everywomanover29 blog

Food, Mood and Women's Health – Be your healthiest, look and feel great!

Oxalates

Cauliflower pizza crust and toppings recipe (gluten-free, grain-free, nut-free, low to medium oxalate, Paleo/keto)

By Trudy Scott Leave a Comment

cauliflower pizza

Today I’m sharing a really delicious cauliflower pizza crust recipe from Megan Gilmore of Detoxinista (the pizza crust recipe is unchanged and perfect just the way it is), my variations on toppings and some additional information on oxalates.

I do acknowledge, as far as pizza goes, my toppings are rather unconventional but I’ve never really been a big pizza lover (there, I said it!) But I do love cauliflower – it’s my favorite veggie – and I was excited when my sister told me about this recipe and then made it especially for me when I visited her and her family in Hawaii recently! Aren’t I spoiled?!

The fact that the cauliflower pizza crust is low oxalate makes a huge difference: the only ingredients are cauliflower, goats cheese and an egg. I’ve seen other cauliflower pizza crust recipes that include a nut flour such as almond flour. That would be a no-no for me and someone with dietary oxalate issues because almonds are high oxalate.

My topping included: a light smearing of tomato sauce, chunks of chicken (left-overs from the night before), a few halves of tinned artichoke and a few halved olives. I added all this to the prepared cauliflower pizza crust and heated it for 10 minutes.

Once it came out of the oven I loaded it up with freshly cut avocado, pieces of fresh basil and chunks of mozzarella cheese. I don’t like melted cheese and have a hard time digesting it so I prefer to add it afterwards. I think I’ll try feta cheese next time for a change.

I personally have dietary oxalate issues but right now I am doing well with a little tomato sauce, a few artichokes, a few olives and some fresh basil (as long as that is all I’m consuming that day in the way of medium oxalate foods). It’s best to figure out your own needs based on your oxalate issues and what you know you can tolerate.

Read on below for the link to the cauliflower pizza crust recipe and more about dietary oxalates.

The cauliflower pizza crust recipe from detoxinista

Here is the recipe for the perfect cauliflower pizza crust from Megan Gilmore. I have permission to only share the ingredients: cauliflower, egg, goats cheese, oregano, salt, and a pinch of black pepper, and photos from the site but you need to go to her site for the recipe instructions. It’s well worth it to see how it looks at the various stages. I’ve included a few of Megan’s images below.

I will add that my sister doesn’t have a food processor and just cooked the chopped cauliflower and then used a stick blender to get it looking like this.

cauliflower pizza
(Images used with permission from detoxinista)

(Images used with permission from detoxinista https://detoxinista.com/the-secret-to-perfect-cauliflower-pizza-crust/)

Once you add the egg and goat cheese it will have a texture and consistency like this. This is done after you have squeezed the liquid out of the cooked cauliflower – a crucial step for a firm and crunchy pizza crust.

cauliflower recipe
(Images used with permission from detoxinista)

Check out Megan’s site for other useful images, especially to see what the cooked crust looks like. One tip from my sister: once the crust is golden and crisp, flip it over and cook it another 10 minutes.

You’ll see there are also some variations with no goat cheese and no egg. If you try either of these please do share how they turned out.

Enjoying family, nature and a cauliflower crust pizza

After a gorgeous evening with my sister and brother (they were camera-shy!) at Kona on the Big Island, we got back home and ate delicious pizza on this home-made cauliflower pizza crust!

It was all prepared in advance – the crust and all the toppings – so we just put it all together based on our own likes and munched away. And boy did I rave about it – so much so that I said “hey take photos of me eating my pizza and I’ll share my my community”

cauliflower pizza

As you can see it’s a pretty firm crust and holds up well with all the toppings I added to mine. And yes my shirt matches the pizza topping – unintentional but still fun!

cauliflower pizza

It’s also really nice to eat something crunchy with a pizza-crust-like texture. If you’re gluten-free and grain-free I’m sure you can relate! And it tastes lovely.

Of course you can make it with conventional pizza toppings too. And I think you could use the pizza crust as crackers too. I plan to make a double batch and try this and freeze them.

Dietary oxalates and the problems they can cause

This blog post is a helpful one to start with if you’re new to dietary oxalates and the issues they can cause – Oxalate crystal disease, dietary oxalates and pain: the research & questions.

These are the common medium-oxalate and high-oxalate foods that many folks have problems with: nuts, nut-butters and nut-flour (especially baking with almond flour and something to watch when eating Paleo or GAPS), wheat, chocolate, kiwi fruit (very high – see the raphides image on the above blog), star fruit (also very high), beets, potatoes, sweet potatoes, legumes, raspberries, spinach and soy.

In the above blog post, I share an overview of oxalates, my pain issues with dietary oxalates (severe foot pain and eye pain), and deeper dive into the condition called oxalate crystal disease (with some of my insights and questions).

The big take-aways are that calcium oxalate crystals are sharp and can cause far reaching harm beyond pain – such as unresolved anxious feelings, thyroid issues, neurological symptoms, eye issues, hearing loss, bladder issues, headaches, fatigue, sleep issues, restless legs, autism symptoms and more. You can have issues with dietary oxalates and not have kidney disease/kidney stones, although there is very little research supporting the latter.

I’m finding dietary oxalate issues to be underappreciated especially in menopausal women when symptoms can show up and be more severe. And there is a strong connection with gallbladder issues and problems with fat digestion, which becomes more of an issue in perimenopause and beyond.

