In this episode of Functional Medicine Research, I interview Sally Norton in a discussion about how oxalates affect your thyroid and your health. We covered what oxalates are and how they can damage the body. We also discussed how oxalates affect gut health, liver health, thyroid health as well as all the symptoms and associated conditions connected to oxalates.
If you’re really struggling to get well, but your diet appears to be healthy, oxalates may be the missing link.
Full Transcript on Oxalates and Thyroid Health
Dr. Hedberg: Well, welcome everyone to “Functional Medicine Research.” I’m Dr. Hedberg, and I’m really looking forward to my conversation today with Sally Norton. Sally is a consultant writer, educator, and speaker with over 30 years in the health promotion and wellness field. Sally specializes in helping people improve their health with an oxalate-avoiding diet. Sally holds a nutrition degree from Cornell University and a Master’s of Public Health degree from the University of North Carolina at Chapel Hill. She worked in the field of medical education at UNC Medical Schools Program on Integrative Medicine and as a research grant writer and research administrator at the Virginia Commonwealth University School of Medicine. Despite a healthy lifestyle, she struggled for over 30 years with seemingly unanswerable health challenges, including chronic pain and fatigue. When she finally discovered the cause and turned her health around, she committed to teaching and reaching out to others stuck in similar frustrating situations. Sally, welcome to the show.
Sally: Thank you. It’s great to be here.
Dr. Hedberg: Yeah, I’m looking forward to this and we were kind of discussing this early on. Oxalates is something that I’ve always kept my eye on for the last 17 years and I was really looking forward to this conversation. So why don’t we lay a little bit of bedrock for the listeners? And if you could just talk about what are oxalates, and do we know why plants actually have oxalates?
Sally: Yes. Plants are a major producer of oxalate and obviously, it’s also ubiquitous in nature itself. Soil is loaded with it. Even apparently sea spray produces some oxalate and polluted air produces oxalates, so, in really heavily polluted cities, the air has got oxalate in it too. So oxalate is this really minuscule molecule that its parent compound is called oxalic acid. And acids ionize and become charged particles because they drop off the acidic protein and so they become these negatively charged ions that attract positively charged things and oxalates can have a one negative or two negative. It is a tiny, tiny little compound. It has four oxygens, which is a heavy load of oxygen on just two little carbon molecules. So it’s very oxygen-heavy, which is probably partly why it’s such a pro-oxidant molecule, you know. Oxidation is very bad for tissues, membranes, mitochondria, and it is a great mitochondrial poison, membrane destroyer, and troublemaker. And it’s not just the oxygen, though. It’s much more about this reactivity that the charge creates where it bonds with minerals and becomes salts. And so, salt is a chemical term for things that can dissolve, but when it…because it can have two negative charges, it will also hook up with minerals that won’t dissolve well. So calcium, for example, is a two positive charge mineral. With that double-positive and double-negative marriage between the two, you create an insoluble oxalate, which is the backbone of oxalate you see in nature because calcium is everywhere in soils and in nature, and plants are having to manage their calcium. And one of the ways they do that…because too much calcium can be toxic to the plant. So one of the ways they do that is they make oxalic acid. Often they make vitamin C first, very similar compounds, and vitamin C naturally degrades just hanging around into oxalic acid and oxalates.
So plants will create vitamin C and they’ll create oxalic acid so they can manage their calcium and store it away like a pantry. And in a siege, you need to store that calcium because calcium can be an enzyme co-factor and promote the germination process. So you store it, you deep-six it in these crystals in your seeds, and then when you germinate as a seed, you liberate off the oxalic acid in the calcium and you get your enzymes going. And in the meantime, those lovely crystals of calcium oxalate in the seed coat protects the seed from degeneration and from predators, and from deterioration, so it helps preserve the seed. But the oxalate has many other uses for plants, and plants deliberately construct special shapes of crystals.
They lay out this kind of protein matrix and then the crystals nucleate and create these crazy shapes, including a double-pointed toothpick, super fine invisible toothpicks made in bundles of like 200 or more. And the plants literally use them as poison arrows to disturb the mucous membranes of predators and so on and it can kill off caterpillars and bugs and can be damaging to be eating a lot of them in certain foods. Or they haven’t actually studied, like, what shape crystals in food plants that much. So we know of a handful. The kiwi is notoriously full of these tooth-picky crystals, for example. So, they use them for self-defense in a direct kind of…I say that plants invented warfare because they have these poisoned arrows and they put on these arrows, proteases and soluble oxalate-related and things that are quite toxic to cells, and if you injure the mucous membrane, then you can enter the intercellular space and potentially enter the circulation and be quite dangerous and hazardous to the victim. But, like, trees will put out hundreds of pounds of oxalate crystals in these cube blocks in their bark, which helps make the bark inedible to the beetles.
