DISCLAIMER: This post is for educational purposes only. This post is not a recommendation, recipe, or guide for self-treatment. Nothing in this post is designed to offer treatment recommendations or aid in a diagnosis of a particular disease or symptom. Ettinger, Inc; Dr. Marcus Ettinger, or www.advancedhealing.com is not responsible for or to be held liable for the reader using or not using any part of this post. Lastly, please seek medical attention or call 911 if you are experiencing a medical emergency.

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  1. What Are Oxalates And Where Do They Come From? (simple answer – no need to make it complicated)
  2. What Strategies Can Be Used To Support The Lowering Of High Oxalate Levels In The Body?
  3. What Testing Will Help Me Diagnose Oxalate Metabolism Issues?
  4. What Increases Your Risk of Oxalate Overload?
  5. What Foods Have The Highest Oxalate Content Per Serving (around 50 mg/serving or higher) Include:
  6. Foods With Low Oxalate Levels (less than 50 mg/serving) Include:
  7. What Animal Proteins Are The Lowest In Oxalates?
  8. What Are The Top 10 Foods Lowest In Oxalates?
  9. Can I Drink Coffee Or Tea If I am Trying To Avoid Oxalates?
  10. Which Grains Are Considered To Be Low In Oxalates?
  11. Are Fermented Foods High In Oxalates?
  12. What Nutrients Are Needed To Support Proper Oxalate Metabolism?
  13. Urinary Alkalinization As A Technique To Lower Oxalate Levels.
  14. Symptoms Of Oxalate Toxicity:
  15. Can Oxalate Crystals Affect The Kidney In Other Ways Than From Just Kidney Stone Formation?
  16. How Long Can Oxalates Stay In The Human Body?
  17. Can Citrate Help The Body Excrete Oxalates?
  18. Can Oxalates Cause Inflammation Of The Prostate Or Prostatitis?
  19. Can Oxalate Build-Up Cause Gastrointestinal Tract Inflammation (IBD or IBS)?
  20. Is There A Correlation Between SIBO and Oxalates?
  21. Can Oxalates Cause Interstitial Cystitis/Bladder Pain?
  22. What Is The Antidote to Oxalate Overload/Toxicity?
  23. Does Detoxing Oxalates Take Time?
  24. What Is Systemic Oxalosis?
  25. What Is The Origin Of Urinary Oxalates?
  26. What Are Examples Of Divalent Cations?
  27. What Is An Oxalogenic Substrate/Precursor?
  28. What Amino Acids Are Oxalogenic Substrates/Precursors?
  29. What Foods Have The Highest Glycine/Hydroxyproline/Gycolate Content?
  30. Can A High Salt Diet Contribute To Calcium Oxalate Kidney Stone Formation?
  31. Can Low Pancreatic Enzyme Production Inhibit Or Influence Oxalate Metabolism, Lead To Oxalate Overload?
  32. Do Oxalobacter formigenes Help To Metabolize Oxalates?
  33. Are There Ways To Increase Levels Of Oxalobacter formigenes?
  34. Can Intestinal Yeast Overgrowth Contribute To Altered Oxalate Metabolism?
  35. Can The Gut Bacteria Akkermansia muciniphila Influence Oxalate Metabolism?

What Are Oxalates And Where Do They Come From?

Oxalates are naturally occurring compounds found in many plant foods. They are small molecules composed of oxalic acid and minerals such as calcium, potassium, sodium, and magnesium. Oxalates can be found in a wide variety of foods, including leafy green vegetables such as spinach and kale, fruits such as berries and rhubarb, nuts and seeds, grains, and some spices. They can also be found in chocolate, tea, and coffee.

 

What Strategies Can Be Used To Support The Lowering Of High Oxalate Levels In The Body?

Implement a low-oxalate diet. This may be especially important if the individual has had yeast or Candida for long periods of time and there is high tissue oxalate buildup.

Low-to-medium oxalate foods: Wild-caught fish, pastured poultry, grass-fed beef, bananas, Golden Delicious apples, cabbage, bok choy, broccoli, Brussel sprouts, celery, endive, cauliflower, cucumber, zucchini, lettuce, onions, and mushrooms.

Avoid high oxalate foods, which tend to be dark leafy greens. One cup of raw spinach contains around 656 mg of oxalate. This is a great resource listing oxalate count in various foods. 

Antifungal drugs can support a reduction in yeast and fungi that may be causing high oxalates. Children with autism frequently require years of antifungal treatment. Arabinose, a marker used for years for yeast/fungal overgrowth, on an ‘Organic Acids Test,’ has been shown to be correlated with higher levels of oxalates.

Supplements such as calcium and magnesium citrate can support a reduction in oxalate absorption from the intestine. Citrate is the preferred calcium form to reduce oxalate because citrate also inhibits oxalate absorption from the intestinal tract.

