Urological Research

, Volume 38, Issue 3, pp 169–178 | Cite as

Probiotic-induced reduction of gastrointestinal oxalate absorption in healthy subjects

  • Joseph Okombo
  • Michael Liebman
Original Paper


Both a high dietary oxalate intake and increased intestinal absorption appear to be major causes of elevated urine oxalate, a risk factor for kidney stone formation. By favorably altering the gastrointestinal bacterial population, probiotics have the potential to lower oxalate absorption/urinary excretion. This study assessed whether a 4-wk daily consumption of a commercially available probiotic by 11 healthy volunteers (8 females, 3 males), aged 21-36 y, would decrease oxalate absorption. The study involved the ingestion of a probiotic (VSL#3®) for a 4 wk period followed by a 4 wk washout period. Oxalate load tests, providing a total of 80 mg oxalate, were conducted at baseline (pre-probiotic), and after the probiotic and washout periods. In the total subject population, mean total 22 h oxalate absorption at baseline (30.8 %) was significantly higher than after the probiotic (11.6 %) and washout (11.5 %) periods. However, four subjects identified as high oxalate absorbers at baseline had a particularly marked probiotic-induced reduction in oxalate absorption, which largely accounted for the reduction observed in the total subject population. The overall data suggested that in individuals characterized by high oxalate absorption levels, VSL#3® ingestion has the potential to reduce gastrointestinal oxalate absorption, which could decrease risk of kidney stones and other disorders related to hyperoxaluria.


Probiotic Oxalate absorption Kidney stones Gastrointestinal tract 



We thank Dr. Dale Isaak for help with the Oxalobacter formigenes culture method and Dr. Milton Allison for providing the culture medium. We also thank all the volunteers who participated in the study. None of the authors had any financial or personal conflicts of interest with any company that may have a financial interest in the information contained in this study. This study was supported by funding from the University of Wyoming. The probiotic (VSL#3®) was provided by Sigma-Tau pharmaceuticals.