And so, they figure maybe six or seven uses of oxalate, and in desert plants, plants make oxalate during the nighttime, create the calcium oxalate crystals, and then during the day in the desert, they have to close their breathing holes under the leaves in order to not dry out. But if you can’t get CO2 through your breathing holes in your leaves, you can’t produce energy as a plant. You need sunlight and you need air. So instead of using CO2 to do photosynthesis in the day, you use calcium oxalate. You break off that… Oxalate becomes a reservoir for carbon because there’s so much oxygen, CO2, right? There’s so much oxygen in that oxalate so perfect carbon-oxygen sync so you can make energy as a plant in the desert. So, like, there’s this really cool stuff. The plants need it for their biology and they’re using it against the predators, against them, and so in us, oxalate is quite toxic. In a plant, it’s a clever strategy for survival.
Dr. Hedberg: Okay. So that was really interesting, and it’s interesting that you bring up the structure of the oxalates because I do remember seeing some microscopic pictures of oxalates and I just thought, “Wow, that looks really deadly looking at them.” The number of spikes, the size of the spikes, how sharp they look. And, you know, you’ve mentioned plants defending themselves and we see that not just with oxalates but also, you know, like, things like methylxanthines in coffee beans and cocoa beans are, you know, natural pesticides and a large human usually can detoxify those but sometimes small amounts or moderate amounts can also be damaging. So can you talk a little bit more about what foods contain oxalates and what foods people should look out for?
Sally: Yes, yes. So the animal kingdom does not have a lot of oxalates, although there’s one rare exception of some giant snail in Asia that is not going to run across your menu anytime soon. It is the plant kingdom. It tends to be the seeds. There are four leafy greens that are particularly problematic and, unfortunately, a lot of people have flattened out the idea about where oxalates are to say all leafy greens are high in oxalate, and that’s just not the case. There’s spinach, which is the poster child of a high oxalate food. Beet greens and…Swiss chard is basically beet greens without the beet, is even worse than spinach. Swiss chard and beet greens are…Spinach is plenty bad enough, but that’s even worse. And then there’s sorrel, which is popular in other countries, not so much here unless you’re going to upmarket restaurant. So those are leafy greens. Beans as a group are generally quite bad, the white beans, the black beans. The peas are not as bad, like a better choice would be black-eyed peas, green peas, and chickpeas would be much safer to use than black beans, for example.
Let’s see. And the grains, it’s almost all of them because the bran and the germ contains oxalate. So bran, whole wheat, bran-related things can really add up to a lot of oxalate. So the white flour stuff tends to be lower in oxalate but, of course, that’s really devoid deficient food, and even that can add up. So even heavy bread users can get into a lot of oxalate, but I think the two most, or I would say the three most common foods that’s universally interesting to modern people across the planet include potatoes and sweet potatoes. You know, the French fries, the tater tots, the potato chips, that is loaded because we eat it so much. Peanuts and peanut butter and anything made with peanuts, nuts in general, and then chocolate. So if you love your Reese’s Peanut Butter Cups and your super dark chocolate and you like nuts, or if you’re on a keto diet, you’re probably super overloading your diet with oxalates.
Dr. Hedberg: Right. And one of the things that I’ve found is that the resources outline for oxalate content in foods tends to be highly variable. So on your website, I purchased the oxalate handout. And then if you compare that to, you know, some of the other handouts that are out there from certain universities and other…you know. There’s a dietician that has a lot of oxalate information online. They tend to be a little bit variable. So where is that coming from? And how do we get accurate information on oxalate content?
Sally: Yeah. This is a huge problem, and it’s part of why the oxalate stuff hasn’t been properly translated into clinical care. And it’s real unfortunate that there’s so much bad data out there, and bad data comes from several places. One of them is the difficulty of getting a correct measurement and lab analysis of biological materials foods. And urine and blood are very complicated materials. They have thousands of compounds in them. And oxalate comes in all these different forms. You’ve got ions with either one or two charges. You’ve got calcium crystals, you got magnesium crystals, you’ve got oxalate as a soluble salt as potassium oxalate. And then there’s the big crystals, and then there’s all the pectins and stuff that are wrapping them up. And there’s a very complicated…so it’s been hard to be good at measuring them.
So, a lot of the data that’s pre-1980 has a lot of mistakes in it. Like, the USDA database is ridiculous. Like, some huge amount of it is just plain wrong. Like, for example, they’ve listed radishes as outrageously high in oxalate when they have almost none. And that’s because vitamin C degenerates into oxalates. So the vitamin C in your radish juice extract or your radish purée that you’re making in the lab to analyze it, during all that handling and light exposure and so on, the vitamin C is turning into oxalate. So you can get these false highs on foods, and so they’ve demonized…certain people are out there demonizing the cabbage family vegetables like radish or arugula, which are very low in oxalate, but that’s that vitamin C factor probably confusing them. So USDA has some really bad data.
