Oxalates in Spinach and Kidney Stones: Should We Be Concerned?

Oxalates in Spinach and Kidney Stones: Should We Be Concerned?
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Even though dietary oxalates may have a limited effect on kidney stone risk in most people, there are some predisposing factors that can put anyone at risk.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Kidney stones affect as many as 1 in 10 people in their lifetime and can cause excruciating pain. Makes me cross my legs just thinking about them! Oxalate stones are the most common type, forming when the oxalate concentration in your urine gets so high it basically crystallizes out of solution, like rock candy. Some foods, like spinach, have lots of oxalates in them. Should we try to reduce our intake of oxalates to lower our risk? It turns out that people who do get stones don’t seem to eat any more oxalates on average than people who don’t get stones. It may be less what you eat, and more what you absorb. People who are predisposed to kidney stones just appear to be born with a higher intestinal oxalate absorption. Their guts just really suck it up: “so-called ‘super absorbers'” assimilate up to “50% more oxalate than non–stone formers.”

Overall, “the impact of [typical] dietary oxalate” on the amount of oxalates that end up in the urine “appears to be small.” “[E]ven a massive dose” of dietary oxalates typically only “results in a relatively mild increase” in the amount that makes it into your urine. A 25-fold increase in oxalate consumption doesn’t even double the concentration of oxalates flowing through your kidneys, so it’s really more determined by genetics than diet. But still, until you get your first stone, how do you know if you’re a super absorber or not? Is it safer to just generally avoid higher-oxalate fruits and veggies? People who eat more fruits and vegetables may actually tend to get fewer kidney stones. When researchers put it to the test and removed produce from people’s diets, their kidney stone risk indeed went up.

Removing fruits and veggies can make your dietary oxalate intake go down, but your body produces its own oxalate internally as a waste product, that you have a more difficult time getting rid of without the alkalizing effects of fruits and vegetables on our urine pH. This may help explain why those eating plant-based get fewer kidney stones (but it also may be due to their cutting animal protein intake, which can have an acid-forming effect in the kidneys). We’ve known this for 40 years. Just a single can of daily tuna fish can increase your risk of forming stones 250%. And even just cutting back on animal protein may help cut kidney stone risk in half.

Surely there’s some level of oxalate intake that could put people at risk regardless. There have been a few rare cases reported of people drinking green juices and smoothies getting oxalate kidney stones, though most had extenuating circumstances. This case describes a woman whose kidneys shut down after a 10-day juice cleanse, which included two cups of spinach a day.

Normally we might not expect a cup or two of spinach to cause such a violent reaction, but she had two aggravating factors—she had gastric bypass surgery (which can increase oxalate absorption) and a history of “prolonged” antibiotic use. There’s actually a friendly bacteria you want in your colon, called oxalobacter, that eats oxalate for breakfast, leaving even less for us to absorb, but it can get wiped out by long-term broad spectrum antibiotic use.

She still probably wouldn’t have run into a problem, though, if she would have used something other than spinach or beet greens or Swiss chard, the trifecta of high-oxalate greens. Kale has hundreds of times less oxalates than spinach. She would have had to have juiced in excess of 650 cups of kale a day to get a comparable dose, so over those ten days more than 6,000 cups of kale. But are the three high-oxalate greens only a problem for people with extenuating circumstances or who are otherwise at high risk? And what if you cook the greens? How much would be too much? I’ll answer all those questions, next.

Please consider volunteering to help out on the site.

Image credits: ThiloBecker via pixabay and Jacek Proszyk via wikimedia. Images have been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Kidney stones affect as many as 1 in 10 people in their lifetime and can cause excruciating pain. Makes me cross my legs just thinking about them! Oxalate stones are the most common type, forming when the oxalate concentration in your urine gets so high it basically crystallizes out of solution, like rock candy. Some foods, like spinach, have lots of oxalates in them. Should we try to reduce our intake of oxalates to lower our risk? It turns out that people who do get stones don’t seem to eat any more oxalates on average than people who don’t get stones. It may be less what you eat, and more what you absorb. People who are predisposed to kidney stones just appear to be born with a higher intestinal oxalate absorption. Their guts just really suck it up: “so-called ‘super absorbers'” assimilate up to “50% more oxalate than non–stone formers.”

Overall, “the impact of [typical] dietary oxalate” on the amount of oxalates that end up in the urine “appears to be small.” “[E]ven a massive dose” of dietary oxalates typically only “results in a relatively mild increase” in the amount that makes it into your urine. A 25-fold increase in oxalate consumption doesn’t even double the concentration of oxalates flowing through your kidneys, so it’s really more determined by genetics than diet. But still, until you get your first stone, how do you know if you’re a super absorber or not? Is it safer to just generally avoid higher-oxalate fruits and veggies? People who eat more fruits and vegetables may actually tend to get fewer kidney stones. When researchers put it to the test and removed produce from people’s diets, their kidney stone risk indeed went up.

Removing fruits and veggies can make your dietary oxalate intake go down, but your body produces its own oxalate internally as a waste product, that you have a more difficult time getting rid of without the alkalizing effects of fruits and vegetables on our urine pH. This may help explain why those eating plant-based get fewer kidney stones (but it also may be due to their cutting animal protein intake, which can have an acid-forming effect in the kidneys). We’ve known this for 40 years. Just a single can of daily tuna fish can increase your risk of forming stones 250%. And even just cutting back on animal protein may help cut kidney stone risk in half.

Surely there’s some level of oxalate intake that could put people at risk regardless. There have been a few rare cases reported of people drinking green juices and smoothies getting oxalate kidney stones, though most had extenuating circumstances. This case describes a woman whose kidneys shut down after a 10-day juice cleanse, which included two cups of spinach a day.

Normally we might not expect a cup or two of spinach to cause such a violent reaction, but she had two aggravating factors—she had gastric bypass surgery (which can increase oxalate absorption) and a history of “prolonged” antibiotic use. There’s actually a friendly bacteria you want in your colon, called oxalobacter, that eats oxalate for breakfast, leaving even less for us to absorb, but it can get wiped out by long-term broad spectrum antibiotic use.

