Comprehensive Guide to Oxalates: Sources, Risks, and Management

[Music] Welcome to our webinar series for professionals

also if you don't mind sharing your slaves with me after the presentation oh sure sure no problem

you'll always appreciate that so do you want me to send it to the email um

I think I send you a meal directly no it was um

yeah that's the one okay okay I'll send it to you I sent you an email um meal that we send out when we send

out the link short introduction I hope everyone is back from

tea break or whatever stretch legs break I might have to just stand up a little bit and when you start the presentation

that's okay waiting around anyway

um now it's uh Lindsay Goddard who's a registered and licensed dietitian and she has a masters in nutrition and a

bachelor's in biology um and you are from what I understand doing a certificate in toxicology now as

well yeah that fits very well with the uh the profile of Mosaic Diagnostics so very nice

working in hospital settings and then uh for the last what was it four years you uh have worked with uh well that would

be great clean so this now we'll see um yeah educating and teaching and supporting practitioners as much as you

can and I'm so excited about this because I yeah it's going to be oxalate for yeah 50 minutes

I guess it's because I have to say more or less the same background as you have um and I'm just very much excited to

hear like the clinical side test when they're high on the oxalates so I will pass on the stage to you and

you may share your slides again if you have questions put them in I might take note of them let's see how time flies

and then I'll just unmute myself but I'll stay online all the time all right hi everybody my name is

Lindsay Goddard I am um like Ann said a registered dietitian um and I am a clinical educator for

Mosaic Diagnostics so a lot of the things that you're going to be hearing from me today are more from like a

biochemistry standpoint and also from a nutrition standpoint and then through the glasses of a consultant for the

plane or for Great Planes now Mosaic Diagnostics um so some learning objectives that I

hope that you gain from this lecture is understanding what oxalates are the sources of them and how to kind of

pinpoint where they're coming from the impacts they can have on the human body and our health

who's at risk and how to start to understand and pick out who you may want to think about oxalates for in your

patient populations um then we'll kind of get into some clinical pearls and some

um and you know interventions that might be helpful for oxalates and then we'll discuss two case studies at the end to

apply the knowledge so what are oxalates and you'll kind of hear these terms interchangeably

oxalates and oxalic acid and basically oxalates are the conjugate base of the oxalic acid

but they're kind of similar in that sense so oxalic acid is actually one of the

more acidic organic acids in human fluids and they themselves can be problematic

but where it becomes an even bigger problem is when these soluble compounds conjugate to a positive charged element

and it's usually minerals and metals and then that becomes insoluble and creates this crystallized structure and

then that can kind of disseminate through the tissues and the system and

I try to put them for the Affinity in order but as you can see you know lead and Mercury

copper zinc iron cadmium calcium and magnesium all have higher higher affinities for oxalates

and so all of these can create the crystallized structure calcium oxalates being the most common

um and you know a lot of times we're talking about these external influences with oxalates but we actually do produce

a little bit on our own and we'll discuss this kind of further on in the lecture and I try to be a little bit

repetitive because sometimes that is helpful in understanding these things um but we ourselves produce some and

then we get also larger amounts normally from other sources and this is what it looks like on the

organic acid test you'll see glyceric glycolic and oxalic and the way I think about this and just in big terms

is you have oxalates and then they have choices they can go in different Pathways and one of the pathways is

glyceric glycolic and oxalic acid okay so so here you have oxalates and plants and these are under a microscope

but it's really neat to see and just so you can kind of have a visual of plants with their oxalates in them and

plants tend to have oxalates for a couple of reasons one is for structural Integrity of the plant itself

but it's also can be a defense mechanism and we'll talk about that a little bit later but you see you can see these

crystallized structures um here and here into the plant cell

and here's oxalates and fungus um and so you know different fungi produce

oxalates not all fungi produce oxalates sometimes they produce glyoxylate which can then potentially turn into oxalates

but it's not always direct and we'll differentiate that later but I want you to appreciate these crystallized

structures and again sometimes it's a defense mechanism and sometimes it's structural Integrity for the organism

and these are oxalates within our cells so um this is in a bone matrix and you can

search it to see these crystallized structures and this is actually um a histopathology uh the kidney and

you can start to see the crystallized structures there from the oxalates just so you can have like a visual

and when you start to think about oxalates I always think it's really important just to have that picture in

