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...

Coconut-banana Bread Muffins

We are mostly egg-free for the moment, but every now and again, I will treat us to an eggy dessert. We actually seem to do okay if we only have them in baked goods. I'm still trying to ferret out the particulars. I think after being on the LOD for awhile, the sulfur issues will get better and eggs will become 100% okay. That's my big hope anyway.

Yesterday, I made these muffins and they were a big hit, and surprisingly low in oxalates: roughly 1.5mg per muffin.

Coconut-Banana Bread Muffins

1C coconut flour
1 tsp baking powder*
1/2 tsp sea salt
1/4 tsp nutmeg
6 eggs
2 ripe, mashed bananas
1/4 C coconut oil (melted)
1 tbsp vanilla**
2 Tbsp coconut milk***
2 Tbsp maple syrup or honey

Preheat oven to 350*F.

1. In a small bowl, mix coconut flour, baking powder, sea salt & nutmeg.

2. In a large bowl (or in the stand mixer), beat 6 eggs. Add coconut milk, coconut oil, vanilla and sweetener. Mix well.

3. Gradually add coconut flour mixture. Then bananas.

4. Scoop into paper-lined or greased muffin tins. Bake at 350*F for roughly 20 minutes. Watch though, because these have a tendency to over brown on the bottom.

Yield: 12 large muffins

* You can make your own if you can't find a safe store-bought version: 1 pt baking soda to 2pts each cream of tartar and tapioca or arrowroot starch. You could also just use 1 tsp of baking soda and then add 2tsps of vinegar to the wet ingredients.

** We make our own by putting vanilla beans in a bottle half filled with alcohol (white rum or vodka usually) and the rest water. Allow it to "cure" for several weeks to fully develop the vanilla flavor.

*** Or really, any liquid would work here: water, juice, whatever.

Pumpkin Seed Butter Recipe

On many of the various elimination diets we've tried, most nuts and seeds are out, except for pumpkin seeds. We've adapted - and perfected, if I don't say so myself - the pumpkin seed version of the Crispy Nut Butter recipe from Sally Fallon's Nourishing Traditions.

2 C raw pumpkin seeds (hulled)
1/2 to 3/4C coconut oil or palm shortening, melted -- depends on which oil you use and how finely ground your seeds are
1/4 tsp sea salt
1 Tbsp maple syrup (more or less, to taste)

1. Put seeds in a bowl, cover with water, add roughly 1 tbsp of sea salt. Let soak overnight.

2. Drain & rinse seeds.

3. Spread onto two baking sheets, sprinkle a bit of salt over each pan. Bake at 200/250*F for several hours, until crispy (higher heat cooks faster, of course, but lower heat dries & crisps w/o burning better).

4. Put seeds & salt in food processor and buzz until seeds are a fine powder.

5. Drizzle in maple syrup & melted coconut oil as food processor is running.

6. Transfer to glass jar. The mixture will be thick, but sort of liquidy, but it will harden once stored in the fridge.

If you try this, let me know if it worked for you, or any substitutions you made.

I often make a double-batch, since I've found that roughly a pound of pumpkin seeds yields 4C soaked, drained & toasted seeds.

Yo yo

I am working on a lengthy post to explain where we're at with the food/rash/general health issue. The short version is that Lily tested positive for H. pylori in her stool as well as a host of malabsorption issues. They kind of exist on a continuum and she runs the gamut. The good news is that everything seems to be related i.e. what on the surface looks overwhelming and depressing is really just one big issue manifest in many ways. The bad news is the doctor we'd been working with, albeit briefly, was not very experienced and has a less than stellar bedside manner. We have an appointment with our family doctor to go over the test results, so I'm hopeful that we will be back on track shortly.

