When life gives you lemons ... make lemonade! - Not the sugary bottled drinks or those from frozen concentrate but from freshly squeezed lemons as the source for natural citrate.

Unlike grapefruits and oranges, the citric acid from lemons and limes contain the highest concentration needed to raise urinary citrate levels significantly to bind with calcium to prevent crystallization of new stones from forming and small stones from growing larger.

Increase your citrate levels = Lower urinary oxalate

Studies have found that 4 oz of lemon juice or 32 oz of lemonade per day is needed to offer the best prevention. While you can drink it straight, the good thing about lemons and limes is it versatility to go with most everything. You can make a bottle of lemonade with low sugar or sugar free to drink from. You can also start your day with your 4 oz freshly squeezed in a small jar or freeze it in an ice tray. Throughout the day spoon a little (or a cube) into every glass of water you drink, on your vegetables, salads, dressings, gravies, soups, meats etc. You’re going to be surprised how fast 4 oz can disappear. Try it! If you cook, you’ll quickly learn one of the key ingredients to making Ceviche, and many Mexican or Southwestern dishes is lime juice which works just as well.

Too much sodium (salt) in your diet decreases your urine output while increasing the amount of calcium excreted in your urine for stones to form.

The lower the amount of salt consumed = the lower your risk for stones to form.

Before you pick up the salt shaker, taste your food then ask yourself ‘does it really need more salt’? Over 75% of the dietary sodium we eat comes from packaged, processed, fast foods and restaurant foods. This includes condiments, salad dressings, seasonings, sauces, breads & rolls, deli meats & cold cuts, cured & smoked meats, cheese, and pizza to name a few which all include salt as a food preservative to maintain freshness and for flavor enhancement.

A slice of pepperoni pizza does not require more salt. A 14” slice contains sodium in the crust, pepperoni, sauce and cheese(s) adding up to 700 mg +/-. The traditional Cheeseburger on a bun with lettuce, tomato, pickle and ketchup adds up to 400 mg +/-. Are you trying to eat healthy? A deli sliced turkey and swiss on whole wheat bread can contain up to a whopping up 900 mg +/- sodium. A single cup of Cottage cheese without fruit? 900 mg. A single slice of bread can contain 80 to 400+/- mg of sodium depending on the brand & type.

The above examples are to make you aware that salt is present in most everything you eat so adding table salt is not required on everything.

The average person eats approximately 3,400 mg of sodium daily. 70% of that sodium comes from packaged/processed, prepared and restaurant foods.

The American Heart Association recommends no more than 2,300 mg (1 teaspoon) which can add up quickly so watch what you eat, reduce your amount of processed foods, buy low sodium food versions when available, and avoid adding additional salt to foods. If you must flavor your food try a salt-free alternative (Mrs. Dash, Lawry’s Salt-Free) which are organic herb seasonings with no sodium. The other option is a low sodium replacement salt (No Salt, Nu Salt etc) which taste identical to table salt but use potassium as a replacement for sodium in sodium chloride. This option is known to lower your blood pressure (a good benefit) but you will need to ask your physician if the additional potassium is a safe choice for you and any medications you may be on.

Fact: Consuming too much sugar is bad for you. It can become stored as fat in your body leading to obesity, diabetes, high blood pressure, heart disease and for stone formers it creates fertile ground for stone formation.

Sugar LOWERS your urine volume and INCREASES the amount of calcium excreted in your urine.

Nowadays sugar can be found in almost everything from yogurt to pasta sauce. Problem foods that are highest in added sugar are processed, packaged, canned, and fast foods which use sugars (fructose, high fructose corn syrup, sucrose, maltose, dextrose, lactose, glucose, galactose, barley malt, beet sugar, etc.) as an additive for freshness and shelf life. With over 60 different names and forms to hide under, a product can contain 3 or more sugars under smaller amounts to make it appear healthier and not listed in the top 5 ingredients.

In addition to sugars listed on food labels you will also need to watch your intake of table sugar. Table sugar or granulated sugar is actually a combination of two sugars (50% glucose + 50% fructose) packaged as white table sugar and sugar cubes under the guise of “sucrose”. Brown sugar is 95% white sugar + 5% molasses making it a tad fewer in calories and a tad higher in nutritional value (from 0 to greater than 0.0 mg) due to the the molasses. Artificial sweeteners such as Saccharin (Sweet’n Low), Sucralose (Splenda) , Aspartame (Equal) and Stevia sweeteners (Stevia in the Raw, Truvia, Pure Via, Pyure) contain zero calories with the added benefit of not raising your blood sugar.

