The low oxalate diet

Many people have reported relief from pain, inflammation, and a range of disorders on a low oxalate diet. If you haven’t done so already, please read Part 1 of this series -  High oxalate foods can trigger pain and inflammation -  to learn about oxalate and its link to a variety of conditions from fibromylagia to IBS to thyroid dysfunction in susceptible individuals.  This is Part 2, where we explore the low oxalate diet and reliable resources for obtaining information about the oxalate levels in food.   I will also provide a  synopsis of my own experience having been on the diet for a year.

Oxalate levels in food

Oxalate occurs in low to high amounts in a wide range of plant foods including fruits, vegetables, legumes, grains, spices, herbs, and almost all nuts and seeds.  Meat, dairy, and eggs contain negligible amounts of oxalate. Many people are able to process oxalate in their body without any problem whatsoever, but others absorb too many oxalate which can then link to calcium and form into sharp crystals that lodge in almost any tissue in the body causing or contributing to pain, inflammation, and other conditions.  The amount of oxalate in a particular food can vary depending upon the soil in which it is grown, the climate, how it’s cooked and other factors.  Despite this caveat, a good amount of useful information has been garnered in recent years on oxalate levels in foods using more reliable testing methods.  This data serves as a guide for trying a low oxalate diet.

Here are a few examples of high oxalate foods:

  • Almonds
  • Tahini
  • Sesame seeds
  • Beets
  • Beet greens
  • Spinach
  • Sweet potato
  • Swiss chard
  • Soy milk
  • Miso
  • Starfruit
  • Rhubarb
  • Figs
  • Potato
  • Tomato
  • Quinoa
  • Most grains
  • Most legumes

Reliable resources for oxalate content

Inaccurate information on the oxalate content of food abounds on the internet.  It is often based on outdated analysis techniques and typically has not been revised as new information has emerged.  This can include information provided on medical sites for dealing with calcium oxalate kidney stones or even information from a medical provider if they have not updated their materials.  Finer methods of content analysis have evolved in recent years and these provide much more accurate data.  In addition, several patient groups who are using the low oxalate diet compile and share their knowledge and experience in online forums.  If a low oxalate diet did not work for you in the past, it may be due to not having accurate information or not implementing the diet correctly due to lack of proper instructions.

These are the most reliable resources I have found:

  • The Low-Oxalate Cookbook, Book Two, The VP Foundation – This “cookbook, ” published by the Vulvar Pain Foundation, is a vital resource for anyone trying the low oxalate diet.  In addition to  comprehensive food lists with tested oxalate levels plus recipes, the book provides an overview of connective tissue research and treatment, guidance for implementing the diet, and answers to frequently asked questions.  Be sure to obtain the updated version—book two—which contains corrections to data contained in the first book.  This book incorporates the experience of many individuals with a wide range of disorders who have used the diet successfully.
  • Trying Low Oxalates Yahoo Group – This is a discussion group for those trying a low oxalate diet.  Susan Owens, M. A., researcher and list owner, regularly updates the forum with information on breaking research about oxalate and its effect in the body.  There is a wealth of useful information in the files section of the group and much to be learned from the experience of other members.  Susan also provides an overview of oxalate information and the diet at www.lowoxalate.info too.  The information there is excellent, however the food tables are not always as current as the information available in the forum.  The forum is an incredibly helpful resource for learning how to implement the diet correctly and thus avoiding potential pitfalls.

Both groups use data from testing done at the labs of Dr. Liebman, Ph.D., a professor of Human Nutrition at the University of Wyoming.  He is a specialist in oxalate research.

Implementing the low oxalate diet

The menu options on a low oxalate diet are numerous and varied.  The diet provides a good nutritional base as long as your eat an array of the available foods.

Implementing the diet requires study, counting numbers, and ongoing dedication.  A low oxalate diet generally means keeping your intake of oxalate from food and beverages between 40 and 60 mg. per day, depending upon your weight.  Some people find they need a very low oxalate intake, while others can tolerate more.  Each person needs to experiment and find their own level.  To use the diet correctly, you will have to count your daily intake and be cognizant of portion sizes.

It is also helpful to bear in mind that oxalate levels can vary dramatically due to growing conditions as well as cooking methods.  The lists provided are guides, not the ultimate truth.  While some foods routinely test low for oxalate and people rarely report problems with them, others do not.  Zucchini and green beans are examples of foods that test at different levels.  There may also be reasons other than oxalate content for why you react to a particular food.  Each person needs to experiment in order to find the foods they best tolerate, but having accurate low oxalate lists and support from others on the diet gives an excellent starting ground.

