Food With Oxalate Content

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Food With Oxalate Content…Fruits: bananas, blackberries, blueberries, cherries, strawberries, apples, apricots, lemons, peaches. Vegetables: mustard greens, broccoli, cabbage, cauliflower, mushrooms, onions, peas, zucchini. Grains and starches: white rice, corn flour, oat bran. Proteins: eggs, meat, fish, poultry.

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What Is the Low Oxalate Diet?

Plate of fish, Brussels sprouts, and white rice
Getty Images / bhofack2
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Table of Contents

  • What Can You Eat
  • Pros and Cons
  • Is the Low Oxalate Diet a Healthy Choice for You?

At VeryWell, we believe there is no one-size-fits-all approach to a healthy lifestyle. Successful eating plans need to be individualized and take the whole person into consideration. Prior to starting a new diet plan, consult with your healthcare provider or a registered dietitian, especially if you have an underlying health condition.

The low oxalate diet works to reduce risk of developing kidney stones. Those who have a history of kidney stones may benefit from reducing their consumption of high oxalate foods.1

Oxalates are found naturally in plant-based foods and are also a byproduct of human waste. While oxalates aren’t necessarily bad for you—the foods they’re found in are highly nutritious—too many oxalates contribute to the formation of kidney stones.1 Individuals who are susceptible to kidney stones or kidney infections may want to consider incorporating this diet into their lifestyle.

You don’t have to eliminate all oxalates when following a low oxalate diet, just foods that are highest in oxalates (meaning they contain more than 10mg of oxalate per serving).1 Foods high in oxalates include many leafy greens, beans, legumes, wheat products, soy, coffee, dark chocolate, certain grains, nuts, and nut butter, to name a few.2

What Experts Say

“A low-oxalate diet is a therapeutic diet that can be prescribed if a person is experiencing kidney stones and their urinary oxalate levels are high. If the urinary levels are not high in oxalate, a low-oxalate diet may not be indicated. Most of the time avoidance of very high oxalate foods, such as spinach, nuts (almonds), beans (navy), rhubarb, and increasing intake of calcium-rich foods such as dairy, can be prescribed to reduce urinary levels of oxalate. Calcium binds oxalate in the intestine. This diet is usually temporary and people following it would benefit from working with a registered dietitian who specializes in this type of eating plan to avoid misinformation that is found online and ensure adequate nutrition.” — Barbara Cervoni, RD

What Can You Eat

The low oxalate diet suggests reducing high oxalate foods. Instead, fill your diet with low and moderate oxalate foods; the occasional high oxalate food should not increase the risk of kidney stones.

Generally, foods don’t come with labels outlining their oxalate content. The website Oxalate.org has a list of 750+ foods and their oxalate levels and is a great place to start. A low oxalate diet is considered less than 100mg per day, though many doctors will suggest 50mg or less.1

Foods that contain 0-9mg of oxalates per serving include fruits and vegetables such as asparagus, apricots, artichoke, banana, blackberries, blueberries, bok choy, broccoli, Brussels sprouts, cantaloupe, cauliflower, celery, cherries, yellow squash, zucchini, strawberries, romaine lettuce, raisins, plums, pineapple, peas, pears, peaches, papaya, onions, mango, grapefruit, and grapes.

Examples of low oxalate grains and starches include oat bran, oat flour, barley, bran muffins, white bread, wheat bread, white rice, corn, and flour tortillas. Low oxalate protein and dairy include eggs, meat, poultry, fish, yogurt, cheese, milk, and butter. In addition, coffee, water, and fruit juice are considered low oxalate.

Moderate oxalate foods contain 10-25mg of oxalates per serving. These foods include avocado, lentils, lychee, olives, parsnip, peanut butter, pecans, pistachios, pomegranate, red kidney beans, refried beans, squash, sunflower seeds, tahini, and tomato sauce.

