Oxalate Panic, Debunked

There are a number of people advocating a diet low in oxalates, essentially eliminating many green leafy vegetables, Brussels sprouts, asparagus, celery, most nuts, berries, cocoa, and numerous otherwise healthy foods. Unfortunately, this advice is misguided and based on an incomplete understanding of the evidence. While there is no harm in reducing dietary oxalates beyond inconvenience, lack of variety, and the absence of many genuinely healthy foods, reducing oxalate exposure is not the primary problem, just a Band-Aid. 

Oxalate hyperabsorption is due to disruption of the gastrointestinal microbiome: loss of the many species that metabolize oxalates but were eliminated or reduced due to antibiotic exposure, and the development of small intestinal bacterial overgrowth, SIBO, that is associated with abnormally increased oxalate absorption. Address the disrupted gastrointestinal and dietary oxalate consumption is no longer an issue for the vast majority of people.

In this episode of the Defiant Health podcast, let’s discuss why so many people have been misled by this dietary oxalate issue and a smarter way to deal with what might be interpreted as oxalate intolerance. 

Chapters

• 0:00 The Oxalate Panic
• 1:18 What Actually Causes High Oxalates
• 3:34 Rare True Hyperoxalate Conditions
• 5:17 Antibiotics, SIBO, and Stone Risk
• 7:07 How SIBO Drives Fat Malabsorption
• 8:58 Probiotic Species That Lower Oxalates
• 10:56 Rebuilding the Microbiome Strategy
• 12:32 Practical Yogurt and Fermentation Tips

