Why there is so much conflicting information about oxalate

Inspire.

Welcome back to the Kidney Stone Diet podcast. The show about reducing your kidney stone risk and living your best life.

I'm your host and fellow student, Jeff Sarris.

And I'm Jill Harris, your kidney stone prevention nurse.

Bum, bum, bum, bum.

I don't know what that was.

That one felt more like a game show.

I felt like it had to come out.

Yeah, I feel like we I feel like that was a little more like a game show, like we need a little theme music to go with that there. I like it.

Yeah, bum, bum, bum.

So, before we dive into a question, we just have

Okay.

A nice message here that I wanted to share.

Oh, that's

Hi, no pressing needs on a Sunday morning.

Just wanted to comment from Greensburg, Pennsylvania,

That as usual, Jill's notes

On making a move, a physical move, relocation,

Only proves to be how helpful she is.

Thanks, Jill,

For all the updates and the up-ticks, on giving us advice to keep those kidneys well-balanced and healthy.

Thanks much from Greensburg, Pennsylvania. This is Suzanne.

Oh, Suzanne! Okay, so here's the thing.

I feel so lucky. We always get such–people say such nice things, right?

It's so kind of them. The first thing I think of is,

Wow, Suzanne, on her Sunday, is calling in

To say thank you. So, I think

I don't even know what to say when I get those, but I will graciously accept it, and Jeff accepts it. And I want you guys to know

That it is a privilege,

It is a privilege to be able to come on here,

Facebook, wherever the heck I am, wherever the heck Jeff is, and try to help people with this because we understand that the over–

There's a lot of information out there and it's conflicting and it's overwhelming. People don't know what to believe. There's not a lot of help unless you really start seeking it out for yourself.

So, anything that we can add that will help you in this journey,

It is a delight, and it is a privilege, and it–we are humbled

By your response to us. So, thank you so very much to take time out of your day,

And let us know how you feel. That means the world to us, right, Jeff? I mean, you couldn't ask for anything, such a

Such a

I'm trying to–

Satisfying

Career. It's just such a satisfying career to be able to help. You know, look, you go into nursing

And

Jeff, I know I've told you this, but, you know, at University of Chicago, when I was there

Years ago, working the floors, it's like, oh, my god, it's so stressful. God bless those nurses, and doctors, everybody.

Because, for patients to even be in-patient, you have to be really sick. So, you have all these patients.

You're trying to figure out, "Well, this one's bleeding out, this one's throwing up." "Who do I go to first?" I, you know, you're just,

You don't know. It's just everyone's so bad. And when I was going to nursing school, I thought, "I'm just going to sit by a bed.

I'm going to listen to people's stories. I'm going to rub their head and hold their hand, and I'm just going to be there."

There's none of that! So, somehow, there's none of that and every day I would leave and I'd be like, "I just did the crappiest job ever" because it wasn't what I thought nursing was. Nursing is so incredibly hard and you're always trying to figure out who to help first when everyone needs your help.

So, to all the health professionals out there in that kind of setting,

Man, do I have a lot of respect for you. I figured out a way,

And Jeff has helped me, to do this on our own terms and to be able to take some time and really spend time with patients so you can listen

And figure out how the best way is to help them. So, maybe I'm not physically rubbing a brow,

But to be able to touch a heart and to listen to someone who hasn't been listened to properly before,

Well, we couldn't ask for a better, a better thing in the world. So, thank you for sharing that with us. It makes us very happy when you do.

It's very kind of you. Thank you, Suzanne.

Yeah, that was very sweet.

All right. Come on, let's get to the show. I Come on.

So, we do have more questions, of course.

Oh, okay. Is this a two-fer? What are we doing here?

Yeah, we are going to talk oxalate. I know we talk oxalate a lot, but, yeah. But, like keep the questions coming because like it's really,

Shocking!

