Chronic Fatigue: Are Oxalates Impacting Your Energy?

Chronic Fatigue Syndrome (CFS) is a complex and often misunderstood condition that leaves many people struggling with persistent exhaustion, brain fog, and muscle aches.

Although there are multiple different factors that contribute to symptoms and every case is different, diet can play a significant role in symptom management. 

There are many different dietary approaches and different things will work for different people depending on the mechanisms contributing to their specific case. One dietary component that has gained attention in this context is oxalates—naturally occurring compounds found in many healthy foods such as spinach, nuts, and berries. For some individuals with chronic fatigue, high oxalate consumption could potentially contribute to and worsen symptoms. 

In this blog, we’ll explore the relationship between oxalates and chronic fatigue, possible causes of oxalate intolerance and how adjusting oxalate intake might help alleviate some of the challenging symptoms of this condition.

What Are Oxalates?

Oxalates are naturally occurring compounds found in many plant-based foods, such as spinach, rhubarb, and certain nuts and seeds. Chemically, they are salts or esters of oxalic acid. In the body, oxalates can bind with minerals, such as calcium, but also magnesium, potassium, zinc and iron, to form insoluble compounds like calcium oxalate, which is a common cause of kidney stones. 

However, kidney stones are not the only ailment associated with oxalates. Once oxalates are bound to minerals an “insoluble precipitate” is formed. These oxalate crystals can be described as tiny shards of glass. They may become deposits in tissue and cause organ and tissue damage, including but not limited to the mitochondria. 

Oxalates can be highly toxic and inflammatory and it is thought that the damage created by oxalate crystals can contribute to symptoms, many of which are associated with Chronic Fatigue. There is evidence that the following could be associated with oxalate intolerance, although there may be other causes for these health issues which are independent of oxalates.

Many people do not find oxalates problematic, but some people can have “oxalate intolerance” which is when the amount of oxalate in the body is too much for them to handle.

How Do You Know If Oxalates Are A Problem For You?

Currently, there are no reliable tests for oxalate intolerance and the best way to know if they are a problem for you is to slowly reduce your oxalate intake and track for improvement in symptoms. 

That being said, organic acids testing (OAT) such as the OAT by Mosaic Diagnostics or Organix by Genova Diagnostics both have markers for glycolic acid, glyceric acid and oxalic acid. 

If someone is presenting high with any of these markers, they are excreting large amounts of oxalates and a low oxalate diet may be worth considering. However, oxalates can clear from the body in fits and starts and therefore, even if oxalates are normal in urine testing, this does not necessarily rule out oxalates as a problem. It can in some cases be helpful to do a 6 hour urine collection to increase the possibility of capturing oxalates which have been cleared. 

How Do You Address Oxalates?

To address oxalates we want to address possible triggers (such as mould), stop the input from dietary oxalates, slowly and support degradation and elimination.

Common Oxalate Triggers

Dysbiosis (Imbalance of Gut Bacteria): A disruption in the balance of gut bacteria can lead to higher oxalate absorption. Certain bacteria in the gut, like Oxalobacter formigenes, help break down oxalates. When these beneficial bacteria are low or out of balance, oxalates are less efficiently broken down and can accumulate in the body. We can test for Oxalobacter formigenes using a stool test such as the GI Effects by Genova Diagnostics. Additionally low levels of species such as B.animalis and L.animalis have also been implicated. These can be measured on a gut zoomer test.

 

Leaky Gut Syndrome: Increased intestinal permeability (leaky gut) can lead to more oxalates being absorbed into the bloodstream, which may increase the burden on the kidneys and other organs.

Candida Overgrowth: Candida may contribute to higher oxalate production in the gut. In some cases, Candida may produce oxalates as a byproduct of its metabolism. This is particularly relevant in individuals with a compromised gut microbiome or leaky gut, where oxalates can be absorbed into the bloodstream rather than being broken down properly.

Mold: Inflammation from mold producing mycotoxins can lead to increased oxalate production and poor oxalate metabolism, increasing the overall oxalate burden on the body.

High Oxalate Diet: A diet which is high in oxalates may contribute to oxalate intolerance, especially when compounded by bacteria or fungal overgrowth, leaky gut and nutritional deficiencies. In her Book “Toxic Superfoods”, Sally K Norton describes a diet which has over 600mg of oxalates per day as extremely high. However, even lower levels of oxalates may still be problematic based on factors previously discussed. 

