Sally K. Norton

Vitality Coach, Speaker & Health Consultant

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Warning: Oxalate Disinformation Doesn’t Make Spinach Safer to Eat

PleaseOne of my fellow oxalate-toxicity sufferers alerted me to The Paleo View podcast episode 286 that attempts to “debunk” reports of the health dangers of lectins and oxalates (the oxalate section starts at minute 30). Unfortunately, the episode contains significant errors that serve only to confuse and misinform listeners by perpetuating myths and misunderstandings about oxalate.

The Paleo View’s Spin

The podcast offers this limited perspective: “Listen to us. Don’t bother to learn about oxalate and its connection to health problems. Don’t moderate your intake of oxalate (unless you have major problems with gut health and kidney health).” The cavalier, dismissive attitude leads to a reckless attempt to justify telling you what they think you want to hear: eat all the spinach you want.

Sadly, the opinions and “facts” aired by the Paleo View podcast are based on inadequate contact with (1) medical literature, and (2) real people who are solving and healing mysterious health problems by avoiding spinach and other high oxalate foods.

The cherry-picked views they present ignore the many medically documented harmful effects of oxalate in the body and how these effects play a role in common illnesses. Instead, they prefer to focus inaccurately on the minor issue of oxalates preventing absorption of certain minerals, and on wishful thinking about colon bacteria consuming enough oxalate to save you from oxalate damage. Let me address these two claims.

Minerals Lost to Oxalate

From the very limited perspective of the podcast, the problem with oxalates is that they bind to important nutrient minerals like calcium and prevent them from being absorbed in the gastrointestinal tract from your food. That’s certainly true, and the consequence is that you’re eating less calcium than you think you are when you consume high-oxalate vegetables, for two reasons.

For one, nutritional tables that count up calcium in high-oxalate foods don’t account for the lack of availability of the calcium that is bound up as calcium oxalate. In other words, nutritional analysis of foods does not distinguish calcium oxalate (a toxin) from calcium (the nutrient). They are not interchangeable as far as your body is concerned, yet nutrition claims for calcium in foods treats them as one in the same.

The second problem is that free calcium, magnesium, and iron can all become bound to the oxalic acid (or soluble oxalates) and be lost as nutrients. (The podcast also makes the entirely fanciful claim that gut bacteria break up calcium oxalate, rendering the unavailable calcium available as a nutrient. There is simply no published evidence for that claim.)

Additional Anti-Nutrient Effects Occur After Oxalates are Absorbed

More importantly, the anti-nutrient effects of oxalate go beyond the loss of minerals from foods. There are anti-nutrient effects from the oxalate we do absorb. This happens because the most reactive forms (ions, nanocrystals, and soluble types) get into the body. There they eagerly bind to calcium, iron, and other minerals that are already present in our bodies. This “mineral-stealing” by oxalate is very real concern and does have important “anti-nutrient” consequences. Still, the podcast claims that oxalates “don’t leach minerals from our bodies.”

In the hours after we’ve overloaded on foods with soluble oxalates, oxalate ions will attach to minerals from our foods or from our blood. As a result, these minerals won’t be available for other purposes (like building bone or maintaining proper cellular metabolism). Depending on the amount we eat over time, repeated meal-after-meal intake of oxalate can add up to deficiencies.

Potassium Problems Too

More insidious (and less well known) is the loss of potassium from muscle cells where oxalate crystals are causing inflammation1–3. This sapping of potassium from cells is a third effect, occurring in addition to the oxalate molecules’ first acts of stealing important minerals from both our food and blood4. Our bones, muscles, and other tissues are the ultimate losers as a result of this mineral high-jacking caused by oxalate, which may contribute to systemic problems such as cardiovascular disease, osteoporosis5, and pain syndromes like fibromyalgia.

Which Oxalates Cross the Gut Lining and How Much?

Oxalates absorbed from food clearly present a major challenge to our health.  But how much do we absorb from food? The podcast wrongly asserts that we don’t absorb much oxalate from foods like spinach. We absorb plenty.

Estimates of the amount that gets into our bloodstream vary a lot. The classic estimate of typical absorption of oxalate from food is 4—10%. When we absorb more than 10% of what is in our foods, it is called hyper-absorption. Some recent studies suggest that absorbing over 10% may be common. Current estimates suggest that a 50% absorption rate is typical when oxalate intake is very low7. And many studies show that when you eat more, the total amount you absorb goes up. The podcast rightly points out that people with gut absorption problems due to Crohn’s disease, bariatric surgery, IBS, leaky gut, and so on are at higher risk for oxalate hyper-absorption problems8–12.

Spinach Leaf

The question of “soluble” and “insoluble” oxalates is also very important with respect to absorption. The podcast falsely claims that spinach contains mostly insoluble crystals of calcium oxalate that stay inside the digestive tract. In fact, only 28-44% of the oxalates in spinach are insoluble.

Most of the of the oxalates in spinach are soluble (56—72%)15–18 (they are not bound to calcium). Instead the oxalate is oxalic acid or is loosely bound to sodium or potassium. Like the nanocrystals of calcium oxalate, the soluble oxalates easily move though membranes (harming cells in the process). Unlike insoluble calcium oxalate, they easily dissociate into reactive ions. These are the principal forms in which oxalates get into the blood stream, cause metabolic problems, and crystallize in body tissues.

