00:00:01 Shireen
In this episode, we welcome Melanie Betts, the founder of The Kidney Dietitian, as she shares her journey from working with top kidney stone doctors at the University of Chicago to launching her blog focused on kidney stone prevention through nutrition. Melanie dispels common misconceptions, highlights the importance of personalized dietary strategies, and offers practical tips for enjoying meals while managing kidney health. She also explores the cultural aspects of food and discusses the future of kidney stone prevention, providing valuable science-backed guidance for anyone looking to prevent kidney stones. Stay tuned. Melanie Betts is a nationally recognized kidney stone expert and dietitian. As founder and CEO of The Kidney Dietitian, she has helped thousands of people prevent kidney stones with nutrition. As a leader in her field, she has published her research about kidney nutrition and regularly speaks for national professional conferences. Welcome, Melanie.
00:01:06 Melanie Betz
Thank you so much for having me. I’m so excited to be here.
00:01:09 Shireen
It’s such a pleasure having you on. So this is a very interesting topic around kidney stones, but I do want to take a step back and just really understand your journey to get here. Can you share your journey from working with top kidney stone doctors over at the University of Chicago to now founding The Kidney Dietitian blog? What inspired you to go on this journey?
00:01:32 Melanie Betz
Yeah, yeah. If you would have told me five years ago that this is what I would be doing, I would have laughed in your face. No plans to be sort of an entrepreneur out on my own, but here I am. So I worked at the University of Chicago for about five years with, like I mentioned, some truly world-renowned kidney stone doctors, Dr. Fred Koh and also his trainees. It was a very, very strong stone prevention program there. As their dietitian, I was just fascinated with how stone prevention is impacted by nutrition. A lot of what they do is food-based, and it was fascinating because I had no idea about any of it. I was like, what? This is a thing? Nutrition for kidney stones is not part of typical dietitian training, and so most dietitians don’t really know anything about it. I didn’t know anything about it, and I thought it was just so, so cool. So I got very interested in it. What started The Kidney Dietitian was actually my frustration and honestly sadness over patients coming to me trying to follow completely the wrong things that were actually sabotaging their efforts—because they were reading all of this terrible information online. I felt this ethical pull to do something about it. I thought, you know what, I’m a dietitian, I can blog, I can put information out there. So I started The Kidney Dietitian. It was actually my COVID project. It went live in April 2020 to just put good quality, science-based information out into the world about kidney stone prevention and also kidney disease. But I’ve really honed in on kidney stones because there’s really no one else doing it, and I’m just so passionate about it—because again, nutrition is such an important part of treatment. It’s grown beyond my wildest dreams. So much so that I was able to make the very difficult decision to leave the university after I had twins about two years ago. Now I am a solopreneur, trying to change the conversation about kidney stone nutrition.
00:03:28 Shireen
And I love that you went down this niche for kidney stone prevention, because one, we don’t hear that niche enough, especially when it comes to nutrition. Help us understand first just the state of kidney stone prevention. At what point in a person’s health journey does it even seem important to look at it?
00:03:46 Melanie Betz
Yeah, absolutely. So I always like to first of all give the stat that 1 in 10 people in the US will have a kidney stone at some point in their life. So prevention is a really, really big deal. We should be talking about kidney stones just like we talk about diabetes or heart disease—kidney stones are actually more common than diabetes. So it really should be part of this public health conversation. And also, if you have one stone, there’s somewhere between a 50 to 75% chance that you’re going to have another one at some point in your life. So that’s very, very high. I would say that every single person that has one stone should be given good quality information for prevention. Unfortunately, that is not so much the case. Typically, when you have a stone, you end up seeing a urologist—the doctor that’s associated with the urinary tract system. They are surgeons, they get rid of the stone, which is very important. We’ve got to get rid of that stone if it’s causing issues. However, urologists are not typically trained for stone prevention. They are stone treaters, not preventers. It’s not part of their curriculum in urology fellowship to learn about effective, targeted stone prevention. And so what has happened is tons of people are having stones and they’re not really getting any information about how to effectively prevent them. There is something called a 24-hour urine test that is critical for us to understand what is going on that caused your stones. Just knowing what type of stone you have is really not enough because there’s a gazillion different things that could be causing the same type of stone. We need that urine test to come up with an effective prevention plan—whether it’s from a medical or nutrition standpoint. There are certainly medications that are wonderful for stone prevention and dietary changes, but we’ve got to know what’s causing your stone to know what we can do about it. This test is actually recommended by the American Urological Association for everyone with more than one stone—or really anyone interested in prevention. But less than 10% of people with stones even get this test. So that’s kind of the state we’re in. Less than 10% are getting the testing necessary to create an effective, targeted preventative plan. Pretty dismal. But I’m here to change that. I always like to end that on a high note—but yeah, most people with stones, and there are a lot of them, are not getting appropriate preventative care.
