Dietary Oxalates – When “Healthy” Foods Harm You, with Sally Norton

Sometimes foods we think are healthy actually harm us.  High FODMAP foods are a good example, as they can be harmful for those with IBS and IBD.  High oxalate foods can also be a problem and are contained in some seemingly healthy foods.  Today we dig into the details regarding oxalates with Sally Norton, who is an authority on this topic.

Dr. R’s Fast Facts

  • Oxalates are compounds found in many foods, found in air pollution, and as a result of metabolism
  • They can become problematic in high levels
  • Oxalates cause histamine release

Who is at highest risk for?

  • Those who have had bariatric surgery
  • Those with kidney stones
  • Those with digestive imbalances (leaky gut, dysbiosis, IBS)
  • Those with histamine sensitivity
  • Those with neurological symptoms: pain, sleep disruption, vision, coordination, memory, focus, mood, hiccups
  • Those with connective tissue disorders: joint pain, carpal tunnel, fibromyalgia

What do the symptoms of this look like, how might someone know it’s affecting them?

  • Non-responsive to other therapies
  • Symptoms ebb and flow randomly
  • History of high consumption, see food list

Food sources of oxalates

  • Potatoes, sweet potatoes, nuts (almonds, cashews)
  • Most seeds and beans
  • Vegetables: okra, spinach, Swiss chard, potatoes, green curly kale (dino Kale is OK)

Supplement sources

  • Vitamin C

Can you prepare foods to mitigate?

  • No. Different food preparation (sprouting, soaking, cooking, fermentation) will not significantly decrease levels in foods

Research

  • Limited studies
  • Good results for kidney stones
  • Susan Owens (researcher)
  • Good case reports

What testing or assessments can be used?

  • Urinary oxalate testing is available, but Sally does not recommend it because quality is often poor
  • Best diagnostic tool is a trial of a low oxalate diet
  • Signs of kidney stress, high BUN

Treatments

  • Remember to start with the gut (aka optimize your gut health)
  • Low oxalate diet
    • Gradually start eating much less of the high oxalate foods listed above
    • Suggestion: Cut oxalates in half for 2 weeks, then cut in half again
  • What does response look like?
    • In some cases it can be dramatic and fast, a few days
    • Sometimes improvement take longer if your system has a high levels of oxalate accumulation, weeks
    • Sometime you can feel worse before you feel better, a withdrawal type reaction
  • Supplements
    • Citrates can be helpful: Calcium, Magnesium, Potassium
    • Calcium citrate without vitamin D: before meals, 250mg, NOW foods
    • Potassium citrate
    • Mag citrate
    • Raw dairy
    • B6
    • Gut support
Dietary Oxalates – When “Healthy” Foods Harm You, with Sally Norton
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Episode Intro … 00:00:40
Dr. Norton’s Background … 00:01:19
Oxalates … 00:03:52
The Problem with Oxalates … 00:05:03
Toxin Susceptibility … 00:06:32
Oxalates and Autism … 00:08:31
Neurological Symptoms and Nerve Damage … 00:09:43
Gut Health & Oxalate Absorption … 00:14:42
Common Symptoms … 00:15:42
High Oxalate Foods … 00:18:01
(click gray Topics bar above to expand and see full outline/time stamp)
Supplementation … 00:23:03
Food Preparation … 00:24:28
Research on Oxalate Toxicity … 00:28:44
Testing for Oxalate Toxicity … 00:35:59
Starting with the Gut … 00:37:41
Approaches and Mistakes … 00:42:01
Oxalate Accumulation and Detox … 00:44:10
Kidney and Cell Issues … 00:47:51
Dr. Ruscio’s Resources … 00:49:38
A Low Oxalate Diet … 00:50:35
Reintroducing Foods … 00:58:31
Supplements and Support … 01:00:16
Additional Information and Resources … 01:07:34
Avoiding Dietary Dogmas … 01:09:55
Ancestral Health Symposium … 01:11:20
Episode Wrap-up … 01:12:28

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Dietary Oxalates – When “Healthy” Foods Harm You, with Sally Norton

Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Sally Norton who is going to enlighten us on the topic of oxalates. Sally, thanks so much for being on the show.

Sally Norton: What a pleasure to connect with you, Michael.

DrMR: I’m excited about this conversation. It’s something that’s been on my radar screen for a little while. It’s something I’ve discussed with some patients to different extents, and I’ve wanted to kind of pick into this a little deeper. So I guess let the picking begin today.

Dr. Norton’s Background

So for people who aren’t familiar, I guess just briefly, with you and your work, tell us a little bit about your background and then we’ll springboard into the discussion of oxalates.

SN: Great. I’m a nutrition geek since about kindergarten and got my nutrition degree from Cornell University. And as I worked in the field, really felt that behavior was the most important thing and not biochemistry. So I went on and got my master’s in public health and worked in public health and integrative medicine at the University of North Carolina and Chapel Hill. And then worked writing public health research grants, helping to establish a public health program in Richmond, VA. VCU, we call it, Virginia Commonwealth University.

DrMR: Gotcha. Cool.

SN: Yeah.

DrMR: And then how did you segue or how did you become interested in the topic of oxalates?

SN: Well, I came to it as a patient essentially. I’ve been surrounded by colleagues in the medical school, colleagues in the field of integrative medicine at 14 other universities across the United States, and in Chapel Hill, surrounded by holistic and alternative providers. And despite all that and my intense desire to live a healthy lifestyle and be awesome and be free of disease, and yet I had all these health problems. And it got to the point where I quit my job as a research administrator because I couldn’t function anymore.

And I spent years after that point still trying to figure it out. When I was at the Ancestral Health Society meeting of 2013, I was on the verge of this recognition that I had been poisoning myself by eating high oxalate foods. I figured it out that fall. And that was so shocking for someone who’s a specialist in health and prevention and been in the field of health education and nutrition to know nothing to the point I didn’t even know it was possible.

DrMR: Well, it’s funny you say that. I think sometimes our most important learning opportunities come from our own health experiences and health challenges. And certainly, I think there’s many people in this field that had their own whatever it was that led them into whatever their niche, their area of specialty is. So certainly, the same thing with myself, I had my own gut issues many years ago, and that’s what made me kind of the gut geek that I am today. So I definitely know where you’re coming from in that regard.

Oxalates

So tell us what are oxalates and why are they a problem?

SN: Oxalate is a term that talks about oxalic acid and all its salt derivatives. So oxalic acid is this super tiny molecule. It has only two carbons. And the whole formula is like 0=C-C=0. That’s like the whole molecule. It’s so tiny. And when it is in ionic form, it quickly grabs minerals and becomes oxalates. And technically, we think of that as a salt. And in the body, you see it usually gravitating to calcium. Calcium’s a great magnet for oxalic acid and becomes calcium oxalate. Now, calcium oxalate is the main ingredient in the majority of kidney stones.

DrMR: Gotcha.

SN: It builds up into these bigger crystals. It’s well-known in the urinary tract to do that. It turns out it can crystallize anywhere in the body and does and collects as well.

The Problem with Oxalates

DrMR: Now, why can they become problematic, because not everyone has a problem with oxalates, I’m assuming. Some people do, some people don’t. Maybe there’s varying degrees. So why are they a problem for people?

