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How to Prevent Kidney Stones Naturally

by Laura Beth Schoenfeld, RD

Last updated on

magnesium kidney stones dissolve, paleo diet kidney stones
Kidney stones are painful, but natural prevention is possible. Monkey Business Images/Monkey Business/Thinkstock

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!

Reduce Fructose

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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Laura Beth Schoenfeld, RD
Laura Beth Schoenfeld, RD

Laura Schoenfeld, MPH, RD, is a licensed registered dietitian and women’s health expert trained in Functional Medical nutrition therapy. She assisted in the creation of educational materials for both the ADAPT practitioner and health coach training programs.

Her passion is empowering women to nourish their bodies, develop true strength, and ultimately use their improved health to pursue their purpose. Laura guides her clients in identifying and implementing diet and lifestyle changes that allow them to live a healthy, fit, symptom-free life without being consumed by thoughts of food and exercise. She draws from a variety of sources to form her philosophy on nutrition, including ancestral diets, principles of biochemistry, current research, and clinical experience. Her areas of expertise include women’s hormones and fertility, gut health, autoimmune disease, athletic performance, stress management, skin health, and weight loss. Recognizing that health goes far beyond just diet and exercise, Laura teaches her clients how to focus on and implement life-changing mental and spiritual health habits as well, including changing their thoughts and beliefs to ones that drive health-supporting decision-making around food, fitness, and life in general.

Her greatest mission is to help health-conscious women realize that, while their health is priceless, they are so much more than a body. When she’s not educating and serving her coaching clients and community, Laura loves traveling with her husband, Sundays with her church family, hikes with her dog, beach trips, live music, and strength training.

Professional website: lauraschoenfeldrd.com

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Join the conversation

  1. I am a morbidly obese 50+ female who had her 1st (and hopefully last!) bout with kidney stones 6 months ago. I happened to be in the urologist’s office when I passed the 1st one, and after about 30 minutes of excruciating pain (birthed 3 kids with no drugs) and nausea – I asked his nurse (worked in urology 30+ yrs) if there was anything I could do to prevent stones, and she told me to drink lemon water or lemonade throughout the day.

    Three factors that I think may have contributed to my stone formation. Since menopause, about 7 yrs ago, I have had 5-6 UTIs – never had one prior to menopause – and some have cultured out some pretty nasty/resistant bugs. Started putting D-mannose (after reading Chris!) in my water once/day and that seems to really help if I remember to do it. Interestingly, recent blood work showed low vit D level. Read somewhere else about low Mg levels and stones, so have started taking that, too – it seems to have almost taken away the nagging, right-sided, kidney area back ache I have had for several years. (My stones were on the right side.) I have been doing low carb, high protein diet for almost 14 yrs – neglected to think about how high protein intake might affect kidney function. I am trying to switch to higher fat diet and decrease the protein intake. I have very unstable blood sugar/very carb sensitive – can only keep it fasting low with little or no intake of carbs – maybe I have been a full blown diabetic all these years and have blown out my kidneys?

    • I am experiencing the same UTI infections that do not clear despite weeks of antibiotics. How did you get rid of them. Have stones as well…pain…menopause…fatigue ect feels totally miserable. No idea what to eat anymore as lemon juice is good for kidneys but irritates the inflamed bladder…all sources of proteins are bad for the kidneys it seems…meats…soy…nuts…I am so lost!

      • Definitely read up on vitamin K2 in the form of MK7. Some people are dosing around 300 mcg per day should help the body keep from depositing calcium in the soft tissues. The usual for stones, is 3 liters of water a day. Can you drink cranberry juice? There is also a certain pH level of the urinary tract that makes it easy for bacteria to grow, read up on that subject. Is your doc. recommending potassium citrate, or other citrates if you cannot drink the lemon juice?

    • The longer you are on the low carb/higher fat diet, your body will continue to repair its metabolism. It is a long slow process, but totally worth it. You are right the high protein is not recommended in most cases, it can even raise your blood sugar. Best.

  2. I was hospitalized twice for kidney stones, years ago. I’d like to give some practical tips that have helped me, though not exactly dietary. Specifically, I get incipient or partial attacks from time to time. I know this because ultrasound has shown gravel in my kidneys, but later scans show them as clear. The key thing is that after my two hospitalizations, I realized that I developed a set of 7 symptoms that appear in a certain order. They include a particular kind of lower back pain.

    When I realize that I have 4 of the symptoms, I know that I have to act fast to avoid a full-blown attack. I drink lots and lots of water – I just push water as hard as I can, until I’m sick of it. Within a short time, hours, the symptoms start to abate, and within a few days are entirely gone. The main disadvantage is the need to urinate frequently at night.