00:06:29 Shireen
That is so interesting. So what you’re saying is that there is this high risk of getting a second kidney stone that already exists in people who have had one. And at that point, they should—once they know they’re at risk—they should reach out to a dietitian much like yourself to really help them prevent further development of additional kidney stones.
00:06:51 Melanie Betz
Yeah, absolutely. If you’re interested in making dietary changes—not everyone is, and that’s your prerogative, right—but if you are, I think it is critical to reach out to a dietitian who is trained in kidney stones and has experience in stones. As I mentioned, most dietitians don’t—because it’s not part of our training like diabetes or heart disease would be. So yeah, if you’re at all interested in prevention, step one is getting that 24-hour urine test. Ask your urologist—they’re the ones who should order it. And from there, work with a dietitian or a doctor. Some urologists are better than others; some do have some education in prevention. Nephrologists—kidney doctors—typically know more about stone prevention than urologists, but not all do. So you unfortunately kind of have to seek out a team that has the experience you’re looking for.
00:07:49 Shireen
And I want to double click into that. So you said something very interesting here, which is how urologists, for instance, don’t receive training for kidney stone prevention, and possibly even nephrologists. As you look at the profession and the types of things that may vary from specialist to specialist, can you discuss some common misconceptions that individuals may have, and how your approach may differ to help prevent kidney stones?
00:08:22 Melanie Betz
Great question. I think the most common misconception is that oxalate is the most important thing that matters. About 75 to 80% of stones are made of calcium oxalate, and from that we’ve developed this narrative that people need to follow a low-oxalate diet. However, there is literally no data—not a shred of evidence—that shows that a low-oxalate diet prevents kidney stones. I have a ton of content about this on my site. I could talk for hours, so I won’t go into the weeds here, but essentially, oxalate comes in really healthy foods—whole grains, leafy greens, nuts, and seeds. And people who eat more of those foods tend to have fewer kidney stones. Yes, they have oxalate, but they also have lots of beneficial nutrients—magnesium, potassium, phytate, alkali—that are good for general health and stone prevention. The low-oxalate message is actually harmful because it could lead people to eliminate healthy foods that help with prevention. It also distracts from what really matters for stone prevention, like salt intake, protein, and calcium. So focusing too much on oxalate is a huge mistake.
00:09:54 Shireen
Mm. How interesting. So now let’s flip the question—what are some key components of a successful kidney stone prevention plan that you can highlight for us? And how does personalized nutrition really play a role in it?
00:10:08 Melanie Betz
Yeah, absolutely. It’s going to be completely different for each person. The idea that there’s one "kidney stone diet" or even one diet for calcium oxalate stones is completely false. Like I mentioned earlier, there are many different things that could be causing calcium oxalate stones—it could be high urine calcium, high oxalate, low citrate, or even just low urine volume. So we really have to know what’s going on in your urine chemistry to come up with an effective plan for you. That being said, most of the time, stones are being driven by high urine calcium. The most effective things I can do as a dietitian to help lower that urine calcium is reduce sodium intake. The more salt you eat, the more calcium your kidneys dump into your urine. So the number one thing we often focus on is sodium—not more than 2,300 milligrams per day, which aligns with general dietary guidelines. Also, drinking enough water—it’s boring, but it’s the most important thing you can do to prevent stones. People with kidney stones need much more water than the general population. Other key strategies include making sure you eat enough calcium, which seems counterintuitive, but dietary calcium actually reduces oxalate absorption in the intestines and protects bone health. And lastly, we often focus on reducing excess intake of non-dairy animal protein—things like meat, poultry, fish. These affect your urine chemistry in ways that can promote stones. So we might work on swapping in more plant proteins or adjusting portion sizes.
