The Low Ox cookbook
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 fibromyalgia 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 can process oxalate in their body without any problem whatsoever, but others absorb too much 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 It is often based on outdated analysis techniques and typically has not been revised as new information has emerged.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.
The Low Oxalate Diet - An overview of the low-oxalate diet created by Susan Owens, M. A.
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 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 limiting exposures or both. Since chemical sensitivity contributes to my gut problems, the low-oxalate diet could not fully do its 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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