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Berberine in perimenopause and menopause: improving mood, calming the anxious mind, and improving heart health, blood sugar and bone health

May 10, 2024 By Trudy Scott 15 Comments

… Berberine, an isoquinoline alkaloid derived from plants of the generis Berberis, has been recognized as being capable of decreasing oxidative stress, LDL, triglycerides, and insulin resistance and of improving the mood. This review describes the cellular and clinical effects associated with the use of berberine, which suggest that this molecule could be an effective natural supplement to ensure a smooth peri- and postmenopausal transition.

The above is from a paper published in 2015, Potential benefits of berberine in the management of perimenopausal syndrome.

These are just a few of the many benefits of berberine. Other research reports impacts on the microbiome, benefits for bone density and kidney health – all very relevant in perimenopause and menopause.

I feel that berberine may be a nutrient to consider, in addition to dietary changes, stress reduction and lifestyle changes, and targeted individual amino acids. Read on to discover some of the mechanisms and the benefits of using a comprehensive approach, and feedback from folks in the community who are using berberine with success.

Impacts on oxidative stress, blood sugar/insulin resistance, lipids and heart health, and mood

I encourage you to read the full paper in order to get an overview of the impacts on oxidative stress, blood sugar/insulin resistance, lipids and heart health, and mood. Here is a very high level summary:

Estrogen deficiency, increased cardiovascular risk, an “overproduction of reactive oxygen species (ROS)” and reduced nitric oxide (NO) which are important contributing factors when it comes to “menopause-related endothelial dysfunction, atherosclerosis, hypertension, cardiovascular, and renal diseases.” Berberine counters this via various mechanisms.
Type 2 diabetes is higher amongst menopausal women, causing high blood sugar and insulin resistance. This paper shares a study that found berberine “significantly lowered fasting blood glucose (FBG), hemoglobin A1c, triglycerides, and insulin levels in patients with Type 2 diabetes as well as metformin and rosiglitazone.” One way berberine does this is via “increased insulin receptor (InsR) messenger RNA and protein expression.”
“inactivity of LDL receptor (LDLR)” in liver cells leads to higher levels of oxidized LDL, a risk factor for “endothelial dysfunction and atherosclerosis.” One mechanism is that berberine improves LDLR expression and has lipid-lowering activity.
When it comes to mood issues, the increased oxidative stress, immune dysfunction and inflammation play a role because of “interactions between neurotransmitters, neuropeptides, oxidative and nitrosative stress, and cytokines.” Higher levels of inflammatory markers such as interleukin-6 (IL-6), C-reactive protein, interleukin-1-beta (IL-1β), and TNFα “can enter the brain and may cause alterations of the metabolism of serotonin and dopamine.” Berberine helps to counter this inflammatory cascade and “inhibits the expression of MAO” , increasing norepinephrine, serotonin, and dopamine – and improving mood and presumably reducing anxiety too.

Berberine benefits menopause — From: Potential benefits of berberine in the management of perimenopausal syndrome

Feedback from folks in the community

When I shared this research on Facebook I received much in the way of positive results.

Susan shared this: “A functional medicine doctor suggested I take it with every meal. My A1C was not bad, (5.3) but my last level was 4.8. This was over the course of about 1 year.”

Becky shared this: “I used it for about 6 months along with diet changes to drop my A1C. Have been holding steady since with dietary measures alone. I didn’t realize berberine also helped lower LDL. Mine is slightly elevated. Not enough that my traditional MD has called me on it, but I’ve adjusted my diet again and hearing this about berberine I think I’ll try going back on it.”

Liz shared this: “I had gained some caregiver weight so started on berberine twice a day and it was helpful. However my Doc quickly had me switch over to [a combination product with berberine, chromium and alpha lipoic acid] and it’s fabulous! Twice a day and I feel great, my carb cravings are at bay and my bloodwork and overall health has vastly improved in just a few months.”

Marcy shared this: “Yes!! My son had been steadily gaining weight from binge eating and medications. In October 2022 his triglycerides were through the roof and I was so worried about his health. I put him on 500 mg of Berberine twice a day. Fast forward to today, he has lost approximately 50 pounds and his triglycerides are normal. There were other factors that may have contributed to the weight loss such as therapy and more structured eating times, but I absolutely believe the Berberine supported all this!” (this was also a combination product with berberine and a small amount of alpha lipoic acid and grape seed extract)

Marcia shared this: “I’ve used Berberine for appetite suppression, which it seems to help with, though not enough for me to lose any weight. But it did also actually lift my mood, which I was not expecting.”