00:12:39 Shireen
Which also takes me to my next question—how do you address challenges that patients may face with restrictive diets? Right? This feeling of being overwhelmed by “forbidden” foods?
00:12:59 Melanie Betz
Mm-hmm. I actually just recorded a podcast episode about unintentional weight loss when people start a kidney stone diet, because they over-restrict out of fear. You’re so afraid to eat anything because you don’t want another stone—which is totally understandable. People get a handout from a doctor or read something online that says “nuts are bad,” so they cut them out completely. Then they read “sugar is bad,” “salt is bad,” “protein is bad,” maybe even “calcium is bad”—and all of a sudden they’re left with white rice and nothing else. You’re just like, “I don’t care, I don’t want another stone,” and you end up taking in way too little food. That’s why working with a dietitian is so important. The number one mistake people make is over-restricting and thinking they can’t have tons of foods. In reality, all foods can fit—unless you have allergies or conditions like celiac disease. Nutrition is not about eating from a yes/no list. It’s about building entire dietary patterns. No one forms a kidney stone from one meal—it happens over weeks, months, years of dietary patterns. It’s about the big picture.
00:14:44 Shireen
That’s such an interesting point. Which also takes me to—what are some practical tips that you can offer to individuals listening to this episode about dealing with kidney stones, but still enjoying the meals they love while following a kidney-friendly diet?
00:15:01 Melanie Betz
I’d go back to what I said earlier—it’s not about cutting out certain things entirely. It’s about making sure you’re eating the right things and not going overboard with others. For example, sodium: our goal isn’t a no-sodium diet—that would actually be unhealthy. It’s about avoiding too much. Let’s say you love potato chips. People often say, “Oh no, I can’t have those—they’re salty.” But you can have them. Just recognize that bag might have 200 mg of sodium, and fit that into your daily intake. Also, think about balancing meals. If you’re having chips, maybe pair them with carrot sticks and a yogurt dip—that way, you get fiber, calcium, and fullness, and end up eating fewer chips. It’s about balance, not restriction.
00:16:14 Shireen
Yeah, it totally makes sense. And one follow-up question I have for you—when we’re thinking about different types of foods, especially ones that are more culturally ingrained, how do you provide nutrition counseling to someone whose foods are different from the standard “American” diet? How does someone approach their own cultural foods while still respecting their background and managing their health?
00:16:40 Melanie Betz
I love that question because I think the narrative around what a “healthy diet” looks like is so whitewashed, right? You do not have to eat kale and quinoa to be healthy. If you look at most cultural or ethnic diets, they actually include a lot of really healthy foods. I think about a Mexican diet—beans, peppers, rice—those are all very healthy. Or in a traditional African American or Southern-style diet—greens, chicken, beans, sweet potatoes. Lots of very plant-based, wholesome ingredients. A good dietitian—or anyone supporting you in dietary change—should never say you can’t eat your cultural foods. We help you work with those foods. Maybe it’s just preparing them in a slightly lower-sodium or less sugary way. But the foods themselves are not the problem. We do not have to eat kale and quinoa to be healthy. That’s totally wrong.
00:17:56 Shireen
And it’s really about looking at your food. If it’s just lowering the salt, it’s lowering the salt—but still within the context of your cultural foods.
00:18:03 Melanie Betz
Exactly.
00:18:04 Shireen
Love that. Love that approach. Excuse me—what advice would you give to someone who wants to prevent kidney stones, maybe is at risk from a previous stone, and is looking for practical, science-backed dietary guidance? Where do they start?
00:18:23 Melanie Betz
That’s a great question. For anyone looking for good, science-based nutrition advice—whether for kidney stones or anything else—the first step is always to check the credentials of the person you’re getting your advice from. There are so many people online—on Instagram, TikTok, podcasts, blogs—who have zero nutrition training. Dietitians are the only healthcare professionals with required nutrition training. That doesn’t mean all of us are perfect—but it’s a solid starting point. My site, The Kidney Dietitian, is packed with blogs, recipes, my podcast, and courses—all science-based. And if you’re looking for another good source, the University of Chicago also has a great blog on kidney stones—mostly written by Dr. Koh, who I used to work with.
