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. Zimmermann
  • 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 

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
  • 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

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