Episode #181: Oxalates with Sally K. Norton, MPH

Why You Should Listen

In this episode, you will learn about the role of oxalates in many chronic health conditions.

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About My Guest

My guest for this episode is Sally K. Norton.  Sally K. Norton, MPH holds a nutrition degree from Cornell University and a Master’s degree in Public Health.   Her path to becoming a leading expert on dietary oxalate includes a prior career working at major medical schools in medical education and public health research.  Her personal healing experience inspired years of research that led to her forthcoming book, Toxic Superfoods, which was released in January 2023 from Rodale Press and is available everywhere books are sold.  As a leading expert on oxalates in food, Sally’s work has been featured by podcasters, radio shows, and several online and print journals.

Key Takeaways

• What are oxalates?
• What symptoms and conditions are associated with oxalates?
• What is the connection between oxalates and gut health?
• Might an Oxalobacter probiotic help with the excretion of oxalates in the future?
• Can oxalates act as a trigger for MCAS?
• Do oxalates play a role in EDS or other hypermobility syndromes?
• What is the best way to test for the potential of hyperoxaluria?
• Do genes play a role in the production of oxalates in the body or in the excretion of oxalates from the body?
• What are the top foods to consider as contributors to elevated oxalates?
• Can oxalate content be reduced with specific cooking practices?
• What is oxalate clearing or dumping?
• Does one need to remain on a low-oxalate diet for life?
• Might supplemental collagen lead to more issues with oxalates?
• Can oxalates be produced by fungal organisms?
• How might calcium, magnesium, and potassium support oxalate excretion or oxalate binding?
• What nutrient deficiencies may lead to more significant oxalate issues?

Connect With My Guest

http://SallyKNorton.com

Related Resources

Toxic Superfoods: How Oxalate Overload is Making You Sick-and How to Get Better

Interview Date

February 22, 2023

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  

[INTRODUCTION]

[00:00:01] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your BetterHealthGuy.

The content of this show is for informational purposes only and is not intended to diagnose, treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health related decisions with your own personal medical authority.

[00:00:35] SCOTT: Hello, everyone, and welcome to episode number 181 of the BetterHealthGuy Blogcasts series. Today's guest is Sally K. Norton. And the topic of the show is Oxalates.

Sally K. Norton holds a nutrition degree from Cornell University and a Master's degree in Public Health. Her path to becoming a leading expert on dietary oxalate includes a prior career working at major medical schools in medical education and public health research. Her personal healing experience inspired years of research that led to her new book, Toxic Superfoods, which was released in January 2023 from Rodale Press and is available everywhere books are sold. As a leading expert on oxalates in food, Sally's work has been featured by podcasters, radio shows, and several online and print journals.

And now, my interview with Sally K. Norton.

[INTERVIEW]

[00:01:28] SCOTT: Oxalates is a topic that's been discussed for many years, and yet it may not get the attention that it deserves in terms of being a potential contributor to many chronic health conditions. Today, we have Sally Norton with us to help crystallize our knowledge on this very important topic. Thanks for being here, Sally.

[00:01:46] SALLY: Thanks for having me. It's going to be fun.

[00:01:48] SCOTT: I'm excited as well.

What was your personal journey, your personal story that drove you to the passion you have today in the realm of oxalates, in the realm of toxic superfoods? Did you have your own health challenges that were kind of the fuel for the work that you're doing today?

[00:02:06] SALLY: I definitely had my own health challenges and no good answers for many decades. And I've outlined my story on my website. I've talked about it in my book. Just to give you a Cliff note, I've had a number of mystery ailments, including arthritis pain, serious foot problems, debilitating fatigue. Sort of pre-autoimmune everything. And the doctors say, "You almost have Lupus. You almost have RA. You have almost this. You look like a fibromyalgia." I certainly felt fibromyalgia. Brain function issues. Focusing, concentrating, remembering.

I was hobbled when I was in my 20s with the foot pain problem. And in my 30s, the fatigue got completely debilitating. And in my 40s, the back pain got to the point where, at one point, I lost a whole month of work because I couldn't get in and out of a car. And I ended up with a bleeding disorder. I needed a complete hysterectomy.

And after that, I was sent to a sleep lab because I wasn't recovering well. And there I had a really bizarre sleep just disorder where the brain wasn't able to sleep for more than – I mean, it was waking up 29 times every hour. And so, I was exhausted and couldn't focus. And I didn't have any clue that my diet, my fabulous, perfect diet had anything to do with any of this.

And looked around for answers and stumbled upon rediscovering the oxalate issue. Because back in 2009, I had an attack of vulvar pain. And that was severe enough. And it was very brief. It wasn't like – I mean, I had various issues down there for years. But I never had this where I was like, "Wow! I don't even want genitals. Take them away."

And my husband found the Vulvar Pain Foundation. And I didn't really learn well enough from their information to put it together until much later. But as I decided to really learn a diet and do it correctly, all this old stuff started clearing up very quickly. And so, I got into the research heavily. I needed to know. This has been my profession forever to be a nutrition….be an expert in holistic health and healing.

And so, I ended up doing health coaching practice, and working with people, and my own recovery, and the research together makes it very clear that dietary oxalate profoundly is interrupting our biology. Interrupting health and healing. And a lot of it's happening very subtly under the radar. And it's biologically under the radar as well as culturally and socially where we don't have any structures in our thinking to even notice it.

And profoundly, it's interrupting the basic systems in the body of self-protection, healing, and even performance. And so, I've really landed on this thing where we'll never achieve our full potential as human beings. And we'll never really achieve our healing goals and our helping goals if we're in a helping role until we recognize that this is one of many toxins. And no mucking around with the other toxins, or bacteria, or any magic potions are going to give you any invincibility to oxalate. You have to take on oxalate as its own inherent root cause issue for so many problems.

[00:05:24] SCOTT: Let's step back and talk about what is an oxalate? Why do they exist in nature? And do they serve a beneficial role in our world or even potentially a beneficial role in the human body?

[00:05:38] SALLY: Well, in plants, oxalate serves many different roles regarding calcium regulation, ion balance, calcium excretion and discarding, calcium protecting the plants from predation in all kinds of ways. Tissue support. They're kind of like – they form these crystals. Oxalic acid is a small dicarboxylic acid that's easily produced in nature. And the plants produce it on purpose often from vitamin C. They produce vitamin C that turns into oxalate very easily. And then they can turn it into these calcium crystals. That can be a way of storing calcium, discarding calcium, creating tough barriers so beetles can't bore into trees, for example. It's a way of detoxifying heavy metals.

And for some plants, thinking in desert situations, there's a sort of drought photosynthesis where the plants are actually saving it for the carbon side. It's basically a carbon dioxide molecule because it's two carbons and four oxygen. Each carbon has the two oxygens similar to carbon dioxide. And so, it's possible that that carbon dioxide-ishness of oxalic acid is serving the plants who can't leave their breathing holes open during a droughty sunlight time of day when they're doing photosynthesis. That's another really interesting idea about plants. And they're using it. Plants have a myriad ways they're using it. And even the plants we eat, a subset of the plants we eat are very high – high enough in oxalic acid to get us into trouble.

Now, humans have been kind of capturing the powers of oxalic acid industrially since the 1700s. We've been using it as a chemical in manufacturing. We use it as a cleaning agent. It chelates metals. And it grabs not just calcium but other metals like iron as well. And you can lift rust off of an engine and out of a patio.

And they're even using – Or proposing to. I don't know how much it's in use. To use oxalic acid to protect monuments that may be dissolving in the acid rain, which is really funny because a lot of the acid in acid rain is oxalic acid. But oxalate and calcium will perform such an endurable bond that it actually can create a patina of protection against the milder acids in the rain. And so, the oxalic acid continues to draw on the calcium in the monuments or the buildings they're trying to protect.

And so, that is one place where oxalate might be doing us a little bit of a service, and that is a tartar on the teeth. The saliva glands concentrate oxalate 10 to 30 times the level that's in the blood. When the blood levels are up, the amount of oxalate in your saliva is up, and that can start to increase tartar in the teeth. But there's a chance that that kind of tartar, the oxalate tartar, performs a bit of a protective bond against mild acids in the mouth.

[00:08:36] SCOTT: What are the primary symptoms that should lead someone to thinking about oxalates as a potential trigger or contributor to a chronic condition? What are maybe some of those clinical indicators that lead you to think, "Ah! This could be oxalate overload."

