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Urinary Health
low-oxalate diet

Oxalate is a naturally occurring substance found in plants and animals. It is found in certain foods that you eat and is also made in your body. Most people do not need to be concerned about the oxalate in their diet. However, if you have ever had a calcium oxalate kidney stone, your doctor may have recommended that you follow a low-oxalate diet to help lower your risk of developing another painful kidney stone. In this article, we will discuss the role of oxalates in kidney health, provide tips on how to reduce your intake and give you some low-oxalate recipes.

How is Oxalate Related to Kidney Stones?

Kidney stones can cause severe pain, blood in the urine, and a constant need or inability to urinate as the stone passes through to be excreted. According to the National Kidney Foundation, calcium oxalate stones are the most common type of kidney stones. These can form when there is too much oxalate, or too little fluid intake, causing the oxalate to bind to calcium and form crystals which can then stick together and form into stones. Risk factors include family history, obesity, and certain medical conditions.  Eating a diet too high in protein, salt, and sugar, as well as not drinking enough fluid, can also increase the risk of forming kidney stones.

Should I Follow a Low-Oxalate Diet?

If you have had calcium oxalate kidney stones, and your urinary oxalate level is high (as determined by a 24-hour urine test), you may benefit from a low-oxalate diet. Switching to a low oxalate diet may help reduce your risk of forming another stone.

The idea behind a low-oxalate diet is to lower your dietary intake of oxalate, making less oxalate available for absorption in your intestinal tract. This results in less oxalate in the urine and reduces the risk of calcium oxalate kidney stone formation.

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What Is a Low-Oxalate Diet?

There is no agreement on the level of oxalates that are acceptable in a low-oxalate diet. There is also disagreement as to the exact oxalate content of certain foods.  However, according to the University of Chicago, a reasonable goal for intake of oxalate is below 100 mg per day, and ideally below 50 mg per day.

So, what does that mean? To make this more understandable in practical terms, the University of Pittsburgh Schools of the Health Sciences created an educational handout highlighting the foods with high, moderate and low oxalate content; and a recent update by the University of Chicago provides the most accurate lists to date. A good rule of thumb is to avoid the highest offenders, some of which contain over 700 mg of oxalate per serving.

Some very high-oxalate foods include:

  • chocolate or cocoa
  • spinach
  • rhubarb
  • beets
  • wheat germ
  • black teas (not green or herbal)
  • some tree nuts (almonds, cashews, and hazelnuts are highest in oxalate)
  • legumes (beans, peanuts, soybeans)

These foods may increase urinary oxalate levels. Generally, when you avoid these foods, the oxalate content of other foods will fall within the amount recommended for calcium oxalate stone formers.

For further guidance, refer to Table 1 (below).  Choose low-oxalate foods that provide 0-2 mg per serving for most meals and snacks. In general, moderate oxalate foods can be eaten twice daily. Choosing low-oxalate foods will keep your intake below the recommended level.  Avoid high-oxalate foods on a regular basis.  If some of your favorites fall into this category, try to save these foods for special occasions.

Table 1. Foods to Choose and Avoid. Adapted from University of Pittsburgh Schools of the Health Sciences  and the University of Chicago Update.

Food GroupsLow-Oxalate Foods
(Choose from These)
Moderate-Oxalate Foods
(Limit to Twice Daily)
High-Oxalate Foods
(Avoid These)
BeveragesCoffee, Sweetened Instant Iced Tea

Water, Fruit Punch, Gatorade, Kool-Aid, Lemonade, Soda,

Apple Juice, Cranberry Juice Cocktail, Orange Juice, Mango Juice, Pineapple Juice, Beer, Red/White Wine
Prune JuiceBlack Tea, Hot Chocolate, Chocolate Milk, Dark Beer
Dairy & SubstitutesButter and Margarine, Cream Cheese, Cheese, Coffee Creamer, Milk, Sour Cream, Whipped Topping, Yogurt Soy Milk, Soy cheese, Soy yogurt
Fruits & BerriesApples, Apricots, Bananas, Cantaloupe, Cherries, Grapes, Honeydew Melon, Lemon, Lime, Mango, Nectarines, Papaya, Peaches, Pears, Pineapple, Plantain, Plums, Raisins, WatermelonFigs

