Did your doctor tell you to stop all dairy once you formed a stone? If so, you are not alone.
Many doctors tell their patients to stop eating foods that contain calcium. The problem with this advice is that eliminating calcium from your diet can cause stones.
Most stone formers, in fact, most adults, are not getting enough calcium. Below you will find out why you need calcium and how to get more of it each day.
Why You Need Dietary Calcium
Not only will eating your RDA (recommended daily allowance) of calcium prevent new kidney stones, but it will also minimize your risk of osteoporosis. Bottom line is you need to get calcium to keep your bones healthy and, if you are a stone former, to lower your risk of kidney stones.
Why is My Urine Calcium High?
Here are several reasons why you may have too much calcium in your urine.
- You are eating too much salt (this pulls calcium from bone into urine).
- You are eating too much sugar (this pulls calcium from bone into urine).
- You are eating too many foods high in protein (this causes calcium pulled from bone to spill into urine).
- You are taking too many Tums (they contain calcium) to alleviate indigestion.
- You are taking your calcium supplements incorrectly.
- You are taking too much of your calcium supplement.
- You are not absorbing your calcium supplements due to other medical conditions.Your parathyroid is overreacting (a simple blood and urine test will tell you).
- You have idiopathic hypercalciuria – a genetic trait that causes calcium loss from bones.
How Much Calcium Do You Need Each Day
Women need 1,000 mg/day if you are still getting your period and 1,200 mg/day if you are postmenopausal.
Men need 1,000 mg/day.
Here is a helpful link to the NIH website that discusses your calcium needs and calcium-rich food sources. Please note that not all of the foods listed on the NIH website will be a good source of calcium if you are trying to limit oxalate and sodium.
How Calcium Lessens Stone Risk
Getting your RDA of calcium helps reduce the amount of oxalate in your body by binding calcium with oxalate in your large intestine so that oxalate can leave the body as waste. If you are not getting enough calcium, oxalate cannot leave the body and gets reabsorbed back into the bloodstream. No calcium, more oxalate!
Pairing Calcium Foods with Oxalate Foods AT THE SAME TIME
If you are going to eat food that is high in oxalate, make sure you are pairing that food with a food high in calcium. For example, you could put a couple of walnuts in your yogurt or drink milk with your peanut butter sandwich.
Vegan Patients
If you are vegan you can choose milk alternatives that are low in oxalates like unsweetened flax, coconut, pea, oatmeal or rice milk.
Lactose Intolerant Patients
If lactose bothers you, try lactose-free milk. I drink Fairlife lactose-free milk because it tastes good but choose any brand you like.
Taking Calcium Supplements
You probably know what I am going to say, don’t you? You absorb your nutrients much better from food than you do supplements. That being said, some of you, for a variety of reasons, might find it hard to get the amount of calcium you need every day from foods. If this is the case, then use a supplement. However, knowing how to do it is very important.
First, calculate how much calcium you are getting from food (many other foods contain some calcium, not just dairy products). Once you see what your daily amount of calcium from food is, adjust your supplements from that baseline. Always take calcium with a meal, not with a snack. Do not go over the RDA. MORE IS NOT BETTER. Most importantly, take calcium supplements throughout the day, not all at once.
Weight Gain with More Calcium
When I work with my patients, I always remind them to allow for extra calories. You can’t add a few hundred calories per day from milk (or other foods/drinks) without reducing calories elsewhere. Just a friendly reminder!
Calcium and Constipation
Dairy products can be constipating for some patients. Always try to get plenty of fiber from plants, fruits, and healthy grains. There are many food options when on a low oxalate diet.
To learn more about exactly how to get the dietary calcium you need and how to properly implement The Kidney Stone Prevention Diet, have a look at my course page.
I’m taking a calcium supplement called. Algaecal Plus. It’s a plant based (ocean algae) plus vitamins & minerals, for bone health. Are you familiar with this, and what is your opinion, for someone like me who was diagnosed with osteoporosis, even tho I’ve always consumed dairy, as well as other calcium supplements? Next Dexa in Dec will tell if this is working for me. Meanwhile, I’m doing all I can to prevent kidney stones!
Hi Nini,
I am not well-schooled on that particular supplement. I have written an article about calcium and why it is important in stone disease and do address supplements in it. Go here:https://kidneystonediet.com/why-you-need-calcium-and-how-to-get-more-of-it/
Best, Jill
Hi— I just ordered this as well and I produce stones. Have you found the answer to your question about this supplement?
Hello Jill, You mention alteratives to some milk alternates such as flax and coconut milk but on the old oxalate list, you don’t have, at least I didn’t see them, any milk alternatives as being high or low. If almond milk is made mostly from just straining water passed through the almond meat, does it really have much oxalates? are oxalates water soluble?
Hi Jennifer,
Harvard did not study these newly fashionable milk alternatives. Based upon the fact that flax and coconut are lower oxalates I suggest both as non-dairy milk substitutes. Based upon the fact that almonds are so very high I ask my patients to refrain from using it. Not taking a chance.
Best, Jill
Great article! Can you elaborate about vitamin D and calcium. I take a calcium supplant everyday and it seems to be working. Should I take vit D. If yes how much and when? If not, why.