    Of course, any dietary means you take to avoid stone problems are all to the good, but this method has helped me out many times. The key is to learn to recognize the symptoms that you yourself experience. I don’t know that they would be the same for everyone.

  3. What about a Rosedale style approach to macronutrients, very low carb and adequate protein and high fat diet ? I guess it’s not related with higher risk of kidney stones unless it is induced some other way than metabolism of this macronutrient combo.

  4. There are some great counter arguments and comments in here!
    What a great article. I just recently passed a kidney stone and I’ve been eating Paleo for about 3 years. So, yes, it is definitely possible to still contract stones while eating, arguable, the most healthy diet on the planet.
    Will be following Laura’s blog now!

  5. I suffered painful kidney stone attacks about every 2 years from age 25 to 42. No doctor could figure out why, as I didn’t have any of the usual risk factors. In 2005, I adopted a low-carb lifestyle. Eight years later, I haven’t had a single attack. Low-carbing, when done properly, results in an increase in dietary fat and therefore increased absorption and retention of fat-soluble vitamins like D and K2, so no surprise there. If anything, I consume more salt than I did previously (on my eggs and meat and in my butter, used to saute my Mg-rich veggies), and even eat more oxalate-containing foods than before. Obviously, I disagree about the starches and fruits – research shows that fat is a superior fuel for many physical activities.

  6. My mother has uric acid stones. I can’t find any info on this as all articles including this one just say they are not common and go on to talk about the other kinds. She has had multiple attacks and is willing to try anything but I can’t find any specific recommendations
    Does any know anything about uric acid stones?

    • Does she have gout? She should consult with her urologist or GP regarding the drug allopurinol.

  7. I think you should have given a little more on the most basic prevention strategies, as some people get their stones due to to one or two bad dietary habits. I had a single very large calcium oxalate stone 20 years, when I was 25, but haven’t had one since, due to two simple changes that I made after learning the basics about oxalate absorption and excretion. The first change was to not get dehydrated! I had been in the habit of getting a bit dehydrated every day while working, then relaxing with a liter of iced black tea. The second change was to add a pinch of calcium oxide to my huge batches of black iced tea. Admittedly a bit odd, but it worked. Oxalate readily combines with calcium from dairy, too. If the oxalate is precipitated with calcium before you eat it, you won’t absorb much, and therefore won’t burden your urinary tract. Put some shaved cheese on those oxalate vegetables, for example. My diet has changed completely since those days, but it didn’t in the five years after that stone, so I know it can be as simple as getting calcium with the oxalate and not getting dehydrated.
    Thanks for the article, I hope to see more from you.

  8. Hi Chris

    Thanks for the great article but can I ask you a few questions.

    1. Are gout and kidney stones similar conditions. Ie when I read artciles it talks about oxalic acid being a cause of gout and kidney stones. I am so confused about oxalic acid and whether I should eat alot of vegetables raw especially the leafy greens. Some articles I read sa cooking helps reduce oxalic acid and some say it turns it into a more dangerous form. In addition there is also the infomation that those raw begis have a negative thyroid effect but my natropath talks about eating more broccoli etc to help with estrogen dominance.

    2. re the lemon water wont this then effect my teeth.
    My holistic dentist talks about all the patients he sees with enamel problems because their natropath gets them to drink lemon water all day

    Thak you again for all very informative articles. I

    • When I used to drink lemon water every day to prevent the recurrent kidney stones that I used to have, it did start to mess up my tooth enamel. My enamel has healed since then, but the key is to only drink it through a straw. They sell stainless steel straws on Amazon.

      • I wonder if raw apple cider vinegar in water has the same effect on enamel and should be consumed through a straw. Can anyone confirm this?

  9. Hi,
    My husband and I went to a dinner that had pasta that looked extremely oilly, and not beef fat; we believed it was vegetable oil, which we never touch. The side dish was homemade salad and salad dressing; which we found out later she put vegetable oil in the dressing. 15 to 30 minutes after eating, he had about a 4 in pain, on a 1 to 10 scale. The pain was only there about 30 minutes to an hour.

    The next day we ate a pastured hog, no nitrates from the Amish, which is high in Vitamin D from the sunlight. He also had a glass of tea. Then about 30minutes later the pain came back in his ankle joint, so excruiating, that he could not stand on it. The pain was so bad he started crying.

