Oxalate Hysteria

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. 

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Episode Transcript

William Davis, MD (00:05):
There are a number of people advocating a
diet low in oxalates,essentially eliminating many
green leafy vegetables, Brusselssprouts, asparagus, celery,
most nuts, berries, cocoa, andnumerous otherwise healthy
foods.
Unfortunately, this advice ismisguided and based on an

(00:25):
incomplete understanding of theevidence.
While there's no harm inreducing dietary oxalates beyond
inconvenience, lack of variety,and the absence of many
genuinely healthy foods,reducing oxalate exposure is not
the primary problem, just aband-aid.
Oxalate hyperabsorption is dueto the disruption of the

(00:47):
gastrointestinal microbiome,loss of the many species that
metabolized oxalates, but wereeliminated or reduced due to
antibiotic exposure, and thedevelopment of small intestinal
bacterial overgrowth, or SIBO,that is associated with
abnormally increased oxalateabsorption, address the

(01:09):
disrupted gastrointestinalmicrobiome, and dietary oxalate
consumption is no longer anissue for the vast majority of
people.
In this episode of the DefiantHealth Podcast, let's discuss
why so many people have beenmisled by this dietary oxalate
issue, and let's discuss asmarter way to deal with what

(01:29):
might be interpreted as oxalateintolerance.
Let's talk about what I calloxalate hysteria.
Well, what I call it that.
So there are many people whoare advocating that you reduce
the intake of something calledoxalates in your diet because

(01:50):
they argue that getting too manyoxalates in your diet can
increase your likelihood of notjust kidney stones, calcium
oxalate kidney stones, but alsoother diseases, heart disease,
dementia, cancers, numerousother conditions.
Is this true?
Well, there's as often happensin these kind of hysterical

(02:11):
stories, there's a germ oftruth.
So oxalates are something thatare ubiquitous in plants.
Most plants have them becausethey are essential for plants'
biochemistry and growth.
And when we eat plants, we getsome oxalates.
So the odd thing is that someof the healthiest foods, like

(02:31):
spinach and kale, and cocoa,nuts, seeds, berries, are all
rich in oxalates.
So some of these people tellyou to cut your consumption of
those foods in order to reduceyour intake of oxalates and
thereby presumptively reducingrisk for all those health
conditions.
Is this true?

(02:52):
It's not true.
It's largely not true.
Let's clarify something.
Who gets high levels of oxalatein their blood?
Well, there's a geneticcondition called primary
hyperoxaluria, meaning highlevels of oxalate in the urine
as well as in the blood.
That's a genetic condition thatafflicts maybe a thousand
people total in the U.S.

(03:14):
In other words, it's very rare.
So this is usually not thesituation.
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 ofoxalates.
So if you're not in kidneyfailure, you don't have that

(03:34):
issue.
Now the third condition iscalled enteric hyperoxalaria.
And all that means is there arevarious gastrointestinal
disorders that involve fatmalabsorption.
That's a number of differentconditions that cause
hyperabsorption, increased,about 30% increased absorption
of oxalates.

(03:54):
And that can indeed lead tosome of those problems.
But we're going to talk aboutwhy the vast majority of people
with this enteric orintestinally driven
hyperoxalaria, high urinarylevels of oxalate, are due to
SIBO, small intestinal bacterialovergrowth, and that this

(04:15):
apparent oxalate intolerance isreally part of a longer list of
food intolerances that peoplehave developed, modern people
have developed.
Intolerances to such commonthings as nightshades, like
eggplant and tomatoes, orFODMAPs, that is, fibers and
sugars, histamine-containingfoods like cheese, and numerous

(04:37):
other foods.
Intolerances, includingapparent oxide intolerances, are
all modern phenomena that yourgreat-grandmother, our
ancestors, did not have anyproblems with.
People who live hunter-gathererlives, a natural life, don't
have these problems.
It's us.
It's a very telling phenomenonthat when you take an

(04:57):
antibiotic, a course ofantibiotics, your likelihood of
calcium oxalate kidney stonesdue to high levels of oxalate in
the urine and blood goes updramatically after antibiotics.
What does that tell you?
Well, it tells you you probablydisrupted the gastrinintestinal
microbiome.
And thereby that somehow led toan increase in oxalate

(05:21):
absorption and thereby calciumoxalate kidney stones.
Well, there's a lot of sciencecoming out now telling us that
it's the gastrointestinicrobiomethat's been disrupted.
If you've been following myYouTube channel, my Defiant
Health Podcasts, my thousands ofblog posts, on my
WimDavisMB.com, you know thatmodern people have massively

(05:43):
disrupted the gastrointestalmicrobiome.
And among the consequences is aloss of many species that were
responsible for clearing ormetabolizing oxalates for you.
So that's one.
And then two, there'sovergrowth of species after
taking an antibiotic, overgrowthof species that are unhealthy

(06:07):
because antibiotics kill offhundreds of beneficial species
in the colon that allows fecalmicrobes to over-proliferate in
the colon and then ascend intothe small intestine.
But when those fecal microbesascend into the duodenum, that's

(06:27):
the area of thegastrointestinal tract, just
beyond the stomach.
Stomach, duodenum, followed bythe jejunum and ileum.
When these fecal microbes haveascended to colonize the
duodenum, it tends to block theaction of both bile and
pancreatic enzymes.
Because the gallbladder and thepancreas empty into the

(06:49):
duodenum.
So when you have fecal microbesinfesting the duodenum,
blocking the digestion of fats,the undigested fats or fatty
acids bind minerals, and theydon't bind the oxalates.
And oxalate levels in thegastrointestinal tract go up,
absorption of oxalates goes upabout 30%, and that's what leads

(07:12):
to high levels of oxalate.
It's not the dietary intake ofoxalates that's the problem.
Of these natural, ubiquitous,wonderful foods like berries and
nuts, it's the binding ofminerals in the
gastro-intestinal tract, in theduodenum, that allows increased
absorption of oxalates.

