Oxalate has been a subject of great interest for me for many years now. It is an intriguing subject, and one that rarely gets the attention it deserves. Oxalate is my family’s one remaining issue at this point. Or more accurately, one remaining “symptom”. You can read my introductory article on oxalate here, and my articles about the relationship between oxalate and candida here and here. I don’t want to rehash that science. In this article, I would like to focus on the possibility of solving your oxalate issue.
I have learned much of what I know about oxalate from studying the work of Susan Owens, oxalate researcher extraordinaire. Susan was really the first person to expand the study of oxalate clinically to outside the kidney. Nobody else thought it had any relevance outside of the potential for kidney stones. Susan discovered the relationship between oxalate and autism and confirmed that relationship in this study in the European Journal of Paediatric Neurology, which found that oxalates may be involved in the pathogenesis of ASD in children. It was her research that got my kiddo out of pain, and living a healthy, happy life. I owe her so much and I am eternally grateful for her work.
But I have to admit that I am troubled by some of the current thinking with respect to oxalate.
I do not believe that my daughter should be restricted to a low oxalate diet for the rest of her life. Sure, I know oxalate is a “toxin”. And we certainly do not thrive on the stuff. But there are plenty of toxins in plant-based foods. Are we to avoid all of them? Avoidance of many foods puts us at risk of malnourishment. And I really don’t believe food is the real problem in most cases.
I lived over 30 years of my life without symptoms from oxalate before they started to impact me. And that happened overnight. Not as in the slow accumulation of toxins, but as in the result of the trauma of a c-section, anesthesia, and antibiotics. So these toxins in food didn’t interfere with my healthy, active life until these major medical interventions.
Yes, it is entirely possible to get yourself into trouble with oxalate with diet alone. This happens quite often with health conscious people. I meet people everyday who come to me for help with diet after making “improvements” to their diet that have made them far sicker, and oxalate is often the explanation. Dr. Shaw from Great Plains Laboratory calculated the average intake of oxalate in the average American diet to be about 100 mg, whereas those eating just one green smoothie (prepared with 2 cups of spinach or the equivalent) were netting 15,000 mg of oxalate! Shaw described oxalate as “probably the most important unrecognized medical factor that is going on today”. I completely agree with this statement!
Yet, my experience on this diet has led me to believe that my reaction to oxalate has significance beyond the mere need to avoid this toxin. There is a reason I have ill effects from oxalate consumption. And I am not eating the spinach smoothies Shaw describes; I suspect many people would react to that kind of oxalate consumption. But there must be a reason I can’t “get away” with even a handful of almonds or a teaspoon of beets.
Endogenous production of oxalate occurs in the body under certain circumstances. Endogenous production of oxalate means that oxalate is being made in the body. You can imagine that under these circumstances, food is only part of the oxalate equation. It makes absolutely no sense to me to blame the oxalate in food when there is obviously something about my biochemistry that needs to be addressed.
And that, my friends, is why we have been working for several years on addressing the underlying issues.
I often have clients that have been eating ridiculously high in oxalate (usually in an attempt to be healthy!) and they improve when they slowly move toward a moderate oxalate diet. But it is true unfortunately for my clients as well as my family, there is usually more to the issue than food.
There are so many roads to oxalate. I can’t address them all in this article but I will address a few that I commonly see in my daily work with clients, and some of which we dealt with here.
As I stated above, foods contain variable levels of oxalate, from negligible to extremely high. Additionally, there are foods that contain precursors to oxalate, that convert to oxalate under a set of circumstances. For example, bone broth contains hydroxyproline, which breaks down to glyoxylate and eventually oxalic acid when conditions are right (or should I say wrong!). It did not matter how much bone broth we drank to “heal our guts” – it took stopping the broth and decreasing the oxalate in our diets to see improvement. Vitamin C can convert to oxalate, especially under certain circumstances, as in when there is high free copper or iron. Most people on a low oxalate diet have to be cautious with various substances in foods and supplements that can convert to oxalate.
The gut plays a large role for some people. Leaky gut increases our absorption of oxalate. Fat malabsorption can as well, by tying up our calcium that would otherwise protect us from absorbing oxalate. When gut bacteria is destroyed by antibiotics and such, we can no longer put it to use degrading the oxalates from our food. A lack of the intestinal bacteria Oxalobacter formigenes has long been discussed as the potential problem. And this makes sense in context with all the antibiotics we take (and get indirectly through food) that could potentially wipe out this darn near impossible to recolonize anaerobe. I have to admit that I once thought that when O. formigenes became commercially available as a probiotic (Trials are underway, but this stuff is not easy to package, people. Again, it is an anaerobe.) we would all be cured of this condition. But after having seen a couple years of my clients using the new version of Genova’s GI Effects which tests for this bacteria I think I can count on my fingers and toes the number of clients I have seen with below detectable levels of this bacteria. Quite often, people have moderate or high levels. I can only assume in many people it is thriving on abundant amounts of oxalate. It is possible that other strains of bacteria that also contribute in a large way to the degradation of oxalate are lacking and this is a factor. Time will tell.