She still probably wouldn’t have run into a problem, though, if she would have used something other than spinach or beet greens or Swiss chard, the trifecta of high-oxalate greens. Kale has hundreds of times less oxalates than spinach. She would have had to have juiced in excess of 650 cups of kale a day to get a comparable dose, so over those ten days more than 6,000 cups of kale. But are the three high-oxalate greens only a problem for people with extenuating circumstances or who are otherwise at high risk? And what if you cook the greens? How much would be too much? I’ll answer all those questions, next.

Please consider volunteering to help out on the site.

Image credits: ThiloBecker via pixabay and Jacek Proszyk via wikimedia. Images have been modified.

Motion graphics by Avocado Video

Doctor's Note

Spoiler alert: As you’ll see in the next video, Kidney Stones and Spinach, Chard, & Beet Greens: Don’t Eat Too Much, anyone can overdo the three high-oxalate greens—spinach, beet greens, and Swiss chard. So, for anyone doing cups of greens a day (as you should!), better to choose any of the other greens, such as kale, collards, or arugula.

It takes a while for videos to be made, and so when I discover something like this in the research, I immediately go to our social media channels to alert people, as I did with this cautionary note on high-oxalate greens. To not miss critical “heads-up” info like this in the future follow us on Facebook, Instagram, or Twitter, and subscribe to our free monthly newsletter.

For some older videos I did on kidney stones, see How to Prevent Kidney Stones with Diet and How to Treat Kidney Stones with Diet.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

121 responses to “Oxalates in Spinach and Kidney Stones: Should We Be Concerned?

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      1. Thanks Dr.
        I know about arugula (it’s also cruciferous, so triple win!) but it’s more expensive where I live and I find it less palatable personally, at least in big amounts. I eat a lot of spinach every day because of this and want to believe its various benefits (including the nitrates) compensate for its high oxalate content, i.e. it’s better to each spinach than nothing; or because of the price, it’s better to eat certain amount of spinach than to eat 1/3 of that of kale, for instance. But I’ll just wait for the next video to make up my mind.

        1. A,

          I don’t know where you live, but I grow arugula in the back yard here in CT — and it grows like a weed! In fact, if I let it go to seed, I get beds and walkways full of arugula!

          And I have a friend who likes it so much that she munches on it right out of the packaging as a snack (she buys it at the store, which I do too, during the winter — though I’ve long wanted to try growing it under a cold frame. Maybe this will be the year?). I like to mix mine with lettuce and other greens, and use a little dressing on it.

          1. I’m finding a few “healthy” restaurants around my neighborhood that are introducing cheese-less pizza on their menus. Some, like True Food Kitchen in SDL, are topped with only sauce and arugula. Also… I just discovered that I can buy cauliflower pizza crusts in my farmers markets here. I have not yet tried one, but maybe a cauliflower-arugula pizza for my next Super Bowl party.

            Or Fourth of July party.

          2. Hmmm. So, if arugula grows like a weed, enough to cover sidewalks, why am I paying $3.79 for a package of it at the grocery?

            1. Dr cobalt,

              The arugula covers wood-chip covered walkways or paths between garden beds, not sidewalks. And it’s a lot of back-breaking labor to harvest it, and wash it. (I call that “moderate exercise” or “yard yoga.”) Though those processes may be mechanized on bigger farms. Maybe the arugula is hydroponically grown?

              Anyway, you could try growing some in your backyard, or maybe even in trays. Plant, harvest, re-plant. Then see what you think of the price.

              Me? I think we pay far too little for our food. I’d rather have farm subsidies for produce farmers, and those who grow grains and beans for human consumption, and NONE for the meat industry, or worse, the ethanol industry. I don’t know what to suggest for Big Food — the processed food industry. I try to avoid processed food. As do most of us who visit this website, no doubt.

              1. I understand a little… you’re saying it’s hard work to harvest and prepare arugula for packaging, so price is fair. Not sure yet why you think we pay “far” too little for comestibles. (I seem to recall something about family farms closing down and losing market share to the factory farms…)

                I think supply and demand has something to do with pricing, regardless of how much work is involved. Think about what it takes to produce a daily newspaper. You have to create and manage a small empire of reporters, writers, technical staff, publishers, advertisement people, distributors… the list goes on and on. But a consumer can still get a paper for about a buck most places. Supply is high and demand is dwindling (in the case of newspapers).

                Prices for groceries in my area have doubled in the last 10-15 years. I used to budget a month’s groceries for two at about $400 (PHX). Today it’s over $800. Part of that is because I’ve switched over to organic produce. But I still wonder how people on limited budgets, like single moms, for example, can afford the unrelenting price escalation.

                I have no idea why I’m off on this tangent. This was about oxalates in spinach or something? =]

                1. Dr. Cobalt,

                  Yes, I would say the exact same jump and the reality that single moms and blue-collar workers and seniors on a fixed income and people on food stamps literally can’t afford it.

                  I think about that every time I shop.

                  That is just food.

                  My brother and I both needed car repairs and our lifelong mechanic passed away and we both ended up with bills over $3000. I think my brother’s bill was closer to $4000.

                  Both of my brothers’ also had medical bills from their surgeries of closer to $10,000. One brother’s wife had surgery last year and the year before. That makes $30,000 plus, they both needed root canals, which was $3000 each.

                  Just their medical and dental bills was a whole year’s salary and that is gross salary, not take home.

                  1. Some of us have people think we are irresponsible for not seeking medical care but in reality, my friends who do seek medical care often end up homeless.

                    My well-paid insurance industry friend just lost her “career job” and she can’t find another. People go from making $60,000 to $100,000 and are suddenly making $14 an hour, part-time, with no benefits.

                    I don’t have a mortgage or rent or car payments and don’t have medical bills or phone or cable bills or wifi. I don’t even know how people do it.

                    I was looking at the Amazon page and their pickers make $25,000 per year. How do you eat and buy gas and pay utilities and people have rent on that? The elderly often are bringing in less than that and so are some of the single mothers who I know. People who get out of prison, for instance, often can’t find jobs at all, but if they do, it is part-time minimum wage. How do you survive at all on that?

                    I say it, but the Starbucks workers all have 3 jobs and the grocery store workers have been working for decades and they all make less than I do.

                    Anyway, I do see it as more and more people are not going to survive it.

