Lemonade: full of citrate, almost empty of alkali

Lemonade has a reputation as a home remedy for kidney stones, and the mechanism usually given for it does not survive the best measurement we have. Twelve healthy adults drank two litres of lemonade a day for five days, blinded and crossed over, on a standardised low sodium, moderate calcium diet. That volume supplied about 168 mEq of citrate and only 12.2 mEq of total alkali, or 16.0 mEq in the diet version. Urine pH did not move on either drink. Alkali is the part that raises urine pH, and lemonade carries very little of it. A second crossover trial ran 13 volunteers on a constant metabolic diet, 9 of them healthy and 4 of them stone formers, through water, orange juice and lemonade. Orange juice raised urine pH and citrate, lemonade did not, even though the two carry comparable citrate. The two litres a day that this literature studies is also a lot of sugar. Against the diet version, ordinary lemonade at that volume added 805 calories and 225 g of sugar to the day.

The numbers, per 100 g

What your body absorbs

• Drinking lemonade with a fortified noodle soup raised iron absorption from 6.0% to 11.0%. — 13 women in Latin America, double isotope method, meals based on wheat flour fortified with ferrous sulfate (n = 13) Evidence B source
  Iron absorption 11.0% with lemonade against 6.0% for the same meal without it (p < 0.02)

What it does to your health

• Two litres of lemonade a day delivered about 170 mEq of citrate but only 12 to 16 mEq of alkali, which is the part that actually raises urine pH. — 12 healthy adults on a standardised low sodium moderate calcium diet, blinded crossover, 5 days per phase (n = 12) Evidence B source
  168.4 mEq citrate and 12.2 mEq total alkali from regular lemonade, 170.2 mEq citrate and 16.0 mEq alkali from diet lemonade; urine pH unchanged with both
• Lemonade made from 4 ounces of lemon juice in 2 litres of water lifted urinary citrate from 142 to 346 mg a day in people who excrete too little of it. — 12 patients with hypocitraturic calcium stones who could not take or would not take citrate tablets, 6 days of therapy (n = 12) Evidence C source
  Urinary citrate from 142 mg/day (range under 10 to 293) to 346 mg/day (range 89 to 814), p < 0.001; 7 of 12 became normocitraturic
• Pooling 34748 adults, each extra daily serving of sugar-sweetened drinks, lemonade among them, went with fasting glucose higher by 0.014 mmol/L and fasting insulin higher by 0.030 log units. — 34748 adults of European descent from 11 US and European cohorts, intake from food frequency questionnaires (n = 34748) Evidence C source
  Fasting glucose +0.014 mmol/L per serving (SE 0.004, p = 1.5 x 10-3); fasting insulin +0.030 loge pmol/L per serving (SE 0.005, p = 2.0 x 10-10)

Safety, limits and interactions

• Drinking 2 litres of ordinary lemonade a day added 805 calories and 225 g of sugar compared with the diet version. — 12 healthy adults, 2 L per day for 5 days in each phase of a crossover trial (n = 12) Evidence B source
  805 extra calories and 225 g of sugar per day
• In 10-year-olds, each daily 250 mL portion of sugar-sweetened drinks including lemonade went with 29% higher odds of caries experience (adjusted OR 1.29, 95% CI 1.06 to 1.57). — 915 ten-year-olds and 996 fifteen-year-olds from two German birth cohorts, Munich centre (n = 915 at age 10) Evidence C source
  Adjusted odds ratio 1.29 (95% CI 1.06 to 1.57) per portion per day for DMF/S at age 10; 1.12 (95% CI 1.01 to 1.25) at age 15
• Caustic cleaning agents left in a returnable glass bottle poisoned a young woman who drank carbonated lemonade from it. — one young woman who drank carbonated lemonade from a non-disposable glass container (n = 1) Evidence D source
  Acute corrosive poisoning, with the alkalis identified and quantified in the drink itself

What people believe that the data does not support

• Orange juice raised urine pH and citrate while lemonade did not, even though the two carry comparable amounts of citrate. — 13 volunteers, 9 healthy and 4 stone formers, on a constant metabolic diet, crossover through water, orange juice and lemonade (n = 13) Evidence B source
  Higher net gastrointestinal alkali absorption, urinary pH and citrate with orange juice only; calcium oxalate supersaturation lower in the orange juice phase
• Against potassium citrate, lemonade failed to raise urinary citrate or pH in stone formers, and its one advantage was keeping urine output up. — 21 stone-forming patients, prospective crossover through lemonade therapy and potassium citrate (n = 21) Evidence C source
  No significant change in urinary citrate or pH with lemonade; urine volume higher on lemonade than on potassium citrate
• Lemonade sweetened with low-calorie sweeteners left total energy intake no different from water, in 166 adults tested acutely and after five weeks of daily use. — 166 healthy non-obese French adults, 80 women and 86 men, infrequent users of low-calorie sweeteners, five-week habituation on 660 mL a day (n = 166) Evidence B source
  No difference from water in total energy intake, macronutrient intake, selection of sweet foods or motivational ratings

Who this works differently for

• Over about 44 months of lemonade therapy, 10 of 11 stone patients raised urinary citrate by 383 mg a day, while potassium citrate raised it by 482 mg. — 11 patients with hypocitraturic nephrolithiasis on long-term lemonade, matched against 11 on slow-release potassium citrate (n = 22) Evidence C source
  Mean urinary citrate increase 383 mg/day on lemonade (p < 0.05) and 482 mg/day on potassium citrate; stone formation rate fell from 1.00 to 0.13 per patient per year, not significant

The bottom line

The stone clinics have results pointing the other way, and it is worth saying exactly why the question stays open rather than picking a side. Twelve patients who excreted too little citrate, and who could not or would not take citrate tablets, drank lemonade made from 4 ounces of lemon juice in 2 litres of water for six days. Urinary citrate rose from 142 to 346 mg a day (p < 0.001), and 7 of the 12 reached a normal level. That trial had no control group and measured urine chemistry rather than stones. A retrospective look at 11 long-term lemonade patients, matched against 11 on slow-release potassium citrate, found a mean rise of 383 mg a day against 482 mg over about 44 months. The drop in stone formation from 1.00 to 0.13 per patient per year did not reach significance. A prospective crossover in 21 stone formers, not randomised, found no improvement in urinary citrate or pH on lemonade at all, and its one advantage over potassium citrate was keeping urine output up. Both of those comparisons ran in patients already under treatment for stones, and in both the drink did less for urinary citrate than the prescribed potassium citrate did. Every one of these studies is small, none is randomised, a home-made drink is hard to verify, and none of them counted stones as the endpoint. That is the whole reason the answer is unclear. What the drink reliably does is deliver sugar, with the usual consequences of sugar in liquid form. In two German birth cohorts, each daily 250 mL portion of sugar-sweetened drinks went with 29 percent higher odds of caries experience in 10-year-olds (adjusted OR 1.29, 95% CI 1.06 to 1.57) and 12 percent higher at age 15 (1.12, 95% CI 1.01 to 1.25). Those are odds from questionnaires, and lemonade was pooled with cola, ice tea and energy drinks, so the category is what was measured. The same limit applies to a pooled analysis of 34748 adults from 11 cohorts, where each extra daily serving of sugar-sweetened drinks went with fasting glucose higher by 0.014 mmol/L and fasting insulin higher by 0.030 loge pmol/L. Cross-sectional data, association, and lemonade inside the category rather than on its own. Sweetened with low-calorie sweeteners instead, lemonade at 660 mL a day for five weeks left total energy intake, macronutrient intake and the choice of sweet foods no different from water in 166 healthy non-obese French adults who rarely used such sweeteners. One genuine small benefit shows up at the table. In 13 women in Latin America, measured with a double isotope method, drinking lemonade with a noodle soup made from iron-fortified wheat flour raised iron absorption from 6.0 to 11.0 percent (p < 0.02), which is one meal type in one small group. Beyond sugar and teeth, the safety shelf here is nearly bare. One young woman was poisoned by caustic cleaning agents left in a returnable glass bottle she drank carbonated lemonade from, which is a report about bottle washing rather than about lemonade. We found nothing in the corpus on lemonade in pregnancy or on interactions with medicines. The USDA records behind the table on this page are powders and frozen concentrates, so read each row as the product it names and not as a glass poured at home.

Sources

1. lmnd-r3-04 · randomised controlled trial
   Iron absorption from noodle soup was significantly higher when given with lemonade (11.0%) compared with absorption of the same meal without lemonade (P < 0.02) or with the absorption of noodles (P < 0.04).
   Nutrition, 2007 · checked 2026-09-24
2. lmnd-r3-01 · randomised crossover trial
   Daily consumption of 2 L of regular and diet lemonade resulted in an intake of 168.4 and 170.2 mEq of citrate but a total alkali intake of 12.2 and 16.0 mEq, respectively.
   J Endourol, 2019 · checked 2026-09-24
3. lmnd-r3-07 · non-randomised clinical trial
   Average levels increased from 142 mg. daily (range less than 10 to 293) at baseline to 346 mg. daily (range 89 to 814) after treatment (p < 0.001).
   J Urol, 1996 · checked 2026-09-24
4. lmnd-r3-10 · meta-analysis of observational studies
   In our combined meta-analyses of discovery and replication cohorts, after adjustment for age, sex, energy intake, BMI and other dietary covariates, each additional serving of SSB intake was associated with higher fasting glucose
   Diabetologia, 2018 · checked 2026-09-24
5. lmnd-r3-02 · randomised crossover trial
   Compared with diet lemonade, regular lemonade provided subjects with 805 additional calories and 225 g of sugar per day.
   J Endourol, 2019 · checked 2026-09-24
6. lmnd-r3-03 · cross-sectional study
   After adjusting for confounders, in 10-year-olds, SSD intake was significantly associated with higher caries experience based on the indices DMF/S (adjusted odds ratio: 1.29; 95% CI: 1.06-1.57), NCCL/S (1.24; 1.03-1.49) and DMF + NCCL/S (1.27; 1.05-1.55).
   BMC Oral Health, 2020 · checked 2026-09-24
7. lmnd-r3-11 · case report
   This case of acute poisoning due to caustic alkalis concerns a young woman who consumed carbonated lemonade from a non-disposable glass container.
   Vet Hum Toxicol, 1997 · checked 2026-09-24
8. lmnd-r3-05 · randomised controlled trial
   Despite comparable citrate content, this study showed that orange juice has greater alkalinizing and citraturic effects than lemonade.
   Clin J Am Soc Nephrol, 2006 · checked 2026-09-24
9. lmnd-r3-06 · non-randomised clinical trial
   The results of our study have shown that lemonade did not provide improvements in urinary citrate or pH levels but did assist patients in maintaining urine output compared with potassium citrate therapy.
   Urology, 2007 · checked 2026-09-24
10. lmnd-r3-09 · randomised controlled trial
    Water and LCS beverage did not differ in their effects on total energy intake, macronutrient intakes or the selection of sweet foods and on motivational ratings.
    Appetite, 2018 · checked 2026-09-24
11. lmnd-r3-08 · retrospective cohort
    Of the 11 patients on lemonade 10 demonstrated increased urinary citrate levels (mean increase +383 mg per day, p <0.05).
    J Urol, 2007 · checked 2026-09-24