Hi Paul,
You will need a blood test and a chat with your doctor to see if vitamin D is needed.
Very Best, Jill
What are your thoughts on taking calcium supplements simultaneously with magnesium? Some reports say they should be taken separately others say they can be taken together as long as the dose isn’t high (250mg calcium / 100mg magnesium).
Thanks.
Hi Shameer,
It depends on how high a dose you are taking as they can compete for absorption if doses are too high. I am not a fan of supplements unless you cannot get calcium by food. The body absorbs calcium best if it is food-based. That being said, some of you will need to take supplements for various reasons.
Best, Jill
Hi Jill,
Thanks so much for this resource. Truly a blessing. Can you tell me whether calcium citrate as a supplement would be stone forming? I do not have stones but do have some chronic kidney/gut/possibly autoimmune inflammation that I’m dealing with (currently working with a functional medicine doc). I am also lowering my purine and oxalate intake because I have high serum uric acid. I used to tolerate diary quite well but recently seem to not be. I would like to supplement with 250mg of calcium citrate with my main 3 meals but do not want to ingest ANY type of calcium supplement that could lead to stone formation. I looked at possibly flax or coconut milk but am not crazy about the synthetic additives. Any input would be greatly appreciated!
Hi Gina,
Your body would absorb it best if it came from a product like flax milk. I guess I would consider the vitamins “synthetic” too. Certainly, if you find you cannot get enough calcium you might want to talk to your doc about adding a supplement. But think about the low oxalate milks like coconut, pea, and flax. Read this article to help you learn how best to supplement if you go down that route.https://kidneystonediet.com/why-you-need-calcium-and-how-to-get-more-of-it/
Best, Jill
Hi Jill, I read somewhere that we absorb the calcium in whole milk better than in low fat milk as fat is needed for absorption? I seem to tolerate the 2% better, but want to make sure I’m benefiting from it.
Thanks!
Hi Anette,
It does not matter what type of milk you drink. As long as it contains calcium, you can have it.
Best, Jill
Hi, can you actually see oxalate crystals in a fresh blood sample?
Hi Brenda,
No, you cannot.
Jill
Dairy:
1. Is Kefir an OK source in terms of oxalates?
2. Should dairy be counted as part of protein intake along with meat and veggie proteins?
Veggies:
Can spaghetti squash be used instead of spaghetti?
Hi Ginger,
Make sure you get your safe oxalate list here so you can see totals for what has been studied:https://kidneystonediet.com/good-oxalate-list/
Also, there is no oxalate in dairy foods only plant foods so kefir is fine to use as a calcium source.
I often use spaghetti squash as a sub for pasta. Less calories too. Put some goat cheese or ricotta cheese on it with some basil and you won’t even miss the caloric pasta noodle.
Best, Jill
You can make your almonds SAFE to eat by simply soaking them for at least 2 or 3 hours (sometimes longer). Then you can slip the almond SKIN off by squeezing the ends of the almond. Discard the skins.
Oxalic Acid is contained in the SKIN of the almond. So removing the SKIN also removes the Oxalic Acid problem. Doing this allows you to benefit from the minerals in the almond, such as Calcium.
Then dry the almonds at low temperature, especially if you purchased RAW ALMONDS! Once they are dry, they will get their taste back. If you have a food dryer, then use it! That’s the best way. Otherwise, I take a large sauce pan (2 Quart or larger) and turn on the electric burner on very low heat. Dump the almonds into the dry pan and let them dry slowly. I keep the heat so low I can touch the pan without burning my fingers. This will take several hours, maybe even overnight.
Yes, it takes some work, but it is well worth it and they taste GREAT after removing the skins and drying them. And no more Oxalic Acid problem!
I don’t buy BLANCHED almond flour. You can make it yourself from the almonds you removed the skins from. I use a Krups coffee grinder to grind my almonds into flour. I don’t know enough about how almond flour is actually manufactured and so we really don’t know how OXIDIZED the almond flour is. The more time it spends on the shelves at your store/warehouse, the older the almond flour gets and the more it OXIDIZES. So it is best to make FRESH almond flour and use it as soon as you make the flour.
🙂
Hi Eugene,
Thanks for all your knowledge of almonds. Personally I think it is just easier to forgo them. But that is just me!
Thanks again for taking the time to write!
Best, Jill
Jill- I have osteoporosis and am interested in knowing how to maximize my calcium through foods. I know that eating certain foods inhibit absorption of calcium . I am looking for a dietary plan that will help me know what to eat and when. For instance , don’t eat dairy at the same time as wheat or other oxalic acid foods. Any suggestions?
Thanks – Margaret
Hi Margaret,
You can certainly discuss with your endocrinologist if you have bone disease. Eating calcium with your foods high in oxalate will help decrease stone production. Not sure why you think this is a problem for calcium absorption? Lowering your sodium will definitely help you keep calcium in the bone where it belongs.
Best, Jill
Jill, I think Margaret has a good question regarding dairy and oxalates. Number three on your list of why we might have too much oxalate in our urine is that protein can pull calcium from the blood. This would include dairy protein. I heard a long time ago that argument used by vegans claiming that dairy is not a good source of calcium.
