October 10, 2022 by Sally K Norton

Fact or Fiction: Dates Are A Low Oxalate Food?

Dates in My Low-Ox Diet Plan: What Does the Data Say?

Following a low-oxalate diet is much easier when you have the right oxalate data. Unfortunately, there’s a lot of misinformation, limited science, and conflicting results on the internet, which leads to confusion when deciding which low oxalate foods to put on your plate.

The debate around the oxalate content of dates perfectly illustrates this conundrum. Rumors suggest they’re high in oxalate, while other sources claim the opposite.

As you’re wading through this conflicting information, what should you believe? Let’s look at the data together to find out how much oxalate dates contain, and whether they have a place in a low-oxalate diet.

Are dates a high or low oxalate food? Photo by VD Photography on Unsplash

Before We Begin: Learning to Read Oxalate Data

Let me provide some orientation on interpreting oxalate data.

The universal way to report the oxalate content of foods is oxalate per 100 grams. However, serving sizes vary from one food to the next.

Most people want to know how much oxalate is in one date. However, a single piece of fruit naturally comes in different sizes, which means oxalate content could vary from one date to another.

Depending on the variety, a date might weigh 7 mg or 24 grams. So, keep in mind that there is not one right number for oxalate in dates—especially by the piece. Understanding oxalate in natural foods takes some thought about several variables involved, especially the weight (amount) of the item you eat.

Now, with that reminder, here I’ll refer to the oxalate content in typical (modest) servings. Let’s get back to the oxalate content of dates.

Dates in My Low-Oxalate Diet Plan: What Does the Data Say?

The peer-reviewed medical literature doesn’t include dates in the oxalate data testing reports. However, the VP Foundation sponsored tests of dates performed in Laramie, WY at the University of Wyoming by Dr. Michael Liebman and his team. They tested Medjool dates three times, California-grown Deglet Noor dates once, and another unspecified variety grown in Pakistan.²

According to their reported results, 24 grams of pitted Medjool dates (around one date) contains approximately 1–2 mgs of total oxalate. 24 grams of Deglet Noor dates (about three and a half dates) contain around 2 mg.¹ No published testing found over 2.5 mg of oxalate per 24-gram serving.

If Dr. Liebman’s testing is right, dates are low oxalate foods. Yet mainstream sources like WebMD and Harvard incorrectly claim dates are high in oxalate, without offering any citations showing where they got this idea. They also failed to indicate the varieties, rendering the data useless.

These “reputable” and familiar institutions are seemingly reporting oxalate data, but not really. Verifiable testing shows them to be flat out wrong. This misinformation, coupled with a lack of transparency, is adding to the confusion around oxalates. This undermines the efforts of their readers to make educated decisions and limit oxalate-rich foods.

Dates vs. Figs: Oxalate Content of Food

Why would Harvard and WebMD post faulty information about dates? Perhaps the mistake comes from someone confusing dates with their Mediterranean counterpart, figs. Dates and figs are often and easily mixed up, both being small, soft, dark, and intensely sweet.

Despite these superficial similarities, dates and figs are very different fruits, especially in the oxalate department.

I know of only five tests of figs, four of them being fresh (not dried) and of the “unspecified” variety and one of them of the dried Mission fig. Some of the unspecified fresh figs have also tested low in oxalate, even lower per 100g than dates!

However, other tests find figs—especially the dried California mission figs we usually encounter in the stores—have about 12 times the oxalate content of dates with up to 95 milligrams of oxalate per 100 grams.

A typical serving of dried figs is 42 grams (four figs), which has ~34 mg oxalate. That’s 11 times higher than the approximately three mg oxalate in two Medjool dates (weighing 47 grams). Eating four to six figs could deliver a substantial oxalate level and have serious health consequences.

If you’re a fan of Fig Newtons, a test also conducted at University of Wyoming found ~8 mg oxalate per cookie—which definitely won’t kill you. But the standard serving size is three cookies (25 mg oxalate). Most people I know eat at least four at a time (32 mg of oxalate).

A photo of three fig varieties from a recent trip to the grocery store.

Moreover, researchers haven’t taken into account that there are more than 700 named varieties of fig trees. With so much breadth for one fruit, even the most exacting of researchers can’t test the oxalate content of each type of fig that exists.

Finding Oxalate Data You Can Trust

The dates versus figs discussion touches on several data-related problems in the oxalate space. And to make things even more contentious and confusing, the oxalate data listings in textbooks (for nurses and other health professions) and nutrient content tables used by dieticians are short and filled with errors.

As a community, we must look at the information out there through a critical lens, and learn to recognize bad data. New interest in this topic is only likely to increase the confusion and arguments in the short run. All of us becoming more data savvy will pave the way forward for having more clarity about healthful food choices. You definitely don’t need to eliminate oxalate foods from your low-oxalate diet plan that you love, like dates.

While it is impossible to correct every problem that exists with the science around oxalates, you can make good food choices with the information that is available. You just need a good filter to cull out the junk. I’ve been working to curate the most accurate oxalate data available, and help you make the most informed food decisions possible. As you’re trekking along your low-oxalate journey, take my (expanding) resources as a trust map and companion.

Sign up for my email list to get accurate, reliable information about the oxalate content of more foods and tips for sticking to a low-ox diet plan.

Data Sources

DATES (are Low Oxalate Foods)

“The Low Oxalate Diet Addendum 2011 Fall- Numerical Values Table.” The VP Foundation Newsletter, no. 36 (November 2011): 17–20.

“The Low Oxalate Diet Addendum 2012 Summer- Numerical Values Table.” The VP Foundation Newsletter, no. 37 (June 2012): 6–9, 19–25.

FIGS

The Low Oxalate Diet Addendum 2008 Fall- Numerical Values Table. The VP Foundation Newsletter 7–11.

The Low Oxalate Diet Addendum 2011 Fall- Numerical Values Table. The VP Foundation Newsletter 17–20.

The Low Oxalate Diet Addendum 2011 Spring- Numerical Values Table. The VP Foundation Newsletter 14–17.

Hönow, R., and Hesse, A. (2002). Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chemistry 78, 511–521. https://doi.org/10.1016/S0308-8146(02)00212-1.

FIG NEWTONS

The Low Oxalate Diet Addendum 2022 Winter- Numerical Values Table. The VP Foundation Newsletter 12.

September 4, 2022 by Sally K Norton

Oxalates in Foods: How To Make Sense of the Data

Starting a low oxalate diet? Going low oxalate can be a huge step into a brand-new world. It’s not only unfamiliar but somewhat disorienting. What to eat? How much to eat? What should your new staples be? How will you learn and remember which foods are high in oxalate? You need practical guidance—and a bit of data on how much oxalate is in your foods.

Oxalates in Foods:
Hard to Measure and a Bit Confusing.
Photo by Jennifer Burk on Unsplash

When you’re researching the oxalate content of foods, where do you turn first? Probably Google. But most internet sites offer scant information laced with factual errors. As you comb through the search results for that list of oxalate-rich foods, you could easily find different websites that don’t agree with one another. A given food may be listed as high on one site and low on another. The lists are also often short, with just a few foods listed. The “top ten” is far from the whole story!

Obviously, the easy-to-find data isn’t especially good. And this mess can be a big, discouraging curve-ball. Don’t let all this conflicting information and lack of consensus among various data resources get you down! It is still possible to succeed in adopting a healthier, oxalate-aware way of eating.

Still, making sense of the data can overwhelming and confusing. It was for me, despite my nutrition education and professional experience. To get you oriented and make you more fool-proof, let me walk you through the mine-field of oxalate content confusion.

**Online Lists Will Keep You Feeling Confused About Oxalate**s in Foods

How can you tell which information is credible? You won’t know just by looking at the list. Fame and fortune (institutional reputation such as USDA, Harvard, or WebMD, for example) do not assure you that a list is correct.

Misinformation about oxalates is widespread, especially among mainstream sources! For example, there’s one false claim that dates are high in oxalate posted on WebMD and thus elsewhere. (Please see my short post on the error with dates here, coming next week). There is also confusion about oxalate content in coffee because some researchers claim coffee is a high oxalate food. Neither is true. Multiple credible sources prove that in both cases, the sites listing dates and coffee as high oxalate are wrong. But mistaken notions persist. And mistaken data goes uncorrected.

Most list makers fail to mention where they got their information, let alone who did the testing and by which methods. Nor do the list makers bother to explain their rationale for designating foods as “high” or “low” in oxalate. And they rarely (if ever) revisit old information and update it.

Since the online lists aren’t good enough, surely medical journals, health agencies, and academia must have trustworthy numbers, right? But if you put on your thinking cap and take a deep dive into the literature, you might have a hard time finding much. In the end, what you manage to dig up from professional papers is also conflicted and confusing. It’s frustrating and frankly shocking how difficult it is to find credible, consistent resources on oxalates in our foods.

The full value of low-oxalate eating is not yet well-known, and sufficient resources have not been assigned to the necessary work.

Oxalate Data Online is a Mess!
Photo by Magnet.me on Unsplash

Despite the jumble of imperfect science, incomplete data, and untrustworthy conclusions about what amount is safe to consume, we can still find our way to low oxalate eating and heal from oxalate toxicity.

How to Get Better Information

Despite the data muddle, you can transition to this eating strategy successfully. Start with my Beginners’ Guide. This vetted, trustworthy list will get you 90% of the way there.

Read on if you want to understand more about the state of oxalate data and why it can be challenging. Remember that enduring some confusion is part of learning.

In the remainder of this post, I’ll attempt to explain the reasons for the discrepancies in oxalate data.

Better Sources Exist for Oxalates in Foods

I want to reassure you that there is enough credible information to support low-oxalate eating. Today we have more knowledge than ever before on oxalate in foods and how they impact health. The work of The VP Foundation and Susan Owens’ Trying Low Oxalates Facebook group has helped to launch our emerging era of growing awareness of oxalate overload. As more of us discover the healing benefits, our growing oxalate-aware community can continue to improve the data, making it more accessible, understandable, and usable over time. Most importantly, we all need to advocate for more food testing.

For a better understanding of the oxalate content of foods and using oxalate data, keep the following five tips in mind.

Need to Know Tip #1: Oxalate Levels Vary for the Same Kind of Food.

Plants naturally produce oxalates for survival to ward off microorganisms, fungi, and plant eaters. It also helps them to discard excess calcium they pick up from soils.

Oxalate levels can also vary between different types of the same food. Let’s look at apples as an example, which have over 7,500 varieties grown worldwide. I know of only 24 tests of apples. An Egyptian study found an apple of average size (~ 6 oz) had 15 mg of oxalate, but it doesn’t indicate which type of apple. Meanwhile, other tests conducted in the US found that a Pink Lady apple contains 2 mg of oxalate, a Gala has 2 to 5 mg, and a medium Granny Smith contains 5 mg. Based on a set of tests done for the VP Foundation, variations in oxalate content between varieties of tomatoes is far wider.

Situational factors such as soil content, pH, and weather can impact how much oxalate each plant contains. Unless you test every individual fruit, vegetable, or slice of bread you eat, it’s impossible to know exactly how much oxalate it has. Research reports typically don’t indicate variety, maturity, and other factors with their test results.

How much oxalate is in an avocado?
Photo by Towfiqu Barbhuiya on Unsplash

Current research typically does not seriously investigate variability in foods. And we don’t know how much each type varies and what factors influence this variability. Different growing conditions may explain the difference between US-grown apples and those grown in Egypt. Thankfully, the amounts in apples are relatively low.

Many foods, herbs, and supplements have only been tested (and reported) once. This means we are unsure of the estimated content for these rarely tested items. Because of natural variation and limited testing, I suggest that you think about the numbers around oxalate levels as somewhat “fuzzy.”

Need to Know Tip #2: Oxalate in Foods Information is Incomplete

What really brings us garbage data are the human factors. It might be the testing method used, sloppy execution of the testing, or inaccurate reporting that explain the 5-times higher oxalate content of the Egyptian apple, and not the apples’ natural variability after all. Without more resources and interest by researchers, we don’t know.

We need to retest many foods to understand the extent of this variability, reveal mistakes, and reduce confusion around the oxalate content of what we eat.

Additionally, plants produce two types of oxalates. The first, oxalic acid, is soluble and is easily absorbed into your bloodstream. The second, oxalate crystals, are insoluble, irritate your digestive tract, but probably don’t enter the bloodstream. Both types of oxalate can impact your body, but in different ways. Many reports don’t make this critical distinction. Only recently has it become common for researchers to distinguish between the two categories of oxalate in their reporting. This can add to the confusion.

What can I eat on a low oxalate diet?
Photo by Thought Catalog on Unsplash

Need to Know Tip #3: Sloppiness is Widespread

Some researchers use unreliable methods in their analysis. (See my coffee post on this problem.) In another case, testing done for the VP Foundation mistakenly used too small a sample in testing oils and got numbers overstating their oxalate content, which is in reality essentially zero. Later, they repeated the testing and reported corrected data. But in both cases the old, wrong data continues to circulate.