your mind of the metabolism and so you can start to see here you can get it from food and then it goes into

the gut and and the hope is that it just gets eliminated through the stool and then it doesn't get into circulation and

it's fine and it moves on however it can start to get absorbed into the bloodstream

and I can go to the liver um and it can be and then it can also come up from produced in the liver and

then it can go through the kidneys and into the urine and so there's all these different it's

kind of interchanging going back and forth to um for reabsorption but just so you have

an appreciation an idea of you can picture how these oxalates are getting into the system

getting produced and then being eliminated um and that kind of takes us to the

elimination and again these are the crystallized structures that you can see but just keep in mind that elimination

is highly individualized and it's not as well understood why that is um a lot of nephrology

um professionals are talking about this trying to figure out why people

um have such problems with oxalate than others it doesn't bother them at all um a lot of different components but

here um some main factors that we do know that's

going to influence elimination is genetics vitamin and mineral status fluid status and gut health

so there are some things that we can have control over to a degree right our nutritional status intake of fluids and

hopefully get to a degree so that can help so let's talk about sources

um so you have direct and indirect so direct would be ourself so we can produce a little bit and and some

genetic disorders we're actually producing a lot and it's very harmful for our kidneys and then you can get it

directly from consuming the plant um and its counterparts because the plant itself has oxalates because of

glyoxylate cycle and we'll get a little bit more in depth about what that glioxylate cycle is but basically in

essence it's a very similar cycle to our citric acid cycle except it produces a compound called glyoxylate and then that

glioxylate our system can take and start to make oxalates from it um and then also internal mold so I'm

I'm sure Jasmine and Dr Bullard talked about this but when there is mold activity going on in the gut

um or you know technically in other places pulmonary tissue sinuses ear canal

um the mold itself the aspergillus is producing oxalic acid and oxalates so that can be just another compounding

factor of the organism being present and then a more indirect way of us getting it is part of that

glyoxylate cycle from those organisms that are present within our system um bacteria habit yeast habit

protist habit so a lot of these organisms have this glyoxylate cycle and remember that's a

similarity to our citric acid cycle but it's producing glyoxally as a byproduct and then our liver is turning that into

oxalates potentially and so that's an indirect source and so just so we have an understanding

of our own production of them we have this compound called glyclycolate it's not very well understood where it's

coming from there's some hypotheses out there that it's coming from our carbohydrate intake but it's not very

clear and what our system will do is it'll take the glycolate and it'll turn it

into glyoxylate and then the hope is that through this AGT enzyme it's B6 dependent it will convert it to Glycine

and then we can make our own glycine however some will start to shunt to oxalate and then our system when it

combines with minerals will start to create those calcium or those oxalate stones

or crystals um and this is done through the lactate dehydrogenase enzyme

and so if you'll remember in in some instances um you know sometimes LDH will be

elevated in serum and it's kind of a red flag for cellular dysfunction and and so that's something that you

want to think about if you're writing those labs and you see that elevated you know what's going on at the oxalate

levels because that's the enzyme that's pushing it so let's talk a little bit about the

genetics [Music] um

so primary hyperal xuria type one this is caused by the deficiency of the alanine glyoxylate amino transferase

enzyme so this enzyme right here and so this is deficient and so therefore the glyoxylate that we're producing converts

over to oxalate um and so this will actually lead to an elevation of oxalic acid and the

glycolic and so when you see these two elevated and the oat together

it's possible it could be genetic I would say that's a very rare occurrence though and

um just really look at your patient and the symptoms and the past medical history to be able to maybe make that

inference and and start thinking about that what I typically do if like that's a question on my mind with that test is

I um I'll address if we found anything else on the first page make sure it's like

process of elimination um because having yeast overgrowth and um mold overgrowth or

um a lot of dysfunction in the yeast and fungal markers can Elevate these two so it's like you do process of elimination

get those down if you rerun the tests and you see these are still very elevated and maybe they do have a

history of kidney dysfunction and kidney stones then maybe you start to think about that but this is very rare

and it's very extreme and then this is just a pathway so you can kind of see it happening and so you

have the glioxide remember and then it goes to the oxalate glycolate and this is happening in the peroxisome and it

can also have an mitochondria to a degree and then you have type two this is a

much less severe case um and so you're you're there's a deficiency in the glyoxylate reductase