00:19:31 Shireen
That’s lovely. And we’ll link everything in the show notes as well. I do have a couple more questions for you. One of them is about education and outreach—what role do you see those playing in improving nutrition care for people? Earlier you shared that stat—1 in 10 people—which is wild. What can we do to raise awareness and improve care?
00:20:11 Melanie Betz
I think that is exactly how we change care—through public education and educating other healthcare professionals. That’s what I do, and it’s what I’m so passionate about. I have lots of resources to help patients advocate for themselves, like asking their doctor for a urine test. That’s really important. I also do a ton of public speaking to doctors and dietitians to help them understand how big of a problem this is—and that there is something we can do. Kidney stones are often brushed off as a one-time painful event, like “Oh, that sucks.” But no—kidney stones are a disease. People don’t just randomly make stones. Something caused that stone. One of the doctors I used to work with at the University of Chicago, Dr. Ana Zisman, calls kidney stones “the canary in the coal mine.” They’re often the first sign that something is going wrong metabolically. People with stones are at higher risk of heart disease, hypertension, and diabetes. So as a healthcare system, we need to treat kidney stones like the chronic disease they are—not just a blip in the medical chart. That’s why education—of both patients and professionals—is so critical.
00:21:48 Shireen
Help us see some of the silver lining stuff next.
00:21:51 Melanie Betz
I don’t mean to be—
00:21:53 Shireen
No, not at all. I think the work is important. I think it truly needs to get the attention it deserves, especially with the numbers being so high. But what I truly meant by that was—help us maybe understand what advancements within this space are you excited about? What’s coming up that we can look forward to?
00:22:12 Melanie Betz
Yeah, I think there’s a lot of interesting stuff going on. The two big things that come to mind are the gut microbiome and genetics. First, the gut microbiome—we know that people who have kidney stones have a very different population of gut bacteria. Some bacteria, like Oxalobacter formigenes, actually eat oxalate. And people with fewer of these may be more prone to stones. So there’s research happening around using probiotics or prebiotics to reduce risk. I’m actually collaborating with researchers at the University of Alabama, Birmingham, on this—it’s super exciting. The second area is genetics. We know there’s a hereditary component to stone formation. Researchers have identified dozens of genes linked to higher risk. As we understand the genetic pathways better, we may be able to create targeted therapies—maybe even medications that correct the specific metabolic problem that leads to stone formation. So we’re getting closer to a much more individualized, effective approach to prevention. Hopefully, all of this helps bring that recurrence rate down from 50 to 75%.
00:24:03 Shireen
That is so interesting, and I’m fascinated by some of this research coming out. It’s going to be exciting to see how it evolves and impacts your work.
00:24:13 Melanie Betz
Right?
00:24:14 Shireen
Incredible. That’s awesome. Well Melanie, with that we are toward the end of the episode at this point. Can you tell our listeners how they can connect with you and learn more about your work? I know you mentioned your blog and website—if you could share those again?
00:24:28 Melanie Betz
Yeah, absolutely. You can find me at www.thekidneydietitian.org. You can also follow me on Instagram @thekidneydietitian. I have a podcast called Eat Away Kidney Stones, and an online course to help people understand their urine test and adjust their diet accordingly. I also have a team of dietitians who work one-on-one with clients if you want a more personal experience. Lots of ways to connect—we’re all about education and prevention!
00:25:02 Shireen
Lovely. Thank you so very much, Melanie, for your time. And to our listeners, thank you for tuning in to another episode of the Yumlish Podcast. You know what time it is—head over to our social media on Facebook or Instagram and answer this quick question: How do you balance enjoying your favorite foods with following a kidney-friendly diet? Find this podcast post and comment below—we’ll continue the conversation there. With that, Melanie, thank you so much again.

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Connect with Melanie Betz
Website URL: www.thekidneydietitian.org
Instagram URL: https://www.instagram.com/the.kidney.dietitian/
Facebook URL: https://www.facebook.com/thekidneyrd
Twitter URL: https://twitter.com/thekidneyrd
LinkedIn URL: https://www.linkedin.com/in/melanie-betz-ms-rd-csr-fand-68576124/
Other promos (books, publications, speeches, etc.) :
Eat Away Kidney Stones Podcast: https://podcasts.apple.com/us/podcast/eat-away-kidney-stones/id1697397874