Many reports also fail to mention food preparation—such as whether something was tested raw, steamed, boiled, or fried—which can significantly impact oxalate levels and the data’s usefulness for estimating how much oxalate you are eating. All of these factors can create bad data.

There may also be simple data entry mistakes (aka, “typos”) causing confusion. Even our most reliable source of oxalate data, the VP Foundation, has reported several items incorrectly. For example, when they calculated the oxalate in one ounce (28 grams) of sweet potato chips, they mistakenly used “17 grams” instead of 28 grams because one ounce is about 17 chips. Thus, they mis-reported the amount of oxalate per one ounce serving as (37 mg oxalate), which is much lower than it really is (60 mg).

Two tree fruits compared. Cluster of 3 tamariallo fruits on left, one tamarind pod on right.

Tamarillo and Tamarind are not the same thing

Here’s another example of a reporting error: the experienced German researchers, Hönow and Hesse, said they tested “tamarillo” (a Central and South American tree fruit in the nightshade family) but they described it as “tamarindus indica” (the Indian fruit taramind). Those are entirely different foods, and we don’t know which one they tested. Thus, it’s garbage data, and probably worse than useless.

I’m not bashing anyone with these examples. What you need to realize is this: These mistakes are very easy to make. Even the best data sources contain them. You need to use your head when looking over the data.

Data discrepancies and misunderstandings about oxalates in foods could have critical implications for our health. The scientific community needs to step up to ensure they are not the reason for the confusion. Unfortunately, taking the time to get the facts right is an unusual approach!

Need to Know Tip #4: Older Oxalate Testing Methods Were Less Accurate

Prior to 1980 or so, the usual testing was prone to error. One important source of error affected tests of foods that have very little oxalate but contain abundant vitamin C. For example, the USDA data (published in dietitians’ handbooks) states that radishes are high in oxalate. But they are, in fact, very low. If the vitamin C in the radishes degraded to oxalate during testing it might be a partial explanation for the error. Or, perhaps it’s just bad data management, yet again.

Accurate testing continues to be challenging, but more recent testing tends to offer more reliable information.

Need to Know Tip #5: Oxalate Data Researchers do not Calculate Portion Sizes

To make things more complex for consumers, researchers often don’t translate their numbers into amounts per typical portion size in their reporting. They might, for example, present the results based on the dry weight without calculating the oxalate content of the food as it is normally consumed (including the moisture that was removed before analysis).

How do I know how much oxalate is in the foods I eat?
Photo by Louis Hansel on Unsplash

Let’s go back to the coffee example. One test of instant coffee found 57 mg oxalate per 100 grams of coffee powder. That sounds like a lot! As I explained in my blog post about coffee, you only use one-half to one gram of instant coffee to brew a cup.

Unless you’re choking down an entire cup of undiluted instant coffee powder—or adding high oxalate ingredients like cocoa to make a mocha—coffee is a low-oxalate food. Even if you drink a Venti dark roast from Starbucks every morning (which I don’t recommend because of the caffeine and other chemicals in coffee), you’re not drinking very much oxalate. In addition to how it’s prepared, portion sizes will impact how much oxalate you consume. Researchers need to do a better job at taking portion sizes into account when publishing reports so that consumers can use the data correctly.

We Need More (and Better) Research on Oxalates in Foods

There are significant knowledge gaps in the current literature regarding oxalates in foods and oxalate toxicity. More research is required to understand how much oxalate various foods contain, how much it varies from one variety to another (or for other reasons such as ripeness), and to weed out the technical errors and mistaken conclusions that linger in obsolete publications and in the minds of researchers, doctors, and the unsuspecting public. Unfortunately, “weeding” of medical literature is not something journals have any incentive to bother with, and it is difficult to execute.

It’s enough to make anyone’s head spin, but I have good news: going low oxalate isn’t about bean-counting. It isn’t about strictly accounting for everything you eat or measuring the exact amount of oxalate down to the milligram.

This isn’t Weight Watchers. I dislike tracking everything I eat. It can be distracting, demanding, and impractical. You can successfully lower your oxalate intake without sweating the data details. However, if you love to track things, please do. It will help if you know what you actually ate instead of just what you remember eating.

Practice Tip #1: You Don’t Have to be Perfect

Going low oxalate is about awareness and consistency, not perfection. We have enough information about oxalates in foods that we can make educated decisions about how to structure our diets without getting too hung up on what we’re eating.

Despite the limitations of oxalate data, we know that certain foods are reliably low in oxalate, including meat, poultry, dairy products, fats, true lettuces, white rice, several herbs (dill and thyme, for example) and spices (white pepper, mustard, cayenne pepper), as well as most vegetables in the cabbage family. If you build your diet around these staple foods, you will have no trouble keeping your oxalate levels in a safe range.

Practice Tip #2: Portion Size Matters

Portion size is critically important. Eating one bite of a high-oxalate food, like chocolate cake, is very different from eating an entire slice. Another example would be choosing ONE (normal-sized) chocolate chip cookie instead of a fudge brownie or mug of hot cocoa. While I don’t recommend throwing caution to the wind, you don’t need to sweat occasionally eating a tiny amount of high-oxalate foods (like a few chocolate chips).

We can learn as a community and advocate for better oxalate information.
Photo by Valiant Made on Unsplash

For example, spinach is a high-oxalate food I recommend avoiding. However, if you order a salad at a restaurant, realize some spinach leaves are mixed in, and you accidentally ate one or two of them, don’t worry: you won’t cause more oxalate to collect in your body. Just pick out the rest of the leaves and make sure the remainder of your meal is built around lower-oxalate foods. In fact, by eating small amounts of oxalate, you might avoid or delay heavy oxalate clearing symptoms. That is a good thing.

On the other hand, giving yourself permission to ignore what you’re eating can be a mistake. For example, taking several solid bites of an intense fudge brownie has the potential to bring on symptoms within one to five hours after the indiscretion. It’s not tragic if it happens, but it’s also easy to avoid if you pay attention.

Practice Tip #3: Keep Learning

Going low oxalate is a nuanced process, and there’s always more to learn. As you transition into low-oxalate eating, I’m here to help you make sense of the information that’s out there.

Get the “big rocks” right by using my Beginner’s Guide to trim out the worst offenders and adopt the “safe bets.” The middle ground foods? I’ll help you with that too, but don’t sweat them in the first phase of getting off the dangerously high foods. Tables available via my group meetings and in my book, Toxic Superfoods, will give you further guidance. For lots of specific data, my forthcoming Oxalate Data Resource Manual will provide you with all the particulars currently available for refining your oxalate-aware diet.

June 29, 2019 by Sally K Norton

What Is the Oxalate Content of Coffee?

One of the most common questions I get when people hear about the health dangers of oxalates is whether coffee is “low” or “high” in oxalate. It’s a good question. After all, most everyone I know depends heavily on coffee to function. This article is not about the wisdom of your caffeine addiction, however. It’s about knowing how much oxalate you’re (not) consuming. To this end, I compiled all the published analyses of the oxalate content of coffee I could find in an attempt to understand why this is a question at all.

It should not have surprised me that looking to scientific reports for answers unearthed a golden example of how bad science comes to pass for truth. We the public don’t know when terrible science is influencing our thinking or inflaming our fears about oxalate in coffee. And we are easy dupes. Our tweet-sized attention span and resistance to technical details makes us headline readers, not thinkers.

Here we enter a bit of a rabbit hole for a good cause. That cause has multiple aims: 1) to improve your confidence that coffee is indeed low in oxalate, 2) raise your awareness that academic journals publish junk science and generate misinformation and, 3) provide an object lesson in the value of taking some time to read the fine print.

Popular Summary Lists Mostly Think the Oxalate Content of Coffee is Low

Lists of high and low oxalate foods from medical centers mostly agree that coffee is low in oxalate (see Table 1. Online Patient-Education Lists from 4 North American Medical Centers). Agreement does not necessarily make them right, nor has it vanquished the ubiquitous confusion about coffee’s oxalate content. Urologists, the public, and even the researchers can’t get or give a straight or consistent answer about oxalate levels. Some medical researchers and clinicians believe that coffee is high in oxalate. I have friends in the medical field who believe it. And they use it as an excuse to resist learning about oxalate or controlling how much they consume. Any threat to the love of their life (coffee) will not be brooked.

Still, there are two solid scientific reasons to believe that coffee is very low in oxalate. The first is that all reputable testing to date has demonstrated that coffee is low in oxalate. The second is the real-world experience of low-oxalate dieters who have maintained a daily coffee habit with health benefits and without signs of oxalate-related symptoms. Other beverages, including hot chocolate, black tea, and green tea, have consistently been found to be high in oxalate and tend to trigger oxalate-related effects (the effects are variable—e.g. night-time irritable bladder).

I have a suspicion that the rumor about coffee being high oxalate originated in confusing reports on the oxalate content of instant coffee powder, which led to misinterpretation of the results. Instant coffee is indeed very high if you eat a whole cup of the undiluted powder. However, no one does that! Instead only about 2g is dissolved in a cup of hot water. The University of Pittsburgh’s patient education lists (Table 1) use a seemingly escalated number for instant coffee (greater than 10 mg per cup). Perhaps their source mistook the powdered coffee’s oxalate content for what is present in a reconstituted cup.

Table 1.

Online Lists of Oxalate Content of Foods

From North American Medical Centers (Patient Education Materials)

List Source	Type (Plain Coffees)	Oxalate Content	URL
Univ. Chicago	Regular Brewed Coffee	1 mg/Cup	https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Univ. Chicago	Decaffeinated	2 mg/Cup	https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
Univ. Harvard	Brewed	1 mg/Cup	https://docs.google.com/spreadsheets/d/1nbDZPxhAW4It-m2-c460w6eGr4dMSIeDiQdqg3MaRgQ/edit#gid=1354389148
Univ. Pittsburgh (2003, PK Diet PDF hosted elsewhere)	Instant coffee powder	"Extremely High"	http://www.pkdiet.com/pdf/LowOxalateDiet.pdf
Univ. Pittsburgh	Brewed	"Moderately High" (2-10mg/Cup)	https://www.upmc.com/-/media/upmc/patients-visitors/education/unique-pdfs/low-oxalate-diet.pdf or http://praveenmodimd.com/wp-content/uploads/2016/01/Low-Oxalate-Diet-_-Patient-Education-Materials-_-UPMC-Pittsburgh-PA.pdf
Univ. Pittsburgh	Instant Coffee	>10 mg/Cup	https://www.upmc.com/-/media/upmc/patients-visitors/education/unique-pdfs/low-oxalate-diet.pdf or http://praveenmodimd.com/wp-content/uploads/2016/01/Low-Oxalate-Diet-_-Patient-Education-Materials-_-UPMC-Pittsburgh-PA.pdf
St. Joseph’s Healthcare Hamilton, ON, Canada (2016)	Coffee and decaffeinated coffee	“good choice”	https://www.stjoes.ca/patients-visitors/patient-education/patient-education-k-o/pd-9447-oxalate-in-food.pdf

Instead of relying on shaky lists, let’s go to the primary sources to consider results reported by credible researchers regarding the oxalate content of coffee.

Published Analyses of the Oxalate Content of Coffee

Oddly, published tests of the oxalate in coffee are relatively few. Perhaps this is because virtually all historically reported tests have found both brewed and instant coffee to be “very low” in oxalate for typical serving sizes (see Table 2. Publications Reporting Oxalate Content in Coffee: Plain and Two Flavored Coffees). There are two articles listed in Table 3 that claim coffee is high in oxalate. I will examine these articles in detail below.

Given that the question appears to be resolved, perhaps that is why testing coffee seems to be uninteresting to researchers. Nobody gets published in a quality journal if they’re reporting one more example of the same old uninteresting result. Lack of interest may perpetuate confusion regarding oxalate content in coffee, as it does for so many other foods.

Table 2 lists 11 published results (from 8 sources) reporting the oxalate content of coffee. These tests analyzed various types of coffee (instant and brewed), as well as two Starbucks flavored coffees. The researchers used a variety of analytical methods.

Coffee cup with question: what is in your cup?

The rightmost column in Table 2 reports milligrams of oxalate in an eight-ounce serving (237 ml). Instant and unflavored brewed coffee have somewhere between 0.7 and 2.4 milligrams of oxalate per cup. Flavored coffees may have higher oxalate content coming from ingredients other than the coffee. In particular, notice that a Starbucks mocha latte has 47 mg of oxalate per cup, which is high – but at least 80% of that oxalate is coming from the (chocolate) mocha.

