[00:00:00] Jay Feldman: Are oxalates really as damaging to our health as we're told and how much does gut health impact oxalate issues? We'll be answering these questions in today's episode of the energy balance podcast, a podcast where we explore health and nutrition from the bioenergetic view and teach you how to maximize your cellular energy to maximize your health.

[00:00:18] In today's episode, which is part one of our oxalate series, we'll be going over whether the harmful effects of oxalates are legitimate or overblown. We'll discuss how your gut health impacts your susceptibility to oxalate issues. We'll go over which nutrients help to decrease oxalate absorption. We'll discuss how fat digestion relates to oxalate absorption and also whether a candida overgrowth may be at the root of your oxalate issues.

[00:00:41] As always, to check out the show notes where I'll link to the articles, studies, and anything else that we referenced throughout today's episode, head over jfeldmanwellness. com/ podcast. And with that, let's get started.

[00:00:50] All right. So we we're going to do a pretty extensive oxalate series here, getting into all the ins and outs, and quite a bit more depth than I think most people really dig into oxalates. We're going to be talking through some of the really common kind of myths, misconceptions. And then just get into the detailed physiology of what happens when we consume oxalates, how they're produced inside our bodies, how we detoxify or clear them out or metabolize them or whether we do and yeah, we'll expand from there.

[00:01:19] And, eventually we'll talk about, we actually want to be doing, if we're concerned about oxalate issues, whether we need to avoid any oxalate containing foods. And so we'll dig into all that throughout the series. But there are a couple of things that I think if you were to ask someone in the health sphere Oxalates, they would mention or parrot some of these things are often said, which is, things like the idea that oxalates are just inherently toxic that they might be a primary driver of health issues, and it's something that everybody should be avoiding.

[00:01:46] None of us should be eating high oxalate foods and that in general, the oxalate containing foods are the main driver of oxalate issues. And there's really not much emphasis placed on what happens endogenously the own, the oxalates that we produce ourselves and how we can prevent that from happening or reduce that from happening, sometimes people in the alternative health space, they'll talk about, citric acid is something that can be helpful for oxalates and maybe a couple other nutrients in there, but that's normally about the extent of it.

[00:02:16] So we'll be really digging into the details here. In terms of all these topics, getting into the weeds as we often do. So yeah, that's the broad picture overview here. Do you have anything else you want to add, Mike?

[00:02:29] Mike Fave: I think the big thing that for me, that's really important about oxalates is that there's a focus on oxalates as being something that's in an exogenous problem.

[00:02:37] So it's mainly from the foods you're eating in your diet. And I think one of the most important things that we can actually talk about here is that it is, there's a large portion of auxlets, depending on your context, that can be endogenously produced. And so we'll get into the ins and outs of the exogenous, like the food source to the oxalates and how you can manage that, because to be honest, it's very easy.

[00:02:56] The other thing that I think that we're going to bring new light into is the endogenous production side, which is not talked about as heavily and which I think will be quite interesting and quite useful for people who are struggling in different diets, like low carb diets, keto diets, carnivore diets, things like this.

[00:03:13] where they're actually dealing with oxalate dumping, but they're not taking in exogenous oxalates. I think these are the, some of the areas that will be quite interesting overall, and it also will be bringing to light some of the concerns with oxalates, like what are they actually doing in the tissues and areas where they can actually be, a problem.

[00:03:30] I think these are really interesting components, like for example, their effects in cardiovascular disease. Atherosclerosis, things like this. It's not something that's talked about or their production locally in tissues under states of poor metabolism or stress, basically stressed out metabolism or damage metabolism.

[00:03:46] I think these are the new areas of light that we're going to be breathing into the oxalate topic. That can take it from just avoid spinach, avoid arugula stop eating chocolate, to like, how do you, how can you manage your, the issues where endogenous production is a concern? And then also, how can you still have a little bit of chocolate in your diet without worrying about. Having atherosclerosis or something like this, so

[00:04:08] Jay Feldman: yeah, and not to mention to within the bioenergetics fear, a lot of foods that are promoted as being beneficial or high or moderate oxalate foods, whether it's potatoes or chocolate or a number of different fruits and. Some other root vegetables that, are considered to be potentially high oxalate foods.

[00:04:26] And so that's something I want to get into as well, because, you and I both have had clients come to us who either think that they have oxalate issues, maybe they do have legitimate oxalate issues and, we can work with that and help them fix those issues, but they're normally really fearful about a number of different foods.

[00:04:41] And so we'll talk about that too. How much of that fear is warranted and what can be done in those situations? I wanted to touch on, some of the really common signs and symptoms that people will point to as being caused by oxalates. Those would be things like joint pain, kidney pain, bladder pain kidney stones.

[00:05:00] Sometimes, there's a number of other things too. It's really one of those areas where like a lot of other scapegoats or potential scapegoats there's legitimate concern. With a number of the scapegoats, but often it's just not quite as much as they're given for everybody. But as with many of the scapegoats, the idea is that this could essentially cause any kind of symptom.

[00:05:19] You're experiencing and we've talked about this, whether it's mold exposure or heavy metals, or in this case, we'll talk about in terms of oxalates. And that doesn't mean that these things can't potentially cause. Harm or can't potentially cause these certain symptoms, but the idea or the likelihood that this is that the cause of those symptoms is something we'll definitely be bringing into question, at least for a lot of people.

[00:05:39] And again, with the knowledge of mind that in some people, it is the culprit here. We'll discuss all that, but those are some symptoms that a lot of people will point to as likely oxalate symptoms or oxalate caused symptoms. Are there any others that come to mind for you, Mike?

[00:05:54] Mike Fave: There's actually a list, so I went through a variety of carnivore YouTube channels to see what people were saying was associated with oxalate dumping.

[00:06:02] So you have obviously kidney pain, bladder pain, cloudy urine, but then you have diarrhea, skin irritation, joint, tendon, muscle pain, eye irritation, anxiety, and depression, brain fog, electrolyte issues, cramps, headaches, sleep disturbances, and arrhythmias. And it's man, it's just like oxalates. And the other thing is if you listen to a video with Sally Norton, it's like oxalates are literally the number one, like problem.

[00:06:23] Like you listen to her and it's they're just causing everything. And the question is for a lot of these circumstances, I think it's really important to delineate what the cause is. Now, I'm not sitting here saying that oxalates can't cause some of these problems. I fundamentally agree with that across the board.

[00:06:38] What I'm saying is we need to determine are oxalates actually the specific cause of these individual problems, especially when you go on a diet like a carnivore diet. Or something like this where you get the dumping symptoms and then this is what people are experiencing or if you're eating sweet potatoes and you're having digestive issues oh, it's just the oxalates.

[00:06:55] It's there could actually be a couple other things besides oxalates, and the problem is that you have so many dietary camps, right? If you're eating sweet potatoes and you have problems, grant general is going to say it's vitamin a, it's beta carotene and then Sally Norton is going to say that it's oxalates and then, the low carb community is going to say it's the carbohydrates.

[00:07:12] And so it's just like you have. All these different theories on why this specific thing could be a problem. And what's important to understand is that these are theories. It's more important to try to sit down and say what is fundamentally across the board with the food, do you tolerate it or not?

[00:07:28] At the end of the day, if you're eating sweet potatoes and you have problems with them whether it's oxalates, beta carotene, whatever the thing is let's just maybe hold that on the side. But then the next component is which thing is the actual problem? And then you gauge from there.

[00:07:39] And the reason I bring this up with the context with the symptoms, and as you alluded to J is that where there's, we have these. These individual components that are being proposed as to catch all, whether it's oxalates, vitamin a or things like this. And I think the fundamental question is more or the fundamental perspective is more that all of these things could be a potential problem for a given individual.

[00:07:59] It just depends on that specific individual which thing is going to be a problem. And I don't think we want to be in a circumstance where we're blanketly avoiding everything. Because of all these theoretical concerns, we want to figure out what is the specific current concern for each person and, what, if they're having a particular symptom, what is that related to instead of just saying, oh, it's everything is just oxalates or everything is just vitamin A or carbs or whatever the deal is.

[00:08:25] So I think that's the one of the important things here. I think that's bring it that shift in thinking is going to be super important for all the dietary stuff. That's because even the biologics fear everything is just poof. Just polyunsaturated fats. Like it's just a mega six.

[00:08:38] That's the major problem for everything. And I think. For both you and I, when we start working with clients, you start to realize it's yeah, this person has been like PUVA depleted or low oxalate for however many times they still have problems. So it's are those actually their primary problems or is there other things going on?

[00:08:51] And I think with each person, it's going to be a case by case basis.

[00:08:54] Jay Feldman: Yeah. Yeah. Not to go too deep into any of those points you brought up, with the PUFA one, I see that a lot where people are just blaming the idea that it takes as much as a couple of years to deplete PUFA. And I think if someone's, if you're not getting better after several months, if you're not seeing improvements, that's a sign that certain things are probably not right.

[00:09:13] We want to explore everything a little deeper. I would not be blaming that on just it taking too long for PUFA depletion, especially because in the vast majority of tissues, basically all except the adipose tissue. Every, there will be pretty significant proof of depletion in a few months. Yeah, it's, I think that can be a scapegoat as well as you're getting at, but a larger point here.

[00:09:32] Mike Fave: Say that with oxalates too. It's you can dump oxalates for years and it'll come in waves and cycles and so and it's the same thing with vitamin a. And I think that is like one of the things where it's this is. That is a potential thing, but it's it's also a slippery slope in how you're thinking about the problem that can lead you down a four year investment into oxalates with a problem or poof.

[00:09:53] It was the problem without resolution of your symptoms and you avoid considering other things because you've decided that this is the thing without verifying that this is the thing. I think these, the oxalate, I know we, I talked about a couple of things. But I think what we're seeing is like the oxalate stuff is in line with these other perspectives in terms of how people are thinking about them.

[00:10:12] And so what we're trying to do is one, bring that to the forefront so you can determine are oxalates your problem? And then two, what are other ways that, how can you manage that? And then what are things like, where is the problem coming from? Is it just from your diet or is there other things that you're doing?

[00:10:27] That are shifting your own endogenous production and things like this, and that's why I think, the perspective that we're going to, that we're going to bring here can become pretty interesting for me. It was extremely interesting when we were, when I was researching it, I got very excited when he was like, oh, wow, it's endogenous side.