Meat, dairy, and eggs contain negligible amounts of oxalate.  However, eating large amounts of meat is not advisable as this can also contribute biochemically to increasing oxalate levels in the body.

Cooking and preparation methods influence oxalate content of foods.  For example, some vegetables have a lower oxalate content when boiled, although it appears there are different explanations for this.  One explanation is that the oxalate leaches into the water.  Therefore, you never want to drink or use the water in which your vegetables are cooked.  While boiling vegetables goes contrary to modern nutritional advice in terms of retaining the most nutrients, there are plenty of good nutritional choices on the diet.  Obviously, avid juicing is not part of the diet, although small amounts of specific juices can be used.

It’s also recommended not to make a dramatic shift to a low oxalate diet.  Most people begin by cutting out high oxalate foods and then over a period of time gradually reducing their intake of medium oxalate foods.  This gives your body time to adjust to the change. Some people find they can tolerate up to 2 servings of medium oxalate foods per day, as long as the remainder of their foods are low oxalate.  Others find they can only tolerate foods in the low and very low oxalate category and some can only handle very low oxalate foods.

There can be a short term increase in symptoms when the diet is started and symptoms can flare periodically while on the diet.  One theory is that during the low oxalate diet a chemical shift occurs at a cellular level from time-to-time causing larger amounts of oxalate to be released from tissue and therefore symptoms as well.  The term “dumping” has been coined to describe this feature.  Ascertaining whether symptoms are due to eating too much oxalate or simply a biochemical shift is not necessarily easy.  This is where support from others on the diet is really useful.

Both approaches to the diet provide a recommended list of supplements either for connective tissue stabilization or to help optimize the processing of oxalate in the body and reduce symptoms.

At times, people report very quick results on the diet, but others find it can take 6 months to see results.  According to Susan Owens, it can take 1-4 years on the diet for the stores of excess oxalate to leave tissues.

There’s much more to learn about the diet than can be provided in a brief article.  The best approach is to obtain the Low-Oxalate Cookbook from the Vulvar Pain Foundation and to utilize the information available from the Trying Low Oxalates Yahoo forum hosted by Susan Owens, which includes participation from people with a variety of conditions with autism being one of the main ones.

Remember, this is cutting edge research so it’s almost like participating in an experiment in process, rather than being an exact science.

My experience on the diet

I started the diet after my medical doctor found that I had numerous calcium oxalate crystals in my urine. He told me that I was absorbing too much oxalate via the gut and that this could be causing or contributing to my muscle pain, digestive distress, and other symptoms.

I’ve been on the low oxalate diet for a year.  After being on the diet for four months, I saw shifts in my blood work including positive changes in unconjugated Bilirubin (a marker for Gilbert’s Syndrome) , TSH, C-Reactive Protein, and Serum Tryptase.  I was also restricting, though not entirely, my exposure to toxic chemicals, so I can’t say for certain whether these changes were due to the diet or to limiting exposures or to both. Since chemical sensitivity contributes to my gut problems, the low-oxalate diet could not fully do it’s work until I was able to completely remove myself from chemical exposures.  This only took place about four months ago.

There have been significant symptom improvements since being on the diet in addition to the blood tests indicated above.   However, I still have a long way to go to heal my gut completely.   For most of us, multiple factors often contribute to our conditions and one remedy is usually not sufficient to effect full recovery.  Nevertheless, the low-oxalate diet has been and continues to be an essential piece of my health puzzle and recovery process.

If you suffer from any of the conditions listed in Part 1 of this series, you might consider exploring the low-oxalate diet.  Naturally, it’s important to consult with your health care provider before embarking upon any diet.  Since excess oxalate reduces glutathione, which is essential for processing many toxic chemicals that enter or are produced by the body, the low-oxalate diet may also be of benefit to those with chemical sensitivity or Gilbert’s Syndrome, especially if they have digestive problems as well.  In the case of Gilbert’s Syndrome, gluthatione is one of two pathways the degrade bilirubin.

There’s a learning curve when it comes to the low oxalate approach, but the efforts required are well worth it for those who achieve reductions in pain, inflammation, and other troublesome symptoms.

To read Part 1:   High oxalate foods can trigger pain and inflammation

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Comments

  1. says

    @Sandra Lee
    I have been so extraordinarily busy that it’s taken me a long time to get here and to read the excellent information in your blog. As you have visited my private blog you know about my health issues and this article addresses one of them. Without doubt, in my own case, high oxalate foods do trigger pain and inflammation.