Below is a list of other nutritional supplements that have been shown to support oxalate metabolism:

  • N-acetyl glucosamine supplements can stimulate the production of the intercellular cement, hyaluronic acid, to reduce pain caused by oxalates.
  • Chondroitin sulfate can prevent the formation of calcium oxalate crystals.
  • Vitamin B6 is a cofactor for one of the enzymes that degrade oxalate in the body and has been shown to reduce oxalate production.
  • Excessive fats in the diet may cause elevated oxalates if the fatty acids are poorly absorbed because of bile salt deficiency. If taurine is low, supplementation with taurine may help stimulate bile salt production (taurocholic acid), leading to better fatty acid absorption and diminished oxalate absorption.
  • Probiotics may be very helpful in degrading oxalates in the intestine. Individuals with low amounts of oxalate-degrading bacteria are much more susceptible to kidney stones. Both Lactobacillus acidophilus and Bifidobacterium lactis have enzymes that degrade oxalates. (More on this below)
  • Increase intake of essential omega-3 fatty acids, commonly found in fish oil and cod liver oil, which reduces oxalate problems.
  • Vitamin E, selenium, and arginine have been shown to reduce oxalate damage.
  • Increase water intake to help eliminate oxalates.
  • How Oxalates Can Wreck Your Health
  • How Oxalates Affect Thyroid Health
  • Genetic And Biochemical Basis Of Disease
  • Primary And Secondary Hyperoxaluria: Understanding The Enigma
  • Oxalate homeostasis is maintained through a delicate balance between endogenous sources, exogenous supply, and excretion from the body. Novel studies have shed light on the essential roles of metabolic pathways, the microbiome, epithelial oxalate transporters, and adequate oxalate excretion to maintain oxalate homeostasis. In patients with primary or secondary hyperoxaluria, nephrolithiasis, acute or chronic oxalate nephropathy, or chronic kidney disease, irrespective of etiology, one or more of these elements are disrupted. The consequent impairment in oxalate homeostasis can trigger localized and systemic inflammation, progressive kidney disease, and cardiovascular complications, including sudden cardiac death.

 

What Testing Will Help Me Diagnose Oxalate Metabolism Issues?

You will want to run an Organics Acids Test to see your levels of oxalate, glyceric, glycolic, and B6 levels. This test measures so much more and is a must for the proper diagnosis of a variety of issues. You will also want to run Genova’s GI Effects Comprehensive Stool Profile to measure your levels of the oxalate-degrading gut bacteria, Oxalobacter formigenes, as well as other supportive intestinal bacteria. I have run hundreds of these tests over the last 34 years. If you need help with oxalates and ordering the above tests, please call me at 714-639-4360

 

What Increases Your Risk of Oxalate Overload?

You have to be sensitive to them because of your genetics, gut bacteria (dysbiosis, or missing the microbes that process them), or nutritional deficiencies, like vitamin B6, magnesium, and thiamine. More information.

 

What Foods Have The Highest Oxalate Content Per Serving (around 50mg/serving or higher) Include:

  • Dark leafy greens: spinach, kale, chard
  • Root vegetables: white/sweet potatoes, parsnips, beets, rutabaga
  • Other vegetables: carrots, celery, green peppers, Brussels sprouts
  • Fruit: oranges, avocados, kiwis, tomatoes, raspberries
  • Dried fruit: figs, dates
  • Nuts/seeds: almonds, walnuts, cashews, pumpkin, tahini
  • Grains: brown rice, buckwheat, wheat
  • Beverages: carrot juice, tomato juice, rice milk
  • Soy products
  • Legumes: navy beans, fava beans, lentils, refried beans, red kidney beans
  • Other: cocoa powder, stevia

 

Foods With Low Oxalate Levels (less than 50 mg/serving) Include:

  • Meats
  • Dairy: all dairy products (although dairy is not recommended for those with Hashimoto’s)
  • Fruits: melons, mangoes, grapes, coconut
  • Vegetables: broccoli, cauliflower, cabbage, lettuce, mushrooms, onions, red peppers, cucumbers
  • Condiments: mustard, vinegar, mayonnaise
  • Sweeteners: honey, maple syrup
  • Beverages: herbal teas, apple juice, water, cider

As mentioned above, a standard diet takes in about 250 mg of oxalates per day. However, some people may choose to eat a low-oxalate diet to prevent oxalate buildup. Consuming under 100 mg is recommended, but under 50 mg is ideal unless your doctor suggests otherwise (more on that later on in this article!).

To discover the amount of oxalates in specific foods, check out this thorough list by Jill Harris and Fred Coe: Oxalate Content by Food Type.

 

What Animal Proteins Are The Lowest In Oxalates?

