Low carbohydrate diets are generally fruit restrictive and protein promoting which results in a higher PRAL. These diets tend to lower urinary citrate levels by causing mild metabolic acidosis and as an effect, decrease citrate excretion and increase urinary calcium excretion. These effects are greater with very low carbohydrate diets that promote ketosis. The popularity of low carbohydrate diets for weight loss raises concern for increasing the risk of kidney stones.

Low potassium intake and urinary potassium are associated with low urinary citrate. Hypokalemia causing intracellular acidosis increases citrate uptake and metabolism by the renal tubules, therefore impairing urinary citrate excretion [2]. Fruits and vegetables are generally good to excellent sources of potassium. Unless a patient has compromised renal function requiring potassium restriction, fruits and vegetables should be encouraged for their ability to enhance urinary citrate excretion as well as for many other health benefits.

Chronic diarrhea and malabsorption are associated with hypocitraturia as bicarbonate wasting leads to acidosis [3]. As previously discussed, acidosis decreases urinary citrate excretion. For patients with conditions such as irritable bowel disease or short bowel syndrome, chronic diarrhea is often present, and reduced urinary citrate excretion usually results. Diarrhea is often improved through the use of a higher fiber diet and/or fiber supplements. A diet high in whole fruits and vegetables (not juices) can help manage diarrhea and also increases intake of organic acids, which are bicarbonate precursors and help normalize acid–base balance [2]. Also, some food agents like psyllium, wheat bran, and corn fiber slow the movement of food through the intestinal tract and can help control diarrhea.