Keep in mind that today’s mugs, like our waistlines, have gotten rather large. Eight ounces is roughly what you get in a “short” Starbucks cup. A typical small takeout coffee is usually twelve ounces (Starbucks “tall”), a medium size is 16 ounces (Starbucks “grande”), and a large is 20 ounces (Starbucks “venti”). Scale the oxalate results accordingly. Portion size always makes a difference, but fortunately coffee is low enough that the oxalate hit even from a large-sized unflavored coffee won’t be especially dramatic.

Table 2

Publications Reporting Oxalate Content in Coffee:

Plain and Two Flavored Coffees

Year	Reference	Analytical Method	Variety Tested	Data as reported	Mg Per 8 ounce (237 ml) serving
1962	Zarembski and Hodgkinson ((Zarembski PM, Hodgkinson A. The oxalic acid content of English diets. British Journal of Nutrition. 1962;16(01):627. doi:10.1079/BJN19620061))	Colorimetric determination of ether-extracted, acid-processed sample	Nescafe Instant powder	57mg/100g powder	0.7 (Estimated as if prepared using 0.5 g powder per 100 ml)
1962	Zarembski and Hodgkinson ((Zarembski PM, Hodgkinson A. The oxalic acid content of English diets. British Journal of Nutrition. 1962;16(01):627. doi:10.1079/BJN19620061))	Colorimetric determination of ether-extracted, acid-processed sample	Ground Arabica with 5% chicory; 2mg powder/100g water, infused for 5-minutes	1mg/100g liquid	2.4
1980	Kasidas and Rose ((Kasidas GP, Rose GA. Oxalate content of some common foods: determination by an enzymatic method. J Hum Nutr. 1980;34(4):255-266))	Enzyme (oxalate decarboxylase) assay modified for food analysis	Nescafe Instant	3.2mg/ liter prepared 0.5g powder per 100ml water	0.8
1992/1993	Elmadfa et al (cited in ((Hönow R, Hesse A. Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chemistry. 2002;78(4):511-521. doi:10.1016/S0308-8146(02)00212-1)))	Unknown	Unknown	1mg/100g brewed	2.4
1995	McKay et al ((McKay DW, Seviour JP, Comerford A, Vasdev S, Massey LK. Herbal Tea: An Alternative to Regular Tea for those who Form Calcium Oxalate Stones. Journal of the American Dietetic Association. 1995;95(3):360-361. doi:10.1016/S0002-8223(95)00093-3))	Enzyme assay	Maxwell House Drip	1.6 mg per 250ml (8.4 ounces) brewed.	1.5
1997	Clinic Ciba-Geigy (cited in ((Hönow R, Hesse A. Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chemistry. 2002;78(4):511-521. doi:10.1016/S0308-8146(02)00212-1)))	Unknown	Unknown	1mg/100g brewed	2.4
2002	Hönow and Hesse ((Hönow R, Hesse A. Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chemistry. 2002;78(4):511-521. doi:10.1016/S0308-8146(02)00212-1))	High Performance Liquid Chromatography (HPLC) with Enzyme-Reactor	Brewed 30g coffee per Liter	0.5 – 0.7 mg/100g brewed	1.4
2004	Galli and Barbas ((Galli V, Barbas C. Capillary electrophoresis for the analysis of short-chain organic acids in coffee. Journal of Chromatography A. 2004;1032(1):299-304. doi:10.1016/j.chroma.2003.09.028))	Capillary electrophoresis	Roasted Colombian	25.6mg/100g ground coffee (not brewed)	1.8 est. for standard brewed equiv.: 30g per liter water
2004	Galli and Barbas ((Galli V, Barbas C. Capillary electrophoresis for the analysis of short-chain organic acids in coffee. Journal of Chromatography A. 2004;1032(1):299-304. doi:10.1016/j.chroma.2003.09.028))	Capillary electrophoresis	Lyophilised Colombian coffee	17mg/100g ground coffee (not brewed)	1.2 est. for standard brewed equiv.: 30g per liter water
2010	Liebman / VP Foundation ((The Low Oxalate Diet Addendum Summer 2010 - Numerical Values Table. The VP Foundation Newsletter. 2010;(34) ))	Capillary electrophoresis or enzymatic assay (not specified)	Starbucks	4.3 mg/100g	10 (“short”)
2010	Liebman / VP Foundation ((The Low Oxalate Diet Addendum Summer 2010 - Numerical Values Table. The VP Foundation Newsletter. 2010;(34) ))	Capillary electrophoresis or enzymatic assay (not specified)	Starbucks	20 mg/100g	47 (“short”)

Coffee urns with overlaid table of oxalate content by cup volume.

Low-Hanging Fruit: Rotten or Not!

Let’s take a close look at the two studies that report that coffee is very high in oxalate.

If you’re expecting the latest publication to offer a definitive answer, you will be misled when you find the 2012 article from Elzbieta Rusinek ((Rusinek E. Evaluation of soluble oxalates content in infusions of different kinds of tea and coffee available on the Polish market. Rocz Panstw Zakl Hig. 2012;63(1):25-30)) which reports very high numbers for the oxalate content in coffee (Table 3: Studies Claiming Coffee is High). Rusinek published in a Polish journal that appears in Pubmed (the online research database of the National Institutes of Health). The easiest article to find when you search for “coffee” and “oxalate” is Rusinek’s. When you look over Table 2, you’ll see that the studies by McKay and by Hönow and Hesse don’t use the word “coffee” in the title of their articles, nor do they have coffee as a key word, making those articles difficult to find.

In addition to being the easiest to find, the full text of the Rusinek article is also freely available to anyone with an internet connection because the journal is an “open access” publication where all articles are free to download. In stark contrast to being free and accessible, the majority of bio-medical studies are issued by publishers expecting payment from readers. if you’re not affiliated with a university (which may pay hundreds of thousands of dollars for subscriptions), you might have to pay $35 or $40 dollars to read or download a single paper, such as the Hönow and Hesse article. Such articles are described as being behind a “paywall”.

How do we explain these very different results?

The trouble with the 2012 Rusinek study is that it seems to be junk. However, that is not obvious to non-chemists. I’ve reported Rusinek’s results, and the results from another Polish study that she was emulating methodologically, in Table 3. Those results state that brewed coffee has 71 to 114 mg of oxalate per cup, and that instant has 110 to 361 mg of oxalate per cup.

All the other recent studies (since 1990) have found coffee to have 1.5 – 2.5mg of oxalate per cup. These two Polish studies report that coffee is nearly forty times higher than all previous studies! Even though Rusinek herself was scratching her head over the vast disparity of her results, she made no effort to determine why her results differed and she published them anyway. With mushy language, she offers readers a vague excuse for her results and their “apparent divergence”; here’s the full passage:

“It is difficult to compare the studies presenting the results of the soluble oxalates analyses in the instant and ground coffees with our results because of their apparent divergence. The result of determinations of oxalates content in teas and coffees is influenced by the various analytical methods of different sensitivity used, as well as processes related to acquisition followed by burning, grinding and mixing procedures, extraction conditions and the initial mass of the sample.”
Rusinek, E (2012) ((Rusinek E. Evaluation of soluble oxalates content in infusions of different kinds of tea and coffee available on the Polish market. Rocz Panstw Zakl Hig. 2012;63(1):25-30)), p. 29

Table 3

Studies Claiming Coffee is High In Oxalate

Hint: Do not believe them!

Year	Reference	Analytical Method	Varieties Tested	Data as Reported	Mg Per 8 ounce (237 ml) serving
2010	Sperkowska and Bazylak ((Sperkowska B, Bazylak G. Evaluation of oxalate content in brews of black teas and coffees available in Poland. Nauka Przyroda Technologie. 2010;4(3):#42. doi:10.17306/J.NPT.2010.3.42))	Potassium Permanganate Titration	Various ground available in Poland	47.94 mg/ 100g brewed; 796 mg/100g dry	114 (brewed)
2010	Sperkowska and Bazylak ((Sperkowska B, Bazylak G. Evaluation of oxalate content in brews of black teas and coffees available in Poland. Nauka Przyroda Technologie. 2010;4(3):#42. doi:10.17306/J.NPT.2010.3.42))	Potassium Permanganate Titration	Various instant coffees available in Poland	152.19 mg/100g prepared; 2536 mg/100g dry	361 (reconstituted instant)
2012	Rusinek ((Rusinek E. Evaluation of soluble oxalates content in infusions of different kinds of tea and coffee available on the Polish market. Rocz Panstw Zakl Hig. 2012;63(1):25-30))	Potassium Permanganate Titration	Various ground and instant available in Poland	18-40 mg /100g for brewed and 37-56 mg/100g for reconstituted instant.	71 (brewed) 110 (reconstituted instant)

Exposed: Bad Methods, Laziness and Sloppiness

To understand why Rusinek’s article is bad science, the next sections of this post consider her poor choice of method, her failure to consider other methods, and errors of fact in her paper. If you don’t have patience for learning about the science, you can skip to the last section on how to make sense of oxalate data.

Permanganate Titration is an Unreliable Method for Measuring Oxalate

Truth be told, it’s pretty likely that the discrepancy begins with the fact that Rusinek (and Sperkowska and Bazyluk, the other paper in Table 3) used an outdated analytic method called permanganate titration. This method uses a titrant, permanganate, to generate a litmus-like test of oxalate content. The persistence of a light pink color indicates that the reaction of the permanganate with the oxalate is complete. Here is Rusinek’s description: “Titration in hot temperature was conducted with 0.02 N solution of potassium permanganate until pink color appeared and remained for about 1 minute.” p.27

There are several inherent problems with permanganate titration. For one, it is very easy to over-estimate the amount of the material (oxalate in this case) that is being sought with this method. Lab instructions for performing this test explain that the overestimate happens because the permanganate ion is able to “autocatalyze” its own destruction which requires additional (excess) permanganate titrant to reach the endpoint. The oxalate content is determined by measuring how much of the titrant was consumed, so if the permanganate consumes itself the result is going to overstate the amount of oxalate.

But there are other problems with the permanganate titration method. In their 1980 study on oxalate in foods, GP Kasidas and GA Rose ((Kasidas GP, Rose GA. Oxalate content of some common foods: determination by an enzymatic method. J Hum Nutr. 1980;34(4):255-266)) point out that “…substances such as citrate could be extracted with oxalate and might have interfered with the subsequent precipitation and titration with permanganate.”² But you can go back 20 years earlier and see that the perils of using the permanganate method were already well-known by the early 1960s. At that time UK-based leaders in the oxalate field, PM Zarembski and A Hodgkinson ((Zarembski PM, Hodgkinson A. The oxalic acid content of English diets. British Journal of Nutrition. 1962;16(01):627. doi:10.1079/BJN19620061)), concluded that alternative colorimetric procedures are less subject to processing-related issues and therefore preferred over the permanganate titration method.

Rusinek does not explain the reasons for choosing an inferior method of analysis that had been out of favor for about 50 years prior to her publication. We can safely conclude that Rusinek’s analytical methods contributed to her wildly skewed results. Given her poor choice of method and lack of comparison to more widely accepted methods, Rusinek’s results can confidently be classified as spurious.

Good Scientists Study their Methods, not just their Samples

It is interesting to compare Ruth Hönow and Albrecht Hesse’s 2002 article ((Hönow R, Hesse A. Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chemistry. 2002;78(4):511-521. doi:10.1016/S0308-8146(02)00212-1)) to Rusinek’s to get a sense of what happens with better science.

In the Department of Urology at the University of Bonn (Germany), Hönow and Hesse sought to validate a new, simpler method for testing oxalate content in food. They also explicitly wanted to determine if or when artifacts of the new testing process could skew their results. And when they tested cherries, they found that for some reason their approach led to higher estimates of oxalate content than previously reported. Instead of brandishing their new findings as “truth”, they did a detailed examination of what might have led their method to “go wrong”, including testing with an alternate method. The result is honest science, and a paper that not only reports believable data obtained using a credible method, but also carefully explains the advantages, pitfalls and limitations of the method.

Errors in Citing Previous Studies

Apart from the poor choice of analytic technique and lack of critical examination of the method and the results, there is one more reason to distrust Rusinek’s report. Her results for coffee deviated massively from every previous study. But in reporting the previous studies, she made misstatements that downplay just how big the deviation is.

First, she claimed falsely that Hönow and Hesse found an oxalate concentration of “10.6 mg/100 cm3 of infusion” (p. 29). In fact, they reported 0.5 to 0.7 mg/100g (see Table 2 above). (For purposes of comparison, 100 cm3 is the same as 100 ml, which for brewed coffee weighs almost exactly 100g, so the reported oxalate content is all on the same basis.)

Rusinek invented a number (10.6mg/100 cm3) that is twenty times larger than the real number (0.5 to 0.7 mg/100g). In doing so, Rusinek implied that her results are two to four times higher than Hönow and Hesse. However it’s much worse than that. If she were honest about the numbers, Rusinek would have to admit her results are 50 times higher: 71 mg per cup versus 1.4 mg per cup.