Berberine: the microbiota, the gut-brain connection and anxiety

The number of studies on berberine is impressive and growing by the day. It’s not discussed in the above paper, but this paper, Effects of Berberine on the Gastrointestinal Microbiota states this: “The mechanism underlying the role of berberine in lipid‐lowering and insulin resistance is incompletely understood, but one of the possible mechanisms is related to its effect on the gastrointestinal microbiota.” Given what we know about the gut-brain connection, this is another likely mechanism for mood and anxiety benefits.

In another paper, Berberine ameliorates ovariectomy-induced anxiety-like behaviors by enrichment in equol generating gut microbiota, the authors propose that the use of berberine “modulates the gut microbiota, stimulates equol production, and improves anxiety-like symptoms” … “suggesting a direct link between gut microbiota modulation and estrogen deficiency-induced anxiety.”

Berberine: osteoporosis and the kidneys

An osteoporosis study shows that berberine regulates “the estrogen and thyroid hormone signaling pathways to treat osteoporosis in a multi-target, multi-pathway, and multi-system manner.”

And berberine used in conjunction with calcium carbonate and vitamin D, helps to prevent drug-induced bone loss too: “berberine inhibits bone resorption and improves bone formation to prevent glucocorticoid-induced osteoporosis.” I’d be considering vitamin K and other approaches like working towards optimal homocysteine, addressing food sensitivities, addressing possible oxalate and gallbladder issues too. The latter are more common during and after perimenopause.

Interestingly berberine also improves kidney health. One study reports that berberine “significantly ameliorated chronic kidney disease by altering the composition of the gut microbiota and inhibiting the production of gut-derived uremic toxins.”

A comprehensive approach that includes amino acids

As I mentioned above, I feel that berberine may be a nutrient to consider, in addition to dietary changes, stress reduction and lifestyle changes, and targeted individual amino acids. Berberine is relatively new to me and not covered in my book “The Antianxiety Food Solution” but it’s a great resource for the rest.

Here are are few blog posts specific to amino acids in perimenopause and menopause:

The good news is that the amino acids provide immediate relief while the berberine is slower-acting and starting to have an impact.

Product recommendation: Thorne Berberine

There are many good berberine products available. I did some reading and research and landed on Thorne Berberine.

It is available from my online store (Fullscript – only available to US customers – use this link to set up an account) and it’s available via iherb (use this link to save 5%).

If you’re new to berberine, be sure to discuss the research and if it may be something to consider with your practitioner.

Additional resources when you are new to using amino acids as supplements

As always, I use the symptoms questionnaire to figure out if low GABA or other neurotransmitter imbalances may be an issue.

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control (this is covered in an entire chapter too), sugar cravings, anxiety and mood issues.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the 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.

Wrapping up and your feedback

I do always appreciate feedback from the community and being able to share it on the blog.

Now I’d love to hear from you – have you used berberine with success? How much have you used, which product and how has it helped?

Were you aware of all these benefits?

Have you also used amino acids and dietary approaches as you start to see hormonal shifts?

If you’re a practitioner do you berberine with your clients/patients?

And please let me know if it’s helpful that I’m now including product recommendations and where to get them.

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

October 13, 2023 By Trudy Scott 28 Comments

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.”

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

October 6, 2023 By Trudy Scott 38 Comments

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.

Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?

May 15, 2020 By Trudy Scott 113 Comments

I have concerns regarding the use of high doses of oral vitamin C for boosting immunity – for a subset of susceptible individuals who have dietary oxalate issues. This is directly related to the many recommendations that have been and are being made in relation to the coronavirus pandemic, but it applies beyond the pandemic for anyone who has dietary oxalate issues. My concerns relate to high doses of vitamin C making existing pain symptoms worse or even causing new pain symptoms in someone who is not aware they may have oxalate problems. This may include joint pain, vulvodynia, bladder pain, painful urination, eye pain, headaches, foot pain, stomach pain, general body pain, deep bone pain etc. All this can manifest as fatigue, irritability, anxiety, low mood and insomnia.

I’ve been promising to blog about this topic for over a month and have gathered enough information for a short book! I figured a good place to start is to share feedback I’ve received so far and ask for your feedback so we can learn and heal, educate and inform others going through this, as well as offer insights to researchers and doctors who are not aware of this issue (and sometimes say “based on biology it’s not possible”).