[00:10:40] It's pretty cool.

[00:10:42] Jay Feldman: Yeah, definitely. And as you're saying, it's, if you're going to sign up for a multi year journey focused solely on one issue, you better be sure that's your issue and that you're also fixing the underlying problems as opposed to just signing up. To avoiding that thing from your diet, whether it's vitamin A or oxalates, obviously, it's very clear that a lot of people do find consuming potentially massive amounts of these things.

[00:11:04] And so if you are not, that's typically a sign that there's something else going on. And if we don't address that, and we just try to avoid this component in foods, the likelihood of us improving in any reasonable amount of time or maybe ever is much lower. And along with that. The really central point to highlight is being sure that's your issue, especially, I can't tell you how many times I've had somebody come to me thinking that one of those things was their issues or thinking that oxalates were their issue and we've seen their issues clear up without focusing excessively on oxalates or avoiding all possible Oxalate containing fluids and things like that.

[00:11:40] So yeah with that, let's first just start by talking a bit about what oxalates are and then why they may or may not be harmful or damaging and how they can cause that those, how they can cause potential issues. First off, oxalates are just they're an organic acid, and we can produce oxalates endogenously, plants can produce them, and that's why we can consume, when we're consuming different plant foods, we can be consuming oxalates produced by those plants.

[00:12:12] They can also be produced by bacteria and fungi, which we'll talk a bit about that as well as degraded by those organisms, but we don't actually have the capacity to. Break down the oxalate itself. So once the oxalate is produced in our bodies, the only way that we get rid of it is by clearing it through the kidneys, through the urine.

[00:12:29] A little bit can go through the bile as well, but the important part here being that we can't enzymatically break it down, we can't degrade the oxalate. So that's an important consideration. Another thing to mention here is that with it being an organic acid, it's Oxalate on its own is oxalic acid, and in general in our human physiology, it's pretty much always going to be bound with some mineral.

[00:12:50] So you'll have calcium oxalate, magnesium oxalate, sodium oxalate, zinc oxalate, and that's going to be an important consideration as well that we'll talk about a little bit. It's also an important consideration when it comes to the bioavailability of certain nutrients. So we'll talk about how. The consumption of certain nutrients reduces the absorption of oxalates.

[00:13:08] We'll also talk a bit about the flip side, which is that the consumption of oxalates reduces the absorption of certain minerals, which is important to consider as well. So those are some big picture, just what are we even talking about here in terms of oxalates? And then the other thing to mention is that when oxalates do bind with especially calcium, that's really the one that's most concerning in terms of what's going on in organ tissues is that it forms crystals.

[00:13:30] So you get these calcium oxalate crystals. That can cause various concerning effects that we'll discuss.

[00:13:37] Mike Fave: Yeah. I think the important thing to consider with the oxalate stuff here, and we're going to get into this is oxalates. The body has capacity to clear them. Because there's an idea that like we just, I think I've seen a podcast with Dr.

[00:13:49] Chafee and Sally Noren. There's Dr. Chafee had made a statement saying oh it's just the body can't like effectively clear them. And it's no, the body can very much clear them. The problem with oxalates is more how much and then also how much is adjusted by how much are you absorbing from your GI tract?

[00:14:07] How much are you producing at the liver or the tissues and then how much are you able to excrete, which will be modified by your kidney function and things like this. It's these things I think are exceptionally important in terms of understanding when are oxalates actually a problem. Because as Jay mentioned it's an end product of metabolism.

[00:14:26] We don't break it down, so it has to be excreted. It needs to go out. It's like urea. We don't break down urea. We excrete urea in our urine. So these are, that's I think a major piece with oxalates to focus on and it makes, it brings a little nuance to the conversation that I think is exceptionally important.

[00:14:44] Jay Feldman: Yeah. Yeah. And again, you're making a very clear distinction, which is that while we can't metabolically or enzymatically break it down, we absolutely can clear it. And we have a pretty, pretty impressive capacity for clearing oxalates, which we'll definitely be talking about. Yeah, that's certainly some important things to consider.

[00:14:59] So let's take into the some of the potential concerns with oxalates, right? What sort of negative effects they can cause and why we may want to reduce our exposure to oxalates. I'll let you start us off.

[00:15:14] Mike Fave: So one of the major problems of oxalates. Is that one, they reduce mineral bioavailability, as Jay mentioned, but two, in doing so, one of the major minerals that they bind to is calcium, and when they bind to calcium, they create crystals that can damage the kidney directly.

[00:15:32] There's a quote here from a paper, the paper is calcium oxalate crystals induce renal inflammation by NLRP3 mediated. I hope I'll one beta secretion and the quote they say in mice intrarenal calcium oxalate deposition induce tubular damage cytokine expression neutrophil recruitment and renal failure.

[00:15:50] We found that calcium oxalate crystals activated murine renals. Then, dendritic cells to secrete aisle 1 beta through a pathway that included and I'll. NLRP 3 and cast base 1 despite a similar amount of crystal deposits. Intra renal inflammation, tubular damage and renal dysfunction were abrogated in mice deficient and at my D88, caspase 1.

[00:16:14] So essentially the major point of this complex paper, I guess the pathways that are talking about basically sound like a foreign language, but essentially the calcium oxalate directly damages. The kidney and the cells, the lining of the tubule cells inside the kidney and stimulates immune activation.

[00:16:33] So basically the crystals when they deposit in the kidney damage the lining, which attracts immune cells and in the local cells, the pathways that they're talking about signal inflammation and also signal cell death. So you're seeing that the crystals themselves are damaging to the kidney. And now this is a problem because the kidney is going to be the main site of excretion of oxalates.

[00:16:54] So what winds up happening is as you have more oxalates, past the point of kidney's ability to actually get rid or clear the oxalates, you start to damage the kidney directly. And then that leads to a cycle of building up oxalates into your blood, which is, we create something called oxa, oxalosis, systemic oxalosis.

[00:17:11] Now, this is something typically seen not in normal people, but in people with genetic oxalate disorders or who have severe digestive disorders like Crohn's or intestinal resections, things like this. We'll get into that in the future, but basically this is what you're, this is just to show that calcium oxalate crystals directly damage the kidney.

[00:17:29] And then also some of those consequences that you can consider from that.

[00:17:33] Jay Feldman: Yeah, absolutely. And We'll talk here in a moment about other areas that the calcium oxalate crystals can potentially be causing damage to, but yes, it is really important to highlight that they're cleared through the kidneys.

[00:17:43] And if we're getting excessive amounts can cause damage at the kidneys and can also cause kidney stone formation. Not all kidney stones are caused by. Are made up of calcium oxalate, but quite a few are, a large proportion of kidney stones are so that's something to keep in mind as well as somebody is prone to kidney issues.

[00:18:00] Kidney stones. This might be something you want to keep an eye on a little bit closer and we'll talk as well about kidney function being related to our capacity to clear oxalates a bit later on. I wanted to touch briefly back on the mineral bioavailability side of things because we mentioned that oxalate combined with minerals, but I just want to be clear here.

[00:18:18] Okay. One other concern of a high oxalate diet is that it will reduce the absorption of minerals like calcium, magnesium, and zinc. And so that's something to be aware of. And especially in the case of foods that are high in oxalates, in the mainstream, which tends to be on the, plant based side these days, some of those foods are really highly recommended like spinach, for example, and it's worth highlighting that, they'll point to spinach having all of these nutrients in it, but some of the most important ones.

[00:18:49] Are not going to be absorbed because of the amount of oxalates in there. It is something that does become relevant. Again, this does not mean that we need to avoid all oxalate containing foods. We'll get into the details of that later, but I did just want to highlight that is also a negative effect of oxalates that we want to be aware of.

[00:19:04] Now, I do want to mention as well. So we're talking about kidney issues here. We'll be talking about cardiovascular health. We'll be talking about gut health, metabolic health. All of these are things that can be affected by oxalates. Now, if you're dealing with these issues, or if you're dealing with any other low energy symptoms, whether that's fatigue, chronic pain, hunger, weight gain, digestive issues, brain fog, sleep issues, hormonal imbalances.

[00:19:26] Or any other low energy chronic conditions, then head over to J Feldman wellness. com slash energy where you can sign up for a free energy balance mini course. And that mini course, I'll walk you through how you can adjust your diet and lifestyle to resolve these various low energy symptoms and chronic health issues.

[00:19:42] These things will also directly impact your capacity for clearing oxalates and also helping to reduce endogenous oxalate production. We'll get into the details of those pathways later on in the series. But just wanted to mention that you can head over to J Feldman. Com/ energy to sign up for that free energy balance mini course.

[00:20:00] Which brings us to the cardiovascular health side of things in relation to oxalates. And there is an association between oxalate levels and cardiovascular health. And there's a study here where they talk about that a little bit. It's titled, Disregulated oxalate metabolism is a driver and therapeutic target in atherosclerosis.

[00:20:18] And they state here, using targeted metabolomics, we identify decreased ratios of glycine to its precursors or related metabolites, serine, threonine, and oxalate. In patients with coronary artery disease, we demonstrate that increased oxalate exposure drives accelerated atherosclerosis in relation with dysregulated redox homeostasis, increased inflammatory response, and enhanced hypercholesterolemia.

[00:20:42] What they're talking about here is a few different mechanisms through which oxalates can cause cardiovascular issues, basically inflammation related. The hypercholesterolemia side increased cholesterol production. Obviously, we have some disagreements on that front. I don't think that's a primary driver here.

[00:20:57] In terms of the potential negative effects of oxalates in terms of cardiovascular health. And I'll link back to episodes where we talked in more detail about that, cholesterol, lipid hypothesis, all of that. But inflammatory response, redox homeostasis, we'll talk a bit about that as well when we dig into the metabolic effects.

[00:21:12] But this is something that's seen in cardiovascular disease, and in atherosclerosis is lower glycine, as they mentioned, and increased oxalates, both of which. Have their own negative effects here and can be contributing to the pathology, which we'll continue to dig into

[00:21:27] Mike Fave: wait, Jay. It's not April. B. It's not like April B isn't the only cause of cardiovascular disease. There could be other causes.

[00:21:35] Jay Feldman: Oh, man, we're opening a can of worms here.