(07:32):
And that's why now we haveseveral studies, about a half a
dozen of them, telling us thatcertain probiotic microbial
species, when restored, reducesoxalate in the urine, in the
blood.
The leading candidate is aspecies of microbe called
oxalobacter formigenes.
Unfortunately, it's notcommercially available yet.

(07:53):
It likely will be.
That science has been uh hasbeen scattered because there's
been some mixed results.
But the more recent resultssuggest that higher doses do
indeed reduce your oxalatelevels, urine, blood, and
intestine.
But the real champion islooking to my great surprise, is
Lactobacillus acidophilus.

(08:15):
There's actually many speciesof 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 calledthat because it actually
consumes oxalates, butLactobacillus aphidophilus,

(08:39):
which is actually a very commonmicrobe in conventional yogurt.
Not even put aside mylactobacillus rotarian and all
those other fancy yogurts wemake from human microbes.
This is a yogurt microbe.
Now, most yogurts are made withLactobacillus bulgaricus and
Streptococcus thermophilus, butsome have added Lactobacillus
acidophilus, or you can buy itas a probiotic or a starter

(09:02):
culture.
That's the one that reducesyour oxalate levels
dramatically.
But even a better answer thanthat is to rebuild your
gastrointestinal microbiome tobring back numerous
lactobacillus bifetobacteriaspecies.
At some point, we'll haveprobably the ideal mix of
microbes.
Maybe it includes oxalobacter,maybe it's got lactobacillus

(09:24):
acidophilus and Streptococcusthermophilus and some other
species.
And perhaps that could be takenas a probiotic.
There are studies showing usthat there's about a 30%
reduction in blood and urinarylevels of oxalates just by
restoring these microbes.
Now, we don't have access tocommercial products that provide
the optimal mix of microbes.

(09:45):
In the meantime, a good policywould be to do all the things we
do to rebuild agastro-intestinal microbiome.
Be sure to include fermentedfoods like kimchi, sauerkraut,
fermented pickles, and otherfermented foods because they
contain leuconostatmesenterites, a species that
also reduces oxalate blood andurine levels.

(10:05):
Make your sparkling juices, aswe often talk about, by
fermenting sacromyces bolardii,makes delicious sparkling
juices, and that further reducesoxalates.
And then take all the steps wetake to rebuild and restore
keystone microbes and reduceSIBO, right?
Because if SIBO is causing fatmalabsorption, thereby

(10:27):
heightening or increasing theabsorption of oxalates, address
the SIBO.
Of course, we do that byincluding three microbes,
lactobacillus rotori,lactobacillus gastri, and
bacillus subtilis.
If you don't know what I'mtalking about, see my prior
discussions about this in myYouTube channel as well as my
Defiant Health podcast and mythousands of blog posts, and of

(10:48):
course my super guide book.
Where I show you how to makethis yogurt that I call SIBO
yogurt that has beenunexpectedly effective in
reducing SIBO and normalizingbreath hydrogen gas.
But this reducing SIBO, gettingrid of the malabsorption of fat
and the duodenum, also beginsthe process of restoring

(11:09):
beneficial lactobacillus andbifetobacteria species.
You can go further by takingother probiotics.
An easy trick, you can actuallydo this with commercial yogurt,
lo and behold.
So while you could use therotori gastribacillus as your
starting point, think aboutadding other microbes.
You could add a starter cultureor even commercial yogurt to

(11:31):
your yogurts and get high countsthat way.
So, in other words, let's sayyou're making rotari yogurt, you
can add a tablespoon or two ofconventional yogurt that
includes hopefully theLactobacillus acidophus and
other species, and ferment thatfor a minimum of 24 hours, and
you'll get these nice highcounts that will help reduce
oxalates further.

(11:51):
Or you could even usecommercial 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 likegel and gum, xanthin gum,
carrageenin, all those thingsthat muck up your microbiome.
You just want plain, full fatyogurt, and consider leaving it

(12:16):
on your kitchen counter foranother 12 to 24 hours to allow
microbial counts to go evenhigher.
But these are ways to reduceoxalate.
There is no need to reduce.
If you don't have kidneyfailure, if you're not in that
rare group of people withprimary hyperoxaluria, but you
have enteric hyperoxaluria orjust want to not be overexposed

(12:36):
to oxalates, you don't have toreduce dietary oxalate.
That's silly.
Those are wonderful foods.
There's nothing wrong withthose foods.
There's something wrong withyour microbiome.
And all the efforts we make torebuild a beneficial healthy
microbiome, including addressingthe fat malabsorption of SIBO,

(12:58):
that's how you control oxalatelevels in your urine and in your
blood, and thereby freeyourself of the comp the
potential complications ofoxalates.
Now, if you're interested inmore information on this topic
on how you can reduce yourexposure to oxalates, not with
dietary manipulation, but withmicrobiome manipulation.
Because you know what?

(13:18):
If you allow SIBO or the lossof all those microbes to
continue, you're exposingyourself not just to oxalate
intolerance, but all kinds ofother health problems, like
increased risk for colon cancerand heart disease, and dementia,
and all the common chronicmodern disease that people have.
So if that interests you, Iinvite you to join my

(13:39):
conversations.
We have regularly on my innercircle.drdavis infinite
health.com.