  • Beef: Beef is considered to be low in oxalates and is a good source of protein.
  • Pork: Pork is also considered to be low in oxalates and is a good source of protein.
  • Chicken: Chicken is considered to be a low-oxalate protein source and is a staple in many diets.
  • Turkey: Turkey is also considered to be a low-oxalate protein source and can be a good alternative to chicken.
  • Eggs: Eggs are low in oxalates and are a good source of protein.

 

What Are The Top 10 Foods Lowest In Oxalates?

  • Beef
  • Pork
  • Chicken
  • Turkey
  • Eggs
  • Butter
  • Milk
  • Cheese
  • Yogurt
  • Rice

 

Can I Drink Coffee Or Tea If I am Trying To Avoid Oxalates?

Tea and coffee consumption and the risk of urinary stones-a systematic review of the epidemiological data – Conclusion: There is no evidence that moderate consumption of coffee raises the risk for stone formation in healthy individuals, provided the recommended daily fluid intake is maintained. The currently available literature supports, in general, a protective role for tea against stone formation, mainly for green tea. However, the heterogeneity of published data and lack of standardization needs to be addressed before final and clear conclusions can be given to patients and to the public in general.

 

Which Grains Are Considered To Be Low In Oxalates?

  • Rice: Both white and brown rice are considered low in oxalates and can be part of a low-oxalate diet.
  • Corn: Corn, including cornmeal and corn flour, is considered low in oxalates.
  • Oatmeal: Oatmeal is considered to be a low-oxalate grain and can be a good option for breakfast.
  • Quinoa: Quinoa is considered to be a low-oxalate grain and is a good source of protein and fiber.
  • Barley: Barley is considered to be a low-oxalate grain and can be used in a variety of dishes.

 

Are Fermented Foods High In Oxalates?

Fermented foods can contain varying levels of oxalates, and it’s difficult to make a general statement about their oxalate content. Some fermented foods like kefir, yogurt, and sauerkraut have low levels of oxalates, while others like pickles and kimchi may contain moderate to high levels of oxalates.

It’s important to note that the oxalate content of food can vary based on a number of factors, including the type of food, the method of preparation, and the source of the food. If you are concerned about oxalate intake, you should speak with a healthcare professional for personalized recommendations.

 

What Nutrients Are Needed To Support Proper Oxalate Metabolism?

  • Pyridoxine (Vitamin B6) supplementation has been shown to be beneficial in patients with PH1. Pyridoxine is a cofactor for the enzyme AGT, which is defective in PH1. Administration of supraphysiological doses of pyridoxine may stabilize this enzyme and enhance its enzymatic activity. The recommended initial dose of pyridoxine is 5 mg/kg with a maximum dose of 20 mg/kg. Pyridoxine has been demonstrated to be effective in only 30% of the patients, and therapeutic success is noted by an approximately 30% reduction in urine oxalate excretion after three months of pyridoxine supplementation at the maximal dose. Role of Pyridoxine
  • Calcium supplementation: Calcium can bind to oxalate in the gut and prevent it from being absorbed into the bloodstream. Taking calcium supplements with meals can help to reduce the amount of oxalate absorbed by the body. The recommended dosage of calcium supplements may vary depending on the individual’s needs and health status.
  • Probiotics: Probiotics can help to promote the growth of beneficial gut bacteria, which may play a role in oxalate metabolism. Some probiotic strains that have been shown to be effective in reducing oxalate levels include Oxalobacter formigenes (more information below), Lactobacillus acidophilus, and Bifidobacterium lactis.
  • Magnesium supplementation: Magnesium can help to prevent the formation of calcium oxalate crystals, which are the most common type of kidney stone. Magnesium supplements may be helpful for those who are at risk for kidney stones or who have a history of kidney stones.
  • Vitamin C restriction: High doses of vitamin C can increase oxalate levels in the body. Restricting the intake of vitamin C to no more than 1000 mg per day may be helpful for those who are at risk for kidney stones or who have a history of kidney stones.

 

Urinary Alkalinization As A Technique To Lower Oxalate Levels.

Alkalinization of the urine is well known to prevent stone formation as citrate complexes with calcium and thus decreases the amount of calcium oxalate available for precipitation. This same principle can be used in patients with hyperoxaluria. Based on research, potassium citrate has been used at a dose of 0.1-0.15 g/kg body weight. Urinary pH must be maintained between 6.2 and 6.8. In patients with renal failure, potassium salt can be replaced by sodium citrate. Other inhibitors of crystallization are orthophosphate and magnesium, though there is no conclusive evidence that magnesium therapy alone inhibits stone formation.

Skip black tea and instant coffee, both very high in oxalates. I used to drink instant Starbucks decaf coffee all day long and learned it was a significant source of my oxalate overload. Green and herbal tea are lower in oxalates.

