English corner:Clearing up the Confusion about Oxalate Lists

Clearing up the Confusion about Oxalate Lists
Negative impact of oxalate on metabolism: Biochemical havoc! (1)
In short
We can handle a small amount of oxalates. When we overload the liver, we need more sulfur; we need sulfur to neutralize oxalate. However, oxalate and sulfate use the same transporter to enter our body. An overloaded liver will have increased difficulty exchanging a sulfur molecule for an oxalate molecule.
If we do not have sufficient sulfur intake or if the liver does not keep up, then we will lose the capacity for methylation. Some useful nutrients will no longer be available, such as B6. The problems will then increase: lack of enzymes, dysregulation of neurotransmitters, impact on liver (detox and homeostasis), assimilation of macronutrients, gene activation, etc. Different pathologies will soon arise. (1)
Internet sources will keep you Clearing up the Confusion about Oxalate Lists 
Oxalates have the capacity to pass through the gastrointestinal tract and can contribute to common gut issues such as constipation, gas, bloating, diarrhea, and more. This situation occurs most likely by people suffering from leaky gut, but in primary dysbiosis state as well.
Of course we can manage to attenuate the side-effects and moderate or prevent inconveniences (e.g. CaOx). I’ll give a link later, in this post.
As Jill Harris, LPN, CHC has stated (2), oxalate levels vary much:  “While the values may differ depending on factors such as growing conditions and measurement methods, the overall advice remains the same: Eat all foods except almonds and spinach products in normal portions”.
            You may have noticed there are plenty of lists, from respectable organisms / authorities, like the University of Michigan, St. Joseph's Healthcare System in Canada, Harvard or Chicago University, and the list goes on.  But if the list hasn’t been updated much. (3)
For example, 2 fruits have changed from category:
- Blueberries have changed from low to medium content, in Harvard update (November 2023): 18.5mg for 1/2 cup (120 ml). (New entry).
- Raspberries have changed from medium to low content in Harvard update, from 24 mg to 2.5 mg for ½ cup (120 ml) ([Vous devez être inscrit et connecté pour voir ce lien]). No explanation has been given nor the conditions for harvest. So, it shouldn’t be kept as main source.
            As Sally Norton mentions it: “Most list makers fail to mention where they got their information, let alone who did the testing, and by which methods. Nor do the list makers bother to explain their rationale for designating foods as “high” or “low” in oxalate. And they rarely (if ever) revisit old information and update it.” (4)
            So I don’t pretend holding the truth or the right list, although I can get close when I use Luc’s pendulum
General situation
While antinutrients are found in almost all plant-based foods, there are a few foods that naturally contain higher than average levels of antinutrients, like whole grains, legumes, leafy vegetables, soy, nuts and seeds. The most common antinutrients in fruits are lectins and tannins, used as protectors so that animals do not abuse (principle of evolution and protection of the species).
For phytates the utility is to bind minerals to store them with a distant goal of growth (and protection too since it’s an antioxidant).
            Oxalates are natural compounds found in vegetables, fruits, nuts, and grains that plants use for regulating calcium levels and for defense from insects or grazing animals, as the calcium oxalates can form hard, undesirable crystal-like formations. (5)
While this binding function of antinutrients is generally useful for plants, it can have the opposite effect on us when they bind to nutrients we want in our bodies, leaving us unable to access them.

Variability of oxalate content
The oxalate content of food can vary considerably between plants of the same species, due to differences in climate, soil quality, state of ripeness, or even which part of the plant is analyzed. Variations also may be caused by the different methods used for measuring oxalate in food.
Another example of confusion: Medjool dates
            Recently I warn a forumer, whose main sources of carbs were dates and honey, that he could get problems with several Medjool dates. He thanked me because he wasn’t aware of but soon after he came back, saying he had read the contrary. He was reassured in his food choices.
How much oxalate is low, medium or high?
Before answering this question, we need to understand there is no one_option_fits_all.
I’ve made 3 categories
1° You eat 1000 mg Ca per day. You have the ability to deal with 150 – 250 mg oxalate a day. (6)
Note: The optimal ratio is 40 mg Ca for 80 mg Oxalate to prevent CaOx (1/3 calcium).
Let’s say you don’t bother because you know how to manage oxalates and you don’t suffer from leaking gut nor dysbiosis. Of course, you vary your food sources and you don’t eat the same type of macronutrients. For instance, you get carbs as well from fruits and honey, as from starch (potato, rice, bread, pseudo-cereals). You don’t forget that ingredients may vary according to time, soil and the way you manage passing excesses. You don’t repeat your excess because “you love sth” or because your mother used to eat so!
2° You suffer from leaky gut or dysbiosis. You vary your food sources.
