Joint Pain & Fatigue Caused by Oxalate Overload

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Are you experiencing joint pain and fatigue after you eat certain foods? Maybe it feels more like muscle soreness and an afternoon slump after lunch? Read on to learn how certain foods can be triggering mitochondrial dysfunction leading to fatigue and body pain. 

The more organic acid testing I order the more I am seeing oxalate issues in my chronically unwell clients. More often than not I will only order stool tests to look for bacterial, fungal and parasite infections and maybe a breath test to look for small intestinal bacterial overgrowth if the symptoms point to it. 

When someone has been unwell for years or if they have failed round after round of treatments from their doctor or other healthcare providers I will often recommend an organic acids test, or OAT test, to assess the body in multiple ways. 

Oxalate Overload is Common

Oxalate overload is common, more common than you would think. 

Before we dive into the issues surrounding oxalate overload (excessive oxalates in the body) I want to point out that most healthy people with good digestion can process and excrete oxalates from their body with no issues.

Even if you do have some digestive issues you may still be totally fine with oxalates. 

This is important to mention up front because oxalates are found in high amounts in very healthy food that shouldn’t be eliminated unless you need to to get better. 

The OAT test, my absolute favourite, by Great Plains Labs, screens for 3 organic acids that are directly related to oxalates in the body. When you really know what you are looking for there are at least another 10 or so markers that can influence oxalate load and detox from the body and another 11 markers on top that may be influenced by high oxalates. 

This is the brilliance of organic acids testing. Not only does it show you what is happening in the body (bacteria, yeast, mould, etc, etc), it shows you how the body is adapting and compensating to the load (oxidative stress, metabolism, nutrient deficiencies). 

Below we can see an image showing a mild elevation is glycolic (probably an enzyme dysfunction leading to poor detox of oxalates from the body) and oxalic acid (probably from the diet but possibly from mould exposure or fungal overgrowths). 

Image taken from: The Great Plains OAT test

I see oxalate excess on numerous OAT tests each month.

When we start to treat the oxalate issues clients start to feel better. 

Joint Pain and Oxalates

There are a number of root causes that contribute to excessive oxalates in the body. The following are a few that make me suspect oxalates 

  • Fungal overgrowths
  • Mould exposure
  • Fat malabsorption (and issues that cause this like SIBO or coeliac disease) 
  • Nutrient deficiencies 
  • Sulphur sensitivity (more on that coming soon) 

When I am working through a case I look at symptoms, lab results and history. 

In my clients with digestive issues joint pain is the one symptom that makes me suspect oxalate overload. 

Hands down. 

When you look into the research on this oxalates are considered an ‘uncommon’ cause of arthritis. Researchers discuss the difference between primary hyperoxaluria (genetic disorders of oxalate overproduction) and secondary hyperoxaluria (gut driven).  

Primary hyperoxaluria type 1 and 2 are rare genetic conditions leading to increased production of oxalates in the liver. This endogenous oxalate overload, occurring in less than 3 cases per million can be fatal if left untreated (1).

For this article we are focusing on the secondary hyperoxaluria. 

Secondary hyperoxaluria has less to do with genes and more to do with digestive disorders. In the research it is frequently seen in combination with fat malabsorption, inflammatory bowel disease, short bowel syndrome or post bariatric surgery (2).

These conditions may sound serious and not relevant to someone experiencing a milder set of symptoms similar to IBS. The fat malabsorption piece is the most relevant here. Any condition that impairs your ability to generate bile (liver stagnation), move bile (methylation issues – ie MTHFR SNPs and Gilbert’s syndrome, methane SIBO) or causes a loss of absorptive surface area in the small intestine (coeliac disease, IBD), bacterial overgrowth in the small bowel (bacteria deconjugate bile rendering it ineffective), insufficient fat digesting enzymes (pancreatic insufficiency, pancreatitis).

Many of the references for above can be found here – Malabsorption Syndromes, with a few extra points from my research and clinical experience.

Image above from a stool test showing high steatocrit (fat malabsorption)

When hyperoxaluria occurs these shard-like crystal formations deposit into bones, joints, heart, eyes, skin and organs. Oxalosis is the end process of excessive oxalates circulating in the plasma, crystallising and ending up in the body tissues (4).