basically or the hydroxypyruvate reductase um and then what you typically see on

the oh if this is the case in this genetic you'll see glyceric elevated and oxalic acid Elevate again pretty rare

um you don't typically see this I would say more often than not these elevations are coming from the organisms or diet

um but it's definitely something to consider because you don't want to miss it just in case

um so and then we talk about other organisms Productions right so we talked about ours now

all of these other organisms that have this glyoxylate cycle plants fungi bacteria protis and nematodes and a lot

of things you'll hear people say like oh I see high oxalates I think mold I think yeast well those are common

um but there's there's other layers to it so I try to think about that too um I think we were talking about the

glyoxylate cycle it's kind of a variation of the TCA cycle the citric acid cycle or Krebs cycle

um it's an anabolic pathway and basically what it's doing is it's helping the organism convert

carbohydrates or convert fatty acids to carbohydrates so just kind of thinking about that too

um and it's and it has this conversion of acetyl-coa to six and eight for that

and here is the pathway you can see and and these organisms the reason why it's assumed that we do not have this

Pathways because they are measuring an enzyme called isocitrate lies and it's the isocitrate lies that takes

this Isis citrate to glyoxylate and to succinate and um this Pathways a little bit further on in the lecture but just

so you have that awareness that this is kind of what it looks like it's very very similar to our cycle this is kind

of where it diverges um and then you have the consumption of plant matter that has the oxalates

already in them um and so it'll happen is you'll get the absorption through the GI tract assembly

through the system conjugates with the minerals or the metals forms the crystals and then starts to embed into

the tissues potentially and this is by no means an exhaustive list of the high oxalate foods but these

are probably the ones that you're going to come into contact with the most right you've got people who are trying to be

healthy and they they love their spinach smoothie with blueberries and maybe they put

um some nut butter in there and maybe they use soy milk because they're Dairy and intolerant

and so so you've got just like a huge oxalate load right there um

and I also want to just be mindful here that um I mean a lot of these foods have

really good components to them too and I try to have that awareness too and I'm talking to patients about this because I

really don't want them to be too restrictive in their diets um but if if athletes are a really big

problem for your patient you have to have this awareness and this is also really good at being able to

um think about what their potential oxalate load is and not just depending on the the urine to help you with that

um but always keep in mind that it's the dose that makes the poison the huge Concept in toxicology it

applies in most of life it's the dose that makes the poison so if if they're eating just a little bit of spinach it's

not going to be a big deal if they're eating a bunch of spinach every day that's a big deal

right and then when people talk about low oxalate diets

it's just kind of this assumption that that means they have to take out all plants

um but that's not really true because plants differ in their Oxley content um and so here are some really healthy

foods that do have that don't have that many oxalates um I like to kind of hone in on bok choy

because bok choy is a nice vegetable to have on board because it's low in oxalates but it's also high in calcium

so if you're dealing with oxalate loads remember oxalates have a high affinity for calcium

and that'll help with conjugating it to help eliminate it um and the other thing that you try to

keep in mind is here if your patients are like big tea drinkers are also kind of getting some oxalate loads there

um but green tea doesn't have it and then something neat is so we talk a lot about fungi as it's glyoxylate cycle and

they have this potential to have like high oxalate loads either directly or indirectly but their fruiting bodies

don't so the mushrooms are fine um and so I try to kind of keep that in

mind too like not all fungi are bad right and not all sometimes I buy products are bad when it comes to

oxalates and then tropical fruits so this will be on a list for a lot of different sources

but just be mindful that glucose levels and oxalate levels uh can influence each other and so tropical fruits tend to be

higher in sugar and so just just having that awareness and what you'll notice is when you start to Google low oxalate

diets or high oxalate Foods it's pretty variable depending on a source there's some that are pretty consistent spinach

being one of them soybean one of them chocolate being one of them but then once you kind of start getting out of

that realm they do differ and part of that is because plants differ in their oxalate levels depending on a few things

soil and age of the plant two has a big play in it so if you're ever out in the woods

and you notice like on different plants that the deers are consuming or the animals are consuming It's usually the

baby leaves instead of the adult leaves and the reason is because oxalate content is

lower and they don't get a stick from them and they're sweeter right and part of that sweetness is

because they don't have as many oxalates and the thought behind that is because plants are

um when they're growing they're spending all their energy growing and not producing uh defense mechanisms yeah