                    1. The reality that if I eat the amount of organic produce that I want, it would cost me closer to $9000 per year is mind-blowing already.

                    2. I have been doing so well with eating broccoli sprouts, blueberries, kale, cabbage, matcha tea, turmeric, ginger, cacao, pomegranate seeds, avocado, etc.

                      I am using them all for the “healing my brain” project but if I don’t succeed this year, it might be harder to keep up with all of it.

                      I feel like I am going to end up The Starch Solution in the end because it will be what I can afford to eat.

                      Beans, lentils, potatoes, rice, and pasta are cheaper than veggie-based meals.

                      I am doing the math because I might figure out a way to eat the minimum amount of superfoods, to still get the benefits without going broke.

                    3. Not only that, but no matter what your politics are, there are thousands of people crossing the border into our country who will be looking for work.
                      Probably most are unskilled, and I just read an article about robots that are planned to take over fast food jobs.

                      Who will support these people? How can working people afford to pay enough taxes to take care of everyone? I find it mind-boggling.

                      Virus-free.
                      http://www.avast.com

                      Virus-free.
                      http://www.avast.com

                    4. God knows what you need before you ask him, Deb. Don’t put your faith in foods or superfoods to heal you.
                      You know what you must do.

          3. Arugula salad is my favorite meal of all time! I mix it with pine nuts, mixed raw nuts, balsamic vinegar, apple, berries, mango and sweet peppers and it is just heavenly! Even in my meat eating days, I do not recall ever having my mouth water, just at the mention of a meal !! But it is expensive here in New England. The cheapest I have seen it for is 1.99 for 12 oz at Trader Joes, and only during the summer. Other stores sell it for 7.99 a pound. It also does not keep for more than a few days even in the coldest sections of my fridge. Has anyone figured out how to prolong its lifespan? Please can I come harvest your walkway?

            1. Al, For greens packaged in those plastic boxes, after you use the first portion, take a piece of paper towel and pad one of the short sides. Then stand the box up with the paper towel side at the bottom of the box.
              Store the box, standing up in the frig. Top shelf is best since they won’t get too cold. The paper towel absorbs the excess water and the greens stay fresher a day or two longer.
              I agree, arugula is hard to keep fresh. Probably accounts for the high price.

          4. Dr. J., check this wonderful book out:
            https://www.amazon.com/Four-Season-Harvest-Organic-Vegetables-Garden-ebook/dp/B005O1FXNE/ref=sr_1_3?crid=628P5XPNLNK6&keywords=eliot+coleman+books&qid=1560805927&s=books&sprefix=eliot+coleman%2Caps%2C202&sr=1-3

            I got a recycled picture window one year and grew lettuce under it in Michigan. I kept scraping the snow off of it, but it worked like a charm. I harvested my first lettuce March 24th when I thought it was warm enough for me to open my “frame” and didn’t buy lettuce again until the following winter. (Sadly, we accidentally broke the glass in the window when trying to move it….)

          5. Trader Joe’s sells really good baby arugula near me. For the first time, I’m growing it in my garden! It’s flowering like crazy… pretty, but I’m pretty sure I need to cut them off. Any growing tips are welcome.

      2. I have a delicious arugula recipe that I wanted to share with you dear friends. It isn’t ideal because it contains a tiny bit of oil and salt but I can’t get enough arugula when I eat it like this —and wanted to share it.

        Chop lots of garlic and onions. Saute them on very low heat with extravirgin unfiltered olive oil. Sprinkle a little salt on the onions and garlic (as you saute them in the extra virgin unfiltered olive oil at very low heat).The salt helps the onions soften more easily.
        After the onions an garlic is soft, add chopped arugula. (Still no added water) Continue to saute/mix the onions and garlic over very low heat with the chopped arugula (but still add no water).
        Sprinkle this with 3 tablespoons of bulgur. (Still no water)
        On top of this mixture add organic grated tomatoes.
        Then add a glass of water and cook.

        I hated arugula and ate it in agony until I discovered this recipe. Now I can’t get enough. I hope it is useful to others.

      1. Forgot to add that I’ve never had kidney stones, even when eating the SAD diet. So I don’t think I’m genetically prone to getting them.

    1. I blend a cup of raw spinach daily, for 7 to 8 years. I did end up with 3ocelate kidney stones. I wanted to keep mlraw spinach in my diet, so my Urelogist suggested the following to prevent kidney stones, drink lots of water and drink a whole squeezed lemon juice every day. He said this should prevent future stones.

    2. Hi Dr. Gregor!

      I am a 22 year old female who has lived a pretty active and healthy lifestyle- except for kidney stones. For being so young and healthy, my first assumption was my predisposed genetics causing the formation of the stones since my grandmother suffered from them. I also went through some time of weight training where I was drinking protein powder, BCAA powder, and pre-workout powder; all without the adequate amount of daily water intake. And then your statement about a single can of daily tuna fish increasing the probability by 250% had me flashback to my younger days where I would come home from school and whip up a can as my snack almost 5 times a week. Needless to say, I cut back on spinach, protein, powdered dietary supplements, and increased my daily water intake which resulted in my last stone passing a year and a half ago!

      I am looking forward to watching your next video!

    1. Romaine lettuce and broccoli are both nutritionally excellent ‘greens’. For example, both are high in folate – much higher than swiss chard and a number of other greens.

  1. Almonds are also high in oxalates yet many of us are making our own almond milk. Perhaps discussing ways to lower the amount in that would be beneficial. I soak my almonds for 12 hours and toss the muddy looking soaking water to lower the phytic acid content. Does this also affect oxalate levels?

  2. An interesting little side note – calcium oxalate crystals are one of the prettiest things you can see on a microscope slide. They look like little ‘glowing envelopes’ owing to their particular shape and they way the respond to backlighting. Lab techs doing routine analysis of centrifuged urine see them every week, and report them out accordingly.

    1. Speaking of pretty stones formed in the body, my cousin actually looked at a photo of one of our relatives removed gallbladder covered in gallstones, and without knowing what it was she said “ooo pretty!” lol… It really was quite sparkly.

  3. This was such a helpful video!

    Genuinely helpful!

    Clap! Clap! Clap! Clap!