[00:08:52] SALLY: Well, we see very clearly there's a genetic form of oxalate poisoning. And it not just comes from the plants we're eating. But some people – it's a very incredibly uniquely rare disease called primary hyperoxaluria. And in that case, you see the manifestations of the disease are completely different in every person. And we see that too with the dietary oxalate poisoning. When and where the problems reveal themselves is going to vary a lot.

And so, wanting that one set of telltale signs, in a way, kind of holds us back from being able to step back further and say, "There are these common patterns. There are these common tissues that get affected. There's this tendency to eat these plants." I mean, exposure is important in any toxicity disease. If you can demonstrate exposure, then you have your first smoking gun.

And then you want to look at the major systems that oxalates known to influence or harm. The digestive tract. Anywhere you've got inflammatory tendencies in the digestive tract with IBS, inflammatory bowel disorders, gallbladder issues, Crohn's disease, connective tissues. Oxalic acid breaks down connective tissues. It cuts through collagen and causes fibrotic responses in the body. If you have fibrosis weakness, loose joints, tight tension, tight fascia, back issues, bone diseases, connective tissue weirdness, thin skin, skin that doesn't recover quickly, wounds that don't recover quickly, then there's the whole neurotoxicity of oxalate.

Neurotoxicity can look like muscle dysfunction, or spasms, or twitches. Because when the nerves are overstimulated, you get these twitching. Eye twitches, face twitches, hiccups, diarrhea, constipation. These can be forms of neurotoxicities. Migraines, mood problems, brain function issues. Bad sleep is really a common one. And pain syndromes.

Autism and developmental neural problems are also connected with oxalate exposure and tend to shift in an improvement direction quite dramatically on a low oxalate diet.

Then there's the urinary tract, which has to concentrate oxalate. Because the urine is the primary way the body excretes oxalate. The body doesn't have a way to break down oxalic acid at all because there's no enzymes that break it down. And so, we don't "detox it with liver detox". We excrete oxalate principally through the urine.

The poor kidneys have the job of concentrating oxalate. Well, so does the saliva glands and other glands are doing work with oxalate too. But the famous part about oxalates in the kidneys are kidney stones. And then there's nephrocalcinosis, and chronic kidney disease, and all forms of kidney disease. Oxalate is a major toxin that harms the kidney. It can be very irritating to the bladder. You can get into bladder pain syndromes, like interstitial cystitis, and urinary frequency, and nighttime arousals. And that can be quite awful because, in itself, an unhappy bladder can ruin your sleep. And bad sleep chronically can make you depressed and demoralized. And just causes a whole cascade of problem. You don't think about your bladder much until it quits being happy. And then it ruins your life. Urinary tract issues, burning urine, cloudy urine.

Then the immune system, oxalate, it gets into your bloodstream after you eat it. It takes about eight hours. But there's a peak around four hours after a meal. And even as soon as 40 minutes after you eat a load of oxalate, research have documented inflammatory distress, and damage, and circulating immune cells. Just 40 minutes after one oxalate load. And you're doing this every meal. If you're eating foods like peanut butter for breakfast, and in a spinach salad for lunch, or a smoothie for one of those meals would be worse. And then some other high oxalate thing. Like, I used to do sweet potatoes and Swiss chard for dinner. Every meal, I'm potentially loading myself up with oxalate.

And by bedtime, your blood levels are at their highest because you get that four-hour leg, times three meals. And then there's your thyroid gland, and your other glands, and your general metabolism that's being regulated by glandular function can all get in a kind of a knotted mess with oxalate damage.

[00:13:19] SCOTT: When we think about things like chronic Lyme disease and mold illness, we know that they can have far-reaching implications on many different systems of the body. The oxalate issue is very similar. I mean, I was surprised at how many conditions could potentially have an oxalate component. You mentioned several of them, but rheumatoid arthritis, for example, vulvodynia, interstitial cystitis, system pain, gout, osteopenia, the fibrosis, those types of issues. I mean, it seems like there's just so many things where we might not think about oxalates as a contributor. And yet, it could be a very significant piece of the puzzle.

I want to talk a little bit more about the connection between oxalates and the gut. How are oxalates impacting the gut and contributing to some of those conditions that you mentioned, like Crohn's, like IBD, like leaky gut. Is it that the leaky gut or intestinal hyperpermeability is allowing more oxalate into the bloodstream? Or is it also that the oxalates are a contributor to the intestinal hyperpermeability?

[00:14:24] SALLY: Both. Yeah, probably both. Because you're eating oxalic acid and you're eating these calcium oxalate crystals. And oxalate crystals are harder than teeth. They're in these different shapes. Plants make them for self-defense. And literally, just chewing on them can wear down the dental enamel.

Already, at the beginning of your intestinal tract, you can wear out your teeth chewing on almond butter, and chewing on almonds, and high oxalate foods. Clearly, if it's not abrasive and mechanically rough on teeth, it's not very friendly to the intestinal mucosal lining.

You have this direct abrasion. And it's not just the hardness and the sharpness. It's also the electromagnetic charges of these crystals. Each face of the crystal has a different charge on it. And so, the positive and negative charges causes problems with cell membrane structure. Same with the acid. Both of these. But the nanocrystals that are often in the environment but are impossible to see and measure, nanocrystals have the highest surface area and the highest charge to surface area ratio where they're just disorganizing cell membranes.

The membrane structures, which fats are on the inner leaflet or outer leaflet of the membrane? The membrane is a two-lipid layer. Has a very important structure. And that structure where and what fats are in the membrane affects the proteins that do all the functions of life itself. All enzymatic reactions of life are happening with proteins embedded in membranes. And the membranes depend on this fatty acid structure to function. And oxalates fundamentally scramble cell membranes. That's a problem.

Now, you've also got the potential for both mechanical abrasion electromagnetic problems that are scrambling the cells. And you have the energy interference with cell metabolism. Now the cells are crippled with inflammation, and damage, and blocking of certain enzymes. The mitochondria start dying. And the ability of the cell to maintain enough energy production in order to do its work slows down. Cell reproduction slows down.

If you have an abrasion or some kind of assault to the gut, the ability of the gut to fill in that little gap that might have happened from a cell dying or a set of cells being damaged is retarded because the cell's reproductive rate is slowed down. The ability to do instantaneous repair of little tiny assaults to the gut wall is a problem. In comes the immune system and fibrotic development. You get fibrotic and cystic responses often from the immune system and for sort of a coping in the gut.

[00:17:11] SCOTT: How much does our microbiome impact how oxalates affect us? I know there is Oxalobacter that some companies outside of the US have developed as a probiotic that, potentially, that organism then can help to break down some of the dietary oxalates. I'm wondering, are there certain people that are less impacted by dietary oxalate because they have a more robust, more diversified microbiome? And do you see a product based on Oxalobacter potentially in the future being part of the solution to this issue?

[00:17:51] SALLY: This is a very complicated set of questions. And we need to break it down where, looking at vulnerability, just general vulnerability to oxalates does depend on not such a leaky gut. If you have a history of anything that's contributing to leaky gut, the use of pain medication is a classic one that's really destructive to gut health. A lot of stress and trauma can promote leaky gut. And any kind of background inflammatory condition. If you're prone to food allergies and that kind of things, that keeps inflammation higher.

Anything that promotes inflammation, post-bariatric surgery, overweight and obesity, use of these drugs and so on increase your permeability. Permeability changes. And other changes, they haven't fully defined yet, can massively increase the amount of oxalate that gets into your bloodstream. And it starts in the stomach. And so, you can go from 10% to 50% absorption, which is a massive overload of absorption. You don't even need a super high oxalate diet if you have leaky gut.

The thing is, the stomach, where absorption begins, doesn't have a lot of bacteria. There's no breaking down by a bacteria happening in the stomach, which is a 20-minute visit in a very acidic environment that helps to liberate oxalic acid and calcium oxalate because it's so acidic. And then the upper – a lot of the absorption is happening. Like I said, within 40 minutes, you see the damage. But within 40 minutes, you don't have any chance for bacterial breakdown of oxalate.

It's a different role really. Bacteria are playing a role in the hind end of the digestive tract. More in the colonic side of things. And this is where excretion is occurring. And protection from oxalates is really about the bacteria telling the body, "Hey, I'm here. I can get rid of some of this for you." Having the bacteria tells the gut wall that it can excrete oxalate safely into the colon. It's important because it supports the body getting rid of it as quickly as possible especially when the kidneys are overloaded, when there's acidity going on that. Tells the colon, "Hey, let's help the kidneys. Let's excrete oxalate."