Image taken from wikipedia 

Research points to kidney dysfunction preceding this process but I believe that is on the extreme end of things and that this process can occur without overt kidney disease.  

As I mentioned above joint pain is a stand out symptom but there are others outlined in Update on Oxalate Crystal Disease including 

  • Bursitis 
  • Kidney stones
  • Arrhythmias 
  • Myopathies
  • Fractures 
  • Increased bone density

Fatigue And Oxalate Overload

The joint pain part of the picture is pretty straightforward and an easy connection to make.

The fatigue part has a bit more to it. 

Let me use a client of mine to explain the basics and we will circle back with some research later on. 

This client, let’s call him Peter, had issues with mild to moderate exercise, he would fatigue quickly, experienced joint pain and muscle soreness and had a history of suspected mould exposure. His OAT test results had a number of markers flagged including his oxalate metabolites. 

With these results we know that oxalates will be at least part of his problem.

Now onto his energy and fatigue picture. 

There is some evidence connecting oxalate overload and poor mitochondrial function. The mitochondria are our little energy producing organelles in each of our cells in our body.

We really want our mitochondria to be functioning well. 

Below we can see that Peter’s mitochondria and energy production was compromised. Basic interpretation here is that his kreb cycle was not spinning properly. This is one of the first steps in energy production. If it isn’t working, the rest of the energy producing machinery isn’t working either.   

Can we blame his oxalate overload on these results above? Probably not. At least oxalates are not the only driver of his symptoms. 

Peter also had a moderate to severe Candida overgrowth which can impact the energy producing mitochondria too. Candida infections can also generate more oxalates via an enzyme it produces called isocitrate lyase. A real double whammy.  

More info on how I use the OAT test to screen for hard to find Candida overgrowths here.

Image taken from: Great Plains OAT test

Oxalates & your Mitochondria 

There have been a few studies exploring the connection between oxalates overload in the kidneys and mitochondrial dysfunction. 

Keep in mind that your mitochondria are your energy producers in each and every cell. 

One in-vitro study showed that renal epithelial cells that were exposed to oxalates often died. The biochemistry here gets complex but the sequence of events caused by oxalate exposure and leading to cell death involves mitochondria and excessive reactive oxygen species (5).

Now it certainly is a stretch to make the jump from mitochondrial damage in the kidney cells to mitochondrial damage anywhere oxalates are hyperaccumulating but I have seen severe fatigue in patients with oxalate overload after they consumed oxalate rich foods. 

Anytime there is a picture of oxidative stress and free radical damage glutathione should be considered. 

Supporting this with the research we can see an animal study showing that oxalate deposition in the kidneys correlated with glutathione depletion. Trying to tease out correlation and cause the researchers then supplemented glutathione and found it helped to maintain mitochondrial function and oxalate deposition into the kidneys even in the presence of excessive oxalates (6).  

We still might be a bit ahead of the science but the connection is clear enough to act on. Does that mean that everyone with oxalate issues and mitochondrial dysfunction gets glutathione? Maybe. 

Long term the goal would be to support the body to generate its own glutathione by ensuring good nutritional status and supporting the NRF2 pathway but that’s a subject for another article. 

Are Oxalates Your Issue? 

As I mentioned above I don’t think that oxalates are an issue for everyone and I don’t think everyone should be limiting such healthy foods. 

Clients that experience joint pain and sore muscles, fatigue after certain foods and have digestive symptoms suggesting fat malabsorption are top candidates for oxalate testing and active treatment if oxalates come back as an issue. 

Now over to you. Do you have symptoms of joint pain and fatigue after food? Any experience treating oxalates? Share your thoughts below. 

References & Resources

  1. An update on primary hyperoxaluria
  2. The primary hyperoxalurias
  3. Malabsorption Syndromes
  4. Update on Oxalate Crystal Disease
  5. Mitochondrial dysfunction is a primary event in renal cell oxalate toxicity
  6. Role of glutathione on renal mitochondrial status in hyperoxaluria

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