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Oxalate crystal disease, dietary oxalates and pain: the research & questions

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oxalate crystal disease

This blog post came out of my quest for finding a medical explanation/term for my own pain caused by dietary oxalates and a desire to gain a better understanding for my clients who experience similar pain. It’s been on my writing list for some time and I’ve been gathering articles and research but the current coronavirus pandemic and recommendations for high vitamin C intake had me concerned enough to blog about it and ask for feedback from my community.

This is the blog, Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?, where I pose the question about recent increased intake of vitamin C or the addition of large doses for immune support and increased pain: joint pain, eye pain, foot pain, vulvodyndia, bladder issues, insomnia, gut pain, kidney pain, changes in thyroid health/labs, bone pain etc?  The feedback on this blog and on Facebook has been huge and confirms the connection.  Thank you if you’ve already contributed to the discussion!

Today I’ll share an overview of oxalates, my pain issues with dietary oxalates, a deeper dive into the condition called oxalate crystal disease (with some of my insights and questions), and the autism and atherosclerosis research. It’s by no means a comprehensive blog on all things oxalates but rather a way to try and connect some dots and pose some questions for going deeper.

The next blog will address my vitamin C/oxalate/pain story and the research on vitamin C, oxalates and pain, together with questions.

Oxalates defined and food sources

Before we review oxalate crystal disease, let’s define calcium oxalates. Julie Matthews, my good friend and colleague and an oxalate expert shares this in her blog, Oxalates: Their Influence on Chronic Disease

Oxalates present in our body as sharp crystals or crystalline structures with jagged edges that cause pain, irritation, and distress. They can bind with certain minerals; particularly calcium and magnesium, as well as iron and copper

You’ll find many different lists of low, medium and high oxalate foods. When I started eating low oxalate I found Susan Owen’s site simple and very helpful. I then joined the Trying Low Oxalates Facebook group for support and feedback.

In summary, these are the common medium-oxalate and high-oxalate foods that many folks have problems with: nuts, nut-butters and nut-flour (something to watch when eating Paleo or GAPS), wheat, chocolate, kiwi fruit (very high – see the raphides image below), star fruit (also very high), beets, potatoes, legumes, berries, spinach and soy.

You can see why these needle shaped calcium oxalate crystals found in kiwi fruit could inflict pain. This is just one example – there are many different shapes of calcium oxalate crystals.

raphides purified from kiwifruit
Raphides purified from kiwifruit. Raphides, needle shaped calcium oxalate crystals, were collected from kiwifruit homogenate through heavy media separation using a dense CsCl solution. (A) The SEM image of purified raphides (x400). Shared from: Synergistic Defensive Function of Raphides and Protease through the Needle Effect via Creative Commons.

My oxalate story: severe foot pain and eye pain

I personally had severe dietary oxalate issues in 2012 which manifested as excruciating foot pain. It was a combination of hot-burning-coals-pain and shards-of-glass-pain. It was just after my book, The Antianxiety Solution (my Amazon link), came out. Due to my book tours and events, I would be on my feet all day presenting, often for 3 full consecutive days, so I figured that must be the reason. When I travelled, I took a blender and made smoothies with berries, ate plenty of healthy nuts as my snacks and took kale chips with me to make sure I was getting my greens. Kiwi fruit was a favorite of mine!

I was eating a high oxalate diet and had no idea until I heard Julie present at an Integrative Medicine for Mental Health Conference on dietary oxalates and autism. A light-bulb went off and then I worked with her to learn about oxalates and figure out if it was in fact because of oxalates and sure enough, as soon as I removed high and medium oxalate foods the pain resolved. Note: the advice is NOT to remove all high and medium oxalate foods at once because dumping can occur. I was fortunate that this didn’t happen with me, possibly because of the vitamin B6 I was already taking as part of the pyroluria protocol.

When I eat a low oxalate diet I do really well. However, more recently dietary oxalates have been causing me eye pain when I have a treat like eggplant or carob. It starts out as a kind of scratchy discomfort and mild pain and then gets worse and worse. I also have 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.  I recently had one very severe incident where the eye pain in my left eye was agonizing for about 2 hours. I was beside myself and tried GABA, DPA and tryptophan for an attempt at pain relief – with no success. When I took 500mg of vitamin B6 the pain eased immediately.

