Treating Kidney Stones with Diet

Image Credit: Sally Plank

Treating Kidney Stones with Diet

Studies suggest that excessive consumption of animal protein poses a risk of kidney stone formation, likely due to the acid load contributed by the high content of sulfur-containing amino acids in animal protein, a topic I explore in my video, Preventing Kidney Stones with Diet. What about treating kidney stones, though? I discuss that in How to Treat Kidney Stones with Diet. Most stones are calcium oxalate, formed like rock candy when the urine becomes supersaturated. Doctors just assumed that if stones are made out of calcium, we simply have to tell people to reduce their calcium intake. That was the dietary gospel for kidney stone sufferers until a 2002 study published in the New England Journal of Medicine pitted two diets against one another—a low-calcium diet versus a diet low in animal protein and salt. The restriction of animal protein and salt provided greater protection, cutting the risk of having another kidney stone within five years in half.

What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones. This means we may get additional benefits bulking up on plant foods in addition to just restricting animal foods.

A reduction in animal protein not only reduces the production of acids within the body, but should also limit the excretion of urate, uric acid crystals that can act as seeds to form calcium stones or create entire stones themselves. (Uric acid stones are the second most common kidney stones after calcium.)

There are two ways to reduce uric acid levels in the urine: a reduction of animal protein ingestion, or a variety of drugs. Removing all meat—that is, switching from the standard Western diet to a vegetarian diet—can remove 93% of uric acid crystallization risk within days.

To minimize uric acid crystallization, the goal is to get our urine pH up to ideally as high as 6.8. A number of alkalinizing chemicals have been developed for just this purpose, but we can naturally alkalize our urine up to the recommended 6.8 using purely dietary means. Namely, by removing all meat, someone eating the standard Western diet can go from a pH of 5.95 to the goal target of 6.8—simply by eating plant-based. As I describe in my video, Testing Your Diet with Pee & Purple Cabbage, we can inexpensively test our own diets with a little bathroom chemistry, for not all plant foods are alkalinizing and not all animal foods are equally acidifying.

A Load of Acid to Kidney Evaluation (LAKE) score has been developed to take into account both the acid load of foods and their typical serving sizes. It can be used to help people modify their diet for the prevention of both uric acid and calcium kidney stones, as well as other diseases. What did researchers find? The single most acid-producing food is fish, like tuna. Then, in descending order, are pork, then poultry, cheese (though milk and other dairy are much less acidifying), and beef followed by eggs. (Eggs are actually more acidic than beef, but people tend to eat fewer eggs in one sitting.) Some grains, like bread and rice, can be a little acid-forming, but pasta is not. Beans are significantly alkaline-forming, but not as much as fruits or even better, vegetables, which are the most alkaline-forming of all.

Through dietary changes alone, we may be able to dissolve uric acid stones completely and cure patients without drugs or surgery.

To summarize, the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score. 

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


35 responses to “Treating Kidney Stones with Diet

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  1. As Dr. Greger mentions above, the second leading cause of kidney stones is high Uric Acid levels. The more prevalent way high Uric Acid presents itself is gout, especially in the lowest extremities. I have gout so bad that I could not walk for days. I lay agonizing on the couch.

    Eliminating flesh-foods and their secretions–dairy and eggs–did relieve some of the pain and gout associated with high Uric Acid in the blood. But I saw complete relief, when I eliminated sugar products–donuts, honey, syrup, jelly, jam, cake, pie, cookies, candies, ice cream (vegan), fruit juices, etc.

    The reason I eliminated sugar products is because refined sugar metabolizes by the liver into Uric Acid and fat. The fat is to store the Uric Acid. Dr. Robert Lustig turned me on to this fact.

    In only 2 days, I can turn gout on with 1 tablespoon of honey for each day. I can turn gout off in 2 days by not eating any flesh-foods or sugar.




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    1. Terry, Wow! That’s impressive! And if you stay off animal foods you probably won’t be needing so much honey.

      My husband and I laugh from time to time about a country and western song he once heard, entitled “I’d Rather Pass a Kidney Stone than Spend Another Night With You”. Really? Really? I don’t think so!

      But seriously, my dad lost the function of one kidney many years ago when a stone damaged the kidney beyond repair. It later atrophied and had to be removed. We can all be thankful for better treatments and better diagnostic tools than he had in the ’50s.




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    2. Great information on uric acid. One correction would be that carbohydrates are metabolized by the liver into uric acid and fat. Uric acid is actually the result of purine metabolism. It is believed that fructose raises uric acid levels by its effects on insulin. Insulin limits nitric oxide bioavailability which reduces glucose uptake. Nitric oxide is a reactive oxygen species scavenger and its reduction allows for more peryoxynitrite production. This is bad. The body compensates by increasing uric acid levels because uric acid reduces peroxynitrite levels. The body is trying to help itself even when we think it is not. Eating a plant based diet while limiting carb intake is certainly a great suggestion.