Additional Foods

While the low oxalate diet does not always suggest including calcium-rich foods, it is beneficial to do so especially if you’re going to include foods with higher oxalate levels. Calcium-rich foods include cheese, dairy, seeds, yogurt, sardines, beans, lentils, almonds, rhubarb, and bread and cereals that have been fortified with calcium.

What You Need to Know

The purpose of the low oxalate diet is to reduce dietary oxalate intake in an effort to reduce someone’s risk of developing kidney stones. Because many nutritious foods are rich in oxalates, cutting high oxalate foods out altogether is not advised.

Calcium binds to oxalates and can increase absorption (instead of contributing to kidney stones) if calcium-rich foods are eaten with high-oxalate foods. In addition, drinking plenty of fluids will help prevent stone formation.

What to Eat

  • Fruits, including bananas, blackberries, blueberries, strawberries, plums, pears, peaches, pineapple, grapefruit, and grapes
  • Vegetables, especially asparagus, cauliflower, celery, romaine lettuce, yellow squash, and zucchini
  • Grains and starches, including oat bran, barley, white or wheat bread, white rice, corn tortillas, and flour tortillas
  • Protein and dairy, eggs, fish, meat, poultry, yogurt, cheese, milk, and butter
  • Beverages, including coffee, water, and fruit juice

What Not to Eat

  • Fruits, including kiwi, raspberries, dates, oranges, tangerines, and rhubarb
  • Vegetables, especially spinach, beets, potatoes, turnips, and carrotsBeans and legumes, including navy, kidney, lentils, fava beans, and chickpeas
  • Nuts, like almonds, walnuts, peanuts, macadamia nuts, and cashews
  • Grains, especially quinoa, brown rice, couscous, millet, bulgar, and wheat
  • Beverages, including hot chocolate, tea, tomato juice, and chocolate milk
  • Other, including soy products, cocoa, and chocolate

Pros and Cons

While a low oxalate diet is often specific in helping individuals who experience kidney stones, there are some downsides to this kind of eating pattern. Finding a balance that allows individuals to avoid kidney stones while still getting the nutrients they need for overall health can be difficult.

Pros

  • May reduce risk of developing kidney stones

Cons

  • Could lead to nutrient deficiencies
  • Difficult to follow
  • May interfere with social situations

Is the Low Oxalate Diet a Healthy Choice for You?

The low oxalate diet is neither healthy nor unhealthy. Anyone can be at risk of developing kidney stones regardless of their diet habits, especially if you don’t drink enough fluids. Additionally, the low oxalate diet does not teach healthy eating habits and in fact, may cause you to feel more restricted and frustrated.

The U.S. Department of Agriculture (USDA) dietary guidelines include recommendations for a healthy, balanced diet. The following foods are meant to encourage and guide a nutrient-dense diet:3

  • Vegetables (spinach, broccoli, bok choy, cauliflower, carrots, asparagus, green beans, peppers, onions, peas, mushrooms, cabbage, etc.)
  • Potatoes, beans, and legumes (potatoes, beans, chickpeas, lentils, sweet potatoes)
  • Fruits (berries, melon, apples, oranges)
  • Grains (rice, quinoa, barley, bread, cereal, crackers, oats)
  • Dairy and fortified soy alternatives (yogurt, milk, cheese, kefir, cottage cheese)
  • Protein Foods (meats, poultry, eggs, seafood)
  • Nuts and seeds (almonds, peanut butter, sunflower seeds, chia seeds)
  • Oils (olive oil, avocado oil)

The USDA does not provide recommendations or tips for those who are prone to kidney stones. Following the USDA guidelines for a healthy, balanced diet does not mean you will reduce your risk of developing kidney stones. Discuss your options with a healthcare professional before beginning any new diet program, including the low oxalate diet.

The low oxalate diet is a medically necessary diet for those who are at risk of developing kidney stones. It is not a diet for weight loss or considered a healthy, balanced diet. You can lead a healthy lifestyle while following the low oxalate diet.