at least to us to a degree so you know sometimes I wonder about that if that's part of a you know

um of why they differ it's because the plants will differ depending on the age of the plant and the soil has a

influence too because that's going to be mineral dependent and how can the minerals and the oxalates play together

to create the structures um and then portions so like how are they differentiating are they using

portions um because that sometimes can move it from a low to a medium to a high just

kind of having that thought because you'll notice like I put the resources where I was getting it here so you can

see that there's there's so many different ones and they'll all differ to a degree

um okay and we kind of talked about this um before but remember it's just the byproducts of other organisms so candida

glyoxylate molds um as the actual oxalates um and then this is what you'll commonly

see on the oat so I kind of picked a an extreme case um but you can see that there's a lot of

fungal activity going on and then look how high those oxalates go um and I would bet you that the spicier

and glycolic is also part of that part of this whole fungal picture so they can get really high and we'll

see it in a case study later of how actually how high I can get I've definitely seen them in the thousands

um just from like a lady eating um Swiss chard the night before she didn't have any symptoms which was odd

um but they were certainly coming out uh so different impacts on health uh so when you're evaluating your

patient and you're trying to figure out if like oxy oxalates can be a component my biggest question is do you have any

pain that doesn't make any sense right like um do you have urinary pain but you

don't have any urinary infections your urine analysis comes out normal um and you know even antibiotics don't

really make a difference um I would say most commonly the places of pain are in the joints and the

muscles the uretha vulva and bladder um sometimes you can get some insight into the stools and in the urine so they

have Sandy and grannies looking stools are very very cloudy urine um that can kind of give you some Clues

um if you work with children a lot of times you'll find that if they're dealing with oxalates it's painful when

they urinate and so maybe they hold their pee um and then they have excessive bed

wetting or they wet their pants often and sometimes with the males you'll have them pulling on their penis like holding

their penis um though the girls will hold on to the vulva

um labia and just like like you can tell they're in pain or they cry when they urinate that's a big question I ask

parents um headaches can be associated with oxalates and if you work with children

or especially in the autism Community if there's head banging that can be a sign that their head is hurting and that

might be oxalate related um increased urinary frequency can be a component to eye pain

um and and this is really interesting Dr Shaw has um some experience with this and he has

some fun stories about how he has actually worked with children who have like pulled their eyes out they were

able to retouch them but they were pulling them out because the pain was just so severe

um and part of it was oxalates but the other component of that is eye pain can be associated with calcium deficiencies

and so like you know these autistic children are typically on dairy-free diets so you have dairy free and then

you if they have like a high oxalate load because of the fungal overgrowth that they're

having or the dysbiosis that's present then um it's kind of

exacerbating the issue because you have high oxalates low calcium intake and then the pain can start to really

get to them um so just being mindful of that and people on

um Dairy restrictions I I typically do see them being um more susceptible to oxalate problems

of fibromyalgia like discomfort um moodiness irritability and and sometimes

that's a little bit hard to differentiate is that like the dysbiosis or is it the pain from the oxalates

anxiety has a high association with oxalates uh you can see this more uh clearly in children because life isn't

as complicated yet as when you get to an adult and like anxiety can be for a number of reasons when you're an adult

um but there is a high association with anxiety and oxalates more clinically based

um and then ear pain so like ear infections but there's really actually no infections

um their ear just hurts and those can be some other signs too and then disorders that have the

potential to be associated with oxalates so fibromyalgia is pretty obvious but all the Denia is a big one

kidney and thyroid dysfunction so kidney is kind of an inherent thought right because it's passing through the kidneys

um but when you have a patient that has a lot of thyroid problems but it's not real clear why this may be something you

want to rule out uh dysbiosis if there's a lot of dysbiosis on board um definitely be thinking about oxalates

part of it is you need the beneficial Flora to um

to break down and to remove the oxalates the other part is you know the organisms there may be producing

um directly or indirectly um so we should be thinking about that mineral dysregulation so if you have

patients that are anemic no matter how much iron you give them um magnesium is really hard to get up I

start thinking about oxalates zinc yes but then you kind of start kind of moving into that pyrol disorder disorder

and so like if that one's a little bit harder to differentiate but you know if they have that and they

have closing and low B6 and you know they might be kind of might be wanting to think about

oxalates being a component and then autism that's a big one so who is at risk

um a lot of times it comes on the lifestyle genes and health status um

so if you have a lot of vegans or vegetarians that population tends to be a little bit higher risk because not

