Oxalate Toxicity
Oxalate, aka oxalic acid, is a naturally-occurring and reactive molecular substance found in a variety of foods, especially plant based food. They are indigestible to humans and for the most part should stay in the GI track and pass through unabsorbed.
Oxalates are found in many healthy foods that you may be consuming on a daily basis, such as seeds and nuts (especially almonds), most greens (especially spinach), many fruits and grains, and sadly, cacao. We provide a more complete list further down.
In a healthy digestive system with no ‘leaks’ and plenty of good bacteria, those oxalates simply go through your digestive tract and end up being degraded by specific bacteria in your gut and excreted in your stools.
HOW DOES HIGH OXALATE CONSUMPTION BECOME A PROBLEM?
As mentioned, if the gut is healthy, oxalates might not be a problem. However, we believe they lead to health issues for everybody if consumed in very large quantities (such as daily green smoothies, lots of nuts/nut flour, cacao... see full list below).
Additionally, people with digestive issues, such as SIBO, leaky gut, or a lack of good bacteria in their gut (aka dysbiosis) are more likely to develop health issues as a result as a result of oxalate toxicity.
Problems occur when excess oxalates are absorbed through the gut due to intestinal permeability (leaky gut), poor fat digestion, inflammation, or prolonged diarrhoea or constipation.
Overuse of antibiotics is also problematic, since this can reduce or eliminate the oxalate-degrading bacteria in the intestines, best known as oxalobacter formigenes.
*The triple therapy used for the treatment of H.Pylori has been shown to completely eliminate the presence of oxalobacter formigenes in the gut, possibly leading to oxalate's sensitivity.
Glyphosate (aka round up) has also been linked to oxalate toxicity, as it can actually convert to oxalate in the body. You can watch this fascinating interview Gen did with Dr Stephanie Seneff to learn more about glyphosate and its negative impact.
Candida and Toxic Mould Illness are also linked to Oxalate Toxicity. Organic Acids Tests (OAT) often show, that when fungal markers are elevated, oxalate markers also tend to be elevated.
When too much oxalate is absorbed in the bloodstream via the gut, it links to calcium and form into sharp calcium-oxalate crystals.
These are best known for causing kidney stones, but what most people do not know is that those crystals can lodge in almost any tissues in the body causing or contributing to pain, inflammation, irritation of tissues and mucous membranes (including the gut membrane), and a host of other conditions. They are more likely to accumulate in places where you've had previous injuries, inflammation or infections.
Excess oxalates can also lead to oxidative damage, mitochondrial dysfunction (essential for energy production) and the depletion of glutathione and sulfate (which is essential for metabolizing many toxic environmental chemicals that enter the body.)
Oxalates can get stored in the body, similar to other toxins such as heavy metals.
FOODS HIGH IN OXALATES
A lot of foods considered to be very healthy are very high in oxalates. As mentioned above, this might not be a problem for all, but we do believe that very high oxalate foods can become a problem for everybody if consumed daily for a long time.
Generally, high oxalate foods include most nuts, beans, greens such as spinach, most berries (except blueberries and strawberries), sweet potatoes and chocolate.
We have included a more comprehensive lists below, including low, medium and high oxalate foods.
** Vegetarian and vegan diets tend to be very high in oxalates. Ketogenic diets can also be very high in oxalates if using a lot of nut flours and consuming a lot of the high oxalates/low carb greens.
SIGNS & SYMPTOMS OF OXALATE TOXICITY
The symptoms actually depend on where the oxalate crystals are deposited in the body, or being excreted. As mentioned above, oxalates are more likely to be attracted (and therefore cause symptoms and pain) to sites of old injuries (including surgery and scar tissue) or infections in the body.
We have highlighted the most common symptoms below.