Probiotics can help. Oxalobacter formigenes and Lactobacillus species, as mentioned previously, help to degrade oxalates in the gut. Taking these as probiotics may help, but I’m not aware of data showing a benefit at this time.

As mentioned previously, changes in the intestinal microbiome can lead to secondary hyperoxaluria. Gut microbiome imbalances can result in a deficiency in the probiotic bacteria Oxalobacter formigenes, which has an enzyme known as “oxalyl-CoA decarboxylase” that breaks down oxalate. As such, a deficiency in Oxalobacter formigenes has also been connected with oxalate sensitivity. (More on this below)

The use of two specific antibiotics, erythromycin and azithromycin (the popular “Z-pack”), is especially likely to cause a depletion of this bacteria. A 2011 study found that while 59 percent of people in the general population had a measurable level of Oxalobacter formigenes on stool tests, only 18 percent of past azithromycin users and 26 percent of past erythromycin users had this bacteria in their stools. In contrast, about 40 percent of Amoxicillin antibiotic users had the beneficial bacteria on stool tests.

Lastly, fungi (yeast and/or mold) overgrowth anywhere in the body can be a root cause of oxalate buildup, as certain kinds of fungi, such as Candida or Aspergillus, produce oxalates in a process called biomineralization. When there is an overgrowth of yeast or fungus, the excess amounts of oxalates that are emitted can lead to oxalate buildup and contribute to the symptoms mentioned above. In my experience, eliminating these pathogenic growths can eliminate or reduce oxalate issues.

 

Symptoms Of Oxalate Toxicity:

  • Calcium oxalate kidney stones (which comprise about 80% of all kidney stones)
  • Itchy rashes
  • Interstitial cystitis (frequent urination and bladder pain)
  • Poor or slow wound healing
  • Frail skin that bleeds easily (as your connective tissues are being damaged)
  • Joint pain
  • Osteoporosis (as the oxalates are extracting minerals from your bones)
  • Calcium deposits
  • Digestive problems
  • Neurological problems ranging from bad mood and klutziness to tremors
  • Poor sleep
  • Rheumatologically, muscle pains like fibromyalgia
  • Vision problems such as near-sightedness, cataracts, and poor night vision
  • Dental plaque or tartar
  • Leaky gut (A GI-MAP stool test which includes ‘zonulin’ level can help to detect this)

 

Can Oxalate Crystals Affect The Kidney In Other Ways Than From Just Kidney Stone Formation?

Indirectly and directly, yes. Monocytes are key players in the innate immune system. They are important for fighting infections and responding to inflammation. Their ability to carry out their physiological functions depends on optimal mitochondrial function. Mitochondria are critical for regulating intracellular signaling via the formation of reactive oxygen species (ROS). However, excessive levels of ROS can damage the cell, disrupt mitochondrial function, and stimulate a cascade of events leading to further ROS generation and inflammation. Crystals and oxalate have been reported to generate ROS in renal cells. In addition, it has been reported that human macrophages exposed to calcium oxalate (CaOx) crystals release inflammatory chemicals called cytokines and chemokines. Thus, monocytes recruited to sites of inflammation and injury within the kidney may have compromised mitochondria due to the pro-inflammatory and pro-oxidative environment.

Patients with CaOx kidney stones have decreased mitochondrial function in their circulating monocytes compared to healthy subjects. This phenomenon stressed the mitochondrial antioxidant system, negatively affecting the levels of two important antioxidants: superoxide dismutase and glutathione. More on this topic here – Oxalate induces mitochondrial dysfunction and disrupts redox homeostasis in a human monocyte-derived cell line.

Oxalates, Monocytes and Mitochondrial Redox State

How Long Can Oxalates Stay In The Human Body?

The length of time that oxalates can stay in the human body varies depending on several factors, including the amount of oxalates consumed, individual differences in metabolism and elimination, and the presence of other medical conditions.

Typically, oxalates are rapidly absorbed from the gut and can be excreted in the urine within a few hours of ingestion. However, in some individuals, a portion of the absorbed oxalates can be stored in tissues, including the kidneys, where they can form insoluble crystals and contribute to the development of kidney stones.

In cases of chronic oxalate overload, such as in primary hyperoxaluria or ethylene glycol poisoning, oxalates can accumulate in tissues over time and cause significant damage. In these cases, treatment may involve reducing the intake of high-oxalate foods, increasing fluid intake, and using medications to help prevent the formation of kidney stones.

 

Can Citrate Help The Body Excrete Oxalates?

Based on a review of the literature, citrate can help the body excrete oxalates. Citrate is a natural organic acid that is found in many fruits and vegetables. It is a chelating agent, meaning that it can bind with minerals in the gut and form soluble complexes that are easily excreted in the urine.

