The Low Oxalate Diet in Autism : Understanding the Research and Clinical Changes

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Widening Our Understanding of What Changes on the
Low Oxalate Diet Susan Costen Owens, MAIS
The Low Oxalate Diet in Autism Understanding
the Research and Clinical Changes
C2 O4
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What is oxalate?

• Oxalate 2 carbons 4 oxygen atoms
• Plants use oxalate
• To sequester and store excess calcium.
• To make crystals that catch light for
  photosynthesis.
• To form sharp edged crystals to defend themselves
  from predators.

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ie
How many with autism have elevated oxalate in the
urine?
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84 had levels two standard deviations above a
reference range set by measuring normal control
children.
Caveat Since these are ratioed to creatinine,
ages should be separated.
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OUTSIDE STANDARDS FOR OXALATE IN URINE RATIOED TO
CREATININE
InterpolatedAGE HIGH 1      138 2      101
3        91 4        88 5        84 6       
81 7        77 8        74 9        70
10      67 11      64 12      60 13      57
14      53 15      50 16      46 17      43
AGE                millimoles of oxalate per mole
creatinine                        low    
mean      high 1-5 months        63    
144        226 6-11 months      50      
113       176 1 year              50        
94       138 2 years             38        
69       101 3-4 years          25        
57        88 5-6 years          25        
50        75 7-17 years        13         
38        63 Adult               26         
31        36Urivetzky et al., J Urol.
1987 Source Matos V, et al. American Journal of
Kidney Disease, 1999.
WARNING!!! Secretion of oxalate to urine may be
impaired in autism due to the sulfate deficiency.
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Environmental insult in genetically susceptible
child
Years ago, Andy Wakefield proposed a gut/brain
connection in autism
Kalle Reichelt Robert Cade Paul Shattock
OPIOIDS
Gut infection damage
This was the theory behind the improvements seen
on the gluten and casein free diet.
Impaired metabolism and increased absorption of
gut-derived chemicals
Direct influences on brain growth behaviour
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After years of doing and evaluating autism
research, one question haunted me
Was there something else we didnt know about
that was causing or prolonging the injury to the
gut, keeping it so inflamed and in so much pain?
About three and a half years ago, I learned that
a toxin from plant food, called oxalate, had been
found to be the cause of pain that would resolve
on a low oxalate diet.
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• Vulvar Pain Foundations Pain project
• 15 years--- 1500 women with chronic vulvar pain.
• Findings
• Oxalates from the diet getting to other tissues
  through circulation can damage GAG layers in
  those other tissues.
• The effect of oxalate often was pain.
• Reducing dietary oxalates could resolve the pain.
  
• After reducing oxalates,women experienced the
  resolution of other chronic and painful
  conditions such as chronic fatigue, fibromyalgia,
  interstitial cystitis, and irritable bowel
  syndrome.

Dr. Clive Solomons
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• Could oxalates be causing the pain and prolonged
  irritation of the gut in autism?
• In late May of 2005 we tested seven children at
  the Solomons laboratory.
• Like the vulvar pain patients, their oxalate
  levels went high into abnormal ranges at
  different times of day.
• Parents were asked to write down the timing
  of bad behavior or pain in these children on the
  day of testing and to try the diet if the levels
  coming back from the laboratory were high.

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On the diet, urinary issues were improving if
they were there, but much more was changing in
these children besides alleviating pain and
behavior issues.

• Improvements in gross and fine motor skills
• Improvements in expressive speech
• Improvements in cognition--expression of complex
  thought
• Resolution of lifelong diarrhea and/or
  constipation
• Resolution of chronic problems with candida and
  dysbiosis
• Ability to tolerate more foods
• Improvements in urinary issues--frequency,
  urgency
• Improvement in growthcatch-up growth
• Improvements in pain--GI, leg, feet, headaches,
  vulvar, penis
• Improvements in mito kids with energy
• Improvements in distended bellies, and more.

