After you've eliminated the high oxalate foods you won't really miss and slowly substituted other things out, the last thing to do is to make sure you're getting enough calcium with your meals.
Soluble Vs Insoluble Oxalate
We talked a little bit about soluble and insoluble oxalate, and how soluble oxalate can be removed from foods with different cooking methods. The topic of soluble vs insoluble oxalate is not only important during cooking, but it's also important while you’re eating.
Soluble oxalate is much more likely than insoluble oxalate to be absorbed into the body after you eat it. In most people, ingesting foods that mostly contain insoluble oxalate (like the cinnamon that we mentioned before) does not significantly raise your urine oxalate. This suggests that it's excreted in the stool before your body absorbs it.
Calcium and Oxalate Will Bind Together in the Gut
If you're being extremely careful with your oxalates, you might not want to rely on this method — but if there was a way to change the soluble oxalate in your food to make it insoluble, you would probably do it, right? Well, the way to do it is to add foods with calcium to your meal. This way, the calcium can bind with some of the soluble oxalate from the food you’re eating in your gut and make it insoluble.
Just like calcium and oxalate readily bind together when they're present together in the kidney to form a stone, they also bind together in the gut when they're present at the same time, and then get eliminated together in the stool.
So again, I would say not to rely on this method or make it the first or only thing you do to lower the oxalate in your diet, but use it more as an insurance policy to bind up the little or medium amount of oxalate left in your diet, or to decrease the amount of oxalate that gets absorbed from high oxalate foods if you decide to eat some of them.
The timing of the calcium is very important. Since the purpose of eating it is to bind the oxalates that exist in your meals, that means having it with meals is the key, and having an in between meals will really be of no help if the food has already been digested.
You can still eat foods with calcium whenever, and it’s important to get the recommended daily value of it each day — but for it to bind with any oxalate from food within the gut, you need to have it at the same time as the food.
You should try to get calcium from food if you can, and supplements only if absolutely necessary. If you decide to use a supplement, make sure that you don't overdo it and go over the recommended daily value of calcium with those supplements. Instead, have some milk or cheese with your meals to get it in normal quantities from food sources.
Try To Incorporate Dairy If You Can
I know some of you may not eat dairy, but it is by far the best way to get calcium into your diet because of the high amount of calcium that's usually present and also the very minimal, if any, amount of oxalate that's present.
You don't have to drink milk or eat cheese with every meal, but if you can somehow sneak in some dairy, then that should help you absorb less oxalate. Don’t forget to check your food’s label to make sure it actually has calcium — not all dairy products do.
If you've had gut issues with dairy in the past, you can slowly try to reincorporate it into your diet by adding a small amount per day to start. You can also try it in fermented or in aged forms since they can be easier on the stomach and/or have less lactose.
Another thing you could try is to look for raw sources if that's a safe option that's available to you, or spend the extra few dollars for organic or grass fed or healthier options, since a lot of times the processing, the source, or the other things that are added can be the actual problem and not the dairy itself.
Lots of yogurts also have added gums and stabilizers and things that can end up upsetting your stomach too, so look for products that come without those added ingredients. The only things in yogurt should really be milk and bacteria cultures. The same goes for cheese — it should just be milk, cheese cultures, salt, and maybe some enzymes that they use to separate the curds from the way when they make it.
If all else fails, you can try an enzyme that helps break down lactose, but I would just use this as a last resort and for a very short period of time as a way to ease back into tolerating dairy. They sound like one of those things that if you keep introducing it into the body from a source outside of your body, then your body itself might slow down or stop its own production, because it knows it doesn’t have to produce it anymore.
Try and reincorporate the dairy if you can, but if you must be dairy-free, then make sure to include high calcium, low oxalate foods with your meals. Things like chickpeas, black-eyed peas, dino or lacinato kale, and collard greens are all low oxalate and higher in calcium.
Aloe Vera Juice is Low Oxalate and High in Calcium
Another food that's also naturally high in calcium is aloe vera juice — just be sure to check the label and the calcium content before you buy it, because some of the juices are diluted and they either have other ingredients or they're processed in some way where they don't have a significant amount of calcium left.
The Lakewood Organic brand is what I usually drink. It just has aloe vera juice and some lemon juice. Be careful if you're watching your sodium because you are prone to forming kidney stones or for any other health reasons — the aloe vera juice can have more sodium than you would naturally expect from a juice, so just double check that on the label as well.
Probiotics May Help Degrade Oxalate
One other thing you can try after making all the other changes here is to include a probiotic. There's a strain of bacteria that's naturally present in the gut called oxalobactor formigenes that we know degrades oxalate in the gut, so that it's not absorbed into the body. Antibiotic use can significantly reduce the population of these bacteria.
This particular strain is very hard to grow in labs, so there are no supplements available yet. That being said, another brand has been shown to reduce the amount of oxalate that gets absorbed into the body — Visbiome.
It may be that there's other strains of bacteria that can also break down oxalates that we just haven't made the connection yet, or the combination of bacteria in Visbiome allows the oxalate-degrading strain to reestablish itself in the gut. Either way, it has been shown to contribute to less oxalate being absorbed.
If you look at the studies, you will see that the brand that was tested originally was called VSL #3. To make a long story short, the creator of the probiotic formulation used to work with the company that made VSL #3, but he left the company and took his patent for the formula with him to Visbiome — so now the effective formula is sold by that company.
Again, this isn't something to really rely on since we're just starting to really understand how the microbiome works. But it is something else that you can use after you've tried all of the other things that we've talked about.