[00:21:38] Mike Fave: It's I'm obviously being sarcastic, but it's like. That it is just interesting 'cause like obviously there can be other causes of damage to the vasculature, which is essentially what cardiovascular disease is and oxalate crystals like you can just imagine, you can visualize it.

[00:21:51] You have a bunch of oxalate crystals running through the vasculature. There's a potential that it could actually damage the vasculature directly, or if there's oxidative stress driven by oxalates in general, that can have a da, a damage to the vascular lining. So this is what you're seeing here.

[00:22:07] Now, interestingly, what they were talking about here is it was about the oxalate levels. I think we're related to a change in metabolism, which goes back to that endogenous. That endogenous piece that we're talking about. Tongue in cheek making a joke about the ApoB things is that's the only thing we need to focus on.

[00:22:24] Not actually, but there's multiple things going on, which can include the lipids, but oxalate can, could be a driver for some people in damaging the arteries, and in the genetic diseases, you can see this, that they the primary hyperoxalorias, where people produce large amounts of oxalates.

[00:22:40] They could run into issues with vascular function and other organ function because of the oxalates directly. But here's a case where you're saying, okay, like there's something else that could actually damage the vascular. It doesn't mean that your dark chocolate is going to give you atherosclerosis, so we'll get into that.

[00:22:54] But it's just another interesting pathway to see.

[00:22:56] Jay Feldman: Yeah, absolutely. Which brings us to some effects on the gut. Do you want to start us off with that?

[00:23:02] Mike Fave: One of the major concerns that we can look at with oxalates is that high amounts of oxalates can actually cause gut dysbiosis. There's a paper here called Hyperoxyluria leads to dysbiosis and drives selective enrichment of oxalate metabolizing bacterial species in recurrent kidney stone endures, endurers, interestingly, the quote says, interestingly, higher than usual concentration of oxalate was found inhibitory to many gut microbes, including oxalobacter formagens, a well characterized oxalate metabolizing bacterial species. So inter, so basically, high amounts of oxalate coming in the gut can actually drive dysbiosis and can lower.

[00:23:36] A bacteria like oxalobacter, which is considered protective against oxalate issues because actually it can actually metabolize oxalates directly and also bifidobacteria and some of the other beneficial species have been shown specific strains of them have been shown to be able to metabolize oxalates as well.

[00:23:56] If you have got dysbiosis, or here it's saying even the oxalates are driving the gut dysbiosis. Can lead to an issue where you are in a vicious cycle of worsening your potentially in this case, oxalate kidney stones. This study was about people with recurrent oxalate kidney stones. And this is another example of how oxalates can damage not only the cardiovascular system, the kidneys and your mineral status, there is the potential that they can damage the microbiome, potentially the gut as well.

[00:24:22] Jay Feldman: Yeah. Yeah. And again, as you're alluding to, normally this is talked about in the reverse, right? That, it's important to focus on these sorts of bacteria that helped to degrade oxalates. And there is an aspect of that will come back to later. But it is interesting that the oxalates themselves actually lead to a lack, a down regulation of Of these bacteria.

[00:24:41] Yeah, and then moving on to another effect of oxalates here, which is talked about in that paper, looking at the effects on atherosclerosis that same one that we had just cited and shared that quote, they state here we confirms the suppression of CYP7B1, but not APOA1 in livers from male AGXT and APOE knockout mice.

[00:25:02] CYP7B1 plays a major role in the acidic pathway of cholesterol metabolism to bile acids in the liver. In line, total bile acids were significantly decreased in livers from male AGXT and APOE knockout mice. Together, these findings indicate that dysregulated oxalate metabolism suppresses cholesterol metabolism to bile acids that may account for the increased hypercholesterolemia found in these mice.

[00:25:24] So again, a lot of technical information here, but the important point being that what they found when manipulating some of these pathways and. And increasing the levels of oxalates pretty significantly by basically reducing their breakdown. They basically induced genetic issues to cause oxalate issues.

[00:25:40] They did find that there is a lack of bile acid production, which we'll talk about later. Again, being one of those things that is actually. Implicated in causing increased oxalate absorption. So when we have a lack of bile acid production. It reduces our capacity, right? It just increases the amount of oxalates wind up absorbing.

[00:25:59] So they're talking about this kind of possible positive feedback loop or like a, negative effects on both sides where the lack of bioassets increases oxalate absorption, which then can reduce the bioasset formation. And so you get this kind of vicious circle. This is not something that's often talked about, right?

[00:26:15] It's just something that they found in this paper that was interesting to point out. It's hard to identify how directly relevant this is in humans when, especially without genetic issues, if you're just exposed to moderate amounts of oxalates, but it is an interesting possibility to know.

[00:26:31] Mike Fave: And also, if you don't have, if you don't have bile acid production going into the small intestine, Because it's being knocked out from the circumstance, then you can actually drive dysbiosis further in the small intestine or overgrowth, because the bile acids actually clear out the bacteria in the small intestine, and you may actually increase things like endotoxin under these circumstances if your bile flow is decreased.

[00:26:52] And then as we'll get to, which Jay, you're going to. Drop us into in a sec, the metabolic section that if the bile acids if you have metabolic dysfunction, which endotoxin can drive, then I can actually worsen your oxalate production endogenously. So these are really important things to consider.

[00:27:08] There's like multiple interlapping ways that these things can play out together.

[00:27:13] Jay Feldman: Yeah, so let's talk about that because I think that's one of the more interesting things here is the metabolic damage caused directly by the oxalates and we'll talk about the influence of like oxidative stress and damage and irritation and metabolic issues in oxalate production, but it's interesting to consider the, when talking about some of the harmful effects of oxalates, how they cause those negative effects, why might it be associated with atherosclerosis or these kidney issues and other issues.

[00:27:40] Yeah. And looking at the metabolic effects really elucidates that. Some pretty interesting things here. We'll dig into some of these studies. And again, we'll simplify them as well since I know sometimes they can be a little bit complex, but I'll just share the first one here titled mitochondrial dysfunction and kidney stone disease.

[00:27:56] And they state calcium oxalate crystals have been found to induce oxidative stress and renal tubular cells, leading to mitochondrial dysfunction and renal cell injury. Renal tubular cell injury and the defective mitochondria and other intercellular organs are evidence of aggravated calcium oxalate crystal retention inside the renal tissue, which is considered as one of the important steps for kidney stone development.

[00:28:17] Just to clarify those 2 things, they're saying that the calcium oxalate crystals themselves cause oxidative stress? And mitochondrial dysfunction, which then also leads to damage to the kidney cells. And they were saying that this sort of damage to the kidney cells is seen, and this is used as evidence of the presence of calcium oxalate crystals.

[00:28:37] They then state, following this line of investigations, several previous studies on kidney stone disease Thus explored the effects of mitochondrial injury, reactive oxygen species production, loss of the mitochondrial membrane potential, and mitochondrial swelling. On the other hand, mitochondrial glutathione maintains the mitochondrial integrity and functions and can also reduce oxalate deposition in hyperoxalaria condition.

[00:29:00] Vice versa mitochondrial glutathione reduction can induce mitochondrial dysfunction and may contribute to the development of calcium oxalate kidney stones. So a couple of interesting things here. Again, I know it can be a little complicated, I think that these things are worth acknowledging, which is that first thing that they're noting is that, some of those direct effects of the calcium oxalate crystals causing mitochondrial injury, loss of membrane potential, mitochondrial swelling.

[00:29:23] So basically interfering With the powerhouse of the cells, as everybody knows, that the mitochondria are that the, significant amounts of calcium oxalate crystals will interfere with energy production will interfere with mitochondrial function. It is something, of course, that's important to consider from that regard.

[00:29:39] And then separately, the presence of glutathione helps to protect against the effects of oxalates and actually reduce their deposition in the 1st place. We'll be coming back to this later. We'll talk about the relationship with glutathione and oxidative stress. and oxalate concerns. And, the other side that's that they mentioned here at the end, that's really important is that the lack of glutathione causes metabolic issues, causes mitochondrial issues, which then allows for the calcium oxalate deposition and development into kidney stones.

[00:30:07] This is something, again, we'll discuss later, but Kind of a sneak peek now that if there's mitochondrial issues, if there are energy production issues, if there are metabolic issues, you'll be more susceptible to the deposition of calcium oxalate crystals, more susceptible to the damage by oxalates. And they dig into this a little bit more with this last quote here.

[00:30:26] They state oxalate and calcium can alter mitochondrial activities, leading to changes in metabolic status that may induce loss or alterations of mitochondrial functions on energy production, reactive oxygen species regulation. And intracellular calcium homeostasis, all of which affects mitochondrial biogenesis.

[00:30:43] So again, just to clarify here, they're talking about the negative impact here of oxalate on mitochondrial function, which is, if we're going to talk about something being harmful, if it's interfering with mitochondrial function, that's central to everything, right? That's central to the function of all of our organ systems.

[00:31:00] And of course, here they're focused specifically on the kidneys themselves, which is a place that we're most concerned about. The effects of oxalates.

[00:31:10] Mike Fave: Yeah, especially because it needs to get beat up by oxalates. Then you have more oxalates floating around that can damage the mitochondria of other cells.

[00:31:17] I think when we're sitting in an overarching picture, we're thinking about how do we set up a diet or how do we set up some type of system where what are we gauging on what we're going to do? We want to have things that optimize mitochondrial functions so we can produce optimal amounts of energy while at the same time minimizing things that will damage.

[00:31:37] Your mitochondrial function. So I think this goes hand in hand with the idea. And I guess just as a preface, like we're on board with not having high amounts of oxalates in general. It's, we're not optimizing for oxalates. I think that's optimizing for it. You mean like we're not trying to increase oxalate production?

[00:31:51] Yeah.

[00:31:52] We're not saying we're not taking contrarian. Yeah. We should be pro oxalate because it's clearly the oxalates are damaging to multiple tissues, multiple structures. But what we are pointing out here, and this is really important, is the state is also really important. If your mitochondrial function is solid, and you have adequate amounts of glutathione present, meaning you don't have high amounts of oxidative stress present in the mitochondria depleting your glutathione, and you have enough resources to produce that glutathione inside the mitochondria, then you may be able to handle the oxalate.

[00:32:21] To some extent, and I would, that would adjust your sensitivity, which brings us, but we'll bring us to this whole endogenous production piece and everything like this. But in general, the body state here is really important. The state of the mitochondria is really important to determine what becomes an insult and what isn't an insult.