You can click on this link to read other blog posts on the topic of oxalates.

A resource if you are looking for a nutritional approach

If you are looking for a nutritional approach for your anxious feelings, mood issues, sleep problems and overall health issues, my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, is a great foundation. Be sure to share it with the practitioner/health team you or your loved one is working with.

If diet isn’t enough, there are entire chapters on the amino acids, gut health, blood sugar control and pyroluria. I don’t cover oxalates because I only became aware of them after my book was published (but I’ve published much on the blog since then – simply search this blog for other articles on the topic).

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the amino acids symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

I’d love to hear if you try this recipe and enjoy it (and what modifications you made).

Do you like cauliflower and what is your favorite way to enjoy it?

Feel free to share and ask your questions below.

Ox bile as a supplement: to help counter the effects of dietary oxalates very likely caused by bile issues and poor fat digestion

By Trudy Scott 69 Comments

ox bile

I’m using ox bile (as a supplement) to help counter the effects of dietary oxalates very likely caused by my bile issues and poor fat digestion.

I started with 125 mg ox bile with lunch and dinner and now I’m up to 250 mg at lunch and 375 mg at dinner. Many ox bile products are 500 mg but I decided to start low and go slow and also use an ox bile only product rather than ox bile combined with digestive enzymes.

I don’t know exactly what my liver or gallbladder issues are but suspect low bile production and/or sluggish bile flow.

I have an issue with dietary oxalates and using ox bile confirms my suspicions because I can feel it helping further with symptom reduction (foot and eye pain, and restless legs at night). Because of improved fat digestion, I’m encouraged it’s going to help with longer term bone health (I was recently diagnosed with osteoporosis), immunity, hormone balance and heart health too. I expect better absorption of healthy fats like omega-3 fatty acids, evening primrose oil and fat-soluble vitamins A, E, D and K (and D and K are so important for bone health).

Of course, all this means less oxalate absorption and a reduced impact of the sharp damaging crystals found in medium/high oxalate foods. Oxalates also bind to minerals like zinc, magnesium, and calcium so those mineral deficiencies should shift too.

Read on for a background on oxalate crystal disease, the research on conjugated bile acid replacement therapy (or ox bile supplementation) and oxalate/fat digestion mechanisms, and more about signs of bile issues and solutions. I also share what else I do to mitigate oxalate issues and improve fat digestion,  and the ox bile product I am using.

Ox bile increases fat absorption and reduces oxalate absorption

This paper, Conjugated bile acid replacement therapy reduces urinary oxalate excretion in short bowel syndrome, explains that “Soluble oxalate is hyper absorbed by the colon leading to hyperoxaluria and an increased risk for renal calcium oxalate stones and deposits” (and other pain issues – more on that below).

Using ox bile as a supplement (or replacement) with meals “increases fat absorption and thereby decreases calcium fatty acid soap formation and oxalate hyperabsorption.”  What does this mean? When fat absorption is improved with ox bile supplements there is more calcium left to bind to excess oxalates in the gut and get rid of them in the stool i.e. less oxalates are absorbed.

I encourage you to read the above paper for a better understanding of the mechanisms.

I do appreciate this team of researchers who have highlighted this approach to help with oxalate issues. Keep in mind I’m experimenting and extrapolating from this single case study of someone with short bowel syndrome and based on what I already know about bile/fat digestion, my own oxalate issues and symptoms of poor bile production/flow (see below).

I don’t have short bowel syndrome but  there are a few related studies like this one from the same department, so I feel comfortable experimenting and tracking.

Other pain issues and my pain symptoms caused by dietary oxalates

Keep in mind that the increased absorption of oxalates also causes issues like joint and soft tissue pain, anxiety, restless legs, insomnia, bladder issues, vulvodynia, eye-poking (in autism), thyroid problems, osteoporosis, damage to the heart etc. even when there are no kidney stones. This is not recognized in kidney stone research but is seen extensively in clinical practice.

In 2012 I made the connection between oxalate intake and my excruciating foot pain – a combination of hot-burning-coals-pain and shards-of-glass-pain. The pain has always been worse at night and at its worst I was unable to sleep with severe restless legs.  A few years later, I noticed my left eye being affected too, with scratchy discomfort and mild pain. There is also a goopy kind of discharge from the inner part of my eye and burning/redness crystal-like teariness on the outer parts of my eyes.

You can read more about my oxalate story and oxalate crystal disease on this blog – Oxalate crystal disease, dietary oxalates and pain: the research & questions.

It’s more than only ox bile replacement to help with oxalate issues

I say that ox bile helps further because this is a journey I’m on and there are many nutritional approaches that have been helping me over the years. My symptoms have reduced as I do eat mostly low oxalate with some medium oxalate vegetables from time to time, and occasional chocolate or carob (which are high oxalate).

I continue to finesse my use of calcium citrate at bedtime when my symptoms do flare. I am fortunate that I am able to eat cheese so this is another source of calcium for me.

I have pyroluria so I have long used vitamin B6 which is recognized to be helpful for some with oxalate issues. I suspect this may have prevented dumping when I first switched to low oxalate eating.