What really matters is this: In absolute terms, the amount of oxalate you ingest is the most important factor influencing how much damage oxalates will cause. Truly, you have no way to know exactly how much oxalate you absorb from your foods. The precautionary approach of limiting how much oxalate you eat is simple and has no intrinsic nutritional risks.

Oxalate Crystals Harm Gut Function

The podcasters do not point out that the insoluble oxalate crystals in plants are a gut irritant13,14. These pointed, sharp microcrystals abrade tissues with a variety of shapes possessing the destructive power of microscopic glassy shards, sand paper, and needles. Chronic abrasions to the gut wall can lead to inflammation and absorption problems. This can set up a vicious cycle making you more susceptible to hyper-absorption and oxalate-realated health problems.

Regardless of the size and shape of crystals, eating less oxalate reduces stress on your gut. Eating less mean fewer nanocrystals and ions are available to damage cells when these ultra-small particles penetrate into and through your gastrointestinal cells. Minimizing inflammation and damage to gut cells (from oxalate AND lectins) may improve your body’s ability to resist the passive movement of the larger oxalate crystals into your blood. Lowering your intake may also help with gut function in general. Many people on the low oxalate diet do better on a gluten free diet as well (less lectins is good for the gut too).

Gut Bacteria Won’t Save You

The Podcast claims that your gut bacteria will protect you from a high oxalate diet. This claim also does not withstand scrutiny. Multiple studies have shown that most people (70% or more) do not have viable gut colonies of oxalobacter formigenes19, a colon-dwelling bacteria which eats oxalate as its primary food.

Oxalate is absorbed throughout the digestive tract, including in the stomach and (primarily) the small intestine20. O. formigenes resides in the colon and only encounters oxalate that has not already been absorbed earlier in the digestive system, or that is released by the body back into the colon. The small proportion of oxalate released back into the colon has already traveled in the blood around the digestive tract and liver. Only a small fraction of this tourist oxalate is sent back into the colon from the blood stream. Given that oxalate ions and nano crystals are so toxic and caustic, this circulation of oxalate can lead to a lot of wear and tear on the digestive tract of people who love spinach, almonds, peanuts, potatoes and other high oxalate foods.

Finally, the podcast also falsely states that eating a high-oxalate diet will encourage the growth of oxalate-eating gut bacteria. There is not much evidence for that claim and no proof that this effect could make oxalate safe to eat. But there is plenty of evidence that if you eat more oxalates (even if you are lucky enough to host a colony of o. formigenes) you will absorb more oxalate (as measured by increased levels in your urine after a meal).  People who host o. formigenes will absorb relatively less than people who do not, but they will still absorb more than if they ate lower-oxalate foods. Efforts to re-establish colonies of o. formigenes have to date been unsuccessful.

The lesson is simple: if you want to avoid or recover from possible problems with oxalates, you should eat foods that contain less of them. It’s not hard, it won’t cut you off from essential foods, and it won’t compromise your nutrition. It could change your attitude about which foods you believe are health-giving, however. This may be the tragedy the Paleo View wants to protect you from.

Choosing Low Oxalate Foods Is Healthy and Nourishing

The podcast vigorously promotes the myth that low-oxalate eating means you have to give up “good” vegetables and therefore you can’t get proper nutrition. Nothing could be more wrong. That view (also promulgated by some kidney specialists who haven’t bothered to find out what foods have oxalates) goes back to the days when people presumed that all greens were high in oxalate. There are plenty of greens and other vegetables that are low oxalate when eaten in reasonable portions (1 C raw or ½ C cooked are typical serving sizes.)

There is no dietary reason that low-oxalate eaters risk being more malnourished than those eating a high-oxalate diet. I suspect that the opposite is a more likely scenario. Of course, no one has offered sound evidence that any vegetables or nuts or potatoes are essential to being well-nourished and healthy. The urgency to defend a plant-based diet, especially one based on high-oxalate foods, originates primarily from science that is increasingly being revealed as flawed (e.g. that animal fats are intrinsically bad for you) and from cultural prejudices that have essentially no basis in science (e.g. that farming animals is more unsustainable or environmentally destructive than farming plants).

But you don’t have to give up plants (or even a mostly plant-based diet) to successfully control your oxalate consumption. Anyone who says otherwise is just trying to scare you into staying ignorant of the danger.

Wishes vs. Facts

Being accurately informed is a necessary step before you can take deliberate, sensible actions to lower the risks that may be present in your own situation and dietary practices. Accurate information is not something the Paleo View wants you to have. They’d rather you trust their preferences, biases, and instincts.

Clearly, they do not want your faith in spinach to be shaken. Heaven forbid! And they don’t want you to consider that a life without spinach may lead to less pain, stronger bones, and many other happy outcomes—as it has for (at least) tens of thousands of actual people.

My Conclusion about Their Conclusions

The Paleo View podcast encourages listeners to ignore the evidence of serious health problems caused by excessive oxalate consumption. Their logic is this: since there is no proof that everyone is harmed by oxalate in foods like spinach, you should eat as much as you like and ignore the possibility that it could be harmful. How tragic indeed if the misinformation in this podcast discourages people from considering, let alone trying, an oxalate-aware eating strategy.

No need to fall victim to myths and misunderstandings about oxalate.

More details here, here, here, and here.

Key Points

Minerals are lost from foods and the body due to high oxalate content of our diets.

Oxalate causes gut damage, and damage to other organs too.

Spinach has a lot of soluble oxalate in it.