Our sloppy researcher makes another important citation mistake as well: “[C]onducted in the Sixties Zarembski and Hodgkinson’s studies on oxalic acid in the English diets the oxalates were at the level of 57.00 mg in the infusion of instant coffee (emphasis mine) ‘Nescafe’ from the Arabica beans which was prepared from 2 g sample soaked for 5 minutes with 100 cm3 water at 40°C.” But as shown in Table 1, the article reported 57mg for the instant coffee powder and not the infusion. Moreover, Zarembski and Hodgkinson did not analyze the prepared instant coffee, only the powder. The statement regarding their preparation method is also a “miscommunication”: the sample preparation method Rusinek describes is the one that Zarembski and Hodgkinson used for brewed coffee, not instant.

In her defense, Rusinek’s mistake is easy to make. Zarembski and Hodgkinson reported brewed coffee results on the basis of milligrams per liter of brewed coffee, yet they reported instant coffee on the basis of milligrams per 100g of dry powder. And I suspect the same mistake is probably happening in patient education materials like those in Table 1 when they decide that instant coffee is spectacularly high in oxalate: they are misinterpreting data presented as oxalate in powder or dry material as if it were the value for the prepared drink. If you’re making a cup of instant coffee from two grams of powder, and the powder has 57mg per 100g, you’re only getting 1.14mg of oxalate in that cup!

I’m not convinced that Rusinek’s sloppiness is entirely innocent. The effect of both these errors is to understate the magnitude of the discrepancy between her results and respected prior research by almost two orders of magnitude.

But Wait! Isn’t There Another Study Saying Coffee is High?

One more reference offered by Rusinek deserves comment (and inclusion next to her results in the Table 3 “Hall of Shame”). In support of her findings, Rusinek cites a 2010 article by Sperkowska and Bazylak published in another Polish journal ((Sperkowska B, Bazylak G. Evaluation of oxalate content in brews of black teas and coffees available in Poland. Nauka Przyroda Technologie. 2010;4(3):#42. doi:10.17306/J.NPT.2010.3.42)) . The study featured in that article appears methodologically identical to Rusinek’s: obtaining coffee and tea samples from local stores, brewing them up, and analyzing them with a harsh preparation process followed by permanganate titration for the measurement step.

Because the Sperkowska and Bazylak article is only available in Polish, I won’t take it on in detail. In the abstract (available in English), their tests found the amount of oxalate in instant coffee powder to be 25.36mg/g of dry mass, or 2.536 grams per 100 grams. In other words, they claim that 2.5% of the instant powder (by mass) is pure oxalate. If instant coffee really were that high, surely someone else using other methods would have noticed! And the vendors would probably make more money selling it as a cleaning product to remove stains from your coffee cup than as a food.

Why were these authors confused? Did they make mistakes? Did they lie? Did they have bad editors? Or did none of them really care what they were publishing? Regardless of how it happened, the bottom line is: low quality papers get accepted and published by seemingly respectable journals.

Other False Claims that Coffee is High in Oxalate

Another article available on Pubmed states bluntly in its title that coffee is a significant source of dietary oxalate. The reference is Gasińska and Gajewska (2007) ((A Gasińska, D Gajewska, Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones. Rocz Panstw Zakl Hig. 2007;58(1):61-7)) entitled “Tea and coffee as the main sources of oxalate in diets of patients with kidney oxalate stones.” (I presume it’s an odd coincidence that this study was published several years earlier in the same Polish journal as Rusinek’s later study. We’ll leave it to someone else to diagnose the curious and apparently unique compulsion for Polish researchers to publish claims that coffee is high in oxalate!)

Gasińska and Gajewska did not conduct any oxalate testing of foods eaten by kidney stone sufferers. Instead, the 2007 study surveyed kidney stone patients (using an unspecified food-frequency questionnaire and 3-day food record) about their diets, and used other published oxalate content numbers to estimate how much oxalate the patients had been eating and from what sources. They offered no real detail about how they performed this magic trick. The Food-Frequency Questionnaire (FFQ) method is rife with pitfalls. For one, FFQs are not designed to distinguish between high and low oxalate foods. For example, spinach and arugula (opposite ends of the spectrum of oxalate content) are considered the same food type; and how much did you eat last year anyway?! Let’s not go any deeper into that annoying topic!

Here’s the stinker: Gasińska and Gajewska stated that their number for coffee oxalate content came from the 1995 McKay et al study ((McKay DW, Seviour JP, Comerford A, Vasdev S, Massey LK. Herbal Tea: An Alternative to Regular Tea for those who Form Calcium Oxalate Stones. Journal of the American Dietetic Association. 1995;95(3):360-361. doi:10.1016/S0002-8223(95)00093-3)). Specifically, they write: “The intake of oxalate was estimated on the basis of [a] table with oxalate concentration in tea and coffee by McKay et al” (Gasińska and Gajewska, p.62). But the McKay study (see Table 2 above) showed that coffee was very low! And the problem is not just that Gasińska and Gajewska misread the data table from McKay. They apparently also didn’t read the article text, where McKay et al state bluntly “Coffee prepared by the drip method was also found to have a low oxalate content–similar to that of herbal teas” (McKay et al, p.361).

So clearly the editors and reviewers of the Gasińska and Gajewska article did a terrible job of fact-checking. (For crying out loud, people, how can you put “coffee” in the title and not check the source?) At best, their article might support the assertion that tea is a major source of dietary oxalate. But that’s not news, and their coffee claim amounts to garbage.

These problematic articles that put the word “coffee” in the title are free. They appear in a seemingly legitimate journal, and in the index on Pubmed, so they must be true, right? Almost no one takes the time to correct the record or have these studies retracted.

And that, dear internet, is how bad science takes flight and lives on and on and on.

How do you make sense of oxalate data?

A lot of the information on the internet about oxalate content for any food (not just coffee) is problematic. The USDA table, for example, is filled with errors and only offers a tiny set of foods. Mistakes get introduced into the record as a result of a combination of outdated or inaccurate testing, bad math (and misinterpretation of what is actually being reported), and poor availability of the science. Even in good research, the numbers are often not reported in units that dietitians and consumers can use directly.

Because of the variability in testing procedures and in the foods themselves, there is always some uncertainty. It would be great if there were programs in operation that would repeatedly:

Oxalate content of Starbucks lattes in different sizes. — Flavored Coffees are Not Necessarily Low in Oxalate

Sample lots of common foods;
Be specific about the botanical variety being tested and its state of freshness and ripeness;
Describe in detail the culinary preparation methods;
Test the foods multiple times for oxalate content using a variety of analytical methods;
Describe the methods in detail, and
Present the results in a format that can be used to calculate dietary intake of oxalate.

For now, we’ll just have to keep making do with what has been reported by responsible researchers: plain coffee, even instant, has under 3mg of oxalate per cup. Let’s hope that the growing interest in the benefits of low-oxalate eating will inspire better standards and more publication of results that are reliable. We should also call attention to bad data on websites (and get the bad data off the USDA list of oxalate content).

Thanks for making it all the way through this technical article. I hope it is a valuable example of how bad science is abundant and problematic.

Disclaimer

I want to point out explicitly that I am not myself a coffee-drinker, and I wouldn’t personally recommend coffee to anyone. I’m not “defending” it because I want to drink coffee, but rather because I have a strong commitment to convey complete, honest, and useful information (and call “BS” when I see it).

March 15, 2019 by Sally K Norton

A Chronic Illness: What Recovery Looks Like

Five+ Years of Low Oxalate — Reflections, Lessons, & Progress.

Back in November of 2018, I had a big anniversary: Five years since my (re)beginning and consistently sticking with the low oxalate diet (LOD)! Those of you who are considering or starting on this path of self-care might like some sort of note from your possible future. What will things be like after years of staying the course? I hope my experience will help to encourage you when things aren’t going as well as you are wanting. First let me offer some context.

A Quick Flash Back

I was in Graduate School at the University of North Carolina (UNC-CH), a patient at the medical clinic for student health. I dared to confess (to the grey-haired doctor) not only my weird symptoms but my observation that my symptoms would follow eating a variety of foods. I knew I was risking his skepticism or criticism, but I really needed help.

After eating whole wheat bread, I would feel both mentally and physically exhausted; soy seemed to cause my face to break out; and some days I would wake up with puffy eyes and a lot of fine wrinkles on my face, other days, not. He ran no tests, asked few questions, and quickly told me that my symptoms were all imaginary. He said, “you need psych-services”—three times. Belittled and soundly dismissed and by “my” doctor, I did sort of feel like I could use a shoulder to cry on. But there was no time for that with a statistics final exam the very next day!

In the meantime, my gynecologist at the UNC student clinic was taking repeat biopsies of my cervix because the tissues there looked so very cancerous. Fortunately, the results kept coming back as “chronic inflammation”. Neither of my doctors could imagine that my body was reacting to toxins, or that my immune system was in hyperdrive, agitated by irritants.

Medical “Care”

Medical practitioners (and other “experts”) have a long history of dismissing problems they don’t understand by accusing the victims of being hysterical or mental cases who need counseling. If you don’t fit their preexisting menu of “legitimate” problems, if you have too many complaints or otherwise feel sort of crummy a lot of the time, then the general attitude is: Well, you can’t be suffering from an organic illness with real causes.

They, the experts, don’t approve of conditions that don’t fit their lists or don’t conform to their assumptions or respond to symptom-hiding remedies. Their inability to help makes us malingerers, cry-babies, or one of the “worried well” (a new blanket term replacing previous labels like “female hysteria”). Likewise, family and friends can also be dismissive, or at best, at a loss as to how to be supportive of us when we struggle with a chronic mystery illness. And, few are tolerant of the idea that dietary changes might have merit.

Sharing to Teach

Given this cultural context, it must be either an act of bravery or recklessness to share publicly the depth and breadth of a multi-focal and wholly ignored illness like dietary oxalosis (oxalate toxicity). Am I foolish, brave, or reckless to admit that I had a lot of stuff bothering me that nobody could figure out? Yes, Yes, Yes. Accuse me of all three. I’m willing to stick my neck out in sharing my story for those who also suffer from a bunch of nasty problems hamstringing their lives.

How Weird is This?

Invariably, the characterization used in the medical literature for this oxalosis problem is “heterogeneous.” The symptoms of excess oxalate in the human body are indeed variable: different for the same individual at different times and different from person to person. Medical writers also use the term “asymptomatic” a lot—but that is yet another issue. The silent start of this disease might mean that things appear normal and healthy until symptoms show up later in the more problematic stages.

The bottom line, confusing as it can be, is this: The same disease looks very different in different people (and is often “silent” in the early stages). All the systems and all the tissues of the body can be affected by oxalate. All of them, every last one. On the other hand, in some people only a few body parts protest. There are no rules of toxic biology that comply with medical expectations or the handbook of medical diagnosis.

A Look at Oxalate Illness

The visible signs that oxalates are interfering with the maintenance and smooth running of our bodies don’t present specific universal patterns unique to this disease. In general, we can divide the likely factors behind this into two general categories. For one, the differing effects and severity in each person most likely reflect a person’s unique history of exposure. Here are some examples of what I mean:

timing of intake of high oxalate foods with age and related developmental stages,

states of wellness or infection at the time (or pseudo-infections that comes with vaccination),

a status of injury or overuse in some area(s) of the body,

personal nutritional and sleep habits,

levels of physical or emotional stress,

microbiome status, gut health,

kidney function.

Another source of the varied individual expressions of this disease are each person’s unique vulnerabilities that come from constitutional or metabolic tendencies and factors influencing genetic expression.

Remember too that the various body parts entangled with oxalate are unlikely to hold meetings to decide who among them can be harmed by oxalate, who may be spared (or appear to be spared for now), and who can cope with their level of oxalate exposure without subpar performance.

Reflections After 5 Years on the Low Oxalate Diet

Trite as it sounds, this diet has brought me back to life. Now, life-long health mysteries are not so mysterious. After years of suffering with pain, fatigue, sinus problems and bad feet, there was the possibility of a cure—discovering the cause, putting an end to it, and reversing my chronic symptoms.

It’s Not Just My Joints that Are Happier

The crazy-long list of my health problems (involving sleep, joints, feet, chemical sensitivity, skin, etc.) has shrunk considerably! The payoff from this diet is many-fold. It has allowed me to work and live a full life again, where once that was far from the case. I feel like I’ve grown 30 years younger. My spine moves, my brain works, I can sleep, run, and play in ways that were not possible five years ago. Back then, I was debilitated—too tired to work, to think, to read, and unable to tolerate exercise without extreme fatigue for days after.

I had an explanation and I had undeniable results. But the explanation, which initially seemed more than perplexing to me, also felt like an outrageous double cross. “Healthy” foods can make you very sick? Oh yes they can!

About the Cause

The toxicity caused by too much oxalate in my diet was the result of eating real, whole foods. It was the result of abiding by the best health advice I knew: “Eat vegetables, emphasize leafy greens, eat beans in place of meat, eat walnuts for omega-3 fats and low-carb snacking”, I did all these things for years. I was very fond of vegetables even as a little kid. I loved real food, and still do.