The theory is that oxalates cause issues where you have a weakness. I injured my left eye walking into a low tree-branch while rock-climbing 15 years ago, so I suspect this is why my left eye is more severely affected.

Oxalate crystal disease

The condition “oxalate crystal disease” is the closest explanation I’ve found that explains the pain I’ve experienced and makes the most sense, other than the fact that all the studies mention kidney disease and yet I don’t have kidney disease and have never had kidney stones. I’ve also never had a problem with my estimated Glomerular Filtration Rate (eGFR). 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/damage.

This paper, Update on oxalate crystal disease, summarizes it:

Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium oxalate crystals within synovial fluid. This condition typically occurs in patients with underlying primary or secondary hyperoxaluria. Primary hyperoxaluria constitutes a group of genetic disorders resulting in endogenous overproduction of oxalate, whereas secondary hyperoxaluria results from gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate. In both conditions, oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is primarily renally eliminated, it accumulates throughout the body in renal failure, a state termed oxalosis. Affected organs can include bones, joints, heart, eyes, and skin. Since patients can present with renal failure and oxalosis before the underlying diagnosis of hyperoxaluria has been made, it is important to consider hyperoxaluria in patients who present with unexplained soft tissue crystal deposition. The best treatment of oxalosis is prevention. If patients present with advanced disease, treatment of oxalate arthritis consists of symptom management and control of the underlying disease process.

Let me break this down because I’ve had to look up terminology and read and re-read papers in order to get a better understanding of things:

#1 Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium oxalate crystals within synovial fluid.

Oxalate arthropathy is a disease of the joints caused by oxalates depositing in the synovial fluid of the joints.  The paper states it is a rare cause of arthritis, but I suspect it is much more common given what we’re seeing clinically.

Also, because all the research connects oxalate crystal disease with kidney disease, it may be overlooked when there is no kidney disease (more on that below).

Synovial fluid is the fluid between the joints that acts as a lubricant and nutrient source.

#2 This condition typically occurs in patients with underlying primary or secondary hyperoxaluria.

Hyperoxaluria occurs when you have “too much oxalate in your urine.”

#3 Primary hyperoxaluria constitutes a group of genetic disorders resulting in endogenous overproduction of oxalate and… secondary hyperoxaluria results from gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate.

Primary hyperoxaluria is genetic and results in endogenous or internal overproduction of oxalate, causing too much oxalate in the urine.

The secondary hyperoxaluria description mentions “gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate.”  There are a number of other factors which I’ll address in a future blog.

According to this paper and others, secondary hyperoxaluria also results in too much oxalate in the urine.

#4 In both conditions, oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is primarily renally eliminated, it accumulates throughout the body in renal failure, a state termed oxalosis.

Affected organs can include bones, joints, heart, eyes, and skin.

Mayo clinic states oxalosis occurs if your kidneys fail. “Because your body can no longer eliminate the extra oxalate, it starts accumulating — first in your blood, then in your eyes, bones, skin, muscles, blood vessels, heart and other organs.”

My comment is that in some instances, oxalates accumulate in various parts of the body without kidney failure. I share more about this aspect and what we see clinically below, plus an autism and atherosclerosis study.

This paper, Oxalate crystal deposition disease, also mentions the following: “osteopathy, acute and chronic arthropathy with chondrocalcinosis, synovial calcification, and miliary skin calcium oxalate deposits and vascular calcifications that affect mainly the hands and feet.” The paper is focused on primary hyperoxaluria (and does also discuss the kidney involvement) but I’m including it because of the conditions listed. You may have received one of these diagnoses and not linked it back to dietary oxalates and/or vitamin C intake possibly playing a role.

The authors do report “systemic life-threatening cardiovascular, neurologic, and hematologic manifestations”, saying they are rare.

Calcium oxalates: anxiety, sleep, headaches, fatigue and other symptoms

Calcium oxalate crystals can also be found in the thyroid, and ear, leading to hearing loss under some circumstances.

Julie Matthews, in her blog, Oxalates: Their Influence on Chronic Disease, also shares that

Clinical studies and anecdotal experience indicate that oxidative stress, mitochondrial disruption and damage, and nutrient depletions, trigger widely varied symptoms including fatigue and inflammatory cascades, joint pain or pain anywhere in the body. Chronic low energy is very common because of a reduction in ATP in the mitochondria. Oxalates could be a hidden source of headaches, urinary pain, genital irritation, joint, muscle, intestinal or eye pain.