In the case of oxalates, citrate can help to bind with calcium, which is commonly associated with the formation of calcium oxalate crystals and kidney stones. By binding with calcium, citrate can help to reduce the concentration of free oxalates in the urine and reduce the risk of kidney stone formation.

Citrate supplements, such as potassium citrate, are commonly used as a preventive treatment for calcium oxalate kidney stones. Increasing the intake of citrate-rich foods, such as citrus fruits and green leafy vegetables, can also help to increase the excretion of oxalates in the urine and reduce the risk of kidney stone formation.

It is important to note that while citrate can help to reduce the risk of kidney stone formation, it is not a cure for oxalate-related conditions, and other strategies, such as reducing the intake of high-oxalate foods and increasing fluid intake, may also be necessary. Additionally, it is important to consult a healthcare provider before taking citrate supplements, especially if you have any medical conditions or are taking any medications, as high doses of citrate can interfere with the absorption of certain minerals.

 

Can Oxalates Cause Inflammation Of The Prostate Or Prostatitis?

There is limited research on the role of oxalates in the development of prostate inflammation or prostatitis. However, some studies have suggested that elevated levels of oxalates in the body could contribute to the development of prostatitis, although the evidence is inconclusive.

Prostatitis is a condition characterized by inflammation of the prostate gland and can cause a variety of symptoms, including pain, discomfort, and urinary problems. The exact cause of prostatitis is not well understood, but it is thought to involve a combination of factors, including infections, immune system dysfunction, and oxidative stress.

Oxalates are naturally occurring compounds that are found in many foods and can also be produced endogenously in the body. High levels of oxalates in the body can contribute to the formation of oxalate crystals in the kidneys, which can cause kidney stones and renal damage. Oxalates can also be involved in the generation of reactive oxygen species and oxidative stress, which can contribute to cellular damage and inflammation.

Oxalatex_ROS_Prostatitis

Therefore, it is possible that elevated levels of oxalates in the body could contribute to the development of prostatitis, although further research is needed to confirm this. If you have symptoms of prostatitis or are concerned about the effects of oxalates on your health, it is important to consult a healthcare provider for a proper evaluation and treatment.

 

Can Oxalate Build-Up Cause Gastrointestinal Tract Inflammation (IBD or IBS)?

Yes, high levels of oxalates can contribute to gastrointestinal inflammation. Oxalates are naturally occurring compounds that can be found in a variety of foods, and in high doses, they can be toxic to the body.

When oxalates are not properly metabolized or excreted, they can accumulate in the body, leading to a condition known as oxalate toxicity. In some cases, high levels of oxalates can cause irritation and inflammation in the gut, leading to symptoms such as abdominal pain, bloating, and diarrhea.

Additionally, high levels of oxalates can contribute to the formation of oxalate crystals in the gut, which can further exacerbate gastrointestinal inflammation and cause additional symptoms.

It is important to note that not all individuals are equally susceptible to oxalate toxicity, and the severity of symptoms can vary depending on a number of factors, including the individual’s overall health and dietary habits.

If you are experiencing symptoms of gastrointestinal inflammation or believe you may have high levels of oxalates in your body, it is important to consult a healthcare provider for a proper evaluation and treatment. Additionally, making dietary changes to reduce the amount of oxalates in your diet and increasing fluid intake may help to reduce the risk of oxalate toxicity and improve symptoms of gastrointestinal inflammation.

 

Is There A Correlation Between SIBO and Oxalates?

There may be a correlation between Small Intestinal Bacterial Overgrowth (SIBO) and elevated levels of oxalates in the body. Oxalates are naturally occurring compounds that can be found in a variety of foods, and in high doses, they can be toxic to the body.

SIBO is a condition in which bacteria from the large intestine overgrow into the small intestine, leading to symptoms such as bloating, abdominal pain, and diarrhea. In some cases, SIBO can interfere with the normal absorption of nutrients in the gut, leading to the malabsorption of oxalates and other compounds.

Additionally, some research suggests that bacteria in the gut can contribute to the production of oxalates and the formation of oxalate crystals, which can further exacerbate symptoms of SIBO and other gastrointestinal conditions.

It is important to note that the relationship between SIBO and elevated levels of oxalates is complex and poorly understood, and more research is needed to fully understand the mechanisms by which SIBO and oxalate buildup may be related.

If you have been diagnosed with SIBO or are experiencing symptoms of gastrointestinal inflammation, it is important to consult a healthcare provider for a proper evaluation and treatment. Your provider may recommend dietary changes, such as reducing the amount of oxalates in your diet, as well as other interventions to help manage symptoms and improve gut health.

 

Can Oxalates Cause Interstitial Cystitis/Bladder Pain?

Interstitial cystitis (IC) is a chronic condition characterized by bladder pain and urinary frequency, urgency, and often, nocturia. The exact cause of IC is unknown, but oxalates have been suggested as a potential contributing factor. Here’s how they may be involved:

Oxalate crystals can irritate the bladder and urinary tract, causing pain and discomfort.

