[HN Gopher] "Green smoothie cleanse" causing acute oxalate nephr...
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"Green smoothie cleanse" causing acute oxalate nephropathy
Author : gardenfelder
Score : 58 points
Date : 2023-08-17 21:11 UTC (1 hours ago)
(HTM) web link (pubmed.ncbi.nlm.nih.gov)
(TXT) w3m dump (pubmed.ncbi.nlm.nih.gov)
| gardenfelder wrote:
| >Given the increasing popularity of juice cleanses, it is
| important that both patients and physicians have greater
| awareness of the potential for acute oxalate nephropathy in
| susceptible individuals with risk factors such as chronic kidney
| disease, gastric bypass, and antibiotic use.
| OJFord wrote:
| Reminds me of 'fruit-only-diet influencer dead at 39'. However
| 'healthy' an extreme diet seems, _in extreme_ it almost certainly
| isn 't. Yes most people should probably eat more fruit; no they
| should not eat exclusively fruit.
|
| (random source: https://www.telegraph.co.uk/world-
| news/2023/08/01/zhanna-sam...)
| TylerE wrote:
| That's wild. The photos on her instagram look like something
| out of a '90s UNICEF commercial.
| atarian wrote:
| This is why I tell people to go easy on the spinach when they're
| making smoothies.
| stickfigure wrote:
| I offer, somewhat tongue-in-cheek, this lecture:
|
| _Don 't eat plants; they're trying to kill you!_
| https://www.youtube.com/watch?v=j1cqNDDG4aA
|
| I usually forward it to friends that rant about meat being bad
| for your health.
| zingababba wrote:
| Yeah, throwing a bunch of greens into a blender is not a great
| way to consume them. Boiling/steaming is the way to go. The
| vast majority of vegetables I personally eat are well cooked
| and mushy.
| Bluecobra wrote:
| I used to make green smoothies all the time, even went as far
| to by an expensive Blentec blender. If you are following
| Weight Watchers you actually get penalized for
| blending/juicing vegetables, so I stopped. Normally these are
| zero point foods. Their justification makes a lot of sense to
| me:
|
| https://www.weightwatchers.com/au/blog/food/why-fruit-
| counts...
| whycome wrote:
| The fiber factor probably plays a big role too. Sometimes
| juicers take that out. Fiber can make you feel full and it
| may also play a role in rate of sugar absorption.
| hombre_fatal wrote:
| Because of a case study of one woman who did a fad cleanse and
| had predisposers like a gastric bypass and prolonged antibiotic
| therapy?
| hackerlight wrote:
| Hmm? Oxalates causing less severe damage (kidney stones) is
| more common than just one woman. If you are a vegan you know
| you need to go easy on things like raw spinach and almonds.
| hombre_fatal wrote:
| Could you bring some empirics to the table for normal
| people having a common problem with oxalates at normal
| doses without predisposing issues like kidney disease or
| the ones the woman had in the case study?
|
| Does "going easy on oxalates" just mean you have fewer than
| six spinach smoothies per day?
|
| I'm used to these dietary memes cashing out into either
| trivial claims or nothing burgers.
| retrac wrote:
| > Oxalic acid has an oral LDLo (lowest published lethal
| dose) of 600 mg/kg.[62] It has been reported that the
| lethal oral dose is 15 to 30 grams.
|
| and
|
| > Frozen commercially available spinach in New Zealand
| contains 736.6 +- 20.4 mg/100g wet matter (WM) soluble
| oxalate
|
| while the USDA says about 900 mg per 100 g for American
| spinach on average.
|
| So roughly 1% of the wet spinach by weight. 1 kilo of
| high-oxalate spinach probably has 10 - 20 grams of oxalic
| acid. That's a lot of spinach, but probably chuggable in
| one day in smoothie format. Far too close to the LD50
| estimate for my comfort!
|
| For one large salad, it's unlikely to exceed a couple
| grams. I'm unsure about the effects of chronic lower dose
| exposure.
| hombre_fatal wrote:
| This is what I mean, though. How many people
| regurgitating "Be sure to watch out for oxalates!" know
| that we're talking about thousands of grams of spinach?
|
| Looking it up, people generally eat 50-200mg of oxalates
| per day with 1000mg being the outlier high end.
|
| Eat your spinach. If you're worried, then cook it.