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Are previous injuries to the gut prolonged by
oxalate?
Once inside cells, oxalates can turn on
inflammatory factors like Cox-2, arachidonic
acid, and NF-KappaB and can cause lipid
peroxidation and a depletion of glutathione.
Excess oxalates can also cause the immune system
to lose its ability to recognize
lipopolysaccharides. These are molecules that
identify bacteria and fungi to the immune system.
Does that lead to dysbiosis? By changing
calcium signalling in the gut, could oxalates be
part of what creates problems in digestion and
motility?
Not many children with autism have urinary issues
or kidney stones. Does autism involve some
difference in the way oxalate is handled? Are
the kidneys spared at the expense of the
intestines and perhaps the brain?
What about the brain? Is there something about
autism that makes the brain more vulnerable to
oxalate damage?
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B

Why were these improvements happening?
When we saw how much our first LODers began to
change neurologically, we had to wonder Could
oxalate have gotten into the brain in
autism? Was the diet helping it leave the brain?
The oxalate scientists who study oxalate-induced
kidney disease asked us Why doesnt oxalate
commonly get into the brain in kidney disease?
What about autism might make oxalates go into
places they dont commonly go in oxalate-induced
kidney disease?
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Blood Brain Barrier
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What is not protected by the blood brain barrier?
The pituitary (master gland of many hormones) The
pineal gland (where sleep is regulated) The tuber
cinereum (which is involved in regulating
histamine in the brain in a way that also
influences diurnal rhythm and The area postrema
(which detects toxins in the blood, and induces
vomiting).   Is there a disease that may be
related to oxalates that has these problems but
is not autism?
AVP
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on
We have learned a lot from people with
fibromyalgia!
There is a connection between nighttime pain and
disrupted sleep that goes beyond the perception
of pain. Disruptions of hormones and their
regulation by the pituitary can cause all sorts
of downstream effects. Insufficient research
informs our understanding!
This condition is teaching us that we will have
to look at the connections between Vitamin D,
cortisol, T3(calcitriol) and Vitamin A.
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FAT maldigestion? hyperabsorption of oxalate
?poor absorption of
Vitamins A, D, E K
(This is helped by lipase, ox bile, or
taurine). Gut inflammation also compromises
absorption.
An hour in the sun can yield more vitamin D than
a bottle of tablets!
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PTH
Oxalate
Our experience with fibromyalgia raises
suspicions that more research should be done on
how oxalate inserts itself into calcium regulation
Calcium
PTH
Pain
AVP
Vit D
Vit K
There is no evidence that Vitamin K has anything
to do with the absorption of oxalate, so
megadosing Vit. K cannot replace the diet.
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v
Two octapeptides acting in the pituitary differ
only in two amino acids! Both may be very
disrupted by oxalates because the function of
both seems to be restored by LOD!!! During
dumping, arginine is an AMAZING alleviator of
pain. Is it AVP? The biggest changes in autism
have been in sociability, which is oxytocins
turf! Both octapeptides contain two cysteines
that find each other.
Arginine Vasopressin
Oxytocin
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What would compromise the blood brain barrier in
autism that wouldnt happen in those whose
oxalate came from a defective liver instead of a
leaky gut?
One difference could be the molecule ZONULIN It
acts on the BBB and on the gut, opening up the
barriers. This immune factor is released by
cytokine activity by an activated immune system.
VACCINES???
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The Progression of Damage That Weve Learned
from Celiac Disease
Fasano Exposure to Gluten (and apparently other
proteins?)? Increases Zonulin ? Zonulin opens
tight junctions-? Leaky gut ? ???
(oxalate?calcium depletion of GAGS?)? Damage to
glycocalyx ? Impaired disaccharidase activity,
easier colonization by bacteria Autoimmune
destruction of villi in celiac-prone haplotypes
(genetically-prone)
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Environmental insult in genetically susceptible
child
Zonulin can open up the blood brain barrier. That
means oxalates may get in the brain when the
immune system is invoked or with exposure to
gluten!
Gut infection damage
OXALATES
Impaired metabolism and increased absorption of
gut-derived chemicals
Direct influences on brain growth behaviour
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Other research showed Exposure to excess
oxalate in other tissues ? leaky epithelial tight
junctions If this happens in the
bladder it might cause the pain and condition
called interstitial cystitis. How would you know
if your child had this pain? Do children who have
lived with chronic pain all their lives recognize
it as pain? Is getting relief from chronic pain
one of the things that helps them want to
interact more with their world and make them able
to identify the location of acute pain?
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Oxalates that are outside of cells generally
ignore healthy cells and go somewhere else. What
would make an oxalate molecule bind and enter a
cell?
Cell interior
Cell exterior
This is how oxalates find and bind sick and
injured tissues and then enter the cell and
modify the cells chemistry, further turning on
inflammatory factors.
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Oxalate may also enter tissues that are looking
for sulfate because the door for sulfate cannot
tell the difference between sulfate and oxalate.
Ca
Autism is a condition where sulfate is often
quite low. (R.H. Waring) This could explain why
oxalate would go to places in autism it wouldnt
go in other conditions.
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When oxalate levels within cells becomes
excessive, then this can lead to two processes of
cell death APOPTOSIS And NECROSIS. These two
types of cell death can open up the barriers in
the gut or the brain by making holes in the
membrane.
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But what besides the immune factor zonulin can
create the Leaky Gut?
Calcium in the gut becomes part of a zipper that
operates in the space between cells, closing the
leaky gut.

