I've Been Poisoned: The Health Edition Part 2 - Issue #44
What are oxalates?
"Oxalate" is a broad term for oxalic acid and oxalate crystals. They are most commonly found in plants, but our livers produce a small amount of them as a normal byproduct of metabolism. In plants, like spinach, the oxalic acid tightly binds to minerals like calcium and iron to form oxalate crystals. Once bound, our bodies cannot absorb these minerals, and worse, the crystals are highly abrasive and can mechanically and microscopically shred whatever tissues they come into contact with. Likewise, oxalic acid in plants like spinach, likes to bind to the same kinds of important minerals in our guts. From there, they are excreted in the feces or via the urine if they have escaped the gut barrier and reached the bloodstream. (You can already begin to see a bit of a problem, here. If you have a diet high in oxalates, you can experience severe mineral deficiencies over time.) The rest of the oxalates you consume but do not excrete will be stowed away in various tissues all over the body to cause manifold problems later.
What foods contain oxalates?
They are in every plant to one degree or another, so it's impossible to avoid them completely unless you go strict carnivore. (Which I do not recommend. More on that later.) But the foods with the highest and most toxic levels of oxalate which modern humans consume the most are:
spinach
almonds
cacao (dark chocolate, etc...)
beets and their greens
swish chard
potatoes
sweet potatoes
rhubarb
turmeric
These are merely the heavy hitters. But you will notice that several foods on that list are heavily promoted by the popular diets right now: paleo, keto, and vegan. The SAD (standard American diet) doesn't get a free pass though with the potato chips and French fries with almost every meal.
How much oxalate is too much?
For a healthy individual, somewhere between 120-150mg. There are certain bacterias in the gut which eat oxalate for lunch. But they can get killed a few ways like antibiotics and, ironically enough, being fed too many oxalates. For this reason, I question the notion that there are many "healthy" people out there who can handle that many oxalates without damage. Folks with severe health issues frequently don't tolerate even that much. The heavy hitters above pretty much demolish the "healthy person's" oxalate allotment for several days. For instance, in one half cup of baby spinach there are 150mg of oxalate. In 1/4c up of almond flour (paleo, keto recipes abound in almond flour) there are 140mg. In one ounce of dark chocolate, there are 120mg. 1 tsp of turmeric contains 50mg of oxalate. Golden milk, anyone? Don't feel bad. I used to make it for myself almost every day. If you're eating all four of those in a day in such small amounts (and let's get real, no one eats these items in small amounts) you're STILL consuming 460mg every day.
But think about it: If you've been on keto for any length of time, you've been eating fathead dough (made with almond flour), chaffles, almond flour cookies with dark chocolate chips, and a big salad with a bunch of spinach in it every day. Paleo: almond flour everything, dark chocolate, all the sweet potatoes and all the beets and all the swiss chard. Vegan: you're downing raw green smoothies every morning with half a cup or more of spinach, you're not eating meat or dairy so you're resorting to legumes for your protein needs (almost all the legumes contain lots of oxalates, just not as many as the heavy hitters), you have no dairy in your diet and are eating spinach like crazy for its calcium content...except that the calcium is bound to oxalic acid and you can't absorb it anyway. Sigh.
What symptoms do oxalate poisoning cause?
Bladder pain and irritation (interstitial cystitis)
Joint pain and swelling where rheumatoid arthritis has been ruled out
Leaky gut
Kidney pain, with or without kidney stones
Vulvodynia (vulvar pain, vaginal pain, painful intercourse; crystals lodge in the tissues on their way out of the bladder through the urine)
Nerve pain
Acid reflux (oxalate crystals lodge in the LES as they are consumed and cause dysfunction, allowing gastric acid to flow up the esophagus)
Chronic UTI (oxalate crystals have been found with E. coli stuck to them)
Heart arrhythmias
Thyroid dysfunction
etc... The list is staggeringly long. I will include links to many informative videos at the end of this letter.
So stop the heavy hitters and I'll be okay, right?
Well, that's a lovely thought, and it might work for you. Then again, it might not depending on how oxalate-heavy your diet has been and for how long. Because remember, the body stores any oxalate it cannot excrete. And it's likely that if you've had a high-oxalate diet for many years, you have lots of oxalate stored up all over the place. So, if you cut out the heavy hitters that you personally consume on a daily basis, you'll probably feel really great for about a week. And then your body will go, "Oh, hey! The poison isn't coming in anymore, so time to take out that trash." This is called oxalate dumping. Oxalates begin to flood your bloodstream and your gut. This can feel anywhere on a continuum from mildly miserable to life-threatening. People have ended up in the hospital.