| DennisP wrote:
| Well there's the dose that kills you, but there's also
| the dose that over time gives you kidney stones, if
| you're prone to that.
| jeffbee wrote:
| Wait how easy do I need to go on the almonds? I've been
| eating maybe half a pound a week.
|
| Despite your statement I don't think this knowledge is
| automatically distributed amongst vegans.
| DennisP wrote:
| Almonds are one of the highest-oxalate foods but I think
| generally it's fine unless you're prone to calcium
| oxalate kidney stones. But most people find out they're
| prone when they get their first stone.
|
| I've gotten two and don't recommend. Things that help,
| short of the sort of restrictions I'm stuck with: drink
| lots of water with high-oxalate foods, and eat foods high
| in calcium with them. The calcium binds with the oxalate
| in your guts instead of your kidneys and passes right
| out. Some people dissolve a calcium pill in the water
| they boil spinach in.
|
| They can see tiny stones in your kidneys with a scan so
| it's possible to check before you get a real problem,
| though I don't know if they would without any symptoms.
| hombre_fatal wrote:
| > Despite significantly more dietary oxalates (254
| mg/day) and oxalate-containing foods such as nuts,
| vegetables, and whole grains, participants with higher
| DASH scores have a 40-50% decreased risk of kidney stones
| [68]. This is perhaps attributed to the protective and
| synergistic effects of phytate, potassium, calcium, and
| other phytochemicals all abundant in the DASH dietary
| pattern. Similar findings regarding the protective role
| of vegetables on urolithiasis risk were reported by Zhuo
| et al. [69]. While animal protein consumption was
| associated with higher kidney stone risk, vegetable and
| tea consumption were associated with a decreased risk of
| stone formation.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600777/
|
| A lot of the "common sense" about oxalates just sound
| like social media memes.
| jacquesm wrote:
| Arsenic is the thing to watch for I believe. Stay away
| from bitter almonds, roasted should be fine. You'd have
| to eat a 25 Kg bag of sweet almonds to get into trouble.
| Not sure about the cumulative effects though, that might
| be worth checking into.
| [deleted]
| ansible wrote:
| I assume this issue is the same with almond milk? I'm
| almost always buying oatmilk, though.
| walnutclosefarm wrote:
| Not Arsenic, but rather bitter almonds contain compounds
| that the body degrades into cyanide.
| jacquesm wrote:
| Ah yes, that was it, sorry for mixing those up. But
| regardless, bad idea to eat any sizeable quantity of
| bitter almonds.
| atleastoptimal wrote:
| Oxalates can be balanced out with calcium, that's why cruciferous
| veggies don't cause as many issues as spinach.
| stevespang wrote:
| [dead]
| kalupa wrote:
| 2017?
| wirelesspotat wrote:
| In the report's keywords it mentions spinach. How much spinach is
| ok vs too much?
|
| Is this issue caused by consuming too much spinach or by
| consuming spinach in combination with specific foods found in
| green smoothies?
| gardenfelder wrote:
| With oxalate nephropathy, I have an oxalate budget of 100/day -
| 2 oz of dark chocolate covers that.
|
| But then, if one is concerned, citrates provide a first-line
| defense,e.g. 4 oz of lemmon juice, or,say, calcium or potassium
| citrate. That doesn't stop things, but it helps.
|
| In your microbiome, oxalobacter formigenes is the primary
| defense. Lose that from, say, antibiotics or IBS, and you've
| got problems.
| gardenfelder wrote:
| Let me build on that visit https://elicit.org/ and type in a
| research question like "what causes oxalate nephropathy" and
| look at the results (elicit is free). That happens to be
| where I found the paper linked at the top.
| KaiserPro wrote:
| too much _raw_ spinach, in combination with gastric bypass
| _and_ prolonged antibiotic use.
|
| The bypass probably doesn't help because you are reducing the
| time exposed to acid/alkali. The antibiotic also kills off any
| bacteria that would absorb oxalates.
