Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Influence of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion

European Journal of Clinical Nutrition volume 62, pages 1090–1097 (2008)Cite this article

Abstract

Objective:

To compare quantitatively the effect of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion.

Subjects and methods:

Eight healthy volunteers (three men and five women, mean age 28.6±6.3) were studied. Each volunteer performed the [13C2]oxalate absorption test thrice on a low-oxalate mixed diet, thrice on a low-oxalate vegetarian diet and thrice on a high-oxalate vegetarian diet. For each test, the volunteers had to adhere to an identical diet and collect their 24-h urines. In the morning of the second day, a capsule containing [13C2]oxalate was ingested.

Results:

On the low-oxalate vegetarian diet, mean intestinal oxalate absorption and urinary oxalate excretion increased significantly to 15.8±2.9% (P=0.012) and 0.414±0.126 mmol/day (P=0.012), compared to the mixed diet. On the high-oxalate vegetarian diet, oxalate absorption (12.5±4.6%, P=0.161) and urinary excretion (0.340±0.077 mmol/day, P=0.093) did not change significantly, compared to the mixed diet.

Conclusions:

A vegetarian diet can only be recommended for calcium oxalate stone patients, if the diet (1) contains the recommended amounts of divalent cations such as calcium and its timing of ingestion to a meal rich in oxalate is considered and (2) excludes foodstuffs with a high content of nutritional factors, such as phytic acid, which are able to chelate calcium.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Ala-Opas M, Elomaa I, Porkka L, Alfthan O (1987). Unprocessed bran and intermittent thiazide therapy in prevention of recurrent urinary calcium stones 21, 311–314.

  • Binder HJ (1974). Intestinal oxalate absorption. Gastroenterology 67, 441–446.

    CAS  PubMed  Google Scholar 

  • Brogren M, Savage GP (2003). Bioavailability of soluble oxalate from spinach eaten with and without milk products. Asia Pac J Clin Nutr 12, 219–224.

    CAS  PubMed  Google Scholar 

  • Ebisuno S, Morimoto S, Yasukawa S, Ohkawa T (1991). Results of long-term rice bran treatment on stone recurrence in hypercalciuric patients. Br J Urol 67, 237–240.

    Article  CAS  Google Scholar 

  • Ebisuno S, Morimoto S, Yoshida T, Fukatani T, Yasukawa S, Ohkawa T (1986). Rice-bran treatment for calcium stone formers with idiopathic hypercalciuria. Br J Urol 58, 592–595.

    Article  CAS  Google Scholar 

  • German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research; Swiss Nutrition Association (2001). Reference Values for Nutrient Intake. Umschau Braus: Frankfurt.

  • Gleeson MJ, Thompson AS, Mehta S, Griffith DP (1990). Effect of unprocessed wheat bran on calciuria and oxaluria in patients with urolithiasis. Urology 35, 231–234.

    Article  CAS  Google Scholar 

  • Grases F, Costa-Bauza A (1999). Phytate (IP6) is a powerful agent for preventing calcifications in biological fluids: usefulness in renal lithiasis treatment. Anticancer Res 19 (5A), 3717–3722.

    CAS  PubMed  Google Scholar 

  • Grases F, Garcia-Gonzalez R, Torres JJ, Llobera A (1998). Effects of phytic acid on renal stone formation in rats. Scand J Urol Nephrol 32, 261–265.

    Article  CAS  Google Scholar 

  • Grases F, March JG, Prieto RM, Simonet BM, Costa-Bauza A, Garcia-Raja A et al. (2000). Urinary Phytate in calcium oxalate stone formers and healthy people – dietary effects on phytate excretion. Scand J Urol Nephrol 34, 162–164.

    Article  CAS  Google Scholar 

  • Hambidge KM, Krebs NF, Westcott L, Miller LV, Peterson KL, Raboy V (2005). Absorption of calcium from tortilla meals prepared from low-phytate maize. Am J Clin Nutr 82, 84–87.

    Article  CAS  Google Scholar 

  • Hesse A, Siener R, Heynck H, Jahnen A (1993). The influence of dietary factors on the risk of urinary stone formation. Scanning Microsc 7, 1119–1127.

    CAS  PubMed  Google Scholar 

  • Hesse A, Strenge A, Vahlensieck W (1984). Oxalic acid excretion of calcium oxalate stone-formers and of healthy persons. In: Ryall R, Gwynne Brockis J, Marshall V, Finlayson B (eds). Urinary Stone. Churchill Livingstone: Melbourne. pp 57–62.

    Google Scholar 

  • Holmes RP, Ambrodius WT, Assimos DG (2005). Dietary oxalate loads and renal oxalate handling. J Urol 174, 943–947.

    Article  CAS  Google Scholar 

  • Holmes RP, Goodman HO, Assimos DG (1995). Dietary oxalate and its intestinal absorption. Scanning Microsc 9, 1109–1118.

    CAS  PubMed  Google Scholar 

  • Holmes RP, Goodman HO, Assimos DG (2001). Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59, 270–276.

    Article  CAS  Google Scholar 

  • 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, 131–139.

    Article  Google Scholar 

  • Hossain RZ, Ogawa Y, Morozumi M, Hokama S, Sugaya K (2003). Milk and calcium prevent gastrointestinal absorption and urinary excretion of oxalate in rats. Front Biosci 8, 117–125.

