Oxalates, a potential problem for Keto, Paleo and vegan diets

[SusanJ]

Most people have heard of oxalates because of their connection to kidney stones. Or with regards to spinach, because the calcium in spinach is bound by oxalates, and therefore spinach is not considered a good source of calcium. But oxalates just might be the missing link to improving your health. They were for me.

I found out the hard way, and hope to maybe help a few others of my fellow E4 travelers on the road to good health. This is a long post, but I wanted to provide some context of why at least some people will want to pay attention to oxalates.

In retrospect, the signs that oxalates were a problem were there all along for me. Here's my background (but also here's a list of who might be concerned about oxalates.)

My grandfather had kidney stones, and 3 of 4 of my brothers have calcium oxalate stones.

Back in my early 50s, after a few years on a mostly vegetarian diet (no animal protein or dairy, just occasional fish, lots of grains and legumes, vegetables), I started having unexplained cloudy urine. Lots of lab tests that were always negative for bacteria. I was always told to drink more water, which sometimes just made my urinary urgency worse.

Then, one day I just woke up with very sore fingers and feet. A trip to the rheumatologist and tests showed that I was negative for rheumatoid arthritis, but he said about 20% of folks never test positive and suggested I take prednisone (which I did for 6 weeks) and then switch to methotrexate (which I quit after a few doses and feeling terrible. MTHFR variants is my guess.) I was also diagnosed with osteopenia in my mid-50s.

I went to an integrative doctor who recommended an elimination diet to reset things, and to eat a more Paleo-like diet (back then, it wasn’t called Paleo). Eliminating grains did a lot to reduce the pain and swelling, but did not eliminate my symptoms. I continued on eating Paleo-like for several years, still having some level of primarily pain and urinary issues. And I would get aches and pains in strange places, in retrospect, mostly in areas where I had prior injuries like from sports, a car accident and too much computer work. (Oxalates build up in scar tissue and old injury sites.)

Then, I found out I was E4, and eventually started on the path to Keto. Weight loss was a struggle for me while on Keto. To add calories to compensate for the reduction of carbs, I added a lot more nuts. Every day. I did smoothies to help keep on weight, with extra protein, nuts and sometimes a handful or two of spinach or cacao for extra anti-oxidants. I ate beets to help with my whacked choline pathways (beets are a good source of betaine), and ate sweet potatoes, parsnips and plantains as healthier carbs. I'd snack on a square or two of chocolate. All. High. Oxalates.

And somewhere in there I stopped taking calcium, because studies were showing calcium supplements were linked to coronary plaque. Bad move, because calcium binds with oxalates to send them out in the stool. Also bad because oxalates are linked to atherosclerosis, which I found I had through a heart scan in my early 60s.

Thinking back there were other signs, too. I went to a high end restaurant in my 30s and ate some sorrel (extremely high oxalate) in a salad. I had a rash for about 3 days. In my 40s, I would get some low back pain and upper right side pain (perhaps gall bladder/stones). Back during that era, adrenal fatigue was everywhere, so I was told to handle stress better, and eat more fiber for the gut pain. I had bouts of vertigo that seemed to come out of no where, and tinnitus showed up in my left ear. All tests were negative, and I was told to just get used to the ringing and shown how to do the Epley maneuver if I got dizzy. (Here's a list of other symptoms and associated diseases...it's long and varied.)

So, two years ago I hit bottom, after trying to recover from a round of 2 antibiotics in 2018. My joints were screaming, I had brain fog on many days, sometimes vertigo, and now I also had vulvadynia. My ankles were beginning to swell daily. My gut was certainly a mess from the antibiotics. But fortunately for me, I had a new doctor, who eventually did a Great Plains OAT test. My oxalic acid was 3 times the normal range.

He suggested we treat for fungal infections, which we did (fungus can produce oxalates). But I also did a lot of research and made some other changes.

Bottom line.

