Oxalates: Beware Eating A Raw Food Diet, High Volume Of Salads, For An Extended Period Of Time | 1 Corinthians 6:19

Oxalates are organic acids found in some of the healthiest foods. Damage to your gut can cause these acids to develop into crystals that can lead to kidney failure and many other problems. Until recently doctors thought that oxalate crystals were found only in kidney stones. Researchers now know that in some people, especially women, oxalates can accumulate in soft tissues or any organ of the body.  When this happens it is called Hyperoxaluria. Symptoms are often the same as fibromyalgia, so some people diagnosed with fibromyalgia may have pain caused by high oxalate levels instead. Oxalates have been seen in brain tissue, organs, including the heart, teeth, bone, tendons, cartilage, and synovial fluid. Oxalates can cause an arthritic type of inflammation and pain in hands, feet, and joints. Crystals may collect more in old injuries. (1) (2)

The oxalate and Covid 19 connection.

Could it be possible that oxalates are responsible for inflammation caused by Covid 19? If this is true, a low oxalate diet may help with some of the symptoms. Studies have found that in cytokine storm, in extreme Covid 19 cases, macrophages and monocytes, (types of white blood cells that fight infection), induce an increase in oxalates throughout the body. One research article states that “Calcium oxalate (CaOx) induces a dose- and time-dependent expression of inflammatory cytokines in the human monocytic THP-1 cell line.” Oxalates could be the cause of extreme damage to lungs, blood vessels, heart, and other organs. See the research articles, here and here.

There are two types of hyperoxaluria. Primary hyperoxaluria is a genetic disorder caused by liver enzyme deficiencies. Secondary hyperoxaluria is the most common type seen in disorders like celiac and Crohn’s disease or with gastric bypass surgery. When the gut is involved the term used is enteric hyperoxaluria. Research has found that gut damage and imbalances cause oxalate levels to rise. Consistently high oxalate levels can result in severe kidney damage leading to dialysis. (1) (2)

Causes of hyperoxaluria are:

• High oxalate diet
• Changes in intestinal absorption and bacterial flora caused by antibiotic use or fungus and mold exposure
• Imbalances or changes in calcium and fat  absorption in the bowel
• Altered synthesis of oxalates in the liver
• Vitamin and enzyme deficiencies
• Any combination of these

Disorders associated with high oxalate levels:

• IBS
• Autism
• Kidney disease
• Crohn’s disease
• Celiac disease
• Short bowel syndrome, a result of bariatric surgery
• Pancreatitis
• Biliary cirrhosis
• Taking medications like orlistat used for obesity to block fat absorption (1) (2) (3)

Symptoms of oxalates in the tissues:

• Aches and pains anywhere in the body
• Rash due to acids causing inflammation
• Nodules on face and hands
• Eye and vision disturbances and sensitivity to light due to oxalates crystallized structure
• Nerve and muscle pain caused by demyelination (damage to nerve and muscle coverings)
• Feeling cold in hands, feet, or in general
• Stinging pain under the skin
• Irregular heartbeat
• Vulvodynia, Vaginal and labia pain, and/or cyst-like deposits or lumps in the vaginal area

In the past, it was believed that a low calcium diet was important in keeping oxalate levels low, but research in the 1980s and 1990s found that calcium, in the citrate form helped bind oxalates and remove them from the body.

It is important for anyone with any gut-related issues to understand the association between enteric hyperoxaluria and malabsorption and the effect of diet and supplements on urinary oxalate levels. Education is important in managing oxalate levels. For some suffering from the condition, eating healthy can be very unhealthy since most healthy foods are high in oxalates.