Most of the textbooks that I’ve opened up and nursing texts and so on have easily like 8 mistakes out of only 30 foods. So I’m like, “Close to a third and they’ll put bad data and just…” Then there’s the data handling problem where anybody who’s moving data from a lab to a table to a paper is potentially already publishing a bad number that nobody catches because, by the time you’ve read your own paper 10 times and the editors sent it back to you twice, you forget to check the table or whatever. They can generate just human error just in the publication process. And then every time someone handles data, they introduce error. The Harvard list is notoriously…got several things wrong with it. It’s one of the better lists out there from universities, but there’s a lot of just bad data that keeps getting passed around. It’s like a bad game of telephone, you know. It started out right, maybe or maybe not, and it got worse in time.
So, there are various universities have little in-house databases that they’re not releasing. The VP Foundation, which stands for Vulvar Pain Foundation realized as they were trying to start educating people about 25 and a half, almost 26 years ago was when they got started is that the data wasn’t very good and it was all controversial and, you know, inconsistent and people couldn’t do the real diet without good data. And they are really the big innovators because they made their mission, the testing of the foods, and they’ve generated lots of data over the years working with Michael Lehman at the University of Wyoming who’s retired a couple of years ago, but they have generated a great amount of decent data. We think it’s good data, and in comparison with others, it mostly works out. And with specific numbers on many different foods and supplements, you can actually achieve a low oxalate diet like no one has ever been able to do before.
And the Vulvar Pain Foundation gets credit for that. So their data is quite good. They also have had some mistakes. I pointed out to them a few mistakes. She was like, “Oh, yeah, that was the week I was really busy,” and she went back and…you know. So, again, even the best data has its mistakes in it. So you can do a diet, though. You can do a low oxalate diet without all the numbers. And that’s why my beginner’s guide is really just a list of high and low foods because if you know which ones we know for sure are low and which ones we know for sure are high if you start weeding out the big ones and start using the lower ones instead you can get a really long way towards protecting your health dramatically.
Dr. Hedberg: Yeah. I was recently taking some graduate-level courses in a master’s degree in microbiology, and in one of the classes, we covered oxalobacter, the bacteria that metabolizes oxalates. And it was interesting to deep-dive into that that the oxalobacter content of our guts has declined over time because of poor diets and a lot of antibiotic use and things like that. So do you have anything to add to that about the oxalobacter bacteria? And is that a part of why we’re seeing a lot of issues with oxalates? Because obviously, we have some bacteria that can metabolize them, but if someone has a strong antibiotic history or a lot of gut problems, it just makes sense that they’re going to have issues with oxalates.
Sally: Well, it’s a really important topic to address because there’s a huge amount of mythology and misunderstandings about the value of the bacteria. And my sense from reading the literature is that about 70% of us don’t have it and recolonizing it has not worked out very well. Obviously, it’s a very fragile bacteria eating a lousy diet. Its main food is oxalate, which is a really crappy source of energy. It’s just not a great…It’s not a good diet. This is like a strange niche to be in. And even too much oxalate in the diet can kill other bacteria, especially that can partially eat oxalate. They can eat a little bit of it and not too much and you can overwhelm them just with a high oxalate diet. But of course, with antibiotics and not playing outside, I think mostly the inoculation with oxalobacters is in childhood in the first two years of life in the days when nobody washed their hands and the kids played out in the farm and the dirt all day long and nobody was running after them with hand sanitizer. And this is just not the world we live in anymore.
So, the problem is that bacteria belong in a colon, not a stomach, where oxalate absorption starts, not a small intestine where most of oxalate absorption is going on. So most of the oxalate that you’re exposed to both direct exposure to the cells of your gut and getting into the bloodstream is happening way before the colon. So the colon excretion and the colon metabolism of the oxalobacter happening in the colon is this really more about the body’s ability to control net absorption in the colon when things are really crazy and there’s acidosis going on and kidney stress will turn on these excreters and start kicking oxalate back out of the bloodstream. And hopefully, even that portal circulation bloodstream before some of the newly absorbed oxalates get into the body, but we don’t really know when and how all that works. It’s complicated. The body is tremendously complex and our ability to understand that is pretty tough. It’s a black box of infinite diversity and flexibility and complexity and our simplistic approaches in science don’t quite catch it all. But I can tell you that there’s no way that having a lot of oxalobacter will let you eat spinach smoothies and keto bread every day and survive it then work.
Dr. Hedberg: So, you know, we’ve talked about what oxalates are and what they look like. So walk us through what’s really happening inside the body when someone is consuming oxalates, beginning with, you know, what is it doing in the gut? What is it doing to the bacteria? Then when it gets absorbed, what is it doing around the body that’s causing problems?