The bacteria is really important to help the body excrete it. But it doesn't protect you from overeating it. And the problem with these probiotics is the reason they haven't been approved and they're not widely used is because they've been failing at producing a good result. They've been working on this for 40 years. They've been thinking, "Oh, this probiotic is the answer." They cannot figure out how to get it to colonize properly. There's some whole environment. There's a probably a set of 200 bacteria or some special magic environment that makes this work and we haven't figured it out.

[00:20:34] SCOTT: I want to touch on the connection between oxalates and kidney stones. Can someone have a history of kidney stones and then not have a broader systemic health impact from those oxalates? Can kidney stones exist and not be an indication of any oxalate issue?

[00:20:55] SALLY: I think a kidney stone is – 10% of people are going to get kidney stones with a high oxalate diet. Because the major ingredient in a kidney stone is oxalate. If you don't supply the ingredient, you can't build a stone. And the primary way we're supplying a gradient, 50% of what shows up in the urine is strictly straight from the diet. That is the oxalic acid in the foods you're eating is contributing 50%. If you lower the amount of oxalate coming into your kidneys by 50%, you dramatically lower the opportunity to create kidney stones.

And the other thing you can do to help prevent kidney stones is have enough citrate. Not be really acidic. And that's where citric acid, like lemon juice, and having enough minerals in the diet helps to keep the pH balance good and helps the kidneys function well.

Interestingly though, most of us are designed with a huge amount of redundancy in our ability to cope with oxalate in the kidney. The majority of us who are poisoned with oxalate will never see kidney stones until a really late stage or in menopause, when you get more this more androgen-dominant metabolism that makes you more vulnerable to kidney stones.

But the sad thing is that we're seeing kidney stones occurring in more women, and younger and younger ages, and in children now. And this is a new phenomenon that didn't used to happen that correlates with lots of other problems that we're having with toxic bodies and a high oxalate diet is the standard thing now for children. We're starting children on high oxalate foods.

[00:22:30] SCOTT: And is it possible to have kidney stones and not have an issue with oxalates?

[00:22:34] SALLY: Well, your oxalate problems could be focused in your urinary tract. I do have one client who's remarkable. He has no kidney stones whatsoever. He has no fatigue. He has no fibromyalgia. He does not have arthritis. He does not have headaches. He has bladder stones by the hundreds of thousands. And the bladder stones have destroyed his urethra. He's in diapers. His life is very limited because of the constantly dribbling on himself. And it's the strangest case where all the other things you expect to see, the neurological problems and the digestive problems, none of it. It's all bladder stones. And he knows, from his history of having cancer and doing all the high oxalate foods to treat his cancer, that he was eating four or five thousand milligrams of oxalate daily when he was trying to get rid of his cancer. And he's been basically on high oxalate foods for 40 something years. He's now 71-years-old and his only symptom is bladder stones.

But after a couple years of working with me doing lemon juice and being on the diet, his bladder is down to maybe two or three stones. Literally, they could not scope him. They said he has hundreds of thousands of stones. He's down to just a few now. And he's even starting to see a stronger urinary stream and a little sense that there's some improvements going on with bladder and urethral function after several years of low oxalate diet.

[00:24:03] SCOTT: It's so ironic how the kids cartoons, Popeye. When I was growing up it was always like, "Eat your spinach. You'll be strong. Get your iron." And now we learn that spinach has oxalates. And that iron isn't always good for us. And so, now this thing that was promoted as this fantastic food really is more of a poison or a “toxic superfood” as you say on the cover of your book.

In the book, you talk about oxalates as drivers of inflammation. In the Lyme and mold community that listens to this podcast, we talk about Mast Cell Activation Syndrome. Very common often due to mold, or parasites, or EMF exposures. Do we know if oxalates can serve as a trigger for mast cells in those people dealing with Mast Cell Activation Syndrome?

[00:24:52] SALLY: There are many studies documenting that nanoparticles and nanocrystals promote chronic inflammation. There's many studies pointing to oxalate itself acting just like asbestos in tissues. Turning on chronic inflammatory conditions that are quite destructive. That includes mast cell activation.

I think the interstitial cystitis that's prompted by and often reversed by oxalate removal from the diet is an example of basically sort of a mast cell activation type problem where you've got the sentient immune cells hanging around in these tissues that have exits to the outside world trying to protect us from these problems. And they get enraged very repeatedly. And some people are just prone to this where they get this interstitial cystitis type reaction. But they can show up and just generalize Mast Cell Activation Syndrome. And it can be sudden mood changes, sudden headaches, sudden changes in your respiratory rate. All kinds of weird stuff that happens with histamines and mast cells are definitely correlated very closely with oxalate and the immune system's attempt to deal with crystals forming in tissues.

[00:26:04] SCOTT: It's interesting, because a lot of people with Mast Cell Activation Syndrome and histamine intolerance then do a low histamine diet, which can be very helpful. But what I'm hearing is, if you're low histamine diet is still high in oxalate, that that could still be the trigger for a component of your histamine intolerance or your Mast Cell Activation Syndrome?

[00:26:24] SALLY: Yes. And we see this often at people who were worrying a lot about histamine and diet suddenly can eat high histamine foods again once they've been on low oxalate diet long enough. We see this a lot. You can go back to your canned fish. And pick some high histamine foods and you're fine with it after a while.

What happens with oxalate is it's easy to play this clinical whack-a-mole game where you get a set of treatments going and it seems like it's relieving the symptoms. And the person carries on and feels like, "Well, my energy is better. I can go back to work. It seems like that worked."

But in fact, really, oxalate can show up in a myriad ways. And so, if you get one area to settle down, the immune system goes off and worries about some other problem. And it moves and it eventually resurfaces often as something else. This happened to me. I was having all these problems. And I'm well connected in the healing world because I ran a big NIH grant at UNC Medical School trying to bring the principles, and the language, and awareness of holistic healing into mainstream medicine, dentistry, nursing, public health, and pharmacy.

And so, we were trying to influence the curriculum in these areas both for undergrads and for postgraduate, continuing ed. I had all these colleagues and friends who were trying to bring in as like experts in homeopathy, and functional medicine, and acupuncture, and herbalism, and massage, and all this stuff to help raise awareness and at least give mainstream practitioners the language so they could speak with a little competence with their clients who were interested in these therapies. I'm very well connected.

And so, I of course had friends offering to take care of me and help me out. And no one could. And my functional medicine doctor friend gave me vitamin C IVs and the whole nine yards. And he did leave me with I felt like I had recovered from my adrenal fatigue. We had used low-dose Cortef and all the stuff. But the IVs didn't help at all. In fact, I broke a needle. One of the IVs, the needle snapped, which is probably hitting an oxalate crystal that had formed from the last IV.

Later on, I just deteriorated and was still in terrible trouble even though I did all those things. My energy was good enough that I could write grants and work 50 hours a week and drive my brain into the ground. But I only lasted three years. In the last year, I was on my knees because my back couldn't sit in a chair anymore. I was bleeding to death with fibroids that they said, "Oh, they're not big enough fibroids to explain this." Turned out I had endometriosis that was getting out of control. My ovaries were dissolving under this toxic mess. And I was still a mess, even though on the surface it seemed like I was still holding a job and functioning. And then I ended up with the sleep disorder that, between all of that, it ended my career as I had known it at the time. I'm really concerned about the whack-a-mole thing.

And then we should go back and talk about the immune system effects and how oxalate is really most likely the underlying factor that makes us vulnerable to chronic infections of all kinds. And how I see so many people recover from things as severe as C. diff by going on a low oxalate diet when nothing else worked. They're about to take out the colon and do extreme things. Finally convinced the person to give up chia seeds and spinach. And voila, they're cured of these incurable infections.

[00:29:44] SCOTT: Would you say that you've also seen that in Borrelia, Bartonella, Babesia, these vector-borne Lyme disease associated infections - that if one can reduce their dietary oxalate, that their immune system then can better support a better response to those microbes that exist in the body?

[00:30:04] SALLY: Yeah. It's is so interesting, because in my case, I didn't know that I had Epstein-Barr and Lyme's disease. But they resurfaced when I was clearing out the oxalates in year four – three, or four, five, somewhere down the road of me now on a low oxide diet. I hit a real rough patch of fatigue and it turned that I had active Epstein-Barr and Lyme's. And I did actually need one round of doxy and it knocked it out.

And I'm pretty convinced that that's an example of how the obsolete crystals form in the body where you have infection, where you have inflammation, where you have tissue regenerations, where we got issues going on. That's the tissues that get hung up with the oxalate that's accumulating in tissues. Inside these crystals, you have heavy metals and these sort of mummified organisms.