I now eat a low-to-moderate oxalate diet - I stopped eating all nuts, spinach, Swiss Chard, beets and beet greens, chocolate, sweet potatoes and plantains (and a few other things). I seem to tolerate a few pumpkin and sunflower seeds, along with some avocado. I have started eating more grains to stem weight loss (mostly medium oxalate like white rice, and small amounts of oats and corn, and I plan to test lentils eventually). Diet has definitely been the hardest to figure out, balancing fats and carbs to keep my weight up, yet not ruin my blood sugar or lipids. (Coconut works well for weight, but my word, it just ruins my lipids.)

I have completely stopped taking Vitamin C. I take 250 mg of calcium citrate with each meal to bind dietary oxalate. I also have genetic snps that predispose me to oxalate problems. (And here's a list of 12 strategies for mitigating oxalate's effects.)

Now, unless I am dumping (see below) or I ate too much oxalate over any given day, my fingers and feet don’t hurt or swell, my brain works better, I don’t have vertigo, my gut is so much better, my urinary urgency and vulvadynia are gone, and I can sleep through night without having to go to the bathroom. My ankles do not swell anymore, even while dumping.

My tinnitus is reduced, but still there. My last bone density scan had stabilized, after 2 successive scans showing continued loss. And a few more miscellaneous symptoms seem to have cleared up.

And looking back even farther in time, I think my mother also suffered from oxalate toxicity. Even though she never had kidney stones (not as common in women), she had lots of bursitis, arthritis, upper back pain, gall stones and also GI problems late in life. It didn’t skip her generation, she just had other symptoms, like me.

Here’s the thing. Even though many of my symptoms seemed unrelated - joint pain, vulvadynia, vertigo, IBS - they weren’t. They can be tied back to my body not handling oxalates. It’s not an allergy or sensitivity, but an inability to safely excrete oxalates. So, excess oxalates were sequestered in other places around the body to reduce the potential damage to the kidneys. Once I made the changes, the sequestered oxalates have started to be excreted (a process called “dumping” by doctors and others who treat oxalate patients).

While dumping, it's just like you've eaten extremely high amounts of oxalate. My symptoms of hand and foot joint pain and swelling, vulvadynia, and urinary issues, all return, sometimes with a vengeance. And I sometimes I will get GI pains, gall bladder pains, and pain in old injuries like my upper back (from a car accident). I also had some severe bouts of vertigo and extreme fullness in my left ear over a couple of weeks.

Dumping is no fun, but necessary. And to prevent some of the more extreme dumping events, my advice is to lower your oxalate intake very slowly if you want to try this. Like, just take one food, like spinach and eat half of what you normally do for a week, then lower again by half. When I feel like I’m dumping, I add in a higher oxalate food to slow it down. On the Trying Low Oxalates Facebook forum, folks have reported dumping from a few months to a year or more. I’ve been at this since last September.

So, in my journey to understand how so many random symptoms were related, I did a lot of research into oxalates, and now want to share what I’ve learned so maybe someone else doesn’t have to go through what I did or at least recognize that oxalates might be a problem. Because unless you have kidney stones, oxalates will not likely be on any doctor’s radar screen, and with lots of random symptoms they probably think you are a hypochondriac anyway.

Lastly, here's the whole wiki post and science behind all of this. https://wiki.apoe4.info/wiki/Oxalates

And feel free to ask questions and I’ll do my best to answer.


[Small edit to include direct links in the wiki to more info.]

[floramaria]

Most people have heard of oxalates because of their connection to kidney stones. Or with regards to spinach, because the calcium in spinach is bound by oxalates, and therefore spinach is not considered a good source of calcium. But oxalates just might be the missing link to improving your health. They were for me.

SusanJ, thanks so much for sharing this remarkable story of your discovering how oxalates were the root of your various , seemingly unrelated problems. I read it as I was eating a spinach salad with nuts and promptly ran to the kitchen to dig out some leftover calcium, a supplement I discontinued years ago for the same reason you had. I have not experienced the problems you have, but your story is really eye-opening. My diet is extremely high in oxalates, with your list of foods you avoid reading like my grocery list,

So, in my journey to understand how so many random symptoms were related, I did a lot of research into oxalates, and now want to share what I’ve learned so maybe someone else doesn’t have to go through what I did or at least recognize that oxalates might be a problem. Because unless you have kidney stones, oxalates will not likely be on any doctor’s radar screen, and with lots of random symptoms they probably think you are a hypochondriac anyway.