SN: There are varying degrees. And it’s a problem for people for two reasons. One is it’s just fundamentally toxic. If you get enough oxalate, it will kill you, and we have plenty of incidences of that. But at lower levels, the body’s designed to handle a small amount of oxalate, because oxalate comes not only from foods where the plants are making it and so we’re eating it in our plant foods, it can actually be in the air by the way. A major ingredient in air pollution is oxalic acid and oxalate.

But the body makes oxalate as a by-product of metabolism. And you can encourage that by overdoing the precursors that can become oxalate, like vitamin C gets converted, excessive vitamin C often. Now, this is a great example, Michael, of individual variability because the research suggests that some people are much more prone to converting all that excess vitamin C to oxalate than others.

DrMR: Interesting.

SN: And we don’t have any way to tell who’s who on that one.

DrMR: So they can come from food. They can come from air pollution. They can be the result of metabolism. So many directions I want to go. I guess…

SN: Me too.

Toxin Susceptibility

DrMR: Before I jump to some of the obvious questions like what are some of the most dense dietary sources, are there maybe some people, some groups of people, maybe people with certain symptoms or certain conditions that are the highest risk for oxalate toxicity?

SN: Yes. Yes. Even though we’re all susceptible to oxalate and the problems it causes, anyone can get in trouble with it. There are definitely groups that are at high risk and aren’t being warned about this. The biggest, most obvious one in the medical literature is the bariatric surgery patients. Because whenever you alter the gut and something’s going on with the gut alteration—they’re really injuring the gut pretty severely in bariatric surgery—that puts them in a state of hyper-absorption of oxalate and low absorption… The whole point of the surgery is so they don’t absorb their food, but now the toxins, like oxalate, can get in much more easily. So something like 50% of bariatric patients are heading to kidney stones and other oxalate accumulation problems.

So that’s one group. Anybody with leaky gut is absorbing more oxalate typically; anyone with dysbiosis is probably absorbing more oxalate. And then there’s a sort of idiopathic—some people just absorb a lot. Now the expectation is that we’re only absorbing two to maybe as much as 10% as an upper limit. And anything over 10% of what we’re eating absorbed is considered hyper-absorption. But research has shown that some people absorb even 50% of what they’re eating. And that’s a super bad thing.

DrMR: Now, would it be fair to say that there’s a difference in risk of oxalate toxicity for those that have kidney stones and maybe those that don’t… And maybe what I’m driving at is could someone have kidney stones and that’s just genetically how they end up processing oxalates? But there may be other people that don’t have kidney stones but are more prone to a different manifestation of oxalate toxicity? So I guess what I’m saying…

SN: Yes.

Oxalates and Autism

DrMR: Someone doesn’t have to have like a family history of kidney stones to be at risk, right?

SN: That’s right.

DrMR: Okay.

SN: That’s absolutely true. In fact, that was demonstrated by the group led by Susan Owens, who’s been looking at autism for 20 years. And she drilled down and ended up focusing strictly on oxalate. And they found in their research they did with a group in Poland that was published, I think, in 2011, they showed that very few of these kids who needed the low oxalate diet—the autistic kids—had any kidney stone problems whatsoever.

But what they found was the autistic children had super-high levels of oxalate in their urine anyway, but it wasn’t turning into kidney stones. But they were still awash in oxalate.

The Problem with Oxalates

DrMR: So great prompt for me to ask a question, which would be are there systems of the body that tend to be affected by oxalates, meaning is oxalate toxicity more prevalent or more apt to cause a neurological sequela or a dermatological or an endocrine? Are there certain areas…?

SN: Yes.

DrMR: Okay. Yeah.

SN: Yes. Yes. Yes. All of the above. The original toxicology research and all the subsequent research that involves case studies—now, case studies are lovely because it’s a direct observation of what’s actually going on, and there’s less interference with theory. And if we get hung up on a theory, like, for example, butter causes heart attacks, we could take ourselves down a path that’s fruitless. But with case reports, you get less of that. In my graduate work, I worked with grounded theory, which is the idea that you let the people or you let the data do the talking and you do the listening.

DrMR: I like that.

SN: Theory is often a form of you talking when you should be listening. So what we’ve known for a very long time is that nerve damage is the first thing to go. It’s the first thing to happen. So you see a lot of neurological symptoms like pain, sleep problems. I had a sleep disorder when I was at Ancestral Health in 2013. My brain was waking up 29 times every hour, and that’s partly why I had to quit writing grants and so on because my poor brain couldn’t function anymore. And it turned out, later on, when I went on the diet I had no idea there was a connection there, but the sleep disorder cleaned itself up in a week. And I had tried for two-and-a-half years on everything the sleep doctor could come up with to do.

So there’s the neurological side which includes that central nervous system, including vision, coordination—someone might be prone to dropping things a lot, getting as far as tremors, having issues with memory, learning, concentration, mood, restlessness, appetite changes. And most interesting to me is this idea that hiccups are a neurological problem. And two reasons why this is interesting. In the research on rats and on humans, often the last symptom before the human or the rat dies from oxalate poisoning is hiccups.

DrMR: So I’ve got to ask you this question then. Is wine a high oxalate food?

SN: No. Generally, not. In fact, most booze is not. It’s pretty okay.

DrMR: Okay. Well, I guess that’s good news there. I know sometimes this question can be hard to answer, but would you say just to try to help the people listening, if they’re trying to piece this together for themselves or if they’re a clinician trying to piece this together for their patients, are neurological symptoms the most common out of all the systems that can be affected?

SN: Nobody’s done that kind of research. We have no idea.

DrMR: What would you…

SN: Because what happened with oxalates is they were just a part of medicine until the 1930s or 40s, and then they got put into the department of kidney stones and got left there. All the research about these toxic effects on the rest of the body is pretty weak. Most of the great reports come from pre-1940, and they start way back into the mid-1800s and before.

DrMR: Gotcha.

SN: So, yeah, the other body areas besides the nerves—connective tissue. Now, that’s in a way kind of a modern insight. Clive Solomons was the one who really solidified that into his theory that this created a connective tissue disorder that could be quite generalized and affect a lot of tissues in the body. He was looking at vulva pain, and he measured the urine. Just like the autistic group was sort of mimicking his research and cribbing on his work to look at the autism, he saw that the vulva pain patients had these spikes of oxalate in the urine once or twice a day at a particular time unique to the individual. And the normal people did not have that pattern.

So what happened there is that group who needed the diet for the pain in the vulva, that’s neurological, partially. It’s probably also because oxalate causes mast cell degranulation histamine release. So you get histamine released that causes pain as well as the direct exposure to the nerves. But that group saw the clearing up—they’ve been around for 25 years. So they’ve had some experience, fibromyalgia and all kinds of other connective tissue disorders related to that.

And some conditions like carpal tunnel is really a combination of connective tissues that aren’t regenerating appropriately, that are under inflammation and stress, and that have a neurological component to it. So some things we’re seeing, it’s not just one system. And probably that’s true for many things we’re looking at clinically.

Gut Health & Oxalate Absorption

So then there’s the gut. Not only does the gut health affect how much you absorb, but also the oxalates are immediately in contact with the whole canal, from your teeth down to the end. You’ve got direct contact, and you’ve got direct contact in many different forms of oxalate which we can talk about. But there’s problems with the gut. It causes gut problems, and that’s kind of this vicious cycle. And of course, there’s the urinary system and the glandular or hormone system. The glands tend to also get bogged down with oxalate.