only are they consuming High oxalate content Foods maybe because they have that misconception that they're getting

their calcium from those food like in spinach and so they'll eat more spinach or they need the iron more

um and sweet um but the other thing is if it's particularly with the vegans they have

low calcium intake already because they're not doing Dairy so just kind of be thinking about that

um genetics so aside from type 1 and type 2 if you use genetics in your practice there might be some

um of these that you want to pay closer attention to so the umod gene sexually codes for Euro

modulin um and this is actually responsible for inhibiting the calcium crystals in the

urine and if there's other variants like this F uh let's saw an S oh sorry spp1

variant that can actually increase the risk uh c-a-s-r the calcium sensing receptor

um and this is the receptor that senses extracellular or calcium levels in the kidney

and so they have this variant maybe you want to pay closer attention and then you have the L the SLC 26a4 Gene and I

would say that this one has some some pretty good evidence behind it um and this actually is what provides

the instructions for making a protein called pendrin and um this is influencing charged particles

and the ions um and it can actually have an influence on Mineral composition size and shape

and this is feminine the cells which then inherently is going to influence the calcium or the oxalates

oh GI disorders um anything that's really going to

influence how nutrients are being absorbed um into the system so Crohn's gastric

bypass um IBS think about those patients frequent

antibiotic use so there's this really neat bacteria that I'm sure you guys have heard of that actually is pretty

direct and breaking down and eliminating oxalates it's oxalobacter form of genes and this is very very very sensitive to

antibiotics so it can be eliminated with around so just being mindful of that and

then of course you know along with antibiotic use you that have the increase of the fungus and the

clostridia and then that's another component you have to think about and then poor fat

absorption so fatty acids if they're more floating around and not able to be metabolized

they will conjugate to calcium which makes that less available for the oxalates and so if there's less calcium

available in the gut for the oxalates to bind to and then be eliminated then they're going to go into the system and

disseminine and this is a really cool picture that I thought was super helpful and kind of

understanding what's influencing oxalate absorption and where it's happening so oxalate absorption

there's a lot of variables to it again but pH is one of them low PH can actually increase the absorption but

thankfully not a lot are being absorbed into the stomach it's like zero to ten percent very very minimal

um so thankfully we don't have to worry about that but if there's a pH disruption and the small intestines or

in the large intestines where oxalates are being absorbed um yeah that that could certainly

influence it the the bacteria the minerals um you know the higher the mineral

content and the gut the less likely those oxalates are going to absorb into the system they're going to conjugate to

those minerals and then be just eliminated through the stool um

and so this just kind of gives you a good idea of what's what's going on in different factors that can influence it

from a GI perspective um okay so now you know where it's coming from you know how to look for it

but what do you do with it um well there's a lot of good evidence in

supporting oxalates um and it's reduction with B6 the the research supports 50 to 100 milligrams

um and the whole point of this is this shunt that glyoxylate more to glycine so it doesn't go to oxalates through the

LDH enzyme and here we saw this figure before and here's another figure and this is actually the one on the oat and

this is where the isocitrate lies enzyme um in that glyoxylate cycle makes the glyoxylate and then again we can push it

to glycine with B6 in the liver or we can take it to oxalates uh calcium citrate and magnesium citrate

with mules so you know we were talking about how they have such a high affinity for these minerals and if you can give

um calcium and magnesium at the time of oxalate intake you can significantly reduce the

absorption through the gut and allow it to go through the stool instead and a lot of times I get the question do

you you know can I use oxide can I use glycinate and I prefer this citrate because the literature supports citrate

because the idea is that the citrate will block the absorption of the crystals and it can actually inhibit the

crystal formation on its own so the citrate is probably the best form to

use and it's typically used in a three to one ratio so for example it's like for every 300 milligrams of calcium it's