[00:32:38] And we're seeing that with oxalates as another example of this.

[00:32:42] Jay Feldman: Yeah, absolutely. And we'll, absolutely. Continue to get to dig into that and they showed that a little bit in these next few codes as well. If you want to, this 1st 1, they're just talking about how much of an impact oxalates can have on mitochondrial energy production. If you want to touch on that 1.

[00:32:57] Mike Fave: Yeah, so basically here what they're showing us that oxalates can directly impair the Krebs cycle, the citric acid cycle, which is very new bodies. Listen to energy balance before. That's like the central piece for energy production that we talk about. So basically the paper is titled influence of oxalate on the rate of the tricarboxylic acid cycle in rat hepatocytes.

[00:33:17] Now, this is in cells. So keep that in mind. But they say in hepatocytes isolated from fed rats. Okay. Physiologic concentrations of oxalate lower the flux to the tricarboxylic acid cycle, about 48%, and reduce the steady state levels of oxaloacetate and other Krebs cycle intermediates. All the metabolic modifications observed are explained by pyruvate carboxylase inhibition, since oxalate hardly modifies the flux through pyruvate dehydrogenase.

[00:33:41] It's not blocking pyruvate dehydrogenase, which is one of the major enzymes that we've talked about that allows pyruvate to be brought into the mitochondria or basically carbohydrates to be turned to pyruvate brought into the mitochondria. But there's another enzyme called pyruvate carboxylase that's like a backdoor to oxaloacetate that oxalates can inhibit that, which can change the flux in the Krebs cycle.

[00:34:04] You're seeing here that the oxalates not only, as Jay just pointed out, damage the mitochondria, unless the mitochondria are in a good healthy state because they're following a bioenergetic diet but they also can impair energy metabolism directly. So these are, this is just another piece to show some of the damaging effects of, or potential damaging effects of oxalate under certain circumstances.

[00:34:27] Jay Feldman: Exactly. And again, just to highlight. So that inhibition of pyruvate carboxylase lowers oxaloacetate availability, and you need that for acetyl CoA to be able to enter into the TCA cycle. And so that's what they're showing here that inhibition interferes with mitochondrial function and our ability to produce energy, which as you said, is essential.

[00:34:46] And that brings us to another effect of calcium oxalates, which is the capacity to cause lipid proxidation. The study is calcium oxalate stone disease, role of lipid proxidation and antioxidants. They state oxalate induced membrane injury was mediated by lipid proxidation reaction through the generation of oxygen free radicals in urolithic rat kidney or oxalate exposed culture cells.

[00:35:10] Both superoxide anion and hydroxyl radicals were generated in excess, causing cellular injury in hyperoxyluric rat kidney, both superoxide And hydrogen peroxide generating enzymes such as glycolic acid oxidase, GAO and xanthine oxidase were increased and hydroxyl radical and transition metal ions, iron and copper were accumulated.

[00:35:32] Obviously a mouthful here, but important points being that there is membrane injury caused by calcium oxalates via lipid peroxidation via reactive oxygen species formation and. Obviously, as we'll get to, something we've talked about quite a few times in this podcast, the more stable those membranes are, meaning the more stable the fats are that compose them, the less susceptible we'll be to lipid peroxidation.

[00:35:57] So of course, a low proof of diet. And having more saturated monounsaturated fats would be very protective here against some of these effects of calcium oxalate as we'll discuss antioxidants specific ones can help as well. I also wanted to touch real briefly here. They talked about the increase in xanthine oxidase activity, and we talked about this in terms of uric acid production in a couple of episodes describing why.

[00:36:20] The concerns regarding fructose and uric acid aren't really warranted. I'll link back to those episodes, but again, we just see a little bit of a nod to that in terms of the fact that the oxidative damage is what's contributing to the xanthine oxidase activity and uric acid production, as opposed to it being the presence of something like fructose.

[00:36:39] But again, that was something we dug into in more detail in that episode. Mike, feel free to hop in on that and then maybe we can go ahead and discuss the impacts of certain antioxidants on in terms of preventing this effect.

[00:36:51] Mike Fave: I think this next quote actually tail typers in pretty well, but I just, and I'll just to cue it up a little bit from what you said, it's still important to minimize how much poof are you having on a regular basis.

[00:37:03] So we still see a win for not loading your tissues up on PUFA, basically creating that nice store of dynamite inside your cells that just anytime you spark a fuse, whether that's oxalate, whether that's endotoxin, whether that's heavy metals, whatever the deal is, you're going to get these cascade of lipid peroxidation.

[00:37:20] So we don't want to be loading up on these fats. But the next study that we talk about talks about how a certain antioxidant that's prominent in the bioenergetic sphere, the vitamin E is actually able to prevent the some of the problems of oxalates. So the paper here is titled vitamin E therapy prevents hyperoxalory adduced calcium oxalate crystal deposition in the kidney by improving renal tissue antioxidant status.

[00:37:43] So they say excess vitamin E completely prevented calcium oxalate deposition by preventing peroxidative injury and restoring renal tissue, antioxidants and glutathione balance. It's a ethylene glycol treatment, which ethylene glycol can actually increase the amount of oxalate present. It's basically a poison.

[00:38:00] So ethylene glycol treatment in group one led to increased lipid peroxidation, protein thiol, excretion of urinary enzymes, oxalate, and decrease in urinary calcium antioxidant enzymes and altered glutathione and redox balance. These changes were more intense with extensive calcium oxalate crystal deposition in rats in group three and prevented in rats group two, except for urinary oxalate levels, which remain high.

[00:38:20] Now group 3 was deficient. Group 2 had excess vitamin E. Essentially, the, in group 3, where things really went bad, they didn't have the vitamin they didn't have vitamin E, they were deficient in it. And then in group two, where things are prevented, they were given excess vitamin E. So basically what we're seeing here again, like if antioxidant status is maintained by something like vitamin E, it can actually protect you from the negative impact of oxalates because the oxalates are driving lipid peroxidation and then the protein diols like damage to protein structure and things like this.

[00:38:55] By taking, having adequate antioxidant status, which doesn't just include vitamin E, like we've talked about many strategies, if you don't have high amounts of PUFA in your tissues, then you don't have a lot of things to propagate the lipid peroxidation process. And if you have vitamin E, you can protect against that.

[00:39:10] And obviously vitamin C, and also interestingly, as Jay was talking about before, but uric acid also has some antioxidant properties. Inside the blood as well. Although this is potentially inside the cell will be a little bit different. So making sure that these things are dialed in can actually protect you from the effects of oxalates and also maybe not being super high in something like iron, which will which may come down into play when we talk about the carnivore diet and oxalates.

[00:39:35] Jay Feldman: Yeah, definitely. And just to expand or highlight on two things you mentioned. One is that anytime we look at the damaging effects of PUFA, the increased lipid peroxidation, vitamin E provision or like excess vitamin E is never enough to fully protect against those effects. It just really helps to reduce those effects.

[00:39:53] So this is not something where you can, if you just eat as much PUFA as you want, but take vitamin E, you're totally good to go. There's still going to be some negative effects there. Okay. And on the flip side, it's also worth noting that buffa consumption and the presence of buffa internally depletes vitamin E because of all the extra lipid peroxidation it causes, which then causes the utilization of vitamin E.

[00:40:13] We can talk about supplementing as one thing, but also as, on the flip side, the less buffa we have, the less. Lipid peroxidation will be susceptible to the more vitamin E will have the more glutathione will have all of that. So that's a central factor here when it comes to the metabolic effects of oxalates as well as many other things that we've talked about everything from, fatty liver disease to cardiovascular health and on from there.

[00:40:37] All right, so that brings us to the exogenous sources of oxalates. So we'll basically for the rest of the episode, we'll talk about. Concerns regarding oxalates from food and what affects how much of those oxalates we're going to absorb and ways that we can basically mitigate that things that we can do to help reduce oxalate absorption.

[00:40:58] And then, the next episode, we'll talk about our endogenous production of oxalates and get into all those pathways and what regulates those. But as a starting place here, when it comes to oxalates and this is what's focused on most often in the alternative health world. So we'll spend a little bit less time on this, but maybe we'll focus on some aspects of it that aren't often highlighted as much.

[00:41:17] But obviously a lot of foods contain oxalates in dramatically varying amounts. As far as the kind of realm of super high oxalate foods. The few that are by far and away the highest are things like spinach and rhubarb and chard and those again have a ton of oxalate. There's then ones that are moderately high in oxalate like almonds, soy, cassava, cacao, and potatoes and sweet potatoes.

[00:41:46] And we'll talk about the details of all these things a bit later on, as far as ways that we can reduce the oxalates that are actually in those foods before we eat them. And then, of course, now we'll talk about what will affect how well we absorb those oxalates. Obviously, we want to reduce the amount of oxalates we absorb from these foods in general, so we'll discuss that.

[00:42:04] But yeah, those are some of the foods that are often pointed to as the main concerns when it comes to oxalates. And in all the spheres where we're told about oxalate issues, generally, the the notion is that we should be trying to minimize all of those foods. We'll dig more into that a bit later on.

[00:42:20] All right, so let's dig into oxalate absorption and what actually affects how much oxalate we're going to absorb. And there's some really interesting things to dig into here. And one of them is how much oxalate we consume. Impacts the amount that we absorb and not in the way that you think where you just eat more and absorb more, but rather there's the absorption of oxalate has kind of maxes and limits.

[00:42:43] And so the more oxalate we have in our diet, actually, the less we consume. So that's 1 factor here. And then, of course, there's the factor of other nutrients and things like that. But just in talking about the amount of dietary oxalate, it's pretty surprising. I think you could say. As to how much difference in absorbability there is just based on the amount that we're consuming.

[00:43:03] So they described that in this study. It's a study titled the contribution of dietary oxalate to urinary oxalate excretion. And as you'll note, when we go through a ton of these studies talking about oxalates. Urinary excretion of oxalates is basically used as a direct correlate for oxalate absorption in many cases because typically we clear it very well and all of it gets cleared through the kidneys for the most part.

[00:43:25] I think it's 97 percent gets cleared through the kidneys. When you look at the amount excreted in the urine, it's a pretty good indicator of. The amount that's getting absorbed, and so they state here, the absorptions of dietary oxalate are depicted in figure 5, the mean fraction absorbed range from 55.