    So we looked back at what we ate. Vegetable oil I believe I read on the Weston A Price website is high in uric acid. I remembered some notes I found on pseudo gout, and how citric acid; which is high in lemons helps dissolve calcium crystals. So I gave him about a 1/2 c of lemon juice with water for 2 days and his pain was cut in half, and he could walk instead of being rolled around. Today it’s been about 4 days, and almost all of the pain is gone, so you are on the right track.

  10. Great article. Regarding the magnesium, I always wondered a bit how our ancestors could have gotten so much that we now find it difficult to get enough through food, and must resort to a supplement (which is fine, I’m not against supplementing what you can’t obtain through diet). Then someone mentioned snails in the comments of one of Chris Masterjohn’s posts. I looked it up, and I think it’s a possible candidate for one of the foods our ancestors ate for magnesium: 250 mg magnesium in 100 g of raw snails (that’s only 16 g of protein, so not that much) = 62% of the required amount. I think it should be added to the list of high magnesium foods? (It’s also pretty high in vitamin E: 25% of the required amount.)

    • The current thought is that much of our magnesium has been leached out of the soil due to poor land management techniques, plus the sheer quantity of plant foods that our ancestors likely ate was higher, plus we engage in modern magnesium-depleting behaviors like coffee and alcohol consumption. I’m sure there are other theories as well but those are the ones I’ve heard.

      • Thanks for the response. Those theories sound pretty plausible. I checked to see how much declining soil magnesium may translate to less magnesium in plants, found this: http://hortsci.ashspublications.org/content/44/1/15.full.pdf
        Looks like there’s definitely a trend of less minerals in plants, though it may be due to an increased yields-decreased nutrients trade-off. I’m guessing the comparison would be worse for today’s plants if we knew the nutrient content of plants from the more distant past.

    • Magnesium Per 200 calories
      SNAIL,RAW : 556mg Magnesium
      SEAWEED,AGAR,DRIED : 503mg Magnesium
      CORIANDER LEAF,DRIED : 497mg Magnesium
      SPEARMINT,DRIED : 422mg Magnesium
      CHIVES,FREEZE-DRIED : 412mg Magnesium
      CONCH,BAKED OR BROILED, this is a type of snail : 366mg Magnesium
      DILL WEED,DRIED : 357mg Magnesium
      CELERY SEED : 224mg Magnesium
      MOTHBEANS,MATURE SEEDS,RAW : 222mg Magnesium
      PUMPKIN&SQUASH SD KRNLS,DRIED : 198mg Magnesium
      YARDLONG BNS,MATURE SEEDS,RAW : 195mg Magnesium
      WATERMELON SD KRNLS,DRIED : 185mg Magnesium
      MOLASSES,BLACKSTRAP : 183mg Magnesium
      MOLASSES : 167mg Magnesium
      HYACINTH BNS,MATURE SEEDS,RAW : 165mg Magnesium
      MUNGO BNS,MATURE SEEDS,RAW : 157mg Magnesium
      RYE FLOUR,DARK : 153mg Magnesium
      TOMATOES,SUN-DRIED : 150mg Magnesium
      Also in a 4oz serving of Halibut fish which is about 159 calories, you get 30.3 % magnesium, and 75.8 % of selenium. WOW!!!

  11. What is significant with lifeguards is that they works outdoors, in sun, in heat and often drink too little fluid. Is it coke they are drinking … so ..

  12. In Sweden it is standard with magnesium as profylax, when you have kidney stones. As a matter of fact, when diagnosted with stones, we do a test finding out if the person is capable to make the urine acidic. So, you make more stones, when the urine is not acidic enough. You also get more urinary infections when the urine is not acidic enough, ordinary infections and yeast infections.

    I agree with BrandonG, what he says about protein. The idea that low-carb and/or paleo diets must be high protein diets is wrong. I do not agree. It´s more of a high-fat diet!

    Honestly, I cannot find any dangers of carbohydrate restriction, even if it is as low as less than 20 grams of carbs a day. You might have choose your carbs well, but nothing dangerous happens.

    • Although I agree with you that paleo is mostly a high-fat diet and that neither paleo nor low-carb necessarily translate to high-protein, I just have to clarify that that was not the crux of the point I was making.

      The point I was really trying to get home is that I’m not certain of the accuracy of the old belief that a high-protein diet contributes to high uric acid or more acidic urine. However, I’m not saying that it’s NOT the case… I’m only challenging the assumption because there has been recent talk in the community that such is not the case — I’d like to know the educated opinion of someone more educated than I who is also very aware of that recent line of thinking.

      • Up above Laura did a good job of putting my concern to rest. Clearly, I was mistaken. 🙂

        But yeah, paleo still equals high nutritional quality and a focus on fats!

