The Next Most Important Thing You’ve Never Heard of: Oxalates
Many people are trying to eat better to stay healthy. Spinach salad with beets for lunch. Sweet potatoes instead of white potatoes. Nuts for snacks. Almond milk instead of cow milk. Tea rather than coffee.
What do these foods all have in common? They are all high in oxalates.
Traditionally, the medical world thinks of oxalates in the context of kidney stones. The most common type of kidney stone is composed of calcium and oxalate.
As is often the case in medicine, oxalates have wider implications and play a role in many chronic conditions beyond kidney stone formation. Oxalates can build up in muscles, the thyroid gland, the bladder, the gastrointestinal system and other tissues within the body.
Many diagnosed with the chronic pain syndrome fibromyalgia have oxalates as the primary issue. Understanding this aspect might be the only way to improve or even resolve their chronic pain. One thing I’ll often do for new patients with a chronic pain syndrome is to go back through the electronic medical record searching for urine analysis results to see if any calcium oxalate crystals showed up.
Izabella Wentz is the bomb. She wrote an important article a few years ago correlating thyroid problems with oxalate deposition in the thyroid gland. Click here to read the article. Via her article, you can find recommendations for management and links to research studies and other good sites on the subject.
Oxalates play a major role in chronic bladder inflammation. Millions of women have an undiagnosed chronic condition called interstitial cystitis (IC). The hallmarks of IC are intermittent flares with urinary frequency, urgency, discomfort and sometimes incontinence. If you have these symptoms on a recurrent basis and they don’t respond well to antibiotics, make sure you know the result of the urine culture. That result is the primary way to differentiate between an IC flare and a urinary tract infection (UTI). Those with IC can get both, so one positive urine culture with E. coli bacteria doesn’t mean you don’t have IC.
Many with IC also have unexplained chronic genital or pelvic pain and end up with diagnoses like vulvodynia. This increases the likelihood that oxalates are a root cause.
There are more questions now about oxalate deposition in the GI tract and whether this might play a role in irritable bowel syndrome (IBS), unexplained stomach inflammation (gastritis) and other conditions.
Some believe that oxalate build up and secondary inflammation are playing a role in cardiac issues, recurrent vertigo (BPPV), TMJ, vasculitis, kidney disease or just about any syndrome where chronic inflammation is active.
You might be wondering why some people with high oxalate intake never develop any of these problems or why some with low to moderate oxalate intake might. One of my lines to the medical and nurse practitioner students when sorting out the root causes for chronic conditions is: “It’s [almost] always more complicated.”
One variable is oxalate intake.
The next is fluid intake to flush oxalates.
Another is how well the kidneys are functioning, but that isn’t often a major aspect to uncover unless the person has certain genetic variants.
It gets really challenging when we try to understand the interrelationship of oxalates with genetic SNP variation relative to imbalances within the microbiome.
NSAIDs, alcohol, gluten, lectins, toxins, steroids, antibiotics and oxalates and others all have the potential to damage the gut lining. This leads to increased permeability (“leaky gut”) and increased absorption of the same oxalates doing the damage. Vitamin D increases oxalate absorption so vitamin D supplements should be avoided for those with oxalate problems. (I can imagine the shriek of horror at this concept for those that believe that vitamin D deficiency is the most important issue in healthcare.)
Oxalates bind iron, calcium, potassium and magnesium so the person can have relative mineral deficiencies especially in cells and tissue. Some research links the muscle pain of fibromyalgia specifically to potassium deficiency within the muscles.
Every day, I imagine a future where machine learning/AI systems help us sort through these complex issues.
So, is the solution to look up high oxalate foods and avoid them? Yes and no. For that variable, most have to decrease oxalate intake gradually to avoid a phenomenon called “oxalate dumping.” You can find references for tracking oxalate intake on the internet. You could use a site called Personal Remedies.
Alkalinizing the system with specific mineral supplements can be tremendously beneficial but that has to be done gradually and preferably under the supervision of an experience practitioner. Those options would include calcium citrate, magnesium citrate, potassium citrate, sodium bicarb and others. Alka Seltzer Gold and Himalayan sea salt are inexpensive, but effective options. Many with oxalate problems also need extra sulfate, so Epsom salts baths can be beneficial.
If you or someone you know has chronic pain, chronic bladder problems, chronic GI issues and/or unexplained sources of inflammation, oxalates are an area worth exploring. This could be the most important health issue you pursue in 2020.
Happy New Year!
Andrew Lenhardt, MD