Health Benefits

Successfully reducing high oxalate foods could reduce the formation of kidney stones for people who experience kidney stones.

May Reduce Risk of Developing Kidney Stones
The conclusion is that oxalates from your diet have an impact on kidney stone formation. Though researchers are not sure of the extent, the risk is there.1 Therefore, reducing your intake of high oxalate foods might help you avoid future kidney stones.

Health Risks

While there are no direct health risks to following the low oxalate diet, eliminating a variety of nutritious foods from your diet could cause you to miss out on important vitamins and minerals. In addition, elimination-style diets are difficult to follow, tough in social situations, and can lead to feelings of frustration and restriction.

Could Lead to Nutrient Deficiencies
Because the low oxalate diet requires you to eliminate so many nutritious foods, the variety of foods left for consumption reduces drastically. Making sure you’re getting enough vitamins, minerals, and fiber is difficult when you’re removing so many fruits, vegetables, beans, legumes, and grains from your diet.

Difficult to Follow
With a laundry list of foods to avoid, following the low oxalate diet precisely is going to be a challenge. Finding yourself frustrated over a lack of options could cause you to ditch the diet altogether.

May Interfere with Social Situations
Diets that restrict foods or food groups make living your life as usual particularly difficult. Finding restaurants or foods at family gatherings that adhere to the low oxalate diet guidelines may pose a challenge leaving you to avoid the social event altogether. This can make you feel down, frustrated, or like you’re being left out.

May Not Be Necessary
Research shows that eating calcium-rich foods with high-oxalate foods helps with the absorption of calcium before it reaches your kidneys.4 Therefore it may not be necessary to eliminate high-oxalate foods.

A Word From Verywell

If you’re at risk of developing kidney stones because of high oxalate levels, you could benefit from the low oxalate diet. However, increasing your consumption of calcium-rich foods and drinking more water may also help reduce your risk of developing kidney stones. Talk to a health care professional regarding your options before starting any new diet plan.

Remember, following a long-term or short-term diet may not be necessary for you and many diets out there simply don’t work, especially long-term. While we do not endorse fad diet trends or unsustainable weight loss methods, we present the facts so you can make an informed decision that works best for your nutritional needs, genetic blueprint, budget, and goals.

If your goal is weight loss, remember that losing weight isn’t necessarily the same as being your healthiest self, and there are many other ways to pursue health. Exercise, sleep, and other lifestyle factors also play a major role in your overall health. The best diet is always the one that is balanced and fits your lifestyle.

What is Oxalate?

What is oxalate?

Oxalate definition: oxalate is a naturally occurring compound found in plants and humans. They are also referred to as oxalic acids. Although oxalates are not generally harmful, excess oxalates can lead to kidney stones.

Kidney stones, also called renal calculi, are solid crystal masses that usually originate in the kidney. They can also develop in other areas of the urinary tract such as the ureters, bladder, and urethra. The most common types of kidney stones are formed when calcium binds with oxalate in the urine to form calcium oxalate.

Kidney stones are typically 4mm or less. These small stones are usually able to pass and be expelled in urine without help. Some kidney stones do not pass on their own or are too large to pass and need surgical removal.

image of kidney stones
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Most people are able to clear excess oxalates in their urine and stool. However, some people have factors that can make them more susceptible to kidney stones. The risk factors include:

  • Drinking too little water
  • Too little or too much exercise
  • Weight loss surgery
  • Eating foods with too much salt or sugar

Oxalate Formula

The oxalate formula is C2O−24C2O4−2. Oxalate is a polyatomic ion. Polyatomic ions are compounds that contain two or more atoms covalently bonded together. They also have an overall positive or negative charge.