Much like sodium, you should limit your sugar intake and avoid processed foods with “high fructose corn syrup” (HFCS) and excessive sugars.

Moderate amounts of animal proteins are important for the maintenance and growth of healthy cells, organs, muscles, and skin. Animal proteins are also acidic. Red meats and organ meats contain high concentrations of a compound called purines that can raise your uric acid level and build up to allow crystallization of new stones forming.

Fact: Consuming too much red meat (animal proteins) are bad for you. Red meat (beef, pork, lamb) and processed meats are especially bad as they are high in saturated “bad” fats, sodium, nitrates & sodium nitrites that can raise your blood cholesterol, increase your risk for heart disease, type 2 diabetes, and to develop kidney stones. A high animal protein diet increases your risk for stones to develop as it will increase your uric acid levels and lower your citrate levels (the chemical that inhibits calcium oxalate crystals to form).

You don’t need to give up red meats or become a vegetarian, but you should limit your portion size to 2-3 ounces and choose lean cuts such as loin, sirloin or round whenever possible. You should also limit the frequency of which you eat red meat. Instead of red meat every night or with each meal, try substituting with white meat (chicken or fish) or a plant based protein such as beans, broccoli, corn, green peas or lentils which in addition to protein are high in dietary fiber.

A common misconception is calcium oxalate stones come from too much calcium. If you think about it, your body has and needs calcium to maintain healthy bones, teeth, tissues, etc.

Eat foods high in calcium or pair calcium rich foods with moderate to high oxalate foods to reduce the likelihood of stones forming. Think of the pairing as Romeo & Juliet travelling hand in hand.

For the pairing to be effective both calcium and oxalate should be consumed at the same meal to avoid flooding your system with oxalates. In other words, a calcium rich breakfast and high oxalate dinner do not cancel out your oxalates.

Due to the way calcium binds to oxalate from foods in the digestive tract, oxalates are prevented from entering the bloodstream which in turn lowers your urinary oxalate that can lead to calcium oxalate stones.

Unless you are lactose intolerant, the recommendation is not to reduce or stop eating milk based products (dairy) or calcium fortified foods (cereal, juices, breads) but to eat your recommended daily allowance as usual.

Unless prescribed by your doctor or dietitian, avoid taking calcium supplements or vitamin D tablets and rely solely on dairy & vitamin D fortified products to meet your daily requirements. Studies have shown that users of calcium supplements have a higher risk for developing kidney stones.

Filling up on orange juice and Vitamin C tablets may be good for your cold, but not recommended if you are prone to forming calcium oxalate stones. Ascorbic acid (Vitamin C) is not only an antioxidant but a water soluble vitamin.

Any excess concentrations of vitamin C (ascorbic acid) not used by your body gets transformed and excreted in your urine as oxalate.

Unless prescribed by your doctor or dietitian, avoid Vitamin C supplements that can overload your system and rely solely on fresh fruits & vegetables to meet your daily requirements. The body has no use for oxalate so any excess concentrations of vitamin C (ascorbic acid) not used by the body is excreted in your urine as oxalate. We all know what too much oxalate means for stone formers…

Note: According to a study in 2013, men who used Vitamin C supplements were twice as likely to develop kidney stones.

The only sure way to take control of what enters your body is to make your own meals and avoid eating out at restaurants & grabbing fast foods. When you cook for yourself, you use fewer processed foods and eat fresher, healthier, more nutritious ingredients. You not only save money and consume fewer calories, but you control the amount of oxalates you consume while cutting back on unhealthy ingredients (additives, preservatives, nitrates, fats, sodium, sugar, etc.) that increase your risk to develop high blood pressure, diabetes, obesity, and heart disease.

Studies have shown that people who eat home-cooked meals on a regular basis consume fewer calories, have a higher energy level and are happier lot.

Become the gatekeeper to the ingredients that enter your body. Start cooking! Who knows, you may even discover you have a talent for it! I’m not saying you’ll become the next Iron Chef or in league with Chef Gordon Ramsey, but you do owe it to your health to at least make a few simple meals per week. Need help? Don’t have the time? We’ve got you covered as future plans will include one of my passions…cooking for the Low Oxalate Diet.

