How to Reduce Oxalates in Your Diet
Scared of Kidney Stones? Who isn’t! Join Wana + Monique Attinger, “The LowOx Coach” and nutritionist to learn how to reduce oxalate accumulation in your diet
1. Can you tell us a bit about yourself and what led you to what you do today?
My journey to the discovery of oxalate as a health issue, and my new career in my 50’s, really started with my young daughter. She had very nasty symptoms, including pain and inflammation of the vulva and perineum, as well as rashes that looked like chemical burns. I was deeply concerned, as she was only 2 ½ at the time! We saw a functional medicine Naturopathic Doctor who diagnosed her with an oxalate problem. I remember distinctly saying, “What’s an oxalate?!” I’d never heard of it before.
We started eating low oxalate; not only did my daughter get better, but I started to improve my health for the first time that I remembered.
It was a radicalizing experience. If I’d had an oxalate issue for years, but no one had realized – how many others might be in that position? When there were indications that oxalate might be affecting us in other ways, why did the research continue to focus on the kidneys? Why was oxalate “flying under the radar”? That continues to be a lot of my motivation, particularly with clients who have been struggling for a long time. Often oxalate has been a “confounding” variable, hidden underneath other symptoms and issues.
2. What are oxalates? Who should be concerned about oxalates? How can you protect yourself from oxalates?
Oxalates are a surprisingly simple chemical. We use the term “oxalate” to refer to both the ionic form of oxalate with the formula C2O2−4 and the chemical salts of oxalate (where oxalate is bound to a mineral, such as calcium oxalate, which is commonly the main component of kidney stones).
Oxalate is found in plant foods almost exclusively. Plants are using oxalate both to draw minerals from the ground into the structure of the plant and as part of their defence against predation. This is a particularly fascinating topic as oxalate is so rich in spinach leaves as an example, that insects attempting to eat the leaf will damage their mouths! But each food can have its own oxalate profile, because it is using oxalate in slightly different ways. This in turn makes the diet more complicated than most because it’s not an all or nothing issue; it’s an issue of threshold.
The human body can handle some oxalate. We do excrete it, and oxalate can be a by-product of human metabolism, so the body does know how to get rid of it. However, the issue is in the dose.
New research shows that oxalates may also be a driver of inflammation, both because of physical injury of crystals, but also because of the impact of oxalate on the mitochondria and inflammasome. It turns out that oxalate is implicated as a mitochondrial toxin; and this has wide-ranging implications.
So the question of who should be concerned is a big one! It could be almost anyone with a condition that is non-responsive to conventional treatment. But I suspect there are a large number of people who have some sort of inflammatory condition, from things like arthritis to inflammatory gut conditions, to even those with chronic pain, who might benefit.
As for protecting yourself from oxalate, the best way to do that is avoidance! This doesn’t mean your diet has to be extremely restrictive either. For most people, reducing their intake into the medium oxalate range will be sufficient for them to avoid the kinds of issues that might occur long term. For those who are currently healthy and happy, all you want is to have your intake low enough that your body can excrete oxalate in a timely manner. So what you are trying to avoid is bioaccumulation (I write about this specifically in an article on Hormones Matters).
3. What is a low oxalate diet? What are some low oxalate foods?
A “textbook” definition of a low oxalate diet is the consumption of 40-60 mg of oxalate per day for a 2,000 calorie diet. While the reference to calories has been made, in practice most people who eat in the 40-60 mg range (regardless of their calorie intake) will be fine.
Further, many don’t need to “count” oxalate at all! If you bias your diet to the very low and low oxalate foods, then you probably don’t need to count. Certainly many of my clients don’t and I still see them get great results.
Your lowest oxalate foods will be animal foods; think dairy, meat, fish and eggs. With that in mind, let’s look at some low oxalate veggie options:
- Arugula
- Asparagus
- Bok choy
- Cauliflower
- Cucumbers
- Some varieties of kale
- Mushrooms
- Cabbage
- Onions
- Radish
- Many varieties of squash
- Many varieties of peppers
- Lettuces
- Pea greens
- Turnip
- Rutabaga
- Collards
- Broccoli
- Some tomatoes (but fresh)
- Celeriac (celery root)
So as you can see, it doesn’t have to be a limited diet! (And this is just vegetables that I’ve focused on).