* > 5; ** > 15; ***> 50 mg
You’d better follow a low oxalate diet, and not take magnesium supplement at a meal when there is calcium. (7) Too long to explain here why. See “Sources & References” (7)
You don't often use the same green vegetable in a smoothie; you don't get your carbs just from fruit and honey; you don't eat a carrot salad every day because you follow a long-term detox diet, without taking breaks every 2 or 3 weeks to let the body breathe and reload with energy; you do not eat the same source at breakfast and midday.
However, if this source is recurring but spaced out (rotating every 5 days, but in cycles of a few days, for practical reasons), without having studied the possibility of disadvantages in terms of contraindications, you would then do well to change the caution level.
3° 3 levels when suffering from methylation conversion
* > 15; ** > 25; ***> 50 mg (*⁴ = 200 mg or more)
=> 3 levels according to TLO list (simplified version). ( 8 ) Low – medium – High (High level is anything behind 25 mg). I add one level (> 200 mg = *4) for people drinking smoothie and eating a plate filled with two thirds of vegetables (or often eating a lot of raw vegetables as a starter twice a day).
If both alleles of the gene MTHFR are defective, your liver is completely inoperative, that is to say that you then suffer from a deficit in genetic functioning, which causes difficulties in metabolizing some molecules. It remains to be seen whether or not the body has the capacity to level off via another pathway. Make a search with Methylation defect if you want to go deeper …
*)  How to get rid of oxalate? Causes and identification
[Vous devez être inscrit et connecté pour voir ce lien]
=> Useful ingredients.
[Vous devez être inscrit et connecté pour voir ce lien]
=> Insoluble and soluble oxalates (same post).

Sources and References
1) Impact négatif de l’oxalate sur le métabolisme : Chaos biochimique !
[Vous devez être inscrit et connecté pour voir ce lien]
=> Pourquoi et comment l’oxalate en excès, non modulé par la prise d’aliment ou molécule utiles, peut être à l’origine de pas mal de désagréments de santé. C’est un euphémisme !
2) Why oxalate levels vary so much – By Jill Harris, LPN, CHC. May 3, 2024
[Vous devez être inscrit et connecté pour voir ce lien]
+ update of Harvard list
[Vous devez être inscrit et connecté pour voir ce lien]
=> Click to open hidden text.
[Vous devez être inscrit et connecté pour voir ce lien] Introduction: Harvard's Updated Oxalate List
[Vous devez être inscrit et connecté pour voir ce lien] The Importance of Fluids, Calcium, and Balanced Nutrition
[Vous devez être inscrit et connecté pour voir ce lien] Portion Sizes and the Role of Advice
Who is Jill HARRIS?
Jill is a nurse and health coach that specializes in educating patients on kidney stone prevention. For more than 20 years she's helped patients understand that kidney stones can be prevented with the right treatment plan. It's one thing to be told to lower oxalate or drink more water, but HOW do you do it? That's where she comes in. Through the educational resources at [Vous devez être inscrit et connecté pour voir ce lien] stone formers can learn everything they need to know to significantly lower new stone risk.
3) Link for updated list (new additions) from Harvard, per serving size. 11/2023
[Vous devez être inscrit et connecté pour voir ce lien]
4) Online Lists Will Keep You Feeling Confused About Oxalates in Foods
[Vous devez être inscrit et connecté pour voir ce lien]
5) Calcium Oxalate in plants. Franceschi, V. (2001)
[Vous devez être inscrit et connecté pour voir ce lien]
6) Excretion of oxalates
[Vous devez être inscrit et connecté pour voir ce lien]
One can consider a whole food 1000 mg calcium 50 mg oxalate as a usable low oxalate diet, and a 150 – 250 mg oxalate diet as relatively high. The balance between diet calcium and diet oxalate does not matter greatly if diet calcium is high. Among normal men and women eating 1000 mg/day of calcium and 750 mg/day of food oxalate, 24 hour urine calcium was about 110 mg/day and oxalate about 44 mg/day.
When diet calcium is at least 1000 mg daily the balance of calcium to oxalate within any one meal is not likely to affect stone risk.
If diet calcium is high, as it should be, at about 1000 mg per day, then one should try to limit diet oxalate below 100 mg daily. 
Note: Bone broth and collagen supply is not a good plan if you bring ¼ of your proteins from these sources, rich in hydroxyproline. 
[Vous devez être inscrit et connecté pour voir ce lien]
=> Ten normal people eating a 1000 mg calcium, 150 mg oxalate diet (typical normal level) were fed supplemental gelatin as one quarter of daily protein intake. Urine oxalate was 24 mg daily vs. 17 mg daily when the same diet was supplemented with whey protein – containing little hydroxyproline – as a control. So lots of jello is not an ideal plan for stone formers.
7) Do not take a magnesium supplement with a rich oxalate ffod.