    Article  Google Scholar 

  • Hossain RZ, Ogawa Y, Morozumi M, Hokama S, Uchida A, Sugaya K (2005). Urinary response to an oxalic load is influenced by the timing of calcium loading in rats. J Urol 174, 2027–2031.

    Article  CAS  Google Scholar 

  • Jahnen A, Heynck H, Gertz B, Classen A, Hesse A (1992). Dietary fibre: the effectiveness of a high bran intake in reducing renal calcium excretion. Urol Res 20, 3–6.

    Article  CAS  Google Scholar 

  • James WP, Branch WJ, Southgate DA (1978). Calcium binding by dietary fibre. Lancet 1, 638–639.

    Article  CAS  Google Scholar 

  • Lemann J (1993). Composition of the diet and calcium kidney stones. N Engl J Med 328, 880–882.

    Article  Google Scholar 

  • Liebman M, Costa G (2000). Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J Urol 163, 1565–1569.

    Article  CAS  Google Scholar 

  • Litwin MS, Saigal CS, Yano EM, Avila C, Geschwind SA, Hanley JM et al. (2005). Urologic diseases in America project: analytical methods and principal findings. J Urol 173, 933–937.

    Article  Google Scholar 

  • Nishiura JL, Martini LA, Mendonca CO, Schor N, Heilberg IP (2002). Effect of calcium intake on urinary oxalate excretion in calcium stone-forming patients. Braz J Med Biol Res 35, 669–675.

    Article  CAS  Google Scholar 

  • Ohkawa T, Ebisuno S, Kitagawa M, Morimoto S, Miyazaki Y (1983). Rice Bran treatment for hypercalciuric patients with urinary calculous disease. J Urol 129, 1009–1011.

    Article  CAS  Google Scholar 

  • Ohkawa T, Ebisuno S, Kitagawa M, Morimoto S, Miyazaki Y, Yasukawa S (1984). Rice bran treatment for patients with hypercalciuric stones: experimental and clinical studies. J Urol 132, 1140–1145.

    Article  CAS  Google Scholar 

  • Prenen JA (1984). Absorption kinetics of oxalate from oxalate-rich food in man. Am J Clin Nutr 40, 1007–1010.

    Article  CAS  Google Scholar 

  • Robertson WG (1987). Diet and calcium stones. Miner Electrolyte Metab 13, 228–234.

    CAS  PubMed  Google Scholar 

  • Savage GP, Charrier MJ, Vanhanen L (2003). Bioavailability of soluble oxalate from tea and the effect of consuming milk with the tea. Eur J Clin Nutr 57, 415–419.

    Article  CAS  Google Scholar 

  • Shah PJ, Williams G, Green NA (1980). Idiopathic hypercalciuria: its control with unprocessed bran. Br J Urol 52, 426–429.

    Article  CAS  Google Scholar 

  • Siener R, Hesse A (2002). The effect of different diets on urine composition and the risk of calcium oxalate crystallisation in healthy subjects. Eur Urol 42, 289–296.

    Article  Google Scholar 

  • Siener R, Heynck H, Hesse A (2001). Calcium-binding capacities of different brans under simulated gastrointestinal pH conditions. In vitro study with (45)Ca. J Agric Food Chem 49, 4397–4401.

    Article  CAS  Google Scholar 

  • Strohmaier WL, Kalchthaler M, Bichler KH (1988). Calcium metabolism in normal and in hypercalciuric patients on farnolith, a dietary fibre preparation. Urol Res 16, 437–440.

    Article  CAS  Google Scholar 

  • Tiselius HG (1991). Aspects on estimation of the risk of calcium oxalate crystallization in urine. Urol Int 47, 255–259.

    Article  CAS  Google Scholar 

  • von Unruh GE, Langer MA, Paar DW, Hesse A (1998). Mass spectrometric-selected ion monitoring assay for an oxalate absorption test applying [13C2]Oxalate. J Chromatogr Biomed Sci Appl 716, 343–349.

    Article  CAS  Google Scholar 

  • 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, 687–690.

    Article  CAS  Google Scholar 

  • von Unruh GE, Voss S, Sauerbruch T, Hesse A (2004). Dependence of oxalate absorption on the daily calcium intake. J Am Soc Nephrol 15, 1567–1573.

    Article  CAS  Google Scholar 

  • Zimmermann DJ, von Unruh G, Hesse A (2005). Influence of high oxalate diet on intestinale oxalate absorption. World J Urol 23, 324–329.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank B Bär and M Klöckner for skilful technical assistance and Dr S Voss as well as A Seidler for measuring the oxalate contents of the foodstuffs. The study was supported in part by grant UN91/3 of Deutsche Forschungsgemeinschaft.

Author information

Authors and Affiliations

  1. Department of Urology, University of Bonn, Bonn, Germany

    E Thomas & A Hesse

  2. Department of Internal Medicine I, University of Bonn, Bonn, Germany

    G E von Unruh

Authors
  1. E Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G E von Unruh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Hesse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E Thomas.

Additional information

Contributors: ET did the experimental part and the statistical calculation and prepared the draft of the manuscript. GEvU developed the analytical part and contributed to the paper. AH supervised the study and contributed to the manuscript.

None of the authors had any personal or financial conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomas, E., von Unruh, G. & Hesse, A. Influence of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion. Eur J Clin Nutr 62, 1090–1097 (2008). https://doi.org/10.1038/sj.ejcn.1602832

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602832

Keywords

This article is cited by

Search

Advanced search

Quick links