And so, there's a relationship in both directions where a high oxalate diet destroys the barrier function of the gut, and the sinuses, and the bladder. And so, you're more prone to infection. It causes acidity, which encourages the growth of pathology type organisms in the body. And it's damaging the immune cells. They can no longer respond well to infections in a couple of ways. Because your immune cells, like your red blood cells, are born in bone marrow.

Bone marrow is a common site of oxalate accumulation because the calcium in bones draws oxalate to the bones. Your immune cells can be born and kicked out of the bone marrow early and slightly not right. And so, they're already not right. Then you eat a spinach smoothie and whack them 40 minutes after that. And they're now putting out pro-inflammatory cytokines, and they need help, and they're the ones who are supposed to protect you from these infections. You set yourself up for much greater vulnerability and a weaker defense response when you're poisoned with oxalate and it's coming in frequently.

[00:31:58] SCOTT: Ehlers-Danlos Syndrome or hypermobility syndromes are becoming very, very common in the chronic illness arena. I don't know that I had even heard of Ehlers-Danlos Syndrome five, six years ago. Now, it seems like I come across someone or some information about it almost every day. There is a genetic form of Ehlers-Danlos Syndrome. There is also potentially a secondary Ehlers-Danlos Syndrome that's triggered by mold exposure, or glyphosate, or environmental toxicants. Maybe infections even like Bartonella, for example. How might oxalates play a role in hypermobility and conditions like Ehlers-Danlos Syndrome if at all?

[00:32:39] SALLY: Yeah, it's so interesting. I wonder if you notice that this condition is affecting people sort of under the age of 40 more than the older folks? It's all the young women, I think, that we're seeing it in often. That suggests to me that it's something about the fetal and childhood environment of women in the last 30 years and that we've – And oxalate is one of those things.

Now, the first time I heard about Ehlers-Danlos was through the Vulvar Pain Foundation who's been teaching the low oxalate diet for 30 years. And they saw very quickly that connective tissue disorders, including this one, went away or improved on a low oxalate diet. That in itself is very solid clinical evidence that there's a connection there. That if you can get improved performance on this disease by taking away an item, there's a connection.

I have been looking around for more of the mechanisms in the literature, and I don't see a lot there except that oxalic acid is the kind of acid that slices through collagen and fibers and breaks them up. And we see this a lot with the oxalate poisoning where the connective tissue makes joints unstable. And you often get muscle tension to help re-stabilize the body in the same time that you may be getting weak bones. And if you have both unstable, like, say, neck – I have some clients. In fact, one, she's been bedridden for over three years. She's in her early 30s. She's had six years of illness, but she's been unable to brush her own teeth for over three years because she can't hold her head because her connective tissue in her neck is so weak. And now, having been on a low oxide diet for a year, she not only can brush her own teeth. She can walk down the stairs.

[00:34:23] SCOTT: Do oxalates themselves bind to minerals in the body potentially leading to mineral imbalances or even deficiencies like zinc or magnesium? Calcium, we know, comes into the conversation as well. Maybe other trace minerals. How are these oxalates creating imbalance in our minerals?

[00:34:42] SALLY: Lots of ways I think. And I think this is the major – one of the major mechanisms of the toxicity of oxalate. You're disturbing calcium metabolism in several ways. You're losing calcium and certain important fluids like the blood. That can lead to arrhythmias and probably with a pacemaker. But the bigger issue is that that electromagnetic stress on the membranes of cells causes the cells to suddenly be more leaky to calcium than they should be.

Normally, calcium is very heavily concentrated in the outside of the cell and very carefully controlled on the inside of the cell. The cell uses little tiny individual ions of calcium to tell itself what to do and to control its functions. This is a major – what they call secondary signaler inside a cell.

And when calcium starts pouring into the cell, all kinds of backflips are happening with the mitochondria, and the endoplasmic reticulum, and the cell trying to cope with this excess calcium. But it's destroying the cell's functionality. You get this dystrophic calcium buildup in cells. And that leaky membrane is losing potassium and losing other minerals. And you don't leave potassium in the blood. You have to pee it out. So, you're draining your body of potassium. You're messing up your – all of the minerals and ions are getting imbalanced.

And I think this creates a general deficiency of nutritive minerals and creates a hunger for any minerals and makes it easier to pick up heavy metals. I warn people, stay out of the pool. The bromine, and chlorine, and all the junk in the pool. When you're mineral deficient, you're just a sponge for anything charged. You're going to pick up more of that stuff.

It's not just, "Oh, it is destroying calcium balance." But it's all of the ions are – you're potentially losing the important ones and collecting the toxic ones. And getting dystrophic calcium deposits that are not only just calcium oxalate deposits, but other forms of calcium deposits can be caused by the cell damage that oxalate initiated.

[00:36:42] SCOTT: And my understanding is that calcium moving into the cells also is part of the EMF conversation. You were on Joe Mercola's show not long ago. And he had written a book on EMFs that talks about the voltage-gated calcium channels and how EMF exposure, that same mechanism of calcium moving into the cells as I recall, plays a role in those that are more EMF affected as well.

[00:37:05] SALLY: I had this EMF sensitivity that is much improved on a low oxalate diet. Because oxalate is another kind of physical EMF, right? It's got this electronic charge that's messing up with the electronics of life. And all these disruptions of basically the battery of life. Every cell is a battery maintaining differential charges on each side of the membrane. Occasionally depolarizing on purpose, but repolarizing at will in order to function.

And other interferences, like the environmental EMFs and these charged ions and particles, like oxalate and crystals, are really quite disruptive to basic cell function. You can't produce an ATP. You can't produce a blink of an eyelid without control over your ions and your charges on your membranes.

[00:37:56] SCOTT: What is the best way to test for the potential of high oxalates, if any? I know the organic acids testing or the OAT is one potential indication of oxalic acid, and glyceric, and glycolic, and so on. But what are your thoughts on the best way to explore beyond symptoms if there is even a good lab test? And does the organic acids testing from your perspective come in as a tool that might be helpful here? If you see any oxalic acid above what they consider to be the normal range, is that something to be concerned about? Or in some cases, can that be healthy excretion and not creating systemic problems?

[00:38:36] SALLY: Well, we don't have really enough research. And I don't think if we did, we could answer those questions completely well. Because the body is, in the background, controlling its oxalate excretion in pulses in ways that's relative to circadian rhythm priorities. And the current moment of oxalate exposure or how much is in the blood and so on, that's not well understood.

We're at a very primitive state of understanding that from a biochemistry standpoint. But I believe, if you see elevated oxalate in any urine test, you should take that seriously as primarily a sign that you're either taking too much vitamin C, which is a precursor of oxalate. You're eating too much oxalate, which is almost universal now, because these foods are so basic to our day-to-day life. And you may have leaky gut problems and other inflammatory things. And that's all working together to demonstrate you've got this high oxalate.

The good thing about a high oxalate marker in your urine it is says your kidneys are still working. If your kidneys are really destroyed by oxalates, they become a sponge that's just a magnet for oxalates. And the oxalates come into the kidneys and then get stuck there. And you're just turning your kidneys into rocks. And then you no longer see very high oxalate in urine. You get normal oxalate levels when the kidneys are in bad shape.

If you're able to produce an elevated oxalate, at least your kidneys are still excreting this stuff. Like, you can be saved. You don't want to wait for it to get worse. If there's an elevation in urine, you want to take that seriously. But if it's normal or below normal, that's no safety – that's no security that you don't have an oxalate problem.

I had an OAT test in 2009. It showed I had absolutely no problems with oxalate, whatsoever. And I can tell you, I am seriously poisoned with oxalate. And that test completely failed me when the doctor said, "You're fine without. That's not an issue." And later, when I told them it was an issue, they were not interested to know about that either. That's the bigger problem. Okay, even if we had the tests, if the doctors know that there's not a profitable product or treatment to offer, it's really not something they want to be bothering with because it just takes up their time without them generating payments that covers their costs.

[00:40:53] SCOTT: That sounds like the topic of your next book maybe. What role do we think genetics play in high oxalates at all? Potentially exogenous food sources of oxalates, but also endogenous production of oxalates. Are there specific SNPs or single nucleotide polymorphisms that maybe play a role? And if someone, for example, has MTHFR SNPs, they can use B12, and folate, and some things to help bypass those. Are there any known ways to optimize the genetics around oxalate? And do some people just genetically have a better ability to remove or detoxify these from their system better than others?

