Many kidney stone patients come to me after trying to lower their urinary oxalate levels on their own. They want to avoid forming more kidney stones but find the recommended dietary changes frustrating and confusing. They believe they have to limit or eliminate foods they have always enjoyed and considered healthy.
As a nurse, I can tell you, I would find it frustrating too. It can be especially challenging for those simultaneously battling other medical conditions such as heart disease and diabetes. There is not a day that goes by where I don’t tell patients, “There are plenty of healthy foods you can still eat”. This article will help you understand what you need to know about eating a low oxalate diet, and I will also share some tips so you can be successful.
What oxalate list should you use?
There are so many lists to choose from. Each of them gives different values and all have conflicting information. Please use one list so you are not confused.
Dr. Coe and I tell our patients to use the Harvard oxalate list. We choose this list because, those of our patients who use it and adhere to our other advice, are successful in lowering their urinary oxalate lab values.
The bank account analogy.
Here is a trick I use to help my clients and students understand how to lower their oxalate.
I tell them every day they have an imaginary bank account filled with 100 bucks (milligrams) of oxalate. It is up to them how to take their withdrawals. If my patients want to spend most of their oxalate bucks on some potatoes that day they can. They will then have fewer oxalate bucks to spend the rest of the day. This simple analogy gives them control over their diet and it also teaches them how to make conscious decisions regarding their food choices.
How to use the oxalate list.
You will see that most oxalate lists rate foods as high, medium, and low. I find that this is more limiting to patients as they only think they can eat the foods that are listed as low on the list. THIS IS NOT TRUE. There is a lot on that list that you can still eat, even favorite foods like chocolate, potatoes, and some nuts.
Please go by the number of milligrams in the portion size of the food you choose. For example, Harvard states that sunflower seeds are “high”, but the portion size is 1 cup. Who eats a cup of sunflower seeds in one sitting? And even if they did, that is only 12 mg of oxalate. Remember that your oxalate bank account contains 100 mg of oxalate per day. You can easily incorporate sunflower seeds as a healthy snack option.
Be aware, foods listed as low on the oxalate list can quickly add up. Hummus is a good example of this. Hummus is listed as “low” on the Harvard list, but note the portion size is only 1 tablespoon. Who the heck only eats 1 tablespoon of hummus? Not I! It’s more like one container. So you can see that the oxalate milligrams will quickly add up making hummus not so “low” once you are done. The lesson here is to understand how to use the list.
Portion not perfection.
Many of my patients will lose weight while working with me. Am I a genius? Do I have magical answers that no one else has unveiled to date? Nope. I don’t. What I do have are patients who are committed to being healthy and keeping stones at bay by eating well (on most days) and taking care of themselves in order to lessen their stone risk. On this diet, they can also simultaneously lower blood pressure, and manage heart and kidney disease. How is this done? What is the answer? Portion control. Portion control is key!
Do you find yourself going back for seconds after heaping up food on your first plate? Before you went for another helping of food, did you ask yourself if you were still hungry? Or is this a habit that you have acquired over the years? Many of our poor food choices are due to long-standing bad habits. Many of my clients are still eating bologna sandwiches with mayo on Wonder Bread because it was what their moms packed them for lunch as a child. They don’t realize it until I take a diet history.
You can eat your favorite higher oxalate foods if you watch portion size and pair it with a glass of milk. Can’t drink milk? Try flax milk or coconut milk. If you are a vegan and have been using legumes as the base of your meals, try reducing the portion size and using legumes as a smaller side dish. Many of my vegan patients continue to eat beans as a healthy protein and fiber-rich food. I tell them to eat ¼ cup and to be sure to make a withdrawal from their oxalate bank account. Also pair this food choice with flax or coconut milk.
Potatoes are a food that many people miss on a low oxalate diet. They are indeed very high in oxalate so you do need to limit quantities. I recommend having them once a week in smaller portion size and combining them with a calcium-rich food or beverage to help absorb the extra oxalate in the potatoes. Again, use your 100 mg/day allotment and you will see you can bring back some of your favorite foods as long as you can control how much you eat at a given time and how many times a week you are eating them.