Signs of low quality bile from Anne Louse Gittleman

These are from her book, The New Fat Flush Plan:

  • Queasiness after a fatty meal (impaired bile flow)
  • Light-colored or floating stools (lack of bile output)
  • Nausea/motion sickness (not enough bile)
  • Dry skin and hair (lack of essential fatty acids)
  • Constipation (inadequate bile for lubrication)
  • Constant feeling of fullness
  • Inability to lose weight
  • Pain under the right rib cage (reflective pain from the gallbladder)
  • Hemorrhoids (congested liver)
  • Varicose veins (pressure from constipation due to thickened bile)
  • Pain between the shoulder blades (reflective pain from the gallbladder)
  • Bloating or gas
  • Headache over the eyes (gallbladder meridian passes over this region)
  • Bitter taste in the mouth after meals (sign of bile regurgitation)
  • History of prescription or recreational drug use (need for more liver and gallbladder support)
  • Sensitivities to chemicals
  • Easily intoxicated (need for more liver and gallbladder support)
  • Fibromyalgia (sign of liver and gallbladder overload)
  • Hypothyroidism (sign of deficient bile to stimulate active thyroid hormone in fat cells)

I’m adding these signs/related issues/conditions:

  • Fatigue
  • Itchy skin
  • SIBO/small intestinal bacterial overgrowth
  • Osteoporosis
  • History of gallbladder attacks or gallstones
  • Oxalate issues

In my Anxiety Summit interview with Anne Louise Gittleman she explains what bile is and why it’s so important (read here if you’re new to this).

What I’ve already done to improve my bile production/quality

Here is a quick summary of the advice Anne Louise Gittleman offers, with a note of what I’ve done. I share this to illustrate that I didn’t jump straight to ox bile supplementation/replacement:

  • Elimination of food allergies (I’ve done this)
  • Addressing low levels of hydrochloric acid or stomach acid (this is not an issue for me)
  • Controlling stress (this is ongoing)
  • Adding bitter greens to the diet (I do this as much as I can, avoiding medium/high oxalate bitter greens)
  • Hot lemon water in the morning (a favorite of the original Fat Flush Plan and something I’ve done for years)
  • Adding non-GMO lecithin from soy and sunflowers to your morning smoothie (I don’t do this)
  • Using a bile building formula that contains choline, taurine, beet root, inositol and methionine, and pancreatic lipase (I use taurine but can’t use beet root because it’s high oxalate; I did a 2 month trial of a lipase only supplement with no changes; I will likely experiment with choline, methionine and inositol in the near future)
  • Using castor oil packs (I plan to do this in the near future)

These are some of the other approaches that can also help:

  • Digestive bitters (it does help me and I continue to use it but it’s not enough)
  • Toxin removal (I’ve experienced the harmful effects of acute environmental toxin exposure and my daily use of taurine helped. I blogged about this here.)
  • Ongoing detox with infrared sauna (I use a Therasage portable sauna)
  • Ox bile supplementation/replacement (I chose to use ox bile to be sure it was a bile issue I was dealing with and I did many other interventions first.)

My observations when using ox bile supplementation

I have not had any severe pain flares and have not needed to use extra calcium citrate in the night. The other profound change was a dramatic increase in energy. A few months ago I thought my Lyme was flaring again as I was so exhausted in the afternoons. This exhaustion has dissipated.

In terms of digestive symptoms, I notice less queasiness after a fatty meal like roast chicken with the skin on or a fatty lamb slow cooker stew. The constant feeling of fullness, gas and bloating has improved too. I suspect ox bile is helping with SIBO because it’s antimicrobial. But I can’t be sure since I started berberine 6 months ago and noticed it reduced methane gas production.

I have yet to test out motion sickness on a boat trip but I haven’t been using wristbands in the car and have been fine. I had been having some unusual/new skin itchiness a few months ago and this has now resolved. I do have sensitivities to chemicals but I haven’t noticed any change yet.

I used my stool color as a gauge to whether the ox bile was working – as I increased the dose I noticed it got darker and I have no more floaters. My bowel movements are much easier (more lubrication) and I feel the urge to go more than before.

It will be interesting to see if longer term this helps with improving my bone density. It makes no sense that I have osteoporosis given I’ve been physically active all my life. I highly suspect my bile issues have been a factor since childhood and then got worse during perimenopause Research shows “Gallbladder emptying time is longer during the perimenopausal period.”  Unfortunately kidney stones and oxalate issues ramp up in menopause so it’s the perfect storm.    I will be discussing all this with my endocrinologist/bone density doctor and ideally do some testing to figure out what the bile issues are (the pancreatic elastase test was fine).

I do track carefully and only make one change at a time so I typically know what improvements I can attribute to what changes.

Ox bile product options

Allergy Research has an Ox Bile 125 mg product and a 500 mg product. You can purchase these from my online store (Fullscript – only available to US customers – use this link to set up an account).

If you’re not in the US, Nutricology has an Ox Bile 125 mg product and a 500 mg product. This is the brand I happen to be using. It can be purchased on iherb (use this link to save 5%).

In conclusion

I’d like to give a shout out to my colleagues… I first learned about oxalates from my dear friend  Julie Matthews. Hearing her present at a conference helped me make the connection to my feet pain issues. She introduced me to Susan Owens, oxalate guru and researcher, and the TLO/Trying Low Oxalate group, and now I communicate regularly with them, the TLO moderators and members. And I met Sally K. Norton a few years ago. She is the author of this excellent book, Toxic Superfoods: How Oxalate Overload Is Making You Sick (my Amazon link).

Unfortunately no-one discusses the use of ox bile replacement/supplementation for those of us with oxalate issues and bile issues, and I suspect it’s an under-appreciated tool for those of us who continue to struggle. Hopefully this research and my results starts a discussion on the topic and further interest.

