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Can Oxalates be Responsible for Your Pain and Hormonal Imbalance? And Why Spinach is My Least Favorite Vegetable!

Oxalates are ANTINUTRIENTS, which means that they block the absorption of important minerals (calcium, magnesium, zinc, and iron) that many high oxalate foods (like spinach) are purported to provide in the diet. They can form physical deposits (think kidney stones, fibromyalgia) that lead to pain and inflammation.

Spinach is one of the highest sources of oxalates. To put it in perspective, a cup of kale contains 2mg, a cup of spinach, more than 650!

Symptoms of high oxalates: Joint and body pain, frequency and pain with urination,  leaky gut, depression, kidney stones, fibromyalgia, thyroid dysfunction, interstitial cystitis, vulvodynia, osteopenia/osteoporosis, ear crystals, and more.

In my practice, I find that they are an underappreciated cause of pain. I have helped many women with vulvovaginal conditions by changing their diet and managing high oxalates. It is not uncommon to learn that many of them are tossing handfuls of spinach into their smoothies, salads, etc. since for years, we’ve been told that it is a healthy food (think Popeye).

Other high-oxalate foods can add to the total load, such as beets, sweet potatoes, soy, chocolate, and almonds. Many gluten-free grains like buckwheat, millet, and cassava are high as well. This information is easily accessible online.

My approach is to work on diet, removing oxalates gradually since doing so too rapidly — meaning taking out too much from the diet at once, can lead to ‘oxalate dumping’ and exacerbate symptoms significantly.

As with all of my patients, we do a deep dive into possible contributors along with a multi-faceted treatment approach:

  • Check for Mold Exposure/Yeast overgrowth since these produce oxalates
  • Do comprehensive testing of the gut, especially examining for Fat Malabsorption: Minerals bind to oxalates and prevent them from entering the bladder and traveling throughout the body since this mineral-oxalate complex is larger and must leave through the bowel. If fat is not being broken down efficiently, undigested fat will instead bind the minerals, leaving the oxalates free to cause harm.
  • Making sure the patient is not taking high dose vitamin C which can contribute to high oxalates, especially in the presence of yeast in the gut.
  • Encouraging eating organic foods and avoiding pesticides since glyphosate (GMO foods, Roundup) is another contributor.
  • Using Cal/Mag citrate to bind oxalates, taken with meals containing higher oxalate foods.
  • We often see other symptoms such as hormonal and detox imbalances since oxalates lead to low levels of important sulfate in the body. Sulfates help to detoxify chemicals and hormones, bile needs sulfate, cholesterol needs to be sulfated, so we recommend Epsom Salt baths, starting slowly and working up to larger amounts more frequently.
  • We test vitamin/mineral levels to replete what has been depleted by the oxalates.
  • We ensure that our patients are well-hydrated.

Two of my favorite clinical cases:

1. A 21-year-old woman with chronic bladder pain, treated for UTI’s that were presumed based upon symptoms but never confirmed. This young lady traveled to the Midwest to see a specialist who put her on a 3-month course of continuous antibiotics. This wreaked havoc on her gut, especially since she had celiac disease. When I met with her and reviewed her diet, not only was she eating many of the high oxalate gluten-free grains, she was consuming spinach at least 1x/day and daily almond milk in her smoothies. Many of the gluten-free foods are also high in almond flour. I adjusted her diet, worked to restore gut health with probiotics and a leaky gut formula, and used digestive enzymes to help with fat malabsorption that was found on Comprehensive Digestive Stool Analysis through specialty labs. She was completely pain-free, off all meds, within 3 weeks’ time.

2. A patient with transitory deafness, meaning her hearing was greatly impaired but occasionally would improve enough for her to use the phone and watch TV. Honestly, when I heard about her case, I was hopeful but skeptical since she had been seen by many specialists, but as soon as I examined her diet journal, I was confident that oxalates were her main issue. Most of what she was eating was on the high oxalate list. When I suggested removing these ‘health foods,’ she thought I was a bit crazy. I was delighted at her follow-up visit to have her able to converse with me and my staff since her hearing was greatly improved.

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