[00:41:37] SALLY: Well, you're not really detoxifying oxalate. You're not really transforming oxalic acid into anything less toxic. You're just excreting it. It's really about your power of excretion. And some people are really good at skin excretion or excretion through their eye secretions. Or their kidneys just hold up and hold up. Mine hold up beautifully. But that didn't prevent me from ruining my bones, and getting arthritis, and having all these problems.

The genetics – In terms of recognizing low-level endogenous production, the researchers really are saying that – and the same researchers give you different numbers. In one study, they say 25% of all the oxalate in urine is from vitamin C in foods. And the same guy says in another paper, 40% of all the oxalate in your urine is coming from vitamin C. I think there is really a genetic component to how much vitamin C you can handle before you're just ruining yourself with oxalate.

And I still think it's pretty low. And anything over 400 milligrams of Vitamin C a day is really contributing to oxalate production in the body in most people. And it's also beyond any level that's really helping the immune system. And that's a level, 400 milligrams a day, that you need when you're sick. But not necessarily need every day.

Vitamin C is a big part of what we call endogenous production. But the ironic part about that is Vitamin C is not an endogenous precursor. It's something you have to consume. Even endogenous production is about diet to some degree.

[00:43:18] SCOTT: And sadly, in the last few years, many people are taking much more vitamin C, two thousand, three thousand milligrams a day to support their immune system because of the pandemic. Not recognizing that this could, and very likely is creating more of an oxalate problem.

You mentioned earlier in the conversation a few of the foods. But what foods are most concerning to you from an oxalate burden perspective? What are the key items that one might want to think about avoiding if they're dealing with hyperoxaluria?

[00:43:50] SALLY: Nuts, especially almonds. Because nuts are not only high – including peanuts, which are a legume. They're not only high – And beans is pretty much in the same category. But nuts are worse in a way. They're not just ridiculous high in soluble, absorbable, bioavailable oxalate. They're full of lectins and all kinds of other enzyme inhibitors and things. They're designed to be indigestible.

The plants are very clearly not offering the knot for your digestibility. They're doing everything they can to have that be indigestible. The nuts are gut-destroying foods. And the more you irritate your gut on nuts, the more of the oxalic acid that's in them is getting into your bloodstream. And now that you're turning nuts into flour and milk, you're often eating them in forms that are even more bioavailable in terms of the oxalic acid.

The almond craze is really a big problem. The chia bowls are a big problem. The cashew cheeses on all the vegan cheeses made with nuts are a problem. The dark leafy green concept that seems to be all about chard, and beet greens, and spinach, that concept needs to go. That's the whole Popeye thing. They are so ridiculously off the chart high in oxalate.

We've known for 100 years that giving spinach is very dangerous especially to children. It's been in the science over and over again. It's bizarre that everyone's saying it's so important based. On some modern concept of phytonutrients in the darkness of a green, it's somehow eradicated all the sensible science that's happened in the last hundred years. Those are the big ones.

And then it's the whole potato culture. You grow up on chips, fries, tater tots, hash browns. And now, every lunch you're offered either chips or fries. And every dinner, you're offered fried are baked. And it's everywhere. And it's starting early in life. And people – I find my men with kidney stones tend to have this potato thing going on.

Chocolate, the darker the chocolate, the higher the oxalate. It's very bioavailable. And people are using it as a reward and as a healthy this and that. And having more because it's so supposedly good. Of course, it's loaded with lead and other contaminants. Heavy metals are very prominent in chocolate. But oxalate in chocolate is used in the research studies because it's easy to convince a volunteer, "Oh, just eat this chocolate bar and let us test your urine." They're like, "Cool, I'll do that. It's an easy one."

[00:46:11] SCOTT: You're dropping a lot of bombs that I think our listeners are really going to be surprised. I mean, I read the book. A lot of them I've heard. But I'm still putting connections together just listening to you talk and learning new things here.

Is there a dietary oxalate intake that is considered acceptable or normal for the average person and then a different level potentially for those that are dealing with oxalate issues or need to be more low oxalate?

[00:46:38] SALLY: Well, the research is all coming out of kidney research. And they're suggesting that your kidneys are capable of hailing about 25 milligrams of oxalate a day. That would be a healthy level of excretion. And since 50% of that comes from your food, that's about 12 milligrams of oxalate from food. If you're 10% absorption rate because you have a perfectly healthy gut, that translates into 150 maybe as a generous rounding up. 150 milligrams a day is an amount that were built to handle. That's one-quarter or one-third of a spinach salad.

[00:47:12] SCOTT: Many people are having green smoothies with spinach with almonds thinking that we're doing the right thing. Obviously, from an oxalate perspective, potentially is doing exactly the opposite of what we want from a health perspective. Another trend recently is daily consumption of celery juice. My understanding is that celery juice can also be high oxalate. Any comment on that?

[00:47:36] SALLY: Well, celery juice is much lower than all the other juices. But when you do it at the rate of two quarts a day, the volume adds up. And anything that's juiced is letting that oxalic acid be very well dissolved in the water, which facilitates its easy simulation into the bloodstream. Because this is just floating in the water between the cells and the gut in what we call a paracellular transit.

The more water around, the more dilute the oxalate, the better it gets into your bloodstream. Which is why almond milk is such a problem, because almond milk is a very dilute solution of oxalate. And it's quite deadly for the kidneys potentially because the absorption rate is so facilitated.

I think the big problem with celery juice is not so much that the highness of celery. It's kind of not nearly as high as the other foods. But it's something to be aware of. You start doing a whole head of celery and in this liquid juicy form. You're expediting and definitely making it an oxalate toxin.

[00:48:37] SCOTT: Something that I was really surprised by in the book, and actually shared with a colleague who's been an amazing doctor for years and also was surprised by this, is that homemade almond milk is much higher in oxalates than store-bought almond milk. If I remember correctly, it was something like eight times higher if you make it yourself at home. That was a real bummer for me.

And then the other thing that I was doing was using phosphatidylcholine. You talked about the cell membranes, which are made of phospholipids. I also use phosphatidylcholine in my morning shake that had almond milk. And so, that is in a way making it more liposomal, which could be increasing the absorption of the oxalic acid potentially.

[00:49:24] SALLY: Yeah, because now you're also absorbing it through the fat absorption mechanism as well as the water flowing mechanisms. You've got two ways to get it. That's an interesting supposition. Obviously, there's no research on that. But every time we try to get so clever, we aren't imagining, "Is there a downside to this? Could something go wrong here?" We're kind of like teenagers jumping over a cliff without looking with all of this. Because a lot of the things we're doing that we think are good for us are facilitating to toxicity.

[00:49:56] SCOTT: Can the oxalate content in foods be reduced or limited with specific cooking practices? Like, blanching your vegetables, or boiling, or soaking? Or is that not going to significantly help?

[00:50:09] SALLY: Heat doesn't do anything. But leeching into water can work with certain foods. We see it in broccoli, boiled broccoli. The test, boil it for 10 or 12 minutes. Now, in a real kitchen, you boil it for about two to three. And then by three, it's starting to turn to mush.12 would be really basically soup. But if you leave the water fraction and don't throw out the water, then you've not achieved anything. You have to throw out the cooking water along with whatever other things leech out in order to lower the oxalate in the foods. Otherwise, you're not achieving it. Soaking doesn't help.

[00:50:45] SCOTT: In the book, you say “clearing oxalates is akin to digging up micro-sized toxic waste dumps and loading the waste into poorly covered dump trucks”. I think that's a really interesting statement there. It's important.

Talk to us about the potential downsides of significant dietary oxalate restriction early on, the concept of oxalate clearance or as some call oxalate dumping. And what the symptoms might be if we do this oxalate reduction too aggressively?

[00:51:21] SALLY: Right. Because the big problem, in addition to the fact that oxalates have harmed your excretion powers, and your digestive powers, and your glandular function, and your metabolic well-being can be compromised from this toxicity. Now you've got particulate nano and micro crystals hanging out in all kinds of vulnerable tissues. Like, your bone marrow, and your joints, and your glands, and so on.

It requires the immune cells to come along, like little Hazmat workers with their little spray guns, and they try to eat a crystal and they can't do it. Then they form giant cells, forming 10 cells come together to try to eat it. That doesn't work. Their next option is to spray enzymes to break down the proteins that it's encoded in and that are infused insiders, these inclusions of proteins in the crystals, to try to break up the crystal make it smaller. And then it blows acid to break down the crystal itself. And if it's intracellular, you've got liposomal enzymes and all this.