Other common oxalate-caused symptoms may include mood conditions, anxiety, sleep problems, weakness, or burning feet. Indicators can be digestive, respiratory, or even bedwetting for children.

What the researchers are saying – always kidney disease

I’ve reached out to a number of researchers, practitioners and labs and they all state that oxalate crystal disease only happens with kidney disease/kidney stones. This is what one researcher shared with me: “Plasma oxalate concentrations only elevate enough to cause systemic disease when there is significant kidney disease (typically GFR <20-30). I have never seen a significantly elevated plasma oxalate without chronic kidney disease.”

Could this be the case because they are kidney specialists and therefore only seeing patients who already have kidney disease?

The good news is that a number of them are intrigued and interested in learning more.

Oxalate crystals in autism and atherosclerosis without kidney issues

However, based on my own experience and according to many in this community and other communities like the Trying Low Oxalates Facebook group, pain issues related to dietary oxalate intake may occur without kidney issues/kidney stones, and often does.

These papers offer some support for what I suspect we are seeing clinically – systemic oxalate deposits can occur deposits without kidney stones or renal failure:

Children with ASD [autism spectrum disorder] demonstrated 3-fold greater plasma oxalate levels … and 2.5-fold greater urinary oxalate concentrations. Despite significant hyperoxaluria no evidence of kidney stone disease…was observed

calcium oxalate crystals were observed within atherosclerotic plaques in the coronary arteries. Similar deposits were seen in the thyroid gland and other organs but not in the kidneys. None of the patients had chronic renal failure…. We suggest the phrase “atherosclerotic oxalosis” to describe this finding.

These are the disconnects I’m seeing in the research and questions I have:

  • Oxalate crystal disease is reported to be rare and it only happens with kidney disease/kidney stones – could it be more common than reported? As Julie states: “New science and clinical experience reveal concerns about oxalates that far exceed traditional kidney stone pathology.”
  • Should we be calling it hyperoxaluria. “too much oxalate in your urine” if the kidney is not involved? Or do we need to expand the definition of hyperoxaluria to include too much oxalate in other tissues outside the kidney and urine?
  • Could oxalate crystal disease with no kidney disease be a new syndrome that has yet to be widely and clearly identified in the research?

I mean no disrespect to the study authors and researchers by sharing my insights and questions here and in the section above.  I appreciate the work they do and the opportunity to learn from them.

Searching through the literature on this has been extremely challenging because studies always refer to the kidney. It may well be that there is a perfectly logical explanation for much of this and someone has already gone through the research and has answers to all my questions.  I am very willing to be enlightened so please do share if you’ve come across a good explanation.

Either way, please share your insights based on what I’ve shared in this blog and in relation to your experiences with pain caused by dietary oxalates and/or pain caused by vitamin C intake. I will be sharing this blog and the comments with the researchers and practitioners who are open to all this.

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

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coronavirus pain vitamin c

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.

******************

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.

Tapping (or EFT) for reducing anxiety, depression, pain and cravings, plus physiological changes in cortisol, heart rate, blood pressure and SigA

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tapping and anxiety

Awareness about tapping or EFT (emotional freedom technique) is growing and so is the research. I’ve been intrigued by tapping for some time and I’m impressed by some of the very positive feedback I’ve heard about how it reduces anxiety, depression, pain and cravings. I’m now more intrigued after reading a 2019 paper that describes some of the physiological changes (i.e. changes in the body) that improve after tapping.

This paper, Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health, describes EFT as “an evidence-based self-help therapeutic method”, reporting that “over 100 studies demonstrate its efficacy.”

It’s further described as “a brief intervention combining elements of exposure, cognitive therapy, and somatic [or physical] stimulation of acupressure points on the face and body.” The full paper here goes into great detail if you’d like to read more.

The objectives of this study were to measure and describe some of the physiological changes that occur after tapping, in order to understand some of the mechanisms. Up until now “information about the physiological effects of EFT is limited.”

As far as physiological changes, these included: heart rate variability and heart coherence, resting heart rate and blood pressure, salivary cortisol (to show changes in the endocrine system), and salivary immunoglobulin A (SigA) (to show impacts on the immune system).