DrMR: And of course, histamine release and the gut are pretty tightly tied, in my clinical observation. And so, I can totally see this being kind of a self-feeding cycle if it’s not addressed properly.

Common Symptoms

SN: If you’re still on the clinical, like, what are we looking at? What does it look like…?

DrMR: Yeah. That’s exactly what I was going to ask you next. Trying to give people some at least key flags they should be on the lookout for.

SN: Number one, the condition does not improve with usual treatment. So the person’s probably been to like six chiropractors and 10 doctors and they’re still looking, just like me and my sleep disorder.

DrMR: Gotcha.

SN: Two, the symptoms tend to ebb and flow totally random ways. You cannot figure it out. They’re just there and they’re not. And they’re there and they’re better. And then they’re worse and they’re awful. And you cannot figure out why. Really, the third one is just a history of being exposed to things that are full of oxalate. And classics might potatoes. You’re a meat and potatoes guy, you’re a French fry freak, you’re a potato chip addict. Nuts, including peanuts. I’ve met some people who used peanuts and peanut butter as their main entrée three times a day.

Swiss chard, which is becoming really popular. That was one of my favorites. I started growing it when I was nine and still did all through college. And it turned out my problems I had in college was because I had an oxalate problem. I was growing Swiss chard. That’s a whole other story. Spinach, rhubarb. There’s a bunch of those.

So if someone has a history, which is, these days, getting really easy to do, because almonds and spinach are considered perfect super foods that you can have all you want, in fact, the more the better.

DrMR: Gotcha. So that’s a good maybe few things for people to look at. Those who are nonresponsive to other therapies, foundational therapies. But there’s definitely a few things that get kind of put into that bucket: Lyme, mold, chronic inflammatory response syndrome. But I totally get where you’re coming from. This is maybe not where you start with people. It’s something that you consider after you’ve gone through some of the frontline therapies. I totally am there with you.

SN: Maybe.

DrMR: Maybe.

SN: Maybe, because toxicity is a baseline concern in modern medicine, or ought to be.

DrMR: Yeah, it means not to say there couldn’t be exceptions to that rule, but trying to give people kind of a hierarchy that they can tentatively try to form in their minds and work through.

High Oxalate Foods

That’s a good transition to what some of the food sources, some of the densest food sources of oxalates are. Can you take us through that now?

SN: We’ll start with the ones that are really popular like the ones I just mentioned. Potatoes, the nuts, especially almonds and cashews are the worst at the top of the nut list. There’s very few safe nuts. Seeds, chia seed, poppy seed, sesame seed are all pretty terrible. In the vegetable world, we’ve got okra and spinach and Swiss chard. Potatoes, sweet potatoes. And then anything in the buckwheat family like sorrel and buckwheat and rhubarb, they’re a problem.

Clinicians who are really going to be able to help people have done the diet and hopefully have experienced what it really is to clean up an oxalate issue in their body. Because just like you’re saying, nothing beats firsthand experience.

DrMR: Yep. I totally agree with you. And you were saying spinach was another one in the vegetable family.

SN: Yes.

DrMR: Okay, I had that already.

SN: And so, spinach has classically been the one that was researched in the past. There’s some famous studies from the 1930s that were demonstrating that the calcium in spinach is useless because it’s all tied up in oxalate. And that’s true for all these high-oxalate foods. The majority of the calcium in the food, even though you can measure it in the lab, it’s not available as a nutrient to nourish the body. It’s tied up in a toxin.

DrMR: Gotcha.

SN: And with spinach, the other nutrients we think are there, aren’t bioavailable either. Ultimately, spinach is kind of some big fraud. I don’t know how it keeps escaping our notice that it really isn’t that valuable as a food.

DrMR: Is a lot of this because of the oxalates or are there other components of this also?

SN: Yeah. Well, there’s other components. The oxalates would be the most important because not getting nutrients is obviously the other big piece of poor health, is deficiencies. But we could easily get the nutrients we want for, say, macular degeneration from egg yolks, much more bioavailability there, versus what we think is in the spinach, which we can’t even absorb from a plant source.

So I’m just referring to the other kind of hype around spinach.

DrMR: Sure.

SN: It doesn’t really hold up if you look at the science.

DrMR: Okay. So we covered potatoes, sweet potatoes, some nuts, many seeds, some vegetables.

SN: Seeds and beans.

DrMR: Beans.

SN: Beans is a group. Navy beans, black beans, that kind of thing. They’re all high. In fact, in nature, that whole category of “I’m a seed,” there’s a strategy apparently where seeds use oxalate as a way to have a pantry to store calcium.

DrMR: Interesting.

SN: When they start to germinate, they click off the oxalic acid part and then use the calcium to generate amino acids and so on in the germination process. So it’s just what nature needs to do in terms of seeds having the nutrients at hand.

DrMR: Sure. Okay. And then we hit some vegetables: okra, spinach, Swiss chard, potatoes. We already said potatoes.

SN: Curly kale.

DrMR: Kale. Okay.

SN: Curly kale. Green curly kale is really high, but the dino kale is low.

DrMR: Okay. That’s good to know.

SN: Mustard is low. Mustard greens, that is.

DrMR: Gotcha. Any other big vegetable sources that you can think of? Because I know our audience eats lots of fruit and vegetables. We kind of have an audience that gravitates toward the Paleo diet, so I’m thinking with them in mind.

SN: Yeah. You see an awful lot of Swiss chard and spinach and the kale, the green curly kale over and over again in chip form, in snack form, and on every beautiful plate you see spinach. Sorrel is now being served as a chic-chic thing in fancy restaurants. And sorrel is worse than either Swiss chard or spinach. There’s actually a case in Europe, in Spain. A guy in Barcelona showed up after a giant dinner of sorrel soup and died two hours later in the hospital from oxalic acid poisoning.

DrMR: Gosh.

SN: That’s fascinating, because sorrel was a traditional soup, food, in Europe. But he’s another example of vulnerability. He was obese and diabetic. And anyone who’s metabolically challenged is not able to handle a toxin well. So his system just overloaded. Probably he’s already had a habit of binge drinking and then using the sorrel soup or healthy greens, like spinach, in order to compensate for his addiction problem.

And I’ve seen this pattern with people I’ve worked with too. Those are the people who really should be protected from foods like spinach, and yet they’re being told that this is going to super-charge their health. From a public health standpoint, it really makes me nervous that this is the message people get.

Supplementation

DrMR: Now, are there certain supplements that are also a source? I believe earlier you said vitamin C.

SN: Yeah, vitamin C. That’s, they think, how plants make the oxalate themselves. They make vitamin C first, and then they convert it into oxalic acid. And then it becomes oxalate. And so, apparently, just this tiny, little two-carbon molecule is quite easily made from other compounds, ascorbic acid being one.

I can’t think of any others that convert, except there is some concern about certain amino acids that might be connective tissue stuff. Clive Solomons was saying oxalate is interfering with hyaluronic acid and degrading it. And that’s how it’s destroying the connective tissue and making repair and recovery of connective tissues lag behind, and these people end up with thin skin and delicate skin. And then you get joints—most of the body is connective tissue so that’s quite a problem.

But we use supplements to counteract the kind of malnourishing side of this. The oxalate grabs calcium and other minerals and sort of steals them from the body and the gut. The problem of processing the oxalate in the body seems to deplete the body of vitamin B6 and probably make our needs for biotin and thiamine go way up.

