Tuesday, October 7, 2008

The Low-Oxalate Diet: Myth?

The Low-Oxalate Diet is a common suggestion for treating vulvodynia. Oxalates occur naturally in foods, and the theory goes that when oxalates leave the body in the urine, they irritate the vulvar skin.

Following a low-oxalate diet involves cutting out those foods with medium and high oxalate content and focusing on foods on the low end. Women might also take calcium citrate with food as it binds to the oxalates and helps them leave the body (the calcium citrate must not have Vitamin D as it inhibits the oxalate-binding process).

When I visited the vulvodynia specialist in August, he affirmed my suspicion that a low-oxalate diet probably isn't a worthwhile pursuit for someone with vulvodynia. Here's my reasoning:
  1. The original study linking oxalates to vulvodynia involved one woman. Initially this woman had abnormally high oxalate levels. After three months of following a low-oxalate diet and taking calcium citrate, she saw a reduction in her vulvar pain. After a year, she was pain-free, and she'd see a flare if she missed her calcium citrate. But again, that was one woman.
  2. A follow-up study involved 130 women with vulvar pain and 23 without. Of the women with vulvar pain, only 59 had elevated oxalate levels in their urine. These women followed low-oxalate diets and calcium citrate routines for three months, after which only 14 saw an improvement in their pain and only 6 were able to have pain-free sex. In other words, the data didn't favor a vulvodynia-oxalate causal link, though it indicated that some women's symptoms might improve with the diet.
  3. Oxalate charts (PDF) are inconsistent. For instance, the first two charts I linked to rate zucchini as low in oxalates, and the third chart says it's high in oxalates. I'm not sure how these sources get their data, but I read somewhere (that I can't find now) that while foods have oxalate patterns, actual oxalate content varies according to how the food was grown. So eating a low-oxalate diet that respects every published chart leaves you with very few foods to eat!
There are two more reasons I'm wary of the low-oxalate diet: one, I'm already on a pretty restrictive diet that eliminates foods I KNOW aren't good for me; eliminating high- and medium-oxalate foods leaves me with a diet that's not very healthy or attractive. Two, I actually did try a low-oxalate diet for a short time (a couple weeks) and took calcium citrate regularly for a while longer (at least a couple months), and I didn't see a change.

It could be that I didn't follow the diet or take the calcium citrate long enough, but my skepticism about the diet makes me unwilling to try it again. If anyone has seen results from the diet or the calcium, please let me know!


  1. my specialist (who is supposedly like THE specialist) says the diet is all bunk. I tried it for awhile, and I agree.

    But, I do find that I have a bit of luck with the Calcium Citrate. I've been taking that on the advice of a friend who does women's medicine. I find that it helps with the whole peeing issues.

    Oh, also, I don't list my VVD blog on my profile so you may be wondering who I am! I write Servicing the Chassis.

    Well, write is a relative term. But I promise to get a post up this week because I have tons to say

  2. And by peeing issues, I mean that I can continue my coffee addiction without crying every time I pee. Which is a lot, because I drink a lot of coffee.

  3. Yeah, I actually still have the calcium on my coffee table (my pill-reminder spot) -- it's good for you regardless! I'll have to see if starting it up again helps my pee pain.

    Your coffee addiction is my tea addiction, especially as the weather cools.

    Nice to know who you are! Thanks for replying.

  4. I just wanted to say, the low oxalate diet is NOT bunk. I suffered horribly from vulvodynia vestibulitis and IC symptoms. I can honestly say the low-oxalate diet has reduced 80% of my pain. it IS worht a shot, especially if you have the bladder symptoms too.

  5. Anonymous, thanks for sharing. I'm glad the diet worked for you. I've become a big believer in diet change for pain, but the low-oxalate diet didn't seem to work for me. But I'll keep your experience in mind.