There's no question can be answered too many times, because we want to be sure that we connect with you when you need to hear it and the way that you need to hear it, and that can really go a long way. So, this is James.

Hi, Jill, I'm an American living in Japan and my name is James and I'm very grateful to have your podcast and very grateful to see your website and very useful to find these things. My question really is about some of the things that on the oxalate list, as you mentioned before, not a whole lot of new foods have been added to that list.

And I know that a lot of Japanese food does not have a lot of oxalates, but there are still some foods that I have some questions about. My question is really about where do I go to get really more up-to-date information on some of these new foods, and what do I do when I find that an item has, for example, different oxalate levels on different websites?

It's very confusing. Sometimes I look up things like oatmeal and find that one website has one bit of information and then I go to another website has completely different information. Thanks.

It's a great question, and yes, I am I am that's always the number one question with people. It's always about oxalate and I'll say this a million times. The Kidney Stone Prevention Diet is oxalate is such a small part.

If I were living in Japan, I'd worry much more about the sodium. That's what I'd be worrying about. However, his question is not about sodium.

It's about

Oxalate. They're excellent questions. I can answer them all day long, okay, because

People always have questions about them because the information is less than. So, let's talk about this.

So, first of all, where can you get updated information? There's not a lot of updated information. It's very

Costly, James, to study

Oxalate levels. Also, you are going to see different values on different lists because

The plant was grown– oxalates only in plants.

The plant was grown in different soil conditions. A plant grown in one part of the country, as opposed to another part of the country, could have had different soil conditions, different light, different stuff. So, they're going to absorb minerals different, all it there's it's very complicated.

And so, the growing conditions can affect oxalate levels.

The researchers may all use a little bit different techniques.

It's not something, we'll see where it goes in the future.

Oxalate is being blamed for a lot of different diseases.

I just I don't ever really comment on that. I just deal with my oxalate in the kidney stone world, but it's getting very popular

To talk about and peg oxalate with different disease processes. So, I think oxalate may be looked into more in the future, so I never discount that new studies could be put out all the time. If you go to PubMed, you may be able to find some studies on newer foods, for sure.

Using the Harvard Oxalate List with Calcium

But

I stick with the Harvard list

Because of the other advice I give with it. Once you take the other advice, you won't have to worry so much about these other things you asked.

So,

And this is one of the reasons that I just believe in this as in the dietary world, but particularly for the Kidney Stone Diet and oxalate. You said different lists will have different oxalate values. I trust the oxalate list from Harvard, we trust those researchers, and also, I've been helping patients understand that list for now 22 years.

So, I look at the follow-up urine collections after educating patients on oxalate and they lower their urine their urine oxalate, so I know that those values stand by. But it's not just those values.

It's the other advice I give when somebody's working with me: Eat

Normal amounts of food. Stop eating the same foods over and over, the highest oxalate foods, and not getting any calcium.

Most of this is a calcium problem. Because people aren't getting their normal amounts of calcium, they have excess oxalate in their system.

Of course, if you have malabsorption issues, you're a different that advice does not hold true for you. You're different than somebody who doesn't have those issues.

So, you may see, even Harvard itself, it will have pancakes listed twice on their list. One says it's higher than the others. What the hell?

I don't know.

People say, "Why, Har–" I don't know. I don't know. I don't know why pancakes, that studied pancake, is higher.

I don't know, did they use a little bit more flour in that pancake? What did they do? I don't know.

But my point is always going to be this: You shouldn't be eating freaking pancakes every day anyway. It's crap, it's crap food. I mean, so I'm always going to go back to this, whether it's 7 mg of oxalate or 14, in the grand scheme of things, that's not the problem.

It's that you're going to eat eight pancakes every day with no calcium, with lots of syrup,

Because, to me, pancakes–and I know I'll get some hate in the comments about it, but I'm going to say it anyway because that's who I am–

The whole reason to eat a pancake is to get syrup in your mouth. It's a vehicle, just like spaghetti, it's a vehicle to get sauce. I mean, come on, people, who wants a piece of cake that don't have icing?