They also measured these psychological symptoms: anxiety, depression, posttraumatic stress disorder, pain, and cravings. After a 4-day training workshop on tapping, the researchers reported that happiness increased by 31% and the following declines in psychological symptoms in 203 participants were reported:

  • anxiety (-40%)
  • depression (-35%)
  • posttraumatic stress disorder (-32%)
  • pain (-57%) and
  • cravings (-74%)

These physiological improvements were found in the subset of 31 participants that were tested:

  • resting heart rate (-8%)
  • salivary cortisol (-37%)
  • systolic blood pressure (-6%) and diastolic blood pressure (-8%)
  • heart rate variability and heart coherence
  • salivary immunoglobulin A (SigA) (+113%)

The authors conclude that

gains were maintained on follow-up, indicating EFT results in positive health effects as well as increased mental well-being.

If you’ve been following me for awhile you know I like to look into the research so I’m excited by this study and look forward to further research and gaining a better understanding of this tool.

I also look forward to learning how lasting these psychological and physiological changes are and if you need to keep tapping in order to sustain the changes.

Possible impacts on boosting neurotransmitter levels

Because of the psychological benefits I was also curious about the possible impacts of tapping on boosting neurotransmitter levels such as GABA and serotonin. I found this research on acupuncture which we may be able to partially extrapolate from since EFT does have the acupressure aspect: Effect of Acupuncture on Neurotransmitters/Modulators

In general, acupuncture enhances the activity of the endogenous opioid peptides, serotonin, dopamine, ACh [actelyl-choline], and inhibitory amino acids such as γ-aminobutyric acid (GABA), glycine, taurine, and lactamine, while it attenuates the activity of noradrenalin and excitatory amino acids including glutamate and aspartic acid.

Compliments the dietary/nutritional/biochemical approach

Based on what I’ve been recently learned, tapping compliments the dietary/nutritional/biochemical approach I use my clients for helping to ease anxiety, overwhelm and stress.

I reached out on Facebook and here is some of the feedback I received:

  • Maria shares how she uses both EFT and tryptophan: I started using EFT and it has helped – wasn’t expecting it to, but it really does work. However, having had a particular problem for many years, I realize that it’s going to take time to really be at the level I want to be. I also got a teenager to try it, and to their amazement, it did settle their anxiousness – from what they initially said was a 10 -11 – down to 7 in just a few minutes. Last night, I tried the Lidtke Tryptophan and couldn’t believe how deeply and undisturbed I slept – thank you Trudy – I learnt about that product from you during the anxiety summit. By the way, I will be joining the Tapping Summit – can’t wait for that one!
  • Terri Hirning is a practitioner and shares that her and her biz partner bring it to their clients in conjunction with lifestyle changes for maximum effect. She shares: I find that anxiety is a big issue for my clients. So while they are implementing dietary or supplement changes, tapping can help reduce those emotions while their biochemistry comes into alignment.

She also says: I taught it to my children and they have The Tapping Solution app and will proactively use it when they need to shift things. I am so thankful for this work.

  • Meeta Darji is a health coach and says this: YES! EFT is profound in helping with anxiety and stress. I have been doing it for the last two years and use it on my kids too. I’m training at the moment and learning how it can help with cravings and addictions. Absolutely incredible and I can’t wait to add it to my health coaching practice.

She does use amino acids like GABA, tryptophan, DPA, glutamine for anxiety and cravings/addictions and agrees that EFT is definitely a good compliment. EFT is great for using with limiting beliefs, traumas, addictions, fears and so much more, so together with amino acids, it’s very powerful.

  • Benita Scott shares this: EFT is so great! I use it as part of my professional practice as a psychologist and in conjunction with Nutritional therapies it’s a game changer for so many vulnerable clients. It’s been shown to increase GABA levels, decrease cortisol and alter brain cells in relation to food cravings too. There has been a paradigm shift in psychology recently and I think EFT, Matrix and nutritional supplements are changing how we work and heal.
  • Dede shares how EFT changed her life: I was on permanent disability for 20 years due to panic attacks. EFT changed all that so I became a practitioner. This was 11 years ago.

She shares how she went through “the literal hell of getting off psych meds. I wouldn’t have survived without EFT and food changes.”