Discovery, Frustration, and So Much to Learn

When I started oxalate-aware eating, I knew nothing about the chemistry or biology of oxalate and oxalic acid or its tendency to leave deposits in the body that needed to come out. (Neither do most doctors and nutritionists.) Knowing so little, I was shocked by all the benefits and funny reactions I was getting. I did not fully understand why this dietary change improves both new and old health problems, yet triggers rashes, eye sties, cold sores, peeling skin, or a variety of other oddities.

My scientific understanding needed a big boost, so I headed to the medical library. Information on chronic oxalate illness wasn’t simple to dig up there, either. After a lot of effort and time, I learned that oxalate is a known toxin with wide-ranging effects on the body. It has a long history of causing illness and the low oxalate diet is known to reverse illness.

Oxalate is known to collect in tissues. This phenomenon lacked much explanation except in cases when the disease is the genetic form, or the oxalate poisoning is acute. The chronic effects of either acute or chronic exposure on the body are still not well understood. Sadly, even the possibility of long-term effects is ignored by the establishment. In its entirety, the science is still waiting to be valued, explored, and understood.

Tragically, the many fascinating scientific findings about oxalate over the last 200 years are not adequately followed-up (if they are not soon forgotten) and the repeated warnings about the risks of routinely eating high oxalate foods are ignored. Of all the many problems with our understanding and recognition of oxalate-related diseases the most frustrating problem is this: Even receptive scientists or clinical workers do not demand accurate information about oxalate in foods. Without this, we cannot implement or study the effects of oxalate-aware eating. Thus, the diet cannot really be successful as a clinical tool. (Not that doctors are receptive to using an elimination diet, as they don’t wish to practice nutrition.)

A Quick Recap of Science Lessons Learned: A List

Here is a short list of some of the science about oxalate’s effects in our bodies. For more about this, please check back with my science page.

Oxalate:

creates crystals anywhere in the body, including in the arteries, joints, bones, and thyroid gland.

gets stuck in our tissues in idiosyncratic ways (different in each individual).

disturbs digestive health and the function of other organs, connective tissues, and cells.

causes muscles to lose potassium (and creates other electrolyte imbalances too), which can cause muscle knots, weakness, and heart palpitations.

triggers immune reactions that promote inflammation, pain, and autoimmune disease.

are toxic to nerves and the brain.

can destroy your sleep. (This is a repeated and widespread finding from real people, I have not seen mention of oxalate specifically in the sleep literature.)

The Beginning is Just the Beginning

As is true with most illness, the condition of oxalate toxicity does not immediately end when the diet begins. Internal residues of oxalate persist. The gradual process of dismantling them can generate difficult symptoms. These symptoms are often inflammatory and typically have some consequences for the nervous system, affecting mood, attention, sleep, physical coordination. This is true for me even after five years of faithful conformity to the diet. The diet allows the healing process to continue in its own mysterious ways.

Still Not on Easy Street

But the five years of recovery have been challenging. There’s much more to it than just “eating less and getting better”, even though that’s a great place for almost anyone to start.

The healing process can be brutal in the first few years. For me, there have been days, way too many days, where the pain and despair caused me to question the extent of the benefits of avoiding oxalate. My own doubt, skepticism, or uncertainty would, at times, compound the miserable physical and mental symptoms. Despite near perfect execution of the diet, pain and ill feelings would reappear in an on-again, off-again fashion. Sometimes they rise up in the middle of a really good week and abruptly stop me in my tracks. Sometimes symptoms would linger. Those days the abyss was wide: The gulf between the struggle I was living and my hope of fully restored health framed a dismally disappointing picture. And yet, it was also fascinating, because it is undeniable that I was continuing to get better. Something powerful is going on here.

Ongoing Recovery Means Still Improving and this Means Some Suffering

The often unpleasant, recovery process is far from over. My body is still blasting away at the oxalate within. Thick, cloudy, crystal-loaded urine both coincide with and follow days of back pain, fatigue, and mental fog. Then, finally a really great day appears: mental clarity and strong supple body enjoying abundant sustained energy. Then a day of symptoms again. So it goes, up and down. The down days get more bearable and the good days more common. Still healing.

So many melodramatic symptoms! They are likely a sign of a strong vital force whipping up a storm intended to blow up and move the mess—out! After one episode passes, the healing force moves on to another junk pile to blow away. And so the process continues on and on. Up and down. Up and down. One good day is followed by 5 hard days. One good week is followed by six hard days. The trend is upward, but the line is jagged!

Is this continuing drama because of some other metabolic problem? Or is this just oxalate deposit removal work? A number of things make it hard to recognize that oxalate is the key to so much suffering. The variable symptom patterns are one factor. The lack of recognition of the implications of persistent high oxalate levels inside the body (due to the sequestering self-defense strategy used when intake is high) is another. Until we have intensive clinical research, the only good way to test this is to eat this way and learn from personal experience. You might be surprised by the benefits that will win you over.

As the body works hard undoing the mess, let’s work with the ways and rhythms of biology. Make your lifestyle supportive. Think: yoga, meditation, rest, limiting sugar and over all carbs, avoiding toxins and junk food. Other modalities (targeted supplements and sauna, for example) can round out a path to vibrant health. All of these self-care practices require constancy to yield the results that unfold gradually over time. Remember that the tortoise won the race. (Rabbits, on the other hand, push too hard, jump around, and either get lost, distracted or burnt out.)

Turn Off the Healing?

How do you moderate or turn-off the body’s impulse to clean out the mess? (We want to do this because it can be brutal.) Hopes of having some say in this requires us to understand the triggers of the clearance process. Down here in the trenches, we can only guess. The triggers seem to be low oxalate intake and being well nourished (with minerals, energy and protein). Does this mean we have to add back some oxalate in the diet? Or fast, or stop taking minerals? Perhaps a diet of 40 mg of oxalate in every meal would hold back the healing reactions? The answers may not be simple, but it would be nice if someone could study this formally. No one individual can do this and prove it a better approach. Careful testing and monitoring of many people over several years would be needed. (I have not done a statistical power calculation.) Such research would take resources and expertise that is out of reach, for now.

Challenge Testing

Some of us don’t notice the benefits or for other reasons. They are more likely to drift off the diet – especially in the early years. This drifting tends to create unintended, private (n=1) “oxalate challenge tests”. This can wake up an oxalate sufferer to the reality of it and pulls them back on course. Just a bowl of freshly picked figs, a baked potato, or a few nut bars and, wow, significant feedback from their body usually pops up—an agitated, sleepless night; too many trips to the bathroom; fatigue; achy wrists; something. It’s as if one’s previous apparent tolerance has been unmasked by the period of avoiding oxalate.

Still, by going back to shunning high oxalate foods and making smart selections among the many other food options, one can relax back into a healing path.

Where I am Today

Now, I am living a full life doing more than most people manage to do. So far, the low oxalate diet has given me a lot. See this table for a before and after comparison:

Now	Before Low Oxalate Diet
Sleep is restorative (after about 10 days on the diet I started waking up feeling good). Restless legs: 95% gone and milder when it does happen.	Brain waking up 29 times every hour. Extreme fatigue, even during mornings. Restless legs (Diagnosis based on sleep lab was “Periodic limb movement disorder” and involved arm movements too).
I can read and think and write.	Had lost my reading comprehension and mental energy (likely due to sleep problem).
Fully functional feet (not seen in 30 years!),	My feet did not tolerate jumping, darting side to side, the wearing of heels, or going barefoot without aching.
More flexible and strong joints with very little pain.	Stiffness of joints and connective tissues; occasional random swelling and weakness of fingers, wrists, knees.
Quick recovery from exercise	Post exercise fatigue would last 3 -4 days
A seemingly better vascular system and improved lung capacity. No more hiccups.	Cold hands and feet. Mildly restricted ability to breathe deeply. Hiccups at night (often severe and painful).
Immune system is calmer with less inflammation overall.	Several “autoimmune” problems like indigestion, IBS, rheumatoid arthritis; “fibro” symptoms, many allergies, and allergic fatigue, puffy eye bags.
Bloating and belching is rare.	Unstoppable belching fits at bedtime.
A more youthful and regenerating body (I’m reclaiming my physical abilities.)	Felt worn out, aged, physical vitality slipping away.
Skin is stronger and less wrinkled. Few to no hangnails. Much tougher skin on the bottoms of my feet.	Bagging neck skin and eye area wrinkle. Frail skin especially noticeable around my nails where hangnails were constant. Tender skin on feet.
Less tartar; no more cavities; less tooth sensitivity (despite some significant flare-ups in the first 2 years on the diet).	Constant tartar and frequent cavities in rear molars, sensitive to sweet and cold. Chewing could be uncomfortable.
Few muscle knots. (Potassium supplements were required to achieve this.)	Abundant painful muscle knots in shoulders and back.
Increased bone density (increase of 4% at hip; 10% in back, according to DEXA scans) (Potassium may be helping with this too.)	Osteopenia.
Improved tolerance to chemicals and fragrances. (No long tail of fatique.)	Headaches and persistent fatigue easily triggered by breathing chemicals and exhaust.
Thyroid lumps and enlargement are gone. Reduced thyroid medication by half.	Lumpy thyroid and below normal thyroid levels.

Changing Perspective

At the five-year point, I can see how far I have come. Yes, I want even more days of awesome. But being alive in this very honest way is good. After all, it is the amazing progress that emboldens me to dare hope for more. New possibilities expand across my horizons, even if some days those possibilities seem teasingly out of reach!

From this high peak of five years of recovery I can enjoy the view. I remember how far I have come. I can do so much more than before. I see so much progress. Part of “getting there” is a matter of remembering just how good you have it now. Not fighting this moment is part of making our next moments better.

Letting the process be what it is (vs demanding different results)

For those of us who are especially loaded with oxalate, the recovery process is a hard endurance challenge. The body needs to and wants to clean out and recover from decades of excessive oxalate consumption. As the body works to heal, it necessarily uses some rough techniques for blasting out oxalate calcifications. It unearths, attacks, dismantles, disintegrates, disperses and expels toxic crystals from cells and tissues. This work involves disruption of the status quo with inflammation and destruction. This can be painful, nerves don’t like it, muscles don’t like it, kidneys don’t like it. Your brain, your mood, your whole self, they all take a hit. It can be truly awful. (This is one major reason why both researchers and individuals overlook the benefits of the diet — the amount of oxalate in the blood and urine doesn’t necessarily drop consistently and the related symptoms persist.)

Don’t fight the waves, let the tide carry you forward.

Well, the bumpy healing process is what it needs to be. I may want joy, bliss, energy, and strength all the time; after all, I’ve been so good! What I get instead is occasional, unpredictable pain, wavering hope, and feelings of defeat. When these conditions prevail, it is our own expectations and impatience that erodes our confidence and threatens our resolve. Don’t give in to the downward pull of the bleak moments. Just know that it is temporary and will pass. Be willing to wait.

In the not-too-distant future, you’ll be feeling better and taking advantage of that. The bigger issue will be the tendency to take the better health for granted while neglecting the memories of just how bad things once were. Even when getting better, it is possible to focus too much on what is still not better. That is a sure path to misery.

Being Complete vs Not

Without acknowledging successful progress, the striving and wishing for physical perfection can generate a kind of illness of its own. It is an illness of discontent, defeat, and feeling incomplete. Instead, I resolve to be complete inside this day. As a personal hero of mine, Geneen Roth (a prolific author and guide for people struggling with food addiction and body image)[i], likes to teach: “ I am enough”. Likewise, this experience of today can be enough. I don’t need all that I desire to make it a good day. I need only my willingness to persist in a spirit of gratitude.

Today and tomorrow I am sticking with this. Joyfully I celebrate the miracles of being alive in an amazing body able to heal itself. I invite you to stick with it too. Look for and enjoy the miracle of healing.

Some Take-Aways:

You are not crazy. You don’t need a doctor to validate you.
It is not always obvious at the beginning that you are benefiting.
The healing process for some of us carries on for years and years.
There will be times when symptoms are in play making the benefits seem subtle, meager, or inadequate. These are not times to give up, but to resolve to stay the course.
Not everyone has dramatic problems or healing symptoms. Still, it is common to overlook the connection between the oxalate clean-out your body is undertaking and the pain, skin issues, headaches, clumsy days, and tired days that arise in the process (even years after you started the diet).
The pain of healing is part of the process. Six months of tooth pain, three weeks of sinus pain, periodic joint pain, a month of emotional fatigue—each will resolve on its own. You don’t need to intervene medically when your body is already taking care of you.
Stick with it despite it all; and find ways to enjoy the ride.
Recovery is real. This diet is a gift that has saved me and many others from a downward spiral that was undoing our lives and our sense of who we are.