- Painful or inflamed joints, similar to fibromyalgia or arthritis
- Muscle aches and tension, especially in neck and shoulders)
- Back pain
- Fatigue (by causing mitochondria dysfunction)
- Weakness or low muscle tone
- Burning urine flow, frequent UTI
- Interstitial cystitis and frequent urination
- Vulvodynia - external female genital pain or irritation
- Digestive issues (often seem to be cyclical)
- Burning bowel movements
- Itchy/irritated anus or vagina
- Depression
- Eye pain/dry eyes
- kidney stones
- Burning feet
- Blood sugar and thyroid issues
- Cloudy urine
- Crystals in urine (you might be able to find these if you let your urine dry out in a container)
- Black flecks in stools
- Low levels of calcium, magnesium, iron and zinc (oxalates is considered an anti-nutrient and can bind to those nutrients, preventing their absorption.)
- Osteporosis - calcium is an oxalate magnet. The calcium you need for strong bones combines readily with oxalic acid to form calcium oxalate. Oxalates can then accumulate in bones, displacing normal tissues and causing weakness and demineralisation.
TESTING
It's important to understand that no test can completely rule out that you might have oxalate toxicity. However, a positive result is a clear indication that oxalate could be an issue for you.
Here are the 2 best tests available:
- Oxalate Spot Urine test (also available as a 24 hour test)
- Organic Acid Test by Great Plains Laboratory: Look for high oxalic acid
CANDIDA AND OXALATES
Candida/yeast overgrowth and oxalates come hand and hand. For this reason, it's helpful to address both at the same time.
Learn more about candida here.
TREATMENT OF OXALATE TOXICITY
The goal is to reduce oxalate intake and consequently reduce the body’s oxalate burden and aid its functioning.
There are also some helpful supplements listed below that can help reduce the absorption of oxalates from food and also reduce the endogenous production.
IMPLEMENTING A LOW OXALATE DIET
Many people feel better quickly as they reduce their oxalate consumption. However, for many, the oxalate dumping can cause a flare up of symptoms and can be very uncomfortable.
RULE #1: GO SLOWLY
For this reason, the most important aspect of implementing a low oxalate diet is to reduce oxalates very slowly, over time. As you reduce your oxalate consumption, your body is seeing an opportunity to get rid of its stored oxalate. It starts moving it out of storage.
This might cause a 'dumping' of oxalates, which can cause serious detox symptoms if reducing oxalates too fast.
If you have a high body burden of oxalates, this 'dumping' can happen on and off for many months or even years.
Symptoms of oxalate dumping can include any of the symptoms of oxalate toxicity listed above flaring up, especially fatigue, sandy stools, cloudy urine, painful or excessive urination, joint pain, skin rashes and peeling skin, eye pain, and more.
For this reason, it is best to go slow and keep the dumping symptoms comfortable.
A good place to start is by reducing your consumption of the foods highest in oxalates.
FOODS HIGHEST IN OXALATES
Certain foods are so high in oxalates that simply avoiding these will reduce your consumption VERY significantly. If you consume a lot of these foods, then simply start by reducing your portions, until you are avoiding these foods completely.
The foods highest in oxalate are: spinach, rhubarb, beets (both leaves and roots), nuts (including nut milks and nut flours), chocolate, most legumes (including soy), tea (except herbal tea), many berries (especially mulberries, blackberries and raspberries) and sweet potatoes.
CLICK TO DOWNLOAD A COMPREHENSIVE LIST OF OXALATES CONTENT IN FOOD
SUBSTITUTE HIGH OXALATE FOODS WITH LOWER OXALATE FOODS
Substitute:
- Spinach with arugula/rocket or other lettuce
- Curly kale with purple kale or dinosaur/cavalo nero kale
- Almond milk with coconut milk
- Sweet potato with butternut squash
FOOD PREPARATION
A food’s oxalate content is decreased through boiling as the oxalate will leach in the water. Make sure you get rid of the water after boiling. Soaking grains and seeds also reduce oxalate levels.
EAT ORGANIC AS MUCH AS POSSIBLE
Glyphosate (aka round-up) which is used in most non-organic crops (less so in Europe) can actually be converted to oxalates. Eating organic becomes essential for people with oxalate toxicity.
HELPFUL SUPPLEMENTS
Magnesium, calcium or potassium citrate: Taken just before food (20 minutes before food if in capsule form), will bind to some of the oxalates in your food to prevent absorption. This does not mean you should consume high oxalate foods. But... because there are oxalates in virtually every food, this helps to make sure you are absorbing as little as possible. The citrate form is better as it also helps to prevent the formation of oxalate stones. However, some people don't tolerate the citrate form, in which case it's OK to take another form.