    I had watched videos with people who struggle with kidney stones and have looked this topic up several times and even still, I would have not had this answer because the “sources” out there don’t do this entire process.

    I love it when the videos cover so many bases so that I can figure out exactly how to live my life!

    Thank you, Dr. Greger!

  4. Concerned? Yes — if you are prone to forming kidney stones.
    Otherwise, enjoy spinach in moderation, drink plenty of water and supplement with a well-absorbed magnesium, as in the citrate form.

  5. Re Kidney stones..I am 56 years old and started getting them when I was 28 years old, in total I have had them about 10 times. Over the last decade I have been getting them every two years. I have had them blasted with lithotripsy several times and zapped by laser. In all the time I have had them I have received zero dietary advice from Doctors, just drink more water….which I do. Then 6 years ago I discovered a herb called Chanca Piedra after a quick search on Google following the discovery of another 10mm stone stuck in my urinary tract. I swallowed 3 capsules a day for a week and passed the stone over a couple of weeks…when I went for my appointment to have it removed with lithotripsy they could not find it and did not believe I had passed it using Chanca Piedra. Last year I got two more stones, the first was removed through an emergency operation but the second I broke down and passed using Chanca Piedra again. When I went to have my lithotripsy operation once more they could not detect a stone which was there only a few months ago on my scan. I told them once again and still they had not heard of Chanca Piedra. I now take Chanca Piedra on the 1st, 2nd and 3rd of each month, two capsules with water before bed time…so far so good!

    1. Yes, I use that for gall bladder attacks too. It’s called stone breaker. It works within 30 min or so, not over a couple weeks.

      1. It may work quickly but I assure you it took two weeks for the stone to break down enough to pass, when it did finally pop out it had a nasty hook on it…ouch!! :D

        1. Dr Julian Whitaker M.D. who ran the Whitaker Wellness Institute and has written many books had several recommendations for kidney stones. The following from Dr Whitaker’s Guide to Natural Healing

          -First the amount and type of fluid intake is critical. He advises 2-3 quarts of pure water daily and to avoid coffee and alcohol.
          -Eat less animal protein and eat more fruits and vegetables.
          Reduce fat and sugar consumption.
          Avoid vitamin D fortified dairy products.
          Take 1000mg magnesium (preferably magnesium citrate) and 100mg B6 daily.
          Use potassium citrate or Bicitra when appropriate.

          Taking magnesium and B6 daily will stop stones from forming even in people who are extremely prone to kidney stones according to the book. The effectiveness is well documented in medical literature. Magnesium makes calcium oxalate more soluble in the urine, and B6 reduces production of oxalic acid in the body.

          In 1974 Harvard physicians Edwin Prien and Stanley Gershoff gave 300mg of magnesium oxide and 10mg of vitamin B6 to 149 patents with a long history of recurrent kidney stone formation. Prior to the study the group had an average of 1.3 stones per year. With magnesium/B6 supplementation, stone production was reduced to 0.1 stone per year….a 92% reduction.

          Decreased urinary citrate is found in 20 to 60 percent of patients with kidney stones. This is extremely important since citrate reduces urinary saturation of stone forming calcium salts by forming complexes with calcium. If citrate levels are low, this inhibitory activity is not present and stone formation is more likely to occur. Citrate supplementation has been shown to be quite successful in preventing recurrent kidney stones. Dr Whitaker advises taking 450mg potassium citrate daily or have your doctor write a prescription for Bicitra….a prescription form of sodium citrate, at a dose of one tablespoon (15ml) daily.

    1. john, you may be if you don’t balance it with magnesium. Also depends on the type of calcium you are taking. The inorganic forms, like calcium oxides, are the worst. They aren’t absorbed very well either. Neither is magnesium oxide.

      1. john, this article may help. The relationship of calcium to kidney stones has been controversial. That’s because it’s complicated.
        Calcium – in the Diet – lowers stone formation. The calcium combines with the oxalates and removes them.
        Also depends on whether you are eating a high acid or alkaline diet. Other factors too.
        But calcium supplements are different. Unfortunately, the type most used in studies, is calcium carbonate, basically a rock.
        Not well-absorbed, and can cause stones.
        In patients that need calcium supplementation for medical reasons, I generally use a malate or citrate form.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708574/

    2. Calcium binds to oxalate in the gut and reduces the amount your body absorbs.

      https://www.ncbi.nlm.nih.gov/pubmed/12631085

      Multiple logistic regression analysis revealed that urinary oxalate excretion was significantly associated with dietary ascorbate and fluid intake, and inversely related to calcium intake.

      CONCLUSIONS:

      These findings suggest that hyperoxaluria (too much oxalate in your urine) predominantly results from increased endogenous production and from intestinal hyperabsorption of oxalate, partly caused by an insufficient supply or low availability of calcium for complexation with oxalate in the intestinal lumen.

  6. It is discouraging that diet issues always seem to wind up being so polarized. On the one hand we have a group that says that dietary oxalates are not a problem and the only health issue related to oxalates is kidney stones. On the other, there’s a group that says that oxalates are the cause of all manner of major illnesses, even atherosclerosis.

    I know from personal experience that the first group is wrong. I was consuming sometimes ~ 2 g / oxalates / day – baked sweet potatoes and almond butter for breakfast, spinach and berry smoothies, buckwheat-chia bread, beet chips for snack, etc. I was also struggling with what my mother called ‘the aches and pains’ – fibromyalgia type symptoms – when I got what I think was a kidney stone, dull flank pain and a brief bout of sharp pain, then a rusty red dot in the toilet the next morning.

    So I lowered my oxalate intake drastically and started drinking a lot of lemonade plus potassium bicarbonate and guess what – the generalized ‘aches and pains’ went away. I’m a carrier for a gene associated with Familial Mediterranean Fever – defective pyrin that leads to a trigger-happy NLRP3 inflammasome; this has been linked to fibromyalgia:
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0008480

    Guess what sets off NLRP3 (among other things)? oxalates.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891250/

    So it’s not just how much you absorb, but how sensitive you are to what is absorbed. Further, I would wager that how quickly you clear it is also a factor as well as how much endogenous oxalates you generate.