[Vous devez être inscrit et connecté pour voir ce lien]   
See & “Tenue de route”
8. TLO list (simplified version) 
Trying Low Oxalates (TLO) group on Facebook (membership required). When you join, just follow the directions there and you will be able to access it (they don't allow to publish the list). Be respectful. [Vous devez être inscrit et connecté pour voir ce lien]
=> Fruit List from [Vous devez être inscrit et connecté pour voir ce lien]
Low Oxalate
● Apples (Gala, Granny Smith, Cox, Fuji, Pink Lady
● Blueberries (up to ½ cup or ~100 grams)
● Grapes (Green, Red)
● Honeydew
● Kumquat
● Lychee
● Passion Fruit
● Tamarind
● Watermelon
Low to Medium Oxalate*
-        Apple (Braeburn, Macintosh)
-        Avocado (Hass, very ripe) ((Mind the type, note’s editor; it’s the black one)
-        Banana
-        Cantaloupe
-        Cherries
-        Cranberries
-        Dates
-        Grapes (Black)
-        Jackfruit
-        Mango
-        Nectarine
-        Pineapple
-        Pear (Bartlett/Williams)
-        Peach
-        Plum
-        Strawberries
*The fruits listed under “Low to Medium Oxalate” can still be eaten. They have been put into a separate category because if they are eaten in larger amounts, they can move into the medium oxalate category. I still use them, but just make sure not to overdo it.
How Much Oxalate is Low, Medium or High?
In general, low oxalate foods will have 5mg of oxalate in a serving, between 5-15mg is considered medium, and anything more than 15mg is going to be high. The key phrases here are in general and in a serving. You might have noticed that one list will refer to a food as low oxalate while another refers to it as medium, or one will say a food is medium, and other will say that the same food is high.

Online Sources for Medjool Dates
*) High but not or not well justified
1) [Vous devez être inscrit et connecté pour voir ce lien]  (Oxalosis & Hyperoxaluria Foundation)
Dates, Chopped 8 mg / 45 gr => 17 mg / 100 g.
2) 24 mg for 1 Medjool date (University of Michigan Health)
Michigan Medicine: “Foods High in Oxalate.” National Food Institute.
Date are high in sugar as well as oxalates, with one date containing 24 milligrams. July 18 2024
[Vous devez être inscrit et connecté pour voir ce lien]  
 “Foods high in oxalate” Michigan Medicine, University of Michigan.
3) Al-Zahrani, Khaled S.; Faqeeh, Akram A.; Abdulghani, Zuhair R.; Thomas, Selvin P. (2022). "A review on the physicochemical properties and utilization of date seeds in value-added engineering products".  [Vous devez être inscrit et connecté pour voir ce lien]: 10433–10490. 
[Vous devez être inscrit et connecté pour voir ce lien]:[Vous devez être inscrit et connecté pour voir ce lien]. 
=> [Vous devez être inscrit et connecté pour voir ce lien] =>Limited to a summary. No details on dates.
4) [Vous devez être inscrit et connecté pour voir ce lien]  (Oxalosis & Hyperoxaluria Foundation)
Mind these fruits: rhubarb, kiwis, dates, raspberries, oranges, tangerines. This doesn't mean you can never have these healthy treats. But you have to manage (…)
 
*) High level of oxalate for Medjool dates (with details)
1) Medjool dates are high in oxalates (18–233 mg/100 g dry weight).
Alahyane, A.; Harrak, H.; Elateri, I; Ayour, J.; Ait-Oubahou, A.; Benichou, M.; et al. (2021). [Vous devez être inscrit et connecté pour voir ce lien]. [Vous devez être inscrit et connecté pour voir ce lien]. 82: e236471. [Vous devez être inscrit et connecté pour voir ce lien]:[Vous devez être inscrit et connecté pour voir ce lien]. [Vous devez être inscrit et connecté pour voir ce lien] [Vous devez être inscrit et connecté pour voir ce lien].
Original Article • Braz. J. Biol. 82 • 2022 • [Vous devez être inscrit et connecté pour voir ce lien]
=>Chemical composition of 17 varieties of Moroccan date fruits (Phoenix dactylifera L.) and to determine their nutritive components. The analysis showed that the dates are rich in sugars (51.80-87.98%), they contain low concentration of proteins (1.09-2.80%) and lipids (0.16-0.39%). The predominant mineral is potassium (1055.26-1604.10 mg/100 g DW). Moreover, they contain high concentrations of malic acid (69.48-495.58 mg/100 g (DW)), oxalic acid (18.47-233.35 mg/100 g DW) and tartaric acid (115.70-484.168 mg/100 g DW). 
2) TLO list
Trying Low Oxalates (TLO) group on Facebook (membership required). When you join, just follow the directions there and you will be able to access it (they don't allow to publish the list). Be respectful.