Food Preparation

DrMR: Okay. And I definitely want to ask you more about what people can do in terms of supplements or other treatments for this. Before we jump to that, let me ask you, are there ways to prepare foods so as to mitigate the level of oxalates in those foods?

SN: What a great question! Because there’s so much mythology out there about that, that you either cook or ferment the foods and that destroys oxalate.

DrMR: Right.

SN: Not true. Oxalate and oxalic acid crystals are so durable they’re used by paleontologists to figure out what people were eating way back when, because the traces of the oxalate crystals, the shapes of those crystals, can be or are thought to be pretty particular to each plant type. So, for example, some skulls, they see a lot of teeth-wear from the crystals in a certain type of root, like a yam-type root. They were eating so much of that it was destroying their teeth.

So you don’t destroy it with heat and cooking. But some vegetables—broccoli is the best and maybe one of the few examples. If you boil the broccoli, the soluble parts that aren’t really crystals that can float out into the cooking water can be leached from the vegetable and thrown away in the cooking water. So broccoli, if you boil it, you reduce it by at least a third amount of oxalate. So I recommend boiling your broccoli.

But cooking, just like sautéing or cooking, does nothing to reduce oxalates.

DrMR: So for broccoli, would that apply if you were to steam broccoli? Would that also have the same effect?

SN: No. No. You will still lose a little bit in the steam because the steam comes up onto the vegetable, touches it, and then flows down off of it. So you’ll get a little bit of leaching, but not nearly as much. And it would be nice to do more testing, because a lot of these tests are based on 15 minutes of boiling. Now, if you boil your broccoli more than six minutes, it’s just almost inedible it’s so smooshed. So the data on that’s a little weak.

But cooking, there are several popular authors who are convincing people that by cooking it, you’re lowering oxalates. And you’re not. And that’s true with fermentation as well. In fact, fermentation may activate—remember I told you about the seed where the seed germinates and it activates the oxalic acid, releases it so it can use the calcium? Fermentation may in fact be raising the soluble oxalate level and converting the insoluble to soluble. And that’s a problem because it’s the soluble that are easily absorbed into the body.

DrMR: Okay.

SN: They just flow right in. With passive transport, they can just go in between those little connects, and there they go.

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Research on Oxalate Toxicity

So I want to come in a moment to the things people can do in terms of treatments and maybe some testing to help try to improve oxalate overload or oxalate toxicity. But before we jump there, I know people in the audience are hoping I will ask what some of the research says regarding oxalates. And mostly, I’m wondering are there any type of clinical trials or maybe some good observational studies that have really kind of put the oxalate toxicity to scientific scrutiny.

SN: The research is really unsatisfying from that point of view. There are a handful of studies, looking at the low-oxalate diet for kidney problems. They’re pretty positive. There’s so much weakness in the study designs. We really need people who know more about this topic to even design a good study. But in terms of the broader effects on the body, there’s been a study done by Susan Owens’ group where they looked at the urine. And then Clive Solomons did his studies with the vulva pain patients. But other than case reports, we don’t have modern studies that are that style of study because that’s kind of a late stage, where, okay, now we’re doing it in the clinic.

DrMR: Sure.

SN: Although, it would be certainly easy enough to take a roomful of carpal tunnel patients and put them on the diet and see what happens. And I would love to see more of that happen and be involved in the research design for that because it would be exciting. It’s pretty stunning how well this works.

DrMR: Gotcha. And so, something I just want to chime in for the audience. We’ve discussed this concept of being evidence-based but not evidence-limited. And that means that we want to make the best educated decision based upon the evidence, but if the evidence is thin, we don’t want to discount a potential therapy or concept because there’s not any high-level scientific data. Because once we have the scientific level data, then we may find some very impressive things. So just because there’s lack of evidence doesn’t mean that this may not be a viable treatment strategy of approach. And I think most of the audience gets that. But I just want to make that point, so as to get us all on the same page.

SN: Yeah, it’s like a common logical mistake to imagine if you don’t see something there, then it’s really not there. That’s not true. You just haven’t gone looking for it. And the truth is there is a load of oxalate research out there. I’ve spent three-and-a-half years digging it up. I spent an awful lot of time in a medical library. I’m still doing that. I’ve been up to the NIH national medical library, and I keep being amazed at how much information is there, both current stuff like the study from 2015 that showed that oxalate induces breast cancers cells to develop in the breast tissue. And then all these older studies showing that it used to be used normally for people who had these problems, including carpal tunnel. And it all got dropped.

DrMR: So the next step you pointed out, which I completely agree with, would be to have someone set up a simple clinical study—and it wouldn’t be difficult, you’re right—and start bringing this to the next level scientifically. And I wouldn’t be surprised within the next few years, hopefully, if that happens, because it sounds like the awareness of this topic is starting to get some more tension. So hopefully, some clinical science will follow fairly quickly.

SN: Well, nothing’s quick in science.

DrMR: Good point.

SN: Hold your horses on that. We’re going to be quite white-haired. And we don’t really want to have to follow them because the priorities, unfortunately, have been so hamstrung by the economic drives to develop pharmaceutical agents and mechanical devices and profit-based therapies, that this more ecological lifestyle issue of how we may be harming ourselves in our day-to-day habits just out of complete unawareness is just not really a driver in the way we fund things these days.

DrMR: Right. Well, I get that. I also have some optimism just looking at how many trials have been done on the Paleo diet and low-carb diets and low FODMAP diets. And yes, there are some mild profit incentives there, but nowhere near the profit incentive that you have for a pharmaceutical or a medical device company.

So I’m optimistic that we’ll see some traction there. But getting us back on track here…

SN: Just in terms of research, though, since that’s my field—writing research grants and designing research. I’ve done a lot of that. A lot of your audience may not be aware that it takes quite a while to pull together the preliminary data to write a convincing grant proposal. The grant proposal is a bear to put together. They can be as long as 200 pages. Then, it has to go through a review process, and the folks that review it are the luminaries in the field. And they’ve already got their stakes in a slightly different thing, if this is a new innovative thing. And so, they’re not real excited to even give you a good score.

Only like 10% of grant proposals even get funded, and then you have to wait six to nine months to find out if you get funded, then wait for the funding, and then do your research, which takes three to five or more years. And then you have to analyze your data and write your report. So that timeline is kind of a decade-long span of time.

DrMR: Certainly, when you’re performing a trial of that extent, which is great science, it’s a bit more cumbersome. But this is where I think something like a retrospective chart review holds a whole lot of utility, where a clinician could fairly easily—let’s go back to the example of carpal tunnel. They could take 10 patients with carpal tunnel and put them on a low-oxalate diet and give no diet to another 10 and simply chart those notes and then do a retrospective chart review and publish that. And that would be something at least somewhat clinical that would be… You get around needing an IRB and funding and you use your current patient population. It doesn’t require a whole lot of fuss.

So I think that is a method that could be used to at least get something documented that’s a bit more clinical in scope.

SN: Well, we do have some of those from the kidney world. The kidney world is seeing people walk in with kidney failure and then figure out through horse sense that the person was overdoing cashews or overdoing spinach or overdoing peanuts or green smoothies. And there’s several of those recently, including one this year on a case of cashews. So they come in with kidney failure. They figure that out.