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          1. Apparently you skipped the second paragraph: “What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones.”




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  2. Great information Dr G.
    Wondering if similar info about gallstones is available?
    I was scheduled to have gallbladder small stones removed instead cancelled surgery.. since eating SOS and following the Daily list no symptoms, huge weight loss and feeling great!




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    1. I’m glad you found this information valuable! Below is a video explaining that a plant-based diet may prevent gallstones and another article describing a gallbladder cleanse. I’m not suggesting you do the cleanse, just giving you some information. You can research further if you are interested. It’s great that you have found a diet that is making you feel better! Keep up the good work!

      https://nutritionfacts.org/video/cholesterol-gallstones/
      http://www.mayoclinic.org/diseases-conditions/gallstones/expert-answers/gallbladder-cleanse/FAQ-20058134




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  3. Maybe a year ago I experienced some gout in the big toe on my right foot. That really, really, really hurt!

    Needless to say, I don’t want me some more gout. But I bought a supplement called benaGene which boasts the ingredient “thermally stabilized oxaloacetate.”

    Knowing this was akin to oxalic acid I was careful not to take the product daily, but every other day.

    The only reason I took it at all is that it claimed to be a Sirt 1 activator, but using a different channel to do so than used by either Nicotinamide Riboside or Resveratrol. This gave me three avenues to my SIRT 1 gene, protein, enzyme (whatever) to fight aging.

    Long story short, when I finished that bottle I changed to a similar product with other nutrients and oxalocetic acid.

    They recommend 2 capsules multiple times a day but I only took one cap once a day… and felt some pain building in my big toe again. I now take a capsule maybe once every two or three days and have no problem with gout.

    But I can only imagine what someone on a less strict diet might be up against with even this low amount of oxalic acid intake.




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  4. I have to advise caution in some of the advice mentioned above by Dr Greger. Drinking 12 cups of water a day is a very good thing but restricting salt while doing this can lead to dehydration. Kidney stone sufferers are more prone to dehydration than the average public and could be having stones due to one of the several known mutations to their sodium ion pumps. This can cause a leaching of sodium and often wont be seen in blood work performed during the day. You would be better off monitoring sodium intake to maintain a constant level.




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    1. I noticed that when I drink a lot of water I become constipated. Just as bad as not drinking enough. I know it’s counterintuitive and I was very surprised coming to that conclusion. I kept increasing my water consumption to avoid constipation but it didn’t work.




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    2. I’ve seen competing salt recommendations from various folks promoting plant-based diets. Some say salt is bad, some say salt is good.

      Some blame ‘salt is bad’ doctors for deaths during summer heat waves.

      More research seems in order.




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    3. For those that disagreed with my previous comments, I did not just make them up. I am a pharmacist, a researcher, and a former kidney stone sufferer. Just because I have researched this topic much more in depth than others does not mean I am incorrect. I would suggest researching more in depth to better inform yourselves. I did not discuss Oxalobacter formigenes, hypothalamus, or parathyroid induced issues but I could if you would like. A direct quote from the literature states “Thus, water was lost and regained pari passu with sodium.”




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  5. Thank you for the valuable information Dr. Greger.
    Starting at age 50 I suffered from gout attacks on a regular basis even after eliminating beer, wine, and red meat from my diet. It wasn’t until I stopped eating chicken and fish that my attacks stopped re-occurring.
    Having since adopted a Whole Foods, Plant Based diet a few years ago, not only has my gout never resurfaced, but I no longer have seasonal allergies, colds or flu episodes and at age 72 I go surfing every day with a big smile on my face. Thank you for your wonderful work and contribution to a better, healthier world.




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  6. I have been vegetarian many years. Got Renal Colic soon after introduction of soy products to my diet. Suffered 10 years. Decided to stop all soy products in diet. No more Renal Colic. Some scientists and doctors I have come across say soy is inherently toxic (oxalic acid etc from memory) and no one should be eating it. Then others say its good for you. In my case its toxic. I love soy. I cant eat it.




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  7. May I correct the grammar on one paragraph? Change the word “their” to “your”.

    Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each




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  8. I was told that Ocelate induced Kidney Stones can be prevented by eating a squeezed lemon every day. The citirc acid in the Lemon attaches to the Ocelate, and a stone cannot be formed. Is this true?