Oxalate is a molecule composed of two carbon atoms (C) and four oxygen atoms (O). The overall charge of oxalate is negative two and is considered a dianion. Dianions are molecules with two negative charges.

structure of oxalate showing two carbon atoms bonded to 4 oxygen atoms
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Oxalate Structure

In the oxalate structure, two carbon atoms (black) in the center are covalently bonded together by a single bond, and then each bonded to two oxygen atoms (red). The molecule is not stable with single bonds between the carbon/oxygen atoms. In order to increase stability, two double bonds are formed between the oxygen and carbon atoms. The dotted lines in the image show the four locations where double bonds are able to be formed. The different arrangements of the double bonds allow for variance in the structure of oxalates, also known as resonance structures.

image showing different places double bonds can form to increase stability
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The two oxygen atoms with a single bond to carbon carry a negative charge. Metal ions such as calcium and iron are positively charged. The negatively charged oxygens on both sides of the oxalate ion are attracted to the positively charged calcium and iron metals. The image here shows the attraction of oxalate to a metal ion similar to compounds that form when spinach is consumed. During spinach digestion, negatively charged oxalate ions bind to positively charged calcium ions in the spinach. This reduces the amount of calcium the body can form by creating calcium oxalate.

image of oxalate ion bonded to two atoms
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Foods With Oxalates

Foods containing 10 mg or more of oxalate are considered high oxalate foods. Foods high in oxalate include:

  • Fruits: berries, kiwis, figs, purple grapes
  • Vegetables: potatoes, rhubarb, okra, leeks, spinach, beets, swiss chard
  • Grains: bran flakes, wheat germ, quinoa
  • Other foods: cocoa, chocolate, tea

When oxalates levels are high in the body, there is a greater chance of oxalate binding creating calcium oxalate and iron oxalate. This prevents the body from absorbing beneficial nutrients. The formation of the calcium and iron oxalate crystals will usually leave the body through urine and stools. However, when oxalate levels are too high, they can sometimes remain in the urinary tract creating kidney stones.

Low Oxalate Diet

What is a low-oxalate diet?

Oxalate is a chemical found in plant foods. You may need to eat foods that are low in oxalate to help clear kidney stones or prevent them from forming. People who have had kidney stones are at a higher risk of forming kidney stones again. The most common type of kidney stone is made up of crystals that contain calcium and oxalate. Your healthcare provider or dietitian may recommend that you limit oxalate if you get this type of kidney stone often.

High Oxalate Foods
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Which foods should I include?

Include the following foods that have a low to medium amount of oxalate.

  • Grains:
    • Egg noodles
    • Graham crackers
    • Pancakes and waffles
    • Cooked and dry cereals without nuts or bran
    • White or wild rice
    • White bread, cornbread, bagels, and white English muffins (medium oxalate)
    • Saltine or soda crackers and vanilla wafers (medium oxalate)
    • Brown rice, spaghetti, and other noodles and pastas (medium oxalate)
  • Fruit:
    • Apples, bananas, grapes
    • Cranberries
    • Peaches, nectarines, apricots, and pears
    • Papayas and strawberries
    • Melons and pineapples
    • Blackberries, blueberries, mangoes, and prunes (medium oxalate)
  • Vegetables:
    • Artichokes, asparagus, and brussels sprouts
    • Broccoli and cauliflower
    • Kale, endive, cabbage, and lettuce
    • Cucumbers, peas, and zucchini
    • Mushrooms, onions, and peppers
    • Corn
    • Carrots, celery, and green beans (medium oxalate)
    • Parsnips, summer squash, tomatoes, and turnips (medium oxalate)
  • Dairy:
    • American cheese, Swiss cheese, cottage cheese, ricotta cheese, and cheddar cheese
    • Milk and buttermilk
    • Yogurt
  • Protein foods:
    • Meat, fish, shellfish, chicken, and turkey
    • Lunch meat and ham (medium oxalate)
    • Hot dogs, bratwurst, bacon, and sausage (medium oxalate)
  • Drinks and desserts:
    • Coffee
    • Fruit punch and lemonade or limeade without added vitamin C
  • Desserts:
    • Cookies, cakes, and ice cream
    • Pudding without chocolate

Which foods should I limit or avoid?