My future is about living life fully in ways that were for so long compromised by pain and fatigue. Today, my bad days are so much better than my good days were before taking the oxalate out of my diet. I am convinced that my body will perform best with as little oxalate on board as it can manage.

A Brief Note of Gratitude and Thanks

This is a good time to take stock and express gratitude to everyone who made this possible. Thank you, Susan Owens[ii] and your devoted moderators, list mates, and loyal followers for sharing your stories of oxalate mobilization (“dumping”) reactions. Your recognition of this process is not only a brilliant insight, it has helped thousands.

Our current recognition of the connection between food oxalate and pain starts with Joanne Yount, founder and director the VP Foundation[iii]. For over 25 years, she has bravely, fiercely, and loyally attended her mission to test foods for their oxalate content on behalf of people with chronic unexplained pelvic and genital pain.

Let me start and end each day with a grateful heart.

Footnotes

[i] Geneen Roth https://geneenroth.com/books/

[ii] Autism Oxalate Project / Trying Low Oxalate Group: http://lowoxalate.info/

[iii] The VP Foundation: http://www.thevpfoundation.org/

October 9, 2018 by Sally K Norton

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 inflammation^1–3. 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 problems^8–12.

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 irritant^13,14. 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

Mulay SR, Anders H-J. Crystallopathies. N Engl J Med. 2016;374(25):2465-2476.
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.
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.
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.
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.
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.
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.
Canos HJ, Hogg GA, Jeffery JR. Oxalate nephropathy due to gastrointestinal disorders. Can Med Assoc J. 1981;124(6):729-733.
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.
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.
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.
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.
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.
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.
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.
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.
The Low Oxalate Diet Addendum Winter 2010 – Numerical Values Table. VP Found Newsl. 2010;(33):18-23.
The Low Oxalate Diet Addendum Summer 2012 – Numerical Values Table. VP Found Newsl. 2012;(37):6-9, 19-25.
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.
Hautmann RE. The stomach: a new and powerful oxalate absorption site in man. J Urol. 1993;149(6):1401-1404.

July 28, 2018 by Sally K Norton

What’s a Dangerous Oxalate Level?

Easy to Over-Do It, Easy to Fix It

Your go-to foods could pave the way for a dangerous oxalate level in your body and lead to very real health problems. Consider these common examples of popular foods that make it way too easy to overdo oxalate:

Are you into peanut butter, chia seeds, seeded wheat bread, sesame crackers, or nuts? If so, you could be eating a dangerous level of oxalate.

Do you reach for spinach for your salads, as a quick-cook side dish, or the tastiest way to green up your smoothies?

Do you like potatoes? Chips, fries, baked, or mashed? Perhaps you like the “healthier” sweet potato chips and fries?

Do you love black beans in your burritos?

Do you like second helpings or “super” serving sizes?

These days, we have at least three factors working against us:

the ubiquity of high oxalate foods,
the frequency with which we eat them (it’s easier than ever to make potato chips or french fries daily fare), and also
restaurant portion sizes that get us in trouble.

Eating quick-and-easy means reaching for nuts, peanut butter, or chips. Eating out, well . . .

Hard-to-Resist Super-Sized French Fries

Many restaurants jumbo size their standard french fry order as cheap advertising. You see, it costs them only pennies to wow the customer and offer a memorable experience that they’ll tell others about. Take Five Guys, for example*. Famous for giant piles of fries, their regular fry order weighs a gargantuan 411 grams—almost a pound! About 5 years ago, Five Guys expanded their menu with a “Little” order of fries. Weighing in at 227 grams (½ lb.) a “Little” Fries order is still too big: it’s easily enough for two people.

Instead of standard fries, try my oven-fried turnips

Unfortunately, your body takes a hit with the 100 mg of oxalate that comes with the “Little” fry order. If they were made with sweet potatoes: a “Little” fry order would deliver 164mg of oxalate.* For perspective, consider this: 150mg is the amount that medical researchers claim is our typical all-day consumption of oxalate in food. Does that ring true to you? On the days you have the “Little” fry order, is that the only plant food you eat all day? (Hint: add at least an additional 12mg oxalate from the white hamburger bun with sesame seeds on it, and another 3 – 5mg for toppings such as tomatoes.)

The ubiquity of “would you like fries or chips with that?” encourages us all to make potatoes a too-frequent, regular thing. But, you don’t need to eat out frequently to get into a high oxalate food habit, it can happen to anyone. Just fall in love with the wrong food. It’s sort of arbitrary. Few people seem to understand that the danger of regular excessive oxalate consumption is not just theoretical. Check out Sam’s story.

Unlucky in Love: Sam

Sam was an author, naturopath, amateur tennis player, and successful business man. He loved the flavor of buckwheat. He ate it every single day, for many decades. He also liked spinach omelets, and frequently ate almonds as snacks. On Sam’s typical day, these three foods alone could have contributed at least 775 mg of oxalate to his total intake (1 cup cooked buckwheat 180mgª & 3/4 cup raw baby spinach 480mg § & 1 oz. almonds 115mg §). Despite his expertise in health, Sam was unaware of the damaging effects of eating high oxalate foods, nor did he know that his go-to foods have so much oxalate.

Let’s fill in the rest of his daily diet. In addition to these favored anchor foods, it’s possible that he also ate:

(at least) one slice of multi-grain wheat bread (16mg) with his omelet,
at least ¼ tsp black pepper (4mg) over the course of the day;
a cup of black or green tea (25mg)
a few carrot or celery sticks (15mg);
a peanut butter snack (50mg / 2 T);
½ c of brown rice with dinner (10mg);
green beans (18mg/ ½ c boiled)
a tiny bite of milk chocolate for a treat or dessert (20mg/½ oz.).

A day that included all these foods would bring Sam to a total intake of 920 mg of oxalate. That is a potentially dangerous oxalate level in only a modest amount of food.

The Trouble with Healthy Food

I learned about Sam’s love of buckwheat, almonds, and spinach omelets on Dec. 29, 2015. Sam called me after reading my article: “When Heathy Isn’t”. He told me that he had been struggling with a set of problems he called “chronic break down”—including attacks of severe muscle soreness in his upper back, neck, and his upper buttock muscles. The debilitating pain would come and then disappear without rhyme or reason. Sometimes it involved severe muscle weakness that would make movement nearly impossible. This was distressing and embarrassing to an accomplished tennis player and health expert.

After reading my article Sam had a “eureka” moment. At last, in his late 60s, he learned of a critical missing piece in his understanding of the health effects of foods. Sadly, Sam died less than 2 years later, despite his devotion to healthy living, a happy marriage, and a thriving business. Based on our conversations, I know he believed that a lifetime of high-oxalate eating contributed to his early passing.

Counting a Daze-Worth of Oxalate

Take a look at the table below. It imagines a diet based on Sam’s favorite meals and snacks and compares it with another menu that some other man might have selected. Neither person selected his foods with oxalate in mind, but the difference is astounding – Sam’s diet is 14 times higher in oxalate. A full gram of oxalate in a day is a toxic level of oxalate exposure!

Meal	Sam (mg Oxalate)	Low-Ox (mg Oxalate)
Breakfast	½ C buckwheat (180) ¼ C Raspberries (18) ½ C whole Milk (0.5) 1 C black tea (24)	1 C Rice Chex™ (8) ½ C Blueberries (4) ½ C whole Milk (0.5) Unflavored Coffee (2)
Breakfast Total	222	15
Lunch	Spinach Omelet with Salsa 3 eggs (0) ¾ C baby spinach leaves (480) 1/8 tsp. black pepper (2) ¼ C Picante salsa (10) 1 slice multi-grain toast (16) Butter (0) 1 med. Anjou pear (20) 1 C Whole Milk (1)	Cheese & Shrimp Quesadilla Cheese (0) Mushrooms, canned (¼ C) (0.3) Baby Shrimp (0) White Flour Tortilla (10). Corn salsa: ½ C corn (2) 2 T red onion (0.5) 2 T red bell pepper (0.25) ½ clove garlic (0.1) 2 tsp. lime juice (0.2) 2 tsp. olive oil (0) ¼ tsp. chili powder (2) ¼ tsp. cayenne (1.5) Apple and Banana Fruit Bar (3)
Lunch Total	530	20
Snack	1 oz. almonds (115)	Cheddar cheese (0) 6 saltines (6)
Snack Total	115	6
Dinner	Homemade chicken soup made with: chicken (0) ½ carrot (5) ½ stalk of celery (5) ¼ C ckd. brown rice (5) ¼ C boiled green beans (10) ½ C raw curly kale (10) 1/8 tsp. black pepper (2) 1/8 tsp. celery seed (4) ½ tsp. dried oregano (4) 1 Tbs. fresh basil (3) ½ oz milk chocolate (20 +)	Baked Chicken seasoned with Shake 'N Bake™ (4) 1½ C Caesar Salad: romaine (1.5), croutons (3.5), dressing (1.5) ½ C cooked mustard greens (6) ½ C buttered white rice (3) 5 oz. red wine (0) ½ C red grapes (2)
Dinner Total	70	22
Evening Snack	1 Clementine (19) 1½ T peanut butter (36) 5 Keebler Toasteds® Sesame crackers (21)	6 oz. vanilla yogurt (6)
Evening Snack Total	75	6
Daily Total	1,012	70

Who’s Looking Out for Us?

Health authorities have dropped the ball. As a result, no one is paying attention to the oxalates in our food and how the amount we’re eating has been creeping up and up and up. We’re paying a price for our ignorance about what we’re eating.

Don’t wait for some official warning. Oxalate is a toxin. Unlike most environmental poisons, this is one toxin that is within your control to avoid. Don’t let your health depend on a roll of the dice. Get started.

Note: You may have good reasons for avoiding Rice Chex™, Shake ’N Bake™, or other packaged foods (check out my recipes!). The point here is that commonly eaten foods can be very high or very low in oxalate, and nobody is aware of the difference.

*reference http://www.fiveguys.com/-/media/Public-Site/Files/FiveGuysNutrition_Aug2014_CAN_E.ashx (Oxalate estimates are based on tests of Russet / Idaho potatoes and frozen fries performed at the University of Wyoming 2011, and 2015)

ªcalculation based on 86g uncooked weight and average of known tests of buckwheat and buckwheat flour which equal 133 + 270/ 2= 202mg/100g

§based on VP Foundation data published in their Newsletter

June 19, 2018 by Sally K Norton

Which spices are high in oxalate?

Spice of Life: about Spices and Oxalate content

Eventually, you’ll get around to wondering: which spices are high in oxalate? You wouldn’t imagine they could make a big difference, those light sprinklings of everyday seasonings. But they do.

A quarter teaspoon of regular old black pepper has as much oxalate as 1.5 cups of sliced onions and 22 times as much as the same amount of white pepper. In fact, if you’re sticking to an intake of 50 mg of oxalate every day, that ¼ teaspoon of pepper would occupy 6% of your days’ total oxalate allowance.

Granted, we need to take care of the heavy hitters first. After all, the 3 mg of oxalate in a ¼ tsp. of black pepper pales in comparison to the 33 mg provided by a 3-ounce portion of french fries or the 150 mg in one fluffy, half-ounce cup of raw spinach. Given the heavy hit made by these modern lunch foods, we’re tempted to discard any concern over how our food is seasoned.

But that would be a mistake.

Helen’s Breakthrough

My friend Helen is a case in point. She was still in chronic pain due to an auto accident 13 years ago. And she was also trying to drop stubborn pounds after decades of frustration at not losing weight while enduring a constant nagging hunger. For years she had struggled to get control of her tendency to reach for chips, soda pop, and a quick sandwich. Thus, she was pleased with her recent success in sticking with a strict no-sugar, no-gluten diet, but feeling discouraged that the excess pounds didn’t drop, not in the least.

Her best efforts to follow the combined advice of her nutritionist and counselor led to other frustrations too. Some of their advice conflicted with what her body was telling her—that many vegetables didn’t agree with her. “Healthy” foods often gave her stomach pains. Her nutritionist and counselor both insisted that she just needed to comply and eat her vegetables. She was caught in a tussle and needing some new ideas. I ran into Helen in a local café and she begged for my input. She needed more options, desperate for a breakthrough.

Trying Low-Oxalate

As we chatted, I told her that my physical energy and mental focus was much better on the low-oxalate diet—simply by avoiding certain vegetables, nuts, and fruits. In no way was I suggesting that this was a fit for her situation. But Helen insisted that I look at her diet and suggest changes. She wanted to know what not to eat. On a napkin, I wrote a list of low-oxalate vegetables she could have and told her to eat more butter and olive oil. I never mentioned spices. Later she set an appointment to get more details and suggestions, so she could try this approach and still comply with her counselor’s advice to eat “healthy foods”.

