Oxalate Myths

This is from a post Susan Owens wrote on November 3, 2018. Thanks to Annie Flanders who originally put this post together!

Myth 1. Oxalate is not a problem and shouldn't be tested unless and until you develop kidney issues.

Reason: A new study in the European Journal of Paediatric Neurology found that the children studied with autism were very high in oxalate, but they had no signs of kidney problems or evidence of risk of kidney stones as evaluated by the Bonn Risk Index. If this is true of one population, it is probably true of others.

Myth 2. People with diseases like Crohn's, short bowel syndrome, those who have had gastric bypass surgery, celiac sprue, inflammatory bowel diseases, or cystic fibrosis don't need to watch the oxalate in their diet until they have kidney issues.

Reason: These conditions predispose someone to enteric hyperoxaluria, where you absorb an excess percentage of the oxalate in the diet to the blood. Oxalate in blood may travel to organs all over the body where it may do damage to mitochondrial function, mineral metabolism, trafficking of other molecules at cell membranes, and may increase oxidative damage and keep injured tissues from healing. It may store in the body where it can come out later and cause symptoms. We need research that helps us understand the reasons behind the improvements we've seen when people with these genetic and other predisposing conditions have done the diet before they got kidney issues.

Myth 3. Primary hyperoxaluria is the only genetic disease where oxalate may be a problem.

Reason: Other genetic diseases where people have never looked at the gut may have tendencies towards having a leaky gut that got unnoticed. People with these conditions may do better or the disease may progress less when the diet is lower in oxalate. We've seen good things happen so far in Rett syndrome, cystic fibrosis, multiple hereditary exostoses and many other genetic conditions. Scientists have found risks related to oxalate in Down syndrome.

Myth 4. All the negative things that oxalate does in the body have been
discovered.

Reason: We are constantly finding new chronic problems that cleared up or went away or got much better when someone reduced the oxalate in the diet. Many people lose chronic pain or chronic inflammation, but the best way to learn what might improve is to talk to those who have been on the diet and find out what they were surprised to see improve.

Myth 5. Calcium should be limited if you have been found to be making stones from calcium oxalate.

Reason: Doctor's thought this for a long time, and then it was studied by scientists. They found that the more limited a diet was in calcium, the more likely someone would be to get calcium oxalate kidney stones. The body will just get the calcium from bones if you restrict dietary calcium too much. Dietary calcium actually binds oxalate in the gut and keeps it in the gut where it can be eliminated in the feces. Soluble oxalate, not bound to calcium or magnesium, is what is most easily absorbed in the colon.

Myth 6. Vitamin C in high doses is always good for you.

Reason: This has been studied extensively. After ascorbic acid is used as an antioxidant in the body, it converts to dehydroascorbic acid, which then may readily convert into oxalate. After this conversion, it becomes a pro-oxidant which can cause further oxidative damage. This has been studied in dialysis patients and in those with other conditions. We have seen lab work after a doctor gave a patient IV vitamin C. and the oxalate level in urine increased 40 fold in just a few hours, and the child had worsened problems for months. It seems prudent to keep daily vitamin C below 250 mgs in an adult, and 180 in a child, which is still way over the RDA.

Myth 7. In inflammatory bowel disease, the bowel is the cause of the oxalate issues.

Reason: More than half of the people who have a genetic disease where excess oxalate is made in the liver complain of serious bowel issues. Many people reducing oxalate in the diet find that their gastrointestinal symptoms clear up. Scientists are now studying how oxalate moves through the body and they know it gets excreted to the gut when blood levels get high. The gut may be as much a victim as a cause of excess oxalate.

Myth 8. My continual symptoms of urinary tract infections mean I must keep taking antibiotics.

Reason: Many who have this complaint have found out after the course of antibiotics that they got back their urine culture and it was negative. Oxalate in urine can feel like a urinary tract infection, and many people who try the diet find that their chronic "UTI's" go away. We need our flora to degrade oxalate for us, and these constant rounds of antibiotics may
compromise that.

Myth 9. Urine is a great place to measure oxalate.

Reason: Spot urine test results can be misleading when the sign of success is finally getting something on the test to move below a reference range. A study in rats showed that when they were made high in oxalate by being made B6 deficient and given the precursor to oxalate, as their oxalate levels increased, their kidneys started to secrete creatinine at four times normal concentrations. Since spot urine tests are ratioed to creatinine, which doctors used to believe was always in urine at steady unchangeable rates, this increased secretion will artificially make it look like the levels of anything on the test have gone down...even oxalate itself! This is a real warning on interpreting any urine test ratioed to creatinine in someone with an oxalate problem. The gold standard is a 24 hour collection that has also been adjusted for height in children.

Myth 10. If I am low in oxalate in urine, that means I don't have an oxalate problem.