Limit the following foods that are high in oxalate.

  • Grains:
    • Wheat bran, wheat germ, and barley
    • Grits and bran cereal
    • White corn flour and buckwheat flour
    • Whole wheat bread
  • Fruit:
    • Dried apricots
    • Red currants, figs, and rhubarb
    • Kiwi
    • Grapefruit
  • Vegetables:
    • Potatoes and yams
    • Collard greens, leeks, okra, and spinach
    • Wax beans
    • Eggplant
    • Beets and beet greens
    • Swiss chard, escarole, parsley, and rutabagas
    • Tomato paste
  • Protein foods:
    • Baked beans with tomato sauce
    • Nut butters and nuts (peanuts, almonds, pecans, cashews, hazelnuts)
    • Soy burgers
    • Miso
    • Dried beans
  • Desserts:
    • Fruitcake
    • Chocolate
    • Carob and marmalade
  • Beverages:
    • Chocolate drink mixes
    • Soy milk
    • Instant iced tea
  • Other foods:
    • Sesame seeds and tahini (paste made of sesame seeds)
    • Poppy seeds

What other dietary guidelines should I follow?

  • Drink about 12 to 16 (eight-ounce) cups of liquid each day. Liquids help clear kidney stones and prevent them from forming again. Water is the best liquid to drink. You may need more liquid if you are physically active. Ask your healthcare provider or dietitian how much liquid you need to drink each day.
  • Your healthcare provider may suggest that you make other diet changes to help prevent kidney stones. This may include decreasing the amount of sodium you eat each day.

Care Agreement

You have the right to help plan your care. Discuss treatment options with your healthcare provider to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2022 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

What is oxalate

Oxalate in the mammalian body originates from two main sources: endogenous (body in your liver) production and external source via dietary intake. The ratio between liver-generated and absorption-related sources depends on oxalate content in ingested food. Both sources have a potentially important role in increasing oxalate concentrations in plasma and urine. Oxalate is a toxic simple organic acid that is ubiquitous in the plant kingdom and widely consumed in normal human diets as a component of fruits, vegetables, grains and nuts 1). The normal daily intake of oxalate ranges from 70 to 920 mg, but strongly increases in vegetarians 2). The average daily dietary oxalate intake content in the United States is 214 mg in men, 185 mg in older women, and 183 mg in younger women; spinach accounts for > 40% of the oxalate intake 3). Despite the toxicity of oxalate to mammals, it cannot be degraded by mammalian enzymes 4). However, it can be metabolized by many gut bacteria, such as Oxalobacter formigenes and Lactobacillus acidophilus, among others 5).

Figure 1. Oxlate sources

oxalate sources
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Note: OX= oxalate; Gall bl.= gallbladder; GIT= gastrointestinal tract[Source 6)]

Factors leading to high rates of oxalate absorption from the gut include the presence of medical conditions or surgical interventions leading to steatorrhea, low dietary content in calcium and magnesium, both of which bind oxalate in the gastrointestinal tract and decrease its absorption and renal excretion, and the absence from the intestinal flora of certain species of bacteria, in particular, Oxalobacter formigenes, an anaerobic bacterium that metabolizes oxalate. The absence of this bacterium from the gut has been associated with hyperoxaluria, but bacteriotherapies involving oxalate-degrading bacteria have met with mixed results 7). While probiotics containing Oxalobacter formigenes, Lactobacillus spp., Bifidobacterium spp., or Enterococcus spp. effectively reduce urinary oxalate excretion, the bacteria and the oxalate-degrading function are often lost when probiotic use ceases and/or oxalate is removed from the diet 8). In some cases, urinary oxalate remains unchanged despite long-term administration of probiotics and persistence of oxalate-degrading microbes in the gut 9).