One of the manifestations of essentially her systemic digestive failure is an intolerance to oxalates. Oxalates are naturally occurring food chemicals that most people naturally break down and excrete. Some people, especially those with compromised digestive systems, cannot easily break them down and the accumulate in the body causing kidney stones, rashes, headaches, mood issues, and of course, digestive upset. We are currently on a Low Oxalate Diet (LOD) to help her body flush out or "dump" the accumulated oxalates.

We were trying to start treating the H. pylori and naturally, at that. The mainstream protocol is to give three or four antibiotics plus antacids for two weeks. The consensus is that it is a very harsh treatment, plus we don't need to add antibiotic therapy to an already fragile gut. It is important to us to treat the H. pylori because it can lead to many dangerous health complications - ulcers, low stomach acid, low B12, cancer. Some research I've been doing suggests that if we can get rid of the H. pylori, the rest of her digestive tract will start to heal.

So, we were looking at other things such as sulfurous veggies, thyme tea and mastic gum. The sulfur seemed a bust, because we couldn't tolerate raw garlic in mass quantities on everything. The thyme tea Lily just won't drink, plus at that concentration, I'm not sure of the oxalate levels. The mastic gum turns out to come from a shrub in the cashew/pistachio family, a family to which I am particularly sensitive, and a family that happens to be super high in oxalates. We had given Lily & I this supplement for four days. So I basically just bombed my child with extremely high oxalates for four days. She is a cranky, yelling, whiny mess and her rash is super flared, open & itchy.

Oh, and when she's got too much oxalates she is HUNGRY constantly and bottomlessly.

My point? She woke up yelling at 7:30 and has been a Crabby McCrabster for the last 3.5 hours solid. And I'm about to lose my ever-loving mind. I can only deal with so much whining and yelling (and threatening) without pause. Mama needed to vent.

Doctor Drama.

Our naturopathic doctor just accused me of "attempting to play doctor and not allowing the real doctor to do his job." He's basically pissed that I pulled all the supplements but CLO and am waiting for Lily to clear again (she totally was before the supplements) and going to intro them one at a time. I also had asked him about mastic gum for treating H. pylori. He said that he hadn't had good success with it. We wanted to try it anyway. In this regard, I am playing doctor.

He also maintains that the fiber supplement with oat seed contains "absolutely no gluten" despite the fact that it states nowhere on the bottle that it's gluten free. I just re-re-re-read the bottle and just now noticed that it says it's processed on equipment that get contact with soy. (I initially questioned the need for a fiber supplement since she goes fine once a day, fine both in form & amount. He said it would help with the gut disbyosis...) Am I being crazy? Would you give your child this product?

Dave was really upset.

The bottom line is as I wrote at the end of my email to the ND:

"I do appreciate the work you've put into our case thus far. I feel
like after years of observation, trial & error, and lots and lots of
reading, we'd arrived at the same conclusions that you had come to
with your blood & stool testing. I am thankful to have that
confirmation. Your suggestions for treatment - B12/folate, betaine,
glutamine, enzymes, s. boulardii - were all on my radar and were a
part of my repertoire of supplements. I needed that confirmation that
what I was doing was on the right track and that I wasn't just
throwing money out the window. I am also very thankful that we
discovered the H. pylori when she is so young."

I think at this point, however, we need to seek additional opinions
and treatment options."

Chore Day!

We canceled our plans today, when I was still wrapped in a towel five minutes after we were supposed to leave. The kids are eating up the sunshine and acting out elaborate scenarios all over the house.

Finally, I have time to cross some chores off my huge list. I'm going to focus on laundry & the bathroom, to keep expectations realistic. That's all I can cram in before lunch anyway.

Incidentally, lunch: scallops sauteed in olive oil with green onions & lemon juice, avocado, lettuce & peeled cucumber slices.

After lunch, we're going to work on labeling things around the house with words in both english and swedish. We'll probably make a poster with numbers, colors, days & months, too. Scheming...

It's time.

I'm declaring this blog officially open. Watch this space for update. Just, um, later. Because it's crazy sunny out and we need to go soak up some proto-spring rays.