[00:43:40] 4 percent on the ultra low oxalate diet to 5. 75 percent on the 250 milligram oxalate diet. So they had a number of different diets here. As you can see, they ranged from 10 milligrams of oxalate in the diet to 250 milligrams of oxalate in the diet. And again, just to clarify what they stated. On the very low oxalate diet, if you just consume 10 milligrams of oxalates in your diet, very low, the absorption is 55%.

[00:44:07] So you're absorbing a very large percentage of those oxalates, whereas if you're consuming a very high oxalate diet, in this case, 250 milligrams. The amount the amount of oxalate absorbed goes down to 5. 8%. So it's about a 10 times difference when you're looking between these two diets, which is substantial, right?

[00:44:23] That's a huge difference in somebody to consider that it's not just a linear effect where the more oxalate you consume, you're directly absorbing more. You actually tend to absorb less as you consume more. Which contributes to it being a little bit less of a concern, right? It contributes to the fact that, we don't have to be quite as concerned because we're going to be absorbing a lot lower percentages.

[00:44:44] Of the oxalates now, you can see also at the end of this figure, there's a low calcium diet and they compare that to the regular amount of calcium. I'll just touch on that now, but we're going to get into more detail there. But what they mentioned, what you can see is that on the low calcium diet. On the low calcium, high oxalate diet of 250 milligrams of oxalates 9.

[00:45:03] 7 percent was absorbed, whereas with the normal amount of calcium, only 5. 8 percent was absorbed. Nearly a 2 times difference. There is huge percentage difference.

[00:45:11] Mike Fave: Just as an example. For the 250 milligrams, 250 milligrams per day of oxalate, you had 14 milligrams absorbed with the 5. 8 percent roughly.

[00:45:19] So let's and then for the 10, you have 5. 5 and for the 250 low calcium, let's say it's roughly double. So you're looking at 28 milligrams. Essentially, or maybe 25 milligrams. Essentially, what you're seeing. Is not really that much oxalate is being absorbed altogether, which is going to be important in the quote that you're just about to read, Jay.

[00:45:39] Jay Feldman: Yeah, thanks for mentioning that. It's good to go through those numbers. As you said, on the low oxalate diet, 10 mg, they absorbed 5. 5 mg. On the very high oxalate diet of 250 mg, they only absorbed 14. 5 mg. Even though they consumed 250, sorry, 240 more mg of oxalate, they only absorbed 9 mg more. It's a huge difference.

[00:45:59] And again, puts into perspective, maybe the fact that we don't need to be quite as concerned about the amount of oxalate we're consuming as we might've thought. And yeah, they state that here, this is, they're talking about a study with a massive oxalate consumption of over 2000 milligrams. So they state here.

[00:46:15] The suppressed absorption of oxalate that is apparent at high oxalate intakes is compatible with the results of Hess et al, who reported that oxalate excretion rose to a mean of only 70 milligrams a day following the ingestion of a diet containing 2, 220 milligrams of oxalate and 1, 210 milligrams of calcium per day.

[00:46:34] So at this level, the amount of oxalate absorbed was less than 3%, 70 out of 2, 220. So we see that. Even past way past the 250 milligram mark, the amount of absorption continues to decrease. Obviously, 70 milligrams of absorbed oxalate is a pretty high amount so that we're not saying this is ideal to eat an over 2000 milligram of oxalate per day diet, which you would have to try very hard to do that unless you were. Yeah, if you're juicing spinach and all of that.

[00:47:02] Mike Fave: Which I definitely did, I'm not gonna lie, I was juicing spinach and kale by like a pound a day at one point in time, so I probably got quite a bit of oxalate, which could have explained some of the problems we'll put that out there,

[00:47:13] Jay Feldman: right? Yeah, maybe the study was on you, Mike but

[00:47:16] Mike Fave: superfood.

[00:47:18] Jay Feldman: Absolutely. Absolutely. And again, we're talking a lot about our disagreements throughout here, but It is, Sally Norton has her like, the whole thing about superfoods, not necessarily being superfoods or at least some of them.

[00:47:28] And that is worth noting, right? This is as we'll get to a concern, a legitimate concern with some of these foods like spinach and definitely I think knocks it out of the superfood category. That's for sure. So Yeah. I think this study is very telling here, right? This is a, something that is going to be something we want to keep top of mind when we're talking about oxalate consumption is how much less gets absorbed as we consume more.

[00:47:50] And again, 10 milligram of oxalate diet versus 250, there's only a difference of nine milligrams of oxalates that actually gets absorbed there. That's massive. That's something that's really important to highlight.

[00:48:01] Mike Fave: Yeah, and that the other thing to keep in mind is this is not even talking about the other factors like it mentions calcium there will tell when we get into that we'll see like calcium, the difference between soluble insoluble oxalates if what's going on in the GI tract, all these types of things.

[00:48:17] And also not we're just talking about what's absorbed when we didn't even get into what can be excreted by the kidney by itself, which all again, as we, as I started out in the beginning of the, of this episode, the, it's there's not only absorption, there's excretion and there's then there's production as well.

[00:48:34] So you keep that if we're keeping in mind there's a really high threshold here. For absorption, and then you have all these other factors that modify it, then it's okay if we have all these things in place, like, how much of a concern does this thing become? And again the, I think Sally's book is toxic superfoods where we agree with her on spinach probably isn't this super nutrient dense superfood because of its oxalate content.

[00:48:57] That there's no argument necessarily against that. That is like the best thing ever. It's just more of like, how much is this actually a problem? And to be fair, for some people, they may have certain, genetic predispositions, stuff going on with the gut, which we'll get into, that may make these oxalates more absorbed, less excretable, and more of a problem for them as an individual.

[00:49:18] So it's not discounting that's a problem for those people. And that's why it's a person by person basis. There has been clients, you and I were talking about this when we were going through the episode, we've had clients where oxalates were a problem. It's just, there's also been a large amount of clients that thought that oxalates were the problem and they weren't necessarily the problem.

[00:49:36] It was something else. But they were like thinking they were like invested in the oxalate idea until we started to interrogate and troubleshoot. Is it really the oxalates? And so that's something that's important. So we're not just we agree with Sally and some of the toxic superfoods, of course.

[00:49:50] And then there's not, doesn't discount people who do have problems. With oxalates, but it also brings in the question is our oxalates this ubiquitous problem for everyone and especially from the exogenous sources. Do we have to go on these super low oxalate diets that we don't damage our kidneys and blow up our mitochondria and all type of stuff?

[00:50:09] It's like potentially not because we have a lot of factors affecting absorption, excretion, et cetera, which we're getting into here.

[00:50:14] Jay Feldman: Yeah, exactly. And they dig into that in more detail in this next study. They talk about some of the big picture things that we'll dig into them, and break apart some of the studies on those.

[00:50:23] And they also talk about solubility of oxalates, which you mentioned, Mike. So do you want to go ahead and share this quote? We can dig into that. Yeah.

[00:50:30] Mike Fave: We have a quote here. They say effect of cinnamon and turmeric on urinary oxalate excretion, plasma lipids, and plasma glucose in healthy subjects. Now, I don't think the major point of the quote that we're going to get to here is specifically the cinnamon and turmeric, but there's something interesting that they talk about in this study in terms of soluble versus insoluble oxalates.

[00:50:50] That we're going to point out here. So they say the amount of uranium oxalate is dependent on both oxalate content of the diet and oxalate bioavailability. So you are what you absorb, right? Not what you eat. Oxalate absorption rates from different foods have been estimated to range from 2 percent to 15%.

[00:51:06] Oxalate absorption appears to depend on a number of factors, including absorptive properties of the intestine, gut transit time, presence of divalent cations, such as calcium, magnesium, basically certain minerals. that combine oxalate within the GI tract and presence of oxalate degrading bacteria like oxalobacter.

[00:51:22] There is a lack of consensus as to whether oxalate absorption is dependent on the amount of soluble compared with insoluble oxalate in food. Our data support the contention that the relative amount of soluble and insoluble oxalate plays a role in determining efficiency of oxalate absorption. A previous study by Chai and Liebman also suggests that the relative amount of soluble and insoluble oxalate in food has an important role in determination of oxalate absorption.

[00:51:45] Oxalate absorption from almonds was 5 at 5. 9 percent was significantly higher than that from black beans at 1. 8 percent soluble oxalate accounted for 31 percent of total oxalate from almonds, whereas black beans had a soluble content of 5%. So if the oxalate cannot be put in a soluble state where it can basically be, dissolved in a solution, then it makes it much more difficult for it to actually move across the intestinal lining and be absorbed. So when you have this dissolvable oxalate, the soluble oxalate versus the insoluble oxalate, the soluble oxalate is really at least based in this paper, the major concern that we would look at and the more insoluble oxalate you have in the food, the less absorbable it's going to be.

[00:52:28] So you have not only do we not absorb large amounts inherently of oxalate. But if you have a food that's very high in insoluble oxalates, that absorption rate would be probably considerably lower than if it's very high in soluble oxalates. And then, as they pointed out here, if you also have certain minerals in the diet, that's going to be even lower because those minerals are going to bind those soluble oxalates and make them insoluble in the GI tract.

[00:52:57] So you have, there's, again, like more factors to this picture than just Got to stay away from the dark chocolate. Like you can't have the cocoa powder. So we want to keep these things in mind when we're determining is our oxalates the problem,

[00:53:12] Jay Feldman: right? Exactly. And just to clarify again, so the soluble oxalates, they're easily dissolvable.

[00:53:17] And this is when oxalates bound with sodium or potassium generally. And instead, if it's bound with. Calcium, magnesium or iron, then it's considered to be insoluble, which means that it's going to be have a much lower absorption rate. And obviously, in the foods themselves, it can be bound with different things.

[00:53:33] And that's what they're touching on here, looking at almonds versus black beans. But then also, if we consume some of these minerals, like magnesium and calcium, as we'll touch on, that can also affect the solubility of the oxalates in our GI tract, which can then affect. The absorption till they touched on it here and how much of a difference that makes, especially with calcium, which is the most notable one here.

[00:53:53] And so this is a study titled dependence of oxalate absorption on the daily calcium intake. And in this study, they looked at a handful of different levels of calcium consumption. And they basically found that up to 1200 milligrams of calcium consumed, there was a major impact. There was a major decrease on oxalate.