High levels of oxalates in the urine may damage the bladder lining, leading to inflammation and pain.

Oxalates can also bind to calcium in the urine, forming calcium oxalate crystals, which can cause bladder irritation and pain.

It’s important to note that oxalates are not the sole cause of IC, and there are likely many other factors that contribute to the development of this condition, including genetics, environmental factors, and bladder and immune system function. If you have IC and are interested in exploring the role of oxalates, it’s best to speak with your healthcare provider.

 

What Is The Antidote to Oxalate Overload/Toxicity?

The good news is there is an “antidote” that can be helpful if you’re struggling with oxalate overload or if you just happened to eat a high-oxalate meal. That antidote is citrate. Magnesium citrate, potassium citrate, and especially calcium citrate, when taken with meals, can help support oxalate assimilation. This way, the absorption of any oxalate in the meal will be inhibited.

You definitely need calcium and magnesium with high oxalate meals if oxalates are a problem for you. That said, the bigger issue is this long-term toxicity because high oxalate foods are ubiquitous in our society. Peanut and almond butter are high, wheat bran is high, potatoes are high…

Citrate forms of minerals are especially important for the long term if getting over a chronic, oxalate-associated illness is what you’re after.

The best version for this issue is calcium citrate because calcium promotes the clearing of oxalate. Recommendation: go slow and titrate up. Some people may have a flare-up in symptoms if this is taken in too high of a milligram dose.

Those on a long-term, high-oxalate diet may have low electrolytes and mineral reserves. This can slow down the excretion from the tissues. Minerals in the citrate can help rebuild these reserves and support proper oxalate processing.

 

Does Detoxing Oxalates Take Time?

The take-home message here is that you need to go slow. It’s a marathon, not a sprint. Typically, after two years to two-and-a-half years on a low-oxalate diet, you may suddenly get sicker because your kidneys are finally cleaned up and able to excrete oxalate more efficiently.

You’re then able to tap into deeper deposits. As a result, you may experience things like gastritis, migraines, anxiety attacks, gout, and other kinds of toxic reactions. It can also increase uric acid, as uric acid replaces oxalic acid. In this instance, it’s a sign that you’re clearing oxalate. Other symptoms of oxalate clearing include tartar buildup on your teeth, gritty eyes, gritty stools, hemorrhoids, and burning stools.

 

What Is Systemic Oxalosis?

Systemic oxalosis is a medical condition characterized by the accumulation of oxalate in various tissues and organs in the body. Oxalates are naturally occurring compounds that are found in many foods and are also produced by the body. In normal amounts, oxalates are filtered by the kidneys and eliminated from the body in the urine. However, in systemic oxalosis, there is an overproduction of oxalates or an impaired ability to excrete them, leading to a buildup of oxalate crystals in various tissues. This can lead to a range of symptoms and complications, including kidney stones, joint pain, and skin rashes. The underlying cause of systemic oxalosis can vary, but it can be due to genetic disorders, metabolic disorders, or the excessive consumption of high-oxalate foods. Treatment for systemic oxalosis may include dietary changes, medication, and other measures to reduce the level of oxalates in the body.

 

What Is The Origin of Urinary Oxalates?

Urinary oxalate is mostly derived from the absorption of ingested oxalate and endogenous synthesis. The breakdown of vitamin C may also contribute small amounts to the urinary oxalate pool. The amount of oxalate absorbed is influenced by the oxalate content of the diet, the concentrations of divalent cations (see below) in the gut, the presence of oxalate-degrading organisms, transport characteristics of the intestinal epithelium, and other factors associated with the intestinal environment. Knowledge of pathways associated with endogenous oxalate synthesis is limited. Urinary oxalate excretion can be modified using strategies that limit dietary oxalate absorption and the ingestion of oxalogenic substrates such as hydroxyproline, as well as collagen protein powder/peptides.

 

What Are Examples Of Divalent Cations?

Divalent cations are metal ions that have a positive charge of +2. Some examples of divalent cations include:

  • Calcium (Ca^2+)
  • Magnesium (Mg^2+)
  • Manganese (Mn^2+)
  • Zinc (Zn^2+)
  • Copper (Cu^2+)
  • Iron (Fe^2+)

These cations play important roles in various biological processes, such as the regulation of blood pressure, nerve signaling, muscle contraction, and bone formation. They can also participate in the formation of mineral deposits in the body and contribute to the development of various diseases, such as osteoporosis, cardiovascular disease, and neurodegenerative disorders.

 

What Is An Oxalogenic Substrate/Precursor?