Sally K. Norton does mention a connection in her book: “The immune system has a method for shielding surrounding tissues from oxalate crystals; entrapping them with extruded DNA called a neutrophil extracellular trap (NET). These NETs forming around oxalates may contribute to gallstones and gallbladder “sludge”. If this is the case in my situation, then my lifelong issues with bile were likely made worse by my intake of medium- and high-oxalate foods.

I do hope that me sharing my personal experiments and healing journey helps you or someone you know. Honestly, I could write a book on oxalates and what I’ve learned over the last few years. There is so much to all this and even though it’s a “pain” to be affected like this it is fascinating. I do feel thankful to have dietary and nutritional “solutions.”

The next step for me is looking into and addressing my endogenous oxalate production i.e. oxalates that are produced internally vs oxalates that are ingested. Stay tuned for an update on this.

Do you have oxalate issues together with gallbladder/bile issues/fat digestion issues and how has ox bile supplementation helped you?

Has ox bile helped you with low bile production or sluggish bile – even if you don’t have oxalate issues?

If you’re a practitioner have you used ox bile with your clients or patients?

Feel free to share and ask your questions below.

Licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system

By Trudy Scott 28 Comments

licorice intake

Licorice, today chiefly utilized as a flavoring additive in tea, tobacco and candy, is one of the oldest used herbs for medicinal purposes and consists of up to 300 active compounds.

The main active constituent of licorice is the prodrug glycyrrhizin, which is successively converted to 3β-monoglucuronyl-18β-glycyrrhetinic acid (3MGA) and 18β-glycyrrhetinic acid (GA) in the intestines.

Despite many reported health benefits, 3MGA and GA inhibit the 11-β-hydrogenase type II enzyme (11β-HSD2) oxidizing cortisol to cortisone. Through activation of mineralocorticoid receptors, high cortisol levels induce a mild form of apparent mineralocorticoid excess in the kidney and increase systemic vascular resistance.

Continuous inhibition of 11β-HSD2 related to excess licorice consumption will create a state of hypernatremia [high sodium], hypokalemia [low potassium] and increased fluid volume, which can cause serious life-threatening complications especially in patients already suffering from cardiovascular diseases.

The above is from the paper, Bioactive Candy: Effects of Licorice on the Cardiovascular System and builds on the recent licorice-hypertension blog, showing a “correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system.”

licorice intake

Correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system
From: Bioactive Candy: Effects of Licorice on the Cardiovascular System

Adverse effects on the heart

As you can see from the above image, there are many ways that licorice intake can adversely affect the heart.

Most folks are aware of the issues with licorice causing high blood pressure and some folks know it can lower potassium. However, many folks are not aware of some of these more severe cardiovascular consequences caused by high blood pressure and  severely low potassium:

Hypertension is one of the major concerns for our healthcare system and was the leading contributor to premature death in 2015.  It has been proven to be a major risk factor of cardiovascular diseases.

Some of the mechanisms include “increased stiffness of large arteries” and “pulmonary edema …caused by the sodium retaining effect of licorice” (this is high blood pressure in your pulmonary arteries, which carry oxygen-poor blood from your heart to your lungs. The earliest symptom is shortness of breath during your usual routine).

In addition to hypertension, the paper mentions the following:

  • “Cardiac arrhythmias are the most serious side effect caused by licorice intake due to severe hypokalemia” (i.e. irregular heartbeat due to low potassium).
  • “Depletion of the body’s potassium stores can cause a prolongation of the QT interval, which is closely connected with ventricular arrhythmias and tachycardia” (i.e. abnormal heartbeats and increased heart rate).
  • “As a consequence, several patients experienced a cardiac arrest with a subsequent recovery.”

I encourage you to read the entire paper in order to fully understand the “correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system.”

Who may be more susceptible to the adverse impacts of licorice intake?

There are many documented health benefits of licorice and the above paper outlines how it may even benefit the heart. However some folks are more susceptible to the adverse effects and the above paper shares who may be more adversely impacted by licorice intake:

  • People aged over 40
  • Patients with a history of cardiac disease (and high blood pressure). I’ll also add those with family members with heart or blood pressure issues
  • Patients who are on medicines lowering potassium levels (such as thiazide or loop diuretics)
  • Patients treated with antihypertensive drugs such as ACE-inhibitors and diuretics
  • Patients suffering from diarrhea or alcoholism, which can worsen hypokalemia
  • Patients with congestive heart failure or resistant hypertension
  • Patients taking digoxin or warfarin to avoid the risk of toxicity

The authors also state that “women seem to be more susceptible to licorice intake. A possible explanation for this gender difference are many other hormonal (estrogenic and antiandrogenic) effects exhibited by licorice in addition to its activity via mineralocorticoid receptor.” And that licorice should also be avoided during pregnancy “because the conversion of cortisone into cortisol plays an important role in lung maturation.”