  13. Thank you for the helpful info re. kidney stones and nutrition.
    Of course, drinking an “acidic” beverage all day long can be harmful to your teeth. Rinsing them afterwards can help, or chewing an appropriate “sugarless” gum.

  14. I used to have chronic kidney stones. I learned to control them by *strictly* controlling oxalates in my diet. I could not even tolerate the medium levels. I used to have a very leaky gut. I have heard that if you have a leaky gut, you can also have “leaky” kidneys which produce stones.

    I don’t know if that is true or not, but as my gut healed, I began reintroducing oxalate foods and can now eat all medium and many high oxalate foods. I haven’t had a stone in years.

    It is very restrictive if you accommodate your diet for all types of stones. Figure out which kind of stones that you get and just eat for that type.

    A great sign that your kidneys are functioning well is how healthy your urine stream is. It should not be too dark and it should just flow out of you like a hose that is on medium flow. If it is splattery, something is wrong. I can tell if I have had too many oxalates within hours of ingestion by my urine stream.

    Diet and magnesium cured me.

      • I have been very strictly following a Paleo diet to heal my gut. For me, it was more about what I quit eating than what I added. The only grain I eat is rice and I eat mostly home cooked whole foods. I also discovered through multiple times doing an elimination rechallenge diet that I had many food sensitivities that should be okay for most people on a Paleo diet. So, I removed those foods also. You don’t want to eat any food that bothers your system. Then, as I healed, I have been able to slowly add back in some of those healthy Paleo foods. I’ve been working on this since 2009, and I wasn’t able to successfully add back in many foods until the last year. Now, I can eat many of those foods on a rotational basis with the proper enzymes. If I had known about rotating foods, eating the problem Paleo foods spaced out at least five days before I eat that food again, and the proper enzymes, I probably could have added these foods back in sooner.

        I do also pay attention to the quality of my food. I ate a lot of bone broth. I only eat grassfed and finished beef and lamb and wild caught seafood. I can eat pastured pork on a rotational basis. I eat a *lot* of virgin red palm oil. I don’t eat any poor quality vegetable oils. The only vegetable oils that I eat are olive oil, red palm oil and coconut oil.

        Our bodies will heal themselves of many conditions if you withhold toxins (the wrong foods are toxins) and give it the proper fuel and some time. I also place a great emphasis on quality and quantity of sleep and keeping my stress levels under control. And, I take a probiotic daily.

        • ReneeAnn… let me run something by you and then ask you a question…

          About 4 years ago my wife and I ate typical SAD. Then during her 1st pregnancy we tried to get her to eat more nutritiously (which included myself as well, at least around her) and upped her veggie-intake well above what we normally ate up to that point. Soon she started getting really sick to her stomach… nausea, very painful. She went to several doctors but the best thing she found was taking a strong antacid… but it was so bad she had to take it every day without fail and it only made the condition tolerable, it didn’t go away.

          She blamed it on me making her eat too many veggies. I didn’t like veggies, but I thought that sounded pretty ridiculous and told her so. She asked her doc, he agreed with me. Told her to keep taking antacids and clean up her diet. So we went vegan for a while, like 4 months. Didn’t improve really. But due to more research I’d been doing, realized humans need meat and sort of stumbled into the paleo world right then. Never looked back. Along they way she got tested for gluten but she’s negative. But she def. correlates to it and says she has gluten sensitivity (I don’t doubt her, but I just don’t know how to confirm it). We eat little to no grains these days, trust me I’m not trying to get back to bread here. LOL.

          Along the way we had a doc tell her the issue was caused by fibroids so she had surgery to have them removed. Nope, not the problem. Pointless and risky for no reason. Ugh.

          These days her pains are largely “resolved” — as long as she eats little to nothing with gluten grains. More solid products she can tolerate a bit of (like a bun, say) — but very, very soft products will just kill her with even very small serving (like pasta, say). She can go weeks and weeks with no issues but once she overconsumes a wheat product (which can be a couple of moderate servings of something like bread over a couple of days — but can be a single serving of just a little bit of noodles), she can be in serious pain for several days to a few weeks. Other non-paleo foods (like sugar) don’t seem to have that affect on her… they can make her feel bloated and chubbier if she eats too much, but no pain.

          Having read all of that… what’s your “take”? Is it gluten sensitivity, per-se, or leaky gut? I know there is a strong relationship but I’m not particularly versed in leaky gut so curious your thoughts.