It does seem to be very individualized and works very well for some folks and not very well or not at all for others:

  • One person said EFT is soothing in the moment but she didn’t find any significant or lasting benefits.
  • Someone else shared: I have tried it, my daughter and her son went to a practitioner, and it did nothing for me or them. I have studied how to do it on-line from well known sites, and still nothing. I’m wondering if a lot of healings are the placebo effect.
  • It doesn’t seem to work for me either (more on that below)

My tapping experience is very limited

I will admit that, at this point, my tapping experience is very limited.  I have such great success with amino acids like GABA, tryptophan and glutamine to provide quick anxiety-relief, end the overwhelm and stop the carb cravings for my clients, I haven’t felt the need to look into tapping.

In case you’re new to me and my work, here is a sampling of a few tools I use with my anxious clients:

  • My main approach is using targeted amino acids such as tryptophan or 5-HTP for the low serotonin worry-in-your-head anxiety where folks may also experience fears, panic attacks, ruminations, phobias, insomnia, PMS, anger, irritability and cravings; and GABA for the low GABA physical-anxiety that also includes muscle tension, overwhelm, insomnia and the need to self-medicate with alcohol to calm down
  • Another amino acid is DPA (d-phenylalanine) and I’m mentioning this one because it boosts endorphins (in a similar way to acupuncture) and helps my clients who are experiencing weepiness, pain and are big comfort/reward eaters. I blog about this here: DPA for weepiness, pain and comfort and reward eating)
  • Since the EFT study mentions cortisol, I’ll share one of my key nutrients for lowering cortisol – Seriphos (I blog about this here: Seriphos Original Formula is back: the best product for anxiety and insomnia caused by high cortisol)
  • And of course everything else: diet, no sugar, no caffeine, gut health, improving sleep, toxin removal and addressing all nutritional deficiencies etc (covered in great detail in my book “The Antianxiety Food Solution” and elsewhere on this blog.)

I’m getting newly acquainted with EFT

I have been hearing about tapping/EFT for years – first from Dr. Mercola and then had a group session at a conference with Brad Yates and didn’t notice any benefits. I’ve tried it again a few times and have yet to experience any profound benefits. I’d expect to be a good candidate given my history with anxiety/insomnia.

I really do like to be able to share resources and products I have experienced personally but in this instance I’m still a newbie.

As of now I don’t know why tapping/EFT doesn’t help me and some other folks. Perhaps there is a bioindividual aspect? Just like some folks do well with herbs and some with vitamins/amino acids; some folks thrive on spinach and some have oxalate issues; some folks do well with  meditation and others struggle with it; some find nature to be an elixir and others find dancing to be their magic?

However, based on what I’ve recently learned about the physiological changes and the feedback I’ve heard, I’m getting newly acquainted with EFT and it’s an additional resource I want to offer you – my community of anxious women.

Right now I’m seeing it as another tool in the toolbox (for some folks), together with dietary changes, addressing biochemical imbalances, gut health, getting out in nature etc.

Resources for additional learning

If you’re new to tapping and would like to learn more, the 12th Annual Tapping World Summit airs online Feb 24 – March 7. Here is the main summit registration page.

This is a great introductory video from summit host Nick Ortner (register to watch it and get access to the summit)

Nick has also written a best-selling book “The Tapping Solution: A Revolutionary System for Stress-Free Living” (my Amazon link)

One of the co-authors of the study mentioned, Dr. Dawson Church, is a speaker on day 1 of The Tapping Summit. The program material says he’ll be talking about latest developments in the field of scientific research into how this technique works, and why it works so well (so I assume he’ll be talking about this study). He has also authored a number of books on EFT.

I’d love to hear back from you in the comments below

  • Do you use tapping/EFT in conjunction with dietary/nutritional/biochemical changes to help ease your anxiety, stress, overwhelm? (if you’re a practitioner, do you use both with clients/patients?)
  • Do you find one approach to be better than the other?
  • Have you tried tapping without success?
  • If you’re new to tapping/EFT are you interested in learning how to incorporate it into your life?

Please share so I can learn from you and we can all learn from each other (and thanks to everyone who has contributed to the discussion already).

RICE, arnica, GABA and DPA for my sprained ankle

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sprained ankle

I’m in the USA for 2 conferences and I just spent 3 super days visiting my brother and his family in Las Vegas. We had a super hike in Red Rocks National Park.

We went early to avoid the heat and it was fabulous until I slipped on some sand when going down a steep section in the way out.

I twisted my ankle and at the time I thought this is bad! This is very bad!