The Connection Between Kidney, Crohn’s, and Celiac Disease:

There is clear evidence that the integrity of your gut has a lot to do with not only pain from oxalates, but your chances of going into renal failure. Increasing numbers of patients are diagnosed with Crohn’s disease and advancing to ESRD. In one study results found that 28.3% of the patients with Crohn’s disease had oxalosis and/or calcium oxalate stones, and 72.7 % had recurrent stones. In the Crohn’s disease patients with hyperoxaluria, 74% had increased intestinal oxalate absorption.  (7)

Research has suggested that end-stage renal disease can be helped or delayed with the proper combination of therapy if the damage is from oxalates. (3) Studies have concluded that in many cases, hyperoxaluria is a direct result of intestinal malabsorption. Since thirty percent of kidney patients are not diagnosed until the patient has reached ESRD (end-stage renal disease) or kidney failure, this is very important. (4) (7)

It makes perfect sense that damage to the gut from celiac disease can cause kidney problems also.  Evidence had also proven that kidney stones are more prevalent in people with celiac disease than in healthy populations. In one study 608 people with untreated celiac disease, had 120% higher urinary oxalate levels and 43% lower calcium levels than the control group. (5)  Research has existed for decades to support the claim that a high oxalate diet combined with calcium intake increases the excretion of oxalates in the urine resulting in reduced oxalate load on the kidneys and organs. Still, there are very few studies that address treatments meant to reduce oxalate formation to help preserve kidney function. (3) (4) (7)

Autism:

High plasma oxalate levels and increased excretion rates of oxalates have been noted in autistic children. In one study, children with autistic spectrum disorder were found to have 3 times the oxalate plasma and urine levels as healthy non-autistic children (6).  Autistic children placed on a low oxalate diet were reported to be more focused, and calm, they walked better and had a reduction in foot and leg pain.

Heart Disease:

Oxalates can deposit in the heart and cause cardiac deposits resulting in conduction abnormalities, arrhythmias, palpitations, and dizziness. Impaired injection fraction is found most often in cardiac testing when oxalates are involved.

First steps needed to control your intake:

Daily intake of oxalates on average should remain below  80 to 120 mg. A half-cup of spinach can have as much as 700 mg, so it is important to know the amounts that you are getting. It is very difficult to manage oxalates. Levels in identical foods may vary. Information on oxalate amounts in certain foods conflict. The Harvard School of Agriculture and the USDA differ greatly when reporting oxalate content of certain foods. This makes it even harder to monitor the amount of oxalates you are actually taking in. For instance, one of the very legitimate sources says kale is high in oxalate, while others say it is low in oxalates. It is always best to listen to your body.

Foods highest in oxalates are:

• Rhubarb
• Nuts
• Spinach
• Beets
• Chocolate
• Wheat
• Teas, the longer they steep the more oxalates!
• Black pepper

Click here for a list of foods with oxalate content from the Harvard School of Public Health Nutrition Department.

Lowering oxalates to 50 mg a day can help even more, but this can be difficult for most patients to achieve since there is no labeling of oxalate content of foods. The healthiest and most nutrient-dense foods are usually high in oxalates. Lowering your fat intake will help decrease intestinal oxalate levels. Fat prevents calcium from removing oxalates in the body. (1)

Calcium and Magnesium: Many ions bind and complex with oxalates but the oxalate binding agents studied most, and found most effective, have been calcium citrate and magnesium citrate. Study results found that magnesium and citrate worked as inhibitors best, only when the urine was diluted. This again emphasizes the importance of hydration in possibly preventing damage done to the kidneys by oxalates.

Diagnosis:

Diagnosis can be difficult because a urine test is usually done that may or may not detect oxalates. Intake of foods high in oxalates and acidic conditions tend to hold them in the body. Enough calcium, magnesium, or citrates must be available in the body to help remove them. When laboratory testing is done the test performed is usually a 24-hour urine test. With this test, if oxalates are in the absorption phase, still collecting in the tissues, the urine may have undetectable levels of oxalates. A few days later the urine may have large amounts of oxalates if oxalate intake is lowered and enough calcium, magnesium, citrates, and water is consumed.