Bacteria that degrade oxalate are in short supply, cannot be replaced with probiotics and can only do so much to protect us from high oxalate foods.

A low oxalate diet can be perfectly nourishing and safe. We have no nutritional requirement to eat any high oxalate food.

Defending the frequent consumption of spinach is a disservice to listeners.

References

  1. Mulay SR, Anders H-J. Crystallopathies. N Engl J Med. 2016;374(25):2465-2476.
  2. Mulay SR, Kulkarni OP, Rupanagudi KV, Migliorini A, Darisipudi MN, Vilaysane A, Muruve D, Shi Y, Munro F, Liapis H, Anders H-J. Calcium oxalate crystals induce renal inflammation by NLRP3-mediated IL-1β secretion. J Clin Invest. 2013;123(1):236-246. doi:10.1172/JCI63679.
  3. Franklin BS, Mangan MS, Latz E. Crystal Formation in Inflammation. Annu Rev Immunol. 2016;34(1):173-202. doi:10.1146/annurev-immunol-041015-055539.
  4. Muñoz-Planillo R, Kuffa P, Martínez-Colón G, Smith BL, Rajendiran TM, Núñez G. K+ efflux is the common trigger of NLRP3 inflammasome activation by bacterial toxins and particulate matter. Immunity. 2013;38(6):1142-1153. doi:10.1016/j.immuni.2013.05.016.
  5. Shavit L, Girfoglio D, Vijay V, Goldsmith D, Ferraro PM, Moochhala SH, Unwin R. Vascular calcification and bone mineral density in recurrent kidney stone formers. Clin J Am Soc Nephrol CJASN. 2015;10(2):278-285. doi:10.2215/CJN.06030614.
  6. Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int. 2001;59(1):270-276. doi:10.1046/j.1523-1755.2001.00488.x.
  7. Holmes RP, Knight J, Assimos DG. Lowering urinary oxalate excretion to decrease calcium oxalate stone disease. Urolithiasis. 2016;44(1):27-32. doi:10.1007/s00240-015-0839-4.
  8. Canos HJ, Hogg GA, Jeffery JR. Oxalate nephropathy due to gastrointestinal disorders. Can Med Assoc J. 1981;124(6):729-733.
  9. Cartery C, Faguer S, Karras A, Cointault O, Buscail L, Modesto A, Ribes D, Rostaing L, Chauveau D, Giraud P. Oxalate Nephropathy Associated with Chronic Pancreatitis. Clin J Am Soc Nephrol CJASN. 2011;6(8):1895-1902. doi:10.2215/CJN.00010111.
  10. Froeder L, Arasaki CH, Malheiros CA, Baxmann AC, Heilberg IP. Response to Dietary Oxalate after Bariatric Surgery. Clin J Am Soc Nephrol CJASN. 2012;7(12):2033-2040. doi:10.2215/CJN.02560312.
  11. 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. Pediatr Nephrol Berl Ger. 2012;27(7):1103-1109. doi:10.1007/s00467-012-2126-8.
  12. Kumar R, Lieske JC, Collazo-Clavell ML, Sarr MG, Olson ER, Vrtiska TJ, Bergstralh EJ, Li X. Fat Malabsorption and Increased Intestinal Oxalate Absorption are Common after Rouxen-Y Gastric Bypass Surgery. Surgery. 2011;149(5):654-661. doi:10.1016/j.surg.2010.11.015.
  13. Altin G, Sanli A, Erdogan BA, Paksoy M, Aydin S, Altintoprak N. Severe destruction of the upper respiratory structures after brief exposure to a dieffenbachia plant. J Craniofac Surg. 2013;24(3):e245-247. doi:10.1097/SCS.0b013e318286068b.
  14. Konno K, Inoue TA, Nakamura M. Synergistic defensive function of raphides and protease through the needle effect. PloS One. 2014;9(3):e91341. doi:10.1371/journal.pone.0091341.
  15. Bong W-C, Vanhanen LP, Savage GP. Addition of calcium compounds to reduce soluble oxalate in a high oxalate food system. Food Chem. 2017;221:54-57. doi:10.1016/j.foodchem.2016.10.031.
  16. Brogren M, Savage GP. Bioavailability of soluble oxalate from spinach eaten with and without milk products. Asia Pac J Clin Nutr. 2003;12(2):219-224.
  17. The Low Oxalate Diet Addendum Winter 2010 – Numerical Values Table. VP Found Newsl. 2010;(33):18-23.
  18. The Low Oxalate Diet Addendum Summer 2012 – Numerical Values Table. VP Found Newsl. 2012;(37):6-9, 19-25.
  19. Barnett C, Nazzal L, Goldfarb DS, Blaser MJ. The Presence of Oxalobacter formigenes in the Microbiome of Healthy Young Adults. J Urol. 2016;195(2):499-506. doi:10.1016/j.juro.2015.08.070.
  20. Hautmann RE. The stomach: a new and powerful oxalate absorption site in man. J Urol. 1993;149(6):1401-1404.

 

 

 

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Our Oxalate-Loaded Environment: No Seasons, No Awareness

I’m very excited to announce a new article in the Journal of Evolution and Health: “Lost Seasonality and Overconsumption of Plants: Risking Oxalate Toxicity” by me: Sally K. Norton. Link http://jevohealth.com/cgi/viewcontent.cgi?article=1085&context=journal (or you can download it from my site)

Please read and share this heavily referenced, peer-reviewed article. Perhaps it will help us all see how we’re eating today in a new light. The article offers an up-to-date synopsis of what we know about oxalates, based on my extensive review of the scientific literature.

