By Dr. Leah Hollon, ND, MPH

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August 18, 2017

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Oxalates have gradually gained more attention in health news recently and the practitioners at Richmond Natural Medicine have been working with and researching them extensively for patient care.

A Low Oxalate Diet is one that reduces foods that are high in oxalates. Oxalates are a chemical compound naturally found in many foods including some “healthy” foods that people feel inclined to eat a lot of, but may not feel well afterwards and not know why. Although it may be your impulse reaction to do so, eliminating oxalates completely is nearly impossible and not entirely necessary. Additionally, the symptoms can be inconsistent, where people may feel fine one day and then off the next day. Thus it can be challenging to nail down what is happening.  

Oxalates are a commonly occurring chemical compound in foods that bind to other minerals (including calcium and magnesium), prohibiting you from absorbing them completely. Oxalates can also impact your ability to digest and process fats. This is because chemically, oxalates have rough or jagged edges, functionally making them more irritating to digest. Certain amounts of oxalates may have drastically different effects on one person than another. A treatment strategy should be individualized and will likely shift gradually. We need to look at not only dietary solutions, but lifestyle factors, epigenetics, stress, age, and the degree of illness. In fact, we see that genetics play a large role, as does past trauma. Therefore, we may need to enhance how certain receptors and enzymes work in the body. All of these individual factors play an important role in how successful and sustainable a long term health solution will be. Thus the plan must be individualized and monitored over time.  

Healing Strategy: Whole Body, Liver & Gallbladder Support

We want to look at how the liver and gallbladder are processing these oxalate containing foods – specifically how the sulfation pathway in the liver is working and how it can use support. The liver goes through two phases of detoxification (phase I and phase II). Sulfation is a process that happens during phase II. The sulfation pathway is responsible for not only processing and eliminating oxalates from the diet, but also catecholamines, hormones, aspirin, aspartame, salicylates, phenolic drugs, and alcohol. Looking at the bigger picture, folks that have a hard time processing foods high in oxalates also have difficulty processing the above-mentioned drugs, foods and food additives, and hormones. People may also present with other symptoms associated with impaired sulfation including IBS, candida, leaky gut, elevated cholesterol, migraines, and rheumatoid arthritis, to name a few. Sulfation specifically metabolizes phenols, a.k.a. oxalates, (drug examples include morphine, acetaminophen, and salicylates), alcohols (examples include benzyl alcohols, ethanol, and insecticides found on fruits and vegetables)  and amines (examples include catecholamines, histamines, and hormones). Phenols, alcohols, and amines are sometimes included in otherwise “healthy” foods like kale, beets and beet greens, spinach, tomatoes, almonds, blueberries, dark chocolate, and sweet potatoes. You do not need to completely eliminate these foods altogether, but start noticing patterns of symptoms when you eat certain foods, take certain drugs, or notice a disruption in hormonal patterns. This may all point to sulfation issues. Getting better is often dependent upon decreasing the load on the system and enhancing normal biochemistry. The more of these compounds that have accumulated, the more support is often needed. Think of oxalate overload as similar to having a sieve that becomes completely full. When you then attempt to pour more water through it, it overflows. This gives you a sense that when the body is overloaded it becomes difficult to function properly. The goal is to get the oxalates out of the sieve so that the normal flow of the body can take place.

However, sulfation is not just about phase II detox. It also allows for the building and rebuilding of the body. In fact, the act of sulfation includes adding a sulfur group to many different biochemical processes and putting sulfur into tissues to make them strong and healthy. Sulfation allows us to build strong ligaments, tendons, gut lining, hair, skin, nails, and also protects the brain. Nearly every tissue of the body has sulfur as the main ingredient and thus sulfation is key to a healthy and strong body.  

However, it is important to understand that adding sulfur groups into the body is not always easy. There are competing factors as discussed above which include genetics, stress, trauma, and the amount of oxalates that we eat. Additionally, sulfur and oxalates specifically compete with one another. Moreover, if we have too much stress and are eating high oxalate foods we can see a decrease in the ability for the body to sulfate to make healthy tissues. If you add in a possible genetic predisposition or a trauma, then you can really see effects of various and complex symptoms. Some people may not just have issues with breaking down oxalates, they could also have issues with breaking down chemicals known as salicylates and histamines. If this is the case, then a more compressive plan will be necessary to enhance phase II detox support to the entire system. This type of support is often recommended for those individuals with multiple chemical sensitivities and those that do not tolerate pharmaceutical drugs well.

Symptoms or Disease States that Correlate to Impaired Sulfation (High Oxalate Overload):

Fibromyalgia Cracking and popping of joints Autism/ASD

IBS Chronic fatigue Autoimmune diseases

Migraines Urinary frequency, burning Frequent infections

Poor sleep Vaginal pain or burning Chemical sensitivities

Diverticulitis Abnormal hormonal levels Depression/Anxiety

Kidney stones Diabetes or glucose issues Slow healing

Rashes Elevated cholesterol Leaky gut

Diet:

When addressing oxalates we must use diet as one therapy tool. Therefore, we try to limit oxalates in the diet to no more than 50mg daily. This is not meant for you to meticulously measure out every little thing you eat, but rather to familiarize yourself with high oxalate foods and limit consumption while increasing foods that are nutrient rich, liver and gall bladder supportive, non-GMO, and as seasonal as possible. Some foods to increase in your diet are the brassicas, including broccoli, brussel sprouts, cauliflower, and cabbage – all of which support the sulfation process. Generally this is a process and reducing high oxalate foods over time is more beneficial than cutting them out cold turkey. Sometimes a more conservative oxalate restriction is recommended up front to try to get as much support early on. It is important to keep in mind that everyone is different and your level of reactivity is very individual. This is when working with a nutritionist is helpful, as we can tailor your diet and monitor your reactions over time. The ultimate goal will be to limit certain foods for a period, support liver and gallbladder function, increase nutrient rich foods, and enhance absorption of nutrients while slowly expanding your diet rather than continually limiting or restricting the foods you can eat. Here is a fairly comprehensive list of low, medium, and high oxalate foods.

Supplementation, Liver and Gall Bladder Support & Lifestyle

Specific supplementation may be helpful in order to support the sulfation pathway in the liver and gall bladder while reducing oxalate foods in the diet. Helpful inputs may include calcium/magnesium, NAC, P-5-P and/or sulfur supplementation. Dosages should be recommended by your doctor or nutritionist and can be case-by-case dependent. Also, the timing of these supplements in relation to mealtimes can be very important. Getting adequate amounts of sunshine and vitamin D is helpful and reducing and avoiding stress and toxic environments as much as possible is also highly recommended. Increasing your water intake to half your body weight in ounces is encouraged. Keeping a food and symptoms journal is extremely helpful for a nutritionist to review.

If you suspect you may have issues with oxalates, liver, gall bladder, or digestive dysfunction, contact our office and consider working with a naturopathic doctor to create a custom care plan that addresses your unique symptomology.

Additional Reading:

Oxalates & MTHFR: Understanding the Gut-Kidney Axis

Oxalates: Their Influence on Chronic Disease

The Downside to High Oxalates

About the Author:

Richmond Native and Naturopathic Dr. Leah Hollon is the Co-Owner of Richmond Natural Medicine. She received her B.S. and MPH from Virginia Commonwealth University. She is a graduate of the National College of Natural Medicine where she received her Naturopathic Medical Degree. Her areas of focus include Autoimmune, Hormones, MTHFR Gene Mutation and Naturopathic Cancer Support. Please check our Book An Appointment for more information about booking an appointment.