• Two things have been shown to keep calcium from
  reaching the zipper to close it
• Calcium getting tied up by maldigested fat, ie,
  steatorrhea.
• Calcium being tied up by oxalate from two
  sources
• a. From food
• b. From oxalate that gets secreted
  into the gut by intestinal cells trying to rid
  the blood of excess oxalate.

This is why we recommend splitting the days RDA
of calcium between the meals you eat without
vitamin D, because the vitamin will make the
calcium cross the membrane and leave the oxalate
free to be absorbed.
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m
If cells in tissues in other parts of the body
are damaged by oxalate, and cells spill their
contents, could this exposure to molecules that
are usually inside cells kick off the production
of autoantibodies? If this keeps happening,
could it create autoimmune disease?
Diabetes? Myelin Basic Protein? Glial fibrillary
acidic protein ? Celiac Multiple
sclerosis Graves disease Hashimotos
thyroiditis Lupus
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Oxalate in small amounts is NORMAL to our cells
because our bodies actually make a small amount
of oxalate.. The only positive role known for
oxalate is its regulation of the level of calcium
that is stored in the endoplasmic reticulum.
Cell signalling
Life Cycle
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Do animals and humans make oxalates?

• Yes--- from carbohydrate, protein, and even from
  fat!
• Vitamin Deficiency ? Trouble with certain enzymes
  that need the vitamins as cofactors.
• If you lose enzyme function ?certain chemicals
  are no longer metabolized correctly. Those
  chemicals will be sent down alternative pathways.
• It ends up that certain alternative pathways for
  enzymes that use B6, thiamine, AKG, or magnesium
  make HUGE amounts of oxalate.

