The Damaging Effects of Oxalates and Their Role in Inflammation and Disease

by Dr. Susan Tanner, MD

Oxalic acid is an organic acid formed in cell metabolism and is the most acidic organic acid in the body. It is also referred to as “oxalate”. When not made by the body, oxalate is commonly found in plants which include leafy greens, berries, fruits, nuts, seeds, and vegetables. Oxalate is thought to be made by plants as a defense mechanism to preserve proliferation and to deter their consumption by animals and humans—think the bitter tastes, or the way in which many seeds are not able to be digested without sprouting and/or soaking. Once ingested, oxalates bind to minerals to form compounds, including calcium oxalate and iron oxalate. Binding usually occurs in the colon, but sometimes occurs in the kidneys and other parts of the urinary tract. Most people eliminate oxalate compound easily in their urine or stool. While it is common to have some oxalate in a normally-functioning system, too much can lead to several negative effects or health symptoms which will be discussed here.

Oxalates can be formed in the body through three primary sources:

  • Diet
  • Cell metabolism
  • Chronic exposure to fungal and yeast organisms

Why Are Oxalates Problematic?

Oxalates are so acidic, that they are capable of impacting many soft tissues resulting in chronic and debilitating pain. Here are a few conditions in which oxalates should always be considered as reason for causality:

  1. Kidney stones. There are several types of kidney stones, the most common of which is calcium. However, oxalic acid kidney stones are not uncommon, and are the result of the accumulation of oxalates in the kidneys. Oxalate stones can become very large and deeply imbedded in the kidney tissues, often referred to as staghorn kidney stones. Patients who have these stones may have a genetic disorder predisposing them to accumulate oxalates when foods high in oxalates are ingested.
  2. Muscle and connective tissue pain. Oxalates can accumulate in these tissues, as well as in nerve tissue, leading to chronic pain and mobility issues. If you have a muscle or tissue injury that never resolves or chronic foot pain, often, oxalates can be to blame.
  3. Interstitial cystitis and vulvar pain. These are extremely painful, debilitating, and aggravating conditions, many times mimicking acute urinary or vaginal infections. If this type of pain plagues you, and your doctor fails to culture bacteria in your urine, rest assured that you are not losing your mind! Most frequently, this particular condition results from oxalate accumulation from chronic yeast or mold exposure. If this is the case, of course, the underlying cause (mold) must be treated by eliminating the exposure and detoxing the body.

While those symptoms listed above are a few of the more common manifestations of high oxalates, other manifestations, which include those that have been noted in children, are as follows:

  • Sandy and grainy stools
  • Eye Pain (eye poking in some children)
  • Body aches, Fibromyalgia-type muscular pain
  • Moodiness, irritability, and aggressive behavior- often seen in autism
  • Tendon pain, trigger point tenderness, increased tension in muscles with movement

Diagnosis of Oxalate Issues

While there is some importance in determining if high oxalates are primary (genetic) or caused by other factors, such as foods, the main takeaway is that they be identified, and reduced in all cases. The biggest difference is that foods that are high in oxalates should be continually avoided in primary cases, whereas in those situations caused by fungal/yeast overgrowth, these particular food avoidances may be temporary.

Currently, the best and most affordable test to do to determine if oxalates are a problem is the urinary organic acids tests. Not only will this show the levels of oxalates, but it will also show if, indeed, there is yeast/mold overgrowth going on in the body. Extremely high levels of oxalates in the urine are more consistent with genetic tendencies.

High Oxalates, Mold Exposure and Candida/Yeast Overgrowth

Not much has been directly studied in regards to high oxalate levels and mold exposure, but there are significant testing correlations between mycotoxin accumulation in the body and oxalate issues. As a matter of fact, some molds produce mycotoxins that then produce oxalates which directly affect the kidneys—namely ochratoxin which is a metabolic byproduct of Aspergillus and Penicillium, molds that are indicative of water damage when found in indoor spaces. Ochratoxin affects kidney function by inhibiting protein synthesis, disrupting DNA and RNA, and inhibiting enzymes in the kidneys. Thus, if high oxalates are found to be plaguing your health, one of the easiest next steps is to test your environment to see if the air you are breathing might be contributing to that issue.

Oxalates levels increase with Candida and yeast overgrowth as well. Candida messes with the tight junctures in the small intestine creating “leaky gut.” Leaky gut in turn allows more oxalates contained in food sources to accumulate in the body, rather than be metabolized and excreted. Candida has been found surrounding the oxalates within kidney stones. Additionally, studies on autistic children with high oxalates have shown lowered levels when antifungal treatments were used and when Candida is specifically addressed.

Addressing Oxalates

Treatment of high oxalates, once found, involves several steps:

(Note: It is recommended that very high levels be treated slowly, as too rapid breakdown can lead to an oxalate “dump” which can actually increase pain and symptoms.)

  1. Getting rid of the mold and yeast in the body. If the environment is problematic it MUST be addressed. If Candida is present, that also must be treated.
  2. Reducing foods high in oxalates in the diet. There is a huge list of these foods, and while taking them all out may be very difficult to do, we recommend removing those on the very high end of the list and to avoid eating multiple foods daily with moderate levels. Some of these high-oxalate foods include soy, almonds, spinach, kale, and dark chocolate. A complete list of high oxalate foods may be found on the Great Plains laboratory website.
  3. Boiling or cooking high oxalate foods such as spinach, chard, and sweet potato to help reduce the soluble oxalates by up to 50%. This may not be enough reduction to help in severe cases.
  4. Supplementing with Vitamin B6 on a daily basis. B6 helps the enzyme that breaks down oxalates. Dosages may vary, but for the intent of this function, I would go with a moderate dose of 10-25 mg daily. Pure Encapsulations B6 in the form of P-5-P is a good one.
  5. Supplementing with Calcium Citrate, balanced with magnesium, to help avoid oxalate accumulation. There are easily-administered chewable forms available for children, with dose ranges from 125 to 500 mg. This should be taken before meals using higher doses if foods higher in oxalates are being consumed. Both Carlson’s and Kirkman’s make the chewable form. For pill form, Klaire Labs and Ecological Formulas are excellent.
  6. Staying properly hydrated. Drinking purified water, at least half of your body weight in ounces daily, reduces oxalate accumulation in tissues.
  7. Taking probiotics. While these are a part of an anti-yeast program anyway, they should never be missed when addressing oxalates. Therabiotic Plus by Klaire Labs and Orthobiotic by Orthomolecular Products are good choices. Additionally, a prescription probiotic, VSL #3, contains a particular type of organism called oxalobacter formigenes. This bacteria lives in the colon and relies solely on oxalate for energy. Therefore, insufficient oxalobacter is thought to encourage elevated oxalate levels. Supplementing with VSL #3 can be used to help reduce levels.
  8. Taking Epsom salts baths. I suggest 2 cups of Epsom Salts in bathwater. Soak for 15 to 20 minutes, and rinse off afterwards.

Successful adherence to an antifungal regimen (air and diet), low oxalate foods, and good supplemental scheduling can make a remarkable difference in pain levels and your body’s ability to function optimally to excrete oxalates.

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