Reason: There appear to be cycles to excretion of oxalate, and you don't know at what point of the cycle you are being tested. In the study in the European Journal of Paediatric Neurology, the relative level of oxalate in urine and blood plasma did not agree. There was a sixteen fold difference in the ratio of blood oxalate to urine oxalate in the 36 children with autism studied. Measuring oxalate in one place could not predict the level in the other. It is just more complicated than that. The Gamelins in France studied cancer patients given a drug that releases oxalate in the blood. Within hours, the urine levels of oxalate tripled, but after five days, the oxalate that showed up in urine was less than half of what it was before they even gave them the oxalate. The Gamelins found that even two weeks later their urine oxalate had not increased back to its level at baseline. Many patients at that point were still reporting neurotoxicity and there was no reason to think that being given oxalate in an IV would lower the body burden of oxalate at all.

Myth 11. Spinach is a very healthy food.

Reason: Spinach is one of the highest foods in oxalate. Studies where spinach was added to the diet in rats to make up a large part of their dietary calcium were extremely sick and many died. Their bones could not calcify and their growth was very stunted. They were unable to reproduce themselves except for one litter that only had two pups where the mother immediately ate her pups. This happened because spinach is so high in oxalate and especially high in soluble oxalate, the worst kind. A daily ration of spinach proved exceedingly toxic. Spinach is also a problem food because it is high in cyanide, another known poison.

Myth 12. There aren't very many healthy low oxalate vegetables and fruits
and I'll have to stop eating green leafy vegetables.

Reason: Our project and the Vulvar Pain Foundation have tested many greens that have reasonably low levels of oxalate. There are actually many foods in every category of food that are much lower in oxalate than other foods in the same category. You just have to find out which foods they are.

Myth 13. Oxalate isn't really toxic because so many health food stores feature very high oxalate substitute grains, and milks, etc. and these must be healthier than what we've eaten in the past.

Reason: Many people gradually find they feel worse when they add these new "healthy" high oxalate foods to the diet. They seem always astonished at how much better they do when they no longer use these products. Some native cultures ate high oxalate foods because it was the only food around, but they found ways of preparing them that at least reduced the oxalate level. These techniques of reducing oxalate are not being used with a lot of these new products.

Myth 14. Juicing fruits and vegetables is always healthier.

Reason: In a lot of plants, the whole fruit as it is added to juicers are much higher in oxalate than the parts we usually eat from the inside. Juicing preserves the oxalate in the juice because the food's soluble oxalate is dissolved in the juice, and the soluble oxalate is the easier form of oxalate to absorb.

Myth 15. Vegetable broths are always healthy.

Reason: When you boil vegetables, the soluble oxalate goes into the water, so if you use the broth from boiling high oxalate vegetables, the broth will be high in oxalate. Some people boil vegetables, throw out the broth, and then make their soup using another type of broth (or from low oxalate vegetables) and then add back in the boiled vegetables that are now reduced in oxalate.

Myth 16. Sprouting and culturing vegetables reduces their oxalate.

Reason: So far, these are claims that haven't been confirmed. At this point, the testing our project has done has not found these techniques to be very effective at reducing oxalate, and certainly cannot turn a very high oxalate vegetable into a low oxalate vegetable. Soaking grains overnight, and throwing out the water, however, can reduce the oxalate. This is not saying cultured vegetables are bad...they just are not proven lower in oxalate than the original vegetable.

Myth 17. Cooking reduces the oxalate in a food.

Reason: Cooking may move oxalate from one place to another (like out of a food into the pot liqueur, or cooking water) but it does not destroy oxalate. All the oxalate is still there somewhere. So it’s not a reduction - it’s a displacement from one location to another.

Myth 18. Kibble type dog food is very healthy for them because scientists have derived these formulas.

Reason: Even veterinarians are not aware that these dog foods that contain grains can be extremely high in oxalate, and dogs don't even have the enzyme AGXT that is broken in primary hyperoxaluria and would help them deal with the oxalate. Dogs are carnivores. Be especially wary of pet foods that contain beet fiber.

Myth 19. It is best to do diets that limit complex carbs and milk and substitute nuts, or nut flours, or nut milks before trying the low oxalate diet.

Reason: We have known many, many people who crashed in health when the oxalates were increased on these diets, and they absorbed so much oxalate while they were on those diets that their bodies had a lot of oxalate to detoxify. This made their first months on the low oxalate diet miserable as their bodies dumped out the oxalate that had been stored in their bodies. Some even required trips to the emergency room because their detox symptoms were so bad and the ER doctors couldn't really help them.

This doesn't happen if you reduce oxalate from a diet that is not excessively increased in oxalate. If you already are on those diets, and had problems, we suggest moving only slowly into reducing oxalate to limit the negative symptoms and be sure your doctor knows you are doing this transition.. The better order is to reduce oxalate first or at the same time as you begin these other diets. Our support group provides plenty of help for people doing combined diets.

Myth 20. Yeast makes a great deal of oxalate so hidden yeast infections can be the cause of excessive oxalate in the body.