The toxicity of oxalate is why the body tries to
keep oxalate levels very low all over the body.
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On
Genetic hyperoxluria The liver produces oxalate
itself in such high quantity that the oxalate
gets in blood then all over the body The damage
is called oxalosis. After liver
transplant Oxalate in in blood and urine go way
up instead of down! This lasts months to a year
or more before the levels will decline and become
normal.
Scientists discovered that oxalates were being
released from tissues all over the body and this
was in organs that had been having diminished
function. The tissues would HEAL after they
released their excess oxalate which is what gave
us hope that the brain would heal if it had
gotten damaged by oxalate.
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OXALATE DOES NOT JUST AFFECT THE
KIDNEYS!!! Doctors doing biopsies or autopsies
of kidney patients and random controls found
oxalate crystals in kidney, thyroid, liver,
neurons, blood vessels, heart, brain, and in both
the bones and the bone marrow and even in the
eyes. In HIV, even the inside of the eyeballs
were full of oxalate! This is likely why we see
the diet affecting children globally! You will
be surprised to see later in the lecture how many
areas parents have seen improvements. BUT!!!! T
he improvements make total sense when you know
HOW oxalate impairs organ function.
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Law of physics-? chemicals will move from an area
of higher concentration to an area of lower
concentration. When there is a barrier like a
cell membrane, things have to even out by using
transporters.
When the oxalate outside a tissue gets lower than
the oxalate inside ? oxalate dumping The
dumping is why we think the diet works. Our
experience is that you dont see the BIG WOWS
in healing on LOD until you go low enough to
dump.
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Many people on the diet have a few days of
glorious improvements followed by their first
dump. (We call these wonderful days the
honeymoon.) The negatives are very similar to
what showed up in kidney transplant patients.

Odd white rashes Livedo
reticularis
We saw problems in autism, though, that had not
been described in the literature but these were
problems that later cleared up in the same
children, like Behavioral issues Speech problems
Increased diarrhea w/ undigested food Stools
full of sandy crystals like some people saw in
the secretin trials.
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We havent seen any difference between the
symptoms of dumping and the symptoms that were
caused by oxalate in the first place. The
symptoms come from cells expressing their
unhappiness about the excess oxalate.

Tell this news to people who tried
LOD and got
negatives and decided to quit! The negatives
were the sign that the diet was relevant and
working! What processes in the cell would
oxalate break if it got too high?
Mainly, ENERGY!
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WHY DO WE SEE SO MUCH INCREASE IN ENERGY?
Oxalate impairs glycolysis at the pyruvate kinase
step.
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Oxalate impairs the citric acid cycle by shutting
down the activity of pyruvate carboxylase. This
enzyme uses acetyl-CoA to supply oxaloacetate to
the cycle. This loss is yet another drain on
cellular energy.
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Succinate dehydrogenase is impaired by oxalate,
which kills its function in both the citric acid
cycle and in the electron transport chain.
RESULT LOW
ENERGY
Someone has calculated that people resynthesize
the equivalent of their body weight of ATP in one
day and this is what they use for that days
energy. This brings home what even a minor glitch
in this system would do! Dicarlo Collins, 2001
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Oxalate impairs gluconeogenesis, a process in the
body where it purposefully breaks down the
protein in muscle to provide a raw material for
the liver to make glucose. If oxalate impairs
this process in the liver ---gt Futile cycling
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n
Please note the impairment of these enzymes is
happening in the mitochondrion and would lead to
what might be recognized clinically as
mitochondrial disease! OXALATE? CELLULAR DISTRESS
AND OXIDATIVE STRESS

• This will
• deplete glutathione
• turn on inflammatory cycles.
• The increase in oxidative stress may lead to
  alterations in mtDNA that have been
  well-described as occurring and as accumulating
  during life.