An oxalogenic substrate refers to a substance that is capable of producing oxalate. Oxalate is a naturally occurring organic acid that can be found in various foods, as well as produced endogenously (within the body) through the metabolism of certain nutrients. An oxalogenic substrate can be a food or a substance that, when metabolized, generates oxalate as a by-product.

Examples of oxalogenic substrates include:

  • Certain amino acids (such as glycolate). More on this below.
  • Vitamins (such as ascorbic acid)
  • Minerals (such as calcium)
  • Foods such as spinach, rhubarb, and beets are also high in oxalate.

The production of oxalate from an oxalogenic substrate can contribute to developing oxalate-related health conditions such as kidney stones, arthritis, and hyperoxaluria.

 

What Amino Acids Are Oxalogenic Substrates/Precursors?

Several amino acids have been identified as oxalogenic substrates, especially if the person is Vitamin B6 deficient. Meaning they can produce oxalate through their own metabolism. These include:

  • Glycine
  • Hydroxyproline 
  • Serine
  • Glycolate 

Additionally, urinary oxalate is derived from both exogenous and endogenous sources that, depending on the dietary intake, may equally contribute to urinary oxalate excretion. There is new evidence that dietary oxalate may contribute to up to 50–80% of the oxalate excreted in the urine. Exogenous sources of oxalate are vegetables, fruits, and tea. Foods with a high oxalate content are spinach, rhubarb, tea, spinach, and soya beans. Endogenous sources of oxalate are mainly synthesized by erythrocytes and the liver. The endogenous sources of oxalate include ascorbic acid, protein (through the metabolism of the amino acids tyrosine, tryptophan, phenylalanine, and hydroxyproline), and the immediate precursors of oxalate, such as L-glycerate glycollate and glyoxylate. The Handling of Oxalate in the Body and the Origin of Oxalate in Calcium Oxalate Stones

 

What Foods Have The Highest Glycine/Hydroxyproline/Gycolate Content?

Glycine is an amino acid that is found in a variety of foods. Of all the foods containing glycine Collagen and bone broth, which are the foods that really should be avoided if oxalate overload or poor oxalate metabolism is an issue:

  • Gelatin or collagen: Gelatin is a protein derived from collagen and is particularly high in glycine. It is commonly used as a thickening agent in foods like jellies and gummies.
  • Skin and bones of animal products: The skin and bones of animal products such as pork skin, chicken skin, and fish bones are also rich in glycine.

 

Can A High Salt Diet Contribute To Calcium Oxalate Kidney Stone Formation?

Yes, high salt intake has been considered one of the main nutritional imbalances favoring calcium stone formation, especially through an increase in urinary calcium excretion and a decrease in urinary excretion of lithogenesis inhibitors, such as citrate []. Dietary salt restriction is significantly associated with a reduction of urinary calcium excretion and the prevention of recurrences in idiopathic calcium stone formers [, ].

 

Can Low Pancreatic Enzyme Production Inhibit Or Influence Oxalate Metabolism, Lead To Oxalate Overload?

Yes, low pancreatic enzyme production can lead to a decreased ability to metabolize oxalate, which can contribute to oxalate overload and the development of kidney stones.

The pancreas produces enzymes in the small intestine that help to digest food, including enzymes such as pancreatic amylase, lipase, and protease. These enzymes are important for the breakdown and absorption of nutrients from food, including oxalate. If the pancreas is not producing enough enzymes, this can lead to the malabsorption of nutrients, including oxalate.

When oxalate is not properly absorbed and metabolized in the gut, it can accumulate and form kidney stones. The increased levels of urinary oxalate that result from low pancreatic enzyme production can increase the risk of calcium oxalate stone formation.

 

Do Oxalobacter formigenes Help To Metabolize Oxalates?

The most commonly described intestinal bacteria known to degrade oxalate are categorized into two groups: (I) the “generalist oxalotrophs,” including some strains of Bifidobacterium and Lactobacillus, that degrade alternative carbon sources in addition to oxalate, and (II) the “specialist oxalotrophs,” such as Oxalobacter formigenes, which is a commensal anaerobe that uses only oxalate as its sole carbon source.

Definition: Oxalotrophs are microorganisms that have the ability to metabolize or utilize oxalate as a carbon and energy source. Oxalate is a dicarboxylic acid that is found in many plants and is also produced by the human body. Oxalotrophs are important in many biological processes, including the biogeochemical cycling of carbon, nitrogen, and other elements in the environment. Some examples of oxalotrophic microorganisms include certain bacteria, fungi, and algae. These microorganisms play an important role in the carbon cycle as they break down oxalate, which is a component of many organic compounds, and convert it into carbon dioxide and other forms that can be used by other organisms.

So yes, Oxalobacter formigenes is a bacterium that has been shown to play an important role in the metabolism of oxalates in the human gut. Studies have shown that individuals with higher levels of Oxalobacter formigenes in their gut have a lower risk of developing kidney stones.

