Even though oxalate is naturally produced in the body and is found in a variety of nutrient-dense foods, there is such a thing as too much of a good thing. A buildup of oxalate in the body can increase the risk of oxalate toxicity which can lead to a number of health issues, including uncomfortable digestive symptoms. So in today’s blog post we discuss what oxalate is, where it’s found, its impact on our body, and its connection to poor gut health. We will also discuss how to diagnose oxalate toxicity and ways to manage it.

What is oxalate?

Oxalate is a naturally occurring molecule found in many plant-based foods including almonds, beets and beet greens, hemp seeds, kiwi, lentils, spinach, raspberries, rhubarb, turmeric, Swiss chard, potato, sweet potato, quinoa, cacao, chia seeds and figs. In addition to being obtained from dietary sources, oxalate is also produced naturally in the body by the liver. While small amounts of oxalate are normal and necessary for various bodily functions, high levels can lead to problems.

What is oxalate toxicity?

Oxalate toxicity occurs when there is an excessive buildup of oxalate in the body. This can result from various factors, such as:

  • A diet high in oxalate-rich foods
  • Certain medical conditions
  • Compromised gut health 

Oxalate toxicity can affect various parts of the body and present with diverse symptoms. It’s important to note that individual experiences may vary, and not everyone will exhibit all of these symptoms. 

Signs and Symptoms of Oxalate Toxicity

Kidney Stones:

Oxalate can bind with calcium in the kidneys, leading to the development of calcium oxalate stones. Kidney stone symptoms may include severe abdominal or back pain, blood in the urine, frequent urination, and discomfort during urination.

Joint Pain and Inflammation:

High levels of oxalate can contribute to joint pain and inflammation, resembling symptoms of arthritis. Individuals with oxalate toxicity may experience joint stiffness, swelling, and discomfort, often affecting the fingers, toes, and larger joints such as knees and hips.

A person holding their wrist joint as a sign of oxalate toxicity.

Digestive Issues:

Oxalate can irritate the gastrointestinal tract, leading to digestive symptoms. These may include abdominal pain, bloating, gas, diarrhea, or constipation. Some individuals may also experience nausea and vomiting.

Neurological Symptoms:

In rare cases, oxalate toxicity can impact the nervous system, resulting in neurological symptoms. These may include tingling or numbness in the extremities, muscle weakness, and even more severe manifestations like seizures or difficulty coordinating movements. However, it’s important to note that neurological symptoms are less common and typically occur in severe cases of oxalate toxicity.

Eye and Skin Symptoms:

Excessive oxalate can sometimes affect the eyes and skin. Eye-related symptoms may include burning or itching sensations, redness, or increased sensitivity to light. Skin symptoms may manifest as itching, rashes, or even the formation of calcium oxalate crystals on the skin.

How does leaky gut relate to oxalate toxicity?

When the gut lining is healthy, it acts as a selective barrier, allowing nutrients to pass through while preventing harmful substances from entering the bloodstream. However, in the case of leaky gut, the tight junctions between the cells of the intestinal lining become loose or damaged, leading to increased permeability. This allows toxins, including oxalate, to enter the bloodstream in higher amounts.

Increased Oxalate Absorption

Normally, a healthy gut efficiently breaks down and eliminates oxalate, preventing its accumulation in the body. However, a compromised gut lining can result in an increased absorption of oxalate from the digestive system and higher amounts of oxalate entering the bloodstream, potentially leading to elevated levels and toxicity. Oxalate crystals are like sandpaper to the GI tract, therefore creating more inflammation that increases leaky gut.

Altered Gut Microbiome

When the gut microbiome is imbalanced, such as in cases of dysbiosis or an overgrowth of harmful bacteria, it can contribute to leaky gut. This imbalance may also influence oxalate metabolism in the gut.

Oxalate-Degrading Bacteria

Within the gut microbiome, there are specific bacteria known as oxalate-degrading bacteria that help break down and degrade oxalate. These bacteria play a crucial role in preventing oxalate buildup and toxicity. However, in the case of dysbiosis or an imbalance in the gut microbiome, the population of oxalate-degrading bacteria may decrease, resulting in reduced oxalate breakdown and potential toxicity.