  1. 1.
    Hatch M, Freel RW (1995) Alterations in intestinal transport oxalate in disease states. Scanning Microsc 9:1121–1126PubMedGoogle Scholar
  2. 2.
    Noonan SC, Savage GP (1999) Oxalate content of foods and its effect on human. Asia Pac J Clin Nutr 8:64–74CrossRefGoogle Scholar
  3. 3.
    Johnson CM, Wilson DM, O’Fallon WM, Malek RS, Kurland LT (1979) Renal stone epidemiology: A 25-year study in Rochester, Minnesota. Kidney Int 16:624–631CrossRefPubMedGoogle Scholar
  4. 4.
    Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276CrossRefPubMedGoogle Scholar
  5. 5.
    Binder HJ (1974) Intestinal oxalate absorption. Gastroenterology 67:441–446PubMedGoogle Scholar
  6. 6.
    Hatch M, Freel RW (2005) Intestinal transport of an obdurate anion: oxalate. Urol Res 33:1–18CrossRefPubMedGoogle Scholar
  7. 7.
    Balaji KC, Menon M (1997) Mechanism of stone formation. Urol Clin North Am 24:1–11CrossRefPubMedGoogle Scholar
  8. 8.
    Prenen JA, Boer P, Mees EJ (1984) Absorption kinetics of oxalate from oxalate-rich food in man. Am J Clin Nutr 40:1007–1010PubMedGoogle Scholar
  9. 9.
    Holmes RP, Ambrosius WT, Assimos DG (2005) Dietary oxalate loads and renal oxalate handling. J Urol 174:943–947CrossRefPubMedGoogle Scholar
  10. 10.
    Hatch M, Freel RW, Vaziri ND (1993) Characteristics of the transport of oxalate and other ions across rabbit proximal colon. Pflugers Arch 423:206–212CrossRefPubMedGoogle Scholar
  11. 11.
    Holmes RP, Goodman HO, Assimos DG (1995) Dietary oxalate and its intestinal absorption. Scanning Microsc 9:1109–1120PubMedGoogle Scholar
  12. 12.
    Chai W, Liebman M, Kynast-Gales S, Massey L (2004) Oxalate absorption and endogenous oxalate synthesis from ascorbate in calcium oxalate stone formers and non-stone formers. Am J Kidney Dis 44:1060–1069CrossRefPubMedGoogle Scholar
  13. 13.
    Krishnamurthy MS, Hruska KA, Chandhoke PS (2003) The urinary response to an oral oxalate load in recurrent calcium stone formers. J Urol 169:2030–2033CrossRefPubMedGoogle Scholar
  14. 14.
    Stauffer JQ (1977) Hyperoxaluria and intestinal disease. The role of steatorrhea and dietary calcium in regulating intestinal oxalate absorption. Dig Dis Sci 22:921–928CrossRefGoogle Scholar
  15. 15.
    Hess B (1996) Low calcium diet in hypercalciuric calcium nephrolithiasis patients: first do no harm. Scanning Microsc 10:547–554PubMedGoogle Scholar
  16. 16.
    Robertson WG, Peacock M (1980) The cause of idiopathic calcium stone disease: hypercalciuria or hyperoxaluria? Nephron 26:105–110CrossRefPubMedGoogle Scholar
  17. 17.
    Ouwehand AC, Salminen S, Isolauri E (2002) Probiotics: an overview of beneficial effects. Antonie van Leeuwenhoek 82:279–289CrossRefPubMedGoogle Scholar
  18. 18.
    Ito H, Miura N, Masai M et al (1996) Reduction of oxalate content of foods by the oxalate degrading bacterium, Eubacterium lentum WYH-1. Int J Urol 3:31–34CrossRefPubMedGoogle Scholar
  19. 19.
    Hokama S, Honma Y, Toma C, Ogawa Y (2000) Oxalate-degrading Enterococcus faecalis. Microbiol Immunol 44:235–240PubMedGoogle Scholar
  20. 20.
    Weese JS, Weese HE, Yuricek L, Rousseau J (2004) Oxalate degradation by intestinal lactic acid bacteria in dogs and cats. Vet Microbiol 101:161–166CrossRefPubMedGoogle Scholar
  21. 21.
    Duncan SH, Richardson AJ, Kaul P, Holmes RP, Allison MJ, Stewart C (2002) Oxalobacter formigenes and its potential role in human health. Appl Environ Microbiol 68:3841–3847CrossRefPubMedGoogle Scholar
  22. 22.
    Gilliland SE (1990) Health and nutritional benefits from lactic acid bacteria. FEMS Microbiol Rev 87:175–188CrossRefGoogle Scholar
  23. 23.
    Azcarate-Peril MA, Bruno-Ba′rcena JM, Hassan HM, Klaenhammer TR (2006) Transcriptional and functional analysis of oxalyl-coenzyme A (CoA) decarboxylase and formyl-CoA transferase genes from Lactobacillus acidophilus. App Environ Microbiol 72:1891–1899CrossRefGoogle Scholar
  24. 24.
    Lewanika TR, Reid SJ, Abratt VR, Macfarlane GT, Macfarlane S (2007) Lactobacillus gasseri Gasser AM63T degrades oxalate in a multistage continuous culture simulator of the human colonic microbiota. FEMS Microbiol Ecol 61:110–120CrossRefPubMedGoogle Scholar
  25. 25.
    Federici F, Vitali B, Gotti R, Pasca MR, Gobbi S, Peck AB, Brigidi P (2004) Characterization and heterologous expression of the oxalyl coenzyme A decarboxylase gene from Bifidobacterium lactis. Appl Environ Microbiol 70:5066–5073CrossRefPubMedGoogle Scholar
  26. 26.