Canned Cherries

Orange (no peel)
Berries (Blackberries, Blueberries, Raspberries, Dewberries, Elderberries, Gooseberries)

Tangerines, Dates, Kiwi, Grapefruit

Dried Figs, Dried/Canned Pineapple, Dried Prunes

Rhubarb
VegetablesBok Choy, Broccoli, Cabbage, Cauliflower, Corn, Cucumber, Green Pepper, Lettuce (Iceberg or Romaine), Mushrooms, Onions, Peas, Pickles, Sauerkraut, Yellow Zucchini, SquashAsparagus, Artichokes, Cooked Carrots, Mixed Frozen Vegetables, Olives, String Beans, TomatoesBeets, Brussels Sprouts, Carrots, Celery, Okra, Parsnips, Potatoes, Rutabaga, Spinach, Turnips, Yams
Beans & NutsHummus

Flaxseeds
Beans (Fava, Kidney, Navy, Red, Soy, and Refried Beans

Nuts (Almonds, Cashews, Hazelnuts, Peanuts, Pecans, Pistachios, Mixed Nuts, Trail Mix, Walnuts

Pumpkin Seeds, Sunflower Seeds
Breads & CerealsCorn Bread, Oatmeal Bread, Oat Bran Muffins

Cheerios, Corn Flakes, Rice Crispies, Special K, Honey Bunches of Oats, Quaker Oat Life
Biscuits (Plain and Buttermilk), Bran Muffins, Cracked Wheat Bread, English Muffin (Regular, Multi-grain & Wheat), Rye Bread, Tortillas (Corn & Flour), Whole Oat Bread, Whole Wheat BreadBlueberry Muffins, English Muffins (Whole Wheat)

All-Bran Original, Frosted Mini-Wheats, Fiber One, Kashi Go Lean, Raisin Bran

Wheat Germ
Pasta, Rice, & GrainsMacaroni & Cheese

White Rice

Oat Bran
Couscous

Cornmeal, Millet
Brown Rice, Barley flour

Bulgur, Corn Grits, Rice Bran, Wheat Bran
Meat, Meat Replacements, Poultry, & SeafoodBacon, Beef, Chicken, Corn Beef, Eggs, Ham, Pork, Turkey, Venison, Wild Game

Shellfish

Fish (except sardines)
Hot DogsSoy Burgers, Tofu
Desserts & SnacksCustard, Popsicle, Oatmeal Cookies, Jello, Tapioca Pudding, Vanilla Pudding, Frozen Yogurt & Sherbert, Ice Cream

Fig Bars, Rice Crispy Treats, Rice Cakes, Saltines, Triscuits, Graham Crackers, Wheat Thins, Popcorn, Ritz Crackers
Pies

Tortilla Corn Chips
Chocolate, Chocolate Cake, Chocolate Chip Cookies, Brownies, Candy with Nuts, Chocolate Syrup, Fudge Sauce

Potato Chips

Pretzels
Other FoodsChicken Noodle SoupBeef Vegetable SoupLentil Soup, Miso Soup

Stevia

Practical Tips to Lower to Risk of Kidney Stone Formation

In addition to following a low-oxalate diet, here are some additional tips to help reduce your risk of kidney stones and optimize your urinary health:

  • Drink 10-12 (8-oz) cups of fluid daily, half of which should be water. Remember to drink extra fluids in hot weather or during exercise. This will prevent dehydration and dilute the urine.
  • Eat 2-3 servings of a dairy food daily; if you take calcium supplements, do so with food. Calcium will bind with oxalate in the stomach and intestine and limit absorption.
  • Eat at least 5-9 servings of fruits and vegetables daily. Intake of potassium, fiber, magnesium, antioxidants, phytate and citrate, all naturally occurring in fruits and vegetables, may help keep kidney stones from forming.
  • If you take vitamin C supplements, limit to no more than 500 mg daily. Vitamin C is converted to oxalate by the body.
  • Limit your intake of meat, fish, and poultry. Your daily protein needs can usually be met with 2-3 servings a day of a protein source the size of a deck of cards. Choosing vegetable protein sources a few times per week can also help. High protein intake may increase the risk of kidney stone formation.
  • Limit salt intake. Avoid using the salt shaker and go for fresh or frozen foods, rather than processed, convenience and fast foods. You can also follow the DASH diet if you choose.