Whether you have dietary restrictions or not, knowing how to read and compare food labels is good practice when it comes to making healthier food choices. All packaged foods in the U.S. are required by the FDA (Food and Drug Administration) to report Nutrition Facts and Ingredients. Both formats are easy to read and understand as long as you understand serving size.

The Nutrition Facts label is a breakdown of a food's nutrient content based on the Serving Size listed. The Serving Size is important as most appear misleading compared to the actual amount we eat. In general, we eat more than the serving size amount. If you consume a package that contains two servings it would require you to double the quantities listed (including calories) for your actual intake. In addition to kidney stones, should you have other health conditions such as high cholesterol, high blood pressure, diabetes, obesity, or heart disease requiring a restrictive diet, the label becomes an indispensable tool for comparing brands and monitoring your basic 13 core nutrients: fat, saturated fat (good fat), trans fat (bad fat), cholesterol, sodium, carbohydrate, fiber, sugars, protein, vitamin A, vitamin C, calcium and iron. The Percent Daily Value (% DV) is another important value that alerts you to how much or how little of each nutrient is included.

The Ingredients Label lists your packaged ingredients according to weight (quantity) in descending order. In other words, ingredients are listed by highest quantities to lowest. While the rule of thumb is to judge by the first 3 ingredients listed, manufacturers have found ways that can lead you to believe foods are healthier than they are.

Using sugar as an example, you will note over 60 different types and forms of sugar that can be listed on a label (see below). If sugar was listed in the first 3 ingredients you would avoid purchasing the product and look to a competitor brand that has less. On the other hand, if 3 different types of sugar are listed in smaller quantities under different names, it may not appear in your top 3-5 ingredients and go unnoticed. Your product now appears “healthier” than it actually is. -Just something to keep in mind.

•Agave
•Agave nectar
•Anhydrous dextrose
•Barbados sugar
•Barley malt
•Barley malt syrup
•Beet sugar •Blackstrap molasses •Brown sugar •Buttered syrup •Cane juice •Cane juice crystals •Cane juice solids •Cane sugar •Cane sugar crystals •Cane syrup •Caramel •Carob syrup •Castor sugar •Coconut palm sugar •Coconut sugar •Confectioner's sugar •Corn sweetener •Corn syrup •Corn syrup solids •Crystalline fructose •Date sugar •Dehydrated cane juice •Demerara sugar •Dextran •Dextrin •Dextrose •Diastatic malt •Diatase •Dried oat syrup •Ethyl maltol •Evaporated cane juice •Evaporated cane juice crystals •Evaporated cane syrup •Evaporated sugar cane •Florida crystals •Free-flowing brown sugars •Fructose •Fructose crystals •Fruit juice •Fruit juice concentrate •Fruit juice crystals •Galactose •Glazing sugar •Glucose •Glucose solids •Glucose syrup •Glucose syrup solids •Glucose syrup solids •Golden sugar •Golden syrup •Granulated sugar •Grape sugar •Gum syrup •HFCS (High-Fructose Corn Syrup)•Honey •Icing sugar •Invert sugar •Invert syrup •King’s syrup •Lactose •Malt sugar •Malt syrup •Maltodextrin •Maltol •Maltose ••Mannitol •Mannose •Maple sugar •Maple syrup •Molasses •Muscovado •Muscovado sugar •Nectar •Palm sugar •Pancake syrup •Panocha •Powdered sugar •Raw sugar •Refiner's syrup •Rice syrup •Saccharose •Simple syrup •Sorbitol •Sorghum •Sorghum Syrup •Sucrose •Sugar (granulated) •Superfine sugar •Sweet Sorghum •Syrup •Treacle •Turbinado sugar •White sugar •Xylose •Yellow sugar

•Brine
•Celtic Sea Salt
•Disodium EDTA
•Disodium guanylate (GMP)
•Disodium inosinate (IMP)
•Disodium phosphate •Fleur de sel •Himalayan pink salt •Kosher salt •Monosodium glutamate (MSG) •Rock salt •Sea salt •Sodium •Sodium benzoate •Sodium bicarbonate •Sodium nitrate •Sodium citrate •sodium chloride •Sodium diacetate •Sodium erythorbate •Sodium glutamate •Sodium lactate •Sodium lauryl Sulfate •Sodium metabisulfite •Sodium saccharin •Sodium phosphate •Sodium propionate •Sodium nitrite •Sodium metabisulfite •Trisodium phosphate