Should I stop my calcium if I have kidney stones?

Many kidney stone formers, especially women with kidney stones, question whether to stop or reduce their calcium intake. Despite the fact that calcium is a major component of 75% of stones, excessive calcium intake is very rarely the cause of stone formation. In fact, several studies have shown that restricting calcium intake in most stone formers actually increases the number of stones they develop. This appears to happen because when less calcium is ingested, it becomes easier for oxalate (which normally binds with calcium in the gut) to be absorbed. Higher levels of oxalate in the urine then lead to an increase in stone risk.

What contains calcium?

Calcium is found in many food types. It is most concentrated in dairy products, such as milk, ice cream, and cheese. It is also present in non-dairy products, such as broccoli and almonds. Many foods are also fortified with calcium, including soy milk and breads.

Calcium is commonly given as a supplement, either by itself or as part of a multivitamin. By itself, it is most commonly in the form of calcium carbonate. Other forms included calcium citrate and coral calcium.

I’m a woman on calcium supplements to help prevent osteoporosis, do I need to stop or reduce my calcium pills?

If you can, it is better for you to get your calcium from dietary sources instead of calcium supplements. This is because supplements can increase your risk of stones slightly. In a large study of over 35,000 women given calcium with vitamin D or placebo, the women on the calcium supplements were 17% more likely to develop stones than those on placebo (Wallace et al, Am J Clin Nutr 2011). Dietary sources of calcium such as dairy have the opposite effect and lowers your risk of stones. In a large study of almost 100,000 female nurses between 27 and 44 years old and without a history of prior stones, researchers found that the nurses with the highest calcium intake had a lower risk of developing a stone than those with the lowest calcium intake. (Curhan et al, Arch Intern Med, 2004). Many other studies have come to similar conclusions and our general recommendation is for most patients to maintain a normal dietary calcium intake but to try to avoid calcium supplements if possible. This is in contrast to older recommendations previously given to kidney stone formers to reduce their calcium intake.

I don’t tolerate dairy and need to take supplements. What about different types of calcium supplements?

The two most common types of calcium supplements are calcium carbonate and calcium citrate. Calcium carbonate tends to be less expensive while calcium citrate is more easily digested and can be taken on an empty stomach. Calcium citrate costs more and has a lower amount of calcium in each pill, requiring more of it to be taken.

Calcium citrate is preferred for stone formers because it has the stone friendly benefit of also increasing urinary citrate concentrations. Citrate is an inhibitor of stones, which makes it more difficult for calcium based stones to form.

What else?

Researchers have found that taking calcium supplements with meals appears to be better than taking supplements by themselves in regards to stone formation. This may be due to the availability of the calcium taken at mealtime to bind oxalate, a stone promoting substance.

*updated 10/16/12 with new information on calcium supplements.

9 Responses to Should I stop my calcium if I have kidney stones?

  1. abbas says:

    Thank you very much for information .Nobody on earth has more complicated problems which I have.Weak joints and osteoporosis. Allergy to sour foods and drug and therefore I can,t take citrate calcium and because I take many other drugs fear of kidney problems are high.The most problematic issue is that I take 3omeprazole caps in the morning and they seriously prevent calcium and iron and many other minerals and vitamins to be absorbed.Taking calcium helps me a lot but I fear the consequences.Please continue your precious comments. Thank you.

  2. Ben Gonzo says:

    My wife had weight loss surgery done back in September (Gastric Sleeve) and she now needs to take calcium supplements for the rest of her life. She has a stone right now and I was curious to know if the supplement caused the kidney stone or was it by other means. Need answers.

  3. I worked with a fellow who read every package label on every item before a meal looking for citrate or citric acid because he was told by his doctor that they CAUSED his stones. The literature on kidney stones always seems to be weighted on one side of the 80% of stonemasons but never the odd physiology.

