How to eat when you have too much oxalate in your urine

This week Jill answers a listener question about hyperoxaluria and how to eat when you have too much oxalate in your urine.

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Jeff Sarris: 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.

Jill Harris: It’s Jill, your Kidney Stone Prevention nurse. Good to see you, Jeff.

Jeff Sarris: Yeah, always great to see you, too. And it’s really funny because we’re batching these so it’s we’ve been looking at each other for the last what, hour? Two? I don’t know how long it was, but it’s fun–

Jill Harris: Yeah, we have to act surprised. “Oh, Jeff, hi! How are you?”

Jeff Sarris: I haven’t seen you since last week! But yeah, it works for us to do it this way because it’s always hard to get these schedules lined up, because we’re both really busy. You are on calls and helping patients all the time. So we have to carve out our windows of opportunity. This is good, though.

So, we are going to go back to another listener question. Before we dive into that, I just wanted to give that number again, sometimes I forget. It’s 773-789-8763. And if you have a question for Jill, we would love to feature it on a future episode. So, this is–actually we don’t have a name for this person, but we will find out.

Listener Voicemail: I’m Paul. I’m from Los Angeles, California. I was wondering about extreme hyperoxaluria. I was just diagnosed with it after I’ve had two kidney stones. I’m 20 years old. I got one the first time when I was 16 and another when I was 19. So, I was wondering, what kind of diet should I look at? I got a test done and it said that my oxalates were very high. Okay, thank you. Bye.

Jill Harris: Oh, it always kills me when somebody–first of all, look, one of the reasons I’ve dedicated my career to this is because it’s people being sick. When I was in the hospital at University of Chicago, this is not what I did. I was dealing with people who had Crohn’s or colitis or bowel surgery–actually the surgeries that I’ve had to have during my rectal cancer–I was dealing with those kinds of patients. Gastric bypass patients, typically any really crappy thing that’s happened to your stomach, I was dealing with those patients on the floor. And it always bothered me that I was dealing with people that were already sick.

It was very stressful working at the hospital. And for all of you in healthcare that work in hospitals, I see you and I know how hard your job is. It was so hard that I couldn’t do it anymore. It was very stressful. And so I tell this little story only because it has been the most rewarding thing of my life to be able to help people prevent something going forward. That’s why you go into healthcare to me. I mean, that’s what I want to do. I wanted to help people, so they didn’t get sick. And so it breaks my heart when somebody so young has had something like this young man. He said his first stone was when he was 16, so that’s terrible. And he’s had other ones, too. I believe he said he’s 19 Did he say that, Jeff?

Jeff Sarris: Yes, I believe he’s 20 now. Oh, yes, he had his first one when he was 19.

Jill Harris: God bless him. So, he’s had a couple of stones and he’s only 20 years old. Number one–I wish I had your name–but number one, I’m very proud of you for taking an interest in your health, so you don’t go through this anymore hopefully. So kudos to you, it’s not easy to do that. Second of all, what I think he is saying is that he has hyperoxaluria which is he has too much oxalate in his urine. So, he’s asking what kind of diet can I go on? We have the Kidney Stone Diet and part of the diet is to lower your oxalate.

Now, some people–and it is very rare do not think you all have this kidney stone audience. It’s so rare. So rare. Think so. Then, think rare, so rare. Only a bip of people will have this. It’s very rare. Some people have primary hyperoxaluria, okay? And there is this just genetic thing that some people typically they have a when they’re–I’ve had a couple patients, they’re two years old, three years old, you know it if you have it because you’re getting stones at two. Very, very rare. And these people are just producing way, so much, think tons of oxalate. And so really we can’t prevent stones for you.

Now, this patient did not say that. He said he has high oxalate in his urine. I would love to see his urine collection, so I can see how high is high. If someone tells you you have high something or low something, “Dear doctor, how high is high? How low is low? Where do I need to be? And how am I going to get there?” Those are the questions to ask. There’s a lot of healthcare professionals that will just say “high, low, bluh, blah.” Well, what does that mean for you? So, I don’t know what that means for him. Is his oxalate over 100? It could be. I’ve dealt with a lot of patients with oxalate levels over 100.

Remind yourself: we want it to be less than 30 in your urine. Thirty, less than! Some patients will have very high oxalate levels in their urine because they are genetically predisposed to that, okay? That is–I think in 22 years I’ve had one patient with that and they are then shipped right away to Mayo Clinic because they have special stuff there for them. He could just have hyperoxaluria; he just has too much oxalate in his urine. And once you lower the highest oxalate containing foods, think spinach and almonds, you will lower your urine oxalate. Also increasing your daily calcium will lower your urine oxalate because that is how oxalate leaves the body. It binds with calcium in your gut, in your colon, and leaves through the stool.

What Vegans & Vegetarians NEED To Watch Out For

So, if you eat a higher oxalate diet–many vegans and vegetarians do. It doesn’t just have to be them, but many do. Spinach is the perfect example. If you’re a vegan and you’re trying to get calcium, you’re gonna eat a crapload of spinach because there’s a lot of calcium in spinach. But there’s also a lot of oxalate in spinach, unbeknownst to a non-stone former until you get a stone and then you realize that. So, dear caller, I would ask you a few things. First of all, I would tell you to follow the Kidney Stone Diet. You can go to kidneystonediet.com. Go to the start page and you will see exactly what the Kidney Stone Diet is. It is less than 100 milligrams of oxalate a day. We give away a free oxalate list on the website: kidneystonediet.com.

