I have.
It is very simple I went online and found a yahoo group, joined it and they have a very comprehensive list of Oxalate food groups. For the last 5 years at the instructions of my Dr. I went on it and found I longer have any pain, my stones have not gotten bigger at all. At first It is a bit restrictive but what would you do if you can remove the threat of kidney stones? I am now adding some forbidden foods with no ill effects. So if you are one of the unlucky ones that suffers all the time please try this. I am not selling anything and I am not making any money from telling you this. Some say this does not work but I am here proving that is wrong. It surely does work for me.. maybe it will work for you.
I agree.WHY in this article does the author recommend Swiss Chard, Spinach and nuts??? These foods are extremely high in oxylates and not permitted on a low oxylate diet.
Absolutely correct, those are VERY high oxalate foods and I avoid them. One leaf of spinach is over the recommended amount of oxalate for the day!
exactly what I thought too. I think I will keep to advice from nhs and bupa websites
I was going to comment on the same thing.I’m pretty sure that my habit of eating around a pound of almonds a week,along with 4/5 cups of tea a day and 45 years of taking Rennie’s (a calcium carbonate antacid) have been the main reason for the stones….oh, and never drinking enough water.
What is the site of the group you found on Yahoo?
The group I found is Trying Low Oxalates. Susan Costen Owens started it, and she has been researching with a focus on oxalate issues for about 20 years.
The diet was very effective for my kidney stones, and my oxalate level is now back in a normal range.
I agree with the comments above, spinach, swiss chard, and most nuts are a pretty bad idea if you have kidney stones.
I have been on a low Oxylate diet for 5 months now as prescribed by my Urologist & received word that my numbers have moved in the right direction! I’m supposed to go back in a year. He also suggested taking CitraCal, as well. So far…so good!!! Good luck to everyone!!
Glad to hear your urologist suggested a low oxalate diet; mine thought it was a waste of time. Found a great resource in the University of Chicago’s Stone Prevention website run by a really nice doctor, Frederic Coe, MD. He actively monitors the website and answers questions. I, too, steer clear of spinach (750mg of oxalate per 1/2 cup!), almonds, and beets. Rhubarb is very high, but really, who eats that? I had switched from coffee to tea 6 months before getting another stone. Thought tea was healthier, and my stomach was being bothered by the coffee. Now I am back to coffee. Found that when I was pushing water to get rid of the stone, one of the benefits was my gastritis went away. Who knew!!!
Thanks for great knowledge. Is there any clinical trial to show that supplementation with vitamin K2 can decrease the risk for kidney stones?
If so, please send its link for me.
In the article you state,
“… the issue is likely due to the fact that VLC diets (<15% of calories from carbohydrate) make the urine more acidic due to the excessive amount of protein metabolism, potentially leading to uric acid stone formation. Generally, this is more of an issue on ketogenic diets,… "
This does NOT make sense as one restricts protein consumption in a Ketogenic Diet in order not to have levels that will then convert to glucose. I suspect that you don't know much about Ketogenic Diets and that you are spouting this off of the top of your head.
Ask Dr. Peter Attia if he thinks he is more prone to kidney stones.