These are ways to sop the extra stuff up in our mouth. So, pancakes, whether it's 20 mg of oxalate or 10, does it matter? It's not the healthiest food,

And it's not a big difference.

The average person, the average kidney stone patient, can easily have 100 mg of oxalate a day, unless your doctor has told you otherwise.

So, focus on that. If you have pancakes that are 28 mg, and I know I'm saying different numbers all the time, but it's my point is it don't matter, then you know you have about, you know, 82 to have for the rest of the day or however much it is, math ain't my thing.

And so, so plan your day. If you want to have more oxalate in one meal, then watch your oxalate for the rest of the day. Here's the deal.

People tend to be very dealing with the minutiae.

This is not a judgment, this is a fact. This is what I see day in and day out. People are so focused on

Pancakes, for example,

That they ain't thinking they have a whole other day to eat other food, so it's only one part of their day.

So, when you open up people's view on food,

On how to incorporate a low-oxalate diet, this list, that list,

It really doesn't matter. Now, I say that because I'm looking at the big picture. Nobody here formed a stone in a week, a month, 3 months, unless you're a very, very rare type of stone former.

It takes a long time. It takes poor eating

Or overeating healthy foods in big portion sizes

Without any calcium, not getting enough fluids, not watching sodium, especially, like I said, if you live in Japan, it's going to be high-sodium sauces, although I'm sure you're probably paying attention to that.

It's all of these things long-term,

Long-term. "Jill, Thanksgiving's coming. Oh, my god.

I can't have–there's nothing to eat." It's only one dinner. It's only one dinner. "Oh, okay, Jill." But, you know, as a patient, as a cancer patient, my diet had to change too while I was going through my treatments.

I understand you because even though I've done this my entire career, I was just like you. I'd be looking at this, "Oh, my god, what am I going to do? I got this all this stuff, I can't I can't eat this, I can't digest that," but I wasn't looking at the bigger picture, okay?

So, I understand when you're a patient,

You get scared, it's overwhelming, and you don't want to screw it up because you don't want to be sick again. So, believe me, with every cell of my being, I tell I tell you I understand. So, sometimes

Because I went through that, I understand how we get sucked down in the minutiae. Like I said, it's not a judgment, it's simply what is. So, when I can teach somebody and educate somebody looking at the bigger picture with your food and that one meal isn't going to make a stone, or one meal isn't going to make you gain 50 lb of weight you just lost, it's not going to.

It's what we do after the next

Choice. It's what we do with the next choice. Don't eat a high-oxalate next choice.

Don't eat a really high-caloric next choice. Get right back to it.

I promise you guys, makes me so happy to know this, that this is the answer. The answer is this:

You can do whatever the heck you want, just get right back on track with the next meal choice,

And you have nothing to worry about.

That, I know. What were we talking about?

That is wonderful advice. That is like because one meal, one

That's it.

One choice isn't going to derail everything. But I fall in the same in the same camp. Like when we first met, I really, really wanted a list that had oxalate say 1 g of X, how much oxalate.

Cuz I'm like a programmer, I'm like analytical. I want to I want to make that system to be like, "Oh, any recipe we can tell you the exact amount of oxalate in a serving." Like that'd be my dream.

100%.

But it's hard to like get past that, to be like, "Oh, that actually isn't, the exact number isn't the point. It's It's one piece of a larger puzzle."

Well, yeah.

Yes, and I think what's that's awesome, Jeff, and I think so many of my patients I talk to, they're like, "Okay." They get their pen and they get their graph paper, their diary, "Jill, tell me everything. I'm going to write it all down," and they want those numbers. So, and then there's some people like me that I'm a little bit of both, and then there's some people that don't want no number.

You say the number two, and they're going to faint. I mean, they just cannot. So, you've got to know who, when you're teaching anything in life, you've got to know, forget about what you came to teach, you got to think about who you teach.