Sally: Right. Right. Great questions. Interestingly enough, there hasn’t been a huge amount of interest in what does eating a high oxalate diet do to the gut? What we do know is that gut symptoms are connected with oxalate disease. We’ve known this since 1850. The original diagnosis was gut disease plus X and Z, and all through, that’s always been a prime central feature of oxalate illness, oxalate overload, oxalate toxicity. And it still is even in the genetic form of oxalate because the other place we’re exposed to oxalate is our metabolism naturally generates some amount of oxalate as we’re processing amino acids and so on. The liver makes oxalate. So that’s an aside piece is that direct mechanistic research studies are rare on gut damage, which is sad because it’s always been a centerpiece of the disease. But the disease from kind of dietary cause got subsumed under a diagnostic setting that is assuming it’s really rare when it probably isn’t. So there hasn’t been a research priority as is often the case with things that are dietary in nature, lifestyle in nature, and don’t lend itself to profit-oriented drug development and things like that so they kind of get dropped in the system. But what happens as you’re eating both ions and these big mega crystals that can harm you and probably nanocrystals. And they start in the stomach already being absorbing, meaning they’re transferring themselves from the space of the gut where the digestion is occurring across the thin layer of cells that are doing that digestion work into the bloodstream.
So that absorption process is primarily what we call paracellular transport where they’re riding in between the cells, and cells have these little junctions that make them, you know, a total sheet of cells called the tight junctions which work like Velcro closures. So you’ve got these hooks of proteins, and that water travels between the cells and in that water are ions like oxalate. So it just flows right in. If you have inflammation, any form of inflammation which comes from obesity and diabetes, and gut problems generally, those tight junctions are wider. So the little rivulets of water flowing from your food into your bloodstream are larger. So normally, we absorb into the gut about 10% to 15% with good gut health and sort of normative food, but it can be as high as like 60% or 70% of the oxalate in the food can come into the body. There’s also active transport where the cells deliberately pick it up and bring it into the body. We don’t know why, but that’s part of it too. So, after meals, it takes about a half an hour, but you start seeing elevations in oxalate in the blood and the urine within half an hour and effects on the blood cells where you’ve got immune cells with damaged mitochondria, damaged immune cells within 30 or 40 minutes after a spinach smoothie.
And a spinach smoothie is a high water food that has been blended up, so all the fibers and the ions have been released from each other. So high water, low calcium, calcium is a binder of oxalate and helps prevent absorption, but something like a juice with spinach in it or a smoothie, those are very high absorption foods. You’re probably going much higher absorption. So you get into this circulatory system that takes all the things you absorb from your food to the liver for processing because there may be bacteria there, there’s nutrients there so the body shunts straight to the liver. The liver does not detoxify oxalate. It makes more oxalates. The liver has to use up a lot of glutathione to protect itself from these loads of oxalate, and it’s good at it. So you don’t often see a lot of liver damage, but if you’re like me and you’ve been eating Swiss chard your whole life and love your beets and beet greens, you can end up with chemical sensitivity because you’re using up the liver’s glutathione and self-defense chemical… Chemicals you would use to detoxify toxins are being used just to protect the liver cells from the oxalate. And then it goes from the liver straight up the inferior vena cava to the heart, so you’ve got blood loaded with oxalate for one to eight hours after a meal going in your vascular system heading for your heart, and then it heads to your lungs, and then it heads back to your heart and then out to the whole body circulation. So a huge amount of vascular tissue and critical organs are exposed in the hours following meals of high oxalate food, and that is a problem because oxalate is pro-oxidative, membrane damaging, engages the immune system. It disrupts electrolytes. So the calcium and magnesium and minerals in your blood can get attracted to those oxalate ions because it’s just those little individual molecules that are primarily getting into the blood.
The big crystals from the kiwi and so on, they just tumble along in your gut, irritating the gut once the pectin bubbles are broken open that they’re living in. And they’re mostly a gut irritant, which is not good because you don’t really want damage to gut cells. You only have one layer of cells. You got to keep them good, and so…that’s not helpful. But then those ions are starting to grab electrolytes in the blood. And if the ion level gets too high, you start getting arrhythmia, blood pressure changes, heart rate changes, and all kinds of effects on heart muscle function or possibly vascular muscle function. And over time, chronic exposure in the vascular system with oxalates creates various diseases we call vasculitis and it can create these muscle problems that are like spastic disorders. So you can get Raynaud’s syndrome, which is an auto-immune . Okay. So we’re talking about the electrolyte disturbance that can change the way the cells function and is especially harmful on muscles like the heart muscle, skeletal muscle. I think it’s harmful to the peristaltic muscles of the GI tract. And you can really get into some serious problems with chronic constipation. With oxalate damage sort of seems like fibromyalgia of the colon or you get a spastic colon where you have fecal incontinence and random periods of diarrhea and the loss of sensory function where you can’t always tell that you even have a BM on the way. It can be really disturbing.