These other possible factors from this paper, Licorice abuse: time to send a warning message, should also be considered:

  • Patients with less common causes of hypokalemia that include Cushing syndrome, Conn’s syndrome and Anorexia nervosa
  • Patients with prolonged gastrointestinal transit time (The amount of glycyrrhetic acid reabsorbed depends on its transit through the small and large intestines, therefore patients with prolonged gastrointestinal transit times are more prone to toxicity after repeated intake)

And I’d add these as factors to consider too:

  • Someone with known high cortisol levels
  • Someone with dietary oxalate issues and/or kidney issues. Licorice tea is listed as low oxalate on the Trying Low Oxalates Facebook group but they will be updating their spreadsheet based on a paper I just shared with them – Oxalate in Foods: Extraction Conditions, Analytical Methods, Occurrence, and Health Implications “Licorice was the highest-oxalate food reported in this review with 3569.3 mg total oxalate/100 g FW (fresh weight).” (this is higher than spinach, sweet potatoes and rhubarb which are really high oxalate)

As with everything, there is no one-size fits all and we need to be diligent about what works for us and what can cause issues.

What are the lasting cardiovascular effects of high blood pressure caused by drinking up to 6 cups of licorice tea a day?

As I shared on the recent licorice-hypertension blog, high blood pressure is one of the many cardiovascular issues with licorice – Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure

In that case report, Hypertension induced by liquorice tea, a 45-year-old woman with hot flushes, sweating and headaches, was found to have high blood pressure and low potassium (mild hypokalemia) when she visited her doctor.

She had been drinking up to six cups of liquorice/licorice tea per day and within 2 weeks of stopping this, all her symptoms, the hypertension and the hypokalemia entirely resolved.

This case report is eye-opening because she had always had low blood pressure. I share more about this, my concerns and a very similar incident that I experienced when drinking Throat Calm tea – on the above blog.

What I do want to add is this woman’s concern about possible longer term effects. She says this: “I don’t know if I’ve had any lasting effects on my body by drinking this tea on a daily basis for over a year.” Hopefully her medical team explained much of what I’ve shared here and she was given a thorough cardiovascular work-up.

My cautions for consuming licorice in any form

I am of the opinion that licorice should be treated like the medicinal/therapeutic herb that it is and only be used when working with a knowledgeable practitioner.

This statement in this paper, The cardiovascular complications of licorice, sums up my beliefs:

The health benefits of licorice are minor compared to the adverse outcomes of chronic use which is never justified nor recommended. The long-established belief among the community that licorice is a natural healthy substance free of side effects promotes its liberal consumption and predisposition to toxicity.

I recommend ongoing blood pressure home monitoring if you regularly consume licorice in any form. I also recommend looking at the list of factors that may make you more susceptible to the adverse effects of licorice and discussing these with your practitioner.

I’d also encourage a thorough cardiovascular work-up for anyone who has observed high blood pressure and/or low potassium after consuming licorice for any duration. My blood pressure increased from 110/80 to 137/84 in just a week and it concerned me enough that I went to the doctor to get my potassium checked (it was in range but was only tested 10 days after I quit the licorice tea). I’ll also be discussing all this with my cardiologist and I’ll update this blog when I learn more.

Learning about all this and reading all this research – together with my personal experience and feedback from my community – has been eye-opening to me and hopefully these licorice blogs will help to create more awareness.

Has intake of licorice from tea, candy, herbal products, cough medicines and even smoking cigarettes caught you by surprise?

How much licorice did you consume and over what period?

Did you know about the caution to avoid licorice if you have high blood pressure? What about if you have low blood or normal pressure?

Are you more susceptible to the adverse impacts of licorice intake? And which factors do you suspect played a part if you had issues?

Feel free to share and ask your questions below.

Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure

By Trudy Scott 38 Comments

licorice tea and hypertension

A 45-year-old woman presented to her general practitioner with a 4-month history of hot flushes, sweating and headaches. On examination, she was found to be hypertensive, and blood tests revealed mild hypokalaemia [low potassium].

While awaiting the results of further investigation into the cause of her elevated blood pressure, the patient conducted her own research and identified liquorice tea [licorice tea] as the potential cause of her symptoms. The patient had been drinking up to six cups of liquorice tea per day as a substitute for caffeinated tea and fruit-based infusions.

The patient immediately stopped consuming the drink and within 2 weeks her symptoms, hypertension and hypokalaemia, had entirely resolved.

This case report, Hypertension induced by liquorice tea, is eye-opening because this woman had always had low blood pressure and so she ignored the small print on the box that states “not advised for people with hypertension.”

I often see this caution about avoiding licorice if you have high blood pressure (hypertension). But I have yet to see a warning on a box of tea about the fact that licorice can actually cause high blood pressure with high consumption – even when your blood pressure is low or normal. I feel the latter aspect is not as well known, which is the reason for this blog.

I’m also sharing this case report and additional information because something similar has just happened to me (more on my story below).

Here are a few more facts about this patient’s case:

  • She went to her doctor “with a history of hot flushes, night sweats and headaches. These symptoms had started over the preceding 4 months. The patient suspected that her symptoms were due to the onset of menopause.”
  • Initially her blood pressure was 162/82 and “Repeat blood pressure measurement confirmed ongoing hypertension of 150/80 mm Hg”
  • “Blood tests demonstrated mild hypokalaemia” (i.e. low potassium of 3.3 mmol/L).
  • Two weeks after she stopped drinking the licorice tea, “repeat blood pressure measurement was 128/84 mm Hg and her hypokalaemia (and other symptoms) had resolved.”

I encourage you to read the entire published case report to get an understanding of the mechanisms of licorice mediating “its effect on blood pressure via the action of glycyrrhizin on the kidney.” And the impacts on sodium, potassium, aldosterone, cortisol/cortisone and blood pressure. I will add that this is one of many such case reports in the published research.