Reason: This has never been proven or even studied scientifically. Look through the scientific literature yourself. Oxalate impairs enzyme activity that may weaken the immune response to yeast and make you more susceptible. That may be why people on the diet often report losing their yeast problems without antifungal treatment. So far, the data our project
has collected shows that treatment with antifungal medication is not lowering, but seems to be what is leading in some people to dangerous increases of oxalate that is being made in the body after or during the treatment.

Myth 21. Vitamin K makes reducing oxalate unnecessary.

Reason: This was a theory espoused by someone who learned that vitamin K dependent enzymes can bind calcium. There was never any more proof than a theory that reducing calcium would make reducing oxalate unnecessary. Scientists have already shown that reducing calcium in the gut increases oxalate absorption. It is a completely separate issue. Take vitamin K if you are deficient, or not eating foods that have enough vitamin K, and get the blood tests if you want to see if you are deficient, but this has nothing to do with oxalate.

Myth 22. If you feel worse on a low oxalate diet (LOD) then you need the oxalate to be well.

Reason: In a way, this falls into the same story as someone saying they need another drink to keep from getting the DT's (Delirium Tremens which is the withdrawal symptom that alcoholics get when they stop drinking).

Things don't get addictive unless they alter normal chemistry in a way that mimics something else, and do it better, and they end up causing the body to make big shifts in chemistry that it wants to keep. There is a price to pay though. An example is how heroin mimics normal neurochemistry but does it one better.

I think the main thing oxalate alters is things that calcium regulates, but that ends up involving a lot of trafficking of neuro-chemistry of various sorts. What it changes gets kind of close to what caffeine does, but it does a lot more than that. One day this will be sorted out, but these sorts of issues may be why people sort of unwittingly select those foods once they start eating a lot of them and then stop eating as much other food.

Myth 23. Eating too little oxalate causes us to make endogenous oxalate.

Reason: The researcher behind the theory had obviously NOT read the literature about primary hyperoxaluria and didn't realize oxalate stores in cells in the body and will come out in cycles when the blood level is allowed to decrease. This is what brings on dumping, but someone isn't making oxalate when this happens; they are just moving it around.

There is no evidence at all that oxalate is purposefully made by human beings, because the only way it could do that is by down regulating AGT (and there is no evidence of that) or by making vitamin C (which we can't). The only times it is observed to increase is if there is a genetic defect, or if someone is vitamin deficient, and of course, from hyper-absorption from the diet.

Myth 24. Oxalate is a food sensitivity or “allergy".

Reason: We have many come in frequently that micromanage their food input by looking for "reactions", as if it were peanuts or casein. Others want to eliminate ALL foods containing oxalate, as if it were like gluten and they were celiac, or who hope that once they get their oxalate "sensitivity" improved, they can go back to eating their previously "healthy" diets based on spinach, chard, dry beans and almonds.

We aren't here because we are "unusual" and have an allergy. We are here because we are aware of our problem with a known poison stored in our bodies. It may just be an issue of identify confusion, but our bodies put oxalates into the tissues and get them out of circulation. It may be a bit uncertain now where this toxin can do the most damage. If our body can (as it determines by biochemical/other signaling), it tries to get rid of oxalate as it comes in. If it can't, then it will be stored. And you may or may not get "symptoms" when it is stored.

This is certainly not like reacting to an allergen! That is immediate - or close enough to eating that you can figure it out. It's also consistent. Oxalate issues will be neither - because it's not an allergen or sensitivity; this is a poison. It's all in the dose: high enough and you die, but lower and you get rid of it immediately. We normally live between these extremes - but as soon as you've eaten more oxalate than your body knows it can easily detox right away, some is being stored.

Once oxalate is absorbed, your body treats it like a toxin. It's that simple. The thing which likely separates us from others who are handling oxalate better are things like: gut issues (if you have them, you are absorbing more oxalate); gut bacteria (if you've got good oxalate degrading gut bacteria, you can eat more of it with less impact); genetic factors (you could be making your own oxalate, for instance).

Why wouldn't you have the right gut bacteria? Well, could be a number of things, including: use of antibiotics; non-vaginal delivery; not breastfed; your mother didn't have the right bacteria either!

Why wouldn't you have good gut integrity? Again, could be a number of things, including: our modern "convenience" foods which can cause gut issues; excessive exposure to gluten (which virtually everyone in North America or Europe would have); high sugar in our diets (that feed the wrong gut bacteria); any chronic gut issue, like celiac, IBS, Crohn's, chronic diarrhea, chronic constipation.

So - we aren't "reacting". Everyone who absorbs oxalate will have some degree of effect, because it's a poison. The reason we are more obvious is that we are absorbing more than others! It may also be that we've been trying to eat really healthy - like spinach and beets - because we can now eat high oxalate foods 365 days a year. Note that even the healthiest person will absorb too much oxalate in their diet if they are eating high oxalate foods all the time. The reason it will happen is that oxalate will move from an area of high concentration (your gut if you've eaten a lot of oxalate) to an area of low concentration (your blood stream on the other side of your digestive tract).