    I have am careful not to eat much, if any at all, of these foods in particular, sweet potato, potatoes, tomatoes, soy products, and all legumes. I haven’t yet detected a problem with the others you have listed and assume I may over time.

    I have never been a plump person. I have always been slender and this past 2 years I have lost 25 lbs. It’s so very hard to find foods that I can digest well and that do not give rise to swollen joints. I do eat meat it’s organically raised right here where I live and I eat either meat or fresh caught local fish about 4 – 5 days per week. I also eat dairy products and egg too.

    I appreciate the resource sharing you have done and also appreciate the cooking tips you shared. Thank you so much.

    Namaste,
    TiTi

    • says

      TiTi: I’m so happy you came by! It’s good to have the pain-oxalate connection verified by your experience too. Some of us are fortunate to discover that foods trigger pain for us, but sadly others never make the connection and continue to eat the wrong foods and suffer badly. I really hope this information can penetrate out to others.

      I surely hope you don’t have problems with more foods down the road! I appreciate the challenge you have finding foods you can digest. Many foods also give me joint problems even low oxalate ones. There is definitely a connection between a messed up gut and joint pain! I’m HLA-B27 positive so that might be the reason in my case. I’ve also had serious weight loss and could only eat a handful of foods at one point. Now I’m able to eat organic chicken, white rice, clarified butter, about 6 lovely vegetables, some plain rice cakes but not others. I’m really grateful to be able to eat all that I can now, even if it’s limited. I don’t tolerate red meat, fresh-caught fish, eggs, dairy, nuts, seeds, oil and most fruit and vegetables! My reactions aren’t as strong as in the past though, there is improvement, and I am looking forward though the healing is very gradual.

      Thanks so much for commenting and sharing a part of your story. I’ve learned so much from both of you blogs and greatly value the connection we’ve made.

      • says

        @Sandra Lee
        I am happy to hear you have discovered at least some foods you can digest well that don’t give rise to with gut or joint problems. Like you I’m looking forward to healing. I spent many years in an undiagnosed state as doctors dimply could not determine what was going on. It was hurtful to be told there’s nothing we can do and one doctors even suggested the problem was all in my mind.

        Well, the next time my joints swelled so bad I could barely walk my husband picked me up and put me in the truck. He then gatecrashed the doctor’s office without and appointment and carried me right past the receptionist into an examining room. The doctors was amazed at the swelling she saw and hospitalized me. I requested a consult with an internal medicine specialist who called in other specialist and finally made some headway. Sadly, my sister got the same runaround too. I strongly believe there are both environmental and genetic connections.

  2. says

    Thank You for sharing your research. The pain and diet connection is very interesting. I’m sad to see a lot of the foods I eat on a regular basis are on the list, interesting. The research can take time to uncover the what’s and the why’s to difficult health. I think it is important for people to take charge of learning when it comes to their own health issues. The medical industry can be so frustrating as well as very expensive.

    • says

      Good question, Joanna. “Oxalic acid has the ability to form a strong bond with various minerals, such as sodium, potassium, magnesium, and calcium. When this occurs, the compounds formed are usually referred to as oxalate salts. Thus, “oxalate” usually refers to a salt of oxalic acid, one of which is calcium oxalate.” Michael Liebman, Ph. D.

      So you could say that it’s a compound derived from oxalic acid. It occurs primarily in plants plant foods. It is also produced in the body.

      Hope that clarifies!

  3. says

    Great post with great info! Thank you for sharing I hope you don’t mind but I’m going to link this post to my new blog about Low Oxalate Family Cooking (http://lowoxalatefamily.wordpress.com). I sure hope if enough of us get the word out there, that lots more people can begin their healing journey. I’ve had almost complete relief from my fibromyalgia, urinary, intestinal, and fatigue symptoms, although vulvar pain still continues to be an issue.
    I hope you continue to heal and thrive on this diet and that you find other treatments that continue your healing process.

    • says

      Hi Heidi,

      Thanks for adding your personal experience here. You’ve had quite extraordinary results with this diet. Congratulations! I am so happy for you. It’s sad that people are suffering but they have no idea that food is one of the links and a change of diet could alter their pain and discomfort remarkable. The more we can get the word out the better. Thanks for your informative and helpful blog. May your healing process continue unimpeded!