Carnivore Diet and Oxalates
If you have visited with me as a patient, you know how hesitant I am with restrictive diets . With the all-meat diet (a.k.a . carnivore diet) taking storm this month; you can likely predict that I am not jumping on the bandwagon.
However, there is often much to learn from people who benefit from restrictive diets and from people who don't do well on restrictive diet. For more on the perils of restrictive diets listen to a recent podcast I hosted.
With the all-meat diet we sometimes here stores that many nagging symptoms of pain, inflammation, fatigue, poor digestive function, and brain fog will vanish. Some people are even claiming it has put their autoimmune condition into remission.
How could taking out supposedly health foods like vegetables, nuts, and fruits possibly make people feel better?!
Isn't this the antithesis of everything we have learned and against everything a well-intended nutrition focused health practitioner would tell you?
Of course there are stories of epic battles of the "carnivore diet trots" . Also people going on the carnivore diet getting extremely bored with the diet.
So, I pose the question as to why some people might be feeling better on the carnivore diet?
Naturally I ask...what is absence in meat that is present in non-meat foods.
The three main groups I have come up with are
If you are eating meat only you are not exposed to these groups in any appreciable amounts..
Of course there are other more obvious triggers you are avoiding like gluten, nightshades, and dairy.
For the purpose of this article I am going to focus on oxalates. Because I see oxalate dysfunction as a growing trend in my practice.
What are oxalates?
Oxalates (or Oxalic Acid) are an organic acid that is found in certain foods that binds with calcium and other divalent cations preventing its absorption .
What is hyperoxaluria?
Hyperoxaluria is an excessive urinary excretion of oxalate. Individuals with hyperoxaluria often have calcium oxalate kidney stones .
Hyperoxaluria can be primary or secondary.
Primary hyperoxalurias (PHs) are autosomal recessive disorders caused by the overproduction of oxalate leading to calcium oxalate precipitation in the kidney and eventually to end-stage renal disease .
Secondary hyperoxaluria is when oxalic acid that is consumed is not properly eliminated properly and is being hyper-absorbed creating excess load of oxalates on the body. It may also come from collateral endogenous production of oxalates (discussed below).
How are oxalates processed and eliminated?
When functioning properly most will be eliminated through the stool by binding with calcium.
The problem is when they are hyper-absorbed and are over processed by the kidney and eliminated in your urine. Endogenous production of oxalates or absorbed oxalates are processed by the liver and then eliminate in through the kidney.
When oxalates build up in the body; they drive salt complex or crystal formation in the body.
Symptoms of hyperoxaluria that is dis-regulated.
There are many consider which makes this a puzzle that should involve a health practitioner. These symptoms are generally not considered in the patient with oxalate issues as most of the focus is on presences or absence of kidney stones. However, a more exhaustive survey is below:
General symptoms: General – burning, tingling or numb hands or feet
cold hands and/or feet, fatigue, chronic fatigue, feeling drained, and/or lethargy.
Mouth-related symptoms: sensitive teeth and gums, burning lips, popping jaws, and burning, stinging, sore and/or tingling mouth/
Head, eyes, ears, nose, throat, and mouth symptoms: Headache, migraine, stiff neck, sensitivity to light and noise, calcium deposits on cornea, and/or ringing in the ears (tinnitus).
Genito-urinary Symptoms: genital - inflammation, genital red or purple sores or bumps, Genital white patches or red spots, Genital stabbing or stinging, clitoral pain (or penile pain in men), pain at vaginal opening, painful intercourse, internal pelvic pain or soreness, rectal burning, vaginal pain ,vaginal itching ,vaginal spasm, vaginal redness ,vaginal tears, vaginal burning discharge, bladder infections, concentrated or pungent urine , chronic interstitial cystitis, painful urination, urethra pain, and/or frequent need to urinate or urgency.
Skin or dermatological symptoms: Sensitive skin, pain when you tug on your hair, itchy skin, hives, welts, rashes, crawling sensation on skin, sensitive skin, and/or sensitive scalp.
Gastrointestinal symptoms: Vomiting, stomach pain, upset, indigestion, constipation, diarrhea, colitis, and/or irritable bowel.
Neuromuscular Symptoms: Dizziness, poor balance, body ache, weak muscles, stiffness, joint pain, fibromyalgia, restless leg Syndrome, restlessness, tension, tics, muscle tremors, cramps, Insomnia, and/or sleep disturbances.