The rest of this blog post revisits and expands on the key points from the article.

Oxalate Toxicity Illness

Once you realize that oxalate in foods is at the root of your suffering, you can’t help but wonder: Why am I in trouble with oxalate? Why is this happening? Hasn’t oxalate been around forever? Is there something wrong with me that made me especially vulnerable to the oxalate problem? Why me? – this is the classic victim question. Yes, you are a victim, but of what? I say you are a victim of modern progress, affluence, cultural trends, and generalized ignorance of oxalate science; hear me out. . .

Oxalate-related illness is, in general, a problem of: 1) oxalate exposure and 2) bioaccumulation inside of our bodies. This is so, regardless if the effects of this exposure and accumulation surface as arthritis, digestive problems, headaches, pain issues, skin trouble, bad sleep, or kidney stones.

The One-Two Punch

Let’s consider that modern eating patterns douse us in oxalate far too routinely. (Missed any meals recently?) When the continuous oxalate marinade (daily low to moderate doses) includes occasional pulses of extreme doses (as in a spinach smoothie or a bag of almonds), accumulation is bound to occur. This combination – constant eating of plant foods (like bread and spices) interspersed with the occasional dark chocolate bar or spinach salad – is especially good at promoting the build-up of minute oxalate deposits in the body. The speed and extent of this process may be what separates the seemingly unaffected from those of us with joint, digestive, brain and neurological issues. Beyond just the level of oxalate intake, these factors seem to be key determinants of how fast and how extensively oxalate toxicity develops:

  • oxalate absorption
    • (many dietary factors and other changing conditions will affect the amount that gets inside the body),
    • it is generally much higher then scientists used to think
  • gut health, and
  • internal inflammation.

Never a Break

Never before has it been so easy to obtain oxalate-heavy foods. At the same time, we’ve become nibblers (or grazers) who believe that six small meals daily make for a healthy and acceptable meal pattern. We never take off from eating plant foods. We used to have those breaks: things called winter, or drought, or crop failure, or high-holy fasting days. And, of course when we’re eating oxalate, we have no idea that we are doing it; no one has bothered to tell us. Hardly anyone is aware of the presence of oxalate in our beloved foods and its potential dangers. Never have we been so at risk for slow, low-grade health damage thanks to our modern food choices, constant eating, and unawareness.

Global Food System Has Erased the Seasons

Winter is gone. No longer do we subsist on ham, onions, pickles, and white biscuits from January to March. Now, fresh green spinach, fruits, and nuts of all kinds can be had any day of the year. Our modern food scene is slick and sexy (packaged with grand promises), tasty and super-convenient, affordable, and . . . risky.

You can get nearly anything you could want, seven days a week, 365 days a year. Refrigerated trucks, the interstate highway system, inter-continental shipping, and the 24-hour grocery store all work to meet the demand for affordable, constant access to any and all foods. We usually see this as a great victory of modern commerce, but the downside… well, it has made it possible to bypass and disarm the body’s own defenses against what was historically only periodic over-dosing on high oxalate plant foods. That’s my guess, anyway. There is not any good research on the amount of oxalate in our diets and how this has changed.

Getting Plenty of Neo Foods

Envision some modern basics: tea, chips, fries, and almond milk. . . Finding our way to a daily cup of tea was never this easy! No longer do you have to haul water from the river, or fire up a wood stove. Potato chips? They were mass-produced for home consumption only recently. And french fries? Routine access to fries came with the invention of cheap (and addictive) fast food in the 1950s. That helped to launch the new and steadily expanding practice of eating meals away from home,  not just on special occasions but as part normal daily life. Restaurants eagerly offer hash browns, potato chips, fries, and mashed (or baked) potatoes as the classic side. (Too cheap, popular, and profitable to resist.)

Almond and rice beverages? These new-fangled products became commercially available and widely distributed only about 10 years ago (and have been growing in popularity). And please note: These faux “milks” are marketed as a fitting substitute for calcium-rich dairy milk. They are not. Not only do they contain oxalate (which real milk does not), but they lack milk’s ability to protect against oxalate absorption offered by dairy calcium.

Normal variability in what and when we eat, and restrictions that once came with the seasons and periodic food scarcity, are all gone in modern affluent societies. Easy, routine access to tasty oxalate-ridden foods has created a new situation for our bodies. The constant bombardment of our bodies by oxalate is an escalating, and uniquely problematic source of toxic stress in 21st Century life. It’s as if it were Thanksgiving Day, every day. The harvest is in and abundance is the theme of the moment. Have whatever you like; if its “healthy”—have a lot of it, frequently.

Modern Concepts of Health Foods

Modern dietary approaches have placed great emphasis on the health benefits of vegetables, nuts, chocolate, and spices, despite their being high in oxalate. There is a great deal of encouragement, pressure even, to eat greens, nuts, fruits, and other “whole” plant foods. We constantly hear that the sure path to complete health is the “plant based” diet. If it doesn’t work, you are just not trying hard enough… so just keep selecting antioxidant-rich “health foods”.

In this culture, how would anyone ever begin to suspect something amiss with this moral and fail-safe approach to eating? They don’t, not until they have exhausted every other possible explanation for why they hurt or can’t think well or get restless sleep… but I digress.