[00:54:12] Absorption after 1200 milligrams. It didn't make as much of a difference. It did still help, but it didn't make as much of a difference. And here they state that in this quote where they say in summary, we showed that reducing intake from 1200 to 400 milligrams of calcium per day increases the absorption of dietary oxalate by fivefold, five times difference in oxalate absorption.

[00:54:31] That's massive. They then go on to state gastrointestinal oxalate absorption depends on depends linearly and strongly on the calcium intake up to 1200 milligrams of calcium per day. The resulting increased urinary calcium excretion did not heighten the risk of crystal formation. Additional calcium beyond 1200 mg per day reduced oxalate absorption further, but only marginally.

[00:54:52] Again, we're comparing, it's still a good difference, but when you're talking about a five times difference, relatively, it's not as big of an effect. And then they go on to state for patients with calcium oxalate urinary stones who are high oxalate absorbers, the advice to avoid dairy products and to follow a calcium restricted diet is a recipe for the generation of recurrent calcium oxalate stones.

[00:55:12] This conclusion, derived from the dependence of the GI oxalate absorption from the calcium content of the diet, was recently independently confirmed by a prospective study of 120 patients who performed idiopathic calcium oxalate stones. So I think that was, a pretty straightforward one there, just talking about how massive of a difference Calcium intake can make again, a five fold difference in oxalate absorption going from 400 milligrams a day of calcium intake to 1200 milligrams a day, which is not that much difference in terms of calcium intake.

[00:55:41] And we'll talk about this later on with calcium containing foods, but, they looked at some other levels of the study and basically they found that as at pretty low calcium intakes of around 200 milligrams, 17 percent of oxalates were absorbed, whereas with 1200 milligrams, only 2. 5 percent give or take were absorbed.

[00:55:57] And then when they went to 1800 milligrams, it went down to about 1. 7%, which again, that's probably. What a 40 percent difference or so, it's still a pretty significant difference going from 1200 to 1800 milligrams of calcium, but obviously much less of a difference than going from a low calcium diet to a moderate calcium diet.

[00:56:17] Mike Fave: And to be fair, like this is in line with the dietary recommendations that we've discussed, not even from an oxalate standpoint, but if you want to optimize your bone mass, lower parathyroid hormone, inhibit, help to protect and inhibit vascular calcification by lowering that parathyroid hormone, you're going to want to be at least one gram of calcium per day, which is the daily recommended intake.

[00:56:37] And then if not up to one with phosphorus, because you, so in any way, like you're going to want to be hitting that calcium intake. Regardless and then on top of that, it has the dual benefit of protecting you from oxalates and then this is like a little tidbit in here, but if you are concerned that you're, if you have too much calcium, it's going to form stones, which this is what they're talking about in the study on the back end here from the quote that you read, Jay, the other thing is citrate is a great inhibitor of that.

[00:57:05] And we'll get into that. We have data to support it, but basically milk and orange juice, man, it's milk and orange juice that the citrate from the orange juice, there's even a paper talking about orange juice and the citrate content being helpful. And even Sally Norton talks about using lemon juice because of its citrate content to have a helpful beneficial effect.

[00:57:23] So having adequate amounts of. Calcium in the diet at least the 1. 2 grams from what we're seeing here and we like to shoot up to one with phosphorus and then also potentially having adequate citrate in a diet can help to form stones. If you have a predisposition towards stones and inhibilate, it's like strongly inhibit.

[00:57:41] Deoxalate absorption from your diet overall, so you'd be quite protective. So it's just something interesting to think about here. Maybe have a little bit of, you're going to have your chocolate chips, put it in your Greek yogurt.

[00:57:51] Jay Feldman: There you go. And I might've misheard you, but you might've said that the citrate helps to increase storm stone formation, but I think, Oh, a

[00:57:57] Mike Fave: decrease.

[00:57:58] Jay Feldman: Okay. Decrease. Yeah. Just making sure.

[00:58:00] Mike Fave: So the citrate, if you were worried that the, if you take a bunch of calcium, you're going to form stones, the citrate will inhibit that process. And then the calcium will inhibit the absorption of oxalate, excess phosphates, things like this in the GI tract, and also help to balance the calcium, the phosphorus ratio and help to protect us against excess levels of parathyroid hormone as well.

[00:58:20] You have, it's like a dual full benefit from combining these things together.

[00:58:25] Jay Feldman: Yeah, absolutely. And we'll talk about some of those studies and effects of citrate later on. And I'll link it back to the episodes specifically where we talked about calcium and parathyroid hormone for people who are interested in that conversation.

[00:58:37] Do you want to go ahead and hear Mike and talk about the next study here looking at impacts of calcium on oxalate absorption again, just a couple of quick or one quick quote here showing the impact.

[00:58:49] Mike Fave: Yeah, so the study that we're going to look at here is titled Contribution of Dietary Oxalate to Urinary Oxalate Excretion.

[00:58:55] They say when the calcium content of a diet containing 250 was reduced from 1002 mg to 391 mg, urinary oxalate excretion increased by a mean of 28. 2 percent and the mean dietary contribution increased to 52. 6%. So basically what we're seeing here is That when you have it's just further supporting the point that when you have calcium present, it drastically helps to minimize the oxalate absorption from the diet.

[00:59:25] And they're just looking at this through the oxalate excretion in the urine. Essentially here, the more calcium and we set a threshold for you up to at least 1200 milligrams. And then you start to get diminishing returns to some extent. But up to 1200 milligrams or so, you see that drop off in here, they're saying if you go from 1000 milligrams of calcium to 391 milligrams of calcium, so it's almost a 3 time drop.

[00:59:47] So you're 1 3rd of the calcium intake urinary oxalate excretion increased by about 30%. And then the dietary contribution. So this is also interesting because we're going to get into this, but the dietary contribution only increased to 52. 6%. So it's like, where's the other 50, 48 and change percent coming from,

[01:00:07] Jay Feldman: right?

[01:00:08] And the flip side of that too, being that if you're eating a moderate calcium diet, if you're getting enough the RDA is 1000 milligrams a day. So if you're just hitting that and not getting extra from, a diet that has. Optimally healthy amounts of calcium, perhaps then the dietary contribution is as low as 25%.

[01:00:23] They pointed out in the study. Yeah it's putting into perspective that if we're doing kind of everything wrong, maybe as you're saying, dietary oxalate contribution is like up to 50 percent of the total, but if we're doing things, even just moderately, okay, it should be quite a bit less. So we'll talk about that more later on in the conversation of, okay.

[01:00:40] Whether it's the diet dietary oxalate is the main concern, but of course, if we're eating just a moderate amount of calcium it reduces that concern dramatically and that goes hand in hand with this next paper. We'll dig into here. Just a quote. I want to share talking about the relationship with the 1 25 dihydroxy vitamin D and parathyroid hormone and the effects on calcium and oxalate absorption.

[01:01:04] And so again, I'll reference back to that prior episode. We did talking about. Okay. Parathyroid hormone and calcium production, but it also comes into play here. So the title of this paper is effective vitamin D on the vitamin D3 on the conversion of ethylene glycol to glycolate and oxalate and ethylene glycol fed rats.

[01:01:22] So as we discussed earlier, ethylene glycol basically is a precursor to oxalates and is you have regarded it as something that's rather poisonous. So that's just what they're using to test the impacts here of vitamin D and it's not just vitamin D, it's specifically the dihydroxy form. So what they state is 125 dihydroxy vitamin D, the active metabolite of vitamin D has been reported to induce hyperoxyluria after either oral or intravenous administration.

[01:01:47] Calcitriol, which is the 125 dihydroxy vitamin D. Increases oxalate absorption as well as its urinary excretion by promoting calcium absorption. So this is another mechanism by which a lack of calcium actually increases oxalate absorption. It's not just the fact that it's There's not as much calcium to bind with oxalate and make it less absorbable, but if we're eating too little calcium and we have excess parathyroid hormone levels, parathyroid hormone is a hormone that causes the release of calcium from our bones when we're not getting enough from our diet because we need enough calcium.

[01:02:18] So if you don't get it from your diet, you get it from your bones. And when that happens, it increases the conversion of what's considered the inactive vitamin D, but it's not really that's 25 hydroxy vitamin D. That's the one that you test for in the blood. It causes the conversion of that to what's considered the active form 125 dihydroxy vitamin D.

[01:02:37] Although again, I would, I don't agree with that nomenclature because what they're calling inactive, that form still has a lot of activity. And instead I would say, this is more of like the stress version of vitamin D that just gets activated when parathyroid hormone is produced. In this case, due to a calcium deficiency, it can also happen due to actually, in this case, they just added it in, but it can happen due to calcium deficiency, magnesium deficiency.

[01:02:58] That's a conversation for another time, but the important point here is that this is another mechanism through which low calcium will cause increased oxalate absorption, and this is via the increased parathyroid hormone, which increases the 125 dihydroxy vitamin D production, which then increases.

[01:03:14] Calcium and oxalate absorption.

[01:03:17] Mike Fave: So basically, just to recap really quick, what you're saying is that if you don't have enough calcium in your diet, you'll raise parathyroid hormone, which will increase the conversion of 25 oh HD three, the one that we're, that we test and that that Dr. P was a fan of, that we're a fan of things like this into 1 25 vitamin dihydroxy, vitamin D, and the 1 25 Dihydroxy vitamin D three actually can promote.

[01:03:40] The absorption of oxalates or increase the amount of oxalates that are being produced in the body all together. So it's another mechanism by which not having enough calcium can lead to increase oxalates.

[01:03:52] Jay Feldman: Exactly. Yeah, exactly. And 1 that I don't think people touch on very often, but cool. And that brings us to magnesium again.

[01:04:00] 1 that I think is a little bit underappreciated when it comes to the impact on oxalate absorption. So I'll let you go ahead and share this for study Mike.

[01:04:10] Mike Fave: The study that we have here is titled the importance of magnesium and absorption and excretion oxalate. And they say the mean intestinal oxalate absorption under standard conditions was 8. 6%. The oxalate absorption with one 10 mmol magnesium supplement was 5. 2%, and with two supplements, 5. 5%. Both decreases were statistically significant relative to standard tests, however not significantly different from each other. Basically the 10 millimole supplementation was equivalent to about 243 milligrams of magnesium.