100 milligrams of magnesium and you can increase that if you're comfortable with it based on the oxalate

load that the patient is taking in now sometimes that gets a little bit hard to administer

um you have to be able to trust your patient and like having that awareness but

a lot of my patients anyway are super Savvy sometimes more savvy than me um

so I I think it's I some I usually trust them with it

um but so you can adjust that dosing it just needs to stay on that ratio depending on the meal

um and don't forget about food pairing this is really I think this is a cool way to do it instead of having to take

one more supplements um so if you have patients that still do dairy that's usually the easiest way to

do it but if not I feel like a lot of people are not so um you know any calcium rich food or

magnesium or food with a high oxalate food you can use that as a way to help ensure

that the oxalates don't absorb into the system and disseminate and get through the stool

now keeping in mind though um and this is this is a big point to drive home is that they're not absorbing

these minerals when you put them through with the oxalates so I usually tell my patients like if you are going to be

consuming um high calcium or calcium rich meal with oxalate Rich meal you're not taking

the cow you're not absorbing the calcium you're just using it as a binder and the same rules apply for the supplements so

I have a lot of providers It'll ask me like well my patient's really worried about the

diarrhea aspect if I give them magnesium well they're not absorbing the Magnesium they're using it as a binder so you

don't necessarily have to worry about that but they just need to make sure that they're taking it with the the meal

and then if you're using magnesium or calcium as a way to get their levels up in their system then you have to get it

separately if that makes sense so just kind of keep that in mind when you're using this as a

intervention um okay so of course improving the microbiome I feel like this one is one

that gets often missed with providers um they're like more focused on like you know killing and

um reducing uh low out and like administering a low oxalate diet but really improving the microbiome will be

very very helpful um it's usually through lactobacillus and bifidobacterium the

um the barima genes if I always mispronounce that one so forgive me those although they have the best

literature they are the ones that are reducing the oxalates they're not really commercially available

and part of that is because they're so sensitive they're sensitive to the conditions that are going to be

necessary for the formulation of the supplement to occur uh because they don't do well in low ph and oxygen-rich

conditions so even if they were able to develop them we'd have to figure out a way to get them uh past the stomach to

bypass it because it's too acidic for it um maybe like a suppository that would be great

um but I just don't think it's out yet so lactoon tend to be the ones that we're kind of focused on and helping

with the breakdown and also you're kind of replenishing because remember oxalates can damage the

beneficial fluid to a degree and um there's actually a product out there

now um that promotes this they have a probiotic that is designed to reduce

oxalates so and this is kind of kind of I feel like Miss too especially

with patients uh they kind of forget about how important hydration is um it's so important and so

you know usually it's like if you don't want to do the math it's two to point 2.5 to 3 liters or if you're using

um pounds it's half your weight in pounds so um it's

to what 2.2 divided by kilograms so um it's just half your weight and water um and I usually tell them that you'll

know you're drinking too much if your urine becomes clear and at that point you probably want to add some

electrolytes just to kind of help with reabsorption uh not doing too much salt and sugar and

so there is some associations now coming out with like blood sugar dysregulations and oxalates and the influence there so

just you know again like blood sugar regulations really really important on a number of levels but from the Oxley

perspective it can also be really important um and then again like adjusting the

oxalate foods and so just remember the proportions and age of the plant can um

kind of liberalize it a little bit um combining nutrients to help with the absorption and if you choose to do a low

oxalate diet my best advice for you is go low and slow um that's going to be really really

important and we'll see that later on but a lot of these things you need to go low and slow with from an oxalate

perspective for certain people address the dysbiosis I mean I feel like Dr Roller probably explained this very well

and suited Dr Brown so um you know just making sure that mold yeast in clostridia and if you find them

to be on the oat you address them I just probiotics versus Botanicals versus Pharmaceuticals your choice

um and then any other pathogens that you find like on a stool test um all right or you know a breath test

and make sure you address those as well um and then other things that if you find

um you know if they do have fat malabsorption bio Acid versus enzymes maybe they need addressing that also

review the supplements um so there's certain supplements that can actually increase oxalate loads uh

bone broth is one of them collagen is one of them um they actually have a compound called

hydroxyproline which can convert to glyoxylate and then you know and then the oxalates can come from that

um glycinate so if you have a patient who is having a very significant problem with oxalates maybe be a little bit

mindful if they're taking you know magnesium glycinate or glycine because it's not a one-way reaction it can go

both ways so glycine can have the potential to convert back to oxalates if and high enough doses

so just being mindful I don't recommend low glycine diets or anything like that I think it's a little too extreme but if

you have somebody who's really sensitive maybe they just don't want to overdo glycine

um okay and this is what I was talking about with low and slow be cautious with oxalate dumping

um and so what will happen sometimes is you have a patient that presents like you would expect a high oxalate load

