How Southerners Can Prevent Kidney Stones with Lemons and Limes

Ron Skaria, MD

The South is also known affectionately as the ‘kidney stone belt’. The map of incidence of kidney stones in the United States shows a stark increase south of the Mason-Dixon line. This is thought to be because of hotter weather and specifically increased sweet tea consumption. However, before you turn to some Bourbon for solace, we will let you know how our favorite fruits, lemons and limes, can help decrease this painful condition.

Kidney stones are caused by stone formation between calcium and oxalate.  Other types of stones including uric acid, struvite and calcium phosphate stones, however, these type of stones are less common. We encourage everyone to should to consult your physician with regards to acute kidney stones and chronic management. In this blog, we will discuss common strategies to inexpensively and effectively reduce the incidence and morbidity from the painful condition of kidney stones, or nephrolithiasis or urolithiasis.

Kidney stones often cause flank (back and side pain), radiating into the groin that is colicky in nature, occurring in waves for an hour then improving.  The pain moves as the kidney stone moves down the urinary tract. Kidney stones may cause blood in the urine and may require surgery or emergency management if there is severe pain, dehydration, lack of urine (anuria) or if the size is large enough that a urologist is needed for a surgical intervention to break or remove the stone.

Kidney stones are caused by the precipitation of calcium and oxalate.  The kidney stone belts in the South is thought to be caused by high consumption of sweet tea which contains a lot of calcium oxalate.  Also, with the Genesis, or the precipitation of stones, is exacerbated by high urine concentration.  This means that if you are dehydrated you have a higher chance of forming kidney stones.

Even though calcium in the urine increases her likelihood of kidney stones, paradoxically calcium in the diet this not, in fact, it decreases your incidence of kidney stones.  This is because if there is sufficient dietary calcium and there is a decreased need for the kidney to resorb calcium for the bodies metabolic needs and thus less likelihood of forming a kidney stone.

Salt is also a precipitators kidney stones, as the kidneys will use the same channels to reabsorb sodium with calcium.  Other factors which will increase the risk of kidney stones are increased protein consumption, excessive vitamin C consumption, and increased fructose and sucrose consumption.

Citric acid prevents the formation of large kidney stones by coating smaller kidney stones and preventing them from becoming larger more problematic stones.  In fact, this is reflective that physicians can prescribe potassium citrate or calcium citrate supplements to help decrease the incidence of stone formation.

If you prefer natural and tastier ways to get citric acid, lemons and limes have been found to have the highest concentration of citric acid foods.  In fact, 4 ounces of lemon or lime juice will give you the equivalent citric acid content as supplements.  Sipping on a lemonade or limeade made is definitely a delicious way to help increase your fluid intake and citric acid content!

Always take care of yourself by seeking prompt medical attention from a physician or emergency department (rather than a citrus blog!) Although we can’t give you official medical advice, US Citrus can definitely supply you with boxes of lemon and lime fruit and for your very own supply of fresh citrus!


1. Penniston, K., PhD. (n.d.). Citric Acid and Kidney Stones. UW Hosptial Metabolic Stone Clinic. doi:8/13/2018

2. Lemonade Helps Kidney Stones Daniel DeNoon -

Try our seasonal citrus box while its available...the Craft Citrus Club!

Our Rio box is a 15-lb curated box of our fresh-harvested citrus from South Texas. The fruit is NOT gassed, rather it is tree-ripened. Our season runs from Nov-May for oranges, grapefruit and mandarins.

Our Grande box is a 30-lb box of either fresh-harvested Rio Red Grapefruit or Sweet Oranges from South Texas.


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