Accumulation of Oxalate

Any tissue of the body can end up with oxalate deposits, not just the kidneys and other parts of the urinary system. But how and why? This question has been posed, but rarely studied, at least since 1940 when a London coroner found oxalate crystals at the site of a brain aneurysm in a 61-year old woman.1 The prevailing theory in medical science is that the entire drainage system had to be broken down (persistent kidney failure) for oxalate to collect in non-renal tissues. Yet the exceptions to this rule are many—littered across the various fields of research.

Pathologists report finding oxalate deposits in eyes, arteries, hearts, skin, wherever—despite functional, healthy kidneys. We find this in cases of acute oxalate poisoning among patients who have tried to commit suicide with oxalic acid washing powders or ethylene glycol anti-freeze (ethylene glycol is a metabolic precursor that becomes oxalate in the body), and in cases of genetic disorders that cause excessive internal production of oxalate. But we also find these deposits in the chronically ill, in previously injured tissues, and in perfectly healthy people.

Stuck in Catch Mode

The scientific evidence suggests that the body is good at a game of “catch and release”. This is a process in which healthy cells take on minute oxalate crystals with the intention of this being a temporary accommodation. When the coast is clear and conditions right, cells recruit immune cells to help them dismantle and release the sequestered oxalate and send it off for excretion. Our diets, however, are pitching oxalate steadily (and at quite a clip). The effect is that the catch and release cycle gets stuck in “catch” mode. Cells holding oxalate attract more oxalate crystals which then become ever-present because oxalate is ever-present in so many of our favored foods. Injured cells or cell fragments passively get saddled with crystals that not only persist but grow, for years and decades.

We don’t see the inevitable but invisible nano-deposits and non-crystalline traces in cells throughout the body. The trained pathologist can see the much larger micro-crystals (when the tissue are fresh and properly handled, and when using the appropriate stain and polarized light). But the hunt for these troublesome contaminants isn’t done in typical tissue biopsy and tissues are usually not fresh. (The central concern being the detection of cancerous cells.) The body, however, is aware of oxalate. It is designed to unload these toxic traces, if it can only get the opportunity.

Let the Toxin Go

The cells await the conditions necessary for dismantling and releasing crystals. It would seem that tissues may need several days of very low-level oxalate intake to start the slow process of dismantling, dissolving, and unloading these nano-deposits. (In one study, looking at rat kidneys, this process was underway in just a matter of days. In another study, complete dissolution of a crystal took five or more weeks to complete).

The way we eat, the “release” conditions don’t come very often or for very long. The next time someone tells you “you’re full of it” they might be right!  And they might be full of it themselves!

References

1. Glynn, L.E. (1940). Crystalline bodies in the tunica media of a middle cerebral artery. J. Pathol. Bacteriol. 51, 445–446.

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Will today’s natural foods fix our health problems?

Today’s health crisis. Have you noticed it? Obesity, insulin resistance, diabetes, kidney disease, cancer, infertility, behavioral and mood problems, poor sleep, and PAIN. Do you know anyone with any of these problems? Yes, you do, even if you are not aware of it. And, the suffering is happening at younger and younger ages. Our kids are in trouble, we’re all in trouble.

It is expensive to be sick. Both time and money are sucked out of our lives, not to mention the fun. And what about the bigger picture all around us? Perhaps you’ve noticed that poor health is threatening social and economic stability, world-wide.

Eating Better?

So, what are we doing about it? Eating better? Going “natural”? Yes, we are indeed eating more veggies and less meat, less fat too. We’re swearing off gluten and A bag of cheese-like "healthy food" substance made from almonds.milk, going for alternative low-carb or gluten-free breads, alternative “milk”, and fake cheese. Is this going to save us? I say no. Hear about one reason why this approach is not a great solution: in this video about oxalate toxicity from natural foods.

My Ancestral Health Symposium Presentation

In September, I had an opportunity to offer an address to the Ancestral Health Society. This presentation argues that many of today’s health foods are having the opposite of the intended effect. Rather than making us healthier, the superfood food craze could, like the holy war against saturated fat, be launching another public health calamity, as expensive and unpleasant as the current diabetes and obesity explosion.

Here are some highlights from this talk:

Bags of chocolate covered almonds on a supermarket produce shelf.

Chocolate is now “produce” at Walmart

  • Low-level toxicity and nutrient deficiencies make us sick.
  • One of the most potent toxins that people regularly ingest in the contemporary diet is oxalate.
  • Oxalate causes nutrient depletion AND toxicity in the body.
  • Oxalate, when purified, can rapidly kill a person.
  • It was even the poison of interest in the very first experimental toxicology study published in 1823 in England, because it caused several accidental deaths in the early1800s.
  • Many of the plant foods we like to think are good for us have enough oxalate to harm our health in much more subtle ways.
  • These natural foods might even cause mechanical abrasion to your digestive tract do to the “needle effect”.
  • Oxalate can collect in your tissues.
  • The availability of high oxalate foods we see today is unprecedented.
  • Today we are eating oxalate in amounts that cause us to begin accumulating oxalate in our arteries, bones, thyroid, breasts, and kidneys.
  • When you eat “normal” levels of oxalate, you “maintain” and grow the oxalate deposits that have already started in your body.
  • Medical and nutrition authorities have virtually no awareness of the threat of biological toxicity posed by over-exposure to oxalate and its precursors. They are not paying attention to the increase in our use of high oxalate foods.
  • Going low destabilizes oxalate in the body, and helps it move out.
  • Going low can prevent and even reverse a lot of common complaints, as proven by thousands of reports from real people in the real world (members of the VP Foundation, Participants in the Trying Low Oxalates online groups, my own clients and followers, and many others).