It is paying attention to how much sodium you have a day. Shoot for 1500 milligrams of sodium a day. How much sugar? Added sugar: sugar that wasn’t born in a food, but added to it. Think candy bar. You want 25 grams of added sugar allotment for a woman 38 grams of added sugar allotment for a male. Calcium: 1000 for men and women 1200 for women who are in menopause. Fluids: you want to drink enough that you get 2.5 to three liters a day output. That’s in pee. Everybody’s different. I may have to drink more than you because I exercise a lot my sweat more to produce the same amount as a urine as you. And then protein; eat normal amounts of meat protein. You can figure that out on my blog. There’s an article that will tell you that. Then, get enough calcium like I already said. I think I got all of it right, Jeff? Sugar, salt, protein, fluids, and calcium.

Jeff Sarris: Yeah, and definitely at the site you can find all of that info.

Jill Harris: The first questions I think of with this caller is how much is high? How high is his urine oxalate? And then if it’s a genetic reason–which is doubtful only because it’s so rare–the Kidney Stone Diet will fix it. Look, I have worked with thousands of vegans in my career and they will come to me and they’re urine oxalate will be over 100. They work with me– one phone call–the next time they do a urine collection, it’s under 30 because I teach them how to do it. And it’s not just taking away spinach and almonds. It’s typically, especially a vegan, “Okay, Jill, I hear that I have to take away these things: all the beans, all the spinach. Now what am I going to eat?” Because that’s what their diet was based upon: a lot of spinach and beans.

And guess what? Not enough calcium. Again, they were thinking they were getting it from spinach, but there’s so much oxalate in that it just don’t matter. So, they then have to relearn the foods they can incorporate into their diet. That’s what’s hard about lifestyle changes. So, dear caller, I would love to see your urine collection. I’d love to see what your urine oxalate is. I would tell you to make sure you’re getting your daily calcium needs met. I have plenty of free articles on my blog at kidneystonediet.com to teach you all the different aspects of the Kidney Stone Diet. There’s also a YouTube video right here and–cue it up–it tells you what the Kidney Stone Diet is. And there’s videos on calcium and how to lower your oxalates, so keep watching the videos and you can learn about it.

Jeff Sarris: So, you mentioned that you would like to know what the levels are. Would you recommend that he get a urine collection now or maybe has one and could submit it?

Jill Harris: No, I think because he knows his doctor said he has high urine oxalate, he must have done a urine collection. And I would assume–but I do not know for sure, so I’m assuming–that when the doctor said “Look, your urine oxalate is high. You need to lower it.” Then, I’m hoping the doctor said “And in two months time, we’ll do a follow-up to see where your urine oxalate is now, so you can stop making stones.” The fact that this caller is so young makes my heart–because I’m a mother–makes my heart sad. I want him to get the right help and the right protocols met because I don’t want him to have a lifelong disease.

What happens is and why I’m so passionate about kidney stones in general–kidney stone formers–is if they don’t get help, if they don’t get educated, they run the risk of having procedure after procedure after procedure. Which then you run the risk–and it’s not uncommon–to have chronic kidney disease, likely higher risk of stroke, cardiovascular disease, dialysis, nephrectomy, which is loss of a kidney. These surgeries that you have to go through, can be damaging, can be scarring to your kidney to your ureter. So, guys, not to mention every time you have a surgery–every time I’ve had a surgery, I’m paranoid. Am I going to get an infection?

You don’t want a surgery, people, if you don’t need them. They’re terrible. I didn’t say that well, but y’all understand what I’m saying. We don’t want you to have to have a surgery. If you can prevent these stones, so you don’t get sick and run the risk of all these other diseases, and the risk of infection and scarring and all the things I just said, well, that’s what you want to do. So, please, I love the fact that he’s so young and he took it upon himself to say, “Hey, let me Google something. Let me go to YouTube and figure out what crazy person’s on and will help me with this.” So, sorry, I got a text. Can you see me still, Jeff?

Jeff Sarris: No, you just went away?

Jill Harris: Oh, my God. Hold on.

Jeff Sarris: No, it’s okay. There you are!

Jill Harris: There I am. So, the fact that he took it upon himself at such a young age to be interested in his health, just makes me so–listen caller, if you want to email me–I know Jeff is going to be like really girl you’re giving our email out! Whatever, I’m going to! jill@kidneystonediet.com. Email me and let me know, privately, more of your story, please. Email me at jill@kidneystonediet.com, and I’ll help you.

Jeff Sarris: Yeah, that’s what you do. You do all of this to help people improve their lives. And there are so many resources, so for anyone else who wants to dive deeper, head over to kidneystonediet.com, where you can find everything from the Prevention Course to all the free content on the blog, the weekly newsletter which is free. There’s a link to the Facebook group, which is a very supportive community of people where you can find people going through the same stage in their life as you are when it comes to kidney stones and people who’ve made it to the other side. So it’s a very helpful resource.

You can find all of that at kidneystonediet.com. And, as always, if you’re enjoying the show, it means a lot if you subscribe, give us a thumbs up, leave a comment below because it really helps us move up the rankings and have more people find us just like today’s caller. Oh, and if you have a question, the number again is 773-789-8763, and we would love to feature your question on a future episode. That’ll do it for this week. We will see you next time!

Jill Harris: Bye, Jeff! Bye, caller! Thank you for your call. It was great!