So it makes sense that GI problems are part of this disorder because you got the lining being messed up, you got the electrolytes and the muscles and the nerves all being damaged by this reactivity of this ion that is grabbing minerals. And some minerals, it’s fascinating when you start learning how cells regulate their own activity and regulate your health and take care of you, and they do it by communicating with little ions of calcium in the cells. They’re called calcium sparks. And when oxalate manages to get into the cells, that’s a big mess there and they are already just in the vascular system. The blood electrolyte balance, the mineral and nutrient balance of the blood can get really off. And it happens not only after meals but it can happen later on when the body starts clearing out oxalate because oxalates, when we’re eating them the way we’d do in modern life, accumulate in the body.
But to give you an example, I used to eat sweet potatoes almost every day, often, both for breakfast and dinner. And with dinner, I would also throw in like Swiss chard and I had a chronic problem at bedtime which would be about four hours after dinner of severe hiccups that would turn into a bloating belching fest that was quite painful and disturbing. I never knew that that was electrolytes sermons messing up the muscles of the diaphragm creating the hiccup problem. And as I was reading about death and neurotoxicity from star fruit, which is a really high oxalate fruit and the juices, particularly bad. The rats in the studies and the human beings right before they die, they start getting hiccups. And I had this hiccup problem at night like crazy because I had been eating these crazy high oxalate foods. Despite my nutrition degree, I had no idea about any of that, but it’s a great example of how the electrolyte balance gets messed up after a meal and you can have weird symptoms and poor sleep. And that’s the neuro side of the toxicity. I was in such bad shape. I had to quit my career. I couldn’t read anymore, and it turned out my brain was waking up 29 times an hour. And I didn’t have any idea at the time that it was oxalate-related until I accidentally discovered it, like, about three years after that sleep study, and then within 10 days of changing my diet, I was starting to sleep.
Dr. Hedberg: Interesting. Yeah, I think it was about six or seven years ago, I ate large amounts of kale and almonds for a couple of months and developed a kidney stone. Passed it. One of the worst days of my life, but it’s just amazing how rapidly you can develop a stone from too many oxalates. So why don’t we…? Just so the listeners can kind of associate their own health issues with oxalates. Can you talk a little bit more about what are some of the symptoms that they want to look for? Some of these could be kind of mystery symptoms, things they’re not sure about. What should people be looking for as far as how they’re feeling?
Sally: Yeah. It’s amazing when you’re messing with basic cell function, it can blow up into diseases like probably anything you could imagine. The original backbone of the disorder, the way it was originally defined in the 1850s, it used to be called the oxalic acid diathesis, and it was related with diet. So gut issues are super common. At least 60% of us who have oxalate problems have some kind of digestive issue. So anything from trouble swallowing, reflux problems, difficulty getting pills down, bloating, belching, indigestion, cramping pain, constipation, diarrhea, IBS, all that stuff can be a sign of oxalate problems with the gut. Then there’s neurological problems, which, of course, includes sensory nerves. It includes your mood. It includes your eye-hand coordination.
So, if you’re clumsy now and then, that could be oxalates. In fact, we use that as an example of a sign that you might be clearing oxalates because these symptoms come back as you’re dumping more oxalate back into the bloodstream when the tissues are releasing them later on with the diet. So lots of neurological stuff like my bad sleep, and there is also cognitive stuff like memory issues and word-finding issues and like coming up with the wrong word. Speech impediments, autism is related. And we know this because so many of these conditions get better when you change the diet, so obviously, it’s a factor. If you take it out and you get improvement, that’s pretty solid stuff. And then you’ve got metabolic problems because oxalate interrupts the function and stops the function of at least three, probably about at least five enzymes that produce energies for cells. So that turns into fatigue, weight problems, again, brain function and neurological problems, cold hands and feet, fibrotic diseases, feeling like you can be low blood sugar, even though you’re not technically a low blood sugar, and diabetes can be related.
And then there’s immune system problems with mast cell activation, rashes, itching, migraines, headaches. So a lot of pain syndromes, whether they be muscle-skeletal like arthritis and gout, or whether they be neurologic or neuropathic pains like neuropathies, those are classic things with oxalate. Granuloma diseases, sarcoidosis, auto-immune problems, healing problems, old injuries that don’t recover well because there’s a lot of connective tissue problems and because of cell energy problems, problems with tissue repair, and so we end up with fibrotic diseases and inflammatory fibrotic diseases of all kinds like, you know, uterine fibroids and endometriosis and these things. These are these immune and fibrotic disorders. So the list is tremendous and a lot of them are really common weird mystery illnesses like fibromyalgia.