Oxalate is also natural chemical in your body. Oxalate is produced by many kinds of cells, including liver cells, kidney, epithelial cells and apocrine cells, among others 10)11). Most of body oxalate is a metabolic end-product generated largely in the liver and represents 85 % to 90 % of the total oxalate circulating in blood (endogenous oxalate). An unknown proportion of the liver-produced oxalate is removed via bile secretion. The remainder (10 % to 15 %) of blood oxalate (exogenous oxalate) originates from the absorption of food in the gastrointestinal tract. The bulk (90 % to 95 %) of circulating oxalate is ultimately excreted by the kidneys, whereas some 5 % to 10 % of blood oxalate is excreted in the terminal parts of the small intestine and colon. And too much oxalate in your urine can cause serious problems.

Hyperoxaluria is defined as excessive urinary oxalate excretion, which occurs when you have too much oxalate in your urine 12). Too much oxalate in your urine can cause serious problems when the excess oxalate combines with calcium in urine to form the most common type of kidney stone, a calcium oxalate stone and has been associated with acute or chronic kidney injury 13).

Hyperoxaluria develops as a consequence of either excessive endogenous oxalate production (primary hyperoxaluria) or excessive oxalate absorption from the gastrointestinal tract. The later can be associated with enteric hyperoxaluria from fat malabsorption, e.g., in patients with Roux-en-Y gastric bypass surgery 14), jejunoileal bypass surgery 15), Crohn’s disease 16), sprue 17) or taking medications such as orlistat that cause fat malabsorption 18). Other potential culprits for excessive oxalate absorption include either excessive dietary intake of oxalate or its substrate (vitamin C) or dietary deficiency of calcium or magnesium 19).

Although there is substantial variation between individuals, urinary oxalate excretion rises in parallel with dietary oxalate intake when other variables potentially affecting oxaluria are under control 20). Chronic intake of food items with a high content of oxalate may lead to hyperoxaluria with urinary oxalate excretion similar to the degree usually seen in primary hyperoxaluria. The component of urinary oxalate excretion that is derived from gastrointestinal absorption is determined by the oxalate content of the diet and the rate of absorption of oxalate in the intestines. Food items high in oxalate include leafy vegetables, such as spinach, various nuts, e.g., peanuts, and tropical fruits, including Averrhoa carambola (starfruit) and Averrhoa bilimbi (commonly known as bilimbi or cucumber tree) 21).

The proportion of urinary oxalate that is derived from dietary oxalate is estimated to range from 10 to 50% 22). In addition to oxalate intake, intake of oxalate precursors may cause hyperoxaluria. Vitamin C (ascorbic acid), pyridoxylate, which is a combination of glyoxylic acid and pyridoxine, and hydroxyproline are potential sources of oxalate that have caused hyperoxaluric renal disease in clinical and experimental studies. Furthermore, hyperoxaluria and oxalate nephropathy may develop as a result of the oxalate salts of parenteral medications. It is well established that a large proportion of urinary oxalate is derived from the endogenous metabolism of glycine, glycolate, hydroxyproline, and dietary vitamin C 23). A recent metabolic study compared a controlled diet with 25% of protein from gelatin (2.75 g of hydroxyproline) with the same diet except with 25% of protein from whey (containing no hydroxyproline) 24). The diet that was high in hydroxyproline increased urinary oxalate excretion by 42%. Another metabolic trial demonstrated that 1000 mg of supplemental vitamin C consumed twice daily increased urinary oxalate excretion by 20 to 33% 25).

A review of oxalate load studies indicates that a peak in urinary oxalate excretion normally occurs two to four hours after the oxalate ingestion 26). Thus, it is quite possible that such transient oxalate loads on the kidney result in a transient hyperoxaluria. Interestingly, Gambaro et al have noted that the fractional excretion of oxalate was 70% higher in stone formers compared with normal individuals 27). It is plausible that a transient renal oxalate load on the kidney associated with an oxalate-rich meal might lead to renal cell injury, most likely in the proximal tubule. This may be amplified in stone formers due to an enhanced oxalate secretion and an elevated intestinal absorption 28). It has been established that oxalate can affect renal cells by either stimulating cellular proliferation or by inducing cell injury 29).