But at the Mayo Clinic, after one of those they went back and looked at like 65 cases and found four cases where it was clearly the peanuts, clearly the spinach, and then published that. And warned people about the juicing problem. Two or three of these folks were in trouble because they had adopted a juicing habit to help them with their weight loss or their diabetes.

Testing for Oxalate Toxicity

DrMR: Gotcha. Okay. So there we go. Transitioning now to testing or other types of assessments. How can people test for this?

SN: Well, you can’t really do it affordably because to do it right you’d have to test every void of urine for a minimum of 24 hours and see if they have that spiking pattern. It’s really hard to predict when they’re going to have that spiking pattern.

DrMR: And I’m assuming that test isn’t available commercially.

SN: Well, you could do an individual test, but often, the urine isn’t handled well. And a lot of things can go wrong in the collection of the specimen and having the right preservative. And there’s just a lot of ways that it goes wrong. But Dr. Solomons was using the non-enzymatic assay technique and was able to detect those peaks in the women. But it took a lab geek who was really focused on this to do it. Whether you can do it from the clinical side, it would require a little more training and a lot of attention I think to really feel confident in it.

And really, the most diagnostic tool we have is the diet itself. You do the diet…

DrMR: So just try the diet and see how you respond.

SN: And you improve. And if you do improve or other things—we’ll get to that—then there is an oxalate issue going on. But the diagnostic value of this is limited only to the positives. So no response to the diet does not mean there is no oxalate problem.

DrMR: So then how do you sort that out?

SN: Yeah, have you got any ideas yourself about what could be going on with that? Just to crack your clinical genius for a second.

Starting with the Gut

DrMR: Well, this is why I kind of like organizing things into a hierarchy and trying to have a logical sequence through which you work. And this is one of the reasons why I often say “start with the gut” and looking at things like SIBO or dysbiosis, which can include histamine toxicity or histamine intolerance, which sounds like it can be involved here. Something I’ve noticed in the clinic is people can have a given thing, whatever that thing is. Let’s say in this case they’re oxalate sensitive or they don’t process oxalates well.

But if we can improve their leaky gut, even though I don’t love that term, but let’s say they have SIBO driving leaky gut. And we repair their SIBO, we modify their diet accordingly, and their gut is now in great shape. And they’re pretty much asymptomatic. A lot of those other things become less problematic. So that’s why I like starting with a foundational gut approach where you look at a good dietary and lifestyle plan, address any dysbiosis, inflammation, infection, and then kind of reevaluate.

So I don’t think that would help a non-responder, but I think it would help you position people for the therapy to have as many confounders out of the way as possible.

SN: Well, that brings up so many issues I don’t even know where to begin. A) if your gut program is working, that’s really good news. And if it isn’t, then the oxalate would be a great place to go next.

DrMR: Right.

SN: Because the oxalate problem is kind of like pollution raining down on a beautiful landscape. The body is a living ecosystem like a river going through a meadow by a forest with soil and air and all these things that can get contaminated by an over-attack of whatever toxin is raining down in this ecosystem. And so, it is foundational, the toxicity problem, and oxalate is a toxin that’s very close to home because it’s in foods we eat. And we eat unaware.

No one has a clue about how much oxalates they’re eating. You could order one thing at the restaurant one day and you accidentally got a nice, low-oxalate meal. And then the next day, you’ve accidentally got an oxalate disaster meal. And you had no idea there’s any difference whatsoever. They could look almost identical.

DrMR: But if you’re following the low-oxalate diet, you would be okay?

SN: Yeah. Well, if you follow the low-oxalate diet, you’re going to have funny things happen potentially. If it is an issue for you at this time, you’re either going to get some improvement, sometimes right away. I had one client who had 13 years of bowel dysfunction with fecal incontinence, and three days later, she texted me and says, “Woohoo! I am totally getting better.” And she had one more week of flatulence, and now she’s permanently cured. I’m just floored at the speed of that. Because I think, Well, tissues have to recover.

Obviously, cell turnover in the rectum is pretty quick, but she was having paralysis of her nerves that were operating the muscles of the rectum and anus and the sensory nerves were gone. She couldn’t even feel these things coming out of her 10 times a day, randomly ruining her life 10 times a day for 13 years. And three days later, she’s better. But everyone is so different. And that’s because, okay, you have this landscape problem of pollution from oxalates. But then, you bring to it all this individuality. It’s genetic individuality. It’s gender. It’s your own history of exposures to other problems, your nutrient status, your lifestyle. You name it. What’s the state of the ecosystem before the toxin messed it up?

DrMR: Right.

SN: That influences which tissues get involved, how it looks when it manifests and bubbles up later, because it’s not bubbling up until you’ve got some dysfunction. And the dysfunction comes after you’ve created cell distress and changes in the metabolism in the cells which came from the exposure.

In that whole process, there’s sort of a delayed—it bubbles up. Now we see the problem. So you imagine, my gosh, how could that heal in three days? I have no idea.

Approaches and Mistakes

DrMR: And that’s a good transition to one of the things I wanted to ask you, and maybe there’s not a super-clear answer here. But I’m trying to give people just some indicators that they’re on the right track or maybe they should change approaches. So the question is what might a typical response look like? Like, how would someone know that they’re on the right track and what might tell them, okay, maybe this isn’t my issue?

SN: Okay, so the biggest mistake is the one that I made. In 2009, I went on the low-oxalate diet because I had an attack of vulva pain. And my husband went online and discovered the vulva pain or the VP Foundation—that’s Clive Solomons’ group. And I tried the diet according to their instructions. I was still working and all these things were going on with my health. And I couldn’t really tell that it was helping me. I had no idea.

So I gradually got away from it and starting growing sweet potatoes again and stopped worrying about it so much. And then did another experiment and had a mental, like finally the lightbulb went on. So what was going on there I know now in retrospect, I did have signs that I didn’t know were signs that my body was responding to the diet. And one of them is this rash.

Now, we didn’t get back to earlier, like, why can some people go on the diet and not seem to respond or even get worse. That’s something else. You can almost have moments when it seems like it’s almost worse on the diet. And one of the probable reasons for this, and we don’t have enough research on this, but it’s real obvious when you read between the lines in the research, it’s there over and over and over again that there’s this tissue accumulation of oxalates going on.

And the longer you’ve been eating oxalates without knowing it—one of my friends and colleagues, he was a buckwheat guy. He ate buckwheat for breakfast every day. And finally, in his 70s, he reads my article, and he’s like, “Whoa. I think I need to try this.” And lo and behold, the naturopath who knows everything has discovered that he’s been hurting himself with his buckwheat.

Oxalate Accumulation and Detox

The thing is with that accumulation of all these years, once the inflow coming from our diets slows way down to a trickle, then the level in the blood—or something’s going on that’s totally shifting the metabolism from one that’s sort of a defensive process. And let me give you a story to kind of explain this. You know that old I Love Lucy episode that’s quite famous, having a new job at the chocolate factory, wrapping chocolates?

DrMR: Vaguely.

SN: Familiar with that? You see, you’re so young.

DrMR: That’s the problem. Yeah.

SN: It’s on YouTube. People should look it up because it’s hilarious and very kitschy. And so she and her best buddy have this new job in the chocolate factory. They’re supposed to wrap the chocolates. The chocolates are coming along on the conveyor belt, and, suddenly, there’s more and more of them coming faster and faster. And they can’t keep up.

DrMR: Oh, do they start eating them? Is that what happens?