My story with elevated blood pressure after drinking Yogi Throat Comfort tea

As I mentioned above, I’m sharing this case report because something similar has just happened to me! I had been drinking Yogi Throat Comfort tea for just over a week to soothe my throat and help after my voice loss. It contains licorice root as well as slippery elm and other herbs.

My blood pressure is typically low at 110/80 or less (sometimes as low as 102/80) and last Friday it was 130/80 which is the highest it had ever been.

I didn’t make the connection to licorice right away because I had just flown internationally from Hawaii to Australia and we were sprayed with insecticide on the plane when we landed in Australia. We all had to sit there in the toxic soup for 10 minutes. (I’ll be sharing more about all this in a future blog).

I suffered severe vertigo the next day and it was at the doctor’s office that I found out my blood pressure was 130/80. I was very surprised but he felt it could be due to the travel or vertigo or voice issues. I also know that bereavement can have major physiological impacts and increased blood pressure is one of them (I was in Hawaii for my darling mom’s memorial).

I finally made the connection when my blood pressure measured 137/84 a few days later and stopped drinking the tea immediately. Over the next few days it came down to 127/93 and then 121/90 and then 118/84.  I expect it to continue to come back down to my normal low blood pressure and will update this blog when it does.

As far as symptoms, I was just not feeling myself and had a strange feeling of apprehension, spaciness and breathlessness when talking too much. These are much improved having stopped the tea. My naturopath also recommended eating a banana each day to increase my potassium levels and to have epsom salt baths to help regulate the electrolytes in my body.

I will admit there are the above confounding/contributing factors – grief, voice loss, travel, vertigo, insecticide exposure – so I can’t be sure it’s only the licorice in the tea, and I’m not willing to test it out right now.

(Update Oct 13, 2023:  A week later and it’s now pretty much back to my usual low blood pressure. Over the course of this last week it measured 125/82, 118/91, 127/84, 118/85 and today it’s 112/85. I will continue to track.)

How much licorice tea is too much?

The authors of the above case report mention this about the dose of glycyrrhizin:

  • Experimental studies have shown that the rise in blood pressure caused by liquorice follows a linear dose–response relationship. Doses of as little as 75 mg of glycyrrhizin (equivalent to 50 g of standard liquorice confectionery) given daily for a 2-week period have been shown to cause a significant increase in systolic blood pressure (the first number).
  • In a survey of 33 brands of liquorice tea, the mean glycyrrhizin content was found to be 126 mg/L (range 2–450 mg/L). A cup of liquorice tea with a volume of 250 mL could therefore be expected to contain, on average, approximately 31.5 mg of glycyrrhizin.”
  • The European Scientific Committee on Food advises that regular glycyrrhizin doses of 100 mg/day present a risk to health, and advocate a safe average daily intake of no more than 10 mg/person/day. This is an amount equivalent to less than half a cup of liquorice tea or just 6 g of liquorice confectionery daily.

In the above published case, the patient had been “averaging around 4–6 cups per day, and had been consuming the licorice tea for about a year.” She was “unwittingly consuming daily volumes of liquorice tea containing up to 190 mg of glycyrrhizin, well in excess of the recommended limit” of 10 mg per day. It was 8 months before she started to notice the adverse effects, but I do wonder how long she had high blood pressure.

We have a home blood pressure monitor but I haven’t used it for ages and if I hadn’t gone in to the doctor for my vertigo, my elevated blood pressure may have gone unnoticed for a while too.

How much did I consume: a total of 10 Yogi Throat Comfort tea bags over the course of a week. The day before leaving I had a few cups of hot tea and was thrilled to be able to talk on my last day there.  I then drank it all day on the 15+ hour flight back: I had 2 tea bags in my 2 liter / 2 quart water bottle and filled it up a few times with cold water.  And I continued to do this once I was home, having it next to my bed if I woke up coughing in the night. I was probably getting 3 or 4 times more than the safe average daily intake of 10 mg/person/day.

I love licorice tea and drink it from time to time, maybe 2-4 cups a month. I’m quite surprised it affected me so quickly but have never consumed this amount and in such a concentrated time period.

Will I drink Yogi Throat Comfort tea or other herbal teas that contain licorice?

For now, I think I will – the Throat Comfort tea helped so much with my voice – but when I do I will monitor my blood pressure carefully and then make a final decision.

I also plan to dig a bit further into some of the confounding factors I mention above to see how they could possibly have made me more susceptible.

I do also have dietary oxalate issues so this could play into the effects of glycyrrhizin on the kidney. I’m finding mixed results on the oxalate content of licorice: some papers say high and some say low. But I didn’t have any of my typical oxalate reactions such as painful feet or eyes. I have, however, noticed some stiffness in my left hip the last few days so will be looking further into this aspect.

(Update Oct 13, 2023: Licorice tea is listed as low oxalate on the Trying Low Oxalates Facebook group but they will be updating their spreadsheet based on a paper I just shared with them – Oxalate in Foods: Extraction Conditions, Analytical Methods, Occurrence, and Health Implications “Licorice was the highest-oxalate food reported in this review with 3569.3 mg total oxalate/100 g FW (fresh weight).” (this is higher than spinach, sweet potatoes and rhubarb which are really high oxalate)

My takeaway messages – a warning and listen to your body

There is no licorice hypertension warning on this Yogi Throat Comfort tea box (or my Tulsi Licorice tea) and I do feel there should be 2 warnings: the usual warning about licorice if you have high blood pressure AND a general warning that licorice may also affect you if you have low or normal blood pressure.