Who is at risk for secondary hyperoxaluria?
In recent studies hyperoxaluria predominantly results from:
increased consumption of dietary oxalates. We go into this below.
intestinal hyperabsorption of oxalate, partly caused by an insufficient supply or low availability of calcium for complexation with oxalate in the intestinal lumen.
people with a jejunal/duodenum bypass are at high risk for high absorption of oxalates.
theoretically if someone is avoiding dairy consumption with other oxalate rich foods then it might put them at risk
In addition, there is recent information that states that candida species overgrowth may be associated with hyperoxaluria. Its is reported that fungi produce Ascorbic Acid (vitamin C) which can also lead to oxalate formation systemically.
This diagram shows the pathways that lead to higher oxalate levels including: diet, yeast/fungi load, vitamin C possibly (ascorbate) , ethylene glycol intake , and also the glyphosate pathway (discussed below).
What diseases /conditions are associated with hyperoxaluria?
If you have been a frequent urinary stone /kidney stones former there is a chance you have been have developed calcium oxalate stones. Unless you caught the stone and had it analyzed you would not know. If you ever pass a stone; do know that kidney stone testing is available.
To see if you are at risk for developing stones in general or hyperoxaluria you can also have the Kidney stone risk profile performed through LabCorp.
Other conditions that may be associated with hyperoxaluria are fibromyalgia and gout.
There is a proposed association of high levels of urinary oxalates in autistic children.
What foods are High in bio-available oxalates. (Source :Mahan, Escott-Strump.2004)
other food concerns:
Glyphosate consumption ( round-up) a herbicide used in the farming/growing of year-round vegetables and grains may add to the oxalate load. As many glyphosate formulations use oxalic acid as a surfactant.
Choose non-glyphosate containing foods.
Glyphosate is metabolized via the glyoxylate pathway (see image above). What is extra concerning about this is the metabolism of The conversion of glyoxylate to oxalate by the enzyme lactate dehydrogenase is inhibited by oxalate. So glyoxylate, derived from roundup may bet trapped from proper clearance in the presence of high oxalate load in the body.
Sort of like a double-edged sword. (see this link for more information).
Glyphosate toxicity has been linked to all kinds of mitochondrial dysfunction disorders including spectrum related illness.
Some foods and medicines contain polyethylene glycol (PEG) which is a petroleum compound made from ethylene glycol (the main ingredient in anti-freeze) and is found commonly in sports drinks, laxatives (Miralax!!!), baked goods and creams.
Who is at lower risk of oxalate concerns:
Oxalobacter formigenes is an oxalate-degrading anaerobic gut bacterium thought to protect against hyperoxaluria and kidney stones by decreasing the amount and absorption of oxalate in the gut (Siener et al., 2013). Other probiotics species have been mentioned to possibly lower oxalate absorption including lactobacillus acidophilus, lactobacillus plantarum, and bifidobacterium lactis. (Usha Vyas and Natarajan Ranganathan Kibow. 2012)
How to enjoy oxalates if you are at risk for secondary hyperoxaluria:
Some intake of calcium rich foods with your oxalate rich foods might help. Like taking some dairy with your spinach or tea. If you are dairy sensitive you might consider consuming a calcium citrate/magnesium citrate supplement with oxalate rich foods.
Also heal the gut if you are currently dealing with intestinal permeability and fungal overgrowth.
Also see link below:
Screening for hyperoxaluria:
If you are someone who has had a history of frequent kidney stones then you should talk to nephrologist about primary hyperoxaluria.
If it is less obvious...
I have come up with a questionnaire to screen if this is something that you might be dealing with. I emphasize "might" with any questionnaire as its a low form of observation.
Also, I think the Great Plains Urinary Organic Acid test (which I offer) is a good way to screen for Oxalate related concerns. Although I wish it was a 24-hour urine collection test as that would be likely more accurate. The test measures fungal load, oxalate levels, vitamin C levels, mitochondrial dysfunction, and also we can add-on glyphosate load measurements.
In conclusion, the Carnivore Diet might alleviate symptoms, but a life with out plants clearly is questionable strategy. Perhaps a better approach vetting out if the issue is related to a subgroup of plants that might be triggering symptoms.
Post release note:
a really great article on how to reduce oxalate content in foods writting by the great Deanna Minich, PhD is here