SN: Yes. First, she stuffs it in the shirt. She stuffs it down her shirt, like down the bra, and then stuffs it under her hat and all over the place and then starts stuffing them in her mouth and her cheeks are all puffed out. She has got an accumulation problem, you see, because it’s been coming at her so fast that she has to stuff it in places that it shouldn’t be just to get through the moment.

And that seems to be a little bit what’s going on with the body with oxalates. It ends up forming these crystal deposits all over to try to corral it, but once the conveyor belt, the trickling in, slows way down, there’s room on that conveyor belt to unload the bra back onto the conveyor belt and get it out. So if your tissues start unloading this accumulation, it’s got to dissolve from big crystals down to small nano crystals and ion forms, which are the forms that cause so much cell damage, mitochondrial death, and mayhem. And that’s the form that moves back into the bloodstream and back out into the urine.

And so, as these deposits start coming apart, they create the same or worse symptoms sometimes in some people as they did going in. So you’ve got to have to re-eat all your spinach salads and almond smoothies to get them back out again. Does that make any sense?

DrMR: It’s almost kind of like using a vague term here that I also don’t really love, but it’s also like a withdrawal or a detox reaction. Kind of similar to some people who have very strong aversions to gluten and dairy. I’ve heard that they can feel a little bit worse before they feel better, potentially because they release these gluteo or caseomorphins every time they eat gluten and dairy that gives them this morphine kind of high. When they come off of them, they no longer have that morphine-type high and they feel kind of crappy for a little while before they feel better. So is it something somewhat similar to that?

SN: Yeah. The body’s unloading and moving some… If it was radioactive, for example. You’ve got to move this radioactive material. It still has to go past your village, and you have to get it safely down the train tracks, out to where it’s supposed to go, which is the kidneys ideally. But in this process of cleaning out, sometimes we see crystals showing up in the fecal matter because we know that when the kidneys start shutting down, these transporters on the cells and in the colon will shunt oxalate back into the gut.

So that sometimes will get activated. When there’s these surges going on, it’ll get activated. You also will get it coming out in the sweat glands. I have certainly experienced both of these. I like to do hot yoga, and I found about six months after I got on the diet for serious and correctly done, about 20% of my yoga classes, I could literally feel the prickly crystals in my pores coming out.

And that’s why things like this, if you haven’t lived it, you wouldn’t even believe it.

Kidney and Cell Issues

DrMR: Right. Coming back to the kidneys being where these things are processed, do you ever see something like a BUN elevation? Is that maybe a giveaway if someone’s had this like high-level BUN on and off and they can’t figure out why? Is this something that may predict?

SN: Probably. Yeah. I think any sign of kidney stress could be a sign that the kidney’s been overloaded with oxalate too much. And even though they’re not a kidney stone former, any sign of kidney issues… This stuff is really quite stressful on the tissues. It creates free radicals, and get close enough to a membrane, the mitochondria start getting affected. They get depolarized and start dying.

And once you get a third of the mitochondria dead in a cell, the whole cell… And so a healthy cell can generate an antioxidant response and be able to sort of put on those gloves and handle it and not die. But a cell fragment, an old cell, a dying cell, a piece of old mitochondria hanging around, people who don’t fast tend to get junk building up in their systems. People who had surgery or other forms of accidental injury—surgery’s kind of an intentional injury—but tissues that have been injured, those cells don’t have their power to handle this stuff well. And then the crystals start to nucleate on these proteins hanging around and then become a place where accumulation is possible.

DrMR: Gotcha.

SN: So if you have old injuries that don’t heal, that’s a great flag.

DrMR: Okay.

SN: Or the healing is a little incomplete because oxalates get stuck. I had that problem myself with my feet. And 30 years after my foot surgery, I’m on a low-oxalate diet and suddenly my feet start really healing for real, finally.

Dr. Ruscio Resources

Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.

For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.

And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.

A Low Oxalate Diet

DrMR: So let’s talk about the low-oxalate diet. What does that look like?

SN: It looks like we stop buying the really high worst offenders, like the almonds and spinach and Swiss chard and find a way to back off from the beans or whatever your favorite food is. But you can start with your least favorite high-oxalate foods and work your way around to it, because in some groups it’s much better to go on this gradually.

It may be because the most recent oxalates are still in a place where they stir up more quickly versus the ones you ate 20 years ago have probably settled down into the bones in a more quiescent place. But if you make this metabolic shift from being Lucy stuffing chocolate in the bra to Lucy unloading the bra, you want to make that kind of gentle. So you don’t have to just cold-turkey, and it’s not really recommended that you go cold turkey off those high-oxalate foods. So you can save your peanut butter or dark chocolate to the very end if you want.

DrMR: Gotcha.

SN: But in the meantime, you get a list like my grocery list of truly low-oxalate foods that have been tested by a proper lab in recent times. And you start buying those foods and figuring out how to stick them on your plate. And it’s pretty straightforward. It’s a learning how to substitute thing. If you are a cook, you’re quicker at figuring out that you could substitute one thing for another.

But anybody who’s already been through a gluten-free or a dairy-free diet generally finds this to be pretty simple once they get over being mad.

DrMR: Mad that they have to take out foods that they may like or think that are healthy?

SN: Yes, it’s more number two. Like, wait a minute. Everybody and their brother, every magazine in the world has told me that these almonds are perfect, and they can’t be the fault, right? And that really upsets people.

DrMR: Yeah, I think our audience may get that, because I think the low FODMAP diet is one that really twists people’s logic a little bit. They’re saying, “Geez, broccoli, avocado.” Well, maybe not avocado if you’re a fat phobic. But broccoli, cauliflower, asparagus, aren’t these super healthy foods? Well, the definition of a healthy food I think depends a lot upon the host.

SN: Right.

DrMR: So I think our audience probably gets that because of the low FODMAP connection.

SN: Good. It’s so painful to keep hearing the hype around foods like spinach and then people are like, ugh, they just want to smack themselves in the forehead. And then the nutrition information landscape is just all over the place. So there’s this ongoing sort of frustration I think just sort of floating around.

I’ve found several people to be in the very short run quite angry about the information. And then their bodies have just proved to them so much over and over again that this is totally on board. They’re the most loyal, not only sticking to the diet for themselves but making an effort to teach other people around them about it. But it’s hard to be the messenger that says all those spinach-pushers are wrong.

DrMR: I’m pretty confident that our audience will be receptive to that, because one of the things that I’ve harped on is really just being open-minded and objective and not letting a philosophy steer you, but rather just letting information and data kind of steer you. I think we’ll be a good fit there. Let me ask you one thing. The gradual introduction into this diet, will that mitigate the withdrawal-type reaction that some people can have? And is that one of the main reasons why you recommend it?

SN: That would be the idea of it. And again, this is based on mostly the observations from the autism group led by Susan Owens where their group has particularly had problems with these tissue release symptoms, which can be kind of brutal. I’m certainly one of those who had a bunch of that going on where these symptoms of the body cleaning up were difficult to go through. So that is the expectation. And some people think they can even stop the body from doing this releasing by eating something with some oxalates in it to get the blood like, “No room for more.” We don’t know what’s going on.

And let me tell you, getting that intimate with what’s going on inside the body and oxalates is really tricky and probably impossible. The oxalates have been confounding researchers for 300 years. They’re really tricky to study. So even the very best researchers have been coming up with totally opposite conclusions. Hey, in one case, one disease, it’s the ion causing the disease process. Another case, it’s the nano crystals. None of it’s ever a straight story.