My other takeaway message is this: listen to your body and get checked out when things don’t seem as they should be.

Has something like this happened to you? How much licorice tea did you consume, which brand and over what period?

Do you typically have low blood pressure and were you also caught by surprise?

Did you know about the caution to avoid licorice if you have high blood pressure?

And what about the fact that licorice may also affect you if you have low or normal blood pressure?

Feel free to share and ask your questions below.

Coconut Macaroon Mini Muffin recipe (low oxalate)

By Trudy Scott 18 Comments

coconut macaroon mini muffin

If you have dietary oxalate issues (pain, anxiety, insomnia, restless legs, hearing loss, eye issues, unresolved thyroid issues, bladder issues and more) and yet really miss the occasional muffin this Coconut Macaroon Mini Muffin recipe is a delicious low oxalate option. I see way too many so-called healthy gluten-free recipes that use almond flour and it’s concerning given that almonds are high oxalate foods. If you’re new to the dietary oxalate issues you can read more about this below. I’m finding it to be underappreciated as an issue especially in menopausal women when symptoms seem to be more severe in susceptible individuals. I have also found that using almond flour in baking affects your zinc/copper balance, increasing copper and hence causing more anxiety and even panic attacks.

If you don’t have dietary oxalate issues, you can certainly enjoy this recipe too. The addition of flaked coconut does make it similar to macaroons.

Coconut Macaroon Mini Muffin recipe (a low oxalate option)

Ingredients

1/2 cup melted butter
1/2 cup coconut sugar
4 eggs
1/2 teaspoon vanilla
1/2 cup sifted coconut flour
2 cups coconut flakes

Method

Melt the butter over low heat and add the coconut sugar. Once it’s cooled add the eggs and vanilla. Stir in the coconut flour and coconut flakes.

Spoon the mixture into a greased mini muffin pan. Bake at 375 degrees F/ 190 degrees C for 18 – 20 minutes. The muffins don’t rise at all but will start to turn golden brown. Remove and cool on a cooking rack. Makes 12 mini muffins.

Eat warm or when cooled. Serve with butter and/or cream and/or coconut butter. For a little added sweetness a small amount of raw honey can be spread on a muffin too.

coconut macaroon muffins
coconut macaroon muffins

I adapted this recipe from the Coconut Butter Cookies recipe in “Cooking with Coconut Flour” by Bruce Fife ND. I pretty much always do this when I cook – adapt recipes to my needs and likes – and always reduce the sugar. In this instance, I halved the sugar and used coconut sugar.

The original recipe does have a reduced sugar option suggesting using ½ cup of sugar and adding ¼ teaspoon stevia. I’d find this too sweet.

I decided to cook them in mini muffin pans instead of making cookies on a baking tray but you could always try this option. Use the same temperature and cooking time per the original recipe.

They were a little dry (next time I’ll use a little extra butter in the recipe) but eating them with butter and/or cream made them delicious. I tried both – I always like to include some healthy fats. If dairy isn’t tolerated, coconut cream could be substituted. I suspect coconut oil could be substituted for the melted butter but have not tried it.

cooking with coconut flour

Here is “Cooking with Coconut Flour” by Bruce Fife ND. You can find it on Amazon here (my link). I’ve baked a number of recipes from this book and I’m impressed. I really appreciate that it’s all coconut flour recipes with no almond flour or other gluten-free flours used.

It’s ideal to keep baked goods – especially the ones shown on the cover of this book – to a minimum. But for an occasional treat this recipe book is excellent.

If you’re new to dietary oxalates as a possible issue

This blog post is a helpful one to start with if you’re new to dietary oxalates and the issues they can cause: Oxalate crystal disease, dietary oxalates and pain: the research & questions

These are the common medium-oxalate and high-oxalate foods that many folks have problems with: nuts, nut-butters and nut-flour (especially baking with almond flour and something to watch when eating Paleo or GAPS), wheat, chocolate, kiwi fruit (very high – see the raphides image on the above blog), star fruit (also very high), beets, potatoes, sweet potatoes, legumes, raspberries, spinach and soy.

In the above blog post, I share an overview of oxalates, my pain issues with dietary oxalates (severe foot pain and eye pain), and deeper dive into the condition called oxalate crystal disease (with some of my insights and questions).

The big take-aways are that calcium oxalate crystals are sharp and can cause far reaching harm beyond pain – such as unresolved anxiety, thyroid issues, neurological symptoms, eye issues, hearing loss, bladder issues, headaches, fatigue, insomnia, restless legs, autism symptoms and more. You can have issues with dietary oxalates and not have kidney disease/kidney stones, although there is very little research supporting the latter.

You may find these oxalate blogs helpful too:

What dietary oxalates issues have you experienced and has a low oxalate diet helped you?

Do let us know if you make this recipe and enjoy it.

Feel free to share a favorite recipe of something you’ve adapted to be low or even medium oxalate.

If you have questions and feedback please share them here too.

Low oxalate success stories: resolution of joint/body pain, insomnia, peripheral neuropathy and can walk without a cane

By Trudy Scott 18 Comments

low oxalate success stories

I’d love to hear how switching to a low oxalate way of eating helped you. And what motivated you to go down this path? Was it pain, weakness, low energy, anxiety, insomnia, bladder issues and/or restless legs and painful feet? (or something else?) How quickly did you see results when making the dietary changes? And what would you say to someone who can’t even imagine a better, easier and pain-free life, and really doesn’t want to give up so many foods?

