What are oxalates?

Welcome back to the Kidney Stone Diet, the show about reducing your risk for kidney stones and living your best life. I'm your host and fellow student, Jeff Sarris, and I'm here, as always, with our resident kidney stone prevention expert, Jill Harris. How you doing, Jill?

Hi Jeff, good to see you. It's good to see you. I'm here, ready.

Ready and able, present.

Excellent. So, we'll just dive right into the topic today. We are going all in on oxalate.

So, oxalate is a huge topic in kidney stones, kidney stone prevention. So, the question we're looking at is, I mean, first, what are oxalates? And then, is the kidney stone diet a low oxalate diet?

I think that's, I think those are excellent questions. So, oxalate is a naturally occurring substance in plants and also in our bodies. And its role is to help guide calcium out of the body, so that's its role, okay?

I never get too scientific, because people then have a habit of like shutting me off. So, I like to keep it lighter, but that's basically what it is.

Our bodies make it, it's a byproduct of general metabolism, but it's also in many, many foods. Only plant foods though, so people will be like, "Do I have to give up meat? What about lamb?

What about this?" It's not in meat, it's only in plant foods, so there you go. But some people will say, "Okay, Jill, so I haven't had a plant food since 1969, so what's up?"

There's other ways the body can get too much oxalate inside of it, and if you have some medical conditions, or like I said, your body's just making too much of it, or you've had surgeries, one could have too much. As far as, is the Kidney Stone Diet a low oxalate diet, I think that's a brilliant question.

Most people come to me and they want to talk about oxalate, because their doctor threw a pamphlet at them, and the doctor, or the medical person, said, "Never eat a green, leafy vegetable again." But the oxalate component of the Kidney Stone Diet is important if you're overeating oxalate. But once you get rid of the highest oxalate foods,

Which is just a little handful—it's not a big, old list, just a little handful—once you get rid of those highest foods, everything is so easy. Most people don't ever go near the high amount of oxalate again. So, no, the Kidney Stone Diet is not a low-oxalate diet.

It is watching your oxalates and taking away the highest, i.e., spinach and almonds, taking away those foods.

That's, that's part of the Kidney Stone Diet. But what, what I freak out about and what gets me, ignited is that people then say, "Oh, my god, I can't have this vegetable or this fruit, or I can never have a salad again." And so what happens is, they start taking away all healthy foods,

When it's only a little bit of those foods that need to be paid attention to. Most fruits and vegetables are perfectly fine to eat on a lower-oxalate diet. It's just that when we're eating spinach and almonds all day long, because other people have said that they're healthy, once the world tells us something is healthy, we tend to eat like this:

Bah, bah, bah. We're going to have as much of that healthy food as we possibly could get in our stomach, because more of that healthy food equals healthy, healthier, right? No, not in the case of a stone former, unfortunately, anyway.

And so a lot of people who changed their diet and decided to eat more spinach, more nuts, lots of nuts, you know, and eating too much of it,

That's what led to their kidney stone, along with not getting enough calcium. So, it's a little complicated, but once you get what is oxalate, what truly are the highest oxalate foods, and do all of everything within moderation, it's really the least problematic part of the Kidney Stone Diet.

Yeah, and I know you talk about portion, not perfection, a lot, where you're not going to cut out everyone's favorite foods. I mean, you mentioned spinach, almonds. Are there any other big hitters, or ones that are sort of in the middle range that are high in oxalate that you would recommend avoiding for some people?

Yeah, so spinach—and people say, "Why, Jill, you say portion, not perfection." But it's hundreds. It's 600, over 600 mg of oxalate in one cup. And you know, by the time you sauté a cup of spinach, it's for a baby doll.

There's no spinach on your plate. So, you know, most people are doing cups and cups of it. And so it's hundreds of milligrams of oxalate.

And some people will say, "Well, there's calcium in that spinach though, Jill." But not enough to get rid of hundreds of milligrams of oxalate. So, we've got to look at that. So, there's oxalate, there's almonds, again, over 100 mg of oxalate in a very small portion.

And Ted or Timmy or Barbara will say, "But, Jill, I only have some handfuls during the day." But look at your hands. It's a lot of nuts fit in those hands.

So, again, it is portion, not perfection, but some of these foods, spinach, almonds, buckwheat groats—whatever the hell they are, people eat them, though. They tell me they do, buckwheat groats are high—soy products tend to be high. So, things like that higher in oxalate.

There's a few, and actually, I have a free resource on my website, kidneystonediet.com.

And if you go under the resources, you're going to see a one-pager, and there's probably like, I don't know, 15 foods on there that we ask that you do avoid eating, okay? I can never remember them, because, you know, I can't. You would think in 21 years I would remember them, but I don't.

So, get that free resource. I made it more for you than I did me, quite frankly.

Yeah, absolutely. And there's also the low, the oxalate food list, where it's searchable to sort of see how they range in terms of oxalate per food, which I think is super valuable. And, so I want to swing back around to calcium just briefly.

We'll obviously dive deep into calcium in another episode, but you've mentioned calcium being paired with oxalate and how that's important for, like people would mention, well, spinach has calcium, is that enough? What is that correlation between calcium and oxalate?

Well, here's the thing. Most people, most people come to me, most grown-ups don't get enough calcium, especially if you're a vegan or vegetarian. And there's nothing wrong at all with being a vegan and vegetarian, I'm vegetarian.

It's just that we lose sight of the calcium. A lot of vegans will say, "Well, I thought I was doing a great job because spinach does have a lot of calcium."

