Dietary Strategies for Kidney Stone Prevention: Emphasizing Citrate Intake

Kidney stone formation, particularly calcium oxalate stones, is a prevalent health concern. A key preventative strategy involves increasing urinary citrate levels. Citrate, a naturally occurring substance, inhibits stone formation by binding with calcium, thus reducing the likelihood of calcium oxalate crystallization¹. While citrate supplements are available, dietary modifications offer a natural and effective approach to increasing citrate excretion, as recommended by the American Urological Association ².

The cornerstone of this dietary approach is increasing the consumption of fruits and vegetables while moderating non-dairy animal protein intake. Meat, a significant source of dietary acid, can contribute to lower urine pH, a risk factor for stone formation. Conversely, fruits and vegetables provide alkali, which helps raise urine pH.

High animal protein intake prompts the body to utilize buffering substances like citrate and malate to neutralize excess acid, limiting citrate availability for urinary excretion. Conversely, a diet rich in fruits and vegetables promotes ample citrate excretion due to reduced acid load ³.

Fruits and vegetables naturally contain small amounts of citrate and malate, further contributing to increased citrate levels with higher consumption. Citrus fruits, strawberries, apples, grapes, pumpkin or sunflower seeds, bell pepper, cucumber, carrots and tomatoes are a few examples of citrate-containing foods. 

Fruit juices, such as orange, lemon, pineapple, and even cranberry ⁴, are excellent sources of citrate. However, due to their sugar content, juice intake should be limited to 4 ounces daily, as excessive sugar can paradoxically increase urinary calcium excretion, potentially promoting stone formation ⁵.

Citrate is also found as a food additive in some processed foods and beverages, enhancing flavor and shelf life. While products like Crystal Light Lemonade and certain diet sodas (e.g., diet 7-Up, diet Sprite) contain citrate, prioritizing whole fruits and vegetables is recommended. Although artificial sweeteners in diet beverages are generally recognized as safe, moderation is advised.

Citrate supplements, available as beverages or pills, may be recommended by a physician or registered dietitian based on individual patient history and 24-hour urine analysis results. Such supplements are best used under professional guidance.

For individuals in the state of Florida seeking expert guidance on kidney stone prevention, our team is ready to help.  We invite you to schedule a complimentary 15-minute discovery call to discuss your needs.

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References: 

1)      Ennis JL Asplin JR. The role of the 24-hr urine collection in the management of nephrolithiasis. Int J Surg. 2016;36(pt D):316-324.

2)      Pearl MS, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324.

3)      Demigne C, et al. Organic anions and potassium salts in nutrition and metabolism. Nutr Res Rev. 2004;17(2):249-258.

4)      Halenlain GE, et al. Assessment of citrate concentrations in citrus fruit-based juices and beverages: implications for management of hypocitraturic nephrolithiasis. J Endourol. 2008;22(6):1359-1366.

5)      Yin S, et al. Association between added sugars and kidney stones in US Adults: data from National Health an dNutrition Examination Survey 2007-2018. Fron Nutr. 2023(10):1226082.