    I’ve slowly added back some moderate oxalate foods and just try to manage my day to day intake. I feel it when I get stuff wrong, e.g., thinking that since bananas are moderate that plantains are, too – some sources list very high estimates for plantains (524 mg/100 g) – then I check and find out what I ate that had a lot of oxalates.
    ~
    OTOH you have people who say that dietary oxalates are a major cause of CVD – doubtful since consumption of both whole grains and legumes, which tend to be on the high side for oxalate content, show a dose dependent reduction in all-cause mortality – and heart disease is a major killer.

    ~
    What would be most helpful is if we could develop more food ‘hacks’ to reduce oxalate content. For example, I read of taro corm slices being pre-soaked in baking soda solution prior to boiling – unfortunately, the l slices were 2 mm thick. I was wondering, though, if making small cubes of sweet potatoes and treat them similarly would at least get down to more moderate levels of oxalates. Also, an effort could be made to find cultivars and growing practices for reduced oxalate levels in foods (while I’m dreaming, I may as well dream big).

  7. Back in the 1950s, when my dad suffered a kidney stone, they didn’t seem to have much help for the poor patients. Eventually it seemed the stone had passed and his pain ended. But a year or two later he thought he had another stone. This time they discovered the previous episode had destroyed his kidney function and the kidney had atrophied, causing the pain, and it had to be removed.

    A strange benefit came unexpectedly from this experience. The surgery was done in a small town hospital which was actually a converted Victorian mansion. There wasn’t such a thing as a recovery room or critical care unit, or privacy. And everybody, including doctors, smoked, even in hospitals. As my dad was coming out from under the anesthesia, feeling nauseated, someone walked by smoking a cigarette. He smelled the smoke, associated it with his nausea, and never smoked again!

    I have to add a silly note on top of this: My husband once heard a comic suggest a country western song to be called “I’d Rather Pass a Kidney Stone than Spend Another Night with You”.

    1. another silly note (with apologies to Abe Lincoln): when a friend complains about a kidney stone, what to tell her/him: This, too, shall soon pass.

  8. When I went to Israel in 1972 for a year, I got my first oxalate kidney stone. I always wondered if I drank more water during the hot summer maybe I wouldn’t have gotten it. But I passed that stone and came back to the US. I continued to get a kidney stone, once a year for the next 8 years. And then in the 9th and 10th year I got 2 stones each year. Then around 1983, I went on weight watchers to lose 20 lbs and after losing the pounds I decided instead of being on weight watchers for the rest of my life, I would change my diet from the western diet to a low fat, high fiber vegan diet. I have not gotten a kidney stone since the day I made that decision those many years ago (and as a by product my weight has stayed the same since then as well).

  9. I must be one of these oxalate super-absorbers. I had my first kidney stone 18 years ago. After that first stone I continued to pass stones on average once every ten days for the next year! I kept asking my urologist what I could do and he just kept saying drink more water. I finally blurted out, “I’m drinking so much water that my bowel movements are just all water!” He said, “Well, don’t drink that much!” I was in so much pain and so frustrated that I was thinking I didn’t want to live the rest of my life like this (in pain and on the toilet all the time). Then by chance I happened to go to a different GP for something else and at the end of the visit he asked if there were any other health problems bothering me. I said yes, I had constant kidney stones, and he asked if I was on Urocit and I said what’s that?
    He immediately put me on Urocit (potassium citrate) and just as immediately I stopped forming kidney stones.
    After not having a kidney stone for 10 years (on Urocit), not knowing the connection with spinach I went crazy eating spinach one time for about a week to 10 days and got a kidney stone (still on Urocit) after not having one for 10 years! So, I learned my lesson. If I eat spinach one day I try not to have any spinach for the next couple of days.

  10. Yale Rosenblatt, thank you for sharing your experience…. encouraging and helpful to hear you in fact benefitted from the plant based diet. I actually suffered gout one year – probably due to running in hot dry climate at the time and not drinking enough water. I have not suffered gout since partly perhaps because of the high water content of my fruit and veg.

  11. Generally, beet is high in oxalates, but how can it be reduced? Will fermentation of beet (beet kvass) help reduce oxalates content?

    1. I know fermentation making kimchi has a negative effect.

      The overall effect will be to increase the soluble oxalate content of the fermenting mix making them more absorbable. In addition, the liquid removed after fermentation that is drank contains leached oxalates.

    2. Sammy:
      There’re two types of oxalates in food:
      1. water-soluble oxalates (potassium oxalate, sodium oxalate, and ammonium oxalate)
      2. water-insoluble oxalate (calcium oxalate, magnesium oxalate, and iron oxalate)

      Only the water-soluble oxalates can be absorbed by the gut. So, if you cut beets into small pieces and boil them, you should be able to remove most of the water-soluble oxalates from the beets.

  12. I may have posted this before, but: My husband used to get bladder stones every few years; in fact, on one of our first dates (11 years ago), he was passing one!! Poor guy! But, since become ovo-lacto-vegetarian (eating my cooking), then eating plant based whole foods (we both switched), he hasn’t had one — in 11 years!

    He also lost weight (which he wanted to do, as he was overweight), first by practicing portion control as an ovo-lacto vegetarian (30 pounds), then while eating PBWF (another 20). He’s very pleased about that. He’s actually buying some new clothes.

  13. It’s not just the acid forming propensity of animal protein (largely due to the sulfur containing amino acids methionine and cysteine). As Dr. Greger glossed over, urinary oxalates perhaps primarily arise from metabolism of other nutrients, such as supplement level vitamin C, and the amino acids glycine, phenylalanine, tyrosine, and especially hydroxyproline. Hydroxyproline is the modified amino acid found in collagen (animal connective tissue), especially high in gelatin and bone broth, with few other metabolic fates. Experimentally, one can induce increase urinary oxalate in humans by 42% with just 30 g of gelatin, and induce kidney stones in animals with gelatin feeding.

    Holmes , 2007. Origin of urinary oxalate. AIP Conference proceedings
    Knight et al., 2006. Hydroxyproline ingestion and urinary oxalate and glycolate excretion. Kidney int, 70(11), pp.1929-1934.
    Sivalingam et al, 2013. Dietary hydroxyproline induced calcium oxalate lithiasis and associated renal injury in the porcine model. J endourology, 27(12), pp.1493-1498.