It is important to note that not everyone has high levels of Oxalobacter formigenes in their gut, and certain factors, such as antibiotics and a low-fiber diet, can reduce the levels of this bacterium. In addition, while Oxalobacter formigenes may help to metabolize oxalates, they are not guaranteed protection against kidney stone formation, and other factors such as fluid intake and diet also play a role in kidney stone prevention.

Additional data:

Oxalobacter formigenes is present at a much lower prevalence in the USA population compared to remote indigenous groups, consistent with the hypothesis that Oformigenes is a part of the ancestral human gut microbiota and that it may be disappearing in the context of socioeconomic advances and medical treatments, potentially contributing to the rise in nephrolithiasis (kidney stones).

Several intestinal bacteria have been reported to degrade oxalate, and these include Eubacterium lentum), Enterococcus faecalis, lactic acid bacteria Lactobacillus sp., Streptococcus thermophilus, Bifidobacterium infantis, and Oxalobacter sp. More recently, a novel oxalate-degrading member of the Enterobacteriaceae (Providentia rettgeri) was identified in human fecal samples and, notably, this organism was also reported to have enzymes similar to those of Oxalobacter formigenes.

 

Are There Ways To Increase Levels Of Oxalobacter formigenes?

Yes, there are several ways to help increase levels of Oxalobacter formigenes in the gut:

Increase intake of soluble fiber: Oxalobacter formigenes thrives on soluble fiber, which is found in foods such as beans, lentils, oats, apples, pears, and citrus fruits. Consuming more of these foods can help to promote the growth of this bacterium.

Consume probiotics: Certain probiotics, such as Lactobacillus acidophilus, Bifidobacterium bifidum, and lactis, have been shown to promote the growth of Oxalobacter formigenes in the gut. These probiotics can be found in fermented foods such as yogurt, kefir, and sauerkraut or in supplement form.

Avoid unnecessary antibiotic use: Antibiotics can disrupt the balance of bacteria in the gut, including Oxalobacter formigenes. It is important only to take antibiotics when necessary and to talk to your doctor about alternatives or strategies to protect your gut microbiome.

Limit intake of high-oxalate foods: While it is important to consume a balanced and varied diet, limiting the intake of high-oxalate foods (such as spinach, rhubarb, beets, and chocolate) can help to reduce the burden of oxalate on the gut microbiome and potentially promote the growth of Oxalobacter formigenes.

It is important to note that increasing levels of Oxalobacter formigenes may not be possible for everyone, and kidney stone prevention requires a multifactorial approach that includes adequate hydration, a balanced diet, and other lifestyle factors. Consulting with a healthcare professional can help you develop a personalized plan for reducing the risk of kidney stones.

 

Can Intestinal Yeast Overgrowth Contribute To Altered Oxalate Metabolism?

Intestinal yeast overgrowth (or dysbiosis) is not a well-established factor in altered oxalate metabolism, and the current scientific evidence on the topic is limited and mixed. Some studies have suggested a potential link between intestinal yeast overgrowth and increased levels of urinary oxalate, while others have found no significant association.

Yeast overgrowth in the gut can potentially disrupt the normal gut microbiota, leading to changes in intestinal oxalate metabolism. Yeast produces oxalate as a byproduct of their metabolism, and their overgrowth in the gut could potentially contribute to increased oxalate production and absorption, leading to higher levels of urinary oxalate.

However, other factors such as diet, gut microbiome composition, and genetic predisposition are known to play a significant role in oxalate metabolism and the development of kidney stones.

 

Can The Gut Bacteria Akkermansia muciniphila Influence Oxalate Metabolism?

There is currently limited research on the specific role of Akkermansia muciniphila in oxalate metabolism. However, recent studies have suggested that Akkermansia muciniphila may play a role in the regulation of intestinal oxalate transporters and the gut microbiome’s response to dietary oxalate.

A study published in the journal Gut in 2020 found that mice supplemented with Akkermansia muciniphila had increased expression of oxalate transporters in the intestine and reduced oxalate excretion in the urine, indicating a potential role of Akkermansia muciniphila in the regulation of oxalate metabolism.

Another study published in the Journal of Urology in 2021 found that supplementing rats with Akkermansia muciniphila reduced the formation of calcium oxalate crystals in the urine, potentially indicating a role of Akkermansia muciniphila in the prevention of kidney stones, which are often composed of calcium oxalate crystals.

“Akkermansia muciniphila metabolizes and reduces the abundance of oxalate in the mammalian gut,” published in the journal Nature Communications in 2020 S. Kang, Z. Ou, Q. Wang, Y. Xie, M. Zhang, Q. Jin, Z. Wang, H. Wei, S. Wang, S. Lu, J. Li, H. Ru, Z. Fan, C. Wang, Y. Lv, and H. Zhang.