4. Top 3 tips for getting started? (And what is oxalate dumping?)
To get started:
- Try taking a calcium or magnesium supplement just before your meal. You can do this even before you start to really reduce oxalate. This can be a gentle introduction to lowering oxalate, as the calcium or magnesium will bind with oxalate in the gut, and help you to avoid absorbing it.
- GO SLOW. Once you are ready to reduce oxalate, don’t drop it out of your diet all at once (i.e. "dumping", see below). Try removing a food, and then give yourself a few days; then perhaps another. If you are eating extremely high oxalate foods (like spinach) and doing that every day, try reducing your serving by ¼. Then perhaps try eating it every other day. What you want to do is reduce oxalate slowly and even intermittently.
- Consider things like epsom salt baths as a gentle support as you excrete oxalate. Epsom salt helps raise your magnesium levels (which is important because oxalate can be chelating it and taking it out of your body), and it also supports the liver with needed sulphate. Sulphate may be compromised by oxalate, because sulphate competes with oxalate for uptake into the cells. So this is another gentle and easy thing to do to support you on your journey.
(BONUS) When it comes to oxalate “dumping”, what this refers to is the process of oxalate exiting the tissues and leaving the body. It can be very stressful! Oxalate causes symptoms as it leaves the body and that can include fatigue, poor digestion, sleep disturbances, mood issues, and many others. Oxalate can also be driving inflammation - so we want it to leave, but we don’t want it to leave so quickly that your body can’t handle it. Oxalate is a toxin; it remains toxic as it leaves the body.
5.What do you think most stands in the way of healing?
This is a tough question.
I suspect the biggest challenge with oxalate is that it is a long term process to get rid of it. What I say to clients is that it is a marathon, and not a sprint! The more fragile your health is now, the more slowly (and carefully) you need to proceed.
If you are trying to do too many things at once, that can hamper you as well. So if you are trying to gain or lose weight and handle lowering oxalate, you have a lot of moving pieces in play. For most, I’ll encourage them to take their time with additional issues like weight gain or loss, and encourage enough good nutrition so that their body has the resources needed to handle the stress of dumping.
About Monique Attinger, “The LowOx Coach”
It’s been an interesting journey to where I am now! I started in sciences at the University of Western Ontario and did a year of nursing until life took me (temporarily) in another direction and away from the focus on helping people get healthy.. I graduated with an Honours BA in sociology after my detour and then a couple years later, got a Masters in Library and Information Science. This took me into the business world and a focus on digital information in companies - but I remained a nutrition geek (and solved my own arthritis issue with diet and supplements in my late 20’s; but I digress.) By my early 40’s, had two kids and was getting sick. I actually felt as if I would not live to see them grow up! Then my young daughter was diagnosed with an oxalate issue. I decided to do the diet with her to show a good example - and I got healthy! I started to read everything I could on oxalate and got involved with the Trying Low Oxalates support group, eventually becoming an administrator there. I loved what I was doing helping others so much, I went back to school. I am now a registered holistic nutritionist. Coaching clients has been my passion for over 8 years.
I may be a little different than any nutritionist you’ve worked with before. I focus on you and your needs and virtually nothing I do comes from a template or out of a database. Each individual is unique; I treat you as such. This means less prescription and more framework. It may take a bit longer to get to what works best for you - but my intention is that you will be “fledged” and able to tackle your diet on your own. I do help with food lists to focus on; we discuss tools that might help you to handle oxalate excretion better, including supplements; I provide menu planning services with recipes that will help you to understand oxalate and how to build a meal for yourself; I can even help you to modify existing recipes to lower oxalate. It’s not just about health; it’s also about enjoying what you eat while you get healthy.
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