Minerals and oxalate have an interesting relationship. We have learned that most of our “oxalate” symptoms are actually mineral deficiency symptoms that are likely induced by the presence of oxalate. Oxalate can effectively “chelate” some minerals from the body, such as calcium. Since calcium in the diet protects us from absorbing oxalate, one has to wonder if casein-free diets could leave someone more vulnerable to oxalate problems. Copper and iron dysregulation seem to relate to oxalate in several ways. And these issues are not at all uncommon in the population I work with. As I mentioned above, Vitamin C can convert to oxalate in the presence of high free copper or iron. But we are learning that while people may have high levels of biounavailable copper or iron, they may be deficient in bioavailable forms of these elements. And these minerals also play an important role in the antioxidant enzymes that are needed to mitigate oxidative stress. This is a really big topic and will be the subject of another blog post.
I discussed the yeast and mold connection in depth in my articles shared above, so I will spare you a repeat of that discussion.
Deficiencies in B vitamins, particularly B6 and often B1 are associated with oxalate problems. While these vitamins are often supplemented on low oxalate protocols nobody is talking about why they are so deficient in the first place. Are there transport issues? Trouble converting them to their active forms? Lack of absorption in the gut? Or are we just burning through them due to oxidative stress? Perhaps increasing our intake can help under some circumstances, but is it possible that these deficiencies are being created by gut bugs that are thriving on the B vitamins, leaving their host deficient? Is adding B vitamins to this situation without getting to the underlying infections ideal?
Just based on the work I have done with clients, I have a strong suspicion that sulfur-reducing bacteria could be behind the oxidative stress and B6 deficiencies in many people. After all, sulfur is needed to make glutathione, our master anti-oxidant! I will have to elaborate on this in the future for risk of writing a novel here.
Many of my clients have Pyroluria, a condition where you waste your B6 and zinc. Low B6 is a well-accepted cause of endogenous oxalate production, and low zinc can lead to high copper. You can see where that could be a problem with respect to oxalate!
Don’t even get me started on Lyme and mold. Most of my clients suffer from Lyme disease and mold illness!
For some people, this is a genetic issue. As I explained in my article Oxalates: Plant Toxins on Your Plate, some people do have a genetic form of hyperoxaluria, and they produce oxalates endogenously (their body produces them) due to mutations in the genes GRHPR and AGXT. There are other genes that are looking like they play a role, but we still have a lot to learn in this area.
While on the topic of genetics, Dr. Amy Yasko lists a number of factors that may contribute to high oxalate levels in Chapter 4 of her latest book, Feel Good Biochemistry, including two polymorphisms both myself and my daughter have the misfortune of having. While Susan Owens has dismissed some of these factors, there are several she has not yet addressed. For my daughter, I leave no stone unturned. I appreciate Dr. Amy’s attention to this issue.
In Dr. Amy’s wise words, “the issue of high oxalate is integrated into my larger concern about overall biochemical balance”. YES.
The enzyme I mentioned earlier, AGXT which is involved in primary hyperoxaluria and protects us from making oxalate is B6 dependent, and this is why B6 is such an important intervention on the protocol. I think people with oxalate issues with high need for B6 should be asking why they have such a high need for B6. Do they have poor absorption in the gut? Are they burning through it trying to make glutathione due to high levels of oxidative stress? Are parasites using it up? In many cases, while taking B6 in higher doses may help mitigate the damage with respect to oxalate, I fear that this treatment does not solve the underlying issues, which may fester and grow.
I have never met a single person who has healed an oxalate problem with B6. And I don’t think high dose B6 is even appropriate for everyone. You have to ask yourself why the high doses of B6 are needed in the first place. What is placing so much demand on B6 chemistry?
Get to the root of the issue.
I know that there is no “quick fix” for an oxalate problem. It is not likely to resolve easily. It takes time. We know this first-hand as we continue to work at reducing our oxidative stress. But issues that are left undetected and untreated could cause more health problems down the road. In my opinion, an oxalate issue that goes beyond oxalate intoxication from eating a high oxalate diet is a warning that there is an imbalance in the body that needs to be addressed.
If you have a problem with oxalate, I encourage you to find the underlying issues and address them. I hope this article helps you start to Peel Back the Onion Layers with respect to oxalate!