    1. Abscorbic acids, which are what most supplemental vitamin C is made of, is a known trigger of kidney stones. Studies found that those who took high doses of vitamin C supplements doubled their risk of getting a kidney stone

  14. Had uric acid stones for years. Thanks to internet information I eliminated meat (purines) 10 years ago and the stones disappeared and haven’t reappeared.

  15. “For example, as evidence that high-oxalate vegetables aren’t a problem for kidney stones (a bold claim, given the wide acceptance of foods like rhubarb and beets as risky for stone formers), Greger cites a paper that doesn’t actually look at the effects of high-oxalate vegetables — only total vegetable intake (pages 170-171).

    Along with stating “there is some concern that greater intake of some vegetables … might increase the risk of stone formation as they are known to be rich in oxalate,” the researchers suggest the inclusion of high-oxalate veggies in participants’ diets could have diluted the positive results they found for vegetables as a whole: “It is also possible that some of the [subjects’] intake is in the form of high-oxalate containing foods which may offset some of the protective association demonstrated in this study” (1Trusted Source).

    In other words, Greger selected a study that not only couldn’t support his claim, but where the researchers suggested the opposite.”
    https://www.healthline.com/nutrition/how-not-to-die-review#section1

    1. In your eagerness to criticise, you may have overstated your case.

      The authors of that article merely wrote ‘may’ and ‘might.’ What is more, you seem to have overlooked the key point in that quote you provided which in fact supports Greger’s point rather than detracts from it ie

      ‘ the researchers suggest the inclusion of high-oxalate veggies in participants’ diets could have diluted the positive results they found for vegetables as a whole: “It is also possible that some of the [subjects’] intake is in the form of high-oxalate containing foods which may offset some of the protective association demonstrated in this study’

      In other words, vegetable consumption is protective and high oxalate vegetables may at worst only ‘dilute’ the positive effects of vegetable consumption.

      I am at a loss to see how this contradicts Dr Greger’s statements.

    2. I don’t even see where he makes any claim like that at all.

      He explains the genetic factor. Eventually he adds other factors like prolonged antibiotic use and gastric bypass.

      But his main point for the rest of us is that avoiding vegetables is not likely to be much of an issue for people who don’t have the higher risk.

      Yes, he uses the study that dropping animal products cuts your risks in half. (As compared to dropping vegetables which makes the risk higher)

      It is not his fault that the study was vegetables in general, but he gave the example that you can switch to kale (or arugula) if you are worried.

      He is constrained by the studies themselves.

      So maybe he cannot make claims like you say he made.

      He can tell the real drop in risk and that is all I see him doing.

  16. Wondering about the impact of a sedentary lifestyle on stone formation. It seems general fitness would be a big factor. Do highly active people get fewer stones?

    1. Hello Rick,

      It would definitely seem that fitness would reduce risk; however, according to this systematic review and meta-analysis, physical activity actually has no impact on stone formation! https://www.ncbi.nlm.nih.gov/pubmed/30066054

      It is important to note, however, that exercise is certainly a part of any healthy lifestyle and has many positive effects outside of kidney stones.

      I hope this helps,
      Matt, Health Support

  17. Oh, I’ve wondered about this question. I had a doctor tell me to stop eating so much spinach because that’s how her niece got kidney stones… (I ignored her.)

    The other big kidney stones question I wonder about a lot is the hardness of the water. I live in a rural area in the Southwest and our tap water is 35 grains per gallon… Lots of locals insist hard water causes kidney stones… I’d love it if you addressed that topic, too, Dr. Gregor!

  18. My urologist prescribes daily calcium, which he says binds with the calcium oxilate and carries it out of the body. He also recommends paying attention to hydration to ensure that CO is flushed from the system. I had three kidney stones prior to his advice.

    1. Calcium?

      Is it Vitamin C?

      I am not saying it as someone who has it memorized.

      I am still solving for how to get any natural Vitamkn D because of CoQ10.

      It is still going to be sixties and rain for this week.

      Rain or overcast and breezy every single day.

      I thought the weather said that we were going to almost get to 90 one of these days, but i must have missed it entirely and now it isn’t even in the forecast.

      1. Yes, it is drink enough water, eat enough foods with calcium and be careful with Vitamin C, stay lower in protein and low sodium.

  19. Could you do an article or video on the best ways to avoid taking in or eating plastics? What are the main sources of plastics getting in to our bodies? What are the best ways to clear plastics from our bodies?

    1. If you mean microplastics,the videos listed in the podcast episode should get you started.
      Then there is the (obvious) avoidance measures like buying re-usable glass/metal straws,glass food containers..
      https://nutritionfacts.org/audio/microplastics-and-you/

      Otherwise just search for plastic in the search box at the top of the page.I agree,a cautious thorough approach with more tips could be good.(not sure if petrochemicals count)

  20. Videos about exotic plant foods that are better at nutrition than what you can get at the supermarket. For example moringa. Promoting them here might improve their popularity and make them available to more people. I feel that there were some really nutritious plants in history but they got lost/extinct for whatever reason. Some help to look for more nutritious varieties of current produce so that people can ask for them.

  21. I was a huge meat eater until I became whole food plant-based four years ago. Unfortunately, I have kidney stones from 10 years ago. Does this mean that I shouldn’t be eating spinach?

    1. I sure hope this organization screens for correct grammar in its volunteer writers. Greger’s is good, but this transcript contains an annoying but common grammatical error. I realize the content is far more important, but there are conventions.

    2. Hello Sheila and thank you for your question,

      I am a family doctor with a private practice in lifestyle medicine and also a volunteer for Dr. Greger on this website. The quick answer to your question is that you should probably limit the amount of spinach you eat, because it has a very high content of soluble oxalates, which are absorbed into your system better than are insoluble oxalates.

      However, my advice about oxalate consumption for someone who has has had a kidney stone depends on what type of kidney stone you had. The most common type (~70%) is calcium-oxalate, which is what I’m assuming. (However, there are several other types: calcium-phosphate–10%, “struvite”–made of Ca, Mg, ammonia, and phosphate–10%, and uric acid (with or without calcium)–5-10%). If your stone did not contain oxalate, you don’t have to worry as much about oxalate content.