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  9. I had a large uric acid bladder stone removed by outpatient laser surgery in January. I went on a no salt added, primarily plant based nutrient rich diet with supplements and 4 oz salmon per week. I lost 14 pounds to put me near the middle of my normal BMI range. It lowered my blood pressure to the normal – prehypertension range. I took a graminex supplement for my enlarged prostate. I no longer need flowmax pills that gave me bad side effects (rapid heart beat). I found that wine is too acidic for my system and may have contributed to tiny uric acid stones forming. I should not let myself be dehydrated as my kidneys do not function well when I am dehydrated and stones reappeared. Occasionally little coarse sand grain sized stones reappeared in the toilet after I emptied my bladder, I increased my potassium intake by drinking Crystal Light sugar free lemonade that contains potassium citrate. That put an end to the stone formation for awhile. I may not need to go back to my urologist.




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    1. dqhall, Please read the label on Crystal Light. Someone served it to me once and I was suspicious after one sip. Yes, it was sweetened with aspartame, which causes me (and many others) to have seizures. I hope you’ll avoid it and find a healthier source of potassium.




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    2. Wow..that is wonderful…I wish more of my relatives would look into eating whole plant based foods & giving up meats…They would lose weight & be healthier in every way…but most of them won’t if what I think..I guess they were programmed too well on eating flesh & eating less vegetables & fruits..




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    3. Dave, I do hope you will reconsider drinking Crystal Light. When I last looked, I found it was sweetened with aspartame. That sweetener is toxic to the brain, just like MSG and other food additives.

      Many years ago I had a major seizure while on vacation in Las Vegas with a friend. I woke up 32 hours later in a hospital. It took a couple of years of taking Dilantin, then weaning off it, then having another seizure before I figured out they had been caused by aspartame – a sweetener I didn’t use regularly, but which I realized I had used a few hours before each seizure.

      My neurologist disagreed, saying it wasn’t the aspartame, but I have scrupulously avoided it since and have not had another seizure in over 18 years.

      There have been more complaints to the FDA about aspartame than any other single food additive. It not only causes seizures, it also causes MS and many other neurological problems because it crosses the blood-brain barrier and it is so toxic. But of course, the FDA plays to industry and doesn’t give a fig about the health of the American people.

      Please, please, please don’t allow aspartame (Equal, and other names) into your body!




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  10. I hope it is just typos or Dr. Greger trying to be humorous. In the last 2 paragraphs:

    “the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

    Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score.”

    Dr. Greger probably does not want us to eat more vegetarians. They are animals and eating them would lower our urine pH. Also not sure how my food group eating habits will affect “their LAKE score”.

    A very helpful article, thank you.




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    1. A grammar checker is a good thing to use along with your spell checker.
      Use the computer to do more of your proofreading. It will often do a better and faster job.




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    2. “Dr. Greger probably does not want us to eat more vegetarians. They are animals and eating them would lower our urine pH. ”

      Please…step away from the vegetarians!




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  11. What about drinking lemon water? My urologist said to decrease salt and increase citric acid. Not mentioned in the article by Dr. G has me wondering if it is still effective.




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  12. Interesting article, thank you. I’ve been a vegetarian all my adult life (20+ years) and a vegan for the last 8 years, and recently suffered my first very painful attack of kidney stones. I consider my diet to be healthy (no vegan junk foods:-) so there must be other aspects that contribute. In my case, I think perhaps inadvertent dehydration after a short 5km run, but I wouldn’t have thought that isolated incident could create the stones. I wondered if vitamin C could be a culprit? I’d recently started liposomal vit C as a supplement.
    Any ideas, anyone?

    many thanks




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    1. There have been some studies that suggest that Vitamin C may contribute to stone formation. Most of those are conjectural. Various studies have shown the opposite — that C helps alleviate the formation of kidney stones.

      http://www.doctoryourself.com/kidney.html

      Drug industry friendly folks tend to continue to quote the old and unproven claims more readily.




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      1. Long time reader of PhD Dr. Saul, Dr. Yourself website and email updates. I put a lot of stock in what he says, as I do Dr. Greger’s videos.




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  13. I have been following the research and findings of Dr. Greger for almost a year now. I eat (as of 8 months ago) as a vegan should and heed his advice on using a plant based diet as a preventative way of life. It has given me amazing results including an increased sense of energy and dramatic weight loss. I put almost 6 of his daily dozen in my morning smoothie each day. Unfortunately, I just had a terrible bout with my very first kidney stone. Thankfully I was able to pass it in 24 hours, but it did cause me some alarm and made me very worried as my wife had a similar episode a month ago (which lasted 22 days) and she is newly vegan like me. We are desperate to find an answer with a reasonable explanation. We want to know why this happened to us and what in our diet (totally lacking all forms of animal proteins) we are doing to cause these extremely painful stones. Thanking you for any help.




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    1. Fascinating. I’d like to know too. Curious to know what your water intake has been? I’m WFPB and I sure would like to be doing everything to avoid kidngey stones if there is more for me to do.




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