  6. 1. The theory that oxalates are irritating the skin is wrong. What is happening is that oxalates are entering the bloodstream, likely through the small intestine. This is caused by a leaky gut which can start for various reasons. If a low oxalate diet is not working 100%, you are probably eating stuff with oxalates and don't know it or you have other food problems. e.g. - try limiting wheat gluten - this can cause leaky gut and was the source of my main problem and led to oxalate problems.

    2. Your reasoning in argument 3 is irrelevant. You try to support your claim by saying that if you followed a low oxalate diet you couldn't eat very many foods... If that is what is causing the problems then it doesn't matter how much your diet is restricted, you need to follow it.

  7. The Low Oxalate Diet is not a myth. It has been the one treatment that has helped me significantly in 30 years of vulvar pain, itching, burning etc. And it helped a lot (about 80% decrease in vulvar symptoms)! It has also helped thousands of other women achieve freedom from pain or significantly lowered their pain levels. The Vulvar Pain Foundation is a great source for finding success stories for women who used the LO diet properly and stuck with it.

    There are many holes in your argument above and many of your statements are false. I would have to write a book to debunk all of them. I urge you and your readers to become better informed about what oxalate is, how it causes inflammation, burning and pain in the body, and how a low oxalate diet works to correct high oxalate levels in your body tissues and blood stream. It is not an easy road or a quick road, but if oxalates are the reason for your pain (or even part your pain), then this is a road I urge you to travel. It also can be an extremely healthy diet with a wide variety of healthy food choices but you have to find the food lists that are accurate and understand why so many old lists are not.

    My blog has links to many helpful and accurate resources for following a low oxalate diet. I urge you to hook up with one of the two groups that can help you start a low oxalate diet and tailor it for your needs. You may also want to look at the Autism Research Institute's information on Oxalate or the Vulvar Pain Foundation's information about oxalate.

    I feel for you and your readers and hope you each find healing from your pain, physical, emotional and spiritual.

    Thank you.


  8. the low oxalate diet did not work for me, but the NO oxalate diet completely cured my symptoms. for me, it's all or nothing. when i "cheat" and eat anything with oxalates in it, i get a reaction but if i'm really good and don't take bites, i am able to achieve 0% symptoms and even had sex once without pain! trying to get back to that place, as i have been experimenting with different foods with negative effects ... getting closer ... every day is better that i avoid veggies, fruits, nuts, chocolate and tea. but i have no idea how i'm going to do this long term as i KNOW i am not getting proper nutrtion ... very worried (also have huge oxalate kidney stones that require surgical removal --- we're talking 1-1/2 to 2 INCH stones ... definitely something going on)

    1. It's great that you've found something that works! How do you eat no oxalates? What are your staples?

      I'm so sorry to hear about those kidney stones -- yeoowch!! I hope that doesn't happen too often.

    2. I'm interested, too, in what you eat on a no oxalate diet. I have been doing a low oxalate diet for 3 months and only had a very minimal relief. Are you just eating dairy and meat?

  9. I once read you should take vitamin B6 to help dissolve the oxalate crystals. Use the P5P version of B6 to get the most available form.

  10. Just wanted to chime in that I went on the low oxalate diet back in, gosh, 2002?

    Anyway, I've been pain free ever since. I don't really follow the diet very strictly anymore. Sometimes, when I eat something high in oxalates or acid, I'll have a flare-up, but that lasts for a very short period of time and doesn't cause the kinds of lasting symptoms I used to have.

    What I think happens is this: You injure yourself by eating too many high oxalate foods somehow. (In my case, I abruptly switched to a vegetarian diet and began eating a lot of high oxalate foods, when I hadn't before.) What you need to do is give your coochie a break by not eating the oxalates for a while. Once you heal, you may very well be able to go back to eating relatively normally. I think that the pain is caused because you are irritating already-irritated tissue.

    Seriously, try the diet. Well, better yet, get your urine tested. If you don't have high oxalates, then don't try it, but if you do, well, then, DUH--That's what's causing your pain.