Optimization of Dietary and Behavioral Strategies for Kidney Stone Prevention

Nutrition is an essential component of kidney stone prevention for many people with kidney stones. Registered dietitian nutritionists are best suited to provide nutrition education via Medical Nutrition Therapy, the gold standard for nutrition education and counseling. Despite the agreement that nutrition education should be given to people with kidney stones, few urologists or nephrologists partner with registered dietitian nutritionists. Nutrition recommendations should be individualized rather than applied uniformly across patients. For effective and realistic change, nutrition recommendations should also be individualized to type of kidney stone and 24-h urine chemistries, as well as other health goals and food preferences. Nutrition recommendations for kidney stones may include reducing sodium, nondairy animal protein, or added sugar-or increasing fluid, calcium, fruits, vegetables, or whole-food plant proteins in place of nondairy animal protein. Low oxalate diets limit intake of most vegetables, many fruits, all whole grains and most beans, nuts, and seeds. Dietary patterns that promote these foods are consistently associated with a lower risk of kidney stones, as these foods provide many different kidney stone inhibitors. Strict low oxalate diets should not be recommended. Instead, the focus should be on reducing oxalate bioavailability, primarily via adequate calcium from food.