A few weeks passed, it was mid-July, and a much happier Helen called me. “I feel like I got my life back. I know this sounds like a trite exaggeration, but this approach has worked miracles” she said. “I feel better and I am not getting headaches. I’ve stopped taking Advil at night. My stomach aches are better, and my digestion is finally working. For once, I feel as if I am digesting and absorbing my food and I don’t feel hungry. I am eating much less, and it is easy. I am feeling a level of peace and simplicity about it like never before.”

Many Spices are High in Oxalate!

Helen got a second breakthrough when she studied my table of oxalate in foods. She was amazed to learn how much oxalate was packed into black pepper, cumin, turmeric, and other spices.

She had always gravitated to spicy foods. Her favorite snack, specially ordered and shipped in, was black pepper potato chips. Her favorite local hot-bar was stocked with heavily seasoned foods loaded with exotic aromas and strong, pungent spices, including: Indian curries, Ethiopian cuisine, and Mexican-style dishes.

Photo by: T. Maari

After seeing the actual numbers, the amount of oxalate conveyed to her diet by seasonings, she made a big, surprising shift. She started cooking most all her meals at home… cooking for one and eating alone, just she and her cats. She does NOT like to cook, and keeps it all as simple as she can. She tells me: This produced another breakthrough. Her back and knee pain were so much better! She could walk, exercise, and take stairs like she hasn’t for years.

Refine Your Diet

Paying more attention to spices might be a good way to refine your oxalate-aware eating plan. If you are really already avoiding potato chips, fries, nuts, snacks with nuts and seeds, spinach, and so on – the spice cabinet might be your next step. After all, most spices are potent seeds.

If you love spice too or love to cook with spices like I do, you might be daunted or otherwise resist this step. (It took me years to discard several spices languishing in my cabinet.) Please, don’t be afraid of cleaning out your spice cabinet. You can still enjoy great food, even with a simplified approach to seasoning. Undoubtedly, the best flavors come from the quality of the ingredients. When handled with care and skill in the kitchen, fresh ingredients shine without excessive embellishment. But, you don’t have to give up spices entirely – just be aware of what you’re eating, and use spices that are consistent with your low-oxalate goals.

Alternatives to High Oxalate Seasoning

Easy Substitutions and Approaches to Bringing out the Flavor of Foods

1. White pepper in place of black pepper

2. Lower the amounts of spices in your cooking by half

3. Use more white pepper, ground mustard seed, pinches of cayenne pepper, and mineral-type salts like pink Himalayan or Real Salt brand salt (ancient sea salt mined in Utah).

4. Use more salt. If you’re not eating processed food, you’re getting half of what most people are. And salt has an undeservedly bad nutritional reputation in any case: you might even need more salt to be healthy!

5. Add a hint of lemon juice, lime juice, or vinegar just before serving to give all the flavors in your dish a subtle lift.

6. Use enough fat when cooking and serving. An extra dash of olive oil or butter when garnishing and serving extends and enhances flavors.

7. Try prepared horseradish more often. It is great with beef and seafood. Good stirred into sour cream or yogurt, too (along with Frank’s Hot Sauce).

Essential oils and extracts can make good substitutes in the kitchen. Begin with these easy substitutions:

1. To replace (whole root) turmeric use a turmeric extract sold as a dietary supplement. (Start with 1 -3 caps per recipe, opened and the capsule discarded.) (Oxalate tends to stick to fibers and other elements removed when an extract is made.)

2. To replace lemon peel: use oil of lemon (1 small drop per tsp. of zest) or lemon extract (1/4 tsp./ lemon). (Oxalate is filtered out during extraction, and does not hang around in the oil fraction of any given food.)

Extracts typically don’t have exactly the same taste as the whole spice, but for certain recipes they can still provide a safe and pleasant flavor enhancement.

An adventurous cook will want to try using other essential oils too…

. . . such as the essential oils of clove, ginger, cardamon, and cumin seed oil (not black cumin seed -nigella- oil – which has very little flavor) (Cumin seed oil is hard to find.)

Purchase high-quality edible grade essential oils and a brown glass dropper bottle.
Dilute the essential oil 10:1 (5 teaspoons macadamia or almond oil to 1/2 teaspoon essential oil).
Label the brown glass dropper bottle with the names of the two oils used and the ratio of your mixture. (invest in a quality label machine). Store the mixture in a dark cabinet.
When cooking, add the oil at the last step of preparation.
Use only one drop of the diluted oil per recipe, taste and adjust up from there.
Make notes about what worked or didn’t.

For Curry Style Foods . . .

Try the curry styles of Thailand. Instead of cumin and turmeric (Indian style curry ingredients), Thai food are seasoned with various combinations of the following: cayenne, chili peppers, garlic, lime, lemongrass, mint, coconut milk, fish sauce, onion, and cilantro. To make the switch, keep these four ingredients on hand: 1) Thai chili paste (red or green), 2) fish sauce, 3) limes, and 4) coconut milk or coconut milk powder. Use the first 3 in ~1 tablespoon amounts… you can make nearly any dish interesting. These four ingredients can easily transform bone broth into something really nice.

Oxalate in Spices

High Oxalate Spices

Milligrams (mg) of oxalate (culinary portions)

Spice	Per 1/2 teaspoon (2.5 ml)	Per 10 grams
Turmeric	24	219
Clove	21	200
Cinnamon	20	168
Celery Seed	16	128
Fennel seed	11	129
Curry Powder	12	120
Cumin Seed, ground	10	100
Allspice	10	105
Lemon Peel, dried	10	73
Onion Powder	10	73
Coriander Seed	9	103
Ginger, Dried	8	96

Moderate Oxalate Spices

Milligrams (mg) of oxalate (culinary portions)

Spice	Per 1/2 teaspoon (2.5 ml)	Per 10 grams
Garlic Powder	0.1	0.7
Almond Extract	0.2	0.6
Mustard, ground powder	0.2	1.7
White Pepper	0.4	3.0
Red Pepper Flakes	1	12
Thyme, Dried	1	18
Mrs. Dash Seasoning Blend	1	19
Ginger, Fresh	2	17.5
Paprika	3	28
Cardamom, ground	3	31
Cayenne Pepper	3	33
Chili Powder	4	31
Oregano, dried	4	45

Oh, Spice Road: Spices in Verse

Pepper black, pepper red,

pepper, pepper

excite me, entertain me,

soothe me.

Conceal, mask, camouflage.

Spice, satisfy me, soothe me.

What longings, what emptiness shall I fill?

What hunger, what boredom, what lack can you displace?

Hunger, hunger what do you want?

Let me run away, travel, find jungle, beach, tropical paradise.

Oh, spice road, take me away from here.

What can you show me? What can you mask?

What fears can you quell? Sadness, aloneness, weakness, death?

Oh, spice entertain me! Oh, spice connect me, me oh spice, warm me, rev me, jolt me alive.

Oh, spice don’t flog me, punish me, or make me fat.

Hunger, hunger what do you want?

May 18, 2018 by Sally K Norton

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.

February 11, 2018 by Sally K Norton

Keto Getaway: Eat Less Plants and Feel Better!

In January I spoke at a wonderful nutrition and health conference, the Keto Getaway Conference, in West Palm Beach held by LowCarbUSA. Even though I was sick and the weather in Florida was cold, I had a wonderful time. Way to go Pam and Doug Reynolds, the founders and organizers who pulled together a wonderful program and a terrific line-up of speakers for the 2018 Keto Getaway!

Including a presentation on dietary oxalate in a low-carb nutrition event… this was a first! I am so grateful to have had the opportunity to introduce oxalates to some of the leaders in the keto nutrition movement. The credit goes to Carole Freeman (a.k.a. Keto Carole) who recommended me to Doug Reynolds. Thanks to her I shared and gained a number of important insights about the relationship between low-oxalate eating and a keto diet, some of which I have summarized below.

For those of you who are new to ketogenic diets, the first part of this post explores the whats, whys, and hows of “ketogenic” eating. If you’re already familiar with keto, you might want skip ahead to My Insights from Hanging in the Keto World.

What is Keto?

Keto is the popular term for eating a diet that is nearly free of carbohydrates, creating a fat-burning body “economy”. The term “keto” comes from the molecules (referred to “ketone bodies”) that your body generates when it burns fat instead of glucose to fuel activity and metabolic functions. Even the brain can switch to burning ketones when carbs are cut from the diet, which is a good thing. Doctors will sometimes worry about the body creating ketones, because they don’t understand the difference between nutritional ketosis (a normal healthy process that occurs when your body burns fat) and ketoacidosis (which also creates ketones, but which occurs when your metabolism is not working due to diabetes or other metabolic disorders).

Long having held the ecological niche of game hunters, human beings have been eating low-carb for many tens of thousands of years. Today’s carb-centric diet is a recent invention; the idea that processed carbs (eaten in abundance) are safe just came into being about 40 years ago. This is about the same time the 24-hour grocery store was invented. Not long after that, cup holders in our cars became standard equipment by the 1980s as well. By then we were hooked on sugar-on-the-go.

Why Keto?

A low-to-no carb diet is not new but is being explored anew by people seeking to:

cure obesity,
reverse diabetes,
treat brain and neurological disorders (Epilepsy, Parkinson’s, Alzheimer’s Disease, brain injury, mood problems and more),
manage endocrine disorders (Polycystic Ovary Syndrome),
support cancer treatment; and to
improve general health, well-being, and longevity.

Also, fasting has become a big buzz of late. Training your body to be good at burning fat and ketones is the best preparation for fasting. For my own health, I have been a carb-restricting eater for at least eight years, with the last year going lower and lower and relying on my fat-burning capacity more consistently over the last 6 months so I can experiment with fasting (and still stay energetic and fully-functioning).

How Keto?

To “go keto,” people remove sugars and starchy foods from the diet: grains, fruits, potatoes, junk foods, juice, sweet drinks, etc. The only effective way to lower carb intake is to eat something else, specifically fats (not excessive protein). Basically, if you want to burn fat for fuel, you need to eat fat. Simple logic, right?

The best example of this type of diet is The Atkins induction diet. Typically, a low-carb, high-fat (LCHF) diet involves a reduction in the amount of plant foods (no grains, beans, or potatoes), more animal foods (eggs, meats, fish) and many more fat calories from both animal (full-fat meats, bacon, chicken skin, bone marrow, lard, tallow, butter, heavy cream, cheese) and vegetable sources (coconut, avocados, nuts).

Bone Marrow

Shrimp Salad

Is it Safe?

A ketogenic diet means eating more butter, olive oil, heavy cream, coconut, avocados, and fatty meats. This is a shock to most people because we have been wrongly told over-and-over again for four decades that eating fat is bad for our health. It turns out that the only real problems with fats come from:

trans-fats (hydrogenated vegetable oils),
processed vegetable oils (e.g. canola, soy, corn),
poor-quality fats in the context of a sugary, high carb diet, and
the contamination of fats with environmental chemicals and, perhaps, with certain naturally-occurring plant sterols (as in soy oil).

Clean animal fats like lard, egg yolks, beef tallow, cream, and butter are beneficial to health because they contain needed nutrients, help the body assimilate nutrients, help act as a solvent, moisturizer, and clean-burning energy source in the body. Coconut oil, and fats from avocado are also safe and beneficial in the context of a low-junk, low-sugar diet. Despite the many unknowns still surrounding very low-carb, high fat diets (see the next section), lowering carbohydrate intake is safe for most people because a healthy body has no intrinsic need for them. (Some conditions, including heart failure, kidney stones, and gout may need special attention from a keto-aware medical professional who can monitor liver, kidney, and heart function to ensure safety.)

The State of the Art of Ketogenic Living

The science and even the definition of ketosis is still emerging. That is, although there are many scientific papers on the subject, many basic questions are just starting to be explored. For example: what is the most accurate way to measure ketone bodies so that we can monitor the state of ketosis? (Is it by the breath, urine, or blood?) How does a fat-burning metabolism affect our need for micro-nutrients? How do we correctly interpret diagnostic testing that has been standardized based on the modern grain-based, high-carbohydrate diet, when these tests are performed during prolonged ketosis? We may need more salt and electrolytes on a keto diet, but how much and when?

I have my own question too: Is the reduction of plant foods (such as wheat, beans, and potatoes) part of the reason that people on a keto diet feel better and love this way of eating? The keto diet is dramatically different from the standard diet, and there are many moving parts that are very much unaccounted for! (Especially the effects of reducing our intake of plant toxins.)

Does a Keto Diet Work?

Yes—if you do it right and give it enough time! That is, to feel your best while burning fat, your cells need to change the equipment they use for energy production. That takes time. There is a transition period of several months or a year, or even longer for some people. This transition can be a bit of an ordeal or it can be straight-forward: everyone is different.