Thanks so much for writing this all out so that we all can benefit from it. Really important information.
Your journey through all of this reminds me of the I Ching line “Persistence furthers.” Happy to learn that you figured this out for yourself and are feeling so much better. Good luck with the dumping. Sounds like you have a good strategy.

[SusanJ]

Thanks so much for writing this all out so that we all can benefit from it.

You're welcome. Not everyone has problems with oxalates - certainly not my hubs who seemingly thrives on a more vegetarian diet!

But it was eye-opening to join the Trying Low Oxalates group on Facebook. It's almost 36,000 people with stories just like mine, many who went to several doctors with no answers, so I'm guessing there might be a few folks here on ApoE4.Info who can benefit.

I listed 12 solid strategies, backed by science, on the wiki page for anyone who feels they might benefit. All doable, but diet really is the tough one.

And I probably wrote a lot more info on the wiki page than most people want or need.

[TheresaB]

Here's the science. https://wiki.apoe4.info/wiki/Oxalates

Such an excellent addition to the Wiki - thanks so much Susan! (Pretend that's an applause emoji)

[SusanJ]

...thanks so much Susan!

You're welcome, T. Many things shocked me when I was researching, but none so more than this one (that I quoted on the wiki).

However, even tiny aggregations of oxalate can cause cell-membrane rupture, up-regulated intracellular reactive oxygen species (ROS), and decreased mitochondrial membrane potential. This eventually leads to necrotic cell death. (Xin-Sun, Xu & Ouyang, 2021) Elevated oxalates were also shown to cause mitochondrial dysfunction in primary monocytes from healthy subjects. (Patel, et al., 2018)

We all try so hard to lower ROS, and have healthy mitochondria, yet, I was probably doing a lot of harm by unwittingly eating too many oxalates. No wonder I felt so lousy sometimes.

[Rosemary]

Hi Susan,
Thank you so much for this timely post! I just made a brown lentil, carrot, spinach soup. The last time I made this soup (no spinach then) it was so good I stuffed myself. The next morning I was stiff as a board. I'll never forget that morning. I knew it was the oxalates in the lentils. I'll have a tiny bit of lentil spinach soup today with a good serving of plain yogurt. No more though! I won't be making it again if I have issues.

I have had many of the symptoms you described including kidney stones. I ingest plain yogurt to bind excess oxalates and take daily doses of potassium citrate. I have been doing pretty good at preventing obvious flare ups. I appreciate the time and effort you took to document your story and create a wiki page on oxalates (I'll be visiting it again!) Also, I checked out the TLO facebook page and signed up.

Your post is inspiring because it shows me when we listen to our body and suspend our rationalizing mind, we can make changes and hopefully experience breakthroughs. What's good for one may not be good for another. I'll give a personal example. A few years back I researched vitamin K2. I was so pumped to try it! Each time I took it I experienced severe headaches behind my left ear that lasted days. At first I didn't connect it with the vitamin. I tried different brands, always low doses, even tried Thorne olive oil K2 drops. I did one drop a day. At first no problem but after a few days in my system the familiar headache came back. So no more vitamin K2 for me. My reaction was apparently rare. There were hardly any reports of severe headaches on various forums. A parallel thought, when I eat too much raw greens (i.e., pesto made from stinging nettles) I get the same type of pounding headache. I thought it was too much vitamin K in the greens that was triggering the headache, but maybe it was the oxalates. Susan, what do you think?

Susan, I admire your intelligence, open mindedness, and perseverance! Your post was godspeed for me.

[SusanJ]

Your post was godspeed for me.

Hello to a fellow traveler! As you know, if we listen to our bodies, they often have a lot to say.

With regards to Vitamin K, there are folks on the TLO page who also have troubles with it. Some claim it starts them dumping. I don't know if there is specific science behind that, but it's good to listen to your body.

Just a heads up about the TLO group, they have very few admins and a lot of members, so know that if you ask a question, it has to be approved (and it sometimes takes a while). Also, read all of the "Units" and Documents available at the top of the main page. It's a little overwhelming because they want you to read all of the comments in those "Units" posts. Comments can number in the 100s. And, if you ask a question whose answer is in the Units, you will be directed back to read them. Think they just get overwhelmed answering the same questions over and over again. My strategy was to read the Units and docs, then use search to find some specific topics.