And that’s why the grounded theory… Like your patient, respect your patient, believe your patient, and give them the confidence that based on—you could use my symptoms and exposure inventory. Right after I figured out this was a real thing, I put together a one-page tool meant to be used in the clinic—I use it for my clients—that helps establish on paper a pattern of these problems, listing some of the many problems and symptoms that come up with this, and then a list of some of the worst high-oxalate foods and see if we can establish a pattern of intake and exposure and a pattern of symptoms that helps them say, “Yeah, I might be a good fit for that.”

And that’s great, because you’re going to enroll and engage your clients and it really helps them decide they want to do it.

DrMR: I like that. Now, I want to in a minute or two ask where people can obtain some of those resources and/or connect with you. But there’s a couple of other questions I want to ask you before we kind of bring things to a close. One is to try to give people just some general parameters, would you say, “Hey, look at your diet. Look at what you typically eat in a week. And for the next two weeks, cut your oxalate load in half. And then after two weeks, cut it in half again. And then at that point, you’re kind of on the low-oxalate diet?” Is there some guide you can provide?

SN: Yeah. I think that’s generally a good approach. Every person’s got their own individual situation and their own tendencies. Once a person is convinced that oxalates are really a problem, a lot of them are afraid to eat too many of them. And I hate for anyone to be afraid of food, but I totally sympathize with that. I love my body so much that I really don’t want to put more of that stuff in there. So some people don’t want to do the gradual thing.

But some people are concerned about the money they just spent on the huge bag of mixed nuts from Costco, and they’re going to now start using that in tablespoons, like one tablespoon every couple of days rather than two cups every day. They’ll find a way to work around it. It’s about your dose.

DrMR: I think that’s important, because sometimes people want to kind of paint these things into a strict and polarized dichotomy, meaning it can only be bad. And anything that is bad and the smallest amount is bad and I’m going to freak out about it, but this sounds like it’s similar to FODMAPs, where it may not be that you can’t have any high FODMAP food, it’s just making sure you don’t overwhelm your capacity. I think that makes a lot of sense.

SN: Yeah. But there is something there where suddenly you get to a point where the amount that’s coming in is so low it’s triggering a healing response, because the body knows how to get rid of this stuff. And it will. And tissues that aren’t too alkaline where the liposomes can generate enough acid to break down the big crystals and start moving them out, that’s a wonderful thing. The body really wants to heal, but it is different.

So if you’re only lowering, you’re lowering the amount that’s coming in. So you’ve stopped maybe making your deposits bigger. But if you want to eventually get to the point where you’re cleaning out your system, you’re going to want to go low and stay there. And most of us need to stay there pretty much indefinitely.

Reintroducing Foods

DrMR: Gotcha. So that’s one of my next questions, in terms of reintroducing of oxalates, would you recommend, if someone cuts out dairy and then they want to see if they can do dairy again, doing a gradual kind of reintroduction to determine where one’s tolerance is?

SN: I think a lot of people do that by mistake anyway. I think that’s how life works.

DrMR: You just forget about the diet for a day or two and you end up eating a bunch of stuff and seeing how you do. Yeah, I think that’s actually a decent way. Sometimes my patients get freaked out about going on vacation or something. And I say, “You know what? This is not a bad chance to just let you…”

SN: Test it out.

DrMR: “Do a life-induced reintroduction and see how you do.” Exactly. Yeah.

SN: Yeah. One of my clients was telling me—we have a monthly support group here in Richmond that I lead. She was telling me how her wrist pain, her husband had a serious heart attack and that got her away from paying attention to oxalates and then she got the wrist pain back. And she was like, “Wait. Why?” And then she changed and then they were better.

And then someone started giving her free salads every day that had sweet potatoes, and quinoa is another high one. And something else that was high. And she just sort of said, “Whatever,” and sort of forgot. And then her wrist pain had come back. And so, she’s done that like five times. And she keeps coming back to got to be on a low-oxalate diet. And she has helped dozens of people. One of her friends was one of the peanut butter addicts. Finally, after repeated messages from her, he gave it a try, and his knees really are better.

So it’s really so much in the hands of the person, the person who wants to be a little better or not get worse or a person who wants to be awesome. You can take it where you want to go as long as you’re enjoying it and being healthy and balanced in your approach.

Supplements and Support

DrMR: Now what about supplements? I’m sure people are dying to know if there are some supplements… And I’m assuming that foundationally if you identify you have an oxalate problem, you probably want to generally be somewhat cautious with oxalates. But are there supplements that can aid in this process?

SN: You definitely do very well with other therapies generally. The low-oxalate diet is really one of these foundational therapies, but it fits into other therapies generally and also very specific supports that help your body handle oxalates and avoid absorbing more of them. If there’s calcium available in the colon, the body can kick out oxalate and the calcium grabs it and then it comes out in the feces. If there’s not calcium in the colon, the oxalate can float back into the body, and this frustrates the body’s attempt to get rid of it in that way.

So we want to keep calcium in the colon. So we like to take calcium in the citrate form, without vitamin D, so we discourage absorption because we want it there as a sponge that becomes our bouncer that helps drag this stuff out of the body. Does that make sense?

DrMR: Yeah. And is there a certain dose for the calcium citrate?

SN: I would suggest before meals or during the time of day when the symptoms are worse. You do right before that time of day, that you do at least 250 mg at that time. NOW makes a powder where you can have that level of control. There’s a 1000 mg tablet that they make as well. I’ve gotten away from using that tablet. There’s very few choices in a no vitamin D in varied doses. It’s a little tricky to control the dose unless you’re using the powdered form. But citrates in general…

DrMR: That powder by NOW is a calcium citrate that does not have vitamin D?

SN: That’s right.

DrMR: Okay. Gotcha.

SN: And citrates generally, magnesium citrate and potassium citrate are also very helpful. Citrate helps protect that hyaluronic acid that gets destroyed in the connective tissue, so it helps protect the connective tissue. It also discourages the crystallization of the oxalates, so the growing of these crystals in the body is reduced. There’s a belief in the kidney world that citrates are part of how the body dissolves a kidney stone. So whenever you’ve got evidence of stoning going on, with hard, swollen glands or thyroid or kidney stones, the citrate is really important.

So taking your calcium, magnesium, and potassium in a citrate form, all assist the body to, first of all, correct some of the electrolyte balances that are happening, because the oxalate’s basically consuming these minerals. There isn’t any research on this, but just from my own experience, I’m really feeling that potassium citrate is incredibly helpful as well as the calcium, which has been established throughout the literature for many decades.

DrMR: So you say lead probably with calcium citrate and potassium citrate?

SN: Yeah.

DrMR: Okay.

SN: Or you can use cal-mag citrate, some folks will have constipation problems with calcium and need the magnesium instead.

DrMR: Gotcha.

SN: You want to watch that. And so, anyone who can do dairy, ought to use a good quality raw dairy and fermented cheeses or yogurt that’s grass-fed and nutritious and clean, because the calcium and the potassium and the nutrients in the dairy are so helpful with this oxalate mess that’s going on.

DrMR: Okay. So we’ve got citrates as calcium, magnesium, or potassium. Preferably calcium and potassium citrate, but if someone’s a little backed up and they need a little bit of movement, they can maybe favor more toward mag citrate. Raw dairy can be helpful. And of course, we want to take large doses of vitamin C. Kidding. Anything else that you’d recommend?