In the coming weeks, if there is enough interest, I’ll share additional information on mechanisms, what the research says and what the research says is not possible, labs, types of oxalate issues (there are many), the possible causes (there are also many) and long-term impacts beyond pain (for the thyroid, mitochondria, heart and more), the solutions, additional resources and feedback from experts (of which there are very few – as of now I’ve been reading everything published by Susan Owens, Julie Matthews, Great Plains Labs and research published by kidney specialists).

Until then I’m humbly asking for your feedback. If you have no idea what oxalates are or are taking vitamin C with no issues, then please don’t worry. Things will become clearer as you read this blog and read follow-on blogs. I feel it’s really important to get this initial blog out rather than waiting until I have everything written up perfectly.

I’ve also been hearing feedback from folks who have now recovered from coronavirus or are still recovering, with many reporting lingering pain and fatigue. I am concerned some of that pain may be related to high doses of oral vitamin C or IV (intravenous) vitamin C leading to oxalate issues they may not be aware of.

My request to you – please share your vitamin C oxalate story

This is what I posted on facebook and I’ll simply share it again here: I’m looking for oxalate vitamin C stories to share with folks who don’t believe or are not aware that high dose vitamin C causes issues for those with dietary oxalate issues.

1) What symptoms do you experience?

2) How quickly do you notice symptoms after taking vitamin C?

3) What form of C have you tried? (ascorbic acid or Ester C or whole food sources of C like camu camu/amla/goji berry/acerola cherry/rosehips/kakadu plum/acai berry/ maqui berry or liposomal or something else). Please also share the brand and source of vitamin C if you know

4) How much vitamin C do you use and is this more than you usually take or are you/were you taking this for the first time?

5) How long did it take to get back to normal/no pain/no symptoms once you stopped taking vitamin C?

NOTE – ONLY VITAMIN C: for questions 2) through 5) – in order to be sure the new symptoms are due to vitamin C and not something else – the addition of vitamin C must be the only change made and then stopping vitamin C must also be the only change made. I have clients keep a log too and repeat the “test” if they are not sure. This can be likened to a gluten elimination trial but in reverse. Repeating the “test”also depends on the symptom severity.

6) Does/did anything help to counter the adverse effects (like calcium citrate, vitamin B6, NAC, MSM, biotin, bile support, Epsom salts baths or anything else)?

7) How long have oxalates been an issue for you and are you eating low oxalate? Or is this all new to you?

8) Would you equate the effects of vitamin C to eating high oxalate foods like spinach, raspberries, nuts and seeds, kiwi fruit, figs, turmeric, chocolate, wheat, white potato, soy, beets etc (less severe/same symptoms/more severe)?

I’m also adding these new questions based on some of the research I’ve been doing:

9) Are you aware of any kidney issues and if you get regular blood work done do you track and take note of your estimated Glomerular Filtration Rate (eGFR)? What have you observed in terms of values? (In case eGFR is new to you it measures how well your kidneys filter the wastes from your blood and is the best overall measure of kidney function. It helps determine if you have any kidney damage.) Have you ever been told you have kidney issues and have other kidney lab markers out of range?

10) What are your results on the Great Plains Lab organic acids test (OAT) for the following: Oxalic acid, Glycolic acid (glycolate), Glyceric acid (glycerate), Arabinose (a yeast/candida marker) Ascorbic acid (ascorbate, vitamin C), Pyridoxic acid (marker of vitamin B6 status), Furandicarboxylic acid and hydroxy-methylfuroic acid (markers for fungi such as Aspergillus), and markers of bacterial imbalance?

11) Do you have pyroluria (based on a urine test) or have more than 15 symptoms from the the pyroluria questionnaire and/or are susceptible to low vitamin B6 (poor dream recall and/or nightmares) and low zinc (and therefore high copper)?

12) How do you score on symptoms of low serotonin, low GABA, low endorphins and low catecholamines? (here is that questionnaire). Is your anxiety, low mood, cravings or sleep worse when you are dealing with your other oxalate symptoms/pain?

13) Do you have any genetic markers that indicate a susceptibility for oxalate issues?

14) Do you have celiac disease, gluten sensitivity, leaky gut, liver issues, gall stones, no gallbladder, poor bile production, fat malabsorption, mold toxicity issues, low pancreatic enzymes, candida, high iron/ferritin?

15) What are your results on a mold toxicity test such as the Great Plains MycoTOX profile? and/or do you live in a moldy home/worked in a moldy environment or have in the recent past?