right they've got a lot of yeast they've got mold not dysbiosis they have a diet that's pretty high in oxalates a lot of

pain and yet you run a note and oxalates look like nothing and when you have a presentation like

that when you start thinking about oxalate holding and so it's when the oxalates are unable

to precipitate out of the tissues and so you're not going to find it in the urine it's kind of what I use I tell providers

like neural or nephrologists are not running oxalate levels on people with kidney stones because they already know

where they are and they're not coming out in the urine yet

so um so in that when that's the case you want to be very careful and how much you

take out at one time because what happens is the body wants to stay in a homeostasis level with oxalates

and so as you start reducing the amount what will happen is the system will start saying like Okay now I can allow

more oxalates to come out and they start precipitating out of the tissue and it's incredibly uncomfortable for the patient

they get a lot more pain um wherever it is that they were having pain and it's and then they don't want

to do the treatment and so that's why I'm usually saying go very low and very slow if you're removing removing

oxalates out of the diet do it one at a time and adjust portions first um and and then you can also add

magnesium if you need more support and epsom salt baths or creams um and for as an intervention

and then there's some common misconceptions that float around um and I just want to address it just

making sure like um you know cooking cooking can remove some oxalates mainly boiling and it

removes about I think 50 percent um but but not all cooking methods do that

and um usually even with the boiling uh you still are getting some oxalates so just

being mindful of that um and we kind of touched on this with the oxalate dumping but normal urine

levels um of oxalates don't necessarily mean that

oxalates are not a problem it just means that you didn't find them in the urine so just you know having that awareness

and then vitamin C causing oxalates so I get this question a lot about like if they have a lot of oxalates they don't

want to give them vitamin C but the reality of it is ascorbate to oxalate is not a favorable reaction in

fact you need a lot of ascorbate for that to occur and it usually happens to the presence of high copper so if you

have a pressure a patient with high copper levels yeah you probably want to be really careful with vitamin C but if

copper levels are normal and the patient needs it I don't ever see it really being a problem until you

get probably around past two grams that's my limit um but I've seen people do four five

grams without a problem so vitamin C isn't always a problem sometimes it can be but

um it's not it's not usually the case okay so we'll do some case studies we

just have two I know we're kind of getting a little short on time so I'll make sure to be honored that

um so here's the first case study um this was a position that I was working with and um as a consultant and

they had a patient uh 40 years old 40 year old female Chief complaint of bladder and urinary pain for the past

six months um but the urine analysis was negative or any growth of the organisms that they

were measuring and it had a history of heavy antibiotic use throughout life

GI complaints for constipation bloating certain foods and then they also had fatigue sugar Cravings irritability

general aches and pains time and diet this variable um meat was a protein source and plant

consumption was pretty inconsistent so it really couldn't like pinpoint because sometimes you know like a 24-hour

dietary recall list I think you have the full picture um

so this is what her out looked like we had an arabinose of uh about 150 or 105 some dysbiosis

um and then there's for her oxalates at 148. so

what the provider did was they did an intervention for the yeast um they gave high-dose probiotics of

lacto and bifido with escalarney and then they also did a killing agent of caprylic acid Arco with unvisalignic

acid and then for the oxalates they added B6 and cow mags citrate with oxalate

contained meals and um a three-month follow-up because

usually I think it's recommended this way I recommend it six um six weeks to three months you want to follow up and

recheck uh the oh to see and make sure your intervention is working appropriately

um the urinary and GI complaints have resolved all other complaints improved um

and the oat showed a decrease in yeast despite this is amoxicillin and there's the yeast the dysbiosis of oxalates the

normal um so the takeaway is I mean this was a pretty simple direct case

um but the takeaway is the oxleys can have direct impacts on various systems um as cane yeast and it may not need

aggressive therapy to reduce the organisms producing the glyoxylate and it's always patient dependent so like

that wasn't a very ex you know I didn't have to hit that hard or anything but um just reducing the yeast and getting

it down really made a huge difference especially from the oxalate space there's a little bit more of a

complicated case this is probably one of the most interesting ones they came across with

um oxalates and this was a four-year-old little boy and actually I was working with his mom

so this was back in the day when we worked with patients too and

um she wanted to go on a vegan diet and um when she started on the vegan diet

a little bit afterwards the little boys started having seizures it's a recent onset no history of seizure activity I

