kidney stones & diabetes

Kidney Stones and Diabetes: What YOU Can Do

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What is the relationship between kidney stones and diabetes? There is a lot to know about the relationship between kidney stones and diabetes. And, what you can do to control both conditions.

Kidney Stones and Diabetes: The Relationship

It has been well established that people who have diabetes are more likely to have kidney stones. (1,2,3) A large study using information from the National Health and Examination Survey found that people with diabetes were up to 59% more likely to have kidney stones compared to people without diabetes.(2)

In addition, the more poorly controlled diabetes is, the higher the risk of kidney stones becomes.(4)

Why Is There a Higher Risk of Kidney Stones in Diabetes?

Acidic Urine

The primary reason people with diabetes are at higher risk of kidney stones is that they tend to have more acid in their urine.(5) Type 2 Diabetes is characterized by insulin resistance, or the inability to use insulin effectively. Insulin resistance makes it harder for the kidneys to produce ammonium, which causes urine to be more acidic. From clinical studies, we know that people who have diabetes do actually have lower urine pH (or, more acidic urine) compared to people without diabetes.(6)

Certain types of kidney stones love to form in acidic urine. Most notably, uric acid kidney stones are more likely to form when the urine pH is too low. This makes sense, as people with diabetes are at especially high risk of uric acid stones, specifically.(7,8)

Higher Urine Calcium

Although people with diabetes are at highest risk of uric acid kidney stones, they also have risk factors for calcium kidney stones.(9) Insulin resistance increases the amount of calcium in urine.(10) High urine calcium is a risk factor for calcium kidney stones.(11) In addition, higher acid in urine (as is found in diabetes), increases the risk of calcium oxalate stones.

Low Urine Citrate

People with diabetes may also have low levels of urine citrate. High acid in the urine is associated with inadequate citrate. Citrate is a good thing because it makes it more difficult for calcium kidney stones to form. Therefore, low urine citrate is a risk factor for kidney stones as well.(11)

Healthy Eating For Kidney Stones and Diabetes

A healthy lifestyle is key for people with kidney stones and diabetes. Eating healthfully can significantly improve both health conditions. However, it can sometimes feel overwhelming to figure out what is healthy for both kidney stones and diabetes. Shuffling through endless lists of “dos” and “dont’s” can be frustrating.

Healthy eating for kidney stones and diabetes doesn’t have to be that complicated. Luckily, there is more in common between the kidney stone and diabetes diets than there are differences.

Venn diagram showing that both the uric acid kidney stone and diabetes diet focus on non-starchy vegetables, low sodium, lowfat or fat free dairy, controlled portions lean protein, heart healthy fats and low added sugar.  In addition, a high fluid intake for kidney stones and controlled portions healthy carbohydrate for diabetes are important.

Food Choices for Kidney Stones and Diabetes

Here are my 6 key points for healthy eating for kidney stones and diabetes.

Drink Water Throughout The Day

A high fluid intake is the most important thing to reduce the risk of kidney stones. Ideally, drink enough fluid to make at least 2 1/2 liters of urine per day. For most people, this means drinking 3 liters of fluid each day.

Ideally, fluid should be drunk consistently throughout the day. For example, if you drink all (or most) of your fluid in the morning, you are at risk for lower urine volume (and higher risk of kidney stone formation) the rest of the day.

Focus on fluids that do not have added sugar. Of course, water is the best choice. But, unsweetened sparkling water and infused water is a great way to mix it up! My favorite brands are LaCroix*, Spindrift* and Bubly*.

For people who are into techy solutions, a “smart” water bottle may be a good option. The Hidrate Spark* water bottle connects to a phone app and reminds you to drink by lighting up and tracks your water consumption.

Eat Lots Of Vegetables!

Make sure every meal includes at least one vegetable. For most people, all non-starchy vegetables are wonderful choices! Non starchy vegetables are essentially any vegetable except corn, green peas, potatoes and winter squash. These vegetables have more carbohydrate, and would be great healthy carbohydrate choices.

Many people ask about oxalate and kidney stones. Because most people with diabetes make uric acid kidney stones, they will not need to be concerned with oxalate. Only a 24 hour urine test will be able to tell you if you should limit how much oxalate you eat. Learn more about oxalate and healthy eating for calcium oxalate kidney stones.

Include a Little Healthy Protein with Meals

A healthy serving size is different for everyone, but for most people should aim for portions 3-6 ounces. Avoid large portions of meat, poultry, fish & seafood. Lots of animal protein can worsen both calcium and uric acid kidney stones. However, healthy portions of animal protein are especially important for uric acid kidney stone prevention. And, uric acid stones are the most common type of kidney stone in people with diabetes.(7,8)

Great lean protein choices include: chicken or turkey breast, boneless pork, fish & seafood, lean beef or eggs. If you prefer plant proteins, garbanzo beans, kidney beans, black eyed peas, lentils, pecans, walnuts and sunflower seeds are lower oxalate choices.

Avoid processed meats such as cold cuts, bacon, sausage, pepperoni, bologna, ham and corned beef. Not only are these meats high in sodium, but they also tend to be loaded with purines. Purines break down to uric acid, increasing risk of uric acid kidney stones. Other foods high in purines include: beer, organ meats and large amounts of red meat & seafood. People who have gout should also avoid large amounts of purines.

Add a Little Healthy Carbohydrate

Even for people with diabetes, carbohydrates are an important part of a healthy diet. The key is portion size and choosing healthy carbohydrates. Healthy carbohydrate choices are:

  • Fruit
  • Starchy vegetables (corn, green peas, potatoes or winter squash)
  • Healthy whole grain such as whole grain bread, whole grain pasta or brown rice.