The TLO list says that red lentils or yellow split peas are low oxalate. Raw carrots are considered high, but if you cook separately for 4 minutes and dump the water before adding to your soup, it will lower the amount into the medium range. You might be able to put together another nice recipe using alternatives. I've also switched to use arugula (rocket) instead of spinach.

Good luck!

[Rosemary]

Hi Susan,
Interesting that some TLO folks think vitamin K2 may trigger oxalate dumping. I think I'll see what I can dig up on the subject.

Thanks for the tips regarding the TLO facebook page. I'll definitely read the "units" and documents before asking a question. I'm looking forward to exploring the site!

[SusanJ]

Another interesting link to oxalates: atherosclerosis.

A possible mechanism. For those of you who don't resonate with the current theories of plaque formation, this is worth the read.

Dysregulated lipid metabolism is a hallmark feature in the pathogenesis of atherosclerosis (Moore et al., 2013). Nevertheless, despite remarkable advances in lipid-lowering therapies, CVDs remain a leading cause of death likely due to lack of influence or detrimental effects on other risk factors beyond dyslipidemia (de Carvalho et al., 2018; Swerdlow et al., 2015). Thus, identification of metabolic pathways that contribute to the pathogenesis of atherosclerosis, beyond altered lipid metabolism, may lead to the development of novel therapeutics. Recent evidence indicates that dysregulated amino acid metabolism plays a role in atherosclerosis (Grajeda-Iglesias et al., 2018; Nitz et al., 2019; Rom et al., 2018; Zaric et al., 2020). Specifically, lower circulating glycine has been consistently reported in various cardiometabolic diseases including coronary heart disease (Wittemans et al., 2019), myocardial infarction (Ding et al., 2015), T2D (Guasch-Ferré et al., 2016), metabolic syndrome (Li et al., 2018), obesity (Newgard et al., 2009) and NAFLD (Gaggini et al., 2018, Rom et al., 2020)

The researchers first looked at the glycine/oxalate ratio in humans, which was most significantly decreased (by 27%) in patients with significant CAD. Then they went on to test whether dysregulated glycine-oxalate metabolism is similarly observed in mice with atherosclerosis. They targeted how alterations of glycine-oxalate metabolism would affect plaque formation. Their findings indicate an impaired glycine-oxalate metabolism through suppressed AGXT enzymatic pathway that leads to atherosclerosis. AGXT is expressed primarily in the liver and its loss-of-function typically leads to oxalate accumulation. They also looked at it's effects on inflammation, cholesterol-bile acid homeostasis and mitochondrial dysfunction. Lastly, they addressed the direct role of oxalate in cholesterol metabolism, by feeding a diet higher in oxalates (and yes, a high oxalate diet caused problems, too).

Collectively, by studying both endogenous dysregulation of oxalate and exogenous oxalate overload, we show that dysregulated oxalate metabolism modulates redox homeostasis, inflammation and cholesterol metabolism leading to accelerated atherosclerosis.

In conclusion, combining data from patients and mice with atherosclerosis and complementary genetic and dietary approaches to manipulate oxalate exposure in vivo and in vitro, the current study uncovered dysregulated oxalate metabolism as a driver of atherosclerosis due to dysregulated redox homeostasis, enhanced inflammatory response and altered cholesterol metabolism. Furthermore, this study demonstrated the therapeutic potential of AGXT and targeting dysregulated oxalate metabolism to reduce atherosclerosis.

Liu, et al., 2021


And would seem prudent to get a carotid screening if you have kidney stones.

The levels of carotid IMT and CS in the CaOx ≥ 50% and CaP groups were all significantly higher than in the controls. These findings suggest a strong link between dyslipidemia, carotid atherosclerosis, and calcium kidney stone disease.

Huang, et al., 2020


Edit: And yes there are studies showing an accumulation of oxalate in human aortic plaque.

[KatieS]

Susan, what a journey to unscramble oxalates as the culprit. Thanks for sharing. Once I figure out my hypothyroidism, you’ll inspired me to post.