The Case: 

• Robin is a 45 year old, super-busy, working mom dealing with aches and pains all over.
• She’s also experiencing stomach aches and unexplained bladder issues that include pain and burning during urination without a detectable UTI.
• She’s seen specialists, taken antibiotics, and tried eating healthier but her symptoms just got worse. 

The Investigation

When I hear that a healthy diet makes someone feel worse, I immediately suspect that the food they are choosing, while healthy on the surface, may not be right for them. This was my suspicion with Robin and I knew it could be one or more of a few things in her diet causing the issue. 

I’ve been wanting to invite Dr. Beth O’Hara on the show for a while and I knew this case was right up her alley. Dr. O’Hara is a Functional Naturopath and the owner of Mast Cell 360, a Functional practice specializing in root cause approach to Mast Cell Activation Syndrome, Histamine Intolerance, and related conditions such as oxalates, mold toxicity, and chemical sensitivities. She is a Research Adviser for the Nutrigenetic Research Institute and also works in-depth with genetic analysis.

What are Oxalates?

Plants are made up of compounds and oxalates are one of these compounds. Under a microscope, oxalates appear to look like tiny razor blades - they are very sharp molecules. Certain plants have a high number of these compounds which serve as a defense mechanism for the plant. Foods that we consider to be very healthy, could be high in oxalates like spinach, beets, rhubarb, sweet potatoes, and almonds. Oxalates can also be created by our bodies and some fungal species may create oxalates in the body. While many people are able to metabolize these compounds without any issue, there are also many that may not.

The Risk of Elevated Oxalates in the Body

Some people struggle to process these oxalates and this can be due to many things  and the oxalates build up. The immune system wants to get rid of this excess which results in inflammation. Overtime, this can become chronic and cause other health issues including kidney stones. however  kidney stones are just the tip of the iceberg and oxalates have also been associated with thyroid issues, autism, endometriosis, bladder issues, vulvodynia, PCOS, diverticulosis/diverticulitis, breast cancer, osteopenia and osteoporosis. 

Causes of Elevated Oxalates

One of the causes of elevated oxalates is eating a diet rich in foods with high levels of oxalates. However, there are plenty of people who eat these foods and don’t have an issue. There are a few other factors that can cause elevated oxalates. 

• Genetics

There are four genetic predispositions that may make someone more susceptible to developing an issue with oxalates. 

• Vitamin Deficiency

A deficiency in B1 or B6 can cause an issue with oxalates

• Leaky Gut

When there is a break in the intestinal lining, oxalates can move into the bloodstream and to muscles, joints and even bone, potentially causing many issues.

• Mold Toxicity in the Body

Exposure to mold can result in that mold colonizing in the body, which demands a lot from the immune system and can make it difficult for the body to deal with oxalates. Additionally, its possible the dysbiotic bugs may produce even more oxalates to add to the load.

Symptoms of Elevated Oxalates

Kidney stones are often noted as a key symptom but only 1% of people experience these. More often, it’s seemingly unassociated symptoms that are hard to nail down like fibromyalgia, joint pain, joint issues, visual problems (including cataracts), lung issues (including asthma), vertigo, urinary tract issues (pain and burning during urination as well as urgency that present like UTIs but no infection is present), and vulvodynia (stinging, burning, and irritation of the vulva). 

Mast Cell Activation Syndrome

Scientists have been studying Mast Cell Activation Syndrome or MCAS since the 90’s but it has only recently (2016) been given a diagnosis code. As a result, many conventional doctors do not know about it. The immune systems ‘front-line defenders’ are known as Mast Cells. It’s their job to recognize a virus, injury, toxin, or bad bacteria that is threatening the body and mount a defence against it (usually causing inflammation to the area) and then signal the immune system to do its job. However, when there is a chronic issue, like elevated oxalates, the Mast Cells become dysregulated, fail to trigger the immune system and cause MCAS. Mast Cell Activation Syndrome affects an estimated 10 - 17% of the general population and is estimated to impact over 50% of those with chronic illness. 

MCAS and Elevated Oxalates

Oxalates stimulate an enzyme called NOX. The role of this enzyme is to kill off pathogens and stimulate mast cells. When there are elevated levels of oxalates in the body, there is an over stimulation of mast cells which dysregulate over time and triggers MCAS. Oxalates can also cause physical damage on a microscopic level (because they are sharp and can wedge into tissue) which causes further mast cell stimulation. 

Diagnosing Elevated Oxalates

The key to diagnosing oxalates is to look at the four key causes, starting with a genetic predisposition to hyperoxaluria (high oxalates). There are labs that can do this test and there are four markers to look for: 

• AGXT (commonly associated with  kidney stones. 
• SPP1
• GRHPR
• HOGA1

The next step is to test for a vitamin B1 or B6 deficiency and an LDH. And, to make sure a leaky gut or mold toxicity are not issues. Dr. O’Hara likes to use the Great  Plains organic acid test as it has three markers for oxalates. The first two are glycemic and glycolic (related to the  human biochemical pathways involved in oxalate production) and third is oxalic (which will show oxalate from over consumption and it should be around 75). However, that is not going to show any oxalates that have been embedded into tissue or muscle. 

Treating Elevated Oxalates

Reducing oxalates in the diet is going to provide almost instant relief to symptoms of elevated oxalates. However, Dr. O’Hara says that you definitely DO NOT want to eliminate all foods with oxalates from your diet at once. Going ‘cold turkey’ can cause problems (including kidney stones). Instead, she suggests a gradual reduction over 6-12 months. She also suggests taking epsom salt baths and introducing binders (like magnesium, biotin, and calcium) as supplements to help ferry the oxalates out.  Of course, it is also important to deal with any compounding issues like vitamin deficiencies, mold toxicity, leaky gut or candida. 

Every individual treatment plan is going to be different and based on the person.

Mystery Solved

In Robin’s case, we found a high level of candida, a B6 deficiency and high oxalate markers through an organic acid test. My suspicions were confirmed. And, it made sense because she was drinking celery juice, putting tons of spinach in her shakes and salads, and eating more nuts in her effort to eat fewer grains. All of which lead to high oxalate intake. 

We started by lowering the high oxalate foods in her diet like spinach, sweet potatoes, almond products, and celery juice a little at a time. We added calcium and magnesium citrate with her meals to help her excrete the oxalates. 

At the same time, we worked on candida eradication with natural antifungal (I used some of my favorite go to’s GI MicrobX, FC Cidal and MicroGone along with enzymes and Probiotics and then used GI Revive and Enteroite to heal the gut and diversify the microbiome. 

She felt a difference in her digestion and urinary symptoms in just 2 weeks! Her joints took a bit longer to improve but in about a month she felt less pain and in 2 months her pain was about 75% better.

She continued to lower oxalates over the course of 6 months, after which she was really in a good place. 

Eliminating Health Mysteries

For Robin we were able to find that missing piece of the health puzzle and help her regain her health. Could oxalates be the missing clue for you or someone in your life? 

Links:

Resources mentioned

Thanks to my guest Dr. Beth O’Hara. You can access her High-Oxalate Foods List and her recipes on her website as well as her Symptoms Survey. Or, connect with her on Facebook. 

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