Advertisement

World Journal of Urology

, Volume 23, Issue 5, pp 324–329 | Cite as

Influence of a high-oxalate diet on intestinal oxalate absorption

  • Diana J. ZimmermannEmail author
  • Albrecht Hesse
  • Gerd E. von Unruh
Topic Paper

Abstract

Hyperoxaluria is a major risk factor for renal stones. In most cases, it is sustained by increased dietary loads. In healthy individuals with a normal Western diet, the majority of urinary oxalate is usually derived from endogenous metabolism. However, up to 50% may be derived from the diet. We were interested in the effect of a high-oxalate diet on oxalate absorption, not merely on the frequently studied increased oxalate excretion. In study I, 25 healthy volunteers were tested with the [13C2]oxalate absorption test once while following a low-oxalate (63 mg) and once while following a high-oxalate (600 mg) diet for 2 days each. In study II, four volunteers repeated study I, and afterwards continued with a high-oxalate diet (600 mg oxalate/day) for 6 weeks. In the last week, the [13C2]oxalate absorption test was repeated. After 4 weeks of individual normal diet, the oxalate absorption test with a high-oxalate diet was performed again. The results of study I show that the mean [13C2]oxalate absorption under low-oxalate diet was 7.9±4.0%. In the presence of oxalate-rich food, the percent absorption for the soluble labelled oxalate almost doubled (13.7±6.3%). The results of study II show that the mean [13C2]oxalate absorption of the four volunteers under low-oxalate diet was 7.3±1.4%. The absorption increased to 14.7±5.2% under 600 mg oxalate. After 6 weeks under a high-oxalate diet, the [13C2]oxalate absorption was significantly decreased (8.2±1.7%). After the wash-out phase, the absorption was again high (14.1±2.2%) under the 600 mg oxalate challenge.

Keywords

High-oxalate diet Low-oxalate diet Oxalate absorption Oxalobacter formigenes 

Notes

Acknowledgements

The study was supported in part by a grant of Deutsche Forschungsgemeinschaft (UN91/3). Skilful technical assistance by B. Bär and M. Klöckner is gratefully acknowledged. Dr. S. Voss measured the oxalate content of the diets and foodstuffs and M.E. Schmidt, MD performed the ultrasound examinations.

References

  1. 1.
    Allison MJ, Dawson KA, Mayberry WR, Foss JG (1985) Oxalobacter formigenes gen. nov., sp. nov.: oxalate degrading anaerobes that inhabit the gastrointestinal tract. Arch Microbiol 141:1–7CrossRefPubMedGoogle Scholar
  2. 2.
    Berg W, Bothor C, Pirlich W, Janitzky V (1986) Influence of magnesium on the absorption and excretion of calcium and oxalate ions. Eur Urol 12:274–282PubMedGoogle Scholar
  3. 3.
    Brinkley L, McGuire J, Gregory J, Pak CYC (1981) Bioavailability of oxalate in foods. Urology 17:534–538CrossRefPubMedGoogle Scholar
  4. 4.
    Earnest DL, Johnson G, Williams HE, Admirand WH (1974) Hyperoxaluria in patients with ileal resection: an abnormality in dietary oxalate absorption. Gastroenterology 66:1114–1122PubMedGoogle Scholar
  5. 5.
    Heaney RP, Abrams SA (2004) Improved estimation of the calcium content of total digestive secretions. J Clin Endocrinol Metab 89:1193–1195PubMedCrossRefGoogle Scholar
  6. 6.
    Hesse A, Strenge A, Vahlensieck W (1984) Oxalic acid excretion of calcium oxalate stone formers and of healthy persons. In: Ryall RL, Brockis JG, Marshall VR, Finlayson B (eds) Urinary stone. Churchill Livingstone, Melbourne, pp 57–62Google Scholar
  7. 7.
    Hesse A, Schneeberger W, Engfeld S, von Unruh GE, Sauerbruch T (1999) Intestinal hyperabsorption of oxalate in calcium oxalate-stone formers—application of a new test with [13C]oxalate. J Am Soc Nephrol 10:329–333Google Scholar
  8. 8.
    Hodgkinson A (1978) Evidence of increased oxalate absorption in patients with calcium-containing renal stones. Clin Sci Mol Med 54:291–294PubMedGoogle Scholar
  9. 9.
    Hönow R, Bongartz D, Hesse A (1997) An improved HPLC-enzyme-reactor method for the determination of oxalic acid in complex matrices. Clin Chim Acta 261:131–139CrossRefPubMedGoogle Scholar
  10. 10.
    Hönow R, Hesse A (2002) Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chem 78:511–521CrossRefGoogle Scholar
  11. 11.
    Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276CrossRefPubMedGoogle Scholar
  12. 12.
    Holmes RP, Assimos DG (2004) The impact of dietary oxalate on kidney stone formation. Urol Res 32:311–316CrossRefPubMedGoogle Scholar
  13. 13.
    Ito H, Miura N, Masai M, Yamamoto K, Hara T (2003) Reduction of oxalate content of foods by the oxalate degrading bacterium Eubacterium lentum WYH-1. Int J Urol 3(1):31–34Google Scholar
  14. 14.
    Liebman M, Chai W (1997) Effect of dietary calcium on urinary oxalate excretion after oxalate loads. Am J Clin Nutr 65:1453–1459PubMedGoogle Scholar
  15. 15.
    Liebman M, Costa G (2000) Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J Urol 163:1565–1569CrossRefPubMedGoogle Scholar
  16. 16.
    Sidhu H, Allison MJ, Peck AB (1997) Identification and classification of Oxalobacter formigenes strains by using oligonucleotide probes and primers. J Clin Microbiol 35:350–353PubMedGoogle Scholar
  17. 17.
    Singh PP, Kothari LK, Sharma DC, Saxena SN (1972) Nutritional value of foods in relation to their oxalic acid content. Am J Clin Nutr 25:1147–1152PubMedGoogle Scholar
  18. 18.
    Tiselius HG (1991) Aspects on estimation of the risk of calcium oxalate crystallization in urine. Urol Int 47:255–259PubMedCrossRefGoogle Scholar
  19. 19.
    von Unruh GE, Langer MAW, Paar DW, Hesse A (1998) Mass spectrometric-selected ion monitoring assay for an oxalate absorption test applying [13C2]oxalate. J Chromatogr B 716:343–349CrossRefGoogle Scholar
  20. 20.
    von Unruh GE, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2]oxalate absorption test. J Urol 169:687–690PubMedCrossRefGoogle Scholar
  21. 21.
    von Unruh GE, Voss S, Sauerbruch T, Hesse A (2004) Dependence of oxalate absorption on the daily calcium intake. J Am Soc Nephrol 15:1567–1573CrossRefPubMedGoogle Scholar
  22. 22.
    Zimmermann DJ, Voss S, von Unruh GE, Hesse A (2005) The importance of magnesium in absorption and excretion of oxalate. Urol Int 74:262–267CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Diana J. Zimmermann
    • 1
    • 2
    Email author
  • Albrecht Hesse
    • 1
  • Gerd E. von Unruh
    • 3
  1. 1.Division of Experimental Urology, Department of UrologyUniversity of BonnBonnGermany
  2. 2.Diabetes Research InstituteMunichGermany
  3. 3.Department of Internal Medicine IUniversity of BonnBonnGermany

Personalised recommendations