    Campieri C, Campieri M, Bertuzzi V, Swennen E, Matteuzzi D, Stefoni S et al (2001) Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 60:1097–1105CrossRefPubMedGoogle Scholar
  27. 27.
    Lieske JC, Goldfarb DS, DeSimone C, Regnier C (2005) Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int 68:1244–1249CrossRefPubMedGoogle Scholar
  28. 28.
    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 141:1–147CrossRefPubMedGoogle Scholar
  29. 29.
    Tang M, Larson-Meyer DE, Liebman M (2008) Effect of cinnamon and turmeric on urinary oxalate excretion, plasma lipids, and plasma glucose in healthy subjects. Am J Clin Nutr 87:1262–1267PubMedGoogle Scholar
  30. 30.
    Li MG, Madappally MM (1989) Rapid enzymatic determination of urinary oxalate. Clin Chem 35:2330–2333PubMedGoogle Scholar
  31. 31.
    Lustgarten JA, Wenk RE (1972) Simple, rapid, kinetic method for serum creatinine measurement. Clin Chem 18:1419–1422PubMedGoogle Scholar
  32. 32.
    Goldfarb DS (2004) Microorganisms and calcium oxalate disease. Nephron Physiol 98:48–54CrossRefGoogle Scholar
  33. 33.
    Turroni S, Vitali B, Bendazzoli C, Candela M, Gotti R, Federici F, Pirovano F, Brigidi P (2007) Oxalate consumption by lactobacilli: evaluation of oxalyl-CoA transferase activity in Lactobacilli acidophilus. J Appl Microbiol 103:1600–1609CrossRefPubMedGoogle Scholar
  34. 34.
    Bibiloni R, Fedorak RN, Tannok GW, Madsen KL, Gionchetti P, Campieri M, De Simone C, Sartor RB (2005) VSL#3® probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 100:1539–1546CrossRefPubMedGoogle Scholar
  35. 35.
    Kim HJ, Vazquez R, Camilleri M, Stephens D, Burton DD, Baxter K, Thomforde G, Zinsmeister AR (2005) A randomized controlled trial of a probiotic combination VSL#3® and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil 17:1–10CrossRefGoogle Scholar
  36. 36.
    Holmes RP, Assimos DG (2004) The impact of dietary oxalate on kidney stone formation. Urol Res 32:311–316CrossRefPubMedGoogle Scholar
  37. 37.
    Grentz L, Massey LK (2002) Contribution of dietary oxalate to urinary oxalate in health and disease. Top Clin Nutr 17:60–70Google Scholar
  38. 38.
    Brigidi P, Swennen E, Vitali B, Rossi M, Matteuzzi D (2003) PCR detection of Bifidobacterium strains and Streptococcus thermophilus in feces of human subjects after oral bacteriotherapy and yogurt consumption. Int J Food Microbiol 81:203–209CrossRefPubMedGoogle Scholar
  39. 39.
    Dobbins JW, Binder HJ (1977) Importance of the colon in enteric hyperoxaluria. New Engl J Med 296:298–301PubMedCrossRefGoogle Scholar
  40. 40.
    Modigliani R, Labayle D, Aymes C, Denvil R (1978) Evidence for excessive absorption of oxalate by the colon in enteric hyperoxaluria. Scand J Gastroenterol 13:187–192CrossRefPubMedGoogle Scholar
  41. 41.
    von Unruh GE, Bell AE, Hesse A (2007) Effect of oxalate test dose size on absolute and percent oxalate absorption. Isotopes in Environ Health Stud 42:107–112CrossRefGoogle Scholar
  42. 42.
    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 169:687–690CrossRefGoogle Scholar
  43. 43.
    Knight J, Holmes RP, Assimos DG (2007) Intestinal and renal handling of oxalate loads in normal individuals and stone formers. Urol Res 35:111–117CrossRefPubMedGoogle Scholar
  44. 44.
    Hatch M, Freel RW, Vaziri ND (1994) Intestinal excretion of oxalate in chronic renal failure. J Am Soc Nephrol 5:1339–1343PubMedGoogle Scholar
  45. 45.
    Goldfarb SD, Modersitzki F, Asplin JR (2007) A randomized, controlled trial of lactic acid bacteria for idiopathic hyperoxaluria. Clin J Am Soc Nephrol 2:745–749CrossRefPubMedGoogle Scholar
  46. 46.
    Allison MJ, Cook HM, Milne DB, Gallagher S, Clayman RV (1986) Oxalate degradation by gastrointestinal bacteria from humans. J Nutr 116:455–460PubMedGoogle Scholar
  47. 47.
    Dimroth P, Schink B (1998) Energy conservation in the decarboxylation of dicarboxylic acids by fermenting bacteria. Arch Microbiol 170:69–77CrossRefPubMedGoogle Scholar
  48. 48.
    Troxel SA, Sidhu H, Kaul P, Low RK (2003) Intestinal Oxalobacter formigenes colonization in calcium oxalate stone formers and its relation to urinary oxalate. J Endourol 17:173–177CrossRefPubMedGoogle Scholar
  49. 49.
    Kaufman DW, Kelly JP, Curhan GC, Anderson TE, Dretler SP, Preminger GM, Cave DR (2008) Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones. J Am Soc Nephrol 19:1197–1203CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Department of Family and Consumer Sciences (Human Nutrition)University of Wyoming, Dep. 3354Laramie USA

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