Action Items for You

  • Please watch the video, it is only 39 minutes and is packed with helpful images and information that will make you want to share it and watch it a second time.
  • Please give it a thumbs up.
  • Share with those you love.
  • Let me know what you think.

… and

The fewer toxins in your body the better, even the natural ones!

“From a practical point of view, it would be better to avoid oxalate-rich foods than to take measures to neutralize the effect of oxalic acid, especially when other sources of green vegetables are available.”

—Hoover and Karunairatnam (1945).
Oxalate content of some leafy green vegetables and its relation to oxaluria and calcium utilization.
The Biochemical Journal 39, 237.

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Arterial Plaque Contains Oxalate

Did you know that oxalates can damage your heart and circulatory system, contributing to heart disease?

Our kidneys clean the blood. All of the oxalate that kidneys excrete every day gets there by traveling in our blood stream. The job of delivering toxic oxalate to the kidneys puts the arteries in harm’s way.

Researchers Don’t Expect Oxalate in Tissues

When oxalate deposits are found in tissues (other than the kidneys) doctors and researchers are surprised that the kidneys are working just fine. They believe that before oxalate collects in our bodies, the oxalate must first ruin the kidneys. This passage, below, from UCLA Pathologists Fishbein and Fishbein illustrates this conventional belief.

In a review of coronary arteries from 80 patients, we found 4 cases in which there were prominent oxalate deposits within the atherosclerotic plaques in coronary arteries. Oxalate deposits were also present in the media of arteries, the thyroid gland, and other organs, but not the kidneys, and the patients surprisingly did not have renal failure. (Fishbein and Fishbein 2009, p. 1315)

This expectation is based on the long-standing but unproven assertion that detectable (non-renal) oxalate deposits are a product of poor kidney function. In a previous report published by the journal Cardiovascular Pathology in 2008 they propose the new term “atherosclerotic oxalosis” to describe arterial plaque containing oxalate crystals.

This report was part of a study of coronary atherosclerosis in HIV infected patients, using atherosclerotic plaque samples from the National Neurologic AIDS Bank.

Whenever oxalate flows into the kidneys and other tissues in amounts beyond what they can handle (exceeding a capacity threshold), oxalate overload can occur. This can trigger accumulation of oxalate in the body. For some people this shows up as kidney deposits and kidney stones.  But oxalate can encounter, be stashed, and be left behind in any susceptible tissue in the body, not just the kidneys.

Other Forms of Oxalate are Usually Overlooked

Note the use of the term prominent in the comment quoted above. The researchers do not mention trace deposits, nano-crystals, ionic oxalate, and other chemical forms of oxalate in the examined tissues as a possibility. Unexplored, no doubt.

There is also no mention of the age of the specimens at the time of examination. We know that oxalate deposits rapidly fade in biopsied tissue and cadavers. (It would be interesting to see a study specific to arteries and arterial plaque to investigate the durability of less prominent oxalate deposits in plaque.) To reliably find oxalate, living tissues need to be examined within two hours of death or excision, but often are not. This may help to explain why oxalate in the arterial plaque is assumed to be rare, it can be hard to detect.

Calcium oxalate may be a factor in “hardening arteries”. And it may be more common than this research suggests, given the crude detection methods we use. Artery plaque oxalosis is most likely in people with metabolic stress such as HIV, metabolic syndrome, chronic inflammation, diabetes, insulin resistance, chemical injury, poly-pharmacy, auto-immune conditions, and so on. We don’t know how oxalate may harm “healthy” people with “perfect” arteries.

Over and over, science has demonstrated that oxalate can collect in any tissue in the body—and not necessarily due to kidney problems.

Reason enough to become oxalate aware!

 

Here is an update: an 2017 report of an Italian study looking at heart artery plaque in 229 people, obtained through a tissue bank. They did a special microanalysis in 41 plaque samples to differentiate between two types of calcifications: calcium oxalate vs hydroxapatite. 37% of the plaques were primarily calcium oxalate and 63% were hydroxyapatite. Oxalate calcifications were detected mainly in unstable plaques in 27% of cases, whereas HA tended to dominate unstable plaques 60% of the time.
Of course, unstable plaques are the ones that tend to break loose and block fine capillaries, restricting blood flow to brain or heart tissues thus causing non-hemorrhagic stroke or heart attacks . https://www.ncbi.nlm.nih.gov/pubmed/28739184

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Taking Vitamin C? Try a Salad Instead.

If you are taking 500 mg or more vitamin C daily, there is something you need to know. Vitamin C (in excess) can become a toxin that can lead to kidney stones, arthritis, other pain conditions, and perhaps, compromised brain function.  For decades we have been told that vitamin C is good for us and may help prevent colds. But too much of a good thing can make trouble. (Research has not been able to confirm the theory that vitamin C supplements help to prevent colds unless you routinely engage in physically demanding work or endurance sports.) [Read more…]

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Letting Patients Down

No one goes through medical training so they can disappoint people with lousy outcomes and grievous errors in performing dangerous procedures. Yet, this is happening as a regular course of business in American Medicine. In my post, The Cost of Too Much Spinach, we have a case in point.  A young woman suffers from a painful aliment, kidney stones. When she turned to medicine for relief, she was granted a series of tests and surgery that were likely injurious. None of these procedures offered any benefit, not even an accurate diagnosis. Patients like tests, as they believe that a test offers them a definite understanding of their condition. This case shows that tests don’t always perform up to our expectations. Our reliance on technology and invasive procedures illustrate some serious failures in how American medicine is practiced.