Calcium stones, including calcium oxalate stones ~ 70% and calcium phosphate stones ~ 15%, are the most common types of kidney stones. Calcium oxalate is also associated with benign breast tissue calcifications 30). Furthermore, a low-calcium diet was shown to be a significant risk factor for the kidney stones (calcium oxalate stones) disease 31). The explanation for the role of dietary calcium was that it complexed intestinal oxalate and limited its availability for absorption 32). In a study 33), a 34% increase in urinary oxalate excretion accompanied the decrease in calcium intake from 1002 mg to 391 mg per day, which is consistent with this theory. The studies of Liebman and Chai also support this role for dietary calcium in showing that supplemental calcium decreased the absorption of an oxalate load by more than 50% 34). Other observational studies have shown an inverse relation between dietary calcium and the risk for incident kidney stones 35)36) suggested that dietary calcium may bind to oxalate in the gut, thereby limiting intestinal oxalate absorption (and subsequent urinary oxalate excretion). Indeed, the inhibitory effect of calcium ingestion on urinary oxalate excretion has been demonstrated in oxalate loading studies 37). Magnesium intake may also decrease urinary oxalate in a similar manner 38)39).

Moreover, there is nearly universal agreement in studies of normal and stone-forming populations that the mean calcium excretion of the stone forming population is higher than that of the normal population, that the incidence of hypercalciuria (high urine calcium concentration) in the stone-forming population is 5 to 10 times above that in a normal population, and that the relative supersaturation of the urine is higher in hypercalciuric individuals than in normocalciuric individuals 40)41). Differences in oxalate excretion are less pronounced, suggesting that if oxalate plays a role it may in part be due to effects other than by affecting relative supersaturation alone.

Currently, there are no established therapies that decrease urinary oxalate excretion in individuals with idiopathic calcium oxalate kidney stones disease. They are often advised, without substantial data to support the efficacy of this dietary recommendation, to avoid oxalate-rich foods 42).

Foods high in oxalate

Dietary hyperoxaluria has been reported after ingestion of large amounts of food products with high oxalate content for medicinal, cosmetic or weight loss purposes. Most commonly implicated vegetables and fruits are peanuts 43), Averrhoa bilimbi (commonly known as bilimbi or cucumber tree) 44), celery, carrots, parsley, beets, and spinach 45).

Even though those food products are ubiquitous in many diets, there have been few reports of renal parenchymal disease secondary to dietary hyperoxaluria 46). Bakul et al have described a case series of 10 patients who developed acute renal failure after consumption of A. bilimbi fruit juice 47). Seven patients required hemodialysis while 3 cases recovered kidney function with conservative management. While their serum creatinine values at time of diagnosis ranged from 5.5 to 12.3 mg/dL, all 10 patients recovered within 2 to 6 weeks.

Figure 2. Oxalate rich foods

oxalate rich foods
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Table 1. Foods that contribute to oxalate

Food%Food%Food%
Cooked spinach23.1Cooked spinach25.8Cooked spinach22.0
Raw spinach17.3Raw spinach18.4Raw spinach20.3
Potatoes (whole)10.2Potatoes (whole)11.1Potatoes (whole)9.9
Cold cereal4.4Cold cereal4.3Cold cereal3.8
Oranges2.9Oranges2.5French fries2.5
French fries1.9Coffee1.7Oranges2.0
Mixed nuts1.7Cooked carrots1.7Pasta2.0
Navy beans (canned)1.7Tea1.6Pasta sauce1.9
Cookies1.6Cookies1.5English muffins1.7
Peanuts1.6Pasta sauce1.4Coffee1.7
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Note : Spinach has 794 mg oxalate/100 g; Potato has 24.7 mg oxalate/100 g

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