Does this mean I can eat spinach?
Unfortunately, if you ate spinach your bank account would be overdrawn by hundreds with just one salad. Sorry. Spinach, almonds, and anything very high like these two foods just needs to be taken out of your diet. I advise my patients to not eat any food where a portion is greater than 50 mg/serving. Look at your list!
Chocolate?
You can definitely fit in a little bit of chocolate a day. The question you need to ask yourself is, “Can I limit myself to a few pieces of (whatever) or am I setting myself up for failure?” If you can just have a few M&Ms, have them. If you cannot trust yourself to limit this treat, then stay away. I am a freak of nature and can just have a few and step away. Yes, I know you hate me right now but don’t hate me too much. Anyone who knows me will tell you I can’t go near a box of Cheez-Its. We all have our favorite things that are hard to limit. Know thyself. Stay away from your trigger foods.
What if a food is not on the list?
I am asked numerous times a day on my Facebook page how much oxalate is in _________? If it is not on the list, I ask you to use this general rule of thumb – eat the food no more than once or twice a week in a normal portion size. This rule has worked for patients who adhere to it. Not all foods have been tested. Oxalate testing is expensive.
The calcium/oxalate ratio.
If you eat calcium-rich foods with the higher oxalate foods throughout the day, you can lower your urinary oxalate levels. By how much you may ask? In this article, Dr. Coe writes about a study that showed how eating a high calcium diet lowered patients’ urinary oxalate.
Got milk?
Most of you are told by your physician to lower your oxalate and drink more water. But lessening your kidney stone risk involves much more than just lowering oxalate levels and drinking water. Dr. Coe and I advise all patients to eat and drink calcium-rich foods to help lower urinary oxalate. More on calcium in an upcoming article.
Get help.
Many of you will still need help after reading this article. It is tough to manage all the dietary changes needed to follow The Kidney Stone Diet. The Kidney Stone Prevention Course is designed to set you up for success, to teach you the best ways of managing the challenges of these dietary changes in order to lower your new stone risk. Read what fellow patients have said about taking the course.
Thank you for this info! I’m dealing with some gut issues and working with a functional doctor. My labs came back showing high levels of Oxalates and my doctor has advised a low Oxalate diet, but I had no clue what that meant! I have been following a Paleo diet for a number of years because of food allergies and sensitivities. I’m borderline celiac and have to avoid gluten at all cost, but I’m also allergic to soy, rice and corn and dairy is out as it causes severe digestive issues. As of now I’ve cut out spinach, sweet potatoes and nuts which I was eating in abundance. I’ve replaced these foods with other leafy greens such as kale, romaine, green leaf and arugala, winter squash, and pumpkin seeds. My question: How do I get the dairy? I can tolerate grass fed butter and ghee. Any help or advice you could offer would be so very much appreciated! Again thank you for your blog and for sharing this information.
Hi Amy,
There are plenty of calcium-fortified non-dairy kinds of “milk” like flax, oat, and coconut. Try them. I like lactose free Fairlife milk. Great calcium and it doesn’t bother my stomach. You might want to try and of these alternatives to dairy and also read this:https://kidneystonediet.com/why-you-need-calcium-and-how-to-get-more-of-it/
Best, Jill
I am on my 2nd round of eating low-oxalate. I am on the look out for a meal plan to continue my low oxalate journey. Are there any you recommend?
I had to cut out chocolate because I can’t limit it lol! I am trying to diversify my diet so I can stick to the low oxalates.
Hi Jenny,
People ask me this question a lot. I do not offer generic meal plans bc many of you have other issues to manage. Best that you get personalized help whether you take the online course or work with me during a private consult. First question: Have you done a urine collection to see if this is truly an oxalate issue? Most of my patients are not getting enough calcium, and once they take away the highest oxalate foods (which is only about 5 foods) and get enough calcium, their oxalate levels are just fine. Think about finally taking the plunge and getting educated specific to YOU! Best, Jill
Dear Jill,
I have a kidney stone sitting quietly for a long time now in my right kidney. I also happen to have high creatinine levels (1.15 mg/dl) and uric acid level of 8.6 mg/dl. There are many foods i have to avoid which can cause my levels of uric acid and creatinine to shoot up but help me with oxalates. How do I find a balance? I do not want to be on medication just yet as I am only 30 years old. Do you have any suggestions for me?