Treatment for hyperoxaluria:

• Low oxalate diet
• Water intake of 2 to 3 liters a day when combined with calcium citrate or magnesium citrate was found to not only help remove oxalates from the body but also change the structure of the crystal giving it a more rounded shape. The rounded shape was thought to prevent some of the damage that the jagged-edged crystals produced.
• Citrates in the form of citrus fruits with no sugar added. Squeezing ½ lemon in a glass of water works great.
• Calcium citrate with meals, studies have shown that taking 150 mg can help excrete up to 100 mg of oxalates into the urine. The easy way to do this to buy it in the powder form and add it to a bottle of water. That way it can be sipped throughout the day and you can better regulate how much calcium you are getting. Oxalates cause calcium levels in the blood to be low since they prevent calcium absorption.
• Magnesium citrate, taken away from the calcium. Magnesium has been found to bind and remove oxalates best, but high doses can result in diarrhea. Best to use this at bedtime. A 300mg dose can cause loose stools in some people.
• Magnesium oxide has a PH of roughly 9 so it alkalizes the urine. Oxalates are highly acidic so the addition of magnesium oxide may help excrete oxalates by increasing the PH. Consistent research has found that an acidic environment causes oxalates to stay in tissues. Since oxalates are made up of calcium oxalate, magnesium in its oxide form may bind oxalates efficiently.  Magnesium oxide should be used in rotation with magnesium citrate for best results.
• Potassium citrate along with magnesium is known to inhibit stone formation in some studies. This may result in low potassium levels in the body if potassium binds and leaves the body the way magnesium does. (7)
• Sulfate is needed to repair cells, sulfur is in every cell of the body and is needed for hormone and protein synthesis. Oxalates remove sulfur from the body. Sulfate also helps detoxify heavy metals. Low sulfate causes low serotonin levels and low neurotransmitter levels in the brain. MSM is a good supplement to replace sulfur losses.
• Chanca Piedra is a South American herb that has been used for ages to break down oxalates and help remove them from the body
• EDTA chelation therapy helps remove heavy metals, balance minerals, and destroy fungus.  When taking EDTA you must take a mineral supplement to replace those that are lost.
• L-Lysine is needed for efficient metabolism, hormone balance, to prevent virus replication and more.
• Folic acid may have an inhibitory effect on oxalate formation.
• Vitamin B-6 deficiency has been connected with high oxalate levels
• Low-fat diet, since fats in the intestines block calcium’s ability to bind and remove oxalates.
• Antifungals, yeast produces oxalates in the body. There are cases of mold exposure that resulted in high oxalate levels in the bloodstream. Candida has been seen surrounding kidney stones in laboratories.
• Taurine may increase bile salts which help break down fats
• Probiotics, Many probiotics have been proven to degrade oxalates. This is the reason antibiotic use, which kills good bacteria, can result in an oxalate overproduction. Non-secretors and those suffering from candida have lower levels of many of these good bacteria.
• Oxalate-degrading enzymes are new enzymes on the market that break down oxalates when taken with high oxalate foods.
• Fish oil, omega 3 help degrade oxalates. Omega 3’s are synthesized into anti-inflammatory prostaglandins. Omega 6 and arachidonic acid were shown to increase oxalate levels.
• Vitamin E has been found to prevent hyperoxaluria in laboratory rats
• Selenium in combination with vitamin E was shown to prevent hyperoxaluria.
• Vitamin A, studies have shown that Vitamin A inhibits oxalate crystal formation in children.
• Vitamin D is best in the form of sunlight. Unfortunately taken with calcium, it can keep oxalates in the tissues and bones, so do not take high amounts if you are trying to get rid of oxalates. Vitamin D is best taken when oxalate levels in the body are not very high. If you are dumping, your body will take calcium from the bones and vitamin D levels may drop even more. People with oxalate problems tend to have low D levels so make sure you check your vitamin D levels periodically.
• Exercise and good circulation may help remove oxalates from the body.
•  (7)(1) (2)

Excesses to watch for:

• High fat intake, blocks calcium from doing its job of binding oxalates and removing them from the body.
• Sugar and high carbohydrate diet increase stone formation
• Phosphorus intake was found in studies to increase kidney stones in men. In women, oxalate excretion in the urine increased. In some studies cola drinks that are high in phosphorus, were found to increase oxalate crystallization in both men and women.
• Vitamin C in high doses may increase oxalate production if over a few grams is taken. Interestingly vitamin C intake helped improve autistic symptoms in some children. Large doses have been found to result in acute kidney injury by people positive for Covid 19, in the clinical setting. See that article here

Dumping:

Dumping is the term used when your body gets rid of oxalates. This can happen after lowering oxalate intake or after taking any of the binders listed above. Conditions have to be right in your body. Again, if your body is too acidic or if there is a high intake of oxalates they will stay in your tissues. A product called tri-salts works well to act as a buffer. Magnesium oxide works great too since it has a PH of 9. Everyone has a different experience when dumping oxalates but increased generalized pain is common.  Signs of dumping are cloudy urine especially if using magnesium as a binder. The urine will have a white-ish appearance or appear to have a chalky like sediment.

Stools may have a sandy appearance. Flecks of black may be seen in urine or in stools. Some people will experience rashes or intense itching. Pain in hands may become more intense and rashes may develop on knuckles or joint areas. Feet can be very painful or extremely cold. Symptoms begin to lighten once enough oxalates have dumped but any intake of high oxalate foods will result in an immediate increase of symptoms again.

Oxalates trap heavy metals in the body tissues and make them difficult to get rid of. When mercury complexes with oxalates it cannot be eliminated from the body. Since vaccines use mercury as a preservative, in conjunction with antibiotics, a yeast overgrowth may occur causing more oxalates to be trapped into the tissues that cannot be excreted.

References:

Click on links for info

(1) Lorenz, E, Michet, C, Milliner, C, and Lieske, J, Update on Oxalate Crystal Disease, Current Rheumatology Report,  2013 Jul; 15(7): 340. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710657/

(2) Lu Y, Bonny O, Oxalate: a poorly soluble organic waste with consequences, Praxis (Bern 1994). 2015 Mar 25;104(7):353-9. https://www.ncbi.nlm.nih.gov/pubmed/25804778

(3) Suryavanshi, M, Bhute, S, Jadhav, S, Bhatia, S, Gune, R, and Shouche R, Hyperoxaluria leads to dysbiosis and drives selective enrichment of oxalate metabolizing bacterial species in recurrent kidney stone endures, Scientific Reports, 2016; 6: 34712. https://www.nature.com/articles/srep34712

(4) Glew, R, Horowitz, S, Konstantinov K, Barry M, Fair, J  Massie, L, Tzamaloukas AH Nephropathy in dietary hyperoxaluria: A potentially preventable acute or chronic kidney disease. World Journal of Nephrology. 2014 Nov 6;3(4):122-42. doi: 10.5527/wjn.v3.i4.122. https://www.ncbi.nlm.nih.gov/pubmed/25374807

(5) Konstantynowicz J, Porowski T, Zoch-Zwierz W, Wasilewska J, Kadziela-Olech H, Kulak W, Owens SC, Piotrowska-Jastrzebska J, Kaczmarski, M, A potential pathogenic role of oxalate in autism, European Journal of Paediatric Neurology Society,  2012 Sep;16(5):485-91. doi: 10.1016/j.ejpn.2011.08.004 https://www.ncbi.nlm.nih.gov/pubmed/21911305

(6) John D. Bullock, Daniel M. Albert, H. Catherine W. Skinner, Calcium oxalate retinopathy associated with generalized oxalosis: x-ray diffraction and electron microscopic studies of crystal deposits https://iovs.arvojournals.org/article.aspx?articleid=2203213

(7) Hueppelshaeuser R, von Unruh GE, Habbig S, Beck BB, Buderus S, Hesse A, Hoppe B, Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease. Pediatric Nephrology. 2012 Jul;27(7):1103-9. https://www.ncbi.nlm.nih.gov/pubmed/22366809