[01:04:44] And what they say here is the results show that magnesium administration decreases the oxalate absorption when magnesium is taken together with oxalate. However, magnesium administration does not decrease the oxalate absorption when magnesium and oxalate intake differ by 12 hours. So you got a nice little margin of error in there for the 12 hour timeframe.

[01:05:01] But basically, taking about 200 mg of magnesium a day, I usually try to get people up to 400 mg of magnesium a day, and I usually have people take it with food. If you're doing calcium and you're doing magnesium at the same time, you can further decrease oxalate absorption from the foods in your diet. So again, if you're looking for at least, one to one with phosphorus.

[01:05:24] With a minimum of 1200 milligrams of calcium per day, and you're shooting for a minimum of 400 milligrams of magnesium per day, you could drastically decrease the amount of oxalate that's absorbed, where already only a small portion of that oxalate is absorbed, depending on how much you're taking in, right?

[01:05:39] You're taking in the, what was it? The 10 milligram dose was the Was a 55%, but then you go to two 50 and we're seeing only like a, it was a 5. 8%. So you're thinking you're taking that and then you're thinking, Oh, if I have calcium, magnesium as well, it's going to be even further reduced.

[01:05:56] Jay Feldman: Exactly.

[01:05:56] And yeah, that was just with 200 200 milligrams, 240 milligrams of magnesium. And just to clarify too, the, when they did, because they did one supplement and that drastically decreased or significantly decreased about 40 percent the amount of oxalate that got absorbed. Relatively speaking, so it's 8.

[01:06:13] 6 percent to 5. 5 or 5. 2. They added a 2nd supplement that didn't provide any further benefit, but that's because that 2nd supplement was provided 12 hours apart from the oxalate consumption. They were trying to see if, if you took the magnesium away from the oxalates, does that have much of an effect?

[01:06:28] And they basically found that it didn't. And that's and rather the effect is much more temporary, just if you're having the magnesium closer to the oxalate consumption, and they dig into that in more detail in this study, which. Again, very interesting here. A couple of key takeaways. The study is titled The Effect of Oral Administration of Calcium and Magnesium on Intestinal Oxalate Absorption in Humans.

[01:06:49] They state during the first 6 hours, magnesium shows a significant decrease of oxalate absorption of approximately 44%. As shown in table 1, the effect of the magnesium supplementation on oxalate absorption is pronounced only during the first 6 hours after application of the capsule. The percentage decrease to standardized condition here is 45 percent compared to 31 percent at the end of the collection of the collecting period.

[01:07:12] The decreasing effect of Cal of the calcium supplementation on the contrary remained almost constant for the entire collecting period of 24 hours. So something that they're getting at here is that the impact of calcium and magnesium differs in a couple of ways. For one calcium has just buying stronger with oxalates and decreases the absorption.

[01:07:30] Of relative to magnesium, it's more effective, but also the effect last longer. So for calcium for the entire 24 hour period after calcium supplementation, it has a significant reduction in oxalate absorption. Whereas magnesium, it was really only after the 1st, 6 hours and then the effect really diminished.

[01:07:48] Just putting into perspective, the impact of calcium and magnesium where magnesium does have a pretty significant impact, but it's just not quite as much as calcium. And also tells us a little bit, we'll get, we'll dig into the details of the applications later on. But what it tells us is that as long as you're getting enough calcium throughout the day, It'll have an impact on the cows on the oxalate absorption.

[01:08:07] You don't have to have the calcium intake at the exact same meal as the oxalates to decrease the absorption, which is important. Again, a lot of people will talk about this and they'll say just make sure to have calcium containing food alongside your oxalate containing food. But really the reality is you just need enough calcium throughout the day.

[01:08:22] It doesn't have to be right at the same time. Whereas with magnesium, it does actually matter a bit more. The timing matters a bit more as to when you're consuming it relative to the oxalate.

[01:08:35] Mike Fave: Would be to have potentially your magnesium with the meals and then calcium just have adequate calcium across the day or at some point in the day. In general, you're hitting at least that 1200 milligram mark.

[01:08:51] Jay Feldman: Yeah, so that brings us to a couple other factors impacting the absorption of calcium. Sorry, oxalate again. This is 1 that this area specifically, I haven't seen talked about very much, but this is. In regard to a couple of B vitamin deficiencies, we'll be talking about these when it comes to endogenous oxalate production, where these two B vitamins matter quite a bit, but they also have an impact, interestingly, on absorption.

[01:09:14] Do you want to go ahead and share this one?

[01:09:17] Mike Fave: Sure. The study is titled Absorption of Glyoxalate and Oxalate in Thiamine and Pyridoxine, which is vitamin B6 deficient rat intestine, say dietary deficiency of thiamine or vitamin B6 has been shown to produce hyperoxaloria and renal stone formation in man and experimental animals.

[01:09:32] Button B6 deficient rats showed a significant enhancement in the rate of oxalate uptake due to the development of a new biphasic transport system. This is actually important because Both vitamin B6 and thiamine are involved in the metabolism of oxalate as well. If you're deficient in both of them, it seems, based on the study, that you are absorbing more oxalate.

[01:09:54] And then we know that if you're deficient in vitamin B6 and thiamine, that you will also have a harder time metabolizing away from oxalate in general. Or, yeah, basically metabolizing away from oxalate. It's like a dual fold negative. So this would be further components to consider with the diet is making sure that your thiamine status and your vitamin B6 status are dialed in on top of your calcium and your magnesium status.

[01:10:19] Jay Feldman: And in this case and for people who aren't aware of thiamine is vitamin B1 and yeah, pyridoxine is vitamin B6, but yeah, in this case, they, we'll talk about how both of these have a pretty significant impact in terms of oxalate issues, but in this case, they talked specifically about the B6 deficiency, increasing oxalate absorption, which is pretty unique and yeah, something to consider that it's not just an internal effect.

[01:10:42] It also affects how much oxalate we're absorbing in the gut. Okay. And that brings us to some other relationships with the gut. So we talked about this a bit earlier in terms of there being certain oxalate degrading bacteria and a couple other factors that affect oxalate absorption. Now, in terms of the bacteria, that's a relatively straightforward one where there's certain bacteria called oxalobacter bacteria.

[01:11:07] And basically they're just certain bacteria that degrade oxalates. And so that's a factor is whether or not we have enough of these bacteria in our gut. But then another factor, a pretty interesting one is fat digestion and bile production as well. So as well as intestinal permeability.

[01:11:23] And so we'll just share a couple of shorter quotes here. Just very brief describing this. So the first one is from a study titled the roles and mechanisms of intestinal oxalate transport. in oxalate and homeostasis, and they state the importance of paracellular oxalate absorption is best demonstrated in the pathology of enteric hyperoxaluria associated with the malabsorption of fatty acids and bile salts.

[01:11:44] So just to explain that, because it's a lot, quite a bit of jargon in there, but they're talking about the absorption of oxalate through intestinal permeability, paracellular means in between the cells. So it's not it's not coming through the cells, which is what happened if the, if there's no intestinal permeability and that happens.

[01:12:02] To an extent, but less. Whereas instead, if there's intestinal permeability, it increases the absorption of oxalates. And they're talking about how the malabsorption of fatty acids and bile salts can affect intestinal permeability. They state normally these luminal solutes are efficiently absorbed in the small intestine.

[01:12:19] However, in malabsorption syndromes, these secretogogues promote increases in the paracellular permeability of the large intestine, meaning intestinal permeability in the large intestine, leading to the passive hyperabsorption of oxalate in proportion to the luminal activity of the oxalate ion. The important part being here that if we are not effectively digesting fats, Or if we're not effectively absorbing bile and you end up with either bile or fat in the large intestine, it causes a lot of irritation there.

[01:12:47] And we've talked about this before, and that causes intestinal permeability, and that's been shown to be to have a really significant effect on oxalate absorption. That's the central point here, and they explain the mechanism of that or a second mechanism independent of intestinal permeability.

[01:13:03] In terms of the fatty acid concerns in this second paper titled oxalate and intestinal disease. Where they state increased solubility of oxalate in patients with ileal disease probably occurs because of malabsorption of fat. Unabsorbed fatty acids bind to dietary calcium forming calcium fatty acid soaps preventing the formation of insoluble calcium oxalate.

[01:13:24] which occurs normally in the absence of fat malabsorption. Thus, the dietary oxalate remains in solution and available for absorption. So we talked about this in terms of oxalate solubility, where if the oxalates are very soluble, they're easier to absorb, whereas if they're insoluble, like if they're bound with calcium or magnesium, they're much harder to absorb.

[01:13:42] And so this is the second mechanism where if we're not digesting fats well, And those fats go into the large intestine, they bind with calcium and they say form those calcium fatty acid soaps, which reduces the calcium availability. So then you have less calcium binding with oxalate and you have more soluble oxalate.

[01:13:58] So there's an increase in oxalate absorption. So there's a couple different mechanisms here. Whereby fatty acid malabsorption, if we're not effectively digesting fats and they're making their way to the large intestine causes oxalate issues, causes oxalate absorption issues, meaning that we absorb too much or excessive amounts of oxalates and the same can happen with bile.

[01:14:18] And so what that basically tells us is that if we're not producing enough bile, which can happen with. Especially with liver dysfunction, gallbladder dysfunction, we've talked about this before. So I'll link to an episode where we discuss that. That can cause these sorts of digestive issues, can cause intestinal permeability, it can cause SIBO, it can cause all sorts of things, but it can increase oxalate absorption.

[01:14:38] And the liver function is central here. We'll be talking about that later on when it comes to oxalate production, since that's really the primary site that we produce oxalates internally. But so if we're having issues there, we'll be producing more oxalates internally, but also we'll be absorbing quite a bit more in many cases due to the problems with bioflow and fatty acid digestion.

[01:14:59] And then anything else, they focus on just fats and bile salts here entering the larger test and causing irritation. But we know that intestinal permeability can be caused by. Any sort of gut microbiome imbalance can be caused by endotoxin itself. If we're eating foods that we don't digest well and they're feeding the bacteria or increase endotoxin, that'll increase permeability.

[01:15:18] There's all sorts of things that can be going wrong in the gut that can increase the oxalate absorption and then lead to some pretty concerning issues with basically excessive amounts of oxalates.

[01:15:29] Mike Fave: Okay, so basically what we're seeing here is If the digestive health is poor, bile acid malabsorption, lack of bile flow, there's also inflammation to the intestine directly.