it can be concluded that mitochondrial damage is
an essential event in hyperoxaluria Veena et
al., 2008.
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be
Consider this when thinking about the recent
vaccine court award made to a child who developed
clinically relevant mitochondrial issues and
autism after vaccine. Years later she was found
to have a gene defect that she shares with her
mother Her mother, however, all her life had
apparently shown no evidence of mitochondrial
disease!
Is it relevant that this child started developing
ear infections, was treated with antibiotics,
developed GI symptoms, and urinary symptoms in
the months after a round of vaccines she received
when she was sick and had eczema. What about
this combination (what mechanism?) pushed her
over the edge and into a condition where
mitochondrial issues were thought to be
clinically relevant to her development of autism?
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HOW IMPORTANT ARE THE MICROBES IN THE GUT?
Some of our microbes in the gut protect the gut
from oxalate by actually digesting oxalates
(which we cannot do).
Many studies have shown oxalate-eating microbes
are missing in those who develop oxalate-related
disease in the kidneys. The most important is
the anaerobe oxalobacter formigenes that is
dependent on oxalate. People who can tolerate
high oxalate levels in foods on the SCD or g/f
c/f diet may still have enough oxalobacter to
degrade the oxalate! They may also be able to
lean more on probiotics like acdophilus and
bifidus which CAN digest oxalate, but the oxalate
these microbes eat may make them sick and die!
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O
Does the gut become injured when the flora has
been changed by excess use of antibiotics?
How many children with autism acquired a
weakened immune system after vaccines leading to
chronic earaches that were treated with multiple
rounds of antibiotics? What about babies whose
mothers were treated with antibiotics
perinatally?
Fluoroquinolones CiprofloxacinEnoxacinGrepafloxa
cinLevofloxacinLomefloxacinNorfloxacinOfloxaci
nparfloxacinTrovafloxacin
These antibiotics kill oxalobacter
Miscellaneous chloramphenicol nalidixic
acid co-amoxiclav (Augmentin)metronidazole
(flagyl)
Macrolides AzithromycinClarithromycinClindamycin
ErythromycinLincomycin
Tetracyclines DemeclocyclineDoxycyclineMinocycli
neOxytetracyclineTetracycline
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COMING SOON!!!!!
Oxabactis an oral product consisting of
lyophilized live Oxalobacter formigenes cells,
which is an oxalate-degrading bacterium isolated
from human gut formulated in enteric-coated
capsules. This bacterium can regulate both the
dietary and endogenous components of the systemic
oxalate in humans. The product supports long-term
perpetual degradation of oxalate in lower
GI-tract and promotes removal of endogenously
produced systemic oxalate through enteric
elimination. Pilot Phase I/II studies have shown
promising results with significant plasma and
urinary oxalate reduction in PH patients.
VSL 3 Our mainstay probiotic that helps
degrade oxalate with acidophilus and
bifidus. Dont start the diet without such a
probiotic in place!
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Pyruvate carboxylase is only one example of the
class of enzymes that use biotin (called
carboxylases) and will be impaired in an
environment where oxalate is elevated in
concentration.

• Look for signs of carboxylase deficiency
• candida,
• hypotonia,
• ataxia,
• hearing loss,
• skin rash,
• hair loss,
• seizures,
• encephalopathy,
• neurodevelopmental delay.
• motor limb weakness,
• loss of visual acuity.

