Mineral / electrolyte diet - oxalate - low
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide a diet that limits oxalate intake to approximately 100mg per day and is moderate in protein and sodium.
Characteristics
Avoids food high in oxalate. Sodium is limited by avoiding high-salt foods and not serving salt.
Indications
Recurrent calcium oxalate stones.
Nutritional adequacy
This diet may not be nutritionally adequate; supplementation of potassium, magnesium and dietary fibre may be required.
Precautions
A liberal fluid intake (at least 2.5 litres per day) is essential. Salt and pepper should not be included on meal trays.
Previously a low-calcium diet was recommended to prevent recurrent kidney stones in patients with idiopathic hypercalciuria, but more recent studies have shown that a normal calcium intake with reduced animal protein and salt is more effective. The difference appears to be due to the different effects of the two diets on oxalate excretion.
Paediatrics
Suitable for use in paediatrics when combined with an age-appropriate diet.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | All meat, but limit to 1.5 serves per day (one serve = 100g meat, 120g fish or 2 eggs) | Meat above allowance All soy products Baked beans, lentils, dried peas, nuts Salty dishes (e.g. bacon, sausages, pies, smoked fish, silverside) |
| Sauces, gravies | Gravy in small amounts (≤30mL) | Soy sauce, Worcestershire sauce |
| Starchy vegetables / pasta / rice | Pumpkin White rice and pasta | Potato, sweet potato Wholemeal pasta, brown rice |
| Vegetables | Low-oxalate vegetables (<5mg per serve): Asparagus, broccoli, brussels sprouts, chives, cabbage, cauliflower, cucumber, endives, lettuce, mushrooms, onions, peas, sweetcorn, turnip, zucchini Moderate oxalate vegetables (5-10mg per serve; limit to one serve per day): Eggplant, parsnip, red cabbage, lima beans | Beetroot, carrots, celery, capsicum, leek, green beans, okra, parsley, spinach, silverbeet, squash, tomato, tomato paste |
| Soups | None | - |
| Sandwiches | Sandwiches made with white bread only All other fillings with permitted vegetables and mayonnaise | Ham, silverside, sardines Vegetables not allowed (e.g. tomato, carrot) |
| Salads, dressings | All others, with meat, cheese or egg from allowance and permitted vegetables only Avocado Mayonnaise or salad dressings | Ham, silverside, sardines Vegetables not allowed (e.g. tomato, beetroot, celery, carrot, capsicum, parsley) |
| Breads, cereals | White bread Refined breakfast cereals (e.g. rolled oats, Corn Flakes®, Rice Bubbles®, Special K®) | Wholemeal and wholegrain bread Bran, bran- based cereals and wholegrain cereals (e.g. All-Bran®, Sultana Bran®, Weet-Bix™, muesli) |
| Spreads | Butter, margarine, other jams, honey | Vegemite™, peanut butter, marmalade, apricot jam |
| Hot breakfast choices | Poached or boiled egg from daily allowance Mushrooms | Baked beans, bacon, canned spaghetti, tomatoes |
| Fruit | Low oxalate fruit (<5mg per serve): Avocado, cherries, grapes, lemons, lychees, melons, nectarines, pawpaw, passionfruit, peaches, plums, strawberries Moderate oxalate (5-10mg per serve; limit to 1 serve per day): Apples, apricots, bananas, grapefruit, oranges, pears, pineapple | Dried fruits Figs, kiwifruit, mandarins, mangoes, rhubarb Berry fruits other than strawberries |
| Yoghurt | Limit to one of the three dairy serves per day | - |
| Desserts | Fresh or stewed fruit from allowance Plain cake, meringue Jelly Custard, ice-cream from dairy allowance | Fruits not allowed Fruit cake Desserts made with chocolate, coffee or nuts |
| Milk and cheese | All, but limit to three dairy food serves per day (250mL milk, 200g yoghurt, 40g cheese) | Milk or cheese above allowance Chocolate milk |
| Beverages | Fruit juice (orange, apple, pineapple): limit to one serve per day Water, cordial, soft drinks Weak tea or coffee: limit to one cup per day | Soy milk Cocoa, Milo®, Ovaltine® |
| Biscuits | Plain biscuits and crackers (e.g. Sao™, Milk Arrowroot™, Milk Coffee™) | Wholemeal and chocolate biscuits |
| Miscellaneous | Olives Coconut | Chocolate Salt and pepper |
References
- Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
- American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 26 April 2010].
- Mahon LK, Escott-Stump S. Krause’s food and nutrition therapy. 12th ed. St Louis: Saunders Elsevier; 2008.
- Taylor EN, Curhan GC. Diet and fluid prescriptions for stone disease. Kidney Int 2006;70:835-9.
- Borghi CL, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. New Eng J Med 2002;346:77-84.
- Homes RP, Kennedy M. Estimation of oxalate content of foods and daily oxalate intake. Kidney Int 2000;57:1662-7.
- Noonan SC, Savage GP. Oxalate content of foods and its effect on humans. Asia Pac J Clin Nutr 1999;8:64-74.