That's what you got to think about. Don't matter what you have to say. It matters who you're saying it to, and once you understand who your audience is, and know that you better change.

I'm dealing with people from New York, Alabama, Maine, California.

I've got to know who I'm talking to on the phone

Without any physical cues, so after doing that for decades, you learn quickly, what is somebody saying, what do they need, who are they, so then you can change how you're going to give the information. Because if I don't understand how to Does anyone know what I'm talking about? What am I talking about?

But this is all true, but this is truth, so you can sit here and want to do numbers, but you've got to also understand the big picture. So, everyone will learn things differently. Jeff likes numbers, but maybe you, the listener, does not.

So, you've got to understand how to do this in different ways, and I think that's why we choose so many different venues to educate people: YouTube, Spotify. Some people don't want to see nobody, most of all me and my fuzzy hair. Jeff, yeah, he's handsome.

Nobody wants to see me. Written.

You know, we do different styles because everyone's different and they're going to soak it in different ways, so it's very important. So, listen,

James,

I want you to use the Harvard list or find a list that you think is working for you. I can only tell you that I see all these follow-up urines. When you see something that's not on the Harvard list, have it once or twice a week.

Have it in a normal portion size. Not in 22 years have I seen somebody make a stone with that advice, okay? So, most of my patients stop making stones, not because I'm a, you know, Glinda the Good Witch, it's because they work their butt off and they incorporate the education I'm trying to teach them, and miracles happen when you learn how to eat properly in normal portions and watch all the elements of the Kidney Stone Diet, all the goals, which you can find on kidneystonediet.com the start page.

You can see all the goals of the Kidney Stone Diet.

Yeah, and just because you mentioned it, the urine collection, we haven't talked about that in a little bit, but that is a very important part of this entire process, so you actually know where you're at. And you have the urine analysis

Oh my goodness, it's so important.

Service on your site where you help people break down actually what those results are and what it means to them.

I love that service and I always say I love that service because then, and again as a patient, I wish I was a little bit more educated going into my office visits because when you're scared and anxious or you're in pain or all the things you're going through, you don't know what you don't know. It's already intimidating going into the doctor's office.

Even me as a nurse, I feel that way. So, you know, the urine analysis service, I can show you what your numbers mean so you can talk to the doctor, so you can get on a great treatment plan and have an educated conversation with your doctor and make the most out of those appointments and out of your copay. I can't tell you how many patients before they met me, not because I'm special, but this is the story, "Jill, I went to my doctor.

I didn't know what to ask, so I left and I was just as bewildered before I went in." So, get educated before–It's 15-minute call. It's very affordable, people. Get I base that upon my experience going to the doctor's offices, so it's going to be it's going to be a very short call, but, man, do I pack it in so you can have a really educated office visit so you can get the most out of that office visit.

So, when you leave there, you feel in control. You feel like, "I got what's going on, I know exactly what I'm going to do, I'm never going to make another stone again." That's what you need. Anyway, go ahead, Jeff.

Yeah, I think that's a great spot to wrap. So, thanks again for listening. If you're enjoying the show, we'd love if you subscribe on YouTube, give it a little thumbs up, leave a comment below the video, that really helps us reach more people and it means a lot.

And as always, head over to kidneystonediet.com to find links to everything, all the free content, all the premium content. You can get to the Kidney Stone Prevention group on Facebook, which is another free piece of content with

Yes.

Over 10,000-plus people. I think there's–

Yeah, almost 11,000 people. It's a very lively community, supportive, kind, nice. I'm the admin there, so I oversee it all, so no one's going off the rails in any way, so I love That's my baby, that Facebook group.

You know I love that group.

Yeah, for sure. So, that'll do it for this week. Thanks again for listening and we'll see you next time.

Thanks very much, James. We appreciate your comments. Wonderful.