      Dietary habits that virtually ALL people who’ve had kidney stones should follow include:

      1) Decrease your “dietary acid load” (DAL). See this video by Dr. G about DAL: https://nutritionfacts.org/video/protein-source-an-acid-test-for-kidney-function/ . The major buffer for acid in your body is calcium, and if you have a high DAL, you will absorb more calcium from your food, some of which winds up in the urine. The best way to reduce DAL, as Dr. Greger mentions, is by eating plants instead of animal foods.

      2) Increase your fluid (water) intake — to about 3 liters per day.

      3) Cut your salt intake: high intake of sodium increases the amount of calcium excreted into the urine. Fruits and vegetables are stone inhibitors, due in part to their high content of potassium, magnesium, citric acid, phytates, fiber, and antioxidants.

      You should know that in general, dietary oxalates have NOT been found to increase risk of kidney stones, in spite of the fact that most urologists still advocate avoiding high-oxalate foods. See this excellent video by Dr. G: https://nutritionfacts.org/video/how-to-treat-kidney-stones-with-diet/.

      If you did have a Ca-oxalate stone, you should limit foods that are very high in soluble oxalates, in particular, turmeric and spinach. See this video by Dr. G: https://nutritionfacts.org/video/who-shouldnt-consume-curcumin-or-turmeric/ — he mentions that consuming curcumin may be preferable to turmeric for those at high risk of kidney stones. Spinach should also be eaten in moderation, as he explains in this video.

      I had a calcium-oxalate stone and I find it hard to figure out what “moderation” means for spinach. So I basically don’t eat it, but if it is present as a salad ingredient, I don’t try to pick out all the spinach leaves. Other foods high in soluble oxalates (but not nearly as high as spinach and turmeric) include: buckwheat, navy beans, peanuts, plantains, and quinoa.

      Beets are high in oxalates but it is mostly insoluble — see this response by Dr. G about beets: https://nutritionfacts.org/questions/oxalic-acid-in-beets/. Likewise, cinnamon is high in oxalates, but mostly is insoluble: https://nutritionfacts.org/video/oxalates-in-cinnamon/.

      So, I hope this helps.
      Dr. Jon
      PhysicianAssistedWellness.com
      Health Support Volunteer for NutritionFacts.org

  22. I am wondering if the spinach oxalates relating to kidney stones could also relate to gout predisposition.
    I consume lots of spinach in smoothie, salad, stir fry, etc. I don’t get stones, but as I grow older, I have some gout issues. Only 3 times in 6 years, but that is too many as any sufferer can attest.
    Thanks for any thoughts regarding.

      1. Small amount. Hardly any dairy. Yogurt and cheese.
        Small portions of meats, not every day.
        Almond milk is beverage for milk.

    1. Hello Barbara,

      According to the study below, there may be a relationship between oxalate stones and gout; however, I failed to find definitive research. Do you consume any meat, dairy, or alcohol? Those are very strongly linked to gout.

      I hope this helps,
      Matt, Health Support

      https://www.ncbi.nlm.nih.gov/pubmed/19779706

  23. Are hemp seeds potentially a problem because hemp is a bioaccumulator of whatever is in the soil? It is used for phytoremediation.

    1. While the video above concentrated on spinach, grape leaves and purslane can also be high in oxalates, while dill is considered low-oxalate.

      I hope this helps,
      Matt, Health Support

      1. May I also ask : When you say dill is considered low oxalate, do you mean as a spice like as a tea spoon? I was thinking of the green dill plant using it instead of other greens in cups….
        God bless you and thank you for your care and patience.

  24. Hi Lale Ann Gokyigit – Dill weed is considered to be a low oxalate food and 1 teaspoon has less than 5 mg of oxalate. Feel free to enjoy either fresh dill weed or as a dried herb!

    -Janelle RD (Registered Dietitian & NutritionFacts.org Health Support Volunteer)

  25. Hi all,

    Is it safe and/or recommended to eat spinach every day due to the high Oxalate content and not knowing if we are super absorbers or not?

    Thanks :)

    1. Hi Brandon,

      I am a volunteer for Dr. Greger. Thank you so much for your question.

      Like Dr. Greger said in the video, if you are blending your spinach up or eating large amounts consistently, it might be best to gradually substitute other greens into your diet, just to be on the safe side. Having spinach once in awhile will not typically cause issues in anyone without a risk for kidney stones, but consistent intake may increase your risk of kidney stones.

      Additionally, I like to keep in mind that green leafy vegetables should ideally be our richest source of calcium. Spinach contains a lot of calcium, but very little is absorbed due to how it binds with the oxalates. Therefore, spinach is not a reliable source of calcium whatsoever. This means that we should ideally be relying on other green leafy vegetables for our calcium intake.

      I hope this helps answer your question!

      1. Mixing cooked spinach with rye or barley malt extract, some acidic medium (fruit juice, hibiscus tea?) and some lukewarm water for a few hours might turn the oxalate to peroxide. The peroxide will break down by reacting to the spinach. It’s a theory; don’t try it.

  26. Re: oxalates in spinach. I had been eating a handful or two most mornings, along with some avocado, mushrooms and onions and a big squeeze of lemon juice on sourdough. (It’s an awesome sandwich) BUT, on a recent brain MRI, whilst looking for metastases (they didn’t find any), the radiologist did find some “microcalcifications”. Can this be a result of the oxalates? None of my doctors can say where these have come from or what may have caused them, and they weren’t there a year ago. I’ve since switched to kale instead of spinach (go Superfood!), but the question keeps popping up in my mind. Thoughts?

    1. Hi, Jen B. There is nothing about dietary oxalate and brain calcification (micro or otherwise) in the medical literature, so I am inclined to say probably not. I would be interested to know what your next brain MRI (if you have one coming up) will show since you switched from spinach to kale. Wish I had a better answer for you, but we don’t know, until we put it to the test!

  27. Amaranth vegetable leaves are very common in some areas than spinach, does anyone know if there is any video on amaranth leaves and oxalates and possibly its nitrate level?

