Friday, March 12, 2010

The (not so great) oxalate debate - part 1

Do excessive oxalates deplete calcium or does excess calcium induce oxalate production?

I've been doing a lot of reading about oxalates. There seem to be two major, conflicting theories about where oxalates come from and how best to treat them. In an effort to get everything straight in my head, I'm going to break it down as I understand it. (Feedback welcome & encouraged!)

Today, I'm exploring the ideas behind the Low Oxalate Diet (LOD).

The underlying assumption here is that a leaky gut and lack of proper intestinal flora lead to an inability to process oxalates, dietary or otherwise. Dietary oxalates are not the only source of oxalates in the body (just the easiest to directly affect). Other sources of oxalates include: excess production of oxalates by our own cells due to vitamin deficiency, genetic defect, or exposure to chemical or environmental precursors to oxalates (essentially things that you body will metabolism into oxalates). The intestines secrete oxalic acid from the rest of the body into the GI tract as it is supposed to be an efficient way for the body to rid itself of excessive oxalates. There they can bind with dietary calcium and once bound up, the Calcium Oxalate crystals are excreted normally through the stool.

However, when the oxalates bind to calcium in the gut, they reduce the amount of calcium available in the gut to "zip up" the junctions between cells on the intestinal wall. [See this paper on the Mechanisms Behind the Leaky Gut for more in depth information on the relationship between leaky gut, oxalates, calcium, celiac, and fat maldigestion.] Calcium oxalate crystals lodged in soft tissue have been attributed to kidney stones, rashes, eczema, diarrhea, food allergies & intolerances, vulvodynia, sleep & mood disturbances, migraines, behavioral issues, including autistic spectrum symptoms.

By decreasing dietary oxalates, increasing calcium supplementation (to bind up remaining oxalates in the gut), and introducing proper gut flora, the above symptoms are reportedly relieved. A person might stay on a LOD for months or years until symptoms are at bay. Each person's tolerance for amount of dietary oxalates is unique and frequently can change.

There are also periods of "dumping" where after a period of relief, a person's old symptoms might temporarily recur. This is seen as a purging of bodily oxalates and is regarded as a necessary, though frustrating, part of healing. There is no way to predict when or how severe a dumping period might last, though epsom salt baths and supplementation with B6 seams to ease symptoms.

The assertion is a long-term LOD, combined with calcium supplementation & probiotics will eventually fix the leaky gut and restore balance to gut flora, after which a person would be able to again tolerate dietary oxalates without recurrence of previous issues. Some people seem to think that LOD is a lifestyle commitment to help ease symptoms - i.e. they don't believe that you can cure an oxalate intolerance.

There doesn't appear to be much consideration to the underlying cause of oxalate intolerance. At first glance, it appears that it is attributed to a leaky gut & improper gut flora, both of which are supposed to heal on a LOD. However, there is little discussion as to why the gut is leaky and the flora imbalanced. If they are the causes of oxalate intolerance, what is the cause of them? Avoiding oxalates appears to help, but what happens if you start eating oxalates again? Does the gut again become more permeable and the flora out of whack? It seems like a circular definition of the problem.

Here are some more resources to learn more about a LOD:

  • Trying_Low_Oxalates Yahoo group

  • Low Oxalate Diet page

  • Vulvar Pain Foundation

  • Stayed tuned for post two, where I explore my understanding of oxalate issues resulting from calcium disregulation, due to Vit K deficiency...


    1. Also, I recently compared the LOD to the FAILSAFE diet. It seems like a good elimination diet and as such, a good tool to see if you are affected by various food chemicals, but beyond that, it is just skimming the surface. Theoretically, you could stay low oxalate forever, but if you didn't have to to experience relief of symptoms, why would you? I want to know *why* are those naturally occurring food chemicals acting as poison. Are they not being detoxed properly? Again: why? Are we deficient in various vitamins or minerals? Are we affected by heavy metal toxicity? Is there an underlying cause that can be addressed which will allow our bodies to then process these food chemicals appropriately? My gut (no pun intended) says yes.

    2. I think you're exactly right about LOD being like FAILSAFE. DS used to react very strongly to salicylates, and most of the sals forums are full of people who have basically given up on ever eating fruit (and anything else not low sals) again. That seemed harsh for a two year old! It's just symptom management. So we looked at the nutrient deficiencies and omega 3:6 imbalances that seem to impact sals sensitivity, and by addressing those (and the metals toxicity that was behind his mag issues), DS can consume a lot more sals. And, I feel like it was important to do that - sals sensitivity might have been the most obvious symptom of low mag, for example, but low mag affects us in lots of other ways too. Same with metals toxicity. Sometimes I think these issues have a genetic basis, and you can't always address that - but sometimes they're just a sign to guide us to root problems we need to address.


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