There are several factors that can make the transition period challenging or even unpleasant. For example, you have to face the addictive nature of carbohydrates–they stimulate insulin and brain chemicals that make us crave sugar, bread, pasta, pizza, fries, chips, potatoes, donuts, desserts, chocolate, etc. Carb withdrawal is ugly. The addictive pull of carbs sets us up to abandon our body’s keto-metabolism training due to “cheats”. When we cheat and eat carbs, the progression to keto is up and down—prolonged and delayed by the internal food fight, personal habits, and the cultural challenges that are waiting around every corner in a carb-centric world. Patience, persistence, and starting again and again eventually pay off for some, but many people give up and prematurely declare themselves “not-a-fit” for this approach.

Key Tips on the Keto Journey

From my experience in being strict about carbs, there a few critically important keys to success:

Eat more salt, a lot more, because your kidneys will “waste” salt and potassium when you switch to low carb. If you keep switching on and off ketosis (like I did for years), you may end up depleted of salt and potassium and electrolytes generally. This can mean dry connective tissues and induce muscle aches and knots.
Get enough food: “strict low-carb” is not “low-calorie”.
Embrace fats: eat much, much more ghee, butter, and other animal fats than you think you should.
Let it take the time it takes (measure in months, not days). You will be reworking daily habits, holidays, ways to celebrate, etc. This involves the psychologly, sociology, and the physiology of eating!
While slowly progressing toward maintaining a consistent keto lifestyle, live and love your life as it is without fretting about the “depth” of your ketosis.

My Insights from Hanging in the Keto World

High-carb foods come from plants, and many (namely: grains, potatoes, beans) are high oxalate. Switching to ketogenic eating means cutting out grains, potatoes, and beans—completely! Unless you are frequently eating spinach, swiss chard, mixed salad greens, nuts, and chocolate, you will often be eating less oxalate on a keto diet. Some keto dieters even move to an all-meat, or mostly animal foods diet. This is exemplified by Amber O’Hearn (find her here and here) and many other 100% carnivorous eaters (think of this as the “feline diet”). What keto dieters may not realize is that this all-animal diet is also one way to do a zero oxalate diet.

One of the medical leaders in the field of therapeutic ketogenic diets is Dr. Eric Westman of Durham NC. He and other keto-promoters like to mention (okay: brag) that not only can they correct (cure) diabetes and obesity with diet, but that their patients also report less pain and digestive problems. He says that 80% of his patients with reflux get relief on the keto diet. He’s crediting ketosis for these bonus outcomes, without considering the effect of reducing plant toxins. However, pain and digestive problems regularly clear up on a low oxalate diet—even without ketosis.

Could it be that cutting out wheat, potatoes, and beans while eating more meat is a path to a moderate oxalate diet? Surely, reducing or removing oxalates and other plant toxins from the diet adds to the benefits of the low-carb, high-fat, ketogenic diet. Still, the keto world is mostly invested in the idea that ketones in the body are the principal source of the “keto magic”. Ketones are only one of the many reasons that people feel better on a keto diet. (Subtracting plant toxins feel good!)

Eat Less Plants

Who is looking at the changes in exposure to plant toxins? Sadly, not many researchers are exploring this angle in nutrition. But some keto proponents do suggest that a “low plant, high animal food diet” results in better health than a keto diet that includes more plants. Psychiatrist Georgia Ede does a great job explaining this seemingly radical idea.

Here is quote from Dr. Ede:

“There’s no evidence that I could find proving that plant foods are good for us. You see many, many studies showing that plant extracts can be used as medication when someone has a disease, are using [a subset of] their naturally toxic properties to your advantage. But if you are a healthy person, do you need to eat plants? As far as I can tell, you don’t…. When it comes to anti-nutrients, these natural chemicals within plants not only can irritate our systems, but they can interfere with our ability to digest and absorb nutrients, key nutrients …. The part of the plant which is most risky for us… is the seed. Because that’s the most heavily protected, that’s the future of the plant. …grains, beans, nuts and seeds are all seeds and they are very heavily protected. And I think that that is why… many people feel better on that [keto] diet, because they’ve removed legumes, they’ve removed grains… They have [often] not removed nuts and seeds, although I think some people who don’t feel better enough on a [low-carb] diet might want to consider that .”

Other Hints that Keto Sometimes Works Like a Low-Oxalate Diet

Example of the Low Oxalate Diet Rash

The “keto rash” sounds just the low-oxalate rash (see the picture nearby)!
Reports of “keto gout” sound a lot like oxalate flooding (dumping) reactions that may happen on the first year or two of a low-oxalate diet.

Why Oxalate Awareness is Needed in the Keto World

Oxalate is one more factor that makes ketogenic eating a good idea, SOMETIMES. There are at least 2 ways oxalate could be a problem in a keto diet:

1. Too Much Oxalate.

Some keto dieters may overdo oxalate by making these mistakes:

relying too heavily on nuts;
routinely eating some of the classic super-high-oxalate greens (spinach, swiss chard, beet greens, micro green salad mixes);
spicing up their foods with high oxalate spices like cinnamon, cumin, turmeric, etc.; or
treating themselves to keto “fat bombs” and hot drinks made with coco and dark chocolate.

Any combination of these low-carb/high-oxalate ingredients can quickly add up to a dangerously high oxalate diet.

2. Too Few Oxalates, Too Fast.

Another Low Oxalate Skin reaction – on a foot

The mostly-animal food version of keto may mean abruptly (and unawarely) switching to a much lower (near zero) oxalate intake. In some people with a history of eating high oxalate foods: Oops! They may experience an abrupt outbreak of a whole new set of problems. Why? Because this switch is likely to destabilize oxalate deposits in the body and trigger oxalate flooding / dumping. Boy can that be unpleasant! Flooding your tissues with ionic or nano-oxalate is hard on your body. The deleterious consequence of the body’s desire to be rid of oxalate can be softened with certain supplements and other strategies that are just beginning to be explored (and that need to be figured out for each individual).

Lets Get Together

In my own experience, Low-Oxalate and Low-Carb are a wonderful combination for enhancing mood and energy, and for managing pain. Both are important for optimal brain development and function, limiting the effects of brain aging, and for preventing and perhaps treating dementia. There is a potentially powerful symmetry in the union of know-how in the previously unconnected worlds of low-carb and low-oxalate. Lets keep thinking together about what we need to learn and teach to bring the greatest possible benefits to human health.

To view videos of 2018 Geto GetAway speakers go here. (https://www.lowcarbusa.org/videos/video-members-area/2018-wpb-premium-videos/)

November 19, 2017 by Sally K Norton

Choices to lessen suffering and open our hearts to joy and Thanksgiving.

My trip to the farmers market today was beautiful. In a magical perfection, bright yellow and orange leaves fluttered everywhere in the swirling wind, contrasting with the strong, steady, black-bark covered limbs arching over streets and sidewalks. Everyone at the market seemed calm and very content to be there. It put me in a mood to slow down, just be, and reflect about the ways we cope, consume, eat.

South of the James Farmers Market

And, I want to suggest to you that, this Thanksgiving, you eat whatever you want.

But, before you do, be sure you really want it. And that you know why. Do we ever know why we do what we do? We say we want to be out of pain, physically, emotionally, and yet… Too often our actions don’t always fit our true wants. Perhaps, we are so busy wanting that we cling to our cravings and beloved symbols of comfort, especially when we get emotionally triggered. And our desire to be loved is often being the biggest “want” of all.

Emotionally triggered? Do you think it’s possible at this time of year? Honestly: do you think it’s not possible? A lot of us go into super-charge mode emotionally, putting ourselves on a hair trigger, easily upset by the smallest of things. It works great for retailers who put all kinds of irresistible comforts, stimulants, and distractions right under our noses. It doesn’t usually play out so well at family gatherings, however.

How will you be in this moment, this time we call Thanksgiving? This is the time we say is the opening of the Season of Joy. Can it be so for you? What would make it so? Is it about the sugar-coated, pecan-topped sweet potatoes, really? Foods like these may serve our past habits and past memories. And so, we tell ourselves that they are security, ground, and comfort—and a pleasure we need and deserve.

Clinging to the Past

The old way of doing things provides a railing that we hold on to as we navigate the steps of relationships, change, and uncertainty. But, truly, life is best lived in a state of uncertainty. That is where discovery lies. That is where novelty, growth, and the best in life reside. Perhaps, too, clinging to our old choices, habits, and memories is just an escape from uncertainty. So often we don’t dare be fully present, or embrace our new path. Perhaps because we fear feeling sad. Sad is bad enough at any time, but horrible in the Season of Joy.

This is an ideal time to build our confidence in our ability to drop our old ways and choose wisely. As Pema Chödrön, puts it: “Natural intelligence is always accessible to us. When we’re not caught in the trap of hope and fear, we intuitively know what’s the right thing to do. If we’re not obscuring our intelligence with anger, self-pity, or craving, we know what will help and what will make things worse” [for us emotionally].

Let your own capacity to feel appreciation, gratitude, tenderness, and a sense of humor be your core, your warmth, your comfort, your peace, your celebration. This is great time to nurture our inner warmth, first to ourselves and then to everyone around us. Light a small fire inside, let it glow with your life energy. Let it be reason enough for the season. Let it give you peace, let it free up your intelligence and be a fuel for making wiser choices. De-escalate the meaning and value of former favorites, and look forward to trying new things that are good for you.

Happy Thanksgiving!! And, remember, a low-oxalate holiday begins with your mindset.

Sources:

Pema Chödrön (2009) Taking the Leap. Freeing Ourselves from Old Habits and Fears. p.5

Photo Credit: Copyright: <a href=’https://www.123rf.com/profile_maxsheb’>maxsheb / 123RF Stock Photo</a>

Links:

http://www.freeuniongrassfarm.com/

Dates in My Low-Ox Diet Plan: What Does the Data Say?

Before We Begin: Learning to Read Oxalate Data

Dates in My Low-Oxalate Diet Plan: What Does the Data Say?

Dates vs. Figs: Oxalate Content of Food

Finding Oxalate Data You Can Trust

Data Sources

DATES (are Low Oxalate Foods)

FIGS

FIG NEWTONS

Online Lists Will Keep You Feeling Confused About Oxalates in Foods

How to Get Better Information

Better Sources Exist for Oxalates in Foods

Need to Know Tip #1: Oxalate Levels Vary for the Same Kind of Food.

Need to Know Tip #2: Oxalate in Foods Information is Incomplete

Need to Know Tip #3: Sloppiness is Widespread

Need to Know Tip #4: Older Oxalate Testing Methods Were Less Accurate

Need to Know Tip #5: Oxalate Data Researchers do not Calculate Portion Sizes

We Need More (and Better) Research on Oxalates in Foods

Practice Tip #1: You Don’t Have to be Perfect

Practice Tip #2: Portion Size Matters

Practice Tip #3: Keep Learning

Popular Summary Lists Mostly Think the Oxalate Content of Coffee is Low

Table 1.

Online Lists of Oxalate Content of Foods

Published Analyses of the Oxalate Content of Coffee

Table 2

Publications Reporting Oxalate Content in Coffee:

Low-Hanging Fruit: Rotten or Not!

How do we explain these very different results?

Table 3

Studies Claiming Coffee is High In Oxalate

Exposed: Bad Methods, Laziness and Sloppiness

Permanganate Titration is an Unreliable Method for Measuring Oxalate

Good Scientists Study their Methods, not just their Samples

Errors in Citing Previous Studies

But Wait! Isn’t There Another Study Saying Coffee is High?

Other False Claims that Coffee is High in Oxalate

How do you make sense of oxalate data?

Disclaimer

Five+ Years of Low Oxalate — Reflections, Lessons, & Progress.

A Quick Flash Back

Medical “Care”

Sharing to Teach

How Weird is This?

A Look at Oxalate Illness

Reflections After 5 Years on the Low Oxalate Diet

It’s Not Just My Joints that Are Happier

About the Cause

Discovery, Frustration, and So Much to Learn

A Quick Recap of Science Lessons Learned: A List

The Beginning is Just the Beginning

Still Not on Easy Street

Ongoing Recovery Means Still Improving and this Means Some Suffering

Turn Off the Healing?

Challenge Testing

Where I am Today

Changing Perspective

Letting the process be what it is (vs demanding different results)

Don’t fight the waves, let the tide carry you forward.

Being Complete vs Not

Some Take-Aways:

A Brief Note of Gratitude and Thanks

Footnotes

The Paleo View’s Spin

Minerals Lost to Oxalate

Additional Anti-Nutrient Effects Occur After Oxalates are Absorbed

Potassium Problems Too

Which Oxalates Cross the Gut Lining and How Much?

Oxalate Crystals Harm Gut Function

Gut Bacteria Won’t Save You

Choosing Low Oxalate Foods Is Healthy and Nourishing

Wishes vs. Facts

My Conclusion about Their Conclusions

Key Points

References

Easy to Over-Do It, Easy to Fix It

Hard-to-Resist Super-Sized French Fries

Unlucky in Love: Sam

The Trouble with Healthy Food

Counting a Daze-Worth of Oxalate

**Online Lists Will Keep You Feeling Confused About Oxalate**s in Foods