Just as an anecdote, I went carnivore early this year for about three weeks, just to see if some gut pain I was dealing with would clear up. It didn't. By the end of three weeks, I was dealing with a very weird heart arrhythmia of some sort. It took at least a month after quitting carnivore for that to go away. You'll remember that oxalate likes to bind to minerals in the gut and in the bloodstream. When you're body is dumping these things, they do just that. This can lead to some wicked electrolyte imbalances and heart arrhythmias.
So now what!?!
Believe me, I feel your frustration. My diet has been a non-stop frustration for the last 6 years. I've been on the Trim Healthy Momma diet (made me feel awful). I've been on the Low FP diet. I have been diagnosed with sensitivities to gluten, dairy, eggs, pinto beans, bell pepper, and all squash. I have been on the low histamine diet which was the absolute worst. So, it can't be much worse than that. And honestly, low-oxalate is really not that restrictive. Just take a deep breath.
The key, I believe, is to find out how many oxalates you, personally, are consuming every day in terms of milligrams and then slowly reduce it by maybe ten milligrams a day. That can be somewhat difficult as testing on oxalate content is woefully inaccurate. Thankfully for us, there are some lovely women (the Vulvar Pain Foundation) who, because of their own suffering with oxalates, have created a Facebook group called, Trying Low Ox. Join their group and read through the "Guides" tab near the top of the page. These are sort of mini classes on all things oxalate and also explain how to get access to a very accurate oxalate content food list.
The key is to reduce oxalate in the diet gradually so that you don't get horribly sick in the process.
What do you eat, Amanda?
So, I started out restricted, already. I cannot eat gluten, conventional dairy or eggs, no squash, and no bell pepper or pinto beans. My gut is such a mess that I cannot eat anything in the cruciferous family without a lot of pain. So, broccoli, cabbage, brussel sprouts and kale are out. Praise be, I discovered I could tolerate A2 dairy and duck eggs earlier this year and it has saved my bacon! The following foods are what my diet consists of, lately:
Meat
Duck eggs
Raw A2 milk
Goat butter (only because no one sells A2 butter, yet)
Gluten free bread I buy from Aldi (may be high oxalate, not sure)
Jasmine rice (it's one of the few grains that is not high oxalate. Yay!)
Potatoes (high oxalate)
Carrots (medium high oxalate)
Peas
Arugula
Onions
Garlic
Green onions
Leeks
Corn (medium oxalate?)
Tomatoes (medium oxalate?)
Goat cheese
Dark Chocolate (high oxalate)
Coffee
Gluten free baked goods I make myself with King Arthur GF flour blend (may be high oxalate, not sure)
Various fresh herbs and spices
It's going to be my long-term chore, slowly weaning myself off the high oxalate foods so I don't make myself worse in the process. The above list looks kinda slim. There are probably other things I'm eating that didn't come to mind, but it's still a small list. However, I don't actually feel deprived anymore. I eat real food until I'm not hungry and it tastes good. It's weird the evolution your emotions take on a long and arduous health journey. At first, every new change caused panic and sadness and feelings of deprivation. Now, I just feel pretty good about everything. But I would be very happy, if my friends didn't have to have such a small list of foods, and I hope that I'll be able to eat more things as I get better. I believe my gut has been damaged by Lyme and oxalates over the years. Leaky gut is what leads to all the food sensitivities. If you can prevent that, you can eat a lot more foods than me without issues.
So, take my advice and deal with this oxalate situation before you end up like me and before oxalates deal with you. I know a lot of you reading this are saying to yourselves right now, "Well, I'm sure oxalates are a problem for her, but they aren't for me."
Sigh.
Yes, they are. You see, I knew about oxalates two years ago and didn't take them seriously. I didn't have the bandwidth to deal with the sense of overwhelm the subject brought up in me.
I get it. Sometimes you're just not ready to process something like this, and that's okay. You will when you're ready as I have. I just have to lay out the information as I learn it, and what you do or don't do with it is none of my business.
In addition to addressing my diet, my doctor has me on a calcium citrate supplement to help bind up some of the oxalate in my gut before it reaches the bloodstream. She also has me on a B6 supplement called P5P-50 because oxalate ends up depleting it over time, and I've been low for a while.
The following are links to more information from people who have spent many years studying the issue and reading the medical literature. I have only scratched the surface with this letter and I know there are important things missing because I don't know my topic as well as these people. So, if you want to know the range of symptoms oxalate poisoning can cause (it's staggering), the ways the body deals or doesn't deal with oxalate, the dumping process, etc... listen to the interviews below while you're driving to work, folding laundry, making dinner...whatever.
That's all for now. Until next time, folks...
PS. The article directly below made my jaw hit the floor. It was as if I was seeing my life and many of its health problems described in painful detail in almost the order in which they appeared.