BIOTIN
Biotin supplements can minimize the damage from
oxalate to carboxylases.
Sulfa Drugs Co-Trimoxazole Trimethoprim Trime
thoprim/ -Sulfamethoxazole Cephalosporins Cefpro
zil Cefuroxime Loracarbef
Antibiotics that kill biotin producers
Penicillin Derivatives Amoxicillin Amoxicillin
and Clavulanate Penicillin V Potassium
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e
Oxalates cause lipid peroxidation and a depletion
and oxidation of glutathione. Both of these
issues are what scientists measure to quantify
oxidative stress. The radicals formed this way
can damage DNA.
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Excess oxalate can disrupt cell signaling if it
doesnt cause cell death.
Examples? Growth hormone --- Catch up growth
Thyroid hormone --
Thyroid resistance
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Oxalate also binds to histones (which organize
DNA) and there are oxalate binding compounds in
the nuclear pore. The significance of this
binding is not yet understood.
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Oxalates structure also makes it a chelator of
minerals. Calcium Zinc
Cobalt Iron
Magnesium Manganese It also
binds minerals that are toxic Aluminum The
strongest bonds are to Mercury
Lead At this point the only salts that have been
studied biologically are calcium oxalate! We
dont know how to recognize anything
else. Oxalate may strip the minerals from
glycoaminoglycans, harming their functions in the
body.
Iron Oxalate
Calcium oxalate
Cobalt oxalate Zinc oxalate
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Oxalate will also get into the transferrin
molecule that brings iron into the cell, and can
make the iron where it cannot be unloaded and
used. This may explain why some children have
solved their anemia by LOD when it wouldnt
respond to iron supplements.
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So, why and when do we need to restrict oxalate
from the diet?
Normally only 1-2 of the oxalate in food is
absorbed during digestion. If calcium in the
food binds free oxalate before it gets to the
colon, neither the oxalate nor the calcium will
be absorbed.(80 of calcium isnt absorbed
normally.) We dont know how well taking calcium
works if you still have gut inflammation or a
leaky gut.
Foodside
Blood side
Oxalate leaving with stool
Oxalate Absorption occurs with inflammation
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Two places collect, concentrate and secrete
excess oxalate
We also wonder about the lungs and the skin!
Kidney advantage Oxalate will leave the body in
urine Gut advantages 1. Oxalate will leave
the body in feces if it doesnt get
reabsorbed.
2. Special gut bacteria can break
oxalate down into
something harmless Our parents and other
listmates are totally changing our views of these
systems because of what they are seeing change on
this diet!
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Remember how the kidney and gut concentrate
oxalate? To do this, they have special jobs in
regulating the movement and the disposal of both
oxalate and its cousin sulfate.
secretion
Basolateral side Blood side
Apical side Food or urine side
Absorption or reabsorption
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Can oxalate be a problem even when urinary tests
look OK? What do we know from responders?
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So, how does that work when oxalate in the blood
has to get inside the cell before it can leave
the cell (becoming part of urine) in trade with
something else that was already on the urine side?
Lack of sulfate may mean that oxalate cannot be
secreted normally.
Oxalate in urine
Apical side Food or urine side
Basolateral side Blood side
This is why urinary tests may not adequately
quantify the present burden of oxalate in the
blood and body for those who have sulfation
problems.
Oxalate in blood
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Hatch and Freel are a husband and wife team who
study the transport of oxalate in the gut and in
the kidney. This team and Dr. Daniel Markovich
have found that most oxalate transporters
exchange sulfate, chloride, bicarbonate, or
even the drug salicylate. or oxalate .
Dr. Hatch elevated blood oxalate ? signal to
the gut to import oxalate from blood? secrete
oxalate to the gut ?where microbes can degrade
the oxalate. Probiotics appear to encourage this
process. Could this explain the diarrhea we
see with dumping?
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Remember how the kidney and gut concentrate
oxalate? To do this, they have special jobs in
regulating the movement and the disposal of both
oxalate and sulfate.
secretion
Basolateral side Blood side
Apical side Food or urine side
Absorption or reabsorption
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Freel and Hatch found that oxalate secretion into
the gut was regulated by some of the same
molecules that are used to govern our appetite
for salt and water. These also are the same
molecules that affect the dilution of our urine.
Many of the children on the low oxalate diet who
loved salt in the past are starting to ignore the
salt shaker.
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T
With the improvements in sleep we have been
hearing are taking place on the LOD, we are
starting to study how oxalate may change the
chemistry involved in inducing deep sleep (a
problem that may be shared with fibromyalgia.

• Too much oxalate reaching the unprotected areas
  of the brain may disrupt circadian rhythms and
  the regulation of hormones.
• Our project hopes to follow up on how it effects
  sleep and pain regulators
• delta sleep inducing peptide
• gamma hydroxybutyrate.
• Oxytocin
• Arginine vasopressin