It's pretty damaging to have the immune cells out doing your little warfare basically causing collateral damage to the local tissues and inflammatory stress. For the cells to get to those crystals, you have to have leaky capillaries. That's part of where you get the swelling and the heat where the tissues are filling up with more fluids because you're putting more white blood cells into tissues. And you can get gout attacks, and you can get headaches, and fatigue attacks. I've had people have neurological symptoms from it where it looks like they've had a stroke on one side of their body. It can be quite toxic to do this disruption. You don't want to turn on your immune system chronically and have all this immune activation. It's the kind of behavior that leads to more cancer cell production in the body, and chronic inflammatory distress, and potentially increase the amount of allergies and reactivities that you have because immune cells shouldn't be on all the time.

Chronic immune activation is the kind of thing that actually kills people in the long run. You don't want to be digging this up. You don't want to be in a hurry to get it all out of your thyroid gland and out of your bone marrow. You want to settle down and heal the tissues. You want to get to a level where you're not encouraging that excessive kind of enthusiasm on behalf of the immune cells. You keep telling your body, "No. No. We're still eating oxalates."

If you come down off of high oxalate diet kind of gradually – and I'll try to give you a format, a sort of structure for doing that in the book. Cut back, and then kind of leave it at this sort of what the body should be able to handle level so the body knows that it's still dealing with exogenous oxalate. Therefore, it has to moderate in order to protect the blood vessels and protect the kidneys. It has to moderate this housekeeping. And you want to keep that housekeeping kind of low and gentle.

At some point, some people need to go on like a plant-free diet to finish healing the gut and really get low oxalate and see how they do on it. And then they have to add back in oxalate as the symptoms come up as a way of telling the body, "Oh! No. Turn that off. That's a little too aggressive." And so, we have to sort of manage it. And it's a really fascinating process to live through it, because sometimes you don't get these severe reactions that has been labeled dumping for several years into the diet.

In fact, I've had people who went from keto using almond flour all day long for years to full carnivore, which is a zero-oxalate diet. And it took three years before these big reactions were occurring that caused such fatigue, and headaches, and disability, they had to stop working. But they seemed fine for three years on a zero-oxalate diet and then it didn't work anymore.

Each person, again, your response to it, the timing of it, what it looks like is fairly individual. You have to step back and understand what's going on and know what to expect and know how to recognize it that this could be a very long process. You don't recover from poisoning overnight. And you shouldn't expect your body to suddenly fix you in a day.

[00:55:18] SCOTT: Yeah. And that was one of the questions from a listener, which is can you just do fasting to help deal with the oxalate issue? But what I'm hearing is it needs to be slow and low, longer-term. That we don't want to be super aggressive and lead to this oxalate clearance or oxalate dumping type intensification. It doesn't sound like the fasting approach is really a solution here.

The Carnivore diet is interesting that you mentioned that. That was going to be one of my questions as well. That, in the book, you say that “plants are toxin cocktails with mixed effects”. And that vegetarian and vegan diets, those are potentially higher in oxalate. The Carnivore diet has become very popular in the past few years. I hear more and more about that. Do you think that maybe one of the reasons or even the primary reason that it can be helpful for some people is because of the reduction of dietary oxalates?

[00:56:14] SALLY: I do. I do feel that's the major advantage of the Carnivore diet. Of course, if you've come from a diet deficient in animal fats and proteins, getting enough animal fats and proteins is really a lovely thing. Your body's going to respond well to that. But simultaneously, removing this major troublemaker is undoubtedly the best feature in the carnivore diet that's making it so dramatic. So dramatically helping people that they become very passionate about it. They want to become a carnivore coach. And they get really devoted to a diet that looks on a surface to be incredibly restrictive. Why would they want to do this so badly? And that's because some really profound benefits are happening for them and they feel so much better.

[00:57:01] SCOTT: And would you say that people can recover from hyperoxaluria? Or is this minimization of oxalate in the diet something that needs to be done for the rest of their life?

[00:57:14] SALLY: I definitely think that we shouldn't be eating past our capacity for oxalates regardless of whether we know we're sick with them or not. And just because you now have gotten rid of your symptoms, it's not an excuse to go back on the level of consumption that exceeds your body's natural capacity.

I think, just generally, human beings need to recognize that we have limits. We don't like to hear that. But there's a limit in how much oxalate we should be exposed to. And we should default to that. And applaud anyone who's doing well on higher amounts but not expect everyone to be able to do that. It's just like some people get away with smoking and never get any real diseases and die at 100-years-old with you know yellow fingers and no lung cancer. That's not an excuse to give blank permission to be smoking. And with oxalates, yeah, become oxalate aware and stay there forever for good health.

[00:58:06] SCOTT: You mentioned that oxalates negatively impact collagen. Many people are using supplemental collagen to support their structural integrity to have better hair, skin, and nails. Collagen contains hydroxyproline, which is said to increase oxalate excretion in urine, apparently metabolizing into oxalate. Should people with oxalate issues avoid supplemental collagen?

And then building on that, glycine is one of the amino acids in collagen. But also, many of us use that as a detoxification support tool. Do we need to be concerned about collagen? And then do we need to also be concerned potentially about supplemental glycine?

[00:58:51] SALLY: Yes. Well, John Knight is one of the lead researchers in this area. And he's still doing research and has another set of NIH funding that he's initiated I think just this last year looking more into this. And what his research has shown in the past is that seven grams of gelatin, which is the kind of old-school form of collagen, is enough to elevate oxalate in the urine. And that's barely a tablespoon of gelatin, which should be the equivalent, I imagine, of a cup and a half to two cups of bone broth too. Depending on how much gelatin is in broth, which varies a lot from batch to batch.

[00:59:29] SCOTT: Oh, now you're going to go after the bone broth too.

[00:59:33] SALLY: No. I like bone broth as a culinary tool. I like it as a nutrition tool. But just like vitamin C, more isn't better. Yes, you might need 90 milligrams of Vitamin C or 60 every day. And you might need that. And that's good. But that doesn't mean you need two grams of it.

Same with the collagen. You need some. But there's enough tissue turnover. You have connective tissue of collagen hydroxyproline in your body. There's enough tissue turnover every day that you're generating at least 10% of the oxalates in your urine. This is really where endogenous – true endogenous production of oxalate is coming from the metabolism of these amino acids.

And then, of course, part of this set of like three major precursors to oxalate that come from toxins, and fermented food, and other things. But the main basic metabolic one is this collagen hydroxyproline and glycine thing. I say stop the collagen supplements. Do other things to prompt your connective tissue health. I suggest BioSil in the book is something that's a signaling molecule that says, "Oh, let's repair connective tissue."

[01:00:46] SCOTT: You're talking about the silica, right?

[01:00:48] SALLY: Yeah, the BioSil silica. And they've just gotten it in a form that's supposed to be bioavailable. There's more research to do on this and really find better ways to support the production of healthy connective tissues and lower inflammation in the body. Because the chronic inflammation of the body is affecting connective tissue function. It literally turns the molecules that make up your connective tissue in a different direction.

And so, a different face of the molecule is a different set of charges and molecules. It makes it stickier. And the connective tissue starts sticking to itself. And you get that tension and tightness. And sometimes you feel shrink wrapped with your fascia. You can feel this tension in your body when inflammation is up.

And so, we need to keep inflammation down and keep connective tissue cells healthy. Keep the acidity down. And quit poisoning our connective tissue. And you won't need to keep supplementing. The supplementation is just making it worse. Yeah, I really discourage people from using more than like a teaspoon of any of that per day, of the dried collagens.

[01:01:53] SCOTT: I had Emily Givler on the podcast back in episode 131, where she talked about oxalates as a secondary mycotoxin produced endogenously by certain fungal organisms. Can you talk to us about the role that environmental exposure, maybe in our home, our workplace, our school, to organisms like Aspergillus or Penicillium might have in terms of the endogenous production of oxalates? And then there is some debate about whether or not Candida or Candida also could be an oxalate producer. What are your thoughts?

[01:02:28] SALLY: Well, the research suggests that Aspergillus is the main oxalate producer and that we're exposed to and can get stuck in our lungs in various tissues. If you've got a lot of black mold in your home, Aspergillus can produce aerosolized oxalic acid in the air. And you could be breathing oxalic acid from the mold in your environment.

If somehow your immune system is so damaged because of the oxalate is usually the reason, you get aspergillus stuck in your lungs or somewhere in your body and it's producing oxalate. You get localized oxalate crystal formation and probably generalized oxalic acid levels go up in the body. And so, that's a really real thing.