  28. Hi, I have been plant based for 3 years and last year I started getting kidney stones. I just got tested for oxolate secretion and my oxolates are insane… 977 umol/d. Essentially, through the roof. The pain from the attacks is debilitating and makes me vomit. I don’t eat meat or eggs or any dairy and I don’t eat spinach, swiss chard, or beet greens!
    Help. :(

    1. Hi, Avigayil Morris! I am sorry you are having to deal with kidney stones. You have said what you don’t eat. It would be helpful to know what you do eat. While we cannot provide individualized nutrition counseling here, we can offer some suggestions that may be helpful. It is difficult to know what is causing your problem without more information. You may want to consult a plant-based dietitian or nutritionist. If you are taking vitamin C supplements, you should discontinue those, as they contribute to oxalate production in the body. More on that here: https://nutritionfacts.org/video/do-vitamin-c-supplements-prevent-colds-but-cause-kidney-stones/ You can find everything on this site related to oxalates here: https://nutritionfacts.org/topics/oxalates/ I hope that helps!

  29. I recently read that blueberries are high in oxalates. Is this true? Anything to worry about? I eat a cup of them a day.
    Typically frozen as I buy organic frozen ones when out of season.
    Thank you

  30. Paul,

    This is another of the devils in the details. It appears that raspberries not blueberries are really in the high level……with that said I’d like to refer you to an interesting article from the University of Chicago, that may shed light on the subject. https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/

    Keep in mind that only those with a genetic issue, upset gut bacteria or really excessive amounts coupled with low calcium and water intakes are the primary risk group. Have your blood/urine checked should this issue be a concern.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

    1. Great! Thank you very much for your reply. I will read the article. There are so many misleading things out there which is why I love this site and its dedication to the facts based on studies:)
      Again thank you.

  31. Hello, I’ve been plant-based for 3 years now. And I had a kidney stone back in 2017 and I didn’t think much of it. Now earlier this year I started having symptoms similar to my kidney stone attack, this includes stomach, abdominal, testicle pain, lower back, side pain. I also had my first panic attack ever and read that it’s not so uncommon if you have kidney problems. Unfortunately, most staples like potatoes, carrots, oats, beans, legumes, nuts, soy are pretty high in oxalates so I’m now worried I cannot be 100% plant-based anymore. I did have a CT scan and it showed no kidney stones but I get fewer symptoms when I eat low oxalate foods and feel better after I’ve gone to the bathroom and done the deed & drink lemon water. I’m confused in all honesty and seeking advice since my doctors can’t seem to help me at the moment as they don’t know either.

  32. Hi MJ – Thanks for your comment and I am sorry to hear about your reoccurring symptoms. I’ve worked in a kidney stone clinic beside a urologist and all of the dietary recommendations we discuss with patients are in alignment with a more plant-based style of eating to help reduce kidney stone formation. Here are some recommendations to offer guidance on the certain plant foods to limit/avoid and to reassure you that a plant-based diet is still beneficial:

    1) Decrease sodium intake: WFPB diets are naturally lower in sodium. Focus on choosing mostly fresh foods over processed. Closely read nutrition labels on canned/packaged items and aim for foods that contain <140 mg/serving. Avoid added salt completely and freely use any herbs/spices or sodium-free seasoning blends like Mrs. Dash.

    2) Drink plenty of water: Talk with your urologist about your personal fluid goals. Larger amounts of fluid are often needed to increase urine output. It is important to be consistently drinking every 1-2 hours throughout the whole day versus drinking a ton of water in one sitting. Setting an alarm can help keep you on track.

    3) Increase citrate: It is so important to eat a minimum of 5 servings of fruits and veggies every day to increase citrate intake. Adding fresh lemon or lime juice to water, or freezing fresh lemon juice in ice cube trays are other ways to boost citrate. The more fruits and veggies, the better.

    4) Decrease oxalates: You're right that certain plant foods contain higher amounts of oxalates that can increase kidney stone formation in those at risk. It is not possible to avoid oxalates completely because they're found in most plant foods but in varying amounts. The big goal is to LIMIT those foods containing large amounts of oxalates. So while boosting fruit/veggie intake, keep in mind certain ones to limit including spinach, potatoes in any form (baked, chips, fries, mashed), nuts/nut butters, beets, and rhubarb. You do not need to avoid other plant-based foods that contain some oxalates.
    (Here's a video for more on this topics: https://nutritionfacts.org/video/kidney-stones-and-spinach-chard-and-beet-greens-dont-eat-too-much/).

    5) Decrease purines: All meats, poultry, and and fish are high in purines and contribute to uric acid formation in the body. For this reason, limiting meat as much as possible is recommended, whether that means adopting a plant-based diet or eating very small amounts of meat only a few times per week. Therefore, it is best to keep focusing on plant-protein sources such as all beans, lentils, soy, and chickpeas. Avoiding alcohol can help reduce uric acid formation as well.

    I hope these tips help!
    -Janelle RD (Registered Dietitian & NutritionFacts.org Health Support Volunteer)

    1. Hello there, thanks for your response. Most of this information for me I already knew about, I’ve increased my water intake, occasionally have Lemon water whenever I feel like I’m not feeling too well. I have about a tablespoon of peanut butter on my oatmeal, a little less than a handful of walnuts. Do you think that’s ok? How much do I need to limit foods like soy, beans, lentils, chickpeas, potatoes, carrots etc? And is calcium important, and how do I make sure I get enough on my plant-based diet?

  33. HI Vec – Thanks for your question and sharing that research article! Parsley is categorized as a higher oxalate-containing leafy green along with spinach, collard greens, beet greens, rhubarb, and Swiss chard. I looked further into some of the research on parsley and kidney stones and also found that it may be beneficial in reducing kidney stone formation (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877626/). However, much of this research has been done in rats so it is limiting and difficult to apply to humans until we know more.

    Because of this, it is best to not overdue it on parsley and instead focus on other recommendations for reducing kidney stones:
    1) Drink tons of water
    2) Increase citrate from foods –> oranges, lemon, limes, and plenty of other low oxalate fruits/veggies
    3) Decrease sodium intake
    4) Decrease purines
    5) Decrease other high oxalate foods

    I hope this helps!
    -Janelle RD (Registered Dietitian & NutritionFacts.org Health Support Volunteer)

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