In hindsight, we know that this young woman’s problem was kidney and urethral stones. She had terrible pain in her rib cage on both sides of her body. The local university medical clinic found a 110-degree fever and kidney infection. They performed many tests and also removed her healthy appendix. As Scott Miners wrote in the article I discussed in my previous blog post, the young woman “was very frustrated and still in pain when the clinic staff released her.”

Still in pain, she traveled across the border to Mexico where a naturopathic doctor performed an ultrasound test that found two kidney stones working their way out of her urinary tract. The naturopath’s herbal treatment may have assisted the stones passing and provided relief for the patient.

Many questions are raised by this case: Why did the doctors do so many expensive tests and surgery, yet not find the real problem? Are doctors unaware of kidney stones? Do they assume that only old men get kidney stones? Are they aware that kidney stones are becoming increasingly common in females and in children? Are they aware that extreme diets with very high oxalate foods can trigger kidney stones (not to mention other health conditions)? Will they ever consider a person’s diet when they’re trying to determine what’s wrong with their patient?

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The Cost of Too Much Spinach

In the July-August issue of Well Being Journal, Scott Miners1 shared the story of a teenager who went through a series of expensive diagnostic tests and unnecessary surgery. She had extreme pain and difficulty urinating. Four MRIs, 2 CT scans, and x-rays failed to detect her kidney-urethra stones. Without a correct diagnosis, they removed her healthy appendix. None of these medical procedures offered any relief.

This young woman suffered a great deal of pain, underwent dangerous surgery, and must have missed out on normal life activities due to kidney stones. Kidney stones are becoming more common, especially in women and the young. Yet, in this case, the best tests of modern medicine failed to detect them. Still, there were bills to be paid.

The costs of these tests vary a lot, in the table below I roughly estimate the expenses generated by this medical “wild goose chase”. Her kidney stone trouble may have generated nearly $50,000 in medical expenses, and they did her 36055303_sno good at all.

Sadly, she was never told, until after Scott read my article, that eating too much oxalate from spinach could be a risk factor for kidney stones. Scott writes: “… she said she had become a vegetarian four years earlier and had been eating massive amounts of spinach in those years, prior to the kidney stone formation.” Her likely purpose in eating spinach was to support her health, and not to make her sick and broke!

Medical Procedure Number Performed Cost Range  Total      Estimated Mean Cost
MRI $1,500 – $5,000 4 6,000 – 20,000 13,000
CT Scan $500 – $1,200 2 1,000 – 2,400 1,700
X-ray $300 – $600 1 300 – 600 450
Appendectomy Surgery median cost is $33,0002 1 33,000
TOTAL: $48,150

References:

  1. Miners, S. Kidney Stones and High-Oxalate Foods. Well Being Journal. 24:4, (2015).
  2. Hsia RY, Kothari AH, Srebotnjak T & Maselli J. Health care as a ‘market good’? appendicitis as a case study. Intern. Med. 172, 818–819 (2012).

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Catastrophic Complication of Weight-Loss Surgery: Kidney Failure

Figure 1 Nagaraju (2013). Large intraluminal translucent crystals of calcium oxalate, tubular epithelial degeneration (foamy cytoplasm, pyknosis, karyorrhexis, indistinct cell borders, dilated lumina), lymphocytic infiltration in the interstitium (H and E, ×400)

Figure 1 Nagaraju (2013). Large intraluminal translucent crystals of calcium oxalate, tubular epithelial degeneration (foamy cytoplasm, pyknosis, karyorrhexis, indistinct cell borders, dilated lumina), lymphocytic infiltration in the interstitium (H and E, ×400)

A case of kidney failure after bariatric surgery is stopped with low-oxalate diet.

Canadian nephrologists reported a case of life-threatening kidney damage caused by kidney deposits of oxalate crystals.1 The doctors performed a kidney biopsy on their patient, a 54-year old man, 20 months after duodenal switch weight-loss surgery. His blood creatinine levels had tripled over the previous nine months. The biopsy found oxalate crystals causing tubular damage and atrophy, fibrosis, and inflammation. They also noted hardening of the blood-filtering glomerular capillaries.

The patient was treated with a low-oxalate diet, calcium citrate (1,000 mg 3 times a day with meals), high water consumption, and the drug cholestyramine to help reduce oxalate absorption. This stabilized his blood creatinine levels and his urine oxalate dropped by a third from 99 to 63mg per day. Normal urine oxalate is under 40-45 mg/day. The authors’ want practicing clinicians to be aware of the increased risk of excessive absorption of oxalates from food following weight-loss surgery (“secondary enteric hyperoxaluria”) which can lead to kidney stones and life-threatening renal failure due to oxalate-induced kidney damage.

This case illustrates: 1) changes to gut function can alter oxalate absorption; 2) oxalates in foods can cause tissue damage; and 3) this process may be arrested by limiting oxalate absorption with a low-oxalate diet and supportive therapies.