Dr. Hedberg: Right. It’s really interesting to look at the list of low and high oxalates on your handout because what’s interesting about it is when I think back to childhood, I actually really loved all of the low oxalate foods. And when I was a kid, all of these, not all, but the vast majority of these high oxalate foods were foods that I just didn’t like as a kid. I just intuitively somehow knew that they were damaging to my body and I wanted to stay away from them. And so, you know, you mentioned things like spinach, always hated that. Beets, couldn’t stand it, sweet potatoes, tomatoes, you know, there’s just a big list here. Do you think that…? You know, one of the issues in health today is that a lot of these so-called health foods are high in oxalates. And I see a lot of patients who come in and they’re eating a lot of foods that are promoted as being really health foods, but they’re eating a lot of them and they’re not feeling well. Can you talk about that, the landscape of the health food industry, and how a lot of these so-called health foods are very high in oxalates?
Sally: Yeah. It’s really interesting too that you start with the idea that children intuitively have a sense that vegetables are really not their friends, especially the high oxalate ones and parents are busy arguing and forcing their children. They’re not recognizing this small toddler leads you into smarter thinking. And what we have leading us is this whole industry of beautiful magazine covers and media promoting this idea that…you know. And some of this like the juicing fad and the smoothie fad, back in the ’60s and ’70s when cancer started becoming a real problem, people started thinking, “Well, carrots and stuff will help us,” and then we got into this idea that the plants have these other compounds that aren’t necessarily vitamins. They’re not minerals. They’re not really nutrients, but they have these other compounds and they have these effects. We call them phytonutrients and now we’re calling them antioxidants, and now we’re calling them superfoods.
They’re not required nutrients at all, especially for humans. They have a lot of toxic effects, but because you can somehow advance a career, I’m thinking that you’re going to have this huge health breakthrough and you’re going to develop supplements and develop drugs and develop new things and be innovative and get a Nobel Prize or get your tenure or whatever. There’s been a lot of energy on some pretty bad research, actually, that quickly gets picked up by the media and becomes cultural truth, even though behind it is a lot of scientific controversy. The studies on quercetin and things like that are notoriously problematic at the bench level and the lab where they’ve been…Some of these studies are just following a false lead that is a by-product of their chemical techniques in the lab that’s giving the plant compound this positive reaction and they’re so sure about it, but there’s actually a huge amount of controversy seeing that at least supposed great effects on say…Turmeric is a great example where there’s major researchers going, “Hey, you guys are just being tricked. This isn’t really a real thing.” And you can even reproduce the sort of placebo-based, “Oh, we love this. It must work” when you start testing it on humans.
So even the human studies looking at, you know, a group of 15 people took turmeric and, oh, it did this for them. Even that is highly questionable and the techniques and research. So we’ve been following this path of self-delusion and building up phytonutrients in plants and herbs and so on into this savior role, which doesn’t really reflect the truth that plants being this passive almost seemingly defenseless old critters who know how to defend themselves are producing a huge amount of chemical toxins deliberately to harm us and we’re pretending that we should eat a lot of those things. Now, if you were to tell your child self to go outside, would you let that little boy eat the bushes? Would you let him eat bark? Would you let him eat pine needles and pine cones and all this plant stuff? You would not because all plants are inherently toxic. The ones in the produce aisle were invented by human development. They didn’t exist in nature at all. The whole produce aisle is an invention. All of it. None of it…I mean, plants are so inedible but we had to develop edible plants, and we think we’ve made them 100% safe.
Dr. Hedberg: Right.
Dr. Hedberg: Yeah. It makes me think about, you know, one of the current popular diets is the carnivore diet, which is going to be very, very low in oxalate, and it just makes me wonder if some of the benefits from the carnivore diet aren’t just because people stop eating gluten and dairy and a lot of other processed foods and things like that but it’s also going to be very low oxalate. And, you know, you mentioned how we’ve changed our foods. And, I mean, I stopped eating almonds a few years ago not just because of the oxalates but also because almonds are a highly water-intensive plant to make. You have to use one gallon of water to grow a single almond, so it’s just not really that great of a crop to eat for the environment. And I think we can see that in a number of other foods that are high in oxalates. So we talked a little bit about gut health, and what about the thyroid? Because a lot of the listeners of this podcast were interested in auto-immune conditions like Hashimoto’s disease and then hypothyroidism. So what does the research show and what have you found on that connection?
Sally: Yeah, this is a really important topic because the thyroid problem is becoming, like, almost universal. It’s so common now. And there is some fascinating bits in the literature and I have a personal story as well where I had developed Hashimoto’s. According to my doctor, it was Hashimoto’s, and then a totally unrelated doctor said, “You know, you’ve got lumpy thyroid. I need to send you for a sonogram.” And it was all hard and lumpy and weird, you know. This was before I knew that my sweet potatoes and Swiss chard were doing all these things to me. And then, later on, you know, when I got put on Armour Thyroid and was on, you know, nearly about a grain of Armour Thyroid, and then as I went on a low oxalate diet, the nodules went away and my dose went in half and my energy is better and that’s really better. Interestingly enough, there was a handful of rat studies in the ’70s, mid-’70s, and post, like ’79 showing hypothyroidism high FSH in rats fed oxalate, and the oxalate not only caused hypothyroidism and oxalate acquisition in the glands but all of the endocrine glands were under-functioning, whether the testes, the adrenal glands, all of them are impacted with hypometabolism from oxalate toxicity. And those studies were not followed up on. Like, there’s a handful of studies in ’70s and whatever, you know, like it has been ignored.