It was a big relief that I was able to walk out. I walked very slowly and used my sister-in-law’s shoulder in the steep sections, always keeping my foot flat.

However when we got home I found I could not put any weight on it at all. The pain was really bad if I tried! How was I going to be able to navigate airports, hotels, conferences, speaking on stages and standing at my booth over the next 10 days?

At Mindshare I’m thrilled to have been selected to present on The Future of Health, a 5 min TEDx type talk. My topic is: Why Social Anxiety, Introversion and Loneliness can be Lethal and a Simple Nutritional Solution. It will be videotaped and I’ll be sure to share with you.

I’ve also be nominated for a Rising Tide award at Mindshare.

And I’m presenting “GABA for Anxiety, ADHD, Autism, Insomnia, and Addictions: Research and Practical Applications.”

I had to get it healed as quickly as possible!

iced foot

I pampered my foot for the next 12 hours, keeping it elevated and alternating between ice and using a compression bandage.

The RICE – rest, ice, compression, elevate – technique really does work.

I was taken care of my my darling nieces and little Rascal, the taco-terrier came to check on me from time to time.

I could not stand on my foot at all that first day. When I did need to get up, I used the crutches. I was keeping well- hydrated so there were frequent bathroom breaks.

I also used arnica cream topically and arnica orally 3 times a day.

It was pretty painful that first day so I also used DPA which is great for physical pain. I decided to use GABA too and I suspect it helped with the muscle stiffness and the pain.

By the next day I was able to walk – carefully and 2 days later I was almost walking with no limp. I did continue with all of the above too.

bruised foot

This is how my foot looks 4 days later. There is slight bruising and very little swelling. I can walk without a limp and can now wriggle my toes with no pain.

What tips do you have for a sprained ankle? And have you used a similar approach? Have you found GABA or DPA to help?

How best to use the amino acid DPA for easing heart-ache, weepiness, comfort eating and a compulsive desire for food

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amino acid dpa

DPA (d-phenylalanine) is an amino acid that destroys the enzyme that breaks down endorphins. Endorphins are feel-good chemicals that you experience with an endorphin rush when you go for a run or when someone gives you a big hug, when you show kindness to someone or an individual does something nice for you.

Taking the amino acid, DPA, as a supplement helps to raise your endorphins and helps when you feel weepy and overly emotional AND reduces the need to self-medicate with treats as a reward or for comfort. This amino acid is a favorite with so many of my clients and community because it makes them feel so lovely.

My recommendation has always been to chew the DPA capsule for the best effects and to get results quickly (in 2-5 minutes) but I’ve now changed my recommendation. Instead of chewing the whole capsule I now recommend opening the capsule into your mouth.

New DPA recommendation – open the capsule instead of chewing it

I’ve updated the Antianxiety Food Solution Amino Acid and Pyroluria Supplements blog as follows:

I used to recommend simply chewing the capsule to get the quickest and best effects and this worked well when it was produced in a gelatin capsule. Now it’s made with a cellulose capsule and chewing doesn’t work at all well, so opening the capsule (or just biting off the top) and tipping the powder into your mouth works best.

When it was in a gelatin capsule, the warmth of the mouth dissolved the gelatin and you could eat the capsule together with the DPA. With the cellulose capsule, chewing it leas to much of the DPA getting partially stuck in the chewed capsule, which is not very pleasant to chew and swallow. The DPA is simply much more palatable and effective when it’s opened up into the mouth, rather than chewed. There is one caveat – the taste of the DPA itself – but if you’ve been chewing it you’ll be fine opening the capsule going forward.

EndorphiGen

My favorite DPA product is Lidtke Endorphigen. It contains 500mg and a tiny amount of vitamin B2 and vitamin B6.

You’ll notice the bottle says: “Maintain healthy endorphin levels to ease minor pain.” Physical pain relief is one of the side-benefits of DPA, but you could easily replace this statement.

Results for weepiness and a deep heart-ache, and the taste of DPA

Missy shares how DPA helps her deep heart-ache sort of feeling:

I have found I was using this product incorrectly. If you are feeling fine, you do not feel much of anything from it. But today I was weepy and felt that deep, heart-ache sort of feeling. I chewed 1000 mgs (2 capsules) and it DID help lift that awful feeling within 15 minutes.

Notice that she said if you’re feeling fine you don’t feel much at all. This is true of all the amino acids – they only make a difference when you need them.