think in the family but when she switched to a vegan diet um

and she died he started having seizures and she's she was a smart cookie and she was like I wonder if it's the oxalates

and so she discontinued the diet and a few weeks later the oxalates result or the teacher's result never had another

one and what she wanted to do is she wanted to take a look at the oxalate levels six

months after stopping the diet and um and I will tell you that after we ran this the genetics were ruled out

because I had her go back and I was like you need to go check genetics genetics were ruled out and he's not had

a seizure since but but look at this this is really interesting so all fungal normal little dysbiosis a little

claustria so I mean we kind of addressed that but look at those oxalates

I mean that that was like one of the highest I'd ever seen and that's six months on a low oxalate diet

and so I can only imagine what his levels were before and maybe at this point he's kind of oxalate dumping

um and he's just eliminating what was left over um but this is I mean this is crazy I

get a 517 on a low oxalate diet she I mean she was really good about like the calcium and everything too

um so it just you know in my opinion the takeaways here and the point of me like

showing you this was that oxalate oxalates can really have a severe impact on patients it can be aside from just

pain um and excretion amounts and times very pretty individually

um and there and sometimes you can control it and you can have an explanation and sometimes not

um and thresholds are variable so you can have patients that can have high oxalates and not have a problem and then

you can have patients uh with even the little less oxalates and they have a big problem

and this little boy didn't have any pain or anything at this point he was just eliminating

it was what we kind of came up with and that's

the presentation so thank you all for listening and I hope it was helpful thank you that was very interesting I

love it when it's Hands-On and which foods and it actually made me think of maybe you have a patient handout that

you would like to share with us I don't know but if you have yeah

easy for us in the clinic oh sure yeah well there's um there's some blogs too on this like on the

Mosaic website um I think Dr Shaw wrote One um but yeah we can send you some

handouts excellent thank you very much and I'll share it with the rest of you so

um some uh was asking if you know the names of the genes that are related to uh oxalate

uh oh I think well I put the jeans here there's some jeans there

and then there's um the AGT and the grhfr okay super screenshot of that

and then uh like do you have an idea of the headache like how to describe the headache from

if you have an oxalate headache it's just uh I've been in my experience it's usually around the eyes

behind and make the frontal lobe a little bit I guess in theory it could

be anywhere I know with um when I was working with a lot of autistic kids they got like red

eels after they had eaten food and it was like painful for them and I don't know what that feels like when

um but um yeah I guess it's some form of like I I imagine that it's something like when it's very cold and your ears

get like Frozen and I don't know why well I know sometimes that can be related to food and um sensitivities

um but this Gene right here the SLC 26a4 um I am not a geneticist by any means but this one had some pretty interesting

um research behind this one and then the ears and how the calcium oxalate crystals can get into the ears and they

had this Gene pretty highly associated with that and then I've been an additional

questions like so if they find it and if the symptoms are in the hits and in the eels is that because the tissue retains

the oxalates and then we may not be able to find it in the urine or so that's where it gets really tricky so

it could be that um and it but if it's particularly behind the eyes it could also be a

Calcium deficiency related to the oxalate so it's like more secondary okay

so yeah we don't know then I what was the last one no I had one asked if you do like I

guess it's like dark field microscopy and you can see these crystals would that then be oxalates that you see you

could potentially see that okay I think that's it just want to know what

you're looking for I think of course um yeah so I think that's that's the questions that I kind of could

but on the side and time is up now we've been sitting here for four hours everyone

and uh some places it's getting rather late and uh dinner is probably being served

around in the Little Homes Etc so oh someone has a last question Susan see if you can type it quickly enough

but if nothing else we have done um the recordings and we will share with that with you as soon as possible

probably next week when we get to the email put together and the movies or the recordings downloaded and cut and what

have you um and then

otherwise um yeah we'll uh if we have maybe if someone has some questions that you

haven't that we haven't answered you can email it to us if I've lost some of them um but otherwise

um we will send out invites for heavy metal uh a webinar which is oh when is that the

well anyway it's in me I think 11th or 17th now I can't remember my head is somewhere else

um but I'll def we'll definitely send out invites so look out for them and look out for the recording here and

thank you for staying tuned for four hours that was pretty well done I know I need to get out and get on my bike and

move around and then say thank you very much for um staying making us all staying focused

here the last hour this is well done you're most welcome thanks for having me take care everyone and have a lovely

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