[01:15:40] There's other studies showing this, which changes as a transporter SLC, I think it's 26A. What basically winds up happening is you will decrease oxalate excretion in the gut and you also increase oxalate absorption. There's If you have gut problems, you may be better able to absorb the oxalate. It's a modifying factor here.

[01:15:58] One of the, if you're dealing with oxalate issues with certain foods, of course, you can adjust those foods. But also, and this is something that I've seen with clients is as you improve gut health, things that were previously a problem, maybe because of oxalates, maybe because of something else, actually start to drastically improve that those foods aren't as much of an issue anymore.

[01:16:16] So we have multiple modifying factors. You strengthen up gut health, you strengthen up digestive function, you straighten it up, make sure you have adequate bioflow into the intestine. And then you also make sure that you're, which would include dialing in your micronutrients, including thiamine and vitamin B6.

[01:16:31] And you have adequate calcium, you have adequate magnesium in the diet, then you're going to drastically decrease the amount of oxalates that are being absorbed. And then on top of that, we haven't even gotten to the metabolism that we talked about things with the kidney. But in general, you can just on the absorption side, if you're concerned about exogenous oxalates, there's many things or many tools we have in our toolkit to actually make a difference and minimize how much of the oxalates that are being absorbed on a regular basis to the point that is like can seems like it'd be pretty negligible overall with all of these factors put into place.

[01:17:07] Jay Feldman: Yeah, absolutely. And as you're getting at, if you have bad enough gut issues, if you have SIBO, which is often tied with a poor bowel flow to begin with, if you have those two issues, And you're going to be dealing with intestinal permeability, you're going to be dealing with excess oxalate absorption, you're going to be dealing with quite a few issues at the liver, considering you already have bioflow issues, which normally stems from issues at the liver, plus that means that you're not clearing things out from the liver that need to be cleared, then you add endotoxin into the picture.

[01:17:33] Which is one of the best ways to drive inflammation at the liver, cause fatty liver, all of that, then you're going to have increased oxalate production. So it really can be something where the gut can be a sole driver of an oxalate of oxalate issues for somebody. And of course, it can be a lot more intricate than that.

[01:17:48] And obviously, the question is then what's causing the gut issue. And we've talked, we've had extensive episodes talking about that side of things. So I'll link back to those, but yeah it really highlights. When we put all these pieces together how much an oxalate issue cannot be an oxalate issue at all.

[01:18:02] And if you're just then focused on lowering oxalates in the diet, you can be totally missing what's actually driving the issue.

[01:18:08] Mike Fave: And just as an example, one of the populations that has popularized The low, the oxalate dumping problem is the low carb keto, especially carnivore community, which is characterized by a diet that's exceptionally low in or zero fiber essentially with a high amount of components like amino acids, like bile acids, like fatty acids, like these components that are making their way into the gut.

[01:18:35] But and while oxalate consumption is drastically decreased. You, I think you get what if you try to transition off the carnivore diet and you've created dysbiosis because of how the diet is actually set up, that could be one of the major reasons that you're having intolerances to all these oxalate based foods or things like this, because now you don't have the bacterial species to degrade it.

[01:18:56] The colon may be permeable and the mucous layer in the colon may be low or minimal because you don't have the fiber going in and then the bacteria are eating the mucous layer because there's no fiber and you shifted towards dysbiotic bacteria that can be causing inflammation and whatnot inside the intestine.

[01:19:11] It's in these communities while you don't have the oxalate intake going in, you may be shifting other components so that maybe make it harder to come out of them and where you become more responsive to some of these foods and it becomes a self fulfilling prophecy. Where it's like, Oh every time I eat, you see this with the carbs or you see this with carbs is when I was on keto and then I ate, I had some carbohydrate, my blood sugar went to 180 or 200.

[01:19:34] And then it's yes, that's if you're on a keto carnivore diet, and you just increase carbs the first time and you're running on fatty acids, you're going to see that if you're on a keto and you're on a carnivore diet, and you've only been putting me into the colon and fatty acids and bile acids, and then you want to start adding in some of these other foods.

[01:19:50] Then you may be intolerant to them when you start because of all these different mechanisms that are changing and not to mention, I won't even get into it now, but we're going to get into it in just a bit here, the actual change in metabolism of the oxalates directly where you may have an increase in endogenous production because one of the things that we've talked about in this episode so far is in, even in circumstances where calcium intake was on the lower side, you had higher solubility of oxalates.

[01:20:16] We're seeing what 52 percent absorption of our 50% 52 percent of the oxalates being excreted were from potentially from the diet from exogenous sources. So where's the other 48 percent coming from? Where's the other percentage of oxalates coming from on a regular basis? And that's where we get into the endogenous production as well.

[01:20:36] Jay Feldman: Definitely. Definitely. And we'll dig into, as you were alluding to a number of different ways through which a low carb diet could be causing some oxalate issues. But if we even take, from what we're focused on here, someone who's not on a low carb diet, but maybe they're transitioning in or they're just on a full on bioenergetic diet.

[01:20:53] And maybe they're having issues with fat digestion, and they're having this fatty acid malabsorption. That could be a major concern here. We might need to decrease fat intake or even better fix our ability to to digest the fat. And we had a whole episode talking about bio issues, and that definitely is central here to this to that question.

[01:21:10] So I'll link back to that. But, yeah, there's a number of reasons. And then, of course, looking at calcium intake, magnesium intake and B6 intake, yeah, and then working on microbiome health. It's huge. It's something that we focus on a lot, so often because it's so central. And obviously, none of these things are independent, right?

[01:21:29] 1 of the biggest drivers of SIBO and liver issues and bioflow issues is hypothyroidism. Something we talked about all the time. And again, if you want to. Discuss the way to drive hypothyroidism, taking all the carbs out of your diet is a good way to encourage that to do it to encourage the hypothyroid state.

[01:21:44] Fasting is another good one to low calorie diets. And we did a whole series on thyroid. So I'll link back to those. But I think it's a good way to round things out here. 1 thing I wanted to mention briefly is that there's a lot of talk about Candida Infections potentially causing excess oxalate production and it, we look through the literature.

[01:22:02] There's really very little to support that. There's a little bit some suggestion of an association between fungal issues in certain areas and oxalate production, but, cause and effect is not particularly clear. There's not a lot of support for that. Obviously, there's a lot of ways that I think my bigger concern in that regard would be If you're dealing with a chronic fungal issue, that means that there's microbiome imbalance.

[01:22:24] It means you're probably dealing with intestinal permeability. You're probably dealing with hypothyroidism, meaning tons of other issues that go with that. And we've talked about, chronic candida issues being related to low body temperature, low metabolic state, low immune function. So link back to that episode.

[01:22:38] But I think that's really where my focus would be more. So is All of the other related things there that would lead to increased oxalate absorption. And of course, as we'll talk about later, increased oxalate production, as opposed to it necessarily being directly driven by a fungal problem.

[01:22:55] Mike Fave: Yeah, and the other thing is, if you have a fungal issue, is the inflammation driven by the fungal issue driving some changes in oxalate metabolism, or is it the fungi directly producing oxalate locally which there are some studies showing that in very specific states, but there was the major fungus that they were looking at in two of the states was aspergillus.

[01:23:13] And then the third state was Candida and the Candida was in the bladder and they just found the Candida on the bladder stones, which doesn't necessarily mean that the Candida were producing the oxalate crystals or precipitating the oxalate crystals in the bladder and the aspergillus may be different because they're in the lung and in soft tissues that could, and it's known that fungi can actually produce the Oxalic acid, but at the same time, it's I don't think it's obvious or clear that it's just the fungi are producing it.

[01:23:41] And that's the major problem. And it's Candida issues are, that's another 1 is Candida is just the problem overall. I would say that is it possible? Yes, but it's also known for example, with the bladder stone situation that bacteria microorganisms, you Will form or interact with the crystals because they can form biofilms on the hard mineral structure, whereas they can't really form it as easily on the tissues inside the body because of the basically the tissues are very slippery.

[01:24:09] We have a mucus layer. We have a bunch of immunoglobulins. We have a bunch of different components that prevent the biofilm formation, but you do get stones lodged. That's now the bacteria actually have a substrate to attach to, which is why you see biofilm formation on teeth. But you don't really necessarily see it on other services in the mouth.

[01:24:25] So it's the same thing going on in the bladder stones or kidney stones or things like this. So I agree. I would agree with you, Jay. I don't think that it's clear that the fungi are causing the problem, but it is the reason we're even touching on it is because in the health sphere, there's an, there's this idea that Candida is like a major driver for some of these oxalate issues,

[01:24:45] Jay Feldman: right?

[01:24:46] Yeah, exactly. Yeah. Great points there. I think we'll wrap it up there and in the next episode, we'll dig into. All the pathways involved in oxalate production, whether you need to be concerned about vitamin C consumption, glycine consumption, collagen consumption due to the proline or hydroxyproline content, we'll get into the regulation of all those pathways.

[01:25:06] Yeah we'll leave all that for the following episode. And with that, Mike, do you want to let the listeners know where they can find more of your work?

[01:25:13] Mike Fave: Yep. They can find me at my YouTube channel, Mike babe. And they can also find me at my website, Mike babe. com.

[01:25:20] Jay Feldman: Perfect. All right. If you guys enjoyed today's episode, please leave a or comment if you're watching on YouTube.

[01:25:26] Or if you're listening elsewhere, please leave a review and five star rating. We really appreciate all of the support in that regard as always to check out the show notes for today's episode, you can head over to J Feldman, wellness. com slash podcast. I'll link to the studies and articles and anything else that we referenced today.

[01:25:43] And if you are looking to optimally support your metabolism, correct your gut health as well as rebalance your hormones fix your thyroid status, get amazing sleep, boost your energy and tons more with clear action steps and strategies alongside personalized guidance from me, then head over to J Feldman wellness.

[01:25:59] com slash solution where you can find all of the information for the energy balance solution program. This program includes customized health coaching, has a pretty large video library with videos on regulating blood sugar, how to restore gut health, how to boost your metabolism, how to rebalance your hormones and tons more.

[01:26:17] It also includes resources like a sample meal plan, recipes, supplement guide, as well as a private community. So again, head over to wellness. com/ solution to check out all the details. And with that, I'll see you in the next episode.