[Vous devez être inscrit et connecté pour voir ce lien]
=> [Vous devez être inscrit et connecté pour voir ce lien]
Fruit List
Low Oxalate
● Apples (Gala, Granny Smith, Cox, Fuji, Pink Lady
● Blueberries (up to ½ cup or ~100 grams)
● Grapes (Green, Red)
● Honeydew
● Kumquat
● Lychee
● Passion Fruit
● Tamarind
● Watermelon
Low to Medium Oxalate*
● Apple (Braeburn, Macintosh)
● Avocado (Hass, very ripe)
● Banana
● Cantaloupe
● Cherries
● Cranberries
● Dates
● Grapes (Black)
● Jackfruit
● Mango
● Nectarine
● Pineapple
● Pear (Bartlett/Williams)
● Peach
● Plum
● Strawberries
*The fruits listed under “Low to Medium Oxalate” can still be eaten. They have been put into a separate category because if they are eaten in larger amounts, they can move into the medium oxalate category. I still use them, but just make sure not to overdo it.
*) Visit the [Vous devez être inscrit et connecté pour voir ce lien] (no Medjool date found)
Harvard has released an updated Oxalate list, providing new information on the oxalate content of various foods.
The values on the list may differ due to factors such as growing conditions and measurement methods.
The overall advice for kidney stone prevention remains the same: eat all foods except almonds and spinach products in normal portions.
Other important factors for kidney stone prevention include getting enough fluids, reducing added sugar and salt, and ensuring adequate calcium intake.
[Vous devez être inscrit et connecté pour voir ce lien]
Note's editor: I haven't the same approach for sodium provided it's well balanced with potassium. You eat home made meals.

Useful link
Video [Vous devez être inscrit et connecté pour voir ce lien]
By Jill Harris, LPN, CHC. May 3, 2024
[Vous devez être inscrit et connecté pour voir ce lien]
+ update of Harvard list
[Vous devez être inscrit et connecté pour voir ce lien] Introduction: Harvard's Updated Oxalate List
[Vous devez être inscrit et connecté pour voir ce lien] The Importance of Fluids, Calcium, and Balanced Nutrition
[Vous devez être inscrit et connecté pour voir ce lien] Portion Sizes and the Role of Advice
Who is Jill HARRIS?
Jill is a nurse and health coach that specializes in educating patients on kidney stone prevention. For more than 20 years she's helped patients understand that kidney stones can be prevented with the right treatment plan. It's one thing to be told to lower oxalate or drink more water, but HOW do you do it? That's where she comes in. Through the educational resources at [Vous devez être inscrit et connecté pour voir ce lien] stone formers can learn everything they need to know to significantly lower new stone risk.
Excerpt
Harvard has updated its Oxalate list, providing new information on the oxalate content of various foods. The list includes six new pages of information, including foods that have never been studied before. While the values may differ depending on factors such as growing conditions and measurement methods, the overall advice remains the same: eat all foods except almonds and spinach products in normal portions. (Irony) (…)
Get the latest [Vous devez être inscrit et connecté pour voir ce lien]
*) The opposite sources. Here is one of them. Jill HARRIS speaking.
Note’s editor: Search with: why are oxalate content of *dates so variable?
[Vous devez être inscrit et connecté pour voir ce lien] 10/2022
 “The Low Oxalate Diet Addendum 2011 Fall- Numerical Values Table.” The VP Foundation Newsletter, no. 36 (November 2011): 17–20.
“The Low Oxalate Diet Addendum 2012 Summer- Numerical Values Table.” The VP Foundation Newsletter, no. 37 (June 2012): 6–9, 19–25.
=> The peer-reviewed medical literature doesn’t include dates in the oxalate data testing reports. However, the VP Foundation sponsored tests of dates performed in Laramie, WY at the University of Wyoming by Dr. Michael Liebman and his team. They tested Medjool dates three times, California-grown Deglet Noor dates once, and another unspecified variety grown in Pakistan.²
According to their reported results, 24 grams of pitted Medjool dates (around one date) contains approximately 1–2 mgs of total oxalate.  24 grams of Deglet Noor dates (about three and a half dates) contain around 2 mg.¹ No published testing found over 2.5 mg of oxalate per 24-gram serving.
If Dr. Liebman’s testing is right, dates are low oxalate foods. Yet mainstream sources like [Vous devez être inscrit et connecté pour voir ce lien]and [Vous devez être inscrit et connecté pour voir ce lien] incorrectly claim dates are high in oxalate, without offering any citations showing where they got this idea. They also failed to indicate the varieties, rendering the data useless.
These “reputable” and familiar institutions are seemingly reporting oxalate data, but not really. Verifiable testing shows them to be flat out wrong. This misinformation, coupled with a lack of transparency, is adding to the confusion around oxalates.