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on
Autism can occur alongside many other
diagnoses. Do any of them that are hereditary
have known leaky guts or loss of bowel
integrity? Yes! In fact, we may find the
central common element in many conditions that
cause developmental delay will be a problem
(built-in or acquired) in gut integrity. DIETS
BRING KIDS BACK!!!!! Thank you, Andy
Wakefield!!!! Good news There is also hope for
adults! Even adults dump and even after years
of stashing away oxalates, their bodies can still
begin healing! Weve seen that now in numerous
conditions including autism! There doesnt seem
to be a lost window of opportunity!!!!!.
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What about children or adults with autism who
never had a leaky gut What about those who never
seemed to have had any gastrointestinal issues
but who may have a depleted sulfur chemistry or
may be very deficient in certain vitamins Could
oxalates be relevant to what is happening in the
brain with them when the diet may not be what
helps?
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As mentioned earlier, scientists have found that
when certain enzymes arent functioning well,
then other enzymes make oxalate out of
intermediate molecules in the metabolism like
glycolic acid, glyoxylate, glycine,
hydroxypyruvate or hydroxyproline.
Hydroxyproline is abundant in collagen and
therefore high in meat. Because of that,
carnivores have a special enzyme in the
mitochondrion that helps to turn hydroxyproline
into glycine instead of oxalate. Humans lack
that enzyme. That means eating a lot of meat may
generate high levels of oxalate in humans.
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Oxalates Generation from Glyoxylate in the
Cytosol happens via Lactate dehydrogenase, the
enzyme that converts pyruvate to lactate or
lactate to pyruvate.
Glycolate
THIOL-
Glycolate
GO
X
Cytosol
Thiols, by binding glycolate, prevent
glycolates conversion to glyoxylate and onto
oxalate.
Glyoxylate
Glyoxylate
GO
LDH
Body
Oxalate
Oxalate
Peroxisome
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Oxalate Metabolism in B6 deficiency
Ethylene glycol
Serine
Xylitol
Glycolate
Glycolate
GO
Hydroxyproline
GRHPR
X
Vit B6
Glyoxylate
Glycine
X
Glyoxylate
AGT
GO
LDH
Urine
Oxalate
Oxalate
Peroxisome
Ascorbate
Cytosol
Adapted from Prof. Ogawa at FASEB
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Ill now review several areas where we need a lot
better science to understand how to interpret
other potential sources of oxalate. These areas
have not been sufficiently examined.
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Arabinose food for yeast Yeasty symptoms
Is this coming from the response of a normal
amount of candida to the elevation of arabinose
in an inflamed gut? Treatment with an
anti-fungal may diminish symptoms by killing an
organism that was making oxalate. That doesnt
necessarily mean that candida was in
overgrowth. The GI doctors say they cant find
overgrowth. IMMUNE SYSTEM By impairing
biotin, oxalate may make it hard for our bodies
to defend against yeast. Many on LOD are finding
that their yeast problems are going away without
treatment.
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Are there risks of generating oxalate from high
dose vitamin C?
Facts As much as 70 of vitamin C we take in
may convert to oxalate in the body, and most may
never get to urine. Most of the ascorbic acid is
not accounted for in studies that measure urine.
In one study the oxalate that came from vitamin
C took about two weeks to get to urine as
oxalate. Most studies were not designed to last
long enough to capture data on this delayed
conversion. Would parents or doctors associate
oxalate-related symptoms to a treatment that
took place so long before? As have doctors
treating hyperoxaluria, our project has
recommended keeping vitamin C at or below 250 mgs
In a day.
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Oxalate may have tied up some of the magnesium
that helps keep the gut working! (Weve had good
luck with Oxypowder!) Many children will lose
their constipation when they start taking
magnesium citrate. If you use Miralax some
microbes that may inhabit the gut, under some
circumstances, may convert Miralax into ethylene
glycol which can be metabolized by our bodies
into oxalate. Miralax may impair GAGs that help
regulate the gut. There is an internet group
called Miralax_at_yahoogroups.com that discuss these
potential risks from Miralax and how to handle
constipation in other ways.
The Problem of Miralax.... and other versions of
Polyethylene Glycol
Desulfovibrio desulfuricans
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What traits seem to be the oxalate-related
symptoms of autism? One poll of parents showed
a flattening of the distended belly in their
child on the Low Oxalate Diet All the way
within a week 18 Some of
the way within a week 25 Some
after more than a month 30 No
change after a month 18
Parents helped me compile a list of other
changes they saw on the low oxalate diet that are
listed on the next pages.
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• Digestive
• Improved gut function digestion
• Loss of chronic diarrhea
• Loss of chronic constipation
• First normal stools in lifetime despite previous
  treatment
• Loss of ravenous hunger
• Needed increase in appetite
• Loss of food allergies or sensitivities
• Eating foods previously avoided
• Improved pancreatic function
• Losing tendency to stomach ache or migraine
• Loss of distended belly
• Loss of dysbiosis and yeast problems
• Ability to get off all GI medications
• Big changes with introduction of VSL 3, an
  oxalate-degrading probiotic
• Improved tolerance for sulfur foods or
  supplements
• Improvements in reflux or esophagitis