16) What are you results on a stool test (and which stool test)?

17) Do you have high mercury, high lead or high levels of other metals?

18) What is your vitamin D level (now if you happen to know it and/or typical levels in the past) and did you start to take extra vitamin D during this pandemic too? If you are taking extra vitamin D how much extra? And does your vitamin D supplement also contain vitamin K1 and vitamin K2?

19) Do you have any other out-of-range (functional levels) markers on blood work or other lab tests?

I will come back and add references and the rationale for posing these questions.

Also, feel free to comment with a nickname to keep your health information private.

Josefin’s story: painful “fat tissue” around elbows, knees and hips, and an irritated bladder

I share some of the Facebook feedback below, but first, here are Josefin’s comments on my coronavirus blog. Josefin thanked me for not ignoring the oxalate problems that might come with higher doses of vitamin C, saying she has “experienced them first-hand and it is not something to take lightly.”

I asked her to share what happens when she eats medium and high oxalate foods (like spinach, nuts, kiwi fruit, chocolate etc). She shared this:

I gradually decreased my oxalate content in food as recommended in the TLO-group. During that year I experienced periods with a lot of the typical dumping-signs like sandy stools, pain in body and especially in joints and muscles, sand in eyes, bladder pain, peeing a lot, cravings for oxalate foods and a temporary relief in the dumping symptoms when I ate some higher oxalate foods.

I also realized that the painful “fat tissue” that I had all over the body (but mainly around elbows, knees and hips) for 10 years was really deposited oxalates with mostly fluid around it, since I lost it more and more while I dumped and had more pain there also when I dumped. Now the deposits are all gone.

I did want to know if the adverse symptoms she experienced with vitamin C were the same as when eating foods high in oxalates, and she confirmed they were:

Many of the symptoms of dumping were the same as I had previously experienced a few days to weeks after trying to do bowel flushes with vitamin C.

Josefin has been on a low oxalate diet for 3 years and has found the most vitamin C she can tolerate is 200-250mg of vitamin C per day. More about that in her own words:

Now after being on a low oxalate diet for 3 years (carnivore the last year) I have tried taking vitamin C very many times and come to the conclusion that about 200-250 mg per day is what I can take. If I take more I will get a gradual increase of that painful fat-tissue that will start after a few days to weeks depending on how much vitamin C I take. I will also get more of a flu feeling and irritated bladder.

When I stop taking the vitamin C I will within a day or two get all my typical dumping symptoms and they will continue for days to weeks depending on how much I have taken. Symptoms severity also depends on how much I have been taking.

It turns out she gets similar reactions with various forms of vitamin C: “ascorbic acid, calcium ascorbate, multimineral buffered ascorbate and also liposomal vitamin C from Quicksilver Scientific”.

Syd’s story: cystitis, along with a crashed brain

Syd shared this on the Facebook post:

I get symptoms from taking high dose Vitamin C within about 45 minutes. It shows up as cystitis, mostly, along with a crashed brain.

She did confirm that when taking vitamin C (possibly the ascorbic acid form) the symptoms mimic her symptoms when eating high oxalate foods. She also wants to try liposomal vitamin C and camu camu to figure out if she gets the same reactions:

I have the very same response to high oxalate foods. I used to think it was a bladder infection, but I tested four times and every time the test was negative. I’m having a response at the moment. I (stupidly) started eating protein bars that have nuts in them and after eating about four of them across several days, I have the cystitis symptoms.

I’m staring at some liposomal Vit C in the fridge that I’ve been wanting to try at a low dose. Same with some camu camu. I need the cystitis symptoms to abate first.

Virginia, Cathi and Melissa and their pain stories

Virginia also offered feedback on Facebook on her experiences with vitamin C, and again they are similar to when she eats high oxalate foods:

I took a pack of Vit C 1000mg (ascorbic acid) at night last week, next morning I noticed oxalate dumping. Took calcium citrate and it was gone within a day and yes the reaction is similar to eating high oxalate foods

On another Facebook thread my question got Cathi wondering if vitamin C was a factor in her worsening arthritis:

Hmmmmmm this has me thinking. I started Vitamin C crystals 1000mg a day – small spoonful in water. It is sour and not awful. Then, a couple of months ago the arthritis deposits in my right hand fingers got much worse and my right wrist has given me so much grief I have had to reduce my yoga. And I got a weird cyst or something on the inside of my right wrist. I wonder…. Gonna stop it and see if it makes a difference!!! Thank you as I was totally stumped and I hope this is the answer!!!!