There's a small chance that some of this metabolism of yeast lead to precursors that could prompt additional oxalate formation in the milieu of the microbiome or even the liver function. But there's no evidence that direct production from yeast and candida in any form, hyphal full or whatever, that's producing oxalate directly. There may be some indirect production of some precursors.

But the bigger issue really is these – the pH changes brought on – the oxalate is affecting your immune cells, your barrier function cells and causing chronic acidity, and mineral deficiencies, and energy deficiencies. All of this is prompting chronic infections. And you're not going to really deal with any chronic infections of any kind if you're not also dealing with all that mess that oxalate is creating. If you deal with the mass of the oxalate, you can start resolving these mold infections and other chronic infections much more easily.

[01:04:16] SCOTT: Let's talk about some of the potential treatment or supportive interventions. I want to talk a little about the role of citrated minerals. If we're looking at calcium citrate, or magnesium citrate, or potassium citrate and taking those with meals that may shave some oxalates, is one better than the other? Are they all good options? And then wondering if oxalates, being calcium depleting, might those with oxalate issues need more supplemental calcium to avoid osteopenia or osteoporosis? I've always been more of the opinion that I avoid calcium supplementation because people think, "Well, that's going to affect your arteries over time," and things of that nature. But maybe that's not the full picture.

[01:05:03] SALLY: Yeah, I don't think it's the picture at all. I think it's cell damage and inflammation causing problems with calcium management in the body. It's not the supplements themselves. It's not the abundance of calcium in our environment is a thing.

Calcium does many things for us, particularly in this scenario of the high oxalate poison person. The calcium acts similarly, I believe, to the Oxalobacter in the gut as a invitation to the colon to excrete oxalate. It makes it more possible for oxalic acid to be excreted from the bloodstream, be met with calcium and then be locked up and not reabsorbed but then excreted through fecal matter. That's the main reason we take the calcium.

Most calcium is absorbed at a rate of about 20% to 22%. Most of what you're taking, three-quarters of it or more, is staying in the digestive tract, which is exactly where we want it because we're using it as a binder. Now, taking calcium will prompt this oxalate excretion. And some people can't handle the calcium because it turns on the oxalate excretion and they feel quite sick. They start getting into these heavy clearance, de-accumulation fits, the dumping. And that doesn't work for them. But eventually it will work for them.

The other thing is if you're in the middle of a syndrome that's causing all this pain and dysfunction, taking more calcium during that time can lower the pain and help you get through it and help you resolve it more quickly. Even if you can't tolerate it because it's prompting dumping. But if you're in the middle of the dump, take it anyway. It's really useful for lowering pain. It's great for helping the brain settle down, both magnesium and calcium. I love to start people with bedtime doses because it helps you sleep better. And of course, at night time, is the time when the body does all its healing and repair work.

For most of us, if you're going to get into some oxalate housekeeping, it's while you're trying to sleep overnight. Circadianly-wise, that's what you're supposed to be doing at night. And so, I call it the time when the janitors come out, right? And so, you really need that calcium magnesium and minerals at bedtime.

And before, when you're eating a high oxalate diet, it's at bedtime when you had the worst amount of oxalate in your bloodstream, which is really debilitating to a good night's sleep. So, now you're fixing all that. Hopefully you can sleep. Your bladder is not bothering you. You're not going to wake up all night long.

So, you may need more calcium and magnesium right away again in the morning because you might wake up feeling a little beat up and like it wasn't the greatest night because you were so busy working on oxalate clearing overnight. And you can sometimes tell that because you'll stand on swollen feet, or you'll have cloudy urine, which is often a sign of crystals of oxalate in the urine in the morning and other signs that that's going on.

The calcium and magnesium are great that way. The potassium also has been shown to really help kidney function, lower kidney distress. Potassium is one of these things that gets lost from the bones. And you really need all these minerals, especially potassium, to rebuild your bones. And my osteopenia, within three years, I was really doing well reversing osteopenia. And then when I added the potassium, I did even better and shot up in two more years to a normal bone density on my bone scan. Because the major cause of osteoporosis is this loss of minerals in the context of the acidity where the body has to compensate for the loss of calcium and the acidity of the oxalate in the diet by mining calcium out of your bones.

And so, once you quit doing that, the bones will start recovering as well. The calcium, magnesium, potassium, and trace minerals, all of them are useful in the recovery because of the deficiency that's there and because of the whole milieu of needing to heal this stuff.

[01:08:56] SCOTT: Calcium, citrate magnesium, citrate possibly at bedtime. If we're taking the citrated minerals with the foods as more of a binder, are we saying that the calcium citrate is significantly better than magnesium citrate? Or are they similar?

[01:09:13] SALLY: Well, that's assuming that you're still eating oxalates. If you're on a moderated oxalate diet, we're not really necessarily needing them as much to bind the oxalate that's in the food to lower the absorption rate. But that would be good prevention for people who aren't willing to change your diet. At least take calcium before your meals, 15 minutes before your meals, to get that calcium kind of ionizing before you hit it with this high-oxalate meal that you want.

That's a different concept of, "Okay, you still get to eat oxalate if you eat enough calcium." Because the calcium will reduce the oxalate absorption by a third often. You might be able to have a little extra bite of the chocolate cake. Rather than one bite, you might get three because you had calcium 15 minutes before. But that's a game that I don't play. But that's a different purpose. And what we're taking it for is for facilitating the excretion of the buildup that's already occurred in your past, and facilitating recovery, and protecting the kidneys.

[01:10:10] SCOTT: Are there specific vitamins, or minerals, or nutrients that can be cofactors for our enzymes that help to deal with oxalates? I know I've read about a good bit recently on biotin. I know some of the B vitamins as well. We've talked about the minerals. What are some of the nutrient deficiencies that we need to think about that's supporting those could also help beyond the calcium and magnesium that we just talked about?

[01:10:36] SALLY: Yeah. Minerals are important. And then there's the B vitamins. And if you start at the top of the list, B1 is at the top of my list. Because thiamine is an enzyme that helps shunt the precursor of oxalate towards a non-toxic sort of ketoacid molecules that aren't oxalate. If you're low in B1, you're going to produce more oxalate. And higher in B1, you can help lower that endogenous production. That's also true with B6 in some cases.

About a third of people who have the primary hyperoxaluria, which is a deficiency of AGT gene, that deficiency is related to the AGT. The cofactor is this B6. And in some cases, giving high B6 can help facilitate getting that enzyme what's there working better. But that only works in a small number of cases.

I think B1 deficiency is the most common B deficiency out there. And maybe biotin might be the second. And so, biotin is a cofactor on many different enzymes. And B vitamins generally are enzyme cofactors. And it can really help you in some cases to take a good active B complex. There aren't many good ones. Because a lot of them have the Pyridoxine HCL, which I don't like and have kind of useless forms of thiamine and questionable forms of other forms.

And the active B, the good ones, at low – You don't necessarily have to mega dose them unless you have some severe situation like schizophrenia or something like that where you definitely need certain ones higher. There's a lot of customization here. But a basic quality B supplement can help lower oxidative stress in cells and help the mitochondria and so on function better and get you back on your feet.

[01:12:22] SCOTT: And for listeners, I did a whole podcast previously with Dr. Chandler Marrs on thiamine. That was a really great discussion. That's available if you'd like to listen to it.

I've seen some products in the oxalate support realm that are using citric acid as the primary ingredient. Many people in this community tend to avoid citric acid because there's this idea that it's produced largely by molds and fungal organisms. I'm wondering what your thoughts are on these supplements that are citric acid in terms of helping with oxalate overload. We've already talked about lemon juice being potentially helpful in this realm. But what about the supplements that are citric acid supplements?

[01:13:02] SALLY: Well, it's true that the bulk of citric acid used in industry is made in four factories in China. And the technique uses Aspergillus mold that's been genetically modified, that instead of producing oxalate, produces citric acid. And so, there is a sort of homeopathic trace of mold. Sort of an energetic imprint in citric acid products that a small percentage of people really respond to. We don't know what percentage that is.

If you know you can't handle citric acid because you can't have colas, and olives, and other – So many foods use citric acid as a preservative. It's everywhere in the food world. If you already know you can't handle citric acid foods, you're not going to do well on citric acid supplements.

But if you're doing fine on foods preserved with citric acid, you're probably going to be fine with the supplements. But you'll be able to tell. Hopefully, you can get a sense of if it's a citric acid and the supplements bothering you. But the reason citric acid is so important is it has like five different advantages that it's giving you for recovery and protection from oxalates. It's a milder acid that surprisingly has a stronger bond with calcium than even oxalic acid, which shocks me. But that's how citric acid helps soften a hard oxalate crystal and turns it from a quartz-like material to something more like chalk, which is much easier for the body to break up.