I’ve seen incredible results personally and my painful feet and restless legs/insomnia (and also severe eye pain in one eye) was my motivation. I’m a nutritionist and understand the power of nutrition and know what is possible. But I know it’s tough to grasp for many individuals.

I’m asking for a dear family member who uses a walker and can’t imagine life without her walker and that dietary changes could make a difference.

I posted the above on Facebook and here are some of the few incredible responses I received. I hope they inspire and motivate you if you’re just beginning this low oxalate journey, or if you have a family member you’re trying to inspire, educate and help.

Beth shared how stopping high oxalate foods – beets, sweet potatoes, almonds, swiss chard, and chocolate – enabled her to stop using her cane in just 2 weeks:

I had to use cane by the time I was 28 and could barely hobble. The pain was like ground glass in my joints. To take a flight I had to get a wheelchair at the airport and had to use the electric carts at the grocery because I couldn’t walk or stand due to the excruciating pain. This went on for a few years.

When I learned about oxalates and stopped beets, sweet potatoes, almonds, swiss chard, and chocolate and went down to only medium oxalate foods or lower, I was off the cane in 2 weeks. I didn’t know about dumping, and I got lucky, but now if I eat too many oxalates the only problem I get is pain in my fingers and toes.

I can personally relate to the ground glass pain she describes – the pain in my feet felt like a mix of shards of glass and hot coals. It’s a common description I hear from clients.

You may be familiar with the wonderful work of Beth O’Hara, functional naturopath and founder of Mast Cell 360. She shares this too: “ I see a lot of mold toxicity underlying oxalate issues due to leaky gut, nutrient depletion, and a few other factors.” 

Quick results for insomnia, bloating, stomach pain, peripheral neuropathy, body pain, brain fog, weird rashes and more

Nicola shared these wonderful results and the fact that her symptoms started to resolve quickly:

I had extremely quick results – a couple of days for some symptoms. But the thrill of the slow realization that I wasn’t actually seriously ill and brewing up ever more and newer ways to suffer, was the biggest relief. Lower stress also equals lower pain.

Insomnia first, then bloating, stomach pain, peripheral neuropathy, chest pains, body pain, swollen lymph glands, brain fog, TMJ pains, weird rashes, arthritis type pains in hands/wrists, headaches. The list is too extensive to enumerate. Suffice to say I no longer feel in imminent danger of contracting lymphoma, heart problems, Alzheimer’s etc.

I am 66 years old and I’ve only been on this TLO (trying low oxalates) journey for about 8 months or so and all those issues have mostly been resolved. Kind of magical really. Still dumping oxalates regularly as I had a long way to come having been mostly Paleo for about 8 years previously.

I think we are too quick to resign ourselves to the ‘aging’ process. I find I am getting younger by the month, the longer I am lowering oxalates. I may not look any younger, but to be living without chronic pain is quite the unexpected boon.

I have to agree with Nicola. It is quite magical to get results like this and too often we take for granted that as we age chronic pain is inevitable. As you can see from these stories it is not inevitable and you have much more control than you may realize!

So desperate with pain that she thought she was going to have to quit work

Yvonne found out she had oxalate issues after having DNA testing done. She shares this about her journey and motivation:

I had extreme shoulder pain, grainy eyes and in the end, I couldn’t take my thyroid meds without the shoulder pain or some other pain. I found my way to the group through DNA testing which …suggested that I may have an oxalate problem. I slowly started eating low oxalate, suggested by the TLO group.

I had been primarily consuming high oxalate foods trying to be healthy but my diet wasn’t diverse enough. I was eating nuts, celery, spinach, kale, chocolate and sweet potatoes.

I was cautious after going low oxalate and having my problems relieved. Over time I’ve gone back to eating medium oxalate foods and done well. I do feel like making my own kombucha and drinking it daily has helped.

Dietary oxalate issues are often worse for women as they start to go through perimenopause and into menopause because of lower estradiol levels (more on that below). Yvonne was 65 at the time.

She shares what motivated her to make changes: “I was so desperate with pain that I thought I was going to have to quit work. That’s the reason I had the DNA testing done.”

Belly pain (maybe bladder), left leg pain, scalp itch, eye stinging and itching reduced immediately

Cristina shared what she observed when switching to a low oxalate diet:

Noticed belly pain (maybe bladder), left leg pain, scalp itch, eye stinging and itching reduced immediately. But might have taken a couple of years to really unload excess oxalates. I still get the exact same symptoms if I have high oxalates, particularly carrots, potatoes and nuts.

With much appreciation for these women for sharing their stories and giving me permission to share. I do hope this is inspiring and motivating for you if you are navigating dietary oxalates and can’t yet imagine that a diet change could lead to a better life and symptom-free existence.  I’ll be sharing all this wonderful feedback with my loved one too.

Additional reading about dietary oxalates

If you’re new to the concept of dietary oxalates here are some blog posts for additional reading:

I’d love to hear how switching to a low oxalate way of eating helped you and which high oxalate foods were you eating?

What motivated you to go down this path? Was it pain, weakness, low energy, anxiety, insomnia, bladder issues and/or restless legs and painful feet (or some other symptoms)?

How quickly did you see results when making the dietary changes?

And what would you say to someone who can’t even imagine a better, easier and pain-free life, and really doesn’t want to give up so many foods?

If you have questions please share them here too.