For most people, healthy portion sizes are around:

  • 1/3-1/2 cup
  • 1 slice of bread
  • 1 medium piece of fruit

Work with your dietitian to know exactly what portion sizes are right for you.

Pair Your Meals with Dairy

Dairy reduces the risk of calcium oxalate kidney stones. In addition, lowfat or fat-free dairy is an important part of a general healthy diet. Good dairy choices include:

  • Lowfat or fat-free milk
  • Yogurt
  • Low sodium cheeses such as mozzarella, Swiss, goat and ricotta

Check out my eCookbook for recipe ideas to include dairy in your meals.

Cook at Home More Often

Cooking at home, from fresh ingredients, allows you to control added salt and sugar. Foods prepared at restaurants, grocery stores and fast foods tend to have lots of sugar and salt added to them.

Example Meal Plan for Kidney Stones and Diabetes

Here is a meal plan to give you some idea of what a healthy meal plan looks like. Healthy portion sizes will depend on how much energy your body needs.

Day #1Day #2Day #3Day #4
Scrambled eggs w/ cheese and onions & peppers
Slice whole wheat toast w/ unsalted butter
Lowfat plain yogurt with grapes and granolaOatmeal made with milk and strawberries
LunchSouthwest Grilled Chicken Salad with romaine, grilled chicken, peppers, cucumbers, corn, onion and a homemade yogurt dressingAvocado Egg Salad sandwich with cheese
Marinated cucumber salad
Low sodium lentil soup
Side salad w/ low sodium dressing
Low sodium turkey sandwich with cheese
Celery & carrot sticks
DinnerHoney Mustard Salmon
Brown Rice Pilaf
Frozen yogurt
Couscous Stuffed Peppers
Side Salad
Low Sodium Pork Stir Fry
Brown Rice
Low Sodium Sloppy Joes
Side salad
Cheddar cheese
Yogurt with melonLow sodium popcornString cheese

Other Healthy Habits

Other than diet, there are many things you can do to improve blood sugar levels. By improving blood sugar, you can improve insulin resistance and reduce your risk factors for kidney stones, and other complications from diabetes.

All of these habits can help improve blood sugar. These types of lifestyle changes are often overlooked, but have a huge impact on overall health.

  • Exercise! Each week, try to do some resistance exercise (weights, yoga, etc.) and some cardiovascular exercise (running, dancing, swimming, etc.). Resistance and cardiovascular exercise have different benefits. Resistance exercise may be most beneficial for insulin resistance.(12) Per week, The American Heart Association recommends at least 75 minutes of vigorous aerobic activity (or 150 minutes of moderate intensity aerobic activity), in addition to two sessions of resistance exercise.
  • Get enough sleep (13)
  • De-stress yourself (as much as you can!). Believe it or not, psychological stress is actually a risk factor for diabetes. (14) Even small things like taking 5 minutes per day to meditate, or making it a practice to call old friends once per week can make a huge difference. More ideas to reduce stress.
  • Stop or reduce smoking (15)
  • Control how much alcohol you drink.(16) If you do choose to drink, limit alcohol to no more than 1 drink per day for women and 2 drinks per day for men. Beer can increase the risk of uric acid stones, so other alcoholic drinks are better choices.

Happy Eating!


4 thoughts on “Kidney Stones and Diabetes: What YOU Can Do”

  1. I keep hearing of research recommending a low carb, almost keto diet for diabetes. This is evidence based research. but, what I can never find is what carbs did the carb group eat? Was it healthy whole grains, legumes, and whole fruit? Or white bread and OJ? Has any research compared a healthy high carb diet with keto for diabetes?
    personal experience: I dropped my A1c 0.2 points by portion control, no snacking on carbs, and eating my fruit to the end of the meal. I continued to eat 3 whole grains, 3 whole fruit, and 1 legume daily. Didn’t give up my starchy veggies, either.

    1. Melanie Betz MS, RD, CSR, FAND

      Hi Kim! I am not an expert in diabetes, so this is a much better question for someone who is. However, I do have quite a bit of experience working with people with diabetes. A keto diet can certainly help get that A1c down. But the question always is – is this something you can do for the rest of your life? If no, what is the point? It will temporarily reduce that A1c, but perhaps put other aspects of your health at risk (such as a higher risk of stones). It sounds like your approach is working for you, and sounds like a much healthier and sustainable way to go than keto.

  2. Thank you for your information on this site. My 13 year old suffers from both T1D and calcium oxylate stones. His pain is constant!! He is taking pain meds! Dr’s cannot figure out what is going on with him. I got him approved to go to Boston ( we live in Naples, FL). we have been up there in October. Now awaiting surgery for a cyscoskopy on Jan 25 to see if there is scar tissue up there from previous surgery. Have you ever heard of a child huting chronically from burning when urinating and flank pain. He does pass stones on his own. He refuses to go to ER here in Florida because the pediatric urologist says its ( AMPS) in his head?? it is definitely not. Everytime he urinates he screams. It has been like this for 11/2 years!! I am trying with the diet!! He drinks tons of water. I appreciate any feedback. Anna

    1. Melanie Betz MS, RD, CSR, CSG

      Hi Anna. I am SO very sorry to hear about your son. Kidney stones in children are especially heartbreaking. I really can’t know what would be best for him without working with him and understanding his medical history a bit better. It sounds like you are going to a stone prevention program in Boston? I’d ask to see if they work with a dietitian (they should!) that could help your son understand what to eat.

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