On this same thread, Melissa shared that noticed severe joint and muscle pain within 2 or 3 days of starting vitamin C:

When the COVID stuff started, I started taking vitamin C as a preventative measure to keep my immune system strong. Within two or three days, I had system joint and muscle pain everywhere. I could hardly move! I stopped the vitamin C and it cleared up in 3 or 4 days. I’ve never had kidney stones, but my brother has, so maybe it’s a genetic predisposition? I do have a history of on & off systemic joint pain since my early 20’s.

I never thought I had oxalate issues but now I’m wondering if it might be related to my random systemic joint pain.

I was taking between 1,000 to 3,000 mg per day. The label says Solaray timed release vitamin c (ascorbic acid), acerola cherry and rose hips.

Thanks to these folks, everyone who has already contributed on other blogs, all the Facebook feedback (and to you if you provide feedback today).

My hesitation – I don’t have all the answers and we are in the midst of a pandemic where vitamin C is so important

I planned to include this in part 2 but I’m adding this section now because a few hours after publication there are already so many comments and questions. I did hesitate about publishing this blog when I don’t have all the answers and because we’re in the midst of a pandemic where vitamin C has been shown to be very important.

There is plenty of research on the benefits of vitamin C and it’s widely used with much success during serious illness and for sepsis. This paper, An Update on Current Therapeutic Drugs Treating COVID-19, published just last month, discusses vitamin C (ascorbic acid) as a supporting agent, playing a role as a potent antioxidant, with benefits for immune health and as an antiviral against flu viruses.

It also discusses an IV vitamin C coronavirus trial and high dosages currently being used in various hospitals for this virus. The authors do also say “no major side effects” which is what we are typically told about vitamin C.

The Orthomolecular Medicine News Service have issued a number of valuable press releases on vitamin C specific to coronavirus but they are steadfast in their conviction that there are no issues with vitamin C, saying it doesn’t cause kidney stones.

For the majority (I think) there will be no major side-effects but for those with oxalate issues high doses of vitamin C are clearly problematic.

One caveat is that there may be a place for short-term high-dose use during a healing crisis, even for someone with dietary oxalate issues. Unfortunately I don’t have an answer for this aspect yet and I’m hoping a vitamin C expert will contribute to the discussion or I’ll discover some research about this.

And let’s not forget this study published in 1994, The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections, where 200mg of supplemental vitamin C per day resulted in an 80% decrease in deaths among severely ill, hospitalized respiratory disease patients.

This topic is near and dear to my heart and folks have oxalate issues now so I decided to go ahead and publish this information. I’m looking for a solution for my community who are already aware they have oxalate issues (many of you have already reached out to me so thank you) and for myself too. I’ll share details of my oxalate story (my pain is in my feet and my eyes) and my vitamin C experiment in a future blog (I used food based vitamin C and 100-200mg/day and it didn’t go well).

As I mentioned above, I’m also concerned there are many people who don’t know they have oxalate issues and may end up with issues because of all the well-meaning vitamin C advice that is being shared during this pandemic.

I may have bitten off more than I can handle with this topic – I’m learning voraciously and it’s like drinking from a fire-hose! But I’m doing what I often do … I learn by teaching and asking for your feedback and questions, and I’m open about the fact that I’m not an expert and don’t have all the answers.

**** Some cautions *****
Please discuss your situation with your doctor and other health practitioners before stopping or reducing vitamin C based on what you’re reading here.

If you are completely new to the topic of oxalates, this is sound advice from Susan Owens on getting started: “work your way gradually into a completely low oxalate diet.” You can learn more on getting started here. Susan runs the Trying Low Oxalate Group (TLO) on facebook and they are extremely helpful. I will be sharing additional resources/studies/practitioner feedback etc. but this will get you started.

A reminder that pain can have many root causes other than dietary oxalate issues (or in addition to oxalate issues): gluten issues, nightshades, low GABA, low serotonin, low endorphins, Lyme disease (bartonella can cause foot pain), fibromyalgia, low B12, heavy metals, mold toxicity, autoimmune conditions etc.

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Feel free to comment below – share your feedback and ask your questions. And do let me know if you’re interested in learning more about this topic and additional blog posts.

If you’re a practitioner who works with individuals with dietary oxalate issues I’d love to hear from you too.

Read all posts in this series: