Oxalates often overlooked driver of chronic health issues

Photo Cred: Stella Schafer/Pexels

By Carolina Brooks, BA, IFMCP

There has been a recurrent pattern in my practice among new patients who have recently switched to a plant-based diet. They come in and complain of headaches, interstitial cystitis, irritable bowel symptoms such as bloating and stomach pain, joint and muscle pain, vulvodynia, fatigue, or an increase in autoimmune flares, but do not understand why they are experiencing such deteriorations when they are doing something they perceive as positive for their health.

Over the years, I’ve come to recognize these symptoms as signs of oxalate accumulation. While oxalate accumulation is not only present in patients who shift their diet, these symptoms can have a gradual insidious onset, which makes it difficult to assess the underlying drivers.

Defining Oxalates

For those unfamiliar, oxalates are crystalline structures that are commonly known to cause calcium oxalate kidney stones, as oxalates bind with minerals and inhibit their absorption. Unbound oxalates can significantly disrupt cellular function and contribute to nutrient deficiencies, particularly calcium and magnesium.

Oxalates can cause tissue damage, particularly of the mucosal lining, and create oxidative stress, impair mitochondrial function and monocyte activity, according to a 2018 paper in Redox Biology, which is why signs and symptoms of hyperoxaluria can be so varied as the inflammatory cascade and histamine release will then be triggered. Oxalate accumulation has been linked with autism, and in my clinical experience are often present in patients with behavioral issues, mold exposures, and in those with heavy metal issues as well as Lyme disease and other tick-borne diseases and chronic infections.

Oxalates can come from multiple sources. They may be endogenously produced as a consequence of gut dysbiosis or from human metabolism, or exogenously from dietary sources. A 2003 paper in the journal Plant Science discussed the role of calcium oxalate crystal formation in plants as having the crucial functions of tissue calcium regulation, defense and metal detoxification. Examples of higher oxalate foods include spinach, chard, raspberries, legumes, grains, nuts, soy products, beetroot, and potatoes.

Animal products do not contain oxalates, which is why many patients with severe oxalate issues often find significant pain relief when they gradually switch over to a more plant-based diet loaded with green juice or smoothies, gluten-free diets, or carnivore diets, although I do not recommend the latter long-term as I have seen many patients present with significant nutrition deficiencies and energy regulation issues.

Where dysbiosis is present, we will often see an overgrowth of bacteria and yeasts, especially Aspergillus, Penicillium, and Candida species, which also drive oxalate production. Our ability to metabolism oxalates is very much dependent on various factors, including genetics, and whether there are specific nutrient deficiencies present, specifically zinc, thiamine (vitamin B1), magnesium and pyridoxine (vitamin B6). A 1994 review paper in Urological Research discussed supplementing with magnesium and pyridoxine to reduce oxalate formation.

Testing Options

It’s possible to pick up clues in functional testing panels around oxalate issues. In a healthy gut, oxalates should be broken down by beneficial bacteria, including the Lactobacillus species. In a stool test, practitioners can assess presence of Oxalobacter formigenes, a commensal bacterium which metabolites oxalates in the digestive tract.

According to a 2008 review paper in the Journal of the American Society of Nephrology, presence of this bacterium is associated with a 70 percent reduced risk of recurrent calcium oxalate stone formation in the kidneys. In an organic acids test, there may be elevated fungal metabolite markers, oxalic acid, glycolic acid, glyceric acid, ascorbic acid, and signs of dysbiosis or nutrient deficiencies.

Treatment Strategies

Aside from avoiding higher oxalate foods and limiting high histamine foods to minimize symptoms while the underlying issues are addressed, switching cooking methods can have a big impact on oxalate levels. Cooking does not destroy oxalates, but boiling can precipitate oxalates into the water and reduce soluble oxalate levels by up to 87 percent, while steaming was less effective at up to 53 percent, according to a 2005 study in the Journal of Agricultural and Food Chemistry. Baking has very little impact in minimizing oxalate levels, while soaking sprouting can reduce oxalate content of foods such as legumes and nuts.

In my clinical experience, pressure cooking has also been an extremely effective method to minimizing oxalate content in food, as well as blanching higher oxalate greens. I very much believe in encouraging as much diversity in the diet as possible, so I prefer my patients to focus more on cooking and preparation methods, eat smaller amounts of the higher oxalate foods, and rotate these foods to minimize symptom aggravation. It’s important to gradually reduce oxalates in the diet to avoid oxalate dumping, which can cause an exacerbation of die-off symptoms such as headaches, muscle stiffness and pain, nausea, gut pain, fatigue, or a worsening other of symptoms that are already present.

Supplementing with calcium citrate as well as using digestive enzymes and taurine to stimulate production of bile and improve fatty acid absorption can help bind oxalates and facilitate their elimination via the stool. I use high doses of omega 3 fatty acids to modulate immune response and bind oxalates, and glutathione to minimize oxidative stress in the body.

High dosing of ascorbic acid, often derived from fungal sources, can also assist in the formation of oxalates, so I am very cautious about supplementing with this and prefer to use a food source such as camu camu or acerola.

I will also use coconut kefir or probiotics to replete microbiome diversity, and, at the other end of the day, anti-inflammatory, antimicrobial, and antihistaminic herbs in tincture form to minimize oxalate content, such as Berberis vulgaris (barberry), Sida acuta (common wireweed), Olea europea (olive leaf), Ocimum sanctum (tulsi), Plantago lanceolata (plantain), and Lavandula angustifolia (lavender) to address bacterial and fungal dysbiosis and minimise risk of die off symptoms or discomfort.

Other strategies include infra-red sauna therapy and Epsom salt baths to reduce pain and facilitate detoxification.

It’s important to make your patients aware that there is no quick fix for addressing hyperoxaluria. In my clinical experience, patients will often see significant improvement after two or three months, but these cases can take years to resolve.

References

Chai, W. and Liebman, M. (2005). Effect of different cooking methods on vegetable oxalate content. Journal of Agricultural and Food Chemistry. Retrieved from: https://pubs.acs.org/doi/pdf/10.1021/jf048128d

Kaufman, D.W., Kelly, J.P., Curhan, G.C., Anderson, T.E., Dretler, S.P., Preminger, G.M., and Cave, D.R. (2008). Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones. Journal of the American Society of Nephrology. Retrieved from: https://doi.org/10.1681/ASN.2007101058

Nakata, A. (2003). Advances in our understanding of calcium oxalate crystal formation and function in plants. Plant Science. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S0168945203001201?via%3Dihub

Patel, M., Yarlagadda, V., Adedoyin, O., Saini, V., Assimos, D.G., Holmes, R.P., and Mitchell, T. (2018). Oxalate induces mitochondrial dysfunction and disrupts redox homeostasis in a human monocyte derived cell line. Redox Biology. Retrieved from: https://doi.org/10.1016/j.redox.2017.12.003

Rattan, V., Sidhu, H., Vaidyanathan, S., Thind, S.K., and Nath, R. (1994). Effect of combined supplementation of magnesium oxide and pyridoxine in calcium-oxalate stone formers. Urological Research. Retrieved from: https://doi.org/10.1007/BF00571844