Missy chewed the capsule but with the new cellulose capsule it’s much more palatable when it’s opened up into the mouth. She also reported what about half my clients say:

Tastes like slightly bitter dark chocolate. 🙂

The remainder of my clients don’t like the taste at all, although many say the taste grows on them. I’ve always been in the dark chocolate camp and find it quite pleasant tasting.

If you have a really hard time with the taste of the DPA, you can mix it with a small amount of GABA powder (assuming low GABA is also an issue) or inositol powder (if low serotonin and obsessions and ruminations are also an issue) as both of these are naturally quite sweet.

Results for a compulsive desire for food

Nanner finds that opening a capsule into her mouth gets rid of the compulsive desire for food:

It really helps! Whenever I notice I am opening cupboards when I cannot possibly be really hungry, I open one capsule and pour it into my mouth, let it dissolve. I like the taste! The compulsive desire for food goes away, and I am able to re-focus my attention and get on with my day. Amazing! Now, I just need to form a new habit and remember to DO IT!!! Lol

Take note how quickly this works for her. She is actually opening cupboards and on the prowl for a treat or reward, recognizes this and has some DPA and viola, she no longer needs the sweet comfort she was seeking. In an ideal world she would be taking DPA a few times a day until she has good levels of endorphins. In this instance there would be no cupboard prowling. But as you can see, it can be used on-demand with excellent results.

DPA, glutamine, GABA, tryptophan (or 5-HTP) and tyrosine are ALL powerful for eliminating sugar cravings – is it low endorphins?

The individual amino acids DPA, glutamine, GABA, tryptophan (or 5-HTP) and tyrosine are ALL powerful for eliminating sugar cravings, often within 5 minutes. It seems that this wonderful benefit – over and above the anxiety-reducing and mood-boosting benefits – is often overlooked or poorly understood.

If you’re not certain if your cravings are comfort/reward cravings the best way to figure it which neurotransmitter deficiency is affecting your sugar cravings is to do the amino acid mood questionnaire and also review the list on this blog for further clarification: The individual amino acids glutamine, GABA, tryptophan (or 5-HTP), DPA and tyrosine are powerful for eliminating sugar cravings, often within 5 minutes

The big clue with low endorphins is that you may also feel weepy, overly emotional and sometimes experience physical pain. The emotional connection to the treat – be it chocolate or ice-cream or cookies – feels very real and very strong too and you can’t imagine having to give up this treat you clearly deserve.

Resources for you related to this blog

Here is one paper, which discusses how DPA inhibits or breaks down enkephalins (endorphins are closely related compounds) and as a result helps with depression and pain, and acts as an anti-inflammatory.  This paper, discusses beta-endorphins and the reward mechanism and how they can induce euphoria, reduce pain and ease addictions and distress. Despite that fact that this is discussed in the context of drugs and alcohol, more and more research is showing parallels between drug and food cravings.

Here is the amino acid questionnaire

You can find the DPA and other amino acid products I use with my clients here.

As always, thanks for sharing your feedback and questions on my facebook page and in all the blog comments. It allows me to write blogs like this and share your own feedback and experiences.

I have to say that I agree with Sandra’s sentiments and so do most of my clients:

Honestly I think the whole world needs this!

Do let us know if DPA has helped you with reducing weepiness, comfort/reward eating?

Has it also helped with easing physical pain too?

And have you noticed DPA works best when opened up onto your tongue? And are you in the dark chocolate camp and find it quite pleasant tasting?

Gut bacteria, pain and anxiety connections: Klebsiella and ankylosing spondylitis

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We know about the gut-brain connection where the health of our microbiome impacts how anxious or depressed we feel, but we often forget that there is a gut-pain connection too and how addressing dysbiosis and bad bacteria in the gut can have far-reaching benefits.

An old work friend recently reached out asking for help for her husband who had been diagnosed with ankylosing spondylitis, ulcerative colitis and gluten sensitivity, and was not seeing results with conventional treatment. I did some digging for them and a colleague mentioned that they had addressed Klebsiella when they discovered that her husband had genes predisposing him to ankylosing spondylitis. Read on to see what I’ve learned.

Klebsiella as a precursor to ankylosing spondylitis

The paper shared with me: The relationship between Klebsiella infection and ankylosing spondylitis, discusses the HLA-B27 gene and the Klebsiella connection:

Klebsiella-reactive arthritis is the precursor stage occurring in the early and active phases of ankylosing spondylitis.