Inflammation and Oxalate Toxicity

Leaky gut is often associated with chronic inflammation in the gut. This inflammation can further exacerbate oxalate toxicity. Inflammatory processes can lead to oxidative stress and tissue damage, which can increase the absorption of oxalate and impair the body’s ability to metabolize and eliminate it effectively.

A person putting their hands on their stomach.

Diagnostic Tests

Diagnosing oxalate toxicity involves assessing oxalate levels in the body and identifying any underlying causes or contributing factors. Here are some diagnostic tests that may be used:

Urine Oxalate Test: 

This test measures the amount of oxalate excreted in urine over a 24-hour period. It helps determine if there is an excessive oxalate excretion, which can be indicative of oxalate toxicity. 

Blood Oxalate Test: 

Blood testing measures the concentration of oxalate in the blood. Elevated levels of oxalate in the blood can indicate increased oxalate absorption or impaired oxalate metabolism.

Kidney Stone Analysis: 

If an individual has a history of kidney stones or exhibits symptoms associated with kidney stone formation, analyzing the composition of the kidney stones can provide valuable information. Calcium oxalate stones are commonly associated with oxalate toxicity.

Genetic Testing: 

In some cases, genetic testing may be recommended, particularly if there is suspicion of a genetic disorder that affects oxalate metabolism. Genetic tests can identify mutations or abnormalities in genes related to oxalate metabolism, providing insights into inherited conditions associated with oxalate toxicity.

Preventative Strategies For Oxalate Toxicity

Dietary Modifications: 

Low-Oxalate Diet: Reduce intake of foods such as spinach, rhubarb, beets, chocolate, nuts, and certain berries. Instead, focus on low-oxalate alternatives like leafy greens, cruciferous vegetables, lean proteins, and healthy fats.

Calcium-Rich Foods: Consuming calcium-rich foods with meals can help bind to oxalate in the gut and reduce its absorption. Good sources of calcium include dairy products, fortified plant-based milk, canned fish with bones, and leafy greens (moderate in oxalate).

Hydration: Staying adequately hydrated can help dilute oxalate in the urine and potentially reduce the risk of kidney stone formation. 

A hand holding up a glass of water as a strategy to prevent oxalate toxicity.

Gut Health Optimization:

Probiotics and Prebiotics: Introducing beneficial bacteria through probiotic supplements or fermented foods can help restore gut microbiome balance. Look for strains that have been shown to degrade oxalate, such as Oxalobacter formigenes. Prebiotics, such as inulin or resistant starch, can provide nourishment for these beneficial bacteria.

Fiber-Rich Diet: Consuming a diet rich in soluble and insoluble fiber promotes regular bowel movements and can assist in eliminating oxalate from the body. Whole grains, fruits, vegetables, and legumes are excellent sources of fiber.

Managing Underlying Conditions:

Treating Digestive Disorders: Managing conditions like inflammatory bowel disease (IBD), celiac disease, or gastrointestinal infections can help improve gut health and reduce oxalate absorption.

Addressing Genetic Disorders: Inherited conditions like primary hyperoxaluria may require specialized treatment and management approaches. Genetic counseling and working closely with healthcare professionals are crucial in these cases.

Hygiene and Lifestyle Practices:

Good Hygiene Practices: Practicing good hygiene, especially washing hands before meals and after using the restroom, helps reduce the risk of bacterial contamination that can lead to gut disturbances and oxalate-related issues.

Physical Activity: Regular exercise and physical activity can support overall health and promote efficient metabolism and elimination of waste products, potentially aiding in oxalate management.

A person wearing running shoes and running outside.

Nutritional Supplements:

Calcium Supplements: In consultation with healthcare professionals, calcium supplements may be recommended to bind with oxalate in the gut and reduce its absorption. However, supplementation should be tailored to individual needs and medical guidance.

Vitamin B6: Some evidence suggests that vitamin B6 supplementation may help reduce oxalate production in the body. Discuss with healthcare professionals to determine if it’s appropriate for your situation.

Final Thoughts 

The strategies and treatments for reducing oxalate toxicity should be individualized based on your specific needs, medical history, and guidance from healthcare professionals. It is also recommended to consult with a registered dietitian who specializes in oxalate management to develop an individualized low-oxalate meal plan that meets your unique needs.

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