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• Urinary
• Loss of excessive urination
• Loss of urinary frequency
• Obtaining nighttime continency
• Obtaining daytime continency
• Loss of vulvar or penis pain inflammation
• Movement
• Improved energy (mitochondrial?)
• Vastly improved gross motor skills
• Improved handwriting
• Improved fine motor skills
• Beginning to enjoy sporting activities
• with friends and siblings
• Better vestibular function and motor planning

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• Cognitive
• Better counting
• Better and more spontaneous coloring
• Better sight word retention
• Less rigidity
• Better expressive language losing apraxia
• Better receptive language
• Increased imitation skills
• Asking more questions who, what, where
• Improved cognition more complex thought
• Speaking in much longer sentences
• Understanding cause and effect
• Increases in imaginary play
• Sociability
• Developing negotiating skills
• Playfulness enjoying life jokes
• Calming of temperament

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• Other areas
• Loss of photosensitivity
• Loss of self-abusive behavior
• New ability to tell parent locations of pain
• Rashes and bumps disappearing
• Sleeping through the night
• Loss of chronic leg and foot aches (growing
  pains)
• Improvement in iron stores and anemia
• Better phenol tolerance incl no-phenol
• product started working
• Loss of salt craving
• .Catch-up growth
• Normalization of Wilsons temperature syndrome
• Normalization of iodine levels
• Improvement in acne in teenager

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• Areas improving in adult listmates on diet (often
  parents of spectrum kids)
• Improvement in hypertension
• Alleviation of carpal tunnel problems
• Loss of fibromyalgic pain
• Cysts healed
• Improved cognition
• Loss of back pain
• Loss of joint stiffness
• Loss of heel pain
• Weight loss
• Improvements in libido
• Monthly periods are starting back in women
• Improvement in balance (cerebellar--per
  physician)
• Regaining daytime urinary continence
• End of severe insomnia

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• As you consider which foods and diet to feed
  your child, Id like you to remember several
  things.
• 1. Quite a few parents joined the oxalate list
  saying they watched their child who only had
  bowel issues before intervention regress into
  full-blown autism while eating high-oxalate foods
  on the SCD or g/f c/f diet.
• The worst problems with oxalate dumping have
  happened with children who were eating high
  oxalate diets before LOD probably because of new
  foods introduced to them and eaten in large
  quantity in the SCD or g/f c/f diet.
• All of the milk substitutes except coconut are
  high oxalate, and many of the gluten-free grains
  are as high or even much higher in oxalate than
  wheat.
• Watch carefully the childs growth. We are seeing
  much catch-up growth in the children on LOD
  without using hormones. Many who couldnt gain
  weight and had ravenous appetites are gaining
  weight while eating much less!

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HIGH OXALATE FOODS
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The Low Oxalate Diet Keeping Oxalates Below 50
mg/day In adults
Information on how to implement the low oxalate
diet with help on coordinating this approach with
other dietary restrictions is available at
Trying_Low_Oxalates_at_yahoogroups.com, where food
lists have been consolidated from organizations
that have used this diet for the treatment of
many other disorders. The Vulvar Pain Foundation
recently published The Low Oxalate Cookbook,
which contains the most complete list of the
oxalate content of foods and supplements
reporting those figures by both mg/serving, and
mg/weight or volume. The cookbook can be
purchased from http//www.vulvarpainfoundation.or
g/cookordform.htm
Susan Costen Owens LWO_at_iadfw.net Check out
our new website at www.lowoxalate.info!