Transcript

William Davis, MD: 0:05

There are a number of people advocating a diet low in oxalates, essentially eliminating many green leafy vegetables, Brussels sprouts, asparagus, celery, most nuts, berries, cocoa, and numerous otherwise healthy foods. Unfortunately, this advice is misguided and based on an incomplete understanding of the evidence. While there's no harm in reducing dietary oxalates beyond inconvenience, lack of variety, and the absence of many genuinely healthy foods, reducing oxalate exposure is not the primary problem, just a band-aid. Oxalate hyperabsorption is due to the disruption of the gastrointestinal microbiome, loss of the many species that metabolized oxalates, but were eliminated or reduced due to antibiotic exposure, and the development of small intestinal bacterial overgrowth, or SIBO, that is associated with abnormally increased oxalate absorption, address the disrupted gastrointestinal microbiome, and dietary oxalate consumption is no longer an issue for the vast majority of people. In this episode of the Defiant Health Podcast, let's discuss why so many people have been misled by this dietary oxalate issue, and let's discuss a smarter way to deal with what might be interpreted as oxalate intolerance. Let's talk about what I call oxalate hysteria. Well, what I call it that. So there are many people who are advocating that you reduce the intake of something called oxalates in your diet because they argue that getting too many oxalates in your diet can increase your likelihood of not just kidney stones, calcium oxalate kidney stones, but also other diseases, heart disease, dementia, cancers, numerous other conditions. Is this true? Well, there's as often happens in these kind of hysterical stories, there's a germ of truth. So oxalates are something that are ubiquitous in plants. Most plants have them because they are essential for plants' biochemistry and growth. And when we eat plants, we get some oxalates. So the odd thing is that some of the healthiest foods, like spinach and kale, and cocoa, nuts, seeds, berries, are all rich in oxalates. So some of these people tell you to cut your consumption of those foods in order to reduce your intake of oxalates and thereby presumptively reducing risk for all those health conditions. Is this true? It's not true. It's largely not true. Let's clarify something. Who gets high levels of oxalate in their blood? Well, there's a genetic condition called primary hyperoxaluria, meaning high levels of oxalate in the urine as well as in the blood. That's a genetic condition that afflicts maybe a thousand people total in the U.S. In other words, it's very rare. So this is usually not the situation. There's also kidney failure. If you have kidney failure, your kidneys are incapable of clearing oxalates in your urine, and you can have a high blood level as well as urine level of oxalates. So if you're not in kidney failure, you don't have that issue. Now the third condition is called enteric hyperoxalaria. And all that means is there are various gastrointestinal disorders that involve fat malabsorption. That's a number of different conditions that cause hyperabsorption, increased, about 30% increased absorption of oxalates. And that can indeed lead to some of those problems. But we're going to talk about why the vast majority of people with this enteric or intestinally driven hyperoxalaria, high urinary levels of oxalate, are due to SIBO, small intestinal bacterial overgrowth, and that this apparent oxalate intolerance is really part of a longer list of food intolerances that people have developed, modern people have developed. Intolerances to such common things as nightshades, like eggplant and tomatoes, or FODMAPs, that is, fibers and sugars, histamine-containing foods like cheese, and numerous other foods. Intolerances, including apparent oxide intolerances, are all modern phenomena that your great-grandmother, our ancestors, did not have any problems with. People who live hunter-gatherer lives, a natural life, don't have these problems. It's us. It's a very telling phenomenon that when you take an antibiotic, a course of antibiotics, your likelihood of calcium oxalate kidney stones due to high levels of oxalate in the urine and blood goes up dramatically after antibiotics. What does that tell you? Well, it tells you you probably disrupted the gastrinintestinal microbiome. And thereby that somehow led to an increase in oxalate absorption and thereby calcium oxalate kidney stones. Well, there's a lot of science coming out now telling us that it's the gastrointestinicrobiome that's been disrupted. If you've been following my YouTube channel, my Defiant Health Podcasts, my thousands of blog posts, on my WimDavisMB.com, you know that modern people have massively disrupted the gastrointestal microbiome. And among the consequences is a loss of many species that were responsible for clearing or metabolizing oxalates for you. So that's one. And then two, there's overgrowth of species after taking an antibiotic, overgrowth of species that are unhealthy because antibiotics kill off hundreds of beneficial species in the colon that allows fecal microbes to over-proliferate in the colon and then ascend into the small intestine. But when those fecal microbes ascend into the duodenum, that's the area of the gastrointestinal tract, just beyond the stomach. Stomach, duodenum, followed by the jejunum and ileum. When these fecal microbes have ascended to colonize the duodenum, it tends to block the action of both bile and pancreatic enzymes. Because the gallbladder and the pancreas empty into the duodenum. So when you have fecal microbes infesting the duodenum, blocking the digestion of fats, the undigested fats or fatty acids bind minerals, and they don't bind the oxalates. And oxalate levels in the gastrointestinal tract go up, absorption of oxalates goes up about 30%, and that's what leads to high levels of oxalate. It's not the dietary intake of