And what we do know is that over the years, the amount of crystals in our thyroid glands because oxalate forms crystals in the body and ends up collecting in the body, usually, as this invisible pathogenic pathological dust that’s very hard to see, some of it is nano-sized and some of it is actually not even crystals or it’s a lipid crystal that bonds with, like, lipids from membranes and things and creates these unscannable…you can’t see them in any way. Even if you’re loaded with crystals of oxalate, you cannot necessarily see it in MRIs and CT scans. Once in a while, they pick them up in those scans, but a lot of times they don’t and they don’t know why sometimes it images out and sometimes it doesn’t.
But even a really skilled pathologist who’s slicing tissues from people who died from oxalate poisoning will miss crystals for a number of reasons. The tissue preparation is very tricky. The material has to be quite fresh or else the crystal starts dissolving as the acids and the cells break down, you know. So it’s really hard to know about this accumulation piece, but it’s real obvious in the thyroid gland. So it might be less obvious in other tissues, but the thyroid gland, you still need good technique. And the thyroid gland too is one of those examples, like within five hours that biopsy specimen you can no longer see the crystals. Despite all the difficulties in seeing the crystals, we know that something like 85% of us have oxalate crystals in our thyroid for over age 50. That’s like everybody. If you’re catching it in these pathology studies at 85%, chances are it’s more like 90% have crystals. They just haven’t developed or they’re just missed for whatever technical reasons.
So that tells you that everybody is overloaded with oxalate in modern living, and those numbers have gotten worse. It used to be 58% in the ’50s and as we’ve progressed in through the ’80s and ’90s, those numbers about how many thyroid glands have obvious crystals in them keep going up. So the thyroid gland is right on the frontline of oxalate damage, and one of the reasons is these glands all have very loose connective tissue and so the pressure in the capillary beds that push nutrients into tissues push this little oxalate crystals out, I mean, not crystals but ions. It’s like a couple of oxygens, you know. It’s just not that big a molecule, and so these naturally permeable capillary beds naturally drop off oxalate in these tissues. And the type of connective tissue that makes up glands is also kind of loosey-goosey and it’s very easy for oxalate to move around and accumulate. And we don’t know if it’s, you know, damaged dying cells where the oxalate crystals start hanging out or if the oxalate creates damage and then it creates places where they hang out, and it’s probably both, and you get this chicken and egg thing. The more oxalate in the tissue, the more tissue stress, the more membrane damage. The more membrane damage, the more oxalate sticks. The more oxalate sticks, the more oxalate sticks and the more oxalate damages. So it becomes this cycle. So once it gets set up, it can continue, and because we tend to eat a little bit of potato chips or a little bit of peanut butter, a little bit of chocolate, or a little bit of salads, or a little bit of beans all the time, there’s never a break. And so, in modern life, the diet just promotes that accumulation and destruction of thyroid function.
Dr. Hedberg: And I found that the testing that’s out there is just really inadequate. I found that the diarrhea is really the best way to address this issue. Can you talk about the pitfalls of testing and how you evaluate people?
Sally: Yeah, it’s much more productive to have a conversation with people about their symptom patterns, their history, and their diet currently, and their diet history. It’s interesting too that in the diet history and in the health history, the people who get sick on oxalates tended to be on the antibiotics and treatments as children. They tended to have some issues as children and, you know, they just struggled from the get-go. And it’s systems that are already inflamed or sick are more likely to be oxalate accumulators and then sort of lose the ability to handle the big oxalate flow, or it just kind of breaks through sooner with really serious health problems.
So, health history is so important because if you try to do it based on tissue analysis of urine and blood samples, you get all kinds of false negatives. The kidneys can only handle so much, and if you’re really overloaded or have been overloading for a long time, or if you’re on your way to a kidney stone, your kidney’s ability and willingness to excrete oxalate goes down and down and down. So the more sick you are with oxalate, the lower the level of oxalate in your urine, potentially. So, you know, you’re looking for oxalate to be high in the urine because the body is high and the kidneys are the way, the primary way the body removes oxalate from the body. So the poor kidneys have to do all this work of getting rid of all your chocolate and almonds, and eventually, that becomes too much. And so you really can’t tell. And the vascular system can only handle so much oxalate after a meal, and the kidneys can only clear so much in that short couple of hours. And so, the rest of the body gets on board and starts sequestering and pulling it out of the blood and holding back some of that oxalate to let the kidneys have a chance to clear things and to protect the vascular system in the meantime.