SN: Yeah, the B6 is good. The biotin is good. If there is this connective tissue issue, I like BioSil. Clive Solomons likes N-acetylglucosamine as the best form of glucosamine to support that re-stabilization of the connective tissue. And then antioxidants like taurine and Co-Q10. Obviously, gut health support is really critical to this and you probably have your favorites there. Lately, I’ve been playing around with Restore. But some of the support is learning to cook at home, getting good quality food, staying hydrated.

A lot of people who are in trouble need to be gluten-free for a while and maybe indefinitely. That was true with Susan’s group with autistic families and children. They do much better if they’re gluten-free.

DrMR: And that could be really a form of gut support of course if someone has a problem with gluten. A lot of the health foundational principles will apply, so that makes sense.

SN: Yeah.

DrMR: Let me see here. I think that’s pretty much everything I wanted to go through. It’s been a fantastic conversation. Before we move to a close—one curveball question for you—but anything else on this topic that you think is important for people to know. I’m sure there’s a thousand things.

SN: Oh, gosh.

DrMR: But any pressing.

SN: There’s a lot of mythology out there that’s confusing things. And it takes an awful lot of time to really learn the data, really learn the foods. For those of us who are in a position of being able to advise people, there aren’t many of us who’ve taken three years and devoted their whole life to the study of the science behind it, what the data is, how you implement the diet.

And so, people who are just talking about it and not doing it, I would listen to people who do it, first and foremost, because there’s so many myths out there. In the medical literature, there’s myths. And then things like, oh, if you cook it, it’s fine.

DrMR: Right.

SN: So get good information. Take the time to learn as much as you possibly can. Oxalate as a concept changes our understanding and really requires that we shift to a more ecological mindset and be able to let go of our wish that some foods are superheroes that are going to save the day. We’ve gotten into this point now where if somebody’s found something good about a food, it must be wonderful. And that is sort of benefits only? Well, what about the other side? See, the other side, the sort of yin-yang of things doesn’t sell in a hype-y world of magazines and so on. So we’ve dropped the caution side and just, “Oh, that had something good. That must be wonderful.” And that’s just an imbalance that needs to be reined in a little bit.

DrMR: Completely agree. It’s another concept that we talk a lot about on the show.

SN: Great. And the other thing is people like me see a huge need for the diet. I would tell you that you can expect that people are coming to you because they have problems that don’t respond well to other treatments. So I’m guessing easily 25% of your clientele needs to be on the diet, maybe 30, maybe more. Nobody’s done the data, done the research to know. But that doesn’t mean that it’s a silver bullet. It’s not a silver bullet; it’s more of a changing the ecologic landscape, like you were saying with foundational, in a way that benefits the entire body now and in the future.

Additional Information and Resources

DrMR: I think that’s well said. One thing that we can do if you have handouts that are readily available, is there some stuff on your website that maybe we can put the link to that in the show notes if people want to try to click through to some sort of guide that you’ve made.

SN: The best guides are going up on the website in the next couple of weeks: a grocery list, the worst offenders list, and some very clear, specific data about greens and berries. Raspberries are really high, but blueberries are not. That kind of thing. And then, a whole tool kit of handouts that I use when I do live presentations about how to do the switch, what kind of supplements to think about. Those will all be available in the next few weeks.

But in the meantime, you can get my article, which is a pretty comprehensive overview. It’s not for people who aren’t kind of health-oriented folks. It’s written for informed people. But that’ll give you a nice overview of a lot of the science, and it’s got a ton of references. Luckily, that journal was willing to take the space to include all those references. So start with that.

And then, go ahead and look at those videos on the results page. There’s only eight-and-a-half minutes of video. They’re all really short. Just three little videos, but it’ll let you meet some of my colleagues, friends, and so on who are benefiting from this information. And really, just meeting those people is useful.

DrMR: Totally. Totally agree. And we’ll put some links in with the transcript for this episode, guys. And Sally, what is your website?

SN: SallyKNorton.com.

DrMR: Perfect. And the curveball question I want to close with, and the backdrop on this is sometimes we learn more and more and more about what we shouldn’t eat and what we shouldn’t do. It can create a neurotic culture.

SN: Yeah.

DrMR: So I try to ask the question to close, which is what is maybe the least healthy but most fun thing that you’ve done lately?

SN: The least healthy and most fun that I’ve done lately… Well, probably coming up next week, my tree guy is coming and he’s bringing a harness so that I can get up into the tree with him and help prune this gigantic tree in my backyard. That’s probably, from a public health standpoint, you know, injuries. But I’m a tree steward. I’m a volunteer who helps take care of trees in my town, and I’m a great lover of plants and have just realized I shouldn’t eat as many of them. I should like them more respectfully maybe.

Avoiding Dietary Dogmas

DrMR: It’s funny that I interviewed a vegetarian advocate a few weeks ago. And it’s interesting sometimes to look at these data points—and this is why I think it’s so hard to be dogmatic on any position, because if you believe that a plant-based diet is so important, and you hear almost like a mantra in some circles. Plant-based diet, plant-based diet, plant-based diet.

SN: Yes.

DrMR: But for some people, especially if you have IBS, the FODMAPs could be problematic and also potentially the oxalates. So again, not to say that that diet may not be good for some, but to try to make these broad recommendations as this is the only healthy diet and you should never eat meat, you can only have that sort of dogmatic position when you’re a little bit ignorant of these other pieces of information like you shared today.

SN: Well, it just doesn’t even make sense. Why divide the world, plant and animal, as a form of nutrient delivery? The whole idea of that is sad. I was a vegetarian myself for eight years, and then I was a vegan for eight more years. And I destroyed my health doing that, and I was so glad to discover grass-fed. So I went through that process. I’m very sympathetic to that point of view. I understand those arguments. I believed in them and taught them. But you have to continually keep learning. If I wasn’t still learning, I wouldn’t have figured out what was wrong with me.

Ancestral Health Symposium

DrMR: Yeah. You have to. You have to just evolve really. I completely agree. Well, Sally, this was a fantastic conversation. Thank you so much for taking the time. And I believe you’ll be at AHS, right? I think that’s how I initially came across your name.

SN: Yes.

DrMR: Okay. So I’ll be seeing you then.

SN: That’s going to be so much fun. I hope more of your listeners decide to come out and join us. That’s always a lovely group of people to be with. It’s going to be a blast. I’m really looking forward to giving you a hug in person and not too long from now.

DrMR: Me too. And guys, just AHS to see Ancestral Health Symposium, and it’s kind of like Paleo f(x), but the more academic version of Paleo f(x). So it’s less about fitness, not to say that they don’t talk about fitness, but it’s a bit more academic, a bit more about the science behind kind of the Paleo movement with a little bit more of an emphasis on maybe diet, community, and some of those other things. Anything you’d add to that, Sally, for people who are thinking about checking it out?

SN: Oh, man. If you love learning and you like smart people and you just like to have fun, just come on out. It’ll be great.

DrMR: It should be a good time, guys. And we’ll have some stuff rolling through the website for information on AHS so you guys can plug in.

SN: Wonderful.

Episode Wrap-up

DrMR: All right, Sally. Well, thank you again for your time. I look forward to meeting you in person soon.

SN: It was fun, Michael. See you soon.

DrMR: See you. Bye-bye.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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