          • I am not a medical professional, but here is my take based on my experience and what I’ve read on the web. I would say, she definitely has wheat sensitivity. I took many tests with my allergist years ago and they all came back negative for every food he tested. He told me that they only test for the most common protein in foods, so if you are sensitive to a different protein in that food, it will come back negative. He said that the gold standard for sensitivities is to do an elimination/rechallenge diet. I doubt if she actually needs to do that. I think that she has enough evidence, that if it were me, I would never touch wheat again.

            But, if she wants to test it. She needs to go five days with zero wheat and I would also say zero gluten. That part of the test is crucial to adhere to religiously. Read every label and try not to eat anything that you didn’t make in your own home. There is a high chance of cross contamination at restaurants. Then, on day six, if she is feeling well (otherwise keep eliminating until she does feel well), eat a little wheat. If she reacts, that’s your answer. If she does not or you are not sure, eat a lot of wheat the next day. Keep in mind that if she reacts, and I think she will, that the reaction will probably be stronger than usual, so she may want to do it on a day that she will be at home.

            As to leaky gut, wheat and gluten are huge causes of leaky gut. The main thing to keep in mind is that any type of reaction, even a headache or zits, indicates an intolerance. Then, you can assume it is doing worse things inside of you that you can’t see. Check with a medical professional before you do this to make sure that this is right for her.

          • I echo ReneeAnn. Not being allergic or having a “tested” diagnosis is not necessarily the same as not being sensitive to it. Last year, I started a wellness program that involved food elimination – elimination of foods that are known to be allergenic, potentially allergenic, and known to be inflammatory. It gets you back to the basics, and while not a toxin cleanse, is more of a reset button for your gut and digestive system.

            A slow and one-by-one reintroduction of foods helps to identify which foods your system is sensitive to and then you decide if the joy/like of that food is worth your body’s negative response. Now, I don’t eat gluten (gas issues for me) or dairy products (dry, itchy skin for me), and I don’t eat citrus (congestion and sinus pressure for me) during allergy season.

            There’s also an overall improvement to the body beyond digestive issues when you address the leaky gut. When the body no longer has to send its soldiers out to combat food-aggravated inflammation, your immunity improves. Learning how your body responds to foods can be very subtle but is well worth the effort it takes.

          • She’s obviously a celiac. Is she Irish, N. European, even Italian? Common in those countries. She shouldn’t cut out wheat until she’s seen a doc. They can do a small intestine biopsy and determine if she has the condition. If she does have it she needs to go gluten free (and that’s not easy–there’s gluten in everything).

        • Renee Ann:

          Your passion and conviction for how you nailed your problems is outstanding and inspiring – thank you!

    • Very interesting – you say “I can tell if I have had too many oxalates within hours of ingestion by my urine stream.”…

      Can you elaborate on this? How do oxalates / kidney function affect the urine stream?


  15. There is much more to the oxalate story than kidney stones, just as there is much more to the adrenal story than Cushing’s or Addison’s. Oxalates can wreak havoc on every organ in your body.

    Everyone’s different – some folks are endogenous oxalate producers and some are more sensitive to exogenous oxalates in the foods one eats. A lo oxalate diet is key. The things that are normally seen as good for us, can be devastating to those with oxalate issues: spinach, cacao powder, beets, carrots, nuts, chocolate. And more.

    There are many supps that an be helpful, and we’re all biochemically different, but biotin and B6/P5P can be crucial for mitigating oxalate symptoms. As can mag citrate. You have to start slow both with decreasing oxalates and with introducing supplements or you can dump too much oxalate too fast and feel awful. This does NOT mean you don’t need to do that, it may mean quite the opposite. It just means you need to take it slower.

    There is a yahoo group from this website. http://lowoxalate.info (The site isn’t updated regularly because the group is so active, and, I’m sure, time consuming for the mods.)

  16. Thank you for this informative article. My addition to the conversation has to do with oxalates. While I have not experienced kidney stones (thank goodness), I did experience other urinary issues when I was consuming a higher than normal amount of high oxalate foods. I found that I needed to lower my oxalate intake because for some people who have less than stellar digestive tracts, oxalates can accumulate in the body and trigger myriad problems (kidney stones and urinary problems among many others). I found it fascinating that some of the veggies I was using a lot of at the time such as spinach, carrots, chard, beets and curly kale are high in oxalates (spinach being sky high), while others are much lower, like dinosaur kale, bok choy, water cress, lettuce, collard greens and turnip greens. It is my understanding that some information on oxalates is outdated but current info can be found on the Trying Low Oxalates Yahoo group, the website http://www.lowoxalate.info and the blog http://www.lowoxalateinfo.com. I know Chris has posted about this topic as well.

    I try to get ample magnesium and other minerals from homemade bone broth and other health promoting foods such as cilantro, pumpkin seeds, a few Brazil nuts, pasture-raised meats and organ meats, seaweed, and ionic magnesium added to my water. I also like to have plenty of coconut oil and pasture-raised lard, tallow, butter and egg yolks to provide the fat-soluble vitamins and enable absorption of the minerals.

    Also, it is my understanding that burdock root and nettles are high in magnesium and can be beneficial for kidney stones (though I am unsure of their oxalate content).

    • Something really interesting is when you lacto-ferment vegetables by leaving them out on the counter top a couple days, they actually make their own vinegar brine, which is very good tasting in the vegetables we have tried so far pickles and beets. This process will reduce the oxalate content in the vegetables quite a bit. You can find Lacto-fermenting recipes on-line.

      • I wish that were so, but it is my understanding from the Trying Low Oxalates Yahoo group contributors that fermentation does not reduce oxalate levels in the foods that are fermented. I do lacto-ferment vegetables frequently (note that they do not create vinegar, but rather lactic acid) and I generally use lower oxalate veggies such as cabbage, cucumbers, zucchini, bok choy, dinosaur/lacinato kale (not curly kale), etc. Also, a common thought is that cooking can reduce oxalate content, but while this may be true to some degree for some foods, apparently some foods are so extremely high in oxalic acid, such as spinach, that no amount of boiling, steaming or sauteing will make enough difference for people with an oxalate issue.

  17. Is it worth it to watch or reduce oxalate consumption? I always worry about whether I’m over-consuming leafy greens, potatoes, and yams because of their oxalate content, but these are some of my favorite foods. I’m also trying to treat my stomach ulcer with cranberry juice, and I’ve seen conflicting news on the role of cranberry juice on kidney stones (sorry this could probably be a whole topic on it’s own).

    • Do you get calcium-oxalate kidney stones? If so, you may need to pay attention to your oxalate intake. It’s easy to eat high oxalate on a Paleo diet.

    • There is a very helpful, well-written book on kidney stones called “No More Kidney Stones.” My husband, a long-distance runner, had been suffering with kidney stones, and after we got the book, we found he had been eating all the wrong things (i.e., cranberry juice, grapefruit, even green beans, and whole-grain products). These were all wrong for him — an oxalic-acid stone former, so after passing a couple of stones and going thru a DORSAL LITHOTRIPSY procedure (the one where you lie in a bathtub and the stone is ultrasonically broken down into particles to be excreted painlessly), we decided to try the diet recommended in the back of the book. He has had no more stones for almost a decade now. I don’t remember any info on “special conditions” such as diabetes, but we are both much happier now! I highly recommend reading this book. It’s an eye opener. (And yes, it took him some time to adjust, but we worked with it and it’s gotten much easier.)

  18. Thanks for this – my mother recently had kidney stones and while she’s very healthy for someone in her late 60s (and treatment has been effective), I was wondering whether there were preventative steps I could take.

  19. I have had multiple frequent kidney stone attacks. I have not had any ever since I started drinking 1/2 lemon in water every day. So far it has been 10 months since the last attack. The were coming every 6-8 weeks. This is not as much lemon juice as you recommend, but it seems to be working for me so far.

    As far as adding in more carbs, I am diabetic and find I cannot eat more than 30-50gm carbs a day without my blood sugar spiking to unacceptable levels. I am trying to keep my blood sugar under 100 all the time. I did way too much damage all the years I did not realize my blood sugar was spiking over 200 after eating.

    • Hi Anne,

      It sounds like you have a calcium/magnesium imbalance. I had blood sugar issues no matter my diet and also had kidney stones. My oldest sister has suffered with the same issues. While a low oxalate diet was helpful what catapulted me into health was doing a hair test. It revealed high calcium and potassium and low magnesium and sodium. I had been dumping salt like crazy and needed more salt to balance out potassium. I was eating a moderate paleo diet but completely deficient in magnesium. A Mg RBC test will also reveal magnesium deficiency.

      Slowly increasing mg with various forms including transdermal Mg Cl has really helped me. I also cut out on some high calcium foods for the time being. I wasn’t even eating that much but do to my low mg status the calcium went out of sorts.

      Calcium/magnesium ratio is also a player for blood sugar issues. My imbalance was high and I’m correcting this imbalance and sugar problems are gone. The hair test reveals a lot more than those minerals and was probably the best thing I’ve done for my health. Best of luck, Lisa

      • Thanks Lisa – My RBC Mg was on the low side of normal so I have increased that. I can keep my BG under 100 if I stick to a low carb diet as described by Richard Bernstein in his book “Diabetes Solution”. Glad you were able to get things into balance.

    • This issue has surfaced for me too. I am diabetic, loosely following Dr. Bernstein’s plan and cannot increase carb intake above 50g/day without spiking my blood sugar. And I have a history of kidney stone episodes. Battles must be chosen, I suppose.

  20. “the issue is likely due to the fact that high protein diets make the urine more acidic, potentially leading to stone formation. Also, high protein diets increase the production of uric acid, increasing the risk of forming uric acid stones”

    Isn’t this an old fairy tale that has been recently debunked in the paleo world? I don’t recall who but I swear one of them has written about this and shown it’s just not accurate… probably Kresser, Sisson, or Wolf since those are the 3 I follow regularly.

    I’d like to see the author or someone else re-address this issue as I’m not sure it’s accurate.

    Otherwise, the article was helpful for me and I appreciate the author pointing to specific foods to incorporate in my diet rather than just saying “get more of nutrient-x” and forcing me to figure out what foods and amounts are appropriate.

    In general, I liked noticing that if most people basically just eat half-plate of unprocessed meats with half-plate of mixed veggies most meals then they will probably fare pretty well in this regard.

    • Sorry, I should have specified that the potential excess uric acid production is from high protein, low carbohydrate diets. Per Paul’s article on kidney stones:

      “One difference between a ketogenic (or zero-carb) diet and a normal diet is the high rate of protein metabolism. If both glucose and ketones are generated from protein, then over 150 g protein per day is consumed in gluconeogenesis and ketogenesis. This releases a substantial amount of nitrogen. While urea is the main pathway for nitrogen disposal, uric acid is the excretion pathway for 1% to 3% of nitrogen. [7]This suggests that ketogenic dieters produce an extra 1 to 3 g/day uric acid from protein metabolism. A normal person excretes about 0.6 g/day. [8]In addition to kidney stones, excess uric acid production may lead to gout. Some Atkins and low-carb Paleo dieters have contracted gout.”

      • Laura, thank you for the response. I don’t, however, feel it clarifies much. To repeat, I could swear there’s been recent ketogenic-paleo commentary showing this to be a false conclusion… my question is, did you consider this new commentary?

        Reflecting on the citation you refer to, I just have to point out that the author himself sounds awfully uncertain. Note the usage of phrasing such as “this suggests”, “may lead to”, and “some have”.

        Now, I am much less educated on this theme and am certainly no health expert such as yourself so I’m not trying to be ornery here or anything. I really did enjoy the remainder of the article and am very very pleased people like you are helping people like me (a computer programmer) figure out how to live more healthily — AND FOR FREE TO BOOT! 🙂

        I’m just unconvinced, based on my previous understanding from other paleo-experts, that this particular statement is accurate. And so all I’m doing is wondering if there is more clarification/certainly/explanation for why the other paleo-experts are wrong on this.

        That aside, I greatly appreciate the free help. Thank you very much for that. 😀

        • BTW… discovered your website, I’ll be checking it out more so kudos! 🙂

          In particular, I hugely identify with this statement from your “About”-page:

          “The focus should be on including these ultimate nutrient-dense foods in your diet, and not focusing on the variety of foods that need to be excluded”

          1000 times “dittos”.

        • Here’s what Chris had to say in a recent podcast:

          “As far as kidney stones, the epidemiological research is pretty inconsistent. There was one study with 45,000 men where researchers found a direct correlation between animal protein and the risk of stone formation, but other studies have shown an inverse relationship. Excess protein intake does increase excretion of substances that could potentially increase kidney stones, like calcium and uric acid, and one study did find that high protein diets are associated with increased uric acid and calcium output in the urine, but in that study, none of the subjects actually developed kidney stones. So even though in theory they were excreting substances that could contribute to kidney stone formation, they didn’t actually develop any kidney stones.

          What’s more, the people in that study were on a ketogenic diet, and it’s fairly well established that ketogenic diets can contribute to kidney stones via other mechanisms. They do increase uric acid production, and low carb dieters, as Paul Jaminet has pointed out in his series on the dangers of zero-carb diets, typically can be inefficient at recycling vitamin C from its oxidized form. And if the oxidized form of vitamin C is degraded rather than recycled, it ends up as oxalate. Oxalate is a waste material that needs to be excreted by the kidneys, and since most kidney stones affecting the general public are calcium oxalate, vitamin C degradation may be one of the main causes there. And why would somebody have problems recycling the oxidized form of vitamin C? It’s usually because of some type of oxidative damage or chronic infection, both of which, of course, are very common.”

          • What is the truth about calcium stones. Most websites state to avoid food high in oxalates such as spinach and nuts and berries and you are suggesting to increases your intake or at least eat them while most sites say to avoid.

            here 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.

          • Hi Laura,

            Given the issue with recycling vit. C and oxidative damage, what is recommended to treat or prevent oxidative damage and begin correctly recycle vit. C? Only in theory, I am not asking for a diagnosis, just general info. Thank you.

        • And as far as Paul sounding uncertain, you should be wary of any health professional or scientist who uses absolute statements such as “will happen” as opposed to “may”, as there is no way to know with 100% certainty what someone’s risk of developing a condition is, or even WHY they developed it in the first place. Science (health science in particular) is based on the repeated confirmation of theory, not unquestionable facts. You will never find anyone who is a credible scientist making statements in 100% certainty because in my opinion, it’s a foolish attitude to have about subjects we still have very incomplete knowledge about.

          But thanks for the compliment about my blog! 🙂

          • Ah yes, you indeed found the most recent thing I’ve read on the subject, thank you! Obviously my recollection of it was pretty off. LOL

            I should probably note that I have left the zero-carb approach in favor more for a low-to-moderate carb approach most days combined with frequent interval fasting. So yeah, I eat potatoes and fruit now pretty often.

            Thank you again for circling the wagons; I appreciate the correction.

            • No problem! I don’t like to be wrong (at least publicly!) so I appreciate the peer review process. It’s important to me that I’m accurately explaining my recommendations.

              Just as an FYI, I shared the correction with Chris and he said he agrees with me, so I hope that helps your confidence!

            • Brandon, thanks for your comments. Seems like you and Laura have clarified things. For the record, my current understanding is reflected in the quote Laura shared above from a recent RHR episode.

              What I’d add is to remember that being at increased risk for something does not in any way guarantee that you’ll experience whatever that something is. For example, if the risk of kidney stones on a moderate carb diet is 1%, and that doubles to 2% on a ketogenic diet, you are at increased risk for kidney stones on a ketogenic diet—but the absolute risk of getting one is still very low. This is a good thing to keep in mind whenever we discuss research like this.

              • Chris, thanks for checking-in. Yes, absolutely she put the issue to rest. The problem I think stems from this being a somewhat confusing issue with different takes on it… but once she cited what you’d said about it recently, I remembered it and realized I was conflating what you’d said with earlier things I’d read elsewhere.

                She did a bang-up job, honestly. Not sure if I made that clear, so there it is.

                • Final thoughts… my step-father suffered a great deal with both diabetes and kidney stones. He underwent a procedure in the hospital (I don’t know what it’s called, I was too young at the time) where they gave him some sort of treatment while he was laying in a tub of water; they returned though. To the best of my knowledge, later on he discovered he could keep them warded off with small but frequent amounts of cranberry juice (which is odd to me, given his diabetes).

                  Then I find out from my bio dad that he’s suffering (as are several of his brothers) from gout. So yeah, issues related to high acid-levels concern me.

                  The problem is understanding and keeping it all sorted in my head. 🙂

                • Hi Brandon,

                  Cranberry juice working for your dad is in line with the info about citric acid in the article. It doesn’t have as much citric acid as lemon juice, but I guess it was enough to make a difference for your dad.

                • Yes, cranberry juice does have citric acid in it. Ironically, sweetened drinks like juices and sodas have citric acid added to them as a preservative in many cases. So while I don’t promote the use of coca cola to prevent kidney stones (for many reasons beyond it’s high fructose content), there might be some level of benefit due to the extremely high citric acid content.

                  Interesting side note – the high citric acid content of Coke is what makes it an effective cleaning solution, which is what it is commonly used for!

                • From RHR: All About Kidney Stones…: “And then treatment of the phosphate stones usually involves acidifying the urine with things like cranberry extract. The problem is that’s kind of contraindicated with oxalate stones.” So, after Laura’s comments above, I’m unsure if cranberry extract is good for oxalate stones, or is cranberry extract different from cranberry juice because of juice’s citric acid content?

                • Ha! Finally a use for Coke I can get behind 😛

                  That’s interesting about the potential benefits of juices/sodas due to citric acid preservatives. Things like that are a potential confound in any nutrition research, though in this case, costs>benefits.

                  I always wonder about the energy drinks with lots of taurine in them: there’s some cost/benefit balance occurring there, especially since other than the raw meat/fish eaters, many people don’t get enough taurine, so I wonder what that translates into health effects for the people who consume them.

      • This would mean that Paloers and low carbers had consistently more kidney stones. There is no study that shows this.