Dear Sneha,
Taking care of the oxalate is important. Take away the highest foods and stick to your doctor’s treatment plan. To find a balance can be tricky and that is why we offer our online course. It has helped so many patients. Read about it here: kidneystonediet.com
Best, Jill
I just had two surgeries to remove two large kidney stones. My doctor told me I know need to be on a low oxalate diet. Is there somewhere I can find a cookbook? I’m still not sure what are portion sizes, how many oxalate are in each serving. I was told I need to stay under 50 per day. I went to a dietitian and she really was not help just gave me a list of foods to stay away from. (What a waste of money). Looking for answers.
Hi Caroline,
Please read the article that goes along with this list of foods from Harvard. It explains how the list works. Think about taking the course. I will help you sort it all out. Here is your list: https://kidneystonediet.com/good-oxalate-list/
Best, Jill
Hello!
I’m 46 years old, live in Sweden.
Where could I take a oxalat test?
I have all this diseases:
Endometriosis
Arthros one toe
Cronic embedded UTI ( it’s the worst one)
Neuropathy symptoms feet and underlegs
Have even been a vegan, vegetarian 35 years with just little fish the last 10 years.
Somehow healty sometimes.
Does it mean I have really high oxalat in my body?
Could a low oxalat diet help me?
Sincereley M
Hi Maria,
I do not think oxalate is your issue as far as the medical conditions you have asked about. Have you made any kidney stones?
Best, Jill
Hi Jill,
I was wondering if calcium supplements can help if not replace a calcium-rich diet? I’m asking because I’m lactose intolerant. I have had one surgery to blast my kidney stones and I continue to produce them. I have four kidney stones on one side and five on the other. I just had another bout with them this past weekend. My doctor continues to tell me to have a low oxalate diet. I’m hoping that I can cut back on some food, eliminate others, and add a calcium supplement to improve my overall health.
Hi Tanya,
Here is a list of calcium from foods and beverages next time you go shopping: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
Supplements can INCREASE your risk for stones. Have you had a urine collection?
Best, Jill
Hi Jill,
I have had two episodes in passing kidney stones. My Dad had kidney stones and all three of my brothers do as well so there is a genetic piece to this. I currently have a 5mm stone in the right lower pole of my kidney which my urologists is watching on a year to year basis.
I know you recommend eating and/or drinking calcium rich foods when eating foods that contain oxalates. It seems most calcium rich foods come from dairy. The problem is that I am lactose intolerant. What would you suggest I eat or drink to get the calcium I need? Thanks Jill
Hi Jon,
First off, please get a urine collection. Your family members should as well. Getting your calcium is very easy now that there are so many non diary milks. I am lactose intolerant too and I use lactose free milk. Give it a try. Also, read this article:https://kidneystonediet.com/calcium/
I am here is you need anything,
Jill
Hi Jon,
I am lactose intolerant too. Plenty of alternatives these days. I use Fairlife or any lactose free milk that is on sale.
Hope that helps,
Jill
I am waiting for the results of a 24 hour test. Pending that, am trying to eat low oxalate foods.
Two questions:
Any idea on barley oxalate levels? Can’t find on your or any other sites.
On your/Harvard list, 4 pancakes are shown to have 10 mgs. of oxalate in the bread/grain section, but 37 mgs. in the breakfast section?
Hi Bruce,
The pancake thing I have never understood. So not sure why the discrepancy. But pancakes are not a healthy food, so either way portion not perfection. And on all foods that we are not sure of portion not perfection and get your daily calcium intake. Go to my YouTube channel on all things oxalate and kidney stone diet. You will find answers there as well.
j
Thanks for sharing this Jill. Moving forward, I know what to prepare for my diet.
GREAT!
Can I benefit from the group without the course? Trying the monthly meal plans is more in my budget……
Hi Pam, the group calls are part of the course.
j