At the same time, looking at calcium levels in food, I don’t really see how we possibly could get enough calcium without taking either dairy (on the hope that the calcium amounts in dairy are not nullified by the protein in the dairy) or by taking some form of calcium supplement. Any thoughts?
Hi Brian,
Most of my patients get their calcium in dairy and or non dairy milk. Meat protein can cause issues with calcium leaching as do added sugar and sodium. Here is a list of other foods that you can find calcium in as well.
High calcium KSD approved shopping list
Produce
Collard greens
Broccoli rabe
Kate
Bok choy
Figs
Broccoli
Oranges
Seafood
Low sodium sardines
Salmon
Shrimp
Dairy
Ricotta, part-skim
Swiss cheese
Yogurt (lower sugar)
Milk
Mozzarella
Fortified food
Coconut milk
Rice Milk
Unsweetened flax milk
Oat milk
Pea milk
Orange juice
Waffles
Oatmeal
Cereal
Best, Jill
Its like you read my mind! You seem to know a lot about this, like you
wrote the book in it or something. I think that you could do
with a few pics to drive the message home a little bit, but instead of that, this
is great blog. An excellent read. I’ll definitely be back.
Hi Jill, Is the product Cascadian Farms Organic, Purely O’S Cereal ok to eat?
It has 240 mg Sea Salt,1 gram sugar, (38g) Whole grain Barley, Whole grain Oats, Wheat Starch, Malted Barley Extract, Calcium Carbonate, Oats, Malted Barley, Vitamin E. States which some foods do, May contain soy and sesame seeds.
Thank you.
Hi Jim,
Not all foods have been studied so I don’t know that oxalate level of this cereal. When that happens I ask patients to have the product with a calcium beverage and watch portion size.
Best, Jill
Hi, Jill
I was looking for a alternative to white pasta and came across Red Lentil Pasta. Would 2-3.5 ounces be ok as far as oxalates are concerned?
Thank you.
Hi Jim,
That portion will be fine to have.
Best, Jill
I am allergic to dairy, so the vast majority of my calcium has to come from supplements. I am 56 and stopped having periods almost one year ago. Also, I take Synthroid every morning, so I cannot have a calcium supplement for four hours after my dose. I am careful to eat a low oxalate breakfast, and I take my magnesium with breakfast since I have read that magnesium helps prevent oxalate stones as well. I am taking 400 mg. calcium citrate with both lunch and dinner for a total of 800 mg. per day. Osteoporosis runs in my family. Is there a better course of action for me, considering my medication and dairy allergy? I would like to increase to 600 mg. twice per day instead of 400 now that I am postmenopausal. Would this be okay?
Hi Mary,
Taking supplements can increase your stone risk. Taking supplements in excess of 500 mg/cap can def increase stone risk. Have you done a urine collection to rule out hypercalciuria? I ask bc you also have bone disease. LMK. Getting your calcium from food is always the best way for the body to absorb it. There are many non dairy ways nowadays. Here is a list you might consider on your next grocery run:
High calcium KSD approved shopping list
Produce
Collard greens
Broccoli rabe
Kate
Bok choy
Figs
Broccoli
Oranges
Seafood
Low sodium sardines
Salmon
Shrimp
Dairy
Ricotta, part-skim
Swiss cheese
Yogurt (lower sugar)
Milk
Mozzarella
Fortified food
Coconut milk
Rice Milk
Unsweetened flax milk
Oat milk
Pea milk
Orange juice
Waffles
Oatmeal
Cereal
Best, Jill
Hi Jill,
I am 51 and just had my first kidney stone. I have never experienced more controversy and complexity in trying to figure out how to eat.
Once my testing is back I look to join your program.
In the meantime, Is Oatmilk an ok dairy substitute for calcium? It is called Planet Oat – Oatmilk. Oatmilk filtered water and oats are the first two ingredients.
Thank you for any guidance!
Hi Chris,
You don’t need your collection results to join up for the course. Many don’t. Get educated now and esp while the course is on temporarily on sale. Oat milk can provide the calcium you need but read the label. Usually, it is lower than the other non dairy milk and it also can be high er in sugar. Ideally, we want low sugar, higher calcium when we are consuming food for calcium. I hope that helps a bit.
Best, Jill
In 2018 I had high blood calcium and developed a kidney stone. Getting your first kidney stone (I was 58) and having high blood calcium is a pretty good indication you have hyperparathyroidism. I had two adenomas removed in December 2018, but never passed a kidney stone as far as I know. My kidneys seem to be bothering me again so I looked into lowering oxalates in my diet. Seeing the list, I notice I’ve been eating things that are medium to high in oxalates. I drink green tea and sometimes white tea. Is black tea the only one to avoid? Avocados are on both good/bad lists. Cooked carrots are okay? I take it the idea is to have a good balance so you aren’t overloaded at the end of the day. Also not to cut back all at once so you don’t have oxalate dumping.
Hi Lynne,
Read this article. It is called “the safe list” and has been very helpful to patients.https://kidneystonediet.com/good-oxalate-list/
Best, Jill