Let’s learn more about Klebsiella, ankylosing spondylitis, the anxiety connection and prevalence, the role of neuro-inflammation and genes, the problems of a high carb diet and the role the amino acids GABA, tryptophan and DPA play in pain and anxiety relief and being able to quit the carbs easily, plus provide sleep support.

In case you’re not familiar with Klebsiella, this excellent FX Medicine article describes it as follows:

Klebsiella pneumoniae (KP) is a type of gram-negative rod-shaped bacteria that can cause different types of infections ranging from pneumonia (lung), blood infections (septicaemia), wound or surgical infections, urinary tract infections, small intestinal bowel overgrowth (SIBO), ankylosing spondylitis, Crohn’s disease, ulcerative colitis and meningitis (brain).

Ankylosing spondylitis is an inflammatory disease of the spine

In case you’re not familiar with the condition ankylosing spondylitis (pronounced like this) the Mayo Clinic site provides this summary:

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body – most commonly, your eyes.

They say there is no cure and the treatments include pain medications and physical therapy to ease symptoms (and surgery in some cases).

I’m all for physical therapy but you’ll notice there is no mention of gut health or Klebsiella. This is why we have to keep searching for root causes – and work with a functional medicine practitioner – no matter what the health condition, be it ankylosing spondylitis or anything else.

Prevalence of anxiety in ankylosing spondylitis

As with most physical conditions there is a connection with anxiety. This paper: Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in Chinese patients with ankylosing spondylitis reports that

AS [ankylosing spondylitis] patients had more severe psychological disorders, sleep disturbance, and stressful life events.

Prevalence of anxiety, depression, and sleep disturbance was 31.6%, 59.3%, and 31.0% respectively.

We have to ask ourselves if we have anxiety, depression and insomnia because of the pain being experienced or because of one or more of the root causes that contribute to both pain and anxiety.

Microbiota disturbance, neuro-inflammation, and anxiety

Often the research focuses on the former but we know that there is Evidence for interplay among antibacterial-induced gut microbiota disturbance, neuro-inflammation, and anxiety in mice. In this 2018 animal study treatment with lactobacilli suppresses this neuro-inflammation.

Ankylosing spondylitis, Crohn’s disease, genes and a high carb diet

The above FX Medicine article shares the connection between ankylosing spondylitis, Crohn’s disease and ulcerative colitis, as well as the genetic susceptibility, together with the problems of a high carb diet:

Genetically susceptible people, such as those who have the HLA-B27 allelotypes and consume a high starch/carbohydrate diet, can trigger a growth in Klebsiella in the bowel, the starch becoming a main food supply for the Klebsiella.

The amino acids for pain, carb addition, anxiety and insomnia

The amino acids come into the picture again, helping to ease the pain, provide precursors for neurotransmitter production until the microbiome is balanced, and eliminate carbohydrate cravings so they can be given up without willpower.

As always figuring out your own imbalance and doing an amino acid trial is key. Here is a summary of how they may help in this instance, assuming you have low levels of GABA, serotonin and/or endorphins:

  • GABA helps with stress eating of carbs, eases physical anxiety, eases some pain.
  • Tryptophan helps with afternoon and evening carb cravings, eases mental worry-type anxiety and depression, and also eases some pain. Both GABA and tryptophan help with insomnia.
  • DPA boosts endorphins providing acupuncture-like pain relief and provides the emotional comfort that starchy treats often do.

The FX Medicine article has treatment and prevention tips for you to share with your functional medicine doctor, who will be able to run a functional stool test such as the GI-MAP offered by Diagnostic Solutions Lab.

Just because there are these gut bacteria, pain, anxiety, Klebsiella and ankylosing spondylitis connections, it doesn’t necessarily mean everyone with ankylosing spondylitis has Klebsiella or that everyone who has Klebsiella will go on to develop ankylosing spondylitis (as stated above) or even that everyone with ankylosing spondylitis will have anxiety. I’m simply connecting some dots so you can start to think outside the box.

I’d love to hear what has worked for you or a loved one with ankylosing spondylitis and/or if you’ve seen elevated Klebsiella on your stool test or have the genetic predisposition?

Have the amino acids and a low-carb diet helped the healing process and eased some of your anxiety while addressing the underlying Klebsiella infection?