What are oxalates?
Many have asked for help understanding oxalates so I decided to give a very brief description of what they are and how to know if you should look into this further. This is far from exhaustive and I am far from an expert but since this has had such a profound impact on the healing of one of my children I wanted to share.
I’ll start with how I got here. I was diagnosed nearly 10 years ago with vulvodynia. I also have had a kidney stone, twice. I did not realize at the time that these two things were merely symptoms of the same problem. After my first kidney stone I read that eating high oxalate foods can cause them and that spinach (which I had recently begun to eat in great quantities) was one, so I stopped eating spinach and left it at that. Fast forward several years I was a mother of 2 and Little J seemed to be reacting to lots of high oxalate foods that I ate. At first I was too overwhelmed by GAPS and everyone’s dietary needs to do more than limit those high oxalate foods I could easily remember. I was far from strict except for the ones that caused obvious symptoms, almonds and chocolate. I just figured GAPS would heal us and I wouldn’t have to get more specific than that. Then this past spring (after nearly 18 months of GAPS) little J began to tell me that it hurt when she peed. She had already turned 3 and I had been wondering when she would ever master potty learning. When I learned that it hurt to pee (a classic sign of oxalate issues) and I realized that her poopy diapers often looked like they were full of beach sand (another classic sign) I decided to really understand oxalates and commit to a low oxalate diet (LOD) for her sake and my own. Thankfully, due to her sensitivities, we didn’t have many high oxalate foods to still eliminate. Within a month or so she was ready to work on potty learning and at this point she only wets the bed when she is dumping oxalates (more about that later).
Here is a list of conditions and symptoms that can be helped by or cured by a LOD:
- Kidney stones
- Urinary pain
- Autism Spectrum Disorders (ASD)
- Vulvodynia/genital pain
- Thyroid disease
- Cystic Fibrosis
- Join Pain
- Chronic Fatigue
- Hormonal Imbalances
- Chronic Candida
Oxalates are a common food chemical. They are indigestible to humans and for the most part should stay in the GI track and pass through unabsorbed. A healthy gut will resist absorbing them and will contain bacteria that break down oxalates to further protect the body. No benefit has been found to oxalates in the body. In fact they disrupt normal body functions on the cellular level. Once absorbed, the body needs to protect itself from them, either by putting them somewhere in storage or by excreting them. There is a limit to how much the body can excrete at once so if too much oxalate is absorbed at least some will be stored. If your detoxification systems aren’t working well, you might not excrete any.
As you can see in the above photo oxalates have a lot of pointy edges. They have been compared to shards of glass. They are best know for causing kidney stones but can be involved in many other problems in the body. Anyone who has ever had a kidney stone knows that even a very tiny stone is very painful. This is because they are sharp and jagged, not smooth like I used to imagine them to be. They are more like grains of sand than like a pearl. These sharp jagged bits need to be stuck somewhere in the body or excreted. In either case they are going to cause pain and other issues sooner or later. Kidney stones are one way that the body eliminates oxalates. The body also eliminates oxalates through the liver (bowel), the lungs and even through the skin.
So why do some people have problems with oxalates while others don’t? Part of the answer is in their gut. Remember I said that a healthy gut will both break down the oxalates and be a barrier to them being absorbed? Well some of us have what is called a leaky gut and these various particles pass through the gut wall and into the body where the body then has to deal with them. Many are also missing the bacteria, oxalobacter formigenes, that loves to break down oxalate. This bacteria can be killed by many different antibiotics. In fact many people’s symptoms of an oxalate overload can be traced back to a round of antibiotics. Oxalobacter formigenes is anaerobic so it isn’t found in fermented foods and isn’t present in any probiotics currently on the market. Remember though that bacterial break down is not the bodies first line of defense against oxalate. A healthy, non-leaky gut is.
Ok so I get it, if I have one of these conditions I just stop eating foods with oxalate in them and wait to see if I feel better. If I do then I’ve got an oxalate problem and if I don’t then I don’t. Just like a food allergy elimination test. Right? Oh and if eating foods that are high in oxalate make me feel good then clearly I don’t have an oxalate problem, right?
Sadly oxalate isn’t that simple. It isn’t like most food chemical issues or allergies where avoiding or limiting that food or chemical prevents symptoms. Oxalates get stored by the body similar to the way heavy metals are stored. While they are coming in rapidly the body is in storage mode, until the storage gets full. There is a limit to how much you can store before your body is overwhelmed and some of it starts “spilling over”. Some people have no symptoms of oxalate overload, not because they aren’t absorbing excess oxalate, but just because they just haven’t hit their personal tipping point yet. They may be storing lots of oxalate in their bodies but in such a way that it isn’t causing obvious symptoms. In fact they may feel worse on a lower oxalate diet and conclude that their body needs the high oxalate foods to be healthy. The problem is that sooner or later their oxalate storage will be full and the problems will be unavoidable. The solution is a LOD but…
DO NOT SWITCH TO A LOW OXALATE DIET COLD TURKEY!
Slowly, over time, (think months not days), step down your oxalate intake. Pick just one or two high oxalate foods in your diet to swap out for low ones at first. For example choose arugula instead of spinach. Pumpkin seeds instead of almonds. At the start some people will have a “honeymoon” period when they feel better than they did before. This usually only lasts a few days, if you have it at all. Next you will start something called dumping. This means that your body is seeing an opportunity to get rid of it’s stored oxalate. It starts moving it out of storage and to the excretion areas. If you reduce intake too quickly you could cause the body to dump too much at once and cause a kidney stone or other severe problem. Some have been hospitalized from the symptoms of too big a dump. Don’t be one of them. Once out of storage the oxalate needs to travel in your blood stream to be eliminated. It can and probably will cause pain, brain fog and other problems along the way. Then when it is being eliminated it may cause uncomfortable symptoms in your elimination systems. “Sandy” poops and cloudy urine are classic signs of an oxalate dump but are not necessary to prove an oxalate problem. Usually symptoms get worse, sometimes much worse, before they get better.
Symptoms of Oxalate dumping include (not an exhaustive list)
- Joint pain
- Painful urination
- Excessive urination/bed wetting
- Burning with bowel movements
- Sandy Poop
- White or black flecks in bowel movement
- Skin rashes
- Brain fog
- Eye pain
One way to slow down or stop dumping if you go too fast is to eat something high in oxalate. This will switch your body back into storage mode and stop the dump for the time being. This will also confirm for you (if you still had doubts about the oxalate connection to your symptoms) that it is indeed the cause. How long will eliminating excessive oxalate take? I am hopeful that after 1 year on the LOD we will have most of our stored oxalate dumped but it may take much longer. Depending on how fast you can dump and how much you have stored it could be several years to get through it all. Then, once that stored oxalate is dumped, you still need avoid absorbing too much oxalate because that will get you right back where you were before.
So where is all this oxalate coming from? It is found in a wide variety of foods, many are thought of as powerhouses of nutrition. Sweet potato, spinach, almonds, some berries, most grains all have high levels of oxalate and must be strictly avoided by people on a low oxalate diet. Some other foods can be enjoyed in very moderate serving sizes, broccoli, macadamia nuts and bananas. While still others have low oxalate per serving and can be enjoyed in nearly unlimited quantities, lettuce, cauliflower, most meats, dairy. It can be complicated to figure out what to eat. There aren’t any easy rules you can apply. Some citrus fruit is high while others are low. Different varieties of green beans have very different oxalate values. It also matters how a food is prepared. Some oxalate is water soluble so soaking and cooking in water and discarding the cooking water lowers oxalates enough on some foods to make them part of a LOD (all the soaking and boiling in the world won’t put almonds or spinach back on the menu though, sorry). For the same reason juicing will likely concentrate the oxalates in a given vegetable and so only low oxalate veggies and fruit should be juiced. For an adult on the LOD, daily oxalate intake shouldn’t exceed 40-60mg of oxalate. Raw spinach has 1145 mg per 1/2 cup. Even one leaf would be too much.
The Yahoo group I have linked below will have the most up to date testing information on Oxalate values in their files.
This is all very confusing and overwhelming. Is there a test I can take to know if this is really an issue for me? Yes there is it is called the OAT (Organic Acids Test) and Great Plains offers it. You will need to get a Doctor to order it for you and it is best to do the test while you are experiencing a flare of symptoms. If your Dr is unwilling to order it you can go through Great Plains My Med Lab to order it for yourself.
Will my Dr know about this? Not likely. Urologists know about oxalate because of kidney stones and many think that is the only worry. The list owner on the yahoo group I have linked below is a researcher who is doing unfunded research into oxalates. She helps to interpret the OAT’s for people who need her expertise and shares much the information that she finds while doing her research. It is a real blessing to have someone so dedicated to understanding this subject and to helping others available online.
Here are a couple of links for more information. Take your time understanding this. There is a lot of information between foods lists and supplements it can be hard to keep it all straight. I am far from an expert myself.
In addition to the LOD there are supplements you can take to help with this problem. Calcium citrate to bind to the oxalate in your meals, probiotics to degrade it, l-arginine helps us with dumping symptoms, b-vitamins to treat or prevent oxidative stress. There are lots more. Each person needs to figure out what is right for them. The people on the yahoo group can point you in the right direction four understanding this further.
I also want to mention that many have found other food sensitivities and diet needs clear up on the LOD. Most notably candida and free thiol sensitivities have cleared up for many. So if you are overwhelmed at the idea of adding even more food restrictions to an already restricted diet, it just might have the opposite impact and allow you to eat more (low oxalate) foods than you could before. My family is choosing to continue following the GAPS diet as our first step toward healing and are adding the LOD for the two of us who have demonstrated a need for it. The other 2 are on a, much lower than before, oxalate diet by default but have demonstrated no reaction to that change in their oxalate intake so I believe they do not have a problem with oxalates.
Edited to add:
Some people create oxalates in their own body because of oxidative stress. These people need more than the LOD in order to rid their body of excessive oxalate. The OAT test I referenced above will show if that is the situation for an individual. They need to be on a LOD but will need some specific (to them) supplements to see real improvement. Also some things, like vitamin C, turn into oxalate in the body, despite not containing any oxalate themselves. Someone on a LOD needs to keep their non-food intake of vitamin C very low.