Interestingly, this patient’s urine oxalate levels, although lower, remained elevated (63mg/day) despite effective diet therapy. Consistent with reports from cases of genetic oxalosis, this may indicate that the patient’s tissues are shedding existing oxalate deposits in the kidney and elsewhere in the body. The clearing of oxalate deposits may contribute to urinary oxalate, perhaps for years. It is likely that shrinking tissue oxalate deposits leave in their wake persistent renal scarring and tissue damage elsewhere.

Oxalate deposits can develop over time after either Roux-en-Y gastric bypass surgery (RYGB) or duodenal switch surgery. These surgeries can trigger an increase in the absorption of dietary oxalates (perhaps due to bile salts in the colon and fat malabsorption in the small intestine). This potential complication -the possibility of increased oxalate absorption leading to high urine oxalates and, eventually, kidney failure – is not typically discussed at the time of consent to surgery.2 Nor are these patients typically told that they can minimize the risk by modifying their diet to avoid oxalates in foods. Discharge and follow-up counseling and education should include instructions for the low-oxalate diet. The gastric banding procedure is not likely to cause this problem.2

Oxalate deposits in the body develop gradually and often without symptoms.3 Although rarely prescribed by clinicians, a low oxalate diet can help avert the risk of too much oxalate and may be especially important for people with intestinal and digestive problems, including, but not limited to weight-loss surgery.4 Other surgical procedures (intestinal resection, ileostomy, bladder diversion surgery) and GI conditions such as irritable bowel syndrome (IBS), celiac disease, Crohn’s disease, small intestinal bacterial overgrowth (SIBO), pancreatic insufficiency, or poor fat digestion (steatorrhea) can also contribute to excessive absorption of oxalates in the digestive tract.

The renal damage caused by oxalates may not be reversible so it is important to start the low oxalate diet as early as possible. Anyone who is increasing their water intake or taking calcium citrate to reduce absorption of oxalates needs to be aware that timing is important. Water with meals can increase oxalate absorption, so drink fluids between meals. Also, calcium citrate tablets need time to dissolve, so take them about 20 minutes before meals to maximize the oxalate sequestration effects.

Key Point: Dietary oxalates can cause kidney failure after bariatric surgery. The progression of the disease can be halted by the low-oxalate diet, if implemented correctly and early enough.

For my low-oxalate grocery shopping list click here.

References

  1. Nagaraju SP, Gupta A, McCormick B. Oxalate nephropathy: An important cause of renal failure after bariatric surgery. Indian J Nephrol. 2013;23(4):316-318. doi:10.4103/0971-4065.114493.
  2. SenthilKumaran S, David SS, Menezes RG, Thirumalaikolundusubramanian P. Concern, counseling and consent for bariatric surgery. Indian J Nephrol. 2014;24(4):263-264. doi:10.4103/0971-4065.133045.
  3. Marengo S, Zeise B, Wilson C, MacLennan G, Romani AP. The trigger-maintenance model of persistent mild to moderate hyperoxaluria induces oxalate accumulation in non-renal tissues. Urolithiasis. 2013;41(6):455-466. doi:10.1007/s00240-013-0584-5.
  4. Lieske JC, Tremaine WJ, De Simone C, et al. Diet, but not oral probiotics, effectively reduces urinary oxalate excretion and calcium-oxalate supersaturation. Kidney Int. 2010;78(11):1178-1185. doi:10.1038/ki.2010.310.

Further Reading about Bariatric Surgery and Oxalates

  1. Agrawal V, Liu XJ, Campfield T, Romanelli J, Enrique Silva J, Braden GL. Calcium oxalate supersaturation increases early after Roux-en-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(1):88-94. doi:10.1016/j.soard.2013.03.014.
  2. Ahmed MH, Byrne CD. Bariatric surgery and renal function: a precarious balance between benefit and harm. Nephrol Dial Transplant. 2010;25(10):3142-3147. doi:10.1093/ndt/gfq347.
  3. Asplin JR. Hyperoxaluria and Bariatric Surgery. In: AIP Conference Proceedings. Vol 900. AIP Publishing; 2007:82-87. doi:10.1063/1.2723563.
  4. Froeder L, Arasaki CH, Malheiros CA, Baxmann AC, Heilberg IP. Response to Dietary Oxalate after Bariatric Surgery. Clin J Am Soc Nephrol CJASN. 2012;7(12):2033-2040. doi:10.2215/CJN.02560312.
  5. Kumar R, Lieske JC, Collazo-Clavell ML, et al. Fat Malabsorption and Increased Intestinal Oxalate Absorption are Common after Rouxen-Y Gastric Bypass Surgery. Surgery. 2011;149(5):654-661. doi:10.1016/j.surg.2010.11.015.
  6. Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int. October 2014. doi:10.1038/ki.2014.352.
  7. Nasr SH, D’Agati VD, Said SM, et al. Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass: An Underrecognized Cause of Irreversible Renal Failure. Clin J Am Soc Nephrol CJASN. 2008;3(6):1676-1683. doi:10.2215/CJN.02940608.
  8. Patel BN, Passman CM, Fernandez A, et al. Prevalence of Hyperoxaluria After Bariatric Surgery. J Urol. 2009;181(1):161-166. doi:10.1016/j.juro.2008.09.028.
  9. Ritz E. Bariatric surgery and the kidney – Much benefit, but also potential harm. Clin Kidney J Clin Kidney J. 2013;6(4):368-372.
  10. Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. 2010;42(2):369-374. doi:10.1007/s11255-009-9602-5.
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