oxalates that's the problem. Of these natural, ubiquitous, wonderful foods like berries and nuts, it's the binding of minerals in the gastro-intestinal tract, in the duodenum, that allows increased absorption of oxalates. And that's why now we have several studies, about a half a dozen of them, telling us that certain probiotic microbial species, when restored, reduces oxalate in the urine, in the blood. The leading candidate is a species of microbe called oxalobacter formigenes. Unfortunately, it's not commercially available yet. It likely will be. That science has been uh has been scattered because there's been some mixed results. But the more recent results suggest that higher doses do indeed reduce your oxalate levels, urine, blood, and intestine. But the real champion is looking to my great surprise, is Lactobacillus acidophilus. There's actually many species of microbes that reduce oxalate in the GI tract. Lactobacillus plantarum, lactobacillus ramnosus, bifidobacterin phantus, lactobacillus brevis. But it looks like the champion, even beyond perhaps Oxalobacter, Oxalobacter called that because it actually consumes oxalates, but Lactobacillus aphidophilus, which is actually a very common microbe in conventional yogurt. Not even put aside my lactobacillus rotarian and all those other fancy yogurts we make from human microbes. This is a yogurt microbe. Now, most yogurts are made with Lactobacillus bulgaricus and Streptococcus thermophilus, but some have added Lactobacillus acidophilus, or you can buy it as a probiotic or a starter culture. That's the one that reduces your oxalate levels dramatically. But even a better answer than that is to rebuild your gastrointestinal microbiome to bring back numerous lactobacillus bifetobacteria species. At some point, we'll have probably the ideal mix of microbes. Maybe it includes oxalobacter, maybe it's got lactobacillus acidophilus and Streptococcus thermophilus and some other species. And perhaps that could be taken as a probiotic. There are studies showing us that there's about a 30% reduction in blood and urinary levels of oxalates just by restoring these microbes. Now, we don't have access to commercial products that provide the optimal mix of microbes. In the meantime, a good policy would be to do all the things we do to rebuild a gastro-intestinal microbiome. Be sure to include fermented foods like kimchi, sauerkraut, fermented pickles, and other fermented foods because they contain leuconostat mesenterites, a species that also reduces oxalate blood and urine levels. Make your sparkling juices, as we often talk about, by fermenting sacromyces bolardii, makes delicious sparkling juices, and that further reduces oxalates. And then take all the steps we take to rebuild and restore keystone microbes and reduce SIBO, right? Because if SIBO is causing fat malabsorption, thereby heightening or increasing the absorption of oxalates, address the SIBO. Of course, we do that by including three microbes, lactobacillus rotori, lactobacillus gastri, and bacillus subtilis. If you don't know what I'm talking about, see my prior discussions about this in my YouTube channel as well as my Defiant Health podcast and my thousands of blog posts, and of course my super guide book. Where I show you how to make this yogurt that I call SIBO yogurt that has been unexpectedly effective in reducing SIBO and normalizing breath hydrogen gas. But this reducing SIBO, getting rid of the malabsorption of fat and the duodenum, also begins the process of restoring beneficial lactobacillus and bifetobacteria species. You can go further by taking other probiotics. An easy trick, you can actually do this with commercial yogurt, lo and behold. So while you could use the rotori gastribacillus as your starting point, think about adding other microbes. You could add a starter culture or even commercial yogurt to your yogurts and get high counts that way. So, in other words, let's say you're making rotari yogurt, you can add a tablespoon or two of conventional yogurt that includes hopefully the Lactobacillus acidophus and other species, and ferment that for a minimum of 24 hours, and you'll get these nice high counts that will help reduce oxalates further. Or you could even use commercial yogurt, just be careful though, right? If you buy commercial yogurt, make sure it's organic, full fat, no added sugars, sweeteners, high fructose corn syrup, no added thickeners like gel and gum, xanthin gum, carrageenin, all those things that muck up your microbiome. You just want plain, full fat yogurt, and consider leaving it on your kitchen counter for another 12 to 24 hours to allow microbial counts to go even higher. But these are ways to reduce oxalate. There is no need to reduce. If you don't have kidney failure, if you're not in that rare group of people with primary hyperoxaluria, but you have enteric hyperoxaluria or just want to not be overexposed to oxalates, you don't have to reduce dietary oxalate. That's silly. Those are wonderful foods. There's nothing wrong with those foods. There's something wrong with your microbiome. And all the efforts we make to rebuild a beneficial healthy microbiome, including addressing the fat malabsorption of SIBO, that's how you control oxalate levels in your urine and in your blood, and thereby free yourself of the comp the potential complications of oxalates. Now, if you're interested in more information on this topic on how you can reduce your exposure to oxalates, not with dietary manipulation, but with microbiome manipulation. Because you know what? If you allow SIBO or the loss of all those microbes to continue, you're exposing yourself not just to oxalate intolerance, but all kinds of other health problems, like increased risk for colon cancer and heart disease, and dementia, and all the common chronic modern disease that people have. So if that interests you, I invite you to join my conversations. We have regularly on my inner circle.drdavis infinite health.com.