1. Foundation — every stone former
- Fluid to produce >2.5 L urine/day (roughly 3 L intake for most adults)
- Sodium under ~2,300 mg/day (lowers urine calcium)
- Normal dietary calcium (~1,000–1,200 mg/day from food; do NOT restrict)
- Moderate animal protein
- Increase fruits and vegetables (natural citrate)
2. Test-guided targets
A 24-hour urine study directs therapy: high urine calcium, low citrate, high oxalate, low volume, and high uric acid each imply different levers.
3. Supplement context (stone-type specific)
- Calcium oxalate — potassium citrate (raises urine citrate); magnesium citrate as adjunct; consider low-oxalate patterns with normal calcium intake
- Uric acid — potassium citrate to alkalinize urine; limit fructose and red meat
- Calcium phosphate — evaluate for hyperparathyroidism and RTA; citrate selectively
- Vitamin B6 — considered for primary hyperoxaluria under specialist care
4. What not to do
- Do not restrict dietary calcium — it increases stone risk
- Do not take large-dose vitamin C supplements (converts to oxalate)
- Do not rely on cranberry — it can lower urine pH and citrate