161: Low Oxalate Diet: Can It Stop Your Rashes?

If you’re working through what foods seem to trigger or flare your rashes, you might at some point consider trying a low oxalate diet.

Though it’s commonly used to reduce the production of kidney stones in those prone to making them, I’ve recevied many questions about this particular elimination diet for rashes.

Aside from my general caution about eliminating more and more foods, improvement on a low oxalate diet (or because you have high oxalates in your urine) is an important clue!

I’m sharing in this episode some clinical pearls about a low oxalate diet that might really surprise you.

AND the circumstance when I think it would be worth a try to eliminate them (and when it’s not).

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

• What is a low oxalate diet + its connection with rashes
• Foods that are high in oxalates
• What high oxalates indicate about your gut
• Probiotics that breakdown oxalates
• Is it worth it to try a low oxalate diet?

Quotes:

More current research shows that those struggling with calcium oxalate kidney stone formation “exhibit dysbiosis in their fecal and urinary microbiota compared with controls”.

Gut bugs like Oxalobacter formigenes, L. plantarum, L. casei, L. acidophilus, L. rhamnosus, L. salviarius, Bifidobacterium infantis, and Bifidobacterium animalis can all break down oxalates.

Low Oxalate Diet: Can It Stop Your Rashes? (FULL TRANSCRIPT)

Welcome back to episode 161 of the Healthy Skin Show! In today’s episode, I want to share an interesting insight that not many know about doing a low oxalate diet.

Diets to control rash symptoms and other health concerns are all the rage.

Many of you have heard me repeatedly warn that diet is oftentimes just one piece of the puzzle. And that explains why bouncing from elimination diet to elimination diet might be a misguided move.

Sometimes improvements on a certain elimination diet can be a clue about what’s going on under the surface.

So while you might experience improvement, it’s not sustainable without maintaining the diet. (This is the case of feeling better on a low salicylate diet.)

Though I’ve never been 100% clear on why some people with rashes try a low oxalate diet, I thought I’d share one pearl with you that has been really eye-opening for those who feel they need to give it a go.

Low Oxalate Diet: A Real-Life Skin Rash Example

Recently I hosted a masterclass for people suffering with Eczema. Towards the end of the class, I took the participants’ questions.

One woman was curious to get my thoughts on a low oxalate diet. She felt that high oxalate intake was triggering her eczema flares.

If you’re not familiar with high oxalate foods, the list includes: (1,2)

• Strawberries
• Spinach
• Chocolate
• Beets
• Rhubarb
• Beans
• Sweet potatoes
• White potatoes
• Berries
• Nuts (like almonds)
• Rice
• Black tea
• Coffee
• Oranges

Though this isn’t a complete list, most of these are foods that many people eat on a regular basis.

This particular woman who asked the question of me was not the first person by a long shot to inquire about shifting to a low oxalate diet to potentially help her rashes!

I shared with this woman that from clinical experience an issue with oxalates tends to be a sign of gut dysbiosis (especially fungal overgrowth).

She was floored (and appreciative) as no one had ever explored fungal issues as a possible skin trigger (which it absolutely can be)!

Oxalate-Gut Microbiome Connection

In my clinical practice, it’s not uncommon for skin rash clients to have some level of gut dysbiosis lurking under the surface. This helps to explain why they can’t pinpoint their flares to something specific!

More current research shows that those struggling with calcium oxalate kidney stone formation “exhibit dysbiosis in their fecal and urinary microbiota compared with controls”.(3)

So basically, the gut microbiome is skewed in a direction that is less favorable to you. And this imbalance can be seen from stool and urine samples.

I initially became aware of this connection several years ago after stumbling across this Townsend Letter article by Dr. William Shaw. He specifically talked about fungal organisms like Candida albicans that can increase your oxalate load quite significantly.

The current idea is that certain fungi are able to produce something called collagenase — an enzyme that breaks down the collagen.(4)

This process then triggers a series of steps that ultimately produce oxalates.

I’ll be honest, I’m not sure we have the human studies yet to prove that this is exactly what’s going on. Most research is pieced together.

But what I can say from my clinical experience is that there seems to be a connection.

This means is that someone who benefits from a low oxalate diet should consider this to be more than just a food or diet driven problem.

Can Your Gut Microbiome Breakdown Oxalates?

Is it possible for your gut microbiome to help you breakdown oxalates before they become a problem?

Normally, yes.

But if your oxalate exposure is through the roof because of a several factors including diet exposure (ahem… watch out for the “green smoothie” trend!), your body might not be able to keep up.

A healthy, balanced microbiome and certain strains of gut flora have the ability to breakdown oxalates.

Gut bugs like Oxalobacter formigenes, Lactobacillus plantarum, Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus salviarius, Bifidobacterium infantis, and Bifidobacterium animalis can break down oxalates.(5)

Oxalobacter formigenes is listed on certain functional at-home stool kits and often alarms clients because the name makes them think that this bug produces oxalates. But it actually degrades them!(3)

Interestingly, Faecalibacterium prausnitzii which produces butyrate in the gut (an important short-chain fatty acid I’ve talked about on the show before) has been shown in some studies to be depleted in those who produce stones.(6)

Does this mean that you should run out and buy probiotics with some of these bacterial strains?

Unfortunately, research at this point doesn’t have a clear answer so probiotics alone might not be enough to help.(3)

Also, I typically discourage clients from taking large amounts of L. acidophilus on its own because too much is not necessarily a good thing. This bug produces D-Lactic Acid which can alter the pH of the colon making it overly acidic.

But what we can take from this is that the state of your microbiome is important if you have a real concern about oxalates.

Is A Low Oxalate Diet Worth A Try For Rashes?

I know you guys want me to be straight with you here, so is doing a low oxalate diet is worth trying for your rashes?

Unless you have a clear issue like kidney stone formation going on, using a low oxalate diet solely as a protocol for skin rashes (because nothing else has worked) is probably not worth it.

To be honest, most research I’ve found connecting oxalates and rashes is pretty specific to contact dermatitis — meaning items you come in physical contact within your environment rather than consuming them directly.

So why practitioners suggest that your rashes are specifically due to oxalates is rather baffling to me.

Even if your Organic Acid panel indicates a high level of oxalates, a low oxalate diet is a management tool (or a band-aid) until you deal with other issues driving oxalate formation.

Remember, if you’ve tried 2 or 3 different eliminations diets at this point and haven’t been able to figure out what’s triggering your skin after a couple of months, diet alone likely isn’t going to be your saving grace.

I’m not suggesting that you should go back to eating a junky diet nor throw in the towel since chronic skin rash cases in my practice tend to be pretty complex.

Diet shifts may be one piece of your puzzle to do in conjunction with other steps.

But hedging your bets on removing yet another group of foods may not improve your skin or help you eat a more varied diet without triggering another flare (which is ultimately the goal).

That’s why using something like my Skin Rash Root Causer eGuide could come in mighty handy to help you pinpoint what else beyond diet is to blame.

If you’ve got questions or experiences to share, please leave them below! I’d love to keep the conversation going.

And if you know anyone struggling with a flare and considering removing oxalate foods, share this episode with them so that they don’t end up just making their diet smaller and smaller.

REFERENCES

1. https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/
2. http://www.uofmhealth.org/health-library/aa166321
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071363/
4. https://www.sciencedirect.com/science/article/abs/pii/S1369703X08003501
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235702
6. https://www.kidney-international.org/article/S0085-2622(19)30391-6/fulltext