Citric acid is a way to break down oxalate crystals. Citric acid has such a strong bond with calcium and minerals that it's the basic molecule in your teeth and bones. That's what holds the minerals to the underlying connective tissue matrix of bones and teeth is citric acid. Getting enough citric acid actually helps you re-enamelize, re-enamel your teeth and strengthen your bones. It's important for bone recovery.

Citric acid acid in the urine protects you from kidney stones because it prevents these clumping of the oxalate crystals. It's really good for the kidneys. It helps to lower the pH of the body – or raise the pH of the body rather. Because the citric acid, some percentage of it, becomes bicarbonate in the liver. It's a way of alkalizing the body. And many other advantages.

It's a really beneficial therapeutic molecule that's non-toxic. It's just you may need – there probably are some specialized producers in the US who don't use the Aspergillus technique. We'll have to learn more about that.

[01:15:32] SCOTT: I want to touch on vitamin C again. If we're consuming plants that have vitamin C in it, those plants obviously are often sources of oxalate. If we're taking a supplement though, the supplement itself may have been processed such that there may not be significant oxalate content in that supplement. But then that vitamin C that we're introducing into the body is going to increase our endogenous production of oxalates. Am I understanding that correctly? Either way, from the plant, we're bringing it directly in. But from a supplement, if it's vitamin C, then we're going to increase our endogenous production.

[01:15:32] SALLY: Right. Some supplements like turmeric whole root is very high in oxalate. But curcumin is low in oxalate. That's a low oxalate option. With vitamin C, any excess vitamin C, whether it's from food or supplements, if it's more than you need at that moment, it has the potential to break down into oxalate in the body. You can get a lot of vitamin C from your food. Lettuce, and red peppers, and some lemon. And you really can cover your vitamin C basic needs when you're healthy.

Now, when you're sick, you may need to add a little bit more, which is the equivalent of like two or three more lemons every day. It's not really that much more. The immune cells can only absorb and utilize so much vitamin C. And throwing more at them isn't doing them any good. They only have so many handles for vitamin C.

[01:16:55] SCOTT: You mentioned earlier that, with oxalates, we're not so much talking about detoxification. But we're looking at ways to facilitate excretion of these. Is there any value in, let's say, sauna, or detox baths, or coffee enemas? Do any of those help with excretion of oxalate?

[01:17:16] SALLY: They have not been officially studied for oxalate excretion. Because the mainstream science doesn't even believe in oxalate accumulation. Even though they know that it's common. But at the same time, they're saying. And the other hand, it doesn't happen. There isn't direct research of it. But you definitely see all forms of toxins being released in sweat. And the skin is the biggest organ of release and excretion. And sauna is fabulous even if it didn't help you excrete the oxalate. And some people are really our skin excreters. We see that in their symptom patterns.

But the sauna itself is lowering inflammation in the body. And because of oxalates, you're so prone to chronic inflammation, you need every chance you get to tell the body to quit being so inflamed. And the sauna is the way to do that. I went for a sauna this morning and then a cold shower. A cold shower is another technique for lowering inflammation in the body.

And I think, possibly – certainly, mineral baths are an important way to get minerals in the body. If people's GI tract can't handle minerals, they need to do mineral baths a lot if they're not prompting bad reactions to it. I highly recommend starting with foot baths. I have my own formula listed in the book. And using mineral baths to support the body is really – I don't know how much it's reducing inflammation. But it's certainly supporting healthier metabolism and putting your body in a better position to be in a healthier state. So, we like that.

I certainly think that people are getting good results with sort of castor oil packs. That seems to be supporting – I don't really understand the mechanisms behind it. It's certainly – Anything like that. These are safe things to do because you're not throwing chemicals in your body. Because once you get heat tolerant and you're not overdoing these things. Go to 80% of your tolerance and then get out of the sauna. Do it in a reasonable way, and it's fine.

I don't know so much about the coffee enemas. Some people seem to do well with them. I would say, in general, they're not necessarily needed. They're a little too aggressive. Some people can't handle the caffeine with them. And that's getting into something that's sort of chemical and aggressive. And I prefer to like support and be a little more gentle and be respectful of a situation we don't fully understand.

[01:19:31] SCOTT: In our last few minutes together, I want to do a few rapid-fire questions.

Chanca Piedra is known as stone breaker. Has been used for kidney stones. Uva ursi, another herb, is said to have an inhibitory effect on calcium oxalate. Have you found either of those two herbs to be helpful in dealing with oxalates?

[01:19:50] SALLY: Not really. And the research is not really supportive of it. And it looks like the – if there is a benefit, it's because it's raising citrate in the urine, which you can do in other ways.

[01:20:02] SCOTT: There are homeopathic products. Boron, for example, has a homeopathic oxalic acid. I'm wondering if homeopathy plays a role in terms of helping the body deal with these oxalates. There are also cell salts, like Nat phos or Lith mur that people have talked about in mitigating oxalates. Any experience or thoughts on those homeopathic tools

[01:20:24] SALLY: Well, all I can say is I think there's a whole electromagnetic wisdom in the body when it's well. And it's sort of like a lace, a delicate lace, that holds you together. And that's partly why some people don't get symptoms because there's this function with that. And homeopathy is intended to sort of help correct this sort of electromagnetic organization and well-being of the system. There are probably people who respond pretty well to homeopathy and then others that don't. I couldn't really speak to it since that's not my area of expertise.

[01:20:56] SCOTT: I see oftentimes supplements that maybe have 10 different ingredients. One of them may be viewed as higher oxalate when you're thinking about it from the food or from the herb. But I'm wondering, for the amount of a substance that might be in a capsule compared to what we're consuming with food, should we – If we're on a low oxalate diet, should we throw out all supplements that contain any ingredient that might have oxalates? Or is that maybe over scrutinizing things?

[01:21:26] SALLY: It depends on the situation how much you're taking. What the product is? What your reactivity is? Because I think some people actually start reacting to the foods themselves that have the oxalate in them. And you start getting that imprint of like, "Oh! Beet greens drive me crazy," kind of thing. "Beets, I hate them." Kind of the body is like –

Generally, I try to get people off of these whole food supplements and away from all that kind of herbal mix because it's just too many compounds, too many signals to give the body more reactivity. And to me, the biggest concern is how to keep the immune system calm and keep the gut healing. And the less of that stuff, the better in many cases.

[01:22:01] SCOTT: With the title of your book being Toxic Superfoods, are there any super foods that you consider at the top of the list of health-supporting superfoods rather than health negating or toxic superfoods?

[01:22:15] SALLY: Probably egg yolks, and clean small fish, and clean animal foods are generally a great way to bring someone back from the dead. And they're very easy to digest. And once your immune system can handle them, they're all pretty safe. But the biggest superfood is really a whole context of a healthy life where you're not poisoning yourself from anything, and you're having a balanced life, and enjoying your food, and using food as part of having a quality life, and not just medicalizing every moment of your day.

[01:22:50] SCOTT: My last question is the same for every guest. And I'm going to be a little light-hearted in asking it to you. And that is, besides spinach, sweet potatoes, and rhubarb, what are some of the key things you do on a daily basis in support of your own health?

[01:23:05] SALLY: Yeah. Well, I do do cold showers. For three something years, I've not had a warm shower. I like to do hot yoga very much. I prioritize three a week, just an hour. Nothing big deal. But I will walk away from unfinished work to keep my three yoga classes and my schedule best I can.

And I'm careful about adding any toxins to my lifestyle. When I got a new refrigerator, we got a pod and let it sit outside for two months to air out it's toxic plastics. And I've just ordered paints through the mail so I could have safe coat on my walls. I do take being nice to my body seriously. I have flowers lining the walk to my front door. And to me, having flowers around in your life is a great way to take care of yourself.

[01:23:53] SCOTT: Beautiful. Beautiful. Such a fantastic conversation. I urge people to get your book, Toxic Superfoods. It is a fabulous read with lots of connecting the dots that happens as you work through it. Thank you for putting that together. Thank you for being here today, being generous with your time and for crystallizing so many of these important concepts for us.

[01:24:17] SALLY: Thank you, Scott. I'm so glad you got interested in this topic. I appreciate getting to spend time with you.

[01:24:21] SCOTT: Thank you, Sally.

[OUTRO]

[01:24:23] SCOTT: To learn more about today's guest, visit SallyKNorton.com. That's SallyKNorton.com. SallyKNorton.com.

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Disclaimer

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.