| gardenfelder wrote:
| I would agree with that. A lot of research does talk about
| both antibiotics and gastric bypass surgery. But, that's only
| a part of the story. My research continues to uncover ways in
| which oxalates can cause mayhem. Just consider ordinary
| kidney stones. Calcium Oxalate. Oxalate damage is not limited
| to that,or to kidney failure through nephropathy. There is a
| medium.com piece by a fellow who had calcium oxalate crystals
| in his hearing canal. To get his hearing back, he had to go
| on a low oxalate diet. There's a pubmed on such situations
| [1]
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898392/
| TazeTSchnitzel wrote:
| This sounds like a Chubbyemu video premise. (It's an excellent
| YouTube channel that posts semi-dramatised medical educational
| videos, usually following a fictionalised patient presenting to
| ER after ingestion of some substance, with an explanation of how
| that substance causes problems in the body and how a medical team
| might try to address it.)
|
| Actually, there has been more than one video about oxalate
| nephropathy already, but from more obviously potentially harmful
| sources (https://youtube.com/watch?v=QJs431FsC_k&t=6m40s,
| https://youtube.com/watch?v=UrbylXMU8Mw&t=7m45s).
| yakshaving_jgt wrote:
| Given that this is a case report rather than a study, what
| confidence can a layman such as myself have that the report
| suggests causation?
|
| Asking in earnest; I don't want to read this and then repeat it
| to people if it's not really true.
| hackerlight wrote:
| I would skip this case study and just research the impacts of
| too many oxalates.
| stevenwoo wrote:
| Almost every study on that page links a separate case of
| gastric bypass with later oxalate dietary issues. There are
| other reasons to be aware of oxalate intake but it's like that
| one woman who almost overdosed on raw bok choi (iirc 1-1.5 kg
| per day https://www.nejm.org/doi/full/10.1056/NEJMc0911005) a
| little moderation in all things.
| Bostonian wrote:
| The "cleanse" notion is batty. A functioning urinary and
| excretory system is all the "cleanse" one needs.
| lukev wrote:
| I'm sure it makes a lot of people feel better, but almost
| certainly because of the cessation of whatever dietary behavior
| was causing them to feel bad in the first place, as opposed to
| eliminating some undefined "toxin."
| Asooka wrote:
| And as we can see in this case, most of the toxins that you
| secrete after a "cleanse" are from the "cleanse" liquid
| itself! Though to play debil's[0] advocate for a second, the
| body can retain toxins from the environment, e.g. heavy
| metals, chemicals from plastics, etc. So there is some basis
| in the idea of trying to purge toxins, but if you find a way
| to do that with a smoothie from store bought vegetables, you
| would be up for at least some kind of prize for advancing our
| understanding of human biology.
|
| [0] https://en.wiktionary.org/wiki/debil
| ryandrake wrote:
| Words like toxin, detox, cleanse, and rejuvenation are red-
| flag words that almost always indicate quackery[1]. It's
| like this generation's "crystal healing".
|
| 1: https://www.theguardian.com/lifeandstyle/2014/dec/05/det
| ox-m...
| dorfsmay wrote:
| From what I am reading, this is true for a lot of diets, what
| you stop eating during your diet often has a bigger impact
| that what the diet prescribe you to eat.
| Mesopropithecus wrote:
| Exactly. So when people take"essential oils" or whatever to
| "detox" - yeah sure, you may feel a difference.
|
| But that's probably because that substance you ingested wasn't
| healthy in the first place and what you're witnessing is your
| body trying to get rid of it fast.
| hirundo wrote:
| A constrained diet can be a useful tool in identifying which
| foods cause inflammation and other issues. I now live on a
| subset of the food groups based on a few dozen such N=1 cleanse
| experiments, with much improved health.
| jzawodn wrote:
| say more?
| hirundo wrote:
| For my idiosyncratic combination of diabetes and
| gastroparesis the removal of carbs and fiber have been life
| savers. I fought hard against recognizing that though and
| had to prove it to myself with cleanses. But the difference
| was too dramatic for me to ignore.
| DebtDeflation wrote:
| It's like the idea that getting a massage releases all the
| toxins in your body and you need to drink water after to flush
| them out. That's what they always tell me after I get one. I
| have to restrain laughter.
| ceedan wrote:
| Even though the toxins myth is incorrect, drinking lots of
| water after is a good idea.
|
| A deep tissue massage can cause mild rhabdomyolysis, which is
| where broken down cells (from the massage) get dumped into
| the blood. Water will help dilute urine while this occurs.
| Many massage therapists probably do think that there are
| harmful toxins get released, though.
| msrenee wrote:
| I suppose the broken down blood cells would be the toxins
| at that point. Blinds sows and nuts... sometimes one finds
| the other.
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