But the problem is, like I said, the oxalate is just so much, so it's not hitting where it needs to hit. The role calcium has is calcium and oxalate bind together in your intestinal tract, and the only way oxalate can leave your body is to bind with calcium, and then it comes out through the stool. If there's not enough calcium to bind with oxalate when you ingest enough oxalate, or oxalate,

Then it gets reabsorbed back into the bloodstream, and that's how we get higher oxalate levels. So, the deal is, whether you have stones or not, we all need calcium, because as Dr. Coe always says, my mentor, he always says, "And by the way, people, you have a skeleton." So, you need to nourish it, too.

So, you need calcium in your body, and it depends upon who you are. If you're a woman who still gets her period, you need about 1,000 mg of calcium a day. If you're a woman who no longer gets her period, you need 1,200 mg a day of calcium.

If you're a man, you need about 1,000 mg of calcium as a day. And as you get a little older, those needs may grow, too. Now, here's the thing.

Don't go over calcium, because all of you think, "Oh, if I do more of this, it's better for me." No, as you learned with your ugly kidney stone, it's not. So, get up to your goals. I'd rather people be just a little short than go crazy over, because the body may not absorb it, and then you have all this excess calcium floating around, right?

So, that's really important, because if you have excess calcium floating around in your urine, that's where oxalate and these other critters—

Nobody social distancing in the kidneys, they're not wearing masks—so we can connect all these little minerals and stuff and salts can connect in your kidney and form these stones. So, it's very important that you're not overdoing calcium. The other deal is, people will say, "Well, how do I know when to do calcium?

Should, if you're saying it binds together in the gut and all that, do I need to, every time I have a little bit of oxalate, should I be grabbing the milk?"

No, you shouldn't do that, because, you know, it's when we're doing like something that's super high, like if you are going to have, you know, something that's 20 mg or higher, and I'm making this up, there is no science to back exact this, but I am, I am saying for a ballpark figure, if you're going to have something that has like 25, 30, 20, you know, anywhere above 30 mg of oxalate in a portion size,

Then maybe you do want to pair it. Maybe you want to put a higher-oxalate fruit, maybe raspberries. People just fell off their chair because they're like, "Jill, you know raspberries are really high?

What the hell are you talking about a raspberry?" But say I'm working with somebody and they're like, "Listen, if I don't get a freaking raspberry in my mouth, even if you just give me two, sister, I need it."

And sometimes with things that are higher in oxalate, or something that has added sugar, or something that's a little saltier, I will always go back to portion, not perfection, because what I'm looking for with patients is long-term compliance with their lifestyle. So, if somebody's like, "I promise I will give you long-term compliance, Jill, if you give me a couple of raspberries."

So, I'll say, "Okay, I'm going to give you raspberries, Tammy, but you've got to pair that with yogurt, okay?" Which has some calcium in it. So, that's a good example. Raspberries are super high for a very little amount.

So, if you're an abstainer, then don't go near the raspberries if that works for you. If you're somebody who's like a moderator and you do things in moderation, have a couple, but you darn well better put it in that yogurt,

Because the raspberries are quite high in oxalate. But it's a perfect example of where you should be, you know, "Hey, Henry, get me some yogurt, I'm having a couple raspberries." So, you know, that's where you want to put it. You do not have to call your spouse or your partner for any kind of calcium if you're just having a few milligrams of oxalate.

What happens is, is people start doing too much, and then before you know it, they've had 1,500, 2,000 mg of calcium.

And so, per day, and you don't need all that. So, most of the time, you do not have to pair it exactly, but also, if you are going to have a higher-oxalate food, you can't have calcium two hours later. That oxalate food is far gone during your digestive tract, okay?

The calcium ain't going to play catch-up. So, what happens is, oxalate is metabolized.

It goes down to your colon. It looks around for its friend calcium. He wants to leave with calcium.

Calcium's not there. He looks around, he's like, "Okay, I guess I better go back in, cause I can't go out like I want to through the stool." And, again, that's how we get higher oxalate amounts.

Yeah, it's really interesting stuff. Yeah, I think that—

Isn't it?

Yeah, I think that really covers it well. We'll obviously dive into calcium, like I mentioned, in a different episode, and more aspects of the diet, sodium and what not. But I think that's that's good for this week.

So, I just want to recommend to anyone who is interested in more to definitely check out kidneystonediet.com. There's the Kidney Stone Prevention Course.

It's a deep dive into everything you need to do to prevent and reduce your risk of kidney stones.

Yes, one of my favorite things, I just have to say, one of my favorite things is educating people on this, because not only is it good for kidney stones, but it hits—it's just healthy lifestyle. It's a it's a diet that gives you goals instead of telling you really what to eat and what not to eat. And so it will fit anybody's lifestyle.

If you're a vegan, vegetarian, carnivore, well, that's not going to work for kidney stones, but you know what I'm saying.

So, allergies, sensitivities, food sensitivities, so whatever you've got, we're giving you goals to hit: how much added sugar, how much calcium, how much sodium. And almost everything we say, everything we say is also what the USDA also says. So, our government agrees with this as well.

This isn't just made up for stones, okay? So—

Yeah, it just has the specifics that are necessary for the various types of stones. So—

Yes.

Yeah, I mean, I think it's a wonderful resource. I mean, of course, we're doing this podcast to get the word out, both about that and just to help people with a free resource such as this. So, yeah, we'll draw that to a wrap today.

And if you're enjoying this podcast, be sure to subscribe on Apple Podcasts, Spotify, wherever you listen to podcasts. And also we have this the video version on YouTube that you can watch.

And don't forget to like, comment, and subscribe, and all those places, wherever's best for you.

Yeah, it helps. It helps, yes. It helps other people find kidney stone help, because otherwise we just get lost in the millions of kidney stone stuff here.

So, yes, it's helpful. I'd appreciate it if you would do that.

Yeah, definitely.

Well, that's it for this week. See you next time.

Bye Jeff, thank you.