Low-Oxalate Recipes

If you have had a kidney stone, you are at a higher risk for forming another one. Follow the tips and incorporate the recipes below to decrease your risk of forming another calcium oxalate kidney stone.

Low-Oxalate Coleslaw

Servings: 4-6
Author: Chef Matt

Ingredients:

  • Salad Mix
  • ½ head of green cabbage, thinly sliced or shredded
  • 8-10 radishes, thinly sliced
  • ½ cup of sliced green onions
  • ½ cup of thinly sliced red onions (optional)

Dressing:

  • ½ cup of high-quality mayonnaise
  • 2 Tablespoons of grainy Dijon mustard
  • 2 teaspoons of honey
  • 2 Tablespoons of white wine vinegar
  • Salt and pepper to taste

Directions:

  1. Whisk together the ingredients for the dressing and toss with the salad mix.
  2. Mix together well and season with salt and pepper.

Low-Oxalate Chicken Jambalaya

Servings: 4-6
Author: Chef Matt

Chicken:

  • 1.5 lbs of chicken breasts
  • 1 teaspoon of Garlic Salt
  • 1 teaspoon of Chili Powder
  • 1 teaspoon of Montreal steak spice
  • Salt and pepper to taste
  • 2 Tablespoons of Olive Oil

Jambalaya:

  • 2 cups of White or Wild Rice
  • 4 cups of chicken stock
  • 1 red pepper 1/4″ dice
  • 1/4 white onion 1/4″ dice
  • 1/2 cup of green peas
  • 1 teaspoon of Chipotle Powder
  • 1 teaspoon of dried basil
  • 1 teaspoon of chili powder
  • 1 cup of Canned Chopped Tomatoes
  • 2 cups of Tomato Sauce
  • 2 Tablespoons of Olive Oil
  • Salt and pepper to taste

Directions:

  1. Cook the rice according to the instructions on the box. Use the chicken stock in place of water.
  2. Heat up on high heat a large saute pan with the 2 Tablespoons of olive oil.
  3. Season the chicken breasts well with the spices and sear in the pan until golden brown.
  4. Add in the peppers, onions, and the jambalaya spices to the pan and put into a 375 degree F oven and cook until the chicken is cooked to 165 degrees F.
  5. Take the chicken out of the pan and set aside. Keep warm.
  6. Make sure the spices are well cooked out and then add in the chopped tomatoes, tomato sauce, and peas and let come to a simmer.
  7. 7. Add in cooked rice and mix together well. Serve on plates with slices of chicken on top.

Low-Oxalate Protein Balls with Cherries and Bananas

Servings: 12 balls
Author: Chef Matt

Ingredients:

  • 4 bananas, peeled and cut in half lengthwise
  • 4 tbsp butter, room temperature, cut into small cubes
  • 1 cup banana chips
  • 4 rice cakes, white or whole wheat
  • 1/2 cup raisins, sultana
  • 3/4 cup canned cherries, chopped
  • 1/2 tsp real vanilla extract
  • 1/4 tsp ground cinnamon
  • 1/4 tsp cayenne pepper
  • 1 egg white

Directions:

  1. Heat up your oven to the broil setting. Sprinkle the cinnamon and cayenne on the banana halves and put on a baking tray. Broil for 5-7 minutes or until the bananas are well caramelized. Set aside to cool.
  2. Set the oven to 350 degrees. Blend the bananas with 2 tbsp. of the cubed butter in a food processor until smooth. Set aside.
  3. Blend the banana chips in the blender until the desired consistency has been achieved. Add in the rice cakes and pulse until chunky, and not too smooth. Put on a baking tray and bake in the oven until crispy, about 10 minutes.
  4. Mix together the banana mixture, and the rice cake mixture with the rest of the ingredients. Mix well to incorporate all ingredients.
  5. Make 1-2 oz balls and bake in the oven for 10 minutes until the protein balls have set. Let cool and enjoy.


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