Table 1.

Dietary recommendations to prevent kidney stone recurrence.

Dietary component	Recommendation
Fluid	Maintain fluid intake that achieves urine volume ≥2.5 L daily
	Limit sugar-sweetened soft drinks
	Consider intake of orange juice with no added sugar to prevent calcium nephrolithiasis
Calcium	Avoid severe dietary calcium restriction
	Maintain calcium intake of 1000–1200 mg/day
Oxalate	Avoid oxalate rich foods (nuts, chocolate, brewed tea, spinach, rhubarb, beets, potatoes, peanut butter, wheat bran, beans)
	Avoid juices with cranberry, grapefruit, starfruit
	Maintain normal calcium intake
Protein	Modestly restrict animal protein (red meat, fish, poultry, pork, shellfish) to no more than 6–8 ounces daily
Carbohydrate	Restrict refined carbohydrates to <20 g/day
Sodium	Limit sodium intake to ≤100 mEq/day (2300 mg/day)
Citrate	Increase intake of fruits and vegetables, orange juice is beneficial
Calcium supplement	Consider for enteric hyperoxaluria (take with the two largest meals) but avoid for idiopathic calcium stone disease if dietary calcium intake is sufficient
Vitamin B6 supplement	Consider for primary hyperoxaluria type 1, but not proven for idiopathic causes
Vitamin C supplement	Limit intake of vitamin C to <2 g/day
Vitamin D supplement	Should not be withheld solely on the basis of stone disease. If deficient and repletion is indicated, monitor with 24 h urine analysis.
Low carbohydrate/high protein diet (Atkins)	Avoid (increase in net acid; hypocitraturia; hypercalciuria, hyperuricosuria)
DASH diet	Likely protective against stone disease
Mediterranean diet	Likely protective against stone disease (inferred from similarities to DASH diet)

DASH, dietary approaches to stop hypertension.