So sometimes if you have low blood and low…I mean, in most cases, you will never detect oxalate in the blood. The body doesn’t leave a lot of oxalate around in the blood, and we tend to test on fasting in the morning. Well, by the time you’ve fasted all night, the body has cleared oxalates out of the blood. It doesn’t leave it hanging around in the blood. You’d have to test it an hour after a meal to see if, you know, there’s a lot of absorption going on and that just doesn’t happen in blood. And same with the kidneys. It’s coming out in these spiky ways that’s being managed in the background by the body’s self-defense and management practices that we’ve not really studied. So if you get a high urine test, and urine tests are usually a 24-hour collection, if you get actually over this 30 milligrams per day, that’s high enough to be at risk of kidney stones, but if it’s over 40 or 45, that’s considered hyperoxaluria, meaning high oxalate in urine, which is a sign of high oxalate in the body. A single test like that is enough to say, “Yes, we’ve got…” That’s enough. And low tests at 25 or whatever doesn’t mean that you don’t have an oxalate problem. It could mean that your kidneys have lost the ability to excrete it or just that day was being protected from having to excrete a lot of oxalate.
Dr. Hedberg: And let’s say someone does have a longstanding issue with oxalates and they just want to do some supportive things to help get them out of the system. Are there any dietary strategies or are there any supplements that help to get oxalates out of the body? I tend to use potassium citrate, but do you have anything to add?
Sally: Yeah. I love the potassium citrate. It’s very helpful for several reasons. One is because the oxalate and the oxalate clearing and the immune engagement that oxalate, this dust all over the body is perpetually aggravating the immune system. And the immune system has to use techniques to get the oxalates out and to manage them that include causing acidosis. So during the years after you changed to a low oxalate diet, you’re still high in oxalate but now the oxalate you’re dealing with is the stuff that’s been accumulating and the body so wants it gone, and it creates a lot of immune issues and additional symptomology, and the potassium citrate is a good alkalizer and it can help you restore the bones because during all this time of stealing calcium from your blood for your spinach, you’ve been stealing calcium from your bones, so chances are you have to rebuild bone health and you need to keep the acidity down. To do that you need the potassium to help with that. So potassium is great. It’s the standard treatment for kidney stone prevention. Calcium is important to keep calcium in the gut as a binder because the colon can help excrete oxalate when the body is high, and when the kidneys are struggling and when there’s acidity going on, that turns on the colon. And so, we take calcium as a way to help the colon assist with this excretion of the excess oxalate that’s trying to be shutted out of the tissues. And so, calcium in any form without vitamin D.
You don’t want to take it with vitamin D because vitamin D promotes absorption of calcium, which is not really our prime reason for taking it, although calcium deficiency, mineral deficiencies are guaranteed in someone who’s been doing oxalate a long time. So micro mineral replenishment of decent clean water is important. Magnesium is important in any of the forms, but often we start people on citrates and then adjust to various forms accordingly to tolerance and, you know, other things we’re achieving with them. Those are the key ones is making sure those minerals are getting replaced, but there’s other supplements as well because we need B vitamins to manage oxalate. We need B vitamins to keep the liver from over-producing oxalate internally. And high oxalate tends to wipe out your B6, and there tends to be a real problem with thymine too, so I like to put people on the new thymines that are more accessible to the cells in pretty high doses and see how they’re doing with that. Put them on a good quality B complex, and usually, it’s a little additional B6, maybe some additional biotins to the minerals, some Bs, and sometimes people need some other things to support inflammation, including sometimes PEA.
Dr. Hedberg: Excellent. Well, this has been great, Sally. Can you talk a little bit about how you’d like people to find you online and some of your resources you’d like them to know about?
Sally: Yes. I have a website, that is sallyknorton.com, and there’s a lot of free information on there. There’s a link to conversations I’ve had and interviews I’ve had. There’s a shop section that has some free downloads that are PDFs, and there’s also…you can purchase a PDF cookbook that’s nearly 200 recipes. So, in that cookbook, there’s a fair amount of advice upfront about how to get started and some basic understandings you need to have as you’re getting going. There’s the beginner’s guide and a little bit of data there. There’s going to be more of that in the future. And then I’m on Instagram primarily really interacting with the public there, and I also have a Facebook page which I don’t spend much time on, but if you’re not on Instagram, you can check out similar posts on Facebook as well.
Dr. Hedberg: Right. So your website is sallyknorton.com. And thank you for tuning in everyone. If you go to drhedberg.com and search for Sally Norton or Oxalates, this interview will come up with a full transcript. So take care, everyone. This is Dr. Hedberg, and I will talk to you next time. Take care.