  4. Sifa Nanono says:

    Thank you so much for information on the diet for kidney stone formers. I was experiencing a lot of pain for some time and when i went for check up i was told i have kidney stones but the doctor as usual here in Africa did not feel the need to explain about the disease or offer any dietary information. I was told to increase water intake and was given medicine which i have been taking for three months but i still feel a lot of pain. With this information i realize that i have been eating wrongly and taking too much salt etc. Now i can take your advise on the diets and hope there will be some changes. There is so little information on this here in Africa where most people just bear pain of disease until it is unbearable then they will go to a dispensary where they will be checked and given medicine usually without any explanation. In my case i do not know where i can get proper treatment for kidney stones here in Tanzania and i have been taking medicine without what kind of stones i have or the causes or even knowing that there are different types of stones which need different attention.Your information has been eye opening and i would appreciate any more info.

  5. Sandi says:

    What about vitamin D?

    • says:

      Although the research on the topic of vitamin D supplementation and kidney stone risk is still in its early stages, two recent studies suggest that taking vitamin D does not increase the amount of calcium in urine in most stone formers. Increased urinary calcium leads to increased stone risk. However, in one of the studies, the authors cautioned that a subset of patient may see an increase in urinary calcium. We’ve attached the studies’ conclusions below:

      Effect of vitamin D repletion on urinary calcium excretion among kidney stone formers. Authors: Leaf DE, Korets R, Taylor EN, Tang J, Asplin JR, Goldfarb DS, Gupta M, Curhan GC. Published in Clin J Am Soc Nephrol. 2012 May;7(5):829-34.
      “Among stone formers with vitamin D deficiency, a limited course of vitamin D repletion does not seem to increase mean urinary calcium excretion, although a subset of individuals may have an increase. These data suggest that vitamin D therapy, if indicated, should not be withheld solely on the basis of stone disease, but 24-hour urinary calcium excretion should be monitored after repletion.”

      Vitamin D repletion does not alter urinary calcium excretion in healthy postmenopausal women. Authors: Penniston KL, Jones AN, Nakada SY, Hansen KE. Published in BJU Int. 2009 Nov;104(10):1512-6.
      “Vitamin D supplementation did not increase the urinary calcium excretion in healthy postmenopausal women. Many stone formers are at risk of premature bone loss, vitamin D insufficiency, or both. Based on the present results we suggest a study of patients with hypercalciuria and nephrolithiasis to determine the risks of vitamin D therapy.”

  6. Sharon says:

    I have taken mag with celeated zinc for years because I was told it would help with developing more stones. My blood level of mag was always low so I’ve been trying it. Well no luck, I still got stones. Now the question is, should I continue to take the supplement even though I have developed stones again?

    • says:

      Magnesium supplementation can be useful for stone reduction in some patients. Typically, patients who benefit from this approach have low urinary magnesium, low urinary citrate, and low urine volume. You mentioned that your low magnesium was based on blood levels and not urine levels. You may want to consider undergoing metabolic evaluation (with a 24 hour urine collection test) with your urologist or primary care physician to re-assess your current stone risk factors. It may be the case that urinary magnesium levels are no longer an issue for you – which would mean that you should focus on other factors.

      • Melissa in Murphy says:

        I just had my first kidney stone and my question is related to supplements. My GYN wants me to take 2000 units of calcium a day, which I had been doing but stopped b/c of getting too busy with life changes (retirement, moving, etc.) So now that I had the kidney stone, which I passed within 36 hours of symptom onset without surgery, and life is somewhat back to normal, I want to know if it is safe to start back on the calcium supplements. I was taking one type-Vitabase’s Osteo Support- in the morning (1200 mg calcium as carbonate citrate + 400 mg magnesium as oxide citrate + D, K, Zinc, Copper, manganese, etc.) and another type in the evening – Vitabase Super Cal/Mag (1000 mg calcium as oyster shell + 500 mg Magnesium as Oxide + 200 iu of Vitamin D-3) as well as 5000 iu of D-3. Is this too much or enough?

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