*Please note that you will not absorb all of the magnesium or calcium when used for this purpose, as it will bind to the oxalates. It's best to also take magnesium away from food. Refer to Phase 1 Supplement Protocol for more info about magnesium.
Fermented foods & probiotics:
Oxalobacter formigenes is the best known oxalate degrading strain. Unfortunately, it is not available commercially yet as a probiotic. Other strains that have some oxalate degrading abilities include:
- Lactobaccilus plantarum
- Lactobaccilus rhamnosus GG
- Lactobaccilus gasseri LG36
- Lactabaccilus acidophilus LA02
- Bifidobacteria HN019 (also good for constipation as it decreases transit time)
- Bifidobacteria breve M16V
- Bifidobacteria longum BB536
Supplements to improve fat digestion: A digestive enzyme containing lipase can be useful for this, or ox bile (buy here in Australia or here in the USA).
Epsom salt baths: Can be especially useful during 'dumping'. Oxalate toxicity can also cause a sulfate deficiency. Epsom salt baths can help supply some of the sulfate that the body desperately needs.
Sulfate: Oxalates and sulfate share the same transporter... which basically means that when oxalate levels go up, sulfate levels go down. For this reason, we believe that most people with oxalate issues are deficient in sulfate. It's worth noting that many people with sulfate deficiency can become sensitive to sulfur in food... this create a vicious cycle! We have found that MSM and NAC are often very well tolerated and can help replenish sulfate levels in the body.
MSM: can greatly help with the pain and inflammation associated with oxalate toxicity. Start with 1 gram twice per day and slowly increase to up to 30 grams daily. Keep increasing until you feel a positive effect on your pain and inflammation.
NAC: a sulfur containing amino-acid, can help support detoxification by increasing glutathione production. Take 500mg to 1 gram daily.
B6: Oxalates deplete vitamin B6. Vitamin B6 deficiency increases oxalate production inside your body because B6 is a required cofactor for the conversion of glyoxylate to glycine. Hence, when vitamin B6 status is inadequate, glyoxylate is converted to oxalate. Some people also have 'snps' in the liver enzyme AGT needed for this conversion. For these people, B6 supplementation might be even more important.
This vicious cycle can lead to deficiency, so supplementing B6 is important. Doses of up to 5mg/kg/day have been used in research without side effect. We recommend 100mg to 200mg of pyridoxine for most people. If using the activated form of B6 (P5P), lower dose might be needed. It's worth noting that for B6, the inactivated form (pyridoxine) is just as effective.
Multi-mineral: Oxalates act as a chelator for many essential minerals, so supplementing with a good multi-mineral will help. Manganese and zinc are especially important. It's best to test to assess deficiencies.
Other useful supplements: Biotin and allithiamine can also be very useful for many people.
SUPPLEMENTS TO AVOID
Glycine can be converted to oxalate in the body in some people. For this reason, it's best to avoid supplements with glycine, or glycinate form of supplements, such as magnesium glycinate.
Vitamin C in high dose can also be metabolised to oxalate. It's recommended to take only small doses, such as 250mg three time per day.
Collagen/gelatin can also be converted to oxalates in the body. Although they don't need to be completely avoided, it may be best not to use these as your everyday protein powder supplement.
Here's a simplified version of the oxalate/glyoxalate pathway to help you better understand what can contribute to the oxalate load in the body:
HEAL YOUR GUT TO IMPROVE OXALATE TOLERANCE
Oxalates can be a problem for a lot of people with gut issues. However, as you go through this program and take steps to heal your gut and restore a healthy balance of bacteria in your gut, it is likely that oxalates won't be as much of a problem for you in the future.
However, we do recommend that most people be careful of over consuming foods that are very high in oxalates, such as almonds, spinach and chocolate.
If you are interested in learning more, we have included below a wonderful interview Gen did with Maria Hunt, who has extensive experience with oxalate toxicity.