High Intake of Vitamin C: Vitamin C (ascorbic acid) can convert into oxalate in the body. While vitamin C is essential for health, excessive amounts, especially from supplements, can lead to an increase in oxalate production. High doses of vitamin C may contribute to the formation of kidney stones in susceptible individuals.

Mitochondria Dysfunction: Mitochondrial dysfunction, which can occur in certain diseases or conditions, may lead to an overproduction of oxalates. This is because the mitochondria are involved in various metabolic pathways, including the breakdown of oxalates.

Nutrient Deficiencies and Oxalates

Oxalate intolerance can both exacerbate and create nutrient deficiencies. Some of the important nutrients to consider are calcium and electrolytes such as magnesium, potassium and sodium.

Calcium Deficiency: Calcium binds with oxalates to form calcium oxalate, which is usually excreted in the urine. If calcium intake is low, the body may absorb more oxalates, leading to higher levels.

Vitamin K Deficiency: Vitamin K is involved in calcium metabolism and helps to direct calcium into bone. If vitamin K is deficient, this can cause increased binding of dietary and/or supplemental calcium to oxalates and increase risk of kidney stones.

Magnesium Deficiency: Magnesium also helps to prevent oxalate buildup. A lack of magnesium can exacerbate the effects of high oxalate consumption.

Vitamin B6 Deficiency: Vitamin B6 plays a crucial role in oxalate metabolism. Low levels of B6 can impair the body’s ability to process oxalates, leading to increased oxalate production.

Digestive Support

Oxalates are typically associated with digestive imbalances and therefore supporting the gut will be part of the process. There is no supplement at the moment which contains the beneficial strains of Oxalobacter Formigenes, L.animalis and B.animalis but spore based probiotics may be beneficial. 

Additionally we may want to address digestive and absorption, especially of fat which can fuel bacterial overgrowth, add support for the gut mucosal lining and address dysbiosis and mold and yeast overgrowth. This needs to be done in a case specific manner depending on individual needs. The challenge can be that many antimicrobial herbs are high in oxalates so sometimes we have to reduce the oxalate load through diet before herbs can be tolerated.

How To Reduce Dietary Oxalates

Often well meaning health conscious people unintentionally switch to a high oxalate diet in an attempt to improve their health. They eat dark chocolate to reduce their sugar intake, give up cows dairy and start consuming almond milk, they have spinach smoothies and turmeric and ginger shots. All of which are high oxalate foods and when you add the content of these foods up, you may be consuming several 100mg of oxalates per day. 

If you are someone who has always believed that an abundance of vegetables is good for you and if you are like me, a lover of green tea, dark chocolate and salad. Following a low oxalate diet is going to challenge some of your belief systems about food. But I promise you that it is possible to change your point of view and you may reap the rewards if you are open to it. 

For someone experiencing oxalate overload a therapeutic diet may be around 60mg of oxalates per day or less. However, dietary oxalates need to be reduced slowly.  When lowering the dietary oxalate load, this may encourage the system to excrete more stored oxalates, which can cause damage and flare symptoms as part of the process. This is often referred to as “oxalate dumping”. 

Symptoms of oxalate dumping may include:

• Increased hunger
• Headaches
• Nausea
• Fatigue
• Brain Fog
• Musculoskeletal pain
• Flank pain (above the kidneys)
• Rectal pain
• Eye pain and pressure
• Rash
• Vulvar pain in women
• Kidney stones

In some cases oxalate dumping can be very dangerous, especially in those who are at risk of kidney stones. Therefore, the approach that I use with clients when addressing oxalates is to ask them to record their baseline intake. There are various apps and resources available online that will inform you of the oxalate content of certain foods. Sally K Norton’s website has some great resources. Note that there are no exact standards for the amount of oxalates in food. Multiple different factors can influence the amount of oxalates in food and therefore we only have a rough guide. 

Once a baseline of intake has been established I recommend a 5-10% reduction each week based on the individual, their sensitivity and overall stability. For sensitive individuals, even a very slow reduction could still cause dumping and therefore it is important that you do not rush. 

If you experience any flares you can slow the process down by increasing your oxalate intake again by a small amount or doing a slightly lower oxalate day followed by a slightly higher oxalate day. Other suggestions might be:

• Make adjustments every 2 weeks instead of weekly
• Please also drink plenty of water
• Baking soda mixed with water 30 minutes before meals may also help with dumping symptoms – this may suppress stomach acid so only to be used when needed
• Sauna or hot/cold contrast can also be supportive if tolerated

In some cases it can also be supportive to reduce the dietary histamine load as oxalate clearance can activate mast cells and cause an increase in histamine levels, which can exacerbate symptoms. 

