The Role of Oxalates in Chronic Disorders like Interstitial Cystitis

Oxalates (the salt form of oxalic acid) are extremely painful when deposited in the body. About eighty percent of kidney stones are caused by oxalates and they are by far the most common factor in kidney stone formation. There is also a large degree of genetic variability in the ability to detoxify the chemicals that produce oxalates. Perhaps twenty percent of the population has a genetic variance that increases their likelihood of producing oxalates, even when not consuming a high-oxalate diet.

Oxalates can form all throughout the kidney and the urinary tract, and can also form in the ureter as well as in the bladder. These star-shaped crystalline stones cause pain as the pressure in the urinary filtrate builds up, and perhaps also by tearing into the walls of the urinary tract itself.

Kidney Stones

Kidney stones are one of the most common medical ailments—ten to fifteen percent of adults will be diagnosed with a kidney stone in their lifetime. One million Americans develop kidney stones each year and most of these are oxalate related. Seventy-five to ninety percent of kidney stones are made of oxalic acid bound to another compound, usually calcium.

Once you have experienced a kidney stone attack, you have a very high chance of having another unless you change your way. The common symptoms are pain in the side and the back below the ribs. The episodes of pain last between twenty to sixty minutes, and it is common to hear women who have suffered kidney stones claim that they are more painful than childbirth.

The pain radiates from the side and the back to the lower abdomen and groin. There may be bloody, cloudy and foul-smelling urine. If there is infection, there may also be fever and chills. Pain with urination may accompany nausea and vomiting, and the sufferer may have a persistent urge to urinate.

NOT JUST IN THE KIDNEYS

Even though oxalate crystals are most common in the kidney, they also can form in virtually any other tissue in the body, including the brain and the blood-brain barrier. Oxalate crystals resembling pieces of glass can form in the heart muscle. As the heart muscle contracts, these pieces of oxalate crystals actually tear into the tissue. If these crystals are deposited in skeletal muscle, normal movement and exercise can be very painful. I’m convinced this is also one of the factors responsible for fibromyalgia. Oxalates may also cause thyroid disease as they react in thyroid tissue.

Other diseases in which oxalates may play a role include arthritis, joint pain and interstitial cystitis.

A FUNGAL ORIGIN

An unexpected finding is the fact that oxalate crystals are produced in very high amounts by molds and fungus. Aspergillus—a common organism that causes infection in humans and also is found in the black fungi that you see in your bathroom—produces oxalates.

VULVODYNIA

Another condition associated with oxalates is vulvodynia, or pain in and outside the vagina. The oxalate crystals act like tiny pieces of glass, which are deposited in the tissue. The oxalate is extremely acidic so it is corrosive as well. The pain is often described as burning or stinging, with a feeling of rawness or irritation.
One of the published studies on the treatment of this condition states that this is due to a reaction with yeast. There is indeed a connection of vulvodynia with yeast, most often Candida. There are about a dozen different species of Candida yeast normally associated with humans, the most common of which is Candida albicans. It was found that the main way to treat volvodynia was anti-fungal treatment to get rid of Candida, along with a low-oxalate diet. These two approaches have been very effective in correcting this condition.
Children who take oral antibiotics will frequently have much higher amount of oxalates. Antibiotics severely disrupt the balance of normal flora in the gut, with a consequent exponential proliferation in the growth of Candida, which is resistant to antibiotics. Oral antibiotics first appeared in the early 1950s, and the pharmaceutical companies actually included antifungal drugs along with the antibiotics because they knew about this problem. The FDA disallowed the addition, declaring that there was no approval for the prophylactic use of anti-fungals, thereby washing their hands of the whole business. It is significant to note that if individuals are given the same amount of antibiotics intravenously, their oxalate values do not rise because there was no effect on the GI tract. In some ways the old medical treatment—a shot of penicillin—was a lot safer.

CHRONIC FATIGUE AND FIBROMYALGIA

Yeast is a common factor in chronic fatigue and fibromyalgia, and antifungal therapy is very useful in treating these problems. Jacob Teitelbaum has written several books about the treatment of fibromyalgia and indicates two-thirds of individuals improved their chronic fatigue and fibromyalgia after anti-fungal therapy.
A Dr. Eaton in England found that individuals who had chronic fatigue would actually produce alcohol from their sugar intake. He describes patients who would do a baseline blood-alcohol test, then take some glucose dissolved in a flavored drink, and measure the blood alcohol one or two hours later. The blood alcohol would be substantially higher if the person had a severe Candida problem.

The OH component readily attaches to minerals like calcium, zinc and mercury, forming oxalates. Oxalates in the body come from food, can be formed in the gut by yeasts and fungi, or can result from an interruption in the glycolate pathway. Nutritional deficiencies and inborn errors of metabolism cause the formation of oxalates rather than the protein glycine.

Eaton found that by using this test he could monitor patients undergoing different treatments for chronic fatigue and fibromyalgia and found that 42 percent of patients improved just with sugar restriction alone. If he combined a low-sugar diet together with anti-fungal drugs, he had about a 78 percent success rate.
The most comprehensive study was that of a Dr. Jessop in California, who treated over one thousand people with chronic fatigue and fibromyalgia using a single anti-fungal drug, ketoconazole. Eighty-four percent of the patients improved. Of the 1,100 patients, 685 were on disability payments. After the treatment with anti-fungal treatment, only twelve remained on disability. It was an extremely effective treatment!

OXALATES IN FOOD

People who are vegetarians really have to be aware of all the oxalates they take in. The biggest culprit for all vegetarians is soy protein, and the second is spinach. Spinach is so high I would not recommend eating it even cooked, as a main course. Lettuces, by the way, are very low in oxalates. The biggest problem vegetarians face is eating a diet high in soy protein and spinach. (Baby Spinach has not matured enough to contain large amounts of oxalate so please eat it, greens are good for you.)

Dr. Massey at Washington State University found that textured soy protein is very high in oxalates. There are 638 milligrams of oxalate per 85-gram serving, which is about the size of one of these small soy burgers and as much as you would find in a typical serving of spinach. The recommended amount of oxalate for people who have kidney stones is less than 30 mg a day. One soy burger contains twenty times the recommended daily dose in just one single portion.

How much oxalate is in the typical diet? There’s a very large range— from 97 to 930 mg a day. To reduce kidney stones you should consume less than 30 to 50 mg a day.

TREATMENT

Even though we can avoid the worst offenders—soy foods and spinach— if you are enjoying a varied diet, it is difficult to reduce dietary oxalate levels to near zero because they occur in so many foods—grains, nuts, vegetables and fruits.

The most effective way to get rid of oxalates is the use of calcium citrate. This supplement exerts a double potency action in eliminating oxalate. The calcium part of calcium citrate binds to the oxalate and causes it to precipitate out in the stool so it will not be absorbed. But part of the oxalate escapes. The citrate is a second line of defense, which competes directly with the oxalate for absorption.

For the treatment to be effective, the calcium citrate must be taken at the same time as the oxalate-containing food. If you have problems with any of conditions caused by oxalates—kidney stones, autism or vulvodynia— then taking calcium citrate with each meal can be very effective. If there is an adequate amount of calcium in the diet—if supplementing with calcium citrate, for example—it will combine with the oxalate in the GI tract, precipitate out in the stool, and then be eliminated in the stool.

The optimum dosage is approximately 300-350 mg calcium as calcium citrate for a total of 1000 mg (one gram) of calcium a day. If you’re taking this you don’t need additional sources of calcium. An even better approach would be to use magnesium citrate. The adult dosage is about 300-400 mg a day. Some practitioners recommend up to 1000 mg but many people report problems with diarrhea if they exceed 400 mg. Again, a divided dose would be best, taking the magnesium citrate with each meal.

The amino acid arginine helps to prevent the depositing of oxalates in the tissues. The omega-3 fatty acids and cod liver oil are also very effective in preventing oxalate deposition. The omega-6 fatty acids, mostly from commercial vegetable oils, behave in the reverse, and accelerate the deposition of oxalate.
The supplement that is most helpful is vitamin B6. This costs only pennies a day and is extremely safe.

There are a number of medical tests for oxalate status, it is too bad that doctors don't take the extra steps to meausre IC patients oxalates and they seldom test for yeast markers. Typically when the yeast marker is very high, the oxalate marker is also very high.


SUPER HIGH OXALATE FOODS

Spinach	Lime peel	Chocolate
Soy protein	Rhubarb	Instant coffee
Tofu	Swiss chard	Leeks
Peanuts	Parsley	Tea
Peanut butter	Sweet potatoes	Okra
Pecans	Pokeweed	Wheat germ
Lemon peel	Black pepper