Food Swaps

In the initial stages of change it can be helpful to swap one food for a lower oxalate food to avoid too much limitation to your diet. The table below is not an exhaustive list but it gives some examples:

High Oxalate Foods	Lower Oxalate Swaps
Spinach	Lettuce
Nuts	Pumpkin seeds, pistachios, macadamia nuts, flaxseeds
Almond Milk	Coconut Milk, Oat Milk, Cow’s Dairy
Raspberries and Strawberries	Blueberries, Honeydew Melon
Sweet Potato, Beetroot	Butternut Squash
Brown Rice	White Rice
Cucumber with skin on	Cucumber with skin off
Dark Chocolate	White Chocolate or Vanilla Ice Cream

Often I will suggest to clients that each week they make one swap and this will support gradually lowering the oxalate load over time. 

Supplements and Degradation

When addressing oxalate overload it is important to be mindful of supplements. Many supplements which are often considered supportive for inflammation (curcumin for example) may be high in oxalates. 

A less is more approach can be helpful but there are some supplements that may be beneficial. These include:

• Calcium; due to its ability to bind oxalates which helps them clear in the urine. 

• Electrolytes such as sodium, potassium and magnesium. These can be taken in various forms such as epsom salt (magnesium sulphate) baths, adding salt to food and oral supplemental forms.

• Sulphur: Oxalate and sulphate share transporters which means that oxalate moves through the body on sulphate transporters and binds to sulphate receptor sites. This means that one will influence and by increasing sulphate and sulphate metabolism we can reduce stored oxalates in the body. Magnesium sulphate is a great way to get both magnesium and sulphur plus so extra self care!

• Citric Acid: Citric acid is naturally occurring in certain fruits such as citrus fruits and berries and can also be taken in a chelated supplement e.g. potassium citrate, calcium citrate or magnesium citrate. Citric acid may help to break down oxalates but it isn’t always tolerated by those who are histamine sensitive, therefore, proceed with caution. 

• Vitamin B6: Vitamin B6 plays a crucial role in oxalate metabolism and therefore vitamin B6 can be supplemented as either part of a B-complex or on its own, depending on tolerance. 

How Long Do You Follow The Diet For?

Following a low oxalate diet is a long term commitment and it is not for the faint hearted. It can take months and in some cases even years to lower one’s oxalate load. It is not something you can necessarily dip in and out of. 

Oxalates can clear in fits and starts. It is not uncommon for people to feel quite well as soon as they reduce their oxalates, only to experience a flare several weeks later. As the body starts to function better, it may begin to clear more. This can sometimes look like going backwards and it can be hard to stick to the diet when you feel it isn’t working. 

Although we do not want to encourage aggressive oxalate dumping, these flares can be a positive sign that there are oxalates to clear and encouragement to continue. As time goes on things may get easier. 

From personal experience I can share that it is important to make space in your life for the process as the ups and downs can be wearing physically and emotionally if we are expecting to just change our diet and get on with things as normal. 

As time goes on and you feel more well and more stable, you may be able to reintroduce some higher oxalate foods back into your diet with around 150mg per day being a good maintenance dose for those with good digestive health. 

If underlying triggers such as dysbiosis, SIBO, Candida, Mold or leaky gut are not addressed, oxalate tolerance may continue to be low. 

Personal Anecdote

In my own journey I did not follow this guidance. Overnight I took Dark Chocolate (about 50g per day) and Almond Butter (about 20-40g depending on the day) out of my diet, which meant the sudden removal of about 200mg of oxalates. 

I broke out in hives on my lower back and backs of my knees which was mildly uncomfortable but subsided in a few days. A month later the hives came back with a vengeance and I had to use steroid cream to manage the itching, an example of delayed dumping. A month after that I had a week of diarrhea of sandy stools (typical of oxalates). 

It was not  fun but it did give me a lot of respect for the process and I found it reassuring that “something” was happening, albeit unpleasant. I would also add that I was sceptical about the whole “oxalate thing” and didn’t think it was a problem for me – I have always had normal oxalate urine tests – but the proof is in the pudding and giving it a good go is something I do not regret